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Petar Rei
Srebrenka uri Havelka
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Biblioteka
"Udbenici i prirunici Zdravstvenog veleuilita
Svezak 42.
Urednik biblioteke
Prof. dr. sc. Predrag Keros
Lektor
Nitor usluge d.o.o.
Recenzenti
Prof. dr. sc. Miljenko Marotti
Prof. dr. sc. Marija Frkovi
Copyright 2013.
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ISBN 978-953-6239-34-4
Grafiko oblikovanje i tisak "Offset NP GTO tisak d.o.o.", 2013.
II
Petar Rei
Srebrenka uri Havelka
Introduction to Basic
Medical Terminology
for Health Professions
A textbook for students of health studies
ZDRAVSTVENO VELEUILITE
Zagreb, 2013
Contents
PREDGOVOR.................................................................................................. VII
INTRODUCTION - Hypocratic Oath 1
About the English Language..................................................................... 3
01. Basic elements of a medical word Grammar revision
the passive voice..................................................................................... 6
02. The Most Common Suffixes and Prefixes................................................ 12
03. Body as a Whole
For further practice: translate into English (the cell)............................. 22
04. Integumentary System............................................................................. 35
05. Musculoskeletal System.......................................................................... 49
06. Gastrointestinal System........................................................................... 70
07. Respiratory System.................................................................................. 87
08. Cardiovascular System............................................................................ 98
09. Urinary System...................................................................................... 111
10. Nervous System..................................................................................... 121
11. Blood and Lymphatic System................................................................. 138
12. Endocrine System.................................................................................. 158
13. Female Reproductive System................................................................ 176
14. Male Reproductive System.................................................................... 191
15. Sense Organs......................................................................................... 204
SUPPLEMENT
16. Oncology Cancer Medicine.................................................................. 219
17. General Care of the Patient .................................................................. 227
VI
Predgovor
Ovaj je udbenik - prirunik namijenjen studentima preddiplomskih i specijalistikih diplomskih studija strunih zdravstvenih studijskih programa
medicinskim sestrama, fizioterapeutima, radnim terapeutima, radiolokim
inenjerima, medicinsko-laboratorijskim inenjerima, sanitarnim inenjerima, primaljama i drugim zdravstvenim strukama, npr. lijenicima. Udbenik
obuhvaa tematske nastavne jedinice utvrene nastavnim programom za
predmet Engleski jezik na zdravstvenim studijima, a temelji se na tjelesnim
sustavima.
Veina poglavlja ukljuuje leksiko-gramatike skupine zadataka vezane
uz odreeni tjelesni sustav te skraene popularne i strune tekstove koje
studenti trebaju prevesti s engleskog na hrvatski ili s hrvatskog na engleski
jezik. Sastavni dio udbenika su sadraji vezani uz tvorbu (morfologiju) medicinskog nazivlja pomou prefiksa i sufiksa latinskog odnosno grkog podrijetla
te njihovi ekvivalenti u engleskom strukovnom i kolokvijalnom nazivlju. Glavni
izvor za engleske tekstove posluio je udbenik The Language of Medicine,
autorice D. A. Chabner, 5. i 7. izdanje, kao i Medical English, tree izdanje iz
1982. godine (autorice: V. Mominovi, V. Tanay i S. uri Havelka).
Dodatak ovom udbeniku (Supplement) su tekstovi koji bi studentima mogli
biti zanimljivi kao dopunske teme u sluaju njihova posebnog interesa.
Nadamo se da e priruni Glosar biti od pomoi naim studentima i svima
zainteresiranima za sadraje iz ovog prirunika.
Autori
VII
Introduction
HIPPOCRATIC OATH
Life is short, and the Art long; the occasion fleeting;
experience fallacious, and judgment difficult. The
physician must not only be prepared to do what is right
himself, but must also make the patient, the attendants, and externals cooperate.
(Hippocrates: Aphorisms)
Hippocratic Oath
I swear by Appolo1, the physician, and by Asklepios2, Hygeia3, and Panacea4,
and all the gods and goddesses, and call them to witness that I will keep this
oath and contract to the best of my ability and judgment; to regard him who
teaches me this art as equal to my own parents; to share my living with him,
and provide for him in need; to treat his children as my own brothers, and
teach them this art if they wish to learn it, without payment or contract; to give
guidance, lectures, and every other kind of instruction to my own sons and
those of my teacher, and to students bound by contract and oath to medical
law, but to nobody else.
I will prescribe treatment at the best of my ability and judgment for the good
of the sick, and never for a harmful or illicit purpose. I will give no poisonous
drug, even if asked to, nor make any such suggestions; and likewise, I will
give no woman a pessary5 to cause abortion. I will both live and work in purity
and godliness. I will not operate, not even on patients with stone, but will give
way to specialists in this work. I will go into the houses that I visit in order to
help the sick, and refrain from all deliberate harm or corruption, especially
from sexual relations with women or men, free or slave. Anything I see or hear
about people, whether in the course of my practice or outside it, that should
not be made public, I will keep to myself and treat as an inviolable secret.
If I abide by this oath, and never break it, let all men honour me for all time
on account of my life and work; but if I transgress and break my oath, let me
suffer the reverse.
Appolo - Greek god of the arts, prophecy, medicine and light, protector of herds and
flocks, son of Zeus and Leto, brother of Artemis. His principal sanctuary and oracle
were at Delphi. In art he is presented as the ideal of young male beauty.
2
Asklepios, also spelt Asclepius, hero and Greek god of healing; he corresponds to
Aesculapius, Roman god of medicine
3
Hyg(i)ea - in Greek mythology, the goddess of health; daughter of Asklepios.
4
Panacea in Greek mythology, the goddess of healing; sister of Hygea; the word
literally means a cure for all ills, a universal remedy or medicine for all diseases. In
English it is also called an All-heal.
5
pessary (Lat. pessarium) an instrument placed in the vagina to support the uterus or rectum or as a contraceptive device.
1
CHAPTER 1
Word Root
cardi
gastr
hepat
nephr
oste
Meaning
heart
stomach
liver
kidney
bone
2. COMBINING FORMS
The combining form (CF) is a WR plus a combining vowel, usually an o.
Examples of Combining Forms
Word Root + Combining Vowel
cardi
o
gastr
o
arthr
o
derm
o
cyt
o
cephal
o
cerebr
o
= Combining Form
cardi/o
gastr/o
arthr/o
derm/o
cyt/o
cephal/o
cerebr/o
Meaning
heart
stomach
joint
skin
cell
head
brain
3. SUFFIXES
A suffix is a word ending. In the words tonsill/itis and tonsill/ectomy, The
suffixes are itis (inflammation) and ectomy (excision, removal). Changing a
suffix gives the word a new meaning. In medical terminology a suffix usually
indicates a procedure, condition, disease, or part of speech. Many suffixes are
derived from Greek and Latin words.
Examples of Suffixes
Combining Form + Suffix
=
arthr/o
-centesis
(joint)
(puncture)
Medical Word
arthrocentesis
Meaning
puncture of a joint
thorac/o
(chest)
-tomy
(incision)
thoracotomy
gastr/o
(stomach)
-megaly
gastromegaly
(enlargement)
enlargement of the
stomach
erythr/o
(red)
-cyte
(cell)
erythrocyte
cyt/o
(cell)
-logy
(study)
cytology
study of a cell
4. PREFIXES
A prefix is a word element located at the beginning of a word. When a
medical word contains a prefix, the meaning of the word is changed. The prefix
usually indicates a number, time, position, direction, colour, or negation.
Examples of Prefixes
Prefix + Word Root + Suffix =
hyper
therm
-ia
(excessive) (heat)
(condition)
Medical Word
hyperthermia
Meaning
condition of
excessive heat
intra
(in, within)
muscul
(muscle)
-ar
intramuscular
(relating to)
macro
(large)
gloss
(tongue)
-ia
(condition)
macroglossia
condition of a large
tongue
micro
(small)
card
(heart)
-ia
(condition)
microcardia
condition of a small
heart
enter/
intestine
(3)
itis
inflammation
(1)
Read as follows:
1. Inflammation of (suffix)
2. Stomach and (first part of the word)
3. Intestine (middle)
GRAMMAR REVISION: THE PASSIVE VOICE
Elementary
Note: appropriate tense of verb to be with the past participle of the main
verb.
Example: Someone has stolen my books My books have been stolen.
No agents with by are required in the following sentences.
Turn the following sentences into the passive voice:
1. People always admire this picture.
2. He hurt his leg in an accident.
3. No one has opened that box for the last hundred years.
4. People formerly used the Tower of London as a prison.
5. Someone has broken two of my dinner plates.
6. They fought a big battle here two hundred years ago.
7. People will forget this play in a few years time.
8
10
--------------------------------------------
11
CHAPTER 2
-ac cardiac
-al carpal
-ary hereditary
-ical physiological
-ous serous
-tic mycotic
-ic splenic
13
4. PLURAL ENDINGS
RULE
Singular
Plural
Retain a and add e
-ae
Drop x and add ces
-ax
Drop en and add ina
-en
Drop ex and add ices
-ex
Drop is and add es
-is
Drop ix and add ices
-ix
Retain ma and add ta
-ma
Drop on and add a
-on
Drop um and add a
-um
Drop us and add i
-us
Drop y and add ies
-y
EXAMPLE
Singular
Plural
pleura
pleurae
thorax
thoraces
lumen
lumina
apex
apices
diagnosis
diagnoses
appendix
appendices
carcinoma
carcinomata
ganglion
ganglia
bacterium
bacteria
bronchus
bronchi
deformity
deformities
5. PREFIXES
A prefix is a word element located at the beginning of a word. Most prefixes
in medical and other terminology are of Greek or Latin origin. A prefix cannot
stand alone and is used in conjunction with combining form or a combining
form and a suffix. Here follows a list of the most common prefixes used not
only in medical terminology, but also in the formation of words frequently used
in other allied health professions.
a) Prefixes of position and direction
14
b) Prefixes of colour
primi- (first)
uni-, mono- (one)
bi-, di- (two)
hemi-, semi- (half)
macro- (large)
micro- (small, minute)
multi-, pan-, poly- (many, all, much)
tri- (three)
quadri- (four)
d) Prefixes of negation
a-, an-, ar- (without, not)
im-, in- (no, not)
15
e) Miscellaneous prefixes
EXERCISES -suffixes
1. Find the suffixes in the following words and give the meaning of the entire term:
1.1. leukemia............................................................................................................................................
1.2. gastrectomy.....................................................................................................................................
1.3. hematoma.........................................................................................................................................
1.4. nephritis.............................................................................................................................................
1.5. gastroscope......................................................................................................................................
1.6. dermatosis........................................................................................................................................
1.7. psychogenic.....................................................................................................................................
1.8. neuralgia............................................................................................................................................
2. Define the suffixes for the following terms and give example of a medical term:
2.1. inflammation...................................................................................................................................
2.2. resection or surgical removal...............................................................................................
2.3. section.................................................................................................................................................
2.4. condition (usually abnormal).................................................................................................
2.5. process of study.............................................................................................................................
2.6. instrument to examine visually............................................................................................
2.7. instrument to cut..........................................................................................................................
2.8. one who specializes in...............................................................................................................
16
3.11. -coccus.....................................................
3.2. -plasty..........................................................
3.12. -trophy......................................................
3.3. -osis..............................................................
3.13. -tomy.........................................................
3.4. -itis................................................................
3.5. -genic...........................................................
3.15. -stomy.......................................................
3.6. -graphy........................................................
3.16. -megaly....................................................
3.7.-oma..............................................................
3.17.-malacia....................................................
3.8. -tome...........................................................
3.18. -dynia........................................................
3.9. -graph..........................................................
3.19. -poiesis.....................................................
3.10. -emia.........................................................
3.20. -centesis..................................................
17
1.16. suprasternal..................................................................................................................................
1.17. perirenal..........................................................................................................................................
1.18. anacidity..........................................................................................................................................
1.19. macrocephaly...............................................................................................................................
1.20. cirrhotic...........................................................................................................................................
2. Fill in the correct medical word that matches the definitions below:
2.1. ........................................................... morbid fear of water.
2.2. ........................................................... abnormally slow breathing.
2.3. ........................................................... rapid breathing.
2.4. ........................................................... difficult or bad breathing.
2.5. ........................................................... condition of hardening.
2.6. ........................................................... poor or bad nutrition.
2.7. ........................................................... good, easy breathing.
2.8. ........................................................... condition of sweating.
2.9. ........................................................... false encephalitis.
2.10. ......................................................... abnormal fear of everything.
3. Fill in the correct medical term for the definitions below:
3.1. ........................................................... left-footed.
3.2. ........................................................... vision in which objects appear blue.
3.3. ............................................................ located behind and at the inner side of a part.
3.4. ........................................................... destroying (poisoning).
3.5. ........................................................... back of the colon.
3.6. ........................................................... abnormal redness of skin.
3.7. ........................................................... pertaining to both sides.
3.8. ........................................................... before birth.
3.9. ........................................................... below the axilla.
3.10. ......................................................... pain in the back.
3.11. ......................................................... black tumour.
19
4.3. sub-...............................................................
4.20. primi-........................................................
FURTHER PRACTICE
1. Give the meaning of the following combining forms:
1.1. aden/o ........................................................
20
3. 8. cystitis......................................................
3.2. nephrotomy..............................................
3.9. hepatoma.................................................
3.3. erythremia................................................
3.10. anemia....................................................
3.4. oncogenic..................................................
3.11. leukemia................................................
3.5. cephalic......................................................
3.12. carcinoma.............................................
3.13. thrombosis...........................................
21
CHAPTER 3
BODY AS A WHOLE
1. Structural Organization
Cell
The cell is the fundamental structural and functional unit of every living
being. The study of cells is called cytology. Cells are everywhere - every organ
is made up of these individual units. They are responsible for all activities associated with life, for instance: utilizing food, eliminating waste, reproducing.
All cells are similar in that they contain a gelatinous substance called the
protoplasm. It is composed of water, protein, sugar, acids, fats, and various
minerals. However, cells are different, or specialized, throughout the body in
order to carry out their individual functions.
The following are among the major parts of the cell.
1. Cell membrane. This structure surrounds and protects the internal environment of the cell, determining what passes in and out of the cell.
2. Nucleus. The nucleus is the controlling structure of the cell. It controls the
way in which a cell reproduces and contains genetic material that determines the functioning and structure of the cell. All the material within the
nucleus is called nucleoplasm or karyoplasm (kary/o = nucleus, pl. nuclei).
3. Chromosomes. These are 23 pairs of thin strands of genetic material (DNA)
located within the nucleus of each cell in a human body, except in sperm
and egg cells, which contain only half of the genetic material each. Chromosomes contain regions known as genes which determine our hereditary
makeup. The DNA within chromosomes regulates the activities of each cell
by guiding the formation of another substance called RNA, which can leave
the cell nucleus, enter the cytoplasm, and direct the activities of the cell.
In the human there are about 31 000 genes that determine unique human
characteristics.
Chromosomes can be studied and classified as to size, arrangement,
and number. This classification is called a karyotype. Karyotyping of chro-
22
23
Tissue
A tissue is a group of similar cells working together to do a specific job.
The study of tissues is called histology. A histologist is one who specializes
in the study of tissues. More than 200 cell types compose four major tissues
of the body:
Epithelial Tissue. Epithelial tissue is located all over the body as lining for
internal organs, cavities and canals, as secreting portions of exocrine and
endocrine glands, at the outer surfaces of the skin covering the body. It is
composed of cells arranged in sheets consisting of one or more layers.
Muscle Tissue. Voluntary, or skeletal, muscles are groups of muscles
attached to bones and they are responsible for the movement of the body in
its external environment. Involuntary, or visceral muscles are those muscles
responsible for the movement of internal organs and their functioning is said
to be involuntary, i.e. not under conscious control. Basic function of muscle
tissue is to provide for the contraction and relaxation of all muscle groups.
Connective Tissue. This is the tissue that supports and connects other
tissues and organs. It is composed of different cell types, e.g. fibroblasts, fat
cells, bone and cartilage cells, blood cells.
Nerve Tissue. Nerve tissue conducts electrical impulses as it relays information throughout the entire body.
Organ
These structures can be made of several types of tissue. For example,
an organ like the stomach is composed of muscle tissue, nerve tissue, and
glandular epithelial tissue. The medical term for internal organs is viscera
(singular: viscus). Examples of abdominal viscera (organs located in the
abdomen) are the liver, stomach, intestines, pancreas, spleen, and gallbladder.
System
These can be briefly defined as groups of organs working together to
perform complex functions. For example, the mouth, esophagus, stomach,
and small and large intestines are organs of the digestive system. Here follows
the list of body systems and their major organs:
1. Gastrointestinal, or digestive system - mouth, pharynx, esophagus,
stomach, intestines (small and large), liver, gallblader, pancreas.
2. Urinary, or excretory - kidneys, ureters, urinary bladder, urethra.
3. Respiratory nose, pharynx, larynx, trachea, bronchi, left and right lung
lobes, alveoli.
4. Musculoskeletal muscles, bones, joints, tendons, ligaments.
5. Integumentary skin, sebaceous and sweat glands, hair, nails.
24
3. Abdominal
Organs
Brain
Lungs, heart, esophagus, trachea, thymus gland, aorta
The thoracic cavity can be divided into two smaller cavities:
a) The pleural cavity - the areas surrounding the lungs.
Each pleural cavity is lined with a double-folded
membrane called pleura; visceral pleura is closest to
the lungs and parietal pleura is closest to the outer wall
of the cavity.
b) The mediastinum- the area between the lungs.
It contains the heart, aorta, trachea, esophagus, and
thymus gland.
Stomach, small and large intestines, spleen, liver,
gallbladder, pancreas. The peritoneum is the
double-folded membrane surrounding the abdominal
cavity. The kidneys are two bean-shaped organs situated
at the back (retroperitoneal area) of the abdominal cavity
on either side of the backbone.
25
4. Pelvic
5. Spinal
The cranial and spinal cavities are considered dorsal body cavities because
of their location on the back portion of the body. The thoracic, abdominal, and
pelvic cavities are considered ventral body cavities because they are on the
front, or belly side, of the body.
The thoracic and abdominal cavities are separated by a muscular partition
called the diaphragm. The abdominal and pelvic cavities are not separated by a
partition and together they are usually referred to as the abdominopelvic cavity.
3. Anatomical divisions of the abdomen 9 regions and 4 quadrants
These divisions are used in anatomy texts to describe the regions in which
organs and structures are found. The following are 9 abdominal regions
1. Hypochondriac regions (two upper lateral regions beneath the ribs)
2. Epigastric region (region of the stomach)
3. Lumbar regions (two middle lateral regions)
4. Umbilical region (region of the navel or umbilicus)
5. Inguinal (iliac) regions (two lower lateral regions)
6. Hypogastric region (lower middle region, below the umbilicus)
Figure 3.2. Anatomical divisions of the abdomen 9 regions & 4 quadrants
Right upper
quadrant
Left upper
quadrant
Right lover
quadrant
Left lover
quadrant
Right
hypochondriac
region
Epigastric
region
Left
hypochondriac
region
Right lumbar
region
Umbilical
region
Left lumbar
region
26
Abbreviation
C
2. Thoracic
T or D
(D = dorsal)
3. Lumbar
4. Sacral
5. Coccygeal
Cg
Location
Neck region. There are 7 cervical
vertebrae (Cl-C7).
Chest region. There are 12 thoracic
vertebrae (T1-T12). Each bone is
joined to a rib.
Loin or flank region (between the
ribs and the hip bone). There are
5 lumbar vertebrae (L1-L5).
Five bones (s1-S5) are fused to
form one bone the sacrum.
The coccyx (tailbone) is a small
bone composed of 4 fused pieces.
efferent
anterior (ventral)
posterior (dorsal)
central
deep
superficial
Near the surface. Example: the wound was a superficial one, just penetrating the skin.
distal
proximal
inferior (caudal)
superior (cephalic)
Pertaining to the head; situated above another structure. Example: in a cephalic presentation of the fetus,
the head comes through the birth canal first.
lateral
28
medial
supine
prone
6. Planes of body
A plane is an imaginary flat surface that anatomists use to identify different
sections of the body. The following are the most commonly used body planes
and their anatomical divisions.
1. frontal coronal vertical plane dividing the body or structure into anterior and posterior portions
2. midsagittal median lengthwise vertical plane dividing the body or structure into right and left portions or into right and left halves.
3. transverse - horizontal - Plane running across the body parallel to the
ground (horizontal).
It divides the body or structure into upper and lower portions.
Figure 3.4 Planes of the Body
29
Meaning
extremity
fat
cartilage
cell
cause
tissue
unknown
nucleus
shape, form
nucle/o
path/o
somat/o
son/o
nucleus
disease
body
sound
viscer/o
int. organ
Terminology
acromegaly = enlargement of extremities
adipose = pertaining to fat (tissue)
chondritis = inflammation of cartilage
cytology = the study of cells
etiology = study of the cause of diseases
histology = the study of tissues
idiopathic = of unknown cause
karyolysis = destruction of the nucleus
morphology = the study of shape, form,
or structure
nuclear = pertaining to the nucleus
pathology = the study of diseases
somatic = pertaining to the body
sonography = the process of recording
sound
visceral = pertaining to internal organs
Definition
fibrous band holding together tissues that are normally
separated
bursting open of a wound
pertaining to a fever; feverish
relative balance of internal environment of the body
body defence against injury, infection etc.
pertaining to a diseases (morbus = lat. disease)
the presence of pathological microorganisms or their
toxins in the bloodstream
associated with the production of pus (purulent)
EXERCISES
1. Answer the following questions:
1.1. Where is the mediastinum?
..........................................................................................................................................................................
2.5. posterior.....................................................
2.2. afferent.......................................................
2.6. caudal..........................................................
2.3. proximal.....................................................
2.7. supine..........................................................
2.4. ventral.........................................................
3. Identify the following planes:
3.1. Which plane divides the body into anterior and posterior portions?
..........................................................................................................................................................................
3.2. Which plane divides the body into upper and lower portions?
..........................................................................................................................................................................
3.3. Which plane divides the body into left and right halves?
..........................................................................................................................................................................
31
pleural cavity
endoplasmic reticulum
chromosomes
catabolism
anabolism
metabolism
32
Contains the heart and other structures between the lungs in the thoracic
cavity.
..........................................................................................................................................................................
34
CHAPTER 4
the most superficial layer of the epidermis, called the stratum corneum. On
this way they become flatten, lose their nuclei and die, becoming filled with
a protein called keratin. Then these cells are called horny cells, because of
the hard protein material they are composed of. Finally, within 3 to 4 weeks
after beginning as a basal cell in the bottom part of the epidermis, the horny,
keratinized cell is sloughed off or shedded from the surface of the skin. In
this way the epidermis is constantly renewing itself, cells dying at the same
rate at which new cells are born. The cells of the protective, horny layer are
nonliving and require no supply of blood for nourishment. As long as the horny
outer layer remains intact, microorganisms cannot enter.
The basal layer of the epidermis contains special cells called melanocytes
which form and contain a black pigment melanin. The amount of melanin
accounts for the colour differences among the races. Also, the presence of
melanin in the epidermis is vital for the protection against the harmful effects
of ultraviolet radiation which can manifest themselves as skin cancer.
(2) Corium, or dermis, is the thicker part of the skin underneath the
epidermis and is made up of connective tissue that contains blood vessels and
nerves. The corium projects into the epidermis in ridges called papillae of the
corium. Lymph vessels and the accessory organs of the skin, which are hair
follicles, sebaceous glands and sweat glands are also located in the dermis.
There are several types of connective tissue cells in the dermis; fibroblastscells that are active in repair of injury, histiocytes (macrophages) - phagocytic
cells that protect the body by devouring foreign substances, and mast cells specialized cells containing histamine and heparin.
Collagen, a fibrous protein material, found also in bone, cartilage, tendons
and ligaments, is another important structural component of the dermis. It is
tough and resistant, yet flexible. Collagen fibres support and protect the blood
and nerve networks that pass through the corium.
(3) Subcutaneous Layer - beneath the corium is a layer of subcutaneous
tissue, which is another connective tissue layer specialized for the formation
of fat. Lipocytes (fat cells) prevail in the subcutaneous layer and they manufacture and store large amounts of fat. This tissue helps insulate the body
against heat and cold and cushions it against shock.
36
Figure 4.1. The three layers of the skin and their structure
Touch receptor
Hair shaft
Sweat gland
pore
Stratum
corneum
Epidermis
Basal layer
Sebaceous
(oli) gland
Dermis
Hair follicle
Subcutaneous
tissue
Adipose tissue
Papilla
Arteriole Venule
Nerve
Sudoriferous
(sweat) gland
37
Nails
Nails are hard keratin plates covering the dorsal surface of the most distal
phalanges of each finger and toe. They are composed of horny cells that are
cemented together tightly and can extend (grow) indefinitely unless cut or
broken. The nails grow in much the same way as the hair. The nail bed, like
the hair root, is situated in the corium. The pink colour of the nails is due to
their translucent quality which allows the underlying vascular tissue to show
through.
The semilunar (half-moon) white region at the base of the nails is called
lunula. It has a whitish appearance because the vascular tissue underneath
does not show through. The narrow band of epidermis that extends from nail
wall on to the surface is called the cuticle or eponychium (onych means nail).
The average growth rate for fingernails is around l mm per week and it is
somewhat slower for toenails. The major function of the nails is to protect the
tips of the fingers and toes from bruises and other kinds of injuries.
Glands
1. Sebaceous Glands
The sebaceous glands produce on oily secretion called the sebum and
are located in the corium layer of the skin. These glands are filled with cells,
the centres of which are saturated with fatty droplets. As these cells disintegrate they yield the sebum. They are closely associated with hair follicles and
their ducts open into the hair follicle through which the sebum is released.
The acidic nature of sebum helps destroy harmful organisms on the surface
of the skin and, thus, prevents infection. Sebum also lubricates the skin and
minimizes water loss.
Sebaceous glands are present over the entire body except the soles of the
feet and palms of the hands. They are influenced by sex hormones, which
cause them to hypertrophy at puberty and atrophy in old age.
2. Sweat Glands
Sweat glands are also called sudoriferous glands (sudor - sweat). They
are located deep in the corium and are found on almost all body surfaces.
They collect fluid containing water, salt and waste products from the blood
and carry it away in canals that end in pores on the skin surface, where it is
deposited as sweat.
The milk producing mammary gland is another type of modified sweat
gland; it secretes milk only after the birth of a child.
38
Combining Forms
adip/o
lip/o
steat/o
Meaning
fat
Terminology
adiposis
lipocele
steatoma
cutane/
dermat/o
derm/o
skin
subcutaneous
dermatology
hypodermic
hidr/o
sudor/o
sweat
hidroadenitis
sudoresis (diaphoresis)
39
Combining Forms
ichthy/o
xer/o
Meaning
kerat/o
horny tissue
keratosis
melan/o
black
melanoma
myc/o
fungus
dermatomycosis
onych/o
ungu/o
nail
onychomycosis
subungual
phyt/o
plant
dermatophytosis
pil/o
trich/o
hair
pilonidal
trichopathy
scler/o
hardening
scleroderma
seb/o
sebum
seborrhea
squam/o
scale
squamous
xanth/o
yellow
xanthemia
xen/o
foreign
xenograft
dry, scaly
Terminology
ichthyosis
xeroderma
vesicle
pustule
40
polyp
ulcer
cyst
fissure
acne vulgaris
(ordinary)
41
albinism
alopecia
athlete s foot
basal cell carcinoma malignant tumour of the basal cell layer of the
epidermis. This is the most frequent type of skin
cancer. It is a slow- growing tumour of the basal
layer of the epidermis and usually occurs on
the upper half of the face, near the nose, and is
nonmetastasizing.
Bowen disease
burns
cellulitis
chloasma
cicatrix
comedo
decubitus ulcer
(bedsore)
42
dermatitis
discoid lupus
ecchymosis
eczema
eschar
hemangioma
hirsutism
impetigo
keratosis
43
lentigo
leukoplakia
pediculosis
systemic lupus
erythematosus
(SLE)
melanoderma
melanoma,
malignant
nevus; nevi
onychia
pemphigus
petechiae
pruritus
44
psoriasis
purpura
rash
scabies
scleroderma
squamous cell
carcinoma
tinea
urticaria
vitiligo
wart (verruca)
EXERCISES
1. a) The functions of the integumentary system are: ....................................................
b) The accessory organs of the skin are: ...........................................................................
2. Complete the following sentences:
2.1. A fat cell is known as a .............................................................................................................
45
2.2. The half-moon-shaped white area at the basis of a nail is called the
..........................................................................................................................................................................
b) eponychium
c) baldness
46
47
48
CHAPTER 5
MUSCULOSKELETAL SYSTEM
1. Introduction
The musculoskeletal system includes the bones, muscles and joints. Each
has several important functions in the body.
Bones, by providing the framework around which the body is constructed,
protect and support our internal organs. Also, by serving as a point of attachment for muscles, bones assist in body movements. The inner core of bones
is composed of hematopoietic tissue (red bone marrow manufactures blood
cells), while other parts are storage areas for minerals necessary for growth,
such as calcium and phosphorus.
Joints are the places where bones come together. Several different types
of joints are found within the body. The type of joint found in any specific location is determined by the need for greater or lesser flexibility of movement.
Muscles, whether attached to bones or to internal organs and blood vessels,
are responsible for movement. Internal movement involves the contraction
and relaxation of muscles that are a part of viscera, and external movement is
accomplished by the contraction and relaxation of muscles that are attached
to the bones.
2. Formation and structure of bones
Bones are organs chiefly composed of connective tissue called osseous
(bony) tissue plus a rich supply of blood vessels and nerves. Osseous tissue is
a dense connective tissue that consists of osteocytes (bone cells) surrounded
by a hard, intercellular substance filled with calcium salts.
During fetal development, the bones of the fetus are composed of cartilage
tissue, which resembles osseous tissue but is more flexible and less dense
because of a lack of calcium salts in its intercellular spaces. As the embryo
develops, the process of depositing calcium salts in the soft, cartilaginous
bones occurs, and continues throughout the life of the individual after birth.
49
The gradual replacement of cartilage and its intercellular substance by immature bone cells and calcium deposits is called ossification (bone formation).
Figure 5.1. Skeletal System
ACROMION
CLAVICLE
SCAPULA
STERNUM
RIBS
XIPHOID PROCESS
COSTAL CARTILAGE
HUMERUS
ILIUM
ULNA
ISCHIUM
PUBIS
SACRUM
RADIUS
CARPALS
METACARPLAS
PHALANGES
FEMUR
PATELLA
TIBIA
FIBULA
TARSALS
METATARSALS
PHALANGES
Osteoblasts are the immature osteocytes that produce the bony tissue that
replaces cartilage during ossification. Osteoclasts (-clast means to break) are
large cells that function to reabsorb, or digest, bony tissue. Osteoclasts (also
called bone phagocytes) digest dead bone tissue from the inner sides of bones
and thus enlarge the inner bone cavity so that the bone does not become overly
thick and heavy. When a bone breaks, osteoblasts lay down the mineral bone
matter (calcium salts) and osteoclasts remove excess bone debris (smooth out
the bone). The formation of bone is dependent to a great extent on a proper
supply of calcium and phosphorus to the bone tissue. These minerals must
be taken into the body along with a sufficient amount of vitamin D. Vitamin
50
D helps the passage of calcium through the lining of the small intestine and
into the bloodstream. Once calcium and phosphorus are in the bones, osteoblastic activity produces an enzyme that causes the formation of a calciumphosphate compound giving bone its characteristic hard quality.
Not only are calcium and phosphorus part of the hard structure of bone
tissue, but calcium is also stored in bones and small quantities are present in
the blood. If the proper amount of calcium is lacking in the blood, nerve fibers
are unable to transmit impulses effectively to muscles; heart muscle becomes
weak and muscles attached to bones undergo spasms. The necessary level of
calcium in the blood is maintained by the parathyroid gland, which secretes
a hormone to release calcium from bone storage. Excess of the hormone
(caused by tumour or other pathological process) will raise blood calcium at
the expense of the bones, which become weakened by the loss of calcium.
3. Types of bones
The shaft, or middle region, of a long bone is called the diaphysis. Each end
of a long bone is called an epiphysis. The epiphyseal line or plate represents an
area of cartilage tissue which is constantly being replaced by new bony tissue
as the bone grows. Cartilage cells at the edges of the epiphyseal plate form
new bone and this is responsible for the lengthening of bones during childhood and adolescence. The plate calcifies and disappears when the bone has
achieved its full growth.
The periosteum is a strong, fibrous, vascular, membrane that covers the
surface of a long bone, except at the ends of the epiphyses. Bones other than
long bones are completely covered by the periosteum. Beneath the periosteum
is the layer of osteoblasts which deposit calcium-phosphorus compounds in
the bony tissue. The ends of long bones are covered by a thin layer of cartilage called articular cartilage. It cushions the bones at the place they meet
with other bones (joints).
51
SHAFT
DIAPHYSIS
(CORPUS)
EPIPHYSIS
Compact (cortical) bone is a layer of hard, dense tissue that lies under the
periosteum in all bones and chiefly around the diaphysis of long bones. Within
the compact bone is a system of small canals containing blood vessels that
bring oxygen and nutrients to the bone and remove waste products such as
carbon dioxide. These channels are called haversian canals. Compact bone
is tunnelled out in the shaft of the long bones by a central medullary cavity
which contains yellow bone marrow. Yellow bone marrow is chiefly composed
of fat cells.
Cancellous bone, sometimes called spongy bone, is much more porous and
less dense than compact bone. The mineral matter in it is laid down in a
series of separated bony fibres called a spongy latticework or trabeculae. It is
found largely in the epiphyses of long bones and in the middle portion of most
other bones of the body as well. Spaces in cancellous bone contain red bone
marrow. This marrow, as opposed to a yellow marrow which is fatty tissue, is
richly supplied with blood and consists of immature and mature blood cells
in various stages of development. In an adult, the ribs, pelvic bone, sternum
(breastbone) and vertebrae, as well as the epiphyses of long bones, contain
red bone marrow within cancellous tissue. The red marrow in the long bones
is plentiful in young children, but decreases through the years and is replaced
by yellow marrow.
52
5. sphenoid bone - this bat-shaped bone extends behind the eyes and forms
part of the base of the skull. Because it joins with the frontal, occipital, and
ethmoid bone, it serves as an anchor to hold those skull bones together
(sphen/o means wedge.)
6. ethmoid bone - this thin, delicate bone is composed primarily of spongy,
cancellous bone. It supports the nasal cavity and forms part of the orbits
of the eyes (ethm/o means sieve).
6. Facial Bones
All of the facial bones, except one, are joined together by sutures so that
they are immovable. The mandible (lower jaw bone) is the only facial bone
capable of movement. This ability is necessary for activities such as mastication (chewing) and speaking.
The facial bones are:
1. nasal bones - two slender nasal (nas/o = nose) bones support the bridge
of the nose. They join with the frontal bone superiorly and form part of the
nasal septum.
2. lacrimal bones - two paired lacrimal (lacrim/o = tear) bones are located
one at the corner of each eye. These thin, small bones contain fossae for
the lacrimal gland (tear gland) and canals for the passage of the lacrimal
duct.
3. maxillary bones - two large bones compose the massive upper jaw bones
(maxillae). They are joined by a suture in the median plane. If they are not
joined together normally before birth, the condition known as cleft palate
results.
4. mandibular bone (mandible) - this is the lower jaw bone. Both the maxilla
and mandible contain the sockets called alveoli in which the teeth are
embedded. The mandible joins the skull at the region of the temporal bone,
forming the temporomandibular joint (TMJ) on either side of the skull.
5. zygomatic bones - two bones, one on each side of the face, form the high
portion of the cheek.
6. vomer- this thin, single flat bone forms the lower portion of the nasal
septum.
Sinuses, or air cavities, are located in specific places within the cranial and
facial bones to lighten the skull and warm and moisten air as it passes through.
7. Vertebral column and structure of vertebrae
The vertebral, or spinal, column is composed of 26 bone segments, called
vertebrae, which are arranged in five divisions from the base of the skull to
the tail bone (coccyx).
54
The first seven bones of the vertebral column, forming the neck bone, are
the cervical (Cl-C7) vertebrae. These vertebrae do not articulate (join) with
the ribs. The second set of 12 vertebrae are known as the thoracic (Tl-T12 or
Dl-Dl2), or dorsal vertebrae. These vertebrae articulate within the 12 pairs of
ribs. The third set of five vertebral bones are the lumbar (Ll-LS) vertebrae.
They are the strongest and largest of the backbones. The sacrum is a slightly
curved, triangularly shaped bone. At birth it is composed of five separate
segments (sacral bones); these gradually become fused in the young child.
The coccyx is the tailbone, and it, too, is a fused bone, having been formed
from four small coccygeal bones.
Although the individual vertebrae in the separate regions of the spinal
column are all slightly different in structure, they do have several parts in
common. A vertebra is composed of an inner, thick, disk-shaped portion called
the vertebral body. Between the body of one vertebra and the bodies of vertebrae lying beneath and above are cartilaginous disks which help to provide
flexibility and cushion most shocks to the vertebral column. The vertebral
arch is the posterior part of the vertebra, and consists of a spinous process,
transverse processes, and laminae. The neural canal is the space between the
vertebral body and the vertebral arch through which the spinal cord passes.
8. Bones of the thorax, pelvis, and extremities
Bones of the thorax:
1. clavicle:- collar bone; a slender bone, one on each side of the body,
connecting the breastbone to each shoulder bone.
2. scapula - shoulder bone; two flat, triangular bones, one on each dorsal
side of the thorax. The extension of the scapula which joins both the clavicle to form the joint of the shoulder is called the acromion (acr/o means
extremity; om/o means shoulder).
3. sternum - breastbone; a flat bone extending down the midline of the chest.
The uppermost part of the stern um articulates on the sides with the clavicle and ribs, while the lower, narrow, portion is attached to the diaphragm
and abdominal muscles. The lower portion of the sternum is called the
xiphoid process (xiph/o means sword).
4. ribs - there are 12 pairs of ribs. The first seven pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages. Ribs 1-7
are called true ribs. They join with the sternum anteriorly and with the
vertebral column in the back. Ribs 8-10 are called false ribs. They join with
the vertebral column in the back but join the 7th rib anteriorly, instead of
attaching to the sternum. Ribs 11 and 12 are the floating ribs because they
are completely free at their anterior extremity.
55
3. tibia -largest of two lower bones of the leg; the tibia (meaning flute)
runs under the skin in the front part of the leg. It joins with the femur
at the patella, and at its distal end (ankle) forms a swelling which is the
bony prominence (medial malleolus) at the inside of the ankle. The tibia is
commonly called the shin bone.
4. fibula - smaller of two lower leg bones; this thin bone, well hidden under
the leg muscles, joins at its proximal end with the tibia laterally, and joins
at its distal end with the tibia and ankle bones to form the bony prominence
(lateral malleolus) on the outside of the ankle.
5. tarsals - ankle bones; these are seven short bones which resemble the
carpal bones of the wrist but are larger. The calcaneus is the largest of
these bones and is also called the heel bone.
6. metatarsals - there are five metatarsal bones- each leads to the phalanges
of the toes.
7. phalanges of the toes - there are two phalanges in the big toe and three in
each of the other four toes.
9. Joints
1.Types of Joints
A joint (articulation) is a place in the body where two or more bones come
together. Some joints are immovable, such as the suture joints between the
skull bones. Other joints, such as those between the vertebrae, are partially
movable. Most joints, however, allow considerable movement. These freely
movable joints are called synovial joints. Examples of synovial joints are the
ball and socket type (hip joint; the head of the femur fits into the acetabular
fossa of the ilium) and hinge type (elbow, knee, and ankle joints). The bones in
a synovial joint are separated by a joint capsule composed of fibrous cartilage
tissue. Ligaments (fibrous bands, or sheets, of connective tissue) often anchor
the bones together around the joint capsule to strengthen it. The surface of
the bones at the joint is covered with a smooth cartilage called the articular
cartilage.
The synovial membrane lies under the joint capsule and lines the synovial cavity between the bones. The synovial fluid contains water and nutrients
which nourish and lubricate the joints so that friction on the articular cartilage is minimal.
2. Bursae
Bursae are closed sacs of synovial fluid lined with a synovial membrane.
They are formed in the spaces between tendons (connective binding bones to
bones), and bones. Bursae lubricate these areas where friction would normally
57
develop close to the joint capsule. Some common bursae locations are at the
elbow joint (olecranon bursa), knee joint (patellar bursa), and shoulder joint
(subacromial bursa).
Figure 5.3. a synovial joint
10. Muscles
There are three types of muscles in the body. Striated muscles, also called
voluntary or skeletal muscles, are the muscle fibres that move all bones, as
well as the face and eyes. We have conscious control over the activity of this
type of muscle.
Striated muscle fibres (cells) have a pattern of dark and light bands,
or fibrils, in their cytoplasm. A delicate membrane called a sarcolemma
surrounds each skeletal muscle fibre. Fibrous tissue that envelops muscles
is called fascia.
Smooth muscles, also called involuntary or visceral muscles, are those
muscle fibres which move our internal organs such as digestive tract, blood
vessels, and secretory ducts leading from glands. We have no conscious control
over these muscles. They are called smooth because they have no dark and
light fibrils in their cytoplasm. While skeletal muscle fibres are arranged in
bundles, smooth muscle forms sheets of fibres as it wraps around tubes and
vessels.
58
ORBICULARIS OCULI
MASSETER
STERNOCLEIDOMASTOID
PectoraLIS MAJOR
Triceps brachii
Biceps brachii
rectus abdominus
There can be more than one origin for a muscle, as is the case with the
upper arm muscle (biceps brachii) where one origin is at the upper end of the
humerus near the shoulder joint and a second origin is above the scapula. The
insertion of the biceps brachii is at the upper end of the radius near the elbow.
Near the point of insertion, a muscle narrows and is connected to the bone by
way of a tendon. One type of tendon that helps attach muscles to larger bone
areas is called an aponeurosis.
Muscles can perform a variety of actions. Some of the terms used to
describe them are listed below:
abduction
adduction
dorsiflexion
extension
plantar flexion
pronation
rotation
supination
torsion
Key Terms
60
Terminology
ankyl/o
stiff, bent
articul/o
arthr/o
joint
burs/o
bursa
calc/o
calci/o
calcium
chondr/o
cartilage
cost/o
rib
dactyl/o
finger, toe
fasci/o
band
kyph/o
humpback
61
Terminology
leiomy/o
smooth
muscle
lord/o
swayback
muscul/o
my/o
myos/o
muscle
myel/o
bone
marrow,
spinal cord
orth/o
straight
osse/o
oste/o
bone
rachi/o
spine
rhabd/o
striated
scoli/o
crooked,
bent
spondyl/o
vertebra
spondylosis = degeneration of
intervertebral disks
syndesm/o
ligament
ten/o, tend/o
tendin/o
tendon
inflammation of joints
bunion
62
bursitis
inflammation of bursae
crepitation
Ewing sarcoma
exostoses
fracture
dislocation
osteoporosis
osteogenic sarcoma
osteomyelitis
sprain
strain
protrusion of an
intervertebral disc
rickets (rachitis)
of the spine takes place, the disorder is identified as scoliosis (bent). Scoliosis
may be congenital, or it may develop in the early teens. Poor posture over a
long period of time is a contributing factor, and it may be accompanied by
lack of muscle tone and general physical inactivity. Surgery, braces, casts and
corrective exercises may eliminate this condition.
Abnormally increased convexity in the curvature of the thoracic spine as
viewed from the side is referred to as kyphosis (hunchback or humpback). This
condition may be caused by rheumatoid arthritis, rickets, chronic respiratory
diseases or a congenital disorder. It never develops from poor posture. There
are no specific symptoms of kyphosis besides back pain and increasing immobility of the spine. Symptoms vary with the cause, and any back pain or injury
should be investigated.
Lordosis (swayback) is a forward curvature of the lumbar spine. I may be
caused by increased weight of the abdominal contents. This could be due to
obesity or excessive weight gain during pregnancy.
Amyotrophic lateral sclerosis is a specific type of movement disorder
(muscles atrophy) with degeneration of nerves in the spinal cord and lower
region of the brain (brain stem). Early symptoms include difficulty in swallowing
and talking, and weakness in the arms and legs. As the disease progresses
there is increased spasticity and atrophy of muscles. Etiology and effective
treatment are unknown.
Muscular dystrophy includes a group of inherited diseases characterized
by progressive weakness and degeneration of muscle fibres without involvement of the nervous system.
Pseudohypertrophic (Duchenne) muscular dystrophy is the most common
form. Muscles enlarge as fat replaces functional muscle cells that have atrophied.
Myasthenia gravis is briefly defined as the lack of muscle strength marked
by paralysis. This condition is characterized by extreme weakness of the
muscles of the face, jaw, and eyelids and difficulty in swallowing. The etiology
is unknown, but it is thought that there is some defect at the myoneural junction where the nerve enters the muscle fibre to stimulate muscle contraction. There is either a lack of acetylcholine to help transmit the impulse across
the myoneural junction or an increase in cholinesterase, which is an enzyme
released at the junction to destroy whatever acetylcholine remains after the
impulse has passed. Treatment consists of giving a drug to interfere with
cholinesterase production. Some cases are associated with benign tumours
of the thymus (thymoma), and thymectomy is found to be beneficial.
65
66
b) inflammation of joints
d) a broken bone
6.8. radius...........................................................
6.9. fossa.............................................................
6.10. femur.........................................................
67
8.9. malignant bone tumour involving the entire shaft of a long bone
......................................................................................................................................................................... .
the spine is the site of most back pain which may simply develop from overworked or underexercised muscles. Strains are especially common when tired
or weak back muscles are called upon to do more than they are capable of
doing. The muscles will then suddenly go into spasm - an involuntary contraction - and become a knotty mass while the body sends out a signal of sharp
pain. Other muscles nearby will also go into spasm in an effort to protect the
strained muscles and prevent further damage.
(From: Ellis, J. W. Medical Symptoms and Treatments)
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69
CHAPTER 6
GASTROINTESTINAL SYSTEM
Functions
The gastrointestinal system is also called the digestive or alimentary
system. It begins with the mouth or the oral or buccal cavity where food enters
the body, and terminates at the anus where solid waste materials leave the
body. The functions of the digestive system are threefold: ingestion of food,
absorption of nutrients, elimination of solid metabolic waste material.
When food is ingested it is in a form that cannot reach the cells because
of its inability to pass through the intestinal mucosa into the bloodstream.
Therefore, the consumed food must be prepared for absorption. Digestive
enzymes are substances that speed up chemical reactions and help in the
breakdown (digestion) of complex nutrients. Complex proteins are digested to
simpler amino acids, complicated sugars are reduced to simple sugars, such
as glucose; and large fat molecules are broken down to fatty acids and triglycerides. Thus, digestion can be defined as a complete process of changing the
chemical and physical composition of food in order to facilitate assimilation
of the nourishing ingredients of food by the cells of the body.
Anatomy of the Digestive System
The gastrointestinal (GI) tract begins at the oral cavity or mouth. The structures within the oral cavity are the cheeks or bucca and the tongue and its
muscles, which extend across the floor of the mouth. The main functions of
the tongue are manipulation of food during the chewing process, speech,
deglutition or swallowing, speech production, and determination of taste.
The surface of the tongue has rough elevations; these elevations are taste
buds. These sense organs are called papillae and are capable of perceiving
a variety of flavours found in our foods, such as bitterness, sweetness, saltiness, and sourness.
70
The teeth are also found in the oral cavity and play an important role in the
initial stages of digestion. The teeth that are located in front of the oral cavity,
the incisors and cuspids, cut and tear the food into small pieces. The teeth
located in the rear of the mouth are called molars. They further crush and grind
the food into finer particles. Teeth are covered by hard enamel, which gives
them a white and smooth appearance. The enamel is the hardest substance
in the body. Beneath the enamel is the main structure of the tooth, the dentin.
It is yellowish and is composed of bony tissue which is softer than enamel.
Dentin is surrounded by a thin layer of modified bone called cementum. In the
innermost part of the tooth is the pulp, a soft, delicate layer, which stores the
nerves and blood vessels of the tooth. The teeth are embedded in pink fleshy
tissue known as gums, or gingiva.
Figure 6.1. Anatomy of a tooth
Some of the other structures located within the mouth are the hard and soft
palates. The hard palate lies in the anterior portion of the roof of the mouth,
while the soft palate lies in its posterior portion. The soft palate forms a partition between the mouth and nasopharynx and is continuous with the hard
palate. Rugae are the irregular ridges in the mucous membrane covering the
anterior portion of the hard palate. The entire buccal cavity, like the rest of
the digestive tract, is lined with mucous membrane.
71
After the food is chewed, it is formed into a round, sticky mass called a
bolus. The bolus is pushed by the tongue from the mouth into the pharynx. Its
downward movement is guided into the pharynx or throat by the soft, fleshy
V-shaped tissue called the uvula. The uvula hangs from the soft palate and also
functions to aid in producing sounds and speech. The pharynx is a muscular
tube which serves as a common passageway for air from the nasal cavity to
the larynx (voice box), as well as for food going from the mouth to the esophagus. The pharynx is divided into three major sections:
1. The nasopharynx or epipharynx (the throat behind the nose)
2. The oropharynx or mesopharynx (the throat behind the mouth)
3. The laryngopharynx or hypopharynx (the throat above the larynx)
The laryngopharynx is further divided into two tubes; one which leads to
the lungs, called the trachea (wind pipe), and one which leads to the stomach,
called the esophagus (gullet). A small flap of tissue, the epiglottis, covers the
trachea. The main function of the epiglottis is to prevent food from entering
the trachea, thus allowing all food to be channelled to the stomach through
the esophagus.
Stomach
The stomach is a saclike structure located in the abdominal cavity directly
below the diaphragm. It is continuous with the esophagus. Thus, food continues
its descent down the esophagus in peristaltic, or wavelike, movements until
it reaches the stomach. The stomach mixes the undigested food with gastric
juices to further break it down for digestion. Within the stomach there are a
considerable number of folds called rugae. The rugae appear only when the
stomach is empty. As the stomach fills, the interior walls become smooth.
The interior lining of the stomach is composed of mucous membranes and
contains the glands that secrete hydrochloric acid (HCl) and gastric juices.
Once the food or bolus is mixed with gastric juices and HCl, it forms a semicreamy fluid called chyme.
There are two valves in the stomach. The first valve is called the cardiac
valve, or cardiac sphincter, and is located at the top or fundus of the stomach. It
connects the esophagus to the stomach. The second valve is called the pyloric
valve, or pyloric sphincter, and is located at the base or antrum of the stomach.
It connects the stomach to the small intestine. Both valves are composed of a
round band of muscles called sphincters which contract and expand to allow
food to enter and leave the stomach.
72
Parotid gland
Submandibular
gland
Sublingual gland
Salivary
gland
Pharynx
Esophagus
Food bolus
Liver
Gallbladder
Duodenum
Hepatic flexure
Pancreas
Jejunum
Stomach
Spleen
Splenic flexure
Transverse colon
Descending colon
Ascending colon
Ileum
Cecum
Appendix
Sigmoid colon
Rectum
Anus
75
Key Terms
absorption passage of materials through the intestinal walls into the
bloodstream
alimentary canal the digestive tract
amino acids building blocks of proteins, produced when proteins are
digested
amylase pancreatic enzyme for digestion of starch
bile digestive juice produced by the liver and stored in the gallbladder
bilirubin pigment resulting from destruction of hemoglobin, released
by the liver
bolus mass of masticated food ready to be swallowed
bowel intestine
canine teeth pointed dog-like teeth
cecum (blind) first part of the large intestine
colon large intestine
deglutition swallowing
dentin basic tissue composing the tooth
digestion breakdown of complex foods into smaller forms
emulsification breakdown of large fat globules into smaller ones
enamel hard outer covering of a tooth
enzyme a chemical that speeds up digestion
esophagus gullet
fatty acids substances produced when fats are digested
feces solid wastes; stools
gingiva gums
glucose simple sugar; blood sugar
glycogen animal starch; glucose is stored in the form of glycogen in
liver cells
hydrochloric acid a substance produced by the gastric mucosa
necessary for digestion of food
incisors front teeth in the dental arch (cutters)
insulin pancreatic hormone important for carbohydrate metabolism
lipase pancreatic enzyme needed in the digestion of fats
mastication chewing
palate roof of the mouth
papilla(e) small elevations on the surface of the tongue; any nipple-like
elevation
parotid gland salivary gland near the ear
peristalsis rhythmic contractions of digestive tubes and other tubular
structures
76
pharynx throat
pulp soft inner part of a tooth containing blood vessels and nerves
ruga(e) folds on the hard palate and gastric walls
saliva digestive juice produced by the salivary glands
sphincter circular muscles inside a tube
triglycerides large fat molecules
villi (sg. villus) microscopic projections in the walls of the small
intestine (blood vessels) through which nutrients are absorbed into the
bloodstream
Terminology
an/o
anus
append/o
appendix
bucc/o
cheek
celi/o
lapar/o
abdomen
cheil/o
labi/o
lip
cholecyst/o
choledoch/o
bile duct
col/o
colon/o
large
intestine
dent/o
odont/o
tooth
enter/o
small
intestine
faci/o
face
gastr/o
stomach
gingiv/o
gums
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Terminology
gloss/o
lingu/o
tongue
hepat/o
liver
mandibul/o
lower jaw
(mandible)
or/o
stomat/o
mouth
proct/o
anus,
rectum
sial/o
anal fistula
anorexia
ascites
borborygmus
79
cachexia
cholelithiasis
cirrhosis
cleft palate
colic
colonic polyposis
constipation
Crohn disease
dental caries
tooth decay
diverticula
(sg.diverticulum)
dysentery
dyspepsia
dysphagia
eructation
esophageal
varices
flatus
80
gallstones
heartburn
(pyrosis)
hematemesis
vomiting blood
hepatitis
icterus
jaundice
ileus
intestinal obstruction
intussusception
irritable bowel
syndrome
jaundice (icterus)
81
laxative
melena
nausea
oral leukoplakia
pancreatitis
regurgitation
steatorrhea
volvulus
EXERCISES
1. What are the three functions of the digestive system?
1.1. .................................................................................................................................................................
1.2. .................................................................................................................................................................
1.3...................................................................................................................................................................
2. Fill in the correct term:
2.1. One of the main functions of the tongue is swallowing or ................................. .
............................................
2.2. The incisors and ......................................... cut and ......................................... the food
into small pieces.
2.3. The teeth are embedded in pink fleshy tissue known as gums or
..........................................................................................................................................................................
2.4. Within the stomach there are many folds called ......................................................
2.5. Bile is also .............................. from the liver through the ............................................
3. Give the opposite of each term:
3.1. hard palate ..............................................
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83
84
(peritoneum). The infection can spread so quickly that gangrene and rupture
may occur within a matter of hours from the first symptoms.
(From: Ellis, J. W. Medical Symptoms and Treatments)
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86
CHAPTER 7
RESPIRATORY SYSTEM
Respiration is usually thought of as being a mechanical process of
breathing, that is the repetitive and, for the most part, unconscious exchange
of air between the lungs and the external environment. Respiratory activity
consists of two separate, simultaneous operations that involve the exchange
of oxygen (O2) and carbon dioxide (CO2).
The first operation, external respiration, refers to the exchange of O2 and
CO2 between the organism and the external environment. In this operation
oxygen-rich air from the environment is brought into the lungs during inspiration (inhaling) and CO2 is removed from the body during expiration (exhaling).
Air inhaled contains about 21 percent oxygen. Oxygen is inhaled into the air
spaces (sacs) of the lungs and immediately passes into tiny capillary blood
vessels surrounding the air spaces. Simultaneously, carbon dioxide, a gas
produced when oxygen and food combine in cells, passes from the capillary blood vessels into the air spaces of the lungs to be exhaled (exhaled air
contains about 16 % of oxygen). More familiarly, external respiration is called
lung breathing.
The second operation, internal respiration (also called cellular respiration), refers to the exchange of O2 and CO2 at the tissue or cellular level. This
exchange is also called tissue breathing. Just as the organism as a whole
requires the exchange of gases to maintain life, each individual cell of the
organism must likewise receive oxygen for the metabolic process and expel
waste gases that have accumulated in the cell. During internal respiration
the red blood cells transport O2 from the lungs to body tissues. They deposit
O2 with the tissue as they remove CO2. The red blood cells return to the lungs
where they finally expel CO2 during external respiration. For example, red
blood cells transport O2 to liver cells and, in turn, receive CO2 from the liver
cells. The CO2 is then expelled from the lungs during external respiration.
87
Adenoids
Nasal cavity
Nasopharynx
Nose
Oropharynx
Palatine tonsils
Laryngopharynx
Epiglottis
Larynx
Glottis and vocal cords
Thyroid cartilage
Trachea
Apex of lung
Bronchi
Bronchiole
Mediastinum
Right lung
Left lung
Visceral pleura
Pleural cavity
Diaphragm
Base of lung
Parietal pleura
During the breathing process, air from the environment is drawn in through
the nose and passes through the nasal cavity to the pharynx (throat). The nasal
cavity is lined with a mucous membrane and fine hairs (cilia) to help filter out
foreign bodies, as well as to warm and moisten the air. Paranasal sinuses are
hollow, air-containing spaces within the skull that communicate with the nasal
cavity. They also have a mucous membrane lining and function to provide the
lubricating fluid mucus, to lighten the bones of the skull and help produce
sound. The pharynx is a muscular tube and consists of three major divisions:
1. the nasopharynx, or epipharynx, posterior to the nose and the nearest to
the nasal cavity;
2. the oropharynx or mesopharynx, posterior to the mouth;
3. the laryngopharynx (also called hypopharynx), posterior to the larynx.
Within the nasopharynx there is a collection of lymphatic tissue known as
adenoids or pharyngeal tonsils. They are more prominent in children, and if
88
89
A double fold of serous membrane, the pleura, surrounds the lungs. The
innermost layer is the visceral pleura; the outermost, the parietal pleura. The
small space between these membranes is the pleural cavity, which contains
a small amount of lubricating fluid permitting the visceral pleura to glide
smoothly over the parietal pleura during respiration.
The ability of the lungs to fill with air and to expel it depends upon a
pressure differential between the atmosphere and the chest cavity. A large
muscular partition, the diaphragm, lies between the chest cavity and abdominal cavity. By contracting and relaxing, the diaphragm produces the needed
pressure differential for respiration. When the diaphragm contracts, it partially
descends into the abdominal cavity, decreasing the pressure within the chest.
This allows the air to enter the lungs. When the diaphragm begins to relax, it
slowly re-enters the thoracic cavity. This increases the pressure within, and air
slowly passes from the lungs. The intercostal muscles assist the diaphragm
in changing the volume of the thoracic cavity. As the diaphragm contracts, the
intercostal muscles elevate the rib cage (chest). Both of these activities result
in enlarging the thoracic cavity. Consequently, the air from the environment
passes into the lungs. The reverse activity causes air to pass from the lungs
into the environment.
Key Terms
adenoids collections of lymphatic tissue in the nasopharynx;
pharyngeal tonsils
alveolus (pl. alveoli) air sac in the lung
apex of the lung the uppermost portion of the lung
bronchioles smallest branches of the bronchi
bronchus (pl. bronchi) branch of the trachea that acts as a passageway
into the air spaces of the lung; bronchial tube
cilia (sg. cilium) thin hairs in the mucous epithelium lining the
respiratory tract
epiglottis a lid-like piece of cartilage covering the larynx
exhalation breathing out (expiration)
glottis the opening to the larynx
inhalation breathing in (inspiration)
larynx voice box
pharynx throat
pleura double-folded membrane surrounding each lung
pulmonary parenchyma cells of the lung performing its main function
trachea windpipe
90
Terminology
adenoid/o
adenoids
alveol/o
alveolus
bronch/o
bronchi/o
capno/o
coni/o
dust
lob/o
nas/o
rhin/o
nose
pector/o
steth/o
thorac/o
chest
phon/o
voice (sound)
phren/o
diaphragm;
mind
pneum/o
pneumon/o
air, lung
pulmon/o
spir/o
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Pleural effusion is a disorder in which fluids or air escape into the pleural
cavity. Two techniques used in the diagnosis of the pleural effusion include
listening to the sounds of the chest cavity with or without a stethoscope
(auscultation) or gently tapping the chest cavity with the fingers to determine
the position, size, or consistency of the underlying structures (percussion).
Pleural effusion may include the escape of pus (pyothorax, empyema), serum
(hydrothorax), blood (hemothorax), air (pneumothorax), or mixture of pus and
air (pyopneumothorax), into the pleural cavity of the chest.
Pneumoconiosis is a condition in which small particles of dust lodge in
the lung. Various forms of pneumoconioses are named according to the type
of dust particle inhaled:
silicosis - silica dust or glass (grinders disease)
anthracosis - coal dust (black-lung disease in coal miners)
asbestosis - asbestos particles (in shipbuilding and construction
industry)
byssinosis - cotton, flax, and hemp (brown-lung disease)
chalicosis - lime stone
siderosis - iron
volcanoconiosis -volcanic ash
Pneumonia is an inflammatory disease of the lungs and infection of the
alveoli. It may be caused by a variety of agents including bacteria, viruses,
chemicals, or other substances. Infection damages alveolar membranes so
that fluid, blood cells, and debris consolidate in the alveoli. Chest pain (thoracodynia), purulent sputum, and coughing up of blood (hemoptysis) are frequent
symptoms of pneumonia. Lobar pneumonia involves one or more lobes of a
lung associated with consolidation.
Bronchopneumonia begins in the terminal bronchioles. Bed rest and antibiotics are important in therapy.
Other Pathological and Related Terms
anosmia
apnea
asphyxia
atelectasis
auscultation
bronchogenic
carcinoma
compliance
coryza
crackle
croup
cystic fibrosis
diphtheria
epistaxis
hypoxemia
hypoxia
pertussis
pleurisy
pulmonary abscess
pulmonary edema
pulmonary embolism
sputum
stridor
a strained, high-pitched noisy breathing associated with obstruction of the larynx and bronchus
unexpected and unexplained death of an apparently normal, healthy infant usually less than 12
months of age; crib death
syndrome (SIDS)
tuberculosis
wheeze
94
EXERCISES
1.1. The main organs in the respiratory system are: .......................................................
1.2. The respiratory system provides the following functions:
..........................................................................................................................................................................
2.4. A large muscular partition, the ...................................... lies between the chest
cavity and abdominal cavity.
2.5. Pulmonary emphysema is a ................................................... in which alveoli lose
..........................................................................................................................................................................
b) coughing up of blood
e) difficulty in breathing
96
97
CHAPTER 8
CARDIOVASCULAR SYSTEM
The cardiovascular system is composed of the heart, blood vessels and
blood. The principal function of the system is to provide all body tissues and
cells with adequate amounts of oxygenated blood and to return blood laden
with cellular metabolic wastes to proper excretory organs. The pumping action
of the heart muscle is of utmost importance in performing these functions.
The Vascular System
Three types of vessels carry blood throughout the body. Each differs in
structure depending on its function. These vessels include the arteries, capillaries and veins.
Arteries
Arteries carry blood from the heart to body tissues and organs. The blood
is propelled by the pumping action of the heart. Consequently, arterial walls
are thick and muscular and capable of expanding to accommodate the surge
of blood that results when the heart contracts. The expansion of the arterial
walls at each heartbeat is referred to as a pulse. Because of the pressure
against the arterial walls associated with the pumping action of the heart, a
cut or severed artery is a serious condition.
Blood in all arteries contains a high concentration of oxygen (02), except
for the blood in the pulmonary artery. Blood that is rich in 02 is referred to as
oxygenated blood. Arteries branch to form smaller vessels called arterioles
(little arteries). Eventually, the arterioles branch to form the smallest vessels
of the circulatory system, the capillaries.
Capillaries
Capillaries are microscopic vessels that join the arterial system with the
venous system. Although seemingly the most insignificant of the three types
98
because of size, they are functionally the most important. The walls of the
capillaries are composed of a single layer of endothelial cells. The thinness of
these walls makes it possible for the substances to pass quite readily into and
out of the vessels. Consequently, the primary function of the vascular system
- providing cells with vital products - is accomplished by the capillaries.
It is important to note that the vast number of capillaries makes their
combined diameter so great that blood tends to flow through them very slowly.
This allows sufficient time for the exchange of materials to occur between
blood and body cells. The pathway for this exchange is as follows:
Vital Products Blood to Body Cells Waste Products Blood to Excretory Organs
Veins
All veins carry blood back to the heart from body organs and tissues.
Veins are formed from smaller vessels called venules (little veins). Capillaries connect arterioles to venules. This connection provides a gateway for
the return of blood back to the heart. The extensive network of capillaries
throughout the body absorbs the propelling pressure exerted by the heart.
Blood in veins now must rely on other methods of propulsion in order to
return to the heart. These methods include muscular contraction (especially
in the legs), gravity (in the upper areas of the body), respiratory activity (in
the thoracic area), and valves. Valves are small structures within the vessels
that prevent the backflow of blood. Valves are especially important in the legs
where blood, in order to reach the heart, must travel long distances against
the force of gravity. The blood carried in veins contains high concentrations of
CO2 (except for the blood in the pulmonary vein). The CO2 is a waste product of
cell metabolism and is carried back to the heart. From the heart it is transported to the lungs where it is expelled.
The Heart
The heart is a hollow, muscular organ that pumps blood through the blood
vessels. It is enclosed in a fibroserous sac called the pericardium. The heart
has three distinctive layers of tissue:
1. the endocardium, a serous, innermost membrane which lines the four chambers of the heart and valves and is continuous with the arteries and veins;
2. the myocardium, the muscular, middle layer of the heart;
3. the epicardium, the outermost (external) layer of the heart.
The heart is divided into four chambers. These chambers are the right
atrium, right ventricle, left atrium and left ventricle. The two upper chambers,
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the atria, collect blood. The two lower chambers, the ventricles, pump blood
from the heart. The right side of the heart provides for oxygenation of blood
(pulmonary circulation), and the left side is responsible for transportation of
blood to and from body cells (systemic circulation). The muscular wall dividing
the right side of the heart from the left is called the septum. Body cells produce
waste substances during metabolism. These waste products include carbon
dioxide (CO2), a gas that must be removed from the cells or tissue death will
occur. Red blood cells accept the CO2 from body cells and transport it to the
heart by way of two large veins: the superior vena cava, a vein which collects
and carries blood from the top portion of the body, and the inferior vena cava,
a vein that collects and carries blood from the lower portion of the body. The
presence of CO2 gives the blood in veins a purple-red colour.
Blood is collected in the top right chamber of the heart, the right atrium.
From the right atrium blood passes through the tricuspid valve to the right
ventricle. The tricuspid valve prevents blood from returning to the right atrium
during contraction of the ventricles. When the heart contracts, blood leaves
the right ventricle by way of the pulmonary artery. This artery branches into
millions of capillaries within the lungs. At this point, CO2 in the red blood cells
is replaced by O2 that has been drawn into the lungs during inspiration. The
oxygenated blood takes on a bright red appearance.
The pulmonary capillaries unite to form the pulmonary veins which carry
blood back to the heart. The right and left pulmonary veins enter the left
atrium of the heart carrying oxygenated blood. This blood passes from the
left atrium through the bicuspid valve (also called the mitral valve) to the left
ventricle. Upon contraction of the heart, the oxygenated blood leaves the left
ventricle through the largest artery of the body, the aorta. Within the aorta
is a valve called the semilunar valve or aortic valve. This valve permits blood
to flow in only one direction - from the left ventricle to the aorta. The aorta
branches into many smaller arteries that carry blood to all parts of the body.
Some arteries derive their name from the organs or areas of the body they
vascularize. For example, the coronary arteries vascularize the heart muscle,
the renal arteries vascularize the kidneys, and so on.
It is important to note that the O2 present in the blood passing through the
chambers of the heart cannot be used by the myocardium. Consequently, an
arterial system called the coronary arteries, which branch from the aorta,
provides the heart with its own blood supply. If, for any reason, the flow of
blood in the coronary arteries is diminished, myocardial damage may result.
If severe damage occurs, death results.
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3. bundle of His
4. Purkinje fibers
The S-A node, located in the upper portion of the right atrium, possesses
its own intrinsic rhythm. Without any stimulation by external nerves, it has
the ability to initiate and propagate each heartbeat, thereby setting the basic
pace for the cardiac rate. For this reason, it is commonly known as the pacemaker. This rate may be altered, however, by impulses from the autonomic
nervous system. Such an arrangement allows outside influences to accelerate or decelerate the rate of the heartbeat. For example, during a period
of physical exertion, the heart beats faster, and during a restful interval the
rate becomes slower.
Each electrical impulse discharged by the S-A node is transmitted to the
A-V node causing the atria to contract. The A-V node is located at the base of
the right atrium. From this point a tract of conducting fibres called the bundle
of His, composed of a right and left branch, relays the impulse to both the
right and left ventricles, causing them to contract. The blood is now forced
out of the heart through the pulmonary artery and the aorta. In summary, the
sequence of involvement of the four structures in the heart that are responsible for the conduction of a contraction impulse is as follows:
S-A node - A-V node - Bundle of His - Purkinje fibres
Impulse transmission through the conduction system generates weak electrical currents which can be detected on the surface of the body. These electrical impulses can be recorded on an instrument called electrocardiograph
Figure 8.2. The Conductive System of the Heart
102
(ECG). The record used to detect these electrical changes in heart muscle as
the heart beats is called an electrocardiogram (ECG) or EKG. The deflection of
the needle of the electrocardiograph produces waves or peaks designated by
the letters P, Q, R, S and T, each of which is associated with a specific electrical event (impulse). The P wave is the depolarization of the atria, and the
QRS complex is the depolarization of the ventricles. The T wave, which appears
a short time later, is the repolarization of the ventricles.
Key Terms
Terminology
angi/o
aort/o
aorta
arter/o
arteri/o
artery
arteriosclerosis = hardening of an
artery
atrio/o
atrium
brachi/o
arm
cardi/o
heart
coron/o
hemangi/o
blood vessel
phleb/o
ven/o
vein
scler/o
hardening
arteriosclerosis = hardening of an
artery
sphygm/o
pulse
sten/o
narrowing
steth/o
chest
thromb/o
clot
valvul/o
valv/o
valve
vas/o
vascul/o
vessel
ven/o
vein
ventricul/o
104
105
106
a) inflammation of a vein
d) profuse sweating
e) pacemaker
107
108
8.5. failure of proper conduction of impulses through the A-V node to the
bundle of His ............................................................................................................................................
8. 6. drugs promoting loss of fluid ..............................................................................................
8. 7. surgical removal of an aneurysm .....................................................................................
8. 8. tissue death ...................................................................................................................................
8. 9. the external layer of the heart ............................................................................................
8.10. the valve which prevents blood from returning to the right atrium
during contraction of the ventricles .........................................................................................
..........................................................................................................................................................................
109
than that of his predecessor, Seattle Dentist Barney Clark, the worlds first
recipient of a permanent artificial heart. Clark s surgery and his 112 days of
life with the man-made pump were fraught with life-and-death crises. I felt
certain that he would die on the operating table, reflected Dr. Robert Jarvik,
38, designer of the Jarvik-7 heart used in both patients. This time, he said,
I felt the opposite.
(TIME, No. 50, December 10, 1984)
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CHAPTER 9
URINARY SYSTEM
In both males and females the urinary system consists of four major structures a pair of kidneys, two ureters, a bladder, and a urethra. The urinary
system acts as the regulator of extracellular products of the body. Protein
foods that we eat contain carbon, hydrogen, and oxygen plus nitrogen and other
elements. The waste that is produced when proteins combine with oxygen is
called nitrogenous waste, and it is more difficult to excrete it (to separate out)
from the body than are gases like carbon dioxide and water vapour.
The body cannot efficiently put the nitrogenous waste into a gaseous form
and exhale it, so it excretes it in a form of a soluble (dissolved in water) waste
substance called urea. Urea is an undesirable substance produced when body
cells metabolize protein. Urea and other waste materials are collected from
body tissues by the blood and are conveyed to the kidneys. The kidneys, in
turn, filter these products from the blood as they form a complex solution
called urine. Urine is eventually expelled from the body. Failure to eliminate
urea may actually result in death.
The major function of the urinary system is to remove urea from the bloodstream so that it does not accumulate in the body and become toxic. Urea is
formed in the liver from ammonia, which in turn is derived from the breakdown of simple proteins (amino acids) in the body cells. The urea is carried in
the bloodstream to the kidneys, where it passes with water, salts, and acids
out of the bloodstream and into the kidney tubules as urine.
Besides removing urea from the blood, another important function of the
kidneys is to maintain proper balance of water, salts, and acids in the body
fluids. Salts (sodium and potassium) and some acids are known as electrolytes
(molecules which can conduct an electrical charge). Electrolytes are necessary
for the proper functioning of muscles and nerve cells. The kidneys adjust the
amounts of water and electrolytes by secreting some substances into urine
and holding back others in the bloodstream for use in the body.
111
In addition to forming urine and eliminating it from the body, the kidneys
also act as endocrine organs, secreting into the bloodstream substances that
act at some distant site in the body. Examples of the kidneys endocrine function include the secretion of the renin, a substance important in the control of
the blood pressure, and erythropoietin, a material that regulates the production
of red blood cells. The kidneys also secrete an active form of vitamin D, necessary for the absorption of calcium from the intestine. In addition, hormones
such as insulin and parathyroid hormone are degraded and extracted from
the bloodstream by the kidney.
Figure 9.1. Anatomy of the major organs of the urinary system
112
113
Nephrons also extract any excess sodium, chloride, and potassium ions
which are referred to as electrolytes. Some pathological states may cause the
appearance in the blood of certain undesirable substances which may also be
removed by the nephrons. For example, when the blood sugar level becomes
elevated, as in diabetes mellitus, the excess sugar is filtered from the blood
and is removed from the body in the urine.
Figure 9.2. Glomerulus and Bowmans Capsule
Each nephron includes a renal corpuscle and a renal tubule. The renal
corpuscle is composed of a tuft of capillaries, the glomerulus, and a modified,
funnel-shaped end of the renal tubule, Bowmans capsule. This capsule encases
the glomerulus. An afferent vessel (arteriola glomerularis afferens) conveys
blood to the glomerulus and a smaller efferent vessel (arteriola glomerularis efferens) carries blood away from the glomerulus. As the efferent vessel
passes behind the renal corpuscle, it forms the peritubular capillaries. Each
renal tubule consists of four sections: the proximal tubule, followed by the
narrow loop of Henle; then, a larger portion, the distal tubule, and finally the
collecting tubule.
Removal of waste products from the blood by the nephron is accomplished
by three physiological activities: filtration, absorption, and secretion. All of these
activities are performed by different sections of the nephron.
The first phase of urine production, filtration, occurs in the renal corpuscle.
Here, water, electrolytes, sugar, amino acids, and other compounds pass from
the blood plasma in the glomerulus into Bowmans capsule. The fluid that is
formed is called filtrate. The next phase of urine production starts with passing
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of filtrate through the four sections of the tubule. As it travels the long and
twisted pathways, most of the water and some of the electrolytes and amino
acids are absorbed by the peritubular capillaries, and thus re-enter the circulating blood. The final stage of urine production occurs when specialized cells
of the collecting tubules secrete ammonia, uric acid, and other substances
directly into the lumen of the tubule. Now the formation of urine is completed,
and it passes from the collecting tubules to the renal pelvis, or basin of the
kidney.
Key Terms
ammonia a pungent colourless gaseous alkaline compound of nitrogen
and hydrogen easily soluble in water (NH3)
calix (calyx), pl. calices a cup-shaped collecting region of the renal
pelvis
catheter a tube for injecting or removing fluids
cortex, pl. cortices outer region of an organ (like a bark of a tree)
creatinine nitrogenous metabolic waste excreted in urine
erythropoietin a hormone secreted by the kidney that stimulates red
blood cell production
filtration a process by which some substances pass through a filter
glomerulus, pl. glomeruli tiny ball of microscopic blood vessels in
kidney cortex
hilum, or hilus a concave borderline or depression in an organ where
blood vessels and nerves enter and exit the organ
meatus opening or canal
medulla the inner region of a structure or organ
micturition urination, passing urine
nitrogenous wastes substances containing nitrogen (wastes produced
in muscle metabolism
renal pelvis central collecting region in the kidney
renal tubules microscopic tubes in the kidney where urine is formed as
water, sugar, and salts are secreted back into the bloodstream
rennin a hormone synthesized, stored and secreted by the kidney
trigone triangular area in the bladder where the ureters enter and the
urethra exits
urea major nitrogenous waste product excreted in urine
ureter one of two tubes leading from the kidney to the bladder
urethra a tube leading from the bladder to the outside of the body
uric acid nitrogenous waste excreted in the urine
voiding expelling urine (micturition)
115
Terminology
cali/o
calic/o
calyx
cyst/o
vesic/o
urinary
bladder
lith/o
stone,
calculus
nephr/o
ren/o
kidney
pyel/o
renal
pelvis
ur/o
urine,
urinary
azotemia (uremia)
bacteriuria
bladder neck
obstruction (BNO)
dysuria
glomerulonephritis
hematuria
hesitancy
116
hydronephrosis
interstitial nephritis
nephrolithiasis
(renal calculi)
nephritic syndrome
(nephrosis)
nocturia
oliguria
polycystic kidney
pyelonephritis
renal failure
renal hypertension
urgency
urinary retention
EXERCISES
1.1. List some functions of the urinary system: ..........................................................................
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a) a slitlike aperture
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CHAPTER 10
NERVOUS SYSTEM
The nervous system is one of the most complicated systems in both structure and function. Along with the endocrine system it controls many bodily
activities that maintain a stable and suitable environment for all of the body
cells - a situation known as homeostasis. The nervous system senses changes
in both the internal and external environment, interprets these changes, and
then coordinates responses that maintain homeostasis.
The central nervous system (CNS) is composed of the brain and spinal cord.
These structures receive, coordinate and transmit nervous impulses. The
peripheral nervous system (PNS) is composed of all other nervous tissue found
outside of the CNS. It includes 12 pairs of cranial nerves, which emerge from
the base of the skull, and 31 pairs of spinal nerves, which emerge from the
spinal cord. These nerves may be sensory or motor, or a mixture of both
sensory and motor fibres.
Figure 10.1. The divisions of the nervous system
Sensory nerves receive impulses from the sense organs, such as the eyes,
ears, nose, tongue, and skin and transmit them to the CNS. These sensory
nerves are also known as afferent nerves, because they conduct impulses
toward a specific site, the central nervous system.
121
Figure 10.2 Transmission of an impulse to the CNS and from the CNS
Motor nerves conduct impulses away from the CNS, thus they are known
as efferent nerves. These impulses travel to muscles and other body organs
causing them to respond in some manner. If the response is under the control
of the individual, such as walking or talking, the impulse is relayed by voluntary or somatic nerves. If the response is involuntary or nonthinking, such as
digesting food or secreting hormones, the impulse is relayed by autonomic
nerves.
122
Nerves composed of both sensory and motor fibres are called mixed nerves.
For example, when the facial nerve supplies the facial muscles with motor
impulses, such as for smiling or frowning, it is functioning as a motor nerve.
But when the tongue transmits a taste impulse to the brain, the facial nerve
is functioning as a sensory nerve.
The autonomic nervous system is responsible for the control of the internal
environment: heart rate, peristaltic movement of the stomach and intestines, constriction of the iris, and other involuntary activities. This system is
composed of a sympathetic and parasympathetic division. The two divisions are
largely antagonistic to each other, although in certain instances they exhibit
independent activity. Generally, sympathetic nerves initiate or accelerate an
autonomic function, and parasympathetic nerves decelerate or stop the initiated activity. For example, in situations of fear or fright, sympathetic nerve
fibres produce vasoconstriction and an increased heart rate and depress
gastrointestinal activity. When the danger is passed, the parasympathetic
system conveys impulses to bring about vasodilation, a slower heart rate, and
a return to normal gastrointestinal activity.
Nervous Tissue
In spite of its complexity, the nervous system is composed of only two principal types of nerve cells, neurons and neuroglia. Neurons, the functional cells
of the nervous system, are responsible for impulse conduction. All neural
circuits are composed of neuron chains. In contrast to neurons, neuroglia
does not transmit impulses. It is specialized nervous tissue that functions as
connective tissue that supports and binds neurons. During infection, neuroglia is capable of performing certain phagocytic activities.
Neurons
Neurons consist of three major sections: the dendrites, which receive
impulses and transmit them to the cell body; the cell body, which contains
the cell nucleus; and the axon, a long single projection, which transmits the
impulse from the cell body. Many axons in both the PNS and CNS are covered
with a white, lipoid sheath called myelin. This wrapping accelerates the
impulses that travel down the axon. The presence of myelin on axons in the
brain and spinal cord gives a white appearance to these structures and makes
up what is called the white matter of the CNS. Unmyelinated fibres, dendrites,
and nerve cell bodies make up the gray matter. On peripheral nerves, a thin
cellular membrane called neurolemma, or neurolemmal (Schwann) sheath,
wraps around the myelin sheath. The neurolemmal sheath may allow a
damaged axon to regenerate. Since no neurolemma can be found in the CNS,
123
injured nerves in the system cannot regenerate. Their nerve function is permanently lost.
Neurons are not continuous with one another. Instead, a small space known
as a synapse is found between the axon of one neuron and the dendrite or
cell body of another. In order for the impulse to travel along a nerve path, the
impulse must be transmitted at the synapse. This transmission is facilitated
by certain chemical substances called neurotransmitters.
Figure 10.3. A neuron, neuroglial cells
Neuroglia
The term neuroglia literally means nerve glue. It was once believed that
neuroglia served only a supporting role for neurons. But it is now known that
different shaped neuroglia cells, perform many other functions.
Astrocytes, as their name suggests, are star-shaped neuroglia and are
believed to be involved in the transfer of substances from the blood to the brain.
124
Oligodendroglia are cells with only a few processes. They are believed to help
in the development of myelin on neurons of the CNS. Microglia, the smallest
of the ncuroglia, possess phagocytic properties and may become very active
during times of infection.
The Brain
In addition to being one of the largest organs of the body, the brain is
also the most complex in structure and function. It integrates almost every
physical and mental activity of the body. This organ is also the centre for
memory, emotion, thought, judgment, reasoning and consciousness. The brain
is composed of four major sections: the cerebrum, cerebellum, diencephalon
(interbrain), and brain stem.
Figure 10.4. Sections of the brain
The cerebrum is the largest and uppermost portion of the brain. It consists of
two hemispheres divided by a deep longitudinal fissure or groove. The fissure
does not completely separate the hemispheres. A structure called the corpus
callosum joins them medially on their inferior surfaces. Each hemisphere is
further divided into five lobes. Four of these lobes are named after the bones
125
that lie directly above them. A fifth lobe of the cerebrum is hidden from view
and can only be seen upon dissection.
Numerous folds, or convolutions, called gyri (singular: gyrus) are found
in the cerebral surface. These are separated by furrows called fissures or
sulci (singular: sulcus). A thin layer of gray matter called the cerebral cortex,
composed of millions of cell bodies covers the entire cerebrum and is responsible for its gray colour.
The remainder of the cerebrum is composed of white matter (myelinated
axons). Major functions of the cerebrum include sensory perception and interpretation, muscular movement, and the emotional aspects of behaviour and
memory.
The second largest part of the brain, the cerebellum, occupies the back
portion of the brain. lt is attached to the brain stem. When the cerebrum initiates muscular movement, the cerebellum coordinates and refines the movement. The cerebellum also maintains the equilibrium, or balance of the body.
The diencephalon, or interbrain, is composed of many smaller structures,
two of which are the thalamus and the hypothalamus. All sensory stimuli, except
olfactory, are received by the thalamus. Here they are processed and transmitted to the proper area of the cerebral cortex. In addition, impulses from
the cerebrum are received by the thalamus and relayed to efferent nerves.
Beneath the thalamus is a small structure, the hypothalamus. Its chief function is the integration of autonomic nerve impulses and the regulation of
certain endocrine functions.
The brain stem completes the last major section of the brain. It is composed
of three structures: the medulla oblongata, the pons, and the midbrain (mesencephalon). In general, the brain stem serves as a pathway for impulse conduction between the brain and the spinal cord. The brain stem also serves as the
origin for 10 of the 12 pairs of cranial nerves.
Spinal Cord
The spinal cord conveys to the brain sensory impulses from different parts
of the body and also transmits motor impulses from the brain to all muscles
and organs. The sensory nerve tracts are also called ascending tracts, since
the direction of the impulse is upward. Conversely, motor nerve tracts that
relay motor impulses to muscles and organs are called descending tracts,
since they carry impulses in a downward direction. A cross-section of the
spinal cord reveals an inner gray area composed of cell bodies and dendrites,
with an outer area composed of the myelinated tissue of the ascending and
descending tracts.
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The entire spinal cord is located within the spinal cavity of the vertebral
column. Thirty-one pairs of spinal nerves exit from between the intervertebral spaces almost throughout the entire length of the spinal column. Unlike
the cranial nerves, which have specific names, the spinal nerves are known
by the region of the vertebral column from which they exit.
Meninges
Both the brain and the spinal cord are protected against injury by bones.
The brain is enclosed within the skull and the spinal cord is enclosed within
the vertebral column. In addition, both the brain and spinal cord receive limited
protection from a set of three coverings called meninges (singular: meninx).
The outermost coat, the dura mater, is tough and fibrous. Immediately beneath
the dura mater is a cavity called the subdural space. It is filled with serous
fluid. The next layer of the meninges is the arachnoid. As its name suggests,
the arachnoid has a spider-web appearance. A subarachoid space, filled with
cerebrospinal fluid, provides additional protection for the brain and spinal cord
by acting as a shock absorber. Finally, the innermost layer, the pia mater,
contains numerous blood vessels and lymphatics, which provide nourishment
for the underlying tissues.
Cerebrospinal fluid circulates around the spin al cord and the brain and
through spaces called ventricles. These ventricles are located within the inner
portion of the brain.
Key Terms
acetylcholine neurotransmitter chemical released at the ends of some
nerve cells
afferent nerves nerves that carry impulses toward the brain and spinal
cord; sensory nerves
blood-brain barrier blood vessels that selectively let certain
substances enter the brain tissue and keep other substances out
cauda equina horses tail; a collection of spinal nerves below the end of
the spinal cord at the level of the second lumbar vertebra
cell body part of the nerve cell that contains the nucleus
cerebral cortex outer region of the cerebrum; the gray matter of the
brain
cerebrospinal fluid (CSF) liquid that circulates throughout the brain
and the spinal cord
convolution elevated portion of the cerebral cortex; gyrus
efferent nerves nerves that carry impulses away from the brain and
spinal cord to the muscles, glands, and organs; motor nerves
127
Terminology
alges/o
pain
cerebr/o
cerebrum
crani/o
skull
(cranium)
dendr/o
tree
esthesi/o
nervous
sensation
feeling
encephal/o
brain
gli/o
glu;
neuroglia
kinesi/o
movement
lept/o
lex/o
word,
phrase
mening/o
128
myel/o
spinal cord
narc/o
stupor;
numbness;
sleep
neur/o
nerve
radicul/o
nerve root
sthen/o
strength
tax/o
order,
ataxia = persistent unsteadiness on the
coordination feet
vag/o
Alzheimer disease
amyotrophic lateral
sclerosis (ALS)
ataxia
aura
autism
129
Bell palsy
cerebral palsy
cerebrovascular
accident (CVA)
cerebral contusion
coma
concussion of the
brain
130
convulsion
dementia
dyslexia
epilepsy
glioma
Guillain-Barr
syndrome
hemorrhage
(bleeding)
herpes zoster
(shingles)
Huntington chorea
hydrocephalus
lethargy
meningioma
meningitis
multiple sclerosis
(MS)
131
myasthenia gravis
neuroblastoma
neurosis
paralysis
paraplegia
paresis
Parkinson disease
poliomyelitis
Reye syndrome
sciatica
seizure
spina bifida
syncope
132
Tourette syndrome
transient ischemic
attack
EXERCISES
1.1. The functions of the nervous system are:......................................................................
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a) neurotoxin
b) trembling
d) weakness
133
134
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Final diagnosis: Left cerebral infarction due to left internal carotid artery
occlusion.
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CHAPTER 11
138
Blood plasma consists mainly of water in which are dissolved the substances
carried by the blood to and from the tissues.
Erythrocytes (Red Blood Cells)
The great majority of the cells in the blood are red blood cells. There are
about 5 million red blood cells in a s peck of blood the size of a pin-head, and
about 35 trillion of them in the average adult. Although microscopic in size,
these cells have a total surface area almost the size of a football field. This
vast surface area is important in the bloods task of carrying oxygen from the
lungs to the tissues, because the exchange of oxygen in both places takes
place across the cell surface and must be accomplished quickly as the blood
flows by.
Figure 11.1. The maturation of blood cells-hematopoiesis
Stem cell
Bone marrow
Erythroblast
Myeloblast
Myelocyte
Normoblast
Metamyelocytes
Mature cells
Reticulocyte
Circulating
bloodstream
Monoblast
Megakaryoblast
Lymphoblast
Erythrocyte
Megakaryocyte
Prolymphocyte
Promonocyte
Band cells
Segmented
Basophilic
Eosinophilic
granulocyte
granulocyte
Neutrophilic
granulocyte
Monocyte
Lymphocyte
Platelets
Agranulocytes
139
Red blood cells are stored in the spleen, which acts as a reservoir for the
blood system and discharges the cells into the blood as required. The spleen
also discharges extra red blood cells into the blood during emergencies such
as hemorrhage or shock. Red blood cells mature from undifferentiated reticuloendothelial cells and they live on the average about 110 to 120 days. Then
red blood cells disintegrate and are removed in the spleen and the liver. About
180 million red blood cells are destroyed every minute. Since the number of
cells in the blood remains more or less constant, this means that about 180
million red blood cells are manufactured every minute. The hemoglobin of
destroyed cells is decomposed and carried to the liver. There the iron is stored
and the rest of the chemicals are passed on to be excreted from the body in
the bile, the feces and the urine.
Leukocytes (White Blood Cells)
The leukocytes are the bodys primary defence against infections. They
have no hemoglobin and thus are colourless and, unlike red blood cells, they
can move about under their own power. White blood cells are larger than red
blood cells and fewer in number. Normally the blood has about 8000 white
blood cells per cubic millimeter. Leukocytes also play a role in tissue repair
but this activity is not yet fully understood.
Leukocytes are classified into granulocytes (those with granules in the cytoplasm) and agranulocytes (those without granules). Granulocytes are further
subdivided into neutrophils, eosinophils and basophils. These names are derived
from the dye which stains their cytoplasmic granules. Agranulocytes include
both monocytes and lymphocytes.
Of the several types of leukocytes, the neutrophils are the most numerous,
forming about 70 percent of the total number; lymphocytes make up about 20
percent of the total. The neutrophils, the lymphocytes and most other white
blood cells are phagocytic that is, they have the ability to engulf and destroy
bacteria. Leukocytes multiply rapidly when the body is invaded by infective
microorganisms. The cells migrate rapidly to the site of the infection, surround
the infective agent and overwhelm it. Under a microscope, as many as 15 or
20 bacteria can be seen within a single white blood cell.
The exact function of basophils is unknown, but their numbers are increased
in leukemia.
Eosinophils are increased in allergic conditions and parasitic infections
and phagocytize antigen-antibody combinations.
Monocytes also fight against disease by phagocytosis. They dispose of dead
and dying cells and other debris by engulfing and swallowing the cells.
140
Platelets (thrombocytes)
Platelets are small, clear, disk-shaped bodies about one-third the size of
red blood cells or even smaller, which initiate blood clotting and are concerned
in contraction of a clot. When they encounter a leak in a blood vessel, they
disintegrate and adhere to the edges of the injured tissue. There are about
25.000 platelets per cubic millimeter of blood.
Plasma
Plasma is the liquid part of the blood which consists of about 90 percent
of water, 7 percent proteins and less than l percent inorganic salts, organic
substances other than proteins, dissolved gases, hormones, antibodies and
enzymes. Plasma from which the fibrinogen and prothrombin have been
removed is called serum.
Dissolved in the plasma are many important proteins such as serum
albumin, gamma globulin and fibrinogen. Serum albumin is important in
the nutrition of the body. It probably originates in the liver, as does fibrinogen. Fibrinogen is essential in the clotting process. Gamma globulin, which
is formed in the lymphoid tissues and reticuloendothelial system, contains
almost all of the antibodies important in establishing immunity.
Blood Groups (Blood Types)
Blood group means the phenotype of erythrocytes defined by one or more
antigenic determinants. Under the usual system of blood typing there are four
main blood types or blood groups: A, B, O and AB. Each of the blood groups has
a specific combination of factors (antigens and antibodies) which are inherited. These antigen (also called agglutinogen) and antibody (also called agglutinin) factors of the various blood types are:
The ABO blood typing system was first introduced in 1900 by Karl Landsteiner and is still generally used today as the basis for transfusing whole
blood. It is now known, however, that many different antigens exist in the red
blood cells, and that as many as 11 or more different antigenic systems of
grouping blood can be recognized. Correct typing and cross-matching of blood
are extremely important clinically in the prevention of transfusion reaction. The
adverse reaction is called agglutination, or clumping, of the recipients blood.
141
Damage to the erythrocytes also occurs, so that hemoglobin leaks out of the
cell (hemolysis). The agglutination is fatal to the recipient because it stops the
flow of blood. Similar problems can occur in other transfusions if the donors
antigens are incompatible with the recipients antibodies.
People with type O blood are known as universal donors because their
blood contains neither A nor B antigens. Those with type AB blood are known
as universal recipients because their blood contains neither anti-A nor anti-B
antibodies. Another important factor, called the Rh factor (named so because
it was first found in the blood of a rhesus monkey) must also be considered
in blood typing. This is a very complex system: eight principal variants of the
Rh factor are known, and there are others not yet identified and grouped. For
practical purposes there are two main groups of Rh types. Persons with the
Rh factor present in the blood are referred to as Rh positive those without are
Rh negative. This particular factor may be involved in hemolytic diseases of the
newborn because of an incompatibility existing between the maternal blood
and the fetal blood.
Figure 11.2. Composition of blood
Blood clotting
Blood clotting or coagulation, is a complicated process involving many
different substances and chemical reactions. The end result of the process
is the formation of a fibrin clot from the plasma protein fibrinogen. Platelets
are important in initiating the process, which, stated more simply, involves
the following steps:
1. When a blood vessel is damaged or breaks, a prothrombin activator is
released into the blood in response to special factors from platelets and
tissues. One of these factors is the protein that is missing in patients
suffering from hemophilia.
2. The prothrombin activator, along with calcium and other plasma factors,
helps to convert prothrombin (a plasma protein) into an enzyme called
thrombin.
142
2. Lymphatic System
Lymphatic system is composed of lymph fluid, lymph capillaries, lymphatic
vessels, lymphatic ducts and lymph nodes. The main function of this system is
to transport fluid from the tissues back to the bloodstream. It also aids in the
control of infection caused by microorganism and in conveyance of lipids or
fats away from the digestive organs. Lymph originates from blood plasma. It is
clear and colourless and contains less protein than blood plasma. Other noncellular constituents of lymph are water, salts, sugar and metabolic wastes,
such as urea and creatinine. The cells of the lymph include lymphocytes,
monocytes and a few platelets and erythrocytes.
143
The fluid filling the spaces between the tissue cells is called the interstitial fluid. It cleanses the body tissues through which it circulates and collects
cellular debris, bacteria, and particulate matter. Eventually the interestitial
fluid enters into open-ended vessels called lymph capillaries. This fluid is now
called lymph. Lymph passes from the capillaries to larger vessels and finally
to lymph nodes which serve as depositaries for cellular debris.
Lymph vessels from the right chest and arm join the right lymphatic duct.
This duct drains into the right subclavian vein a major vessel in the cardiovascular system. Lymph from all other parts of the body joins the thoracic duet,
which drains lymph into another large blood vessel, the left subclavian vein.
In this way lymph is redeposited into the circulating blood in order to begin
the cycle again.
Three organs are associated with the lymphatic system: the spleen, thymus
gland, and tonsils.
Spleen
The spleen acts as a filter for blood. Phagocytic cells within the lining of the
spleen remove cellular debris, bacteria, parasites, and other infectious agents
thereby cleansing the lymph. Although the spleen is not essential to life it is
important for its hemolytic activity, filtration of microorganisms, production
of antibodies and immunity, chiefly by leukocytes, for production of lymphocytes and monocytes and as a storage of blood, especially red blood cells.
Also, the spleen seems to have a stimulatory effect on the production of blood
from the bone marrow.
Thymus Gland and Immunity
The thymus gland is located in the mediastinum, posterior to the breastbone and between the lungs. It plays an important role in the bodys immunologic system, especially in fetal life and the early years of growth. It is known
that thymectomy performed in animals during the first few weeks of life im
pairs the ability of the animal to make antibodies to fight against foreign antigens.
The immunological activity of an organism involves the production of two
types of lymphocytes, B-cells and T-cells, and is basically divided into two
categories: humoral immunity and cell-mediated immunity.
Humoral immunity is provided by B-lymphocytes. B-cells are produced in
bone marrow. Humoral immunity involves the production of a substance called
an antibody which seeks out and renders harmless the invading substance
called an antigen. As a general rule, the antigen-antibody reaction is a specific
144
reaction; that is, the antibody reacts only with the antigen that induced its
formation. For example, if the body has developed antipolio antibodies in
response to the presence of polio antigens (a situation that occurs after the
administration of polio vaccination), these polio antibodies provide no protection against any other antigen except polio. In order to produce antibodies, the
B-cells are activated in the p resen ce of an antigen to become plasma cells.
Plasma cells synthesize and export antibodies. Some activated B-cells do not
develop into plasma cells but remain as memory cells. These cells stay in
the lymphoid tissue. In the event of a future encounter by the same antigen,
the memory cells immediately produce the plasma cells that are capable of
manufacturing a specific antibody. The antibodies that are made by plasma
cells are called immunoglobulins.
Cell-mediated immunity is dependent on T-cell lymphocytes and is seen
in the fight against chronic bacterial infectious (such as tuberculosis), viral
and fungal diseases, malignant cell growth, and cells of transplanted organs.
T-cells mature in the thymus gland and are active in destruction of foreign
materials, such as bacteria, viruses, and foreign tissues such as skin grafts.
When they encounter an antigen, T cells become sensitized and change
into killer cells. They produce a lymphotoxin or cytotoxin (lymphokines)
that damages or ruptures the cell membranes of the antigen and that helps
the macrophages (large phagocytes found in lymph nodes and other body
tissues) do their job. T-cells also aid in the production of interferon, a protein
released from cells that have been invaded by a virus or other antigen. Interferon induces non-infected cells to form an antiviral protein that inhibits viral
multiplication within the cell.
Tonsils
There are three different kinds of tonsils: palatine tonsils are oval-shaped
structures partially embedded in the mu co us membrane, one on each side
of the back of the throat; below them, at the base of the tongue, are the
lingual tonsils; and on the upper rear wall of the mouth cavity are the pharyngeal tonsils, or adenoids, which are of fair size in childhood but which usually
shrink after puberty.
These tissues are part of the lymphatic system and help to filter the circulating lymph of bacteria and any other foreign material that may enter the
body, especially through the mouth and nose. In the process of fighting infection the palatine tonsils and the adenoids sometimes become enlarged and
inflamed (tonsillitis).
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Key Terms
acquired immunity formation of antibodies and lymphocytes after
exposure to an antigen
agglutination clumping of recipients blood cells when incompatible
bloods are mixed
albumin protein found in blood; also called serum albumin
antibody a protein substance developed by lymphocytes in the presence
of antigen
antigen foreign material causing the production of an antibody
cell-mediated immunity an immune response involving T cell
lymphocytes
coagulation the process of blood clotting
corpuscle little body (refers to a blood cell)
cytotoxic cells T cells that directly kill foreign cells (killer cells); also
called T8 cells
fibrin protein threads that form the basis of a blood clot
fibrinogen plasma protein that is converted to fibrin in the clotting
process
globin the protein part of haemoglobin
globulin plasma protein (alpha, beta, gamma)
helper cells T cells that aid B cells in recognizing antigens and
stimulating antibody production; also called T4 cells
heme iron-containing non-protein portion of the haemoglobin molecule
haemoglobin blood protein enabling the red blood cell to carry oxygen
heparin an anticoagulant produced by liver cells and found in blood and
tissues
humoral immunity immune response in which B cells transform into
plasma cells and secrete antibodies
immune reaction reaction between an antigen and an antibody
immune response or immunity the bodys capacity to resist all types of
organisms and toxins that can damage tissue and organ
immunoglobulin a protein (globulin) with antibody activity
interferons antiviral proteins secreted by T cells
interleukins proteins that stimulate the growth of T cell lymphocytes
macrophages large phagocytes that destroy old red blood cells
megakaryocyte platelet precursor (forerunner) formed in the bone
marrow
myeloid derived from bone marrow cells
natural immunity ones own genetic ability to fight off disease
plasma liquid portion of blood
146
Terminology
chrom/o
colour
coagul/o
clotting
hem/o
hemat/o
sanguin/o
blood
immun/o
protection
lymphaden/o
lymphangi/o
phag/o
poikil/o
varied,
irregular
sider/o
iron
spher/o
splen/o
spleen
thym/o
tox/o
poison
147
148
graft rejection
graft-versus-host
disease (GVHD)
granulocytosis
haemophilia
Hodgkin disease
leukemia
Leukemias are malignant disease of the bloodforming organs (spleen, lymphatic system, and
bone marrow). Numerous malignant leukocytes
spread and proliferate throughout the bone
marrow. The cells are immature (blastic) and
unable to function in a normal manner. Since
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lymphocytosis
lymphosarcoma
(lymphoma)
mononucleosis
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multiple myeloma
polycythemia
(primary or vera)
purpura
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sarcoidosis
septicemia
EXERCISES
1.1. The main functions of the blood are: ...............................................................................
1.2. The function and the accessory organs of the lymphatic system are as
follows: ........................................................................................................................................................
2. Fill in the correct term:
2.1. Blood is composed of ............................. called .......................................................... and
....................................................
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b) iron-containing non-protein
portion of the hemoglobin
molecule
d) platelet
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tivity. Although anyone can develop an allergy after repeated exposure to some
offending allergen, it is believed that some individuals inherit the tendency
or predisposition.
In addition to microorganisms, dust, dog dander, pollens, grasses, mol
d spores, and practically any substances in the environment - collectively
termed allergens - may function as antigens and stimulate the production
of antibodies within the host. Allergens can enter the body by being inhaled,
swallowed, touched or injected. The allergen is not directly responsible for the
allergic reaction, but sets off the chain of events that brings it about.
A variety of allergic reactions can take place almost anywhere in the body;
the cell affected may be destroyed or injured, and they release powerful defensive chemicals such as heparin, leukotaxine and especially histamine that
cause systemic symptoms which may range from sneezing, slight local edema
and numerous other discomforting signs and symptoms to fatal anaphylactic
shock (dyspnea, cyanosis, rapid drop of blood pressure, weakening of pulse,
convulsions and loss of consciousness). Emotional factors such as anxiety,
fear, anger and strong excitement are also known to have a role in allergy,
not exactly as causes but mostly in view of evidence that emotional upset may
set off an allergic attack.
Common allergic diseases include hay fever, asthma, allergic dermatitis
(eczema), allergic contact dermatitis, urticaria (hives), food allergies, drug
allergies, and allergies to insect bites.
In most cases allergy is dealt with by identifying the responsible allergen
and then avoiding it. An allergy that is resistant to cure may be controlled with
medication (antihistamines, epinephrine, ephedrine, aminophylline and varieties of steroids of the cortisone and ACTH type). In many instances the patient
can be cured of the allergy by a series of desensitization treatments, in which
the patient is exposed to gradually increasing amounts of the allergen until
his resistance is built up to immunity.
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Common Allergens
inhaled substances: pollens from weeds, grasses, treed, and plants;
dusts, mold spores, animal skin/hair, feathers, hair
lotions, kapok, tobacco.
foods:
lobster, crab, shellfish and fish; meats, fowl, chocolate, nuts, spices, eggs, milk and grains.
skin contact
substances:
injected drugs:
drugs given by
mouth:
(From: Charles Carroll and Dean Miller: Health, the Science of Human
Adaptation; and Miller-Keane: Encyclopedia and Dictionary of Medicine and
Nursing.)
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CHAPTER 12
ENDOCRINE SYSTEM
The endocrine and nervous systems comprise the two major systems of the
body. The first one functions by means of chemical reactions and the second
one by means of electrical impulses. Once the nervous system receives either
an internal or external stimulus, the stimulus produces a series of electrical
impulses, which are then transmitted to the brain via neurons.
The endocrine system works differently. It affects bodily activities by
releasing chemical messengers, or hormones, into the bloodstream. These
chemical substances can regulate the many and varied functions of an
organism. The word hormone is of Greek origin and means urging on. The
hormones, produced by various glands, stimulate or inhibit activities of the
body. For example, one hormone stimulates the growth of bones, another
causes the maturation of sex organs and reproductive cells, and another
controls the metabolic rate (metabolism) within all individual cells of the body.
Hormones produce their effects by binding to receptors, which are recognition sites in the various target tissues upon which the hormones act. The
receptors initiate specific biological effects when the hormones bind to them.
Each hormone has its own receptor, and binding of receptor by hormone is
much like the interaction of a key and a lock.
It is important to distinguish the two different types of glands within our
body. The exocrine glands, which are not part of the endocrine system, secrete
their products directly into ducts, which carry them to specific places within
the body. Examples of exocrine glands are sweat, mammary, mucous, salivary,
digestive, and lacrimal (tear) glands. Endocrine glands are ductless glands, and
their products are hormones, which are released directly into the bloodstream.
The ductless, internally secreting endocrine glands are the following:
1. Thyroid gland
2. Parathyroid glands (four glands)
3. Adrenal glands (one pair)
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ovaries. In the male, gonadotropins (FSH and LH) from the adenohypophysis influence the development of spermatozoa and testes.
5. Prolactin (PRL) - this hormone promotes the growth of breast tissue and
stimulates and sustains milk production after birth.
6. Melanocyte-stimulating hormone (MSH) - this hormone influences the
formation of melanin and causes increased pigmentation of the skin. This
effect is observed only when hypersecretion of the hormone occurs.
The neurophypophysis secretes two important hormones. They are formed
in the hypothalamus but secrete through the posterior pituitary gland:
1. Antidiuretic hormone (ADH) - this hormone, also known as vasopressin, stimulates the reabsorption of water by the kidney tubules. In addition, ADH
can also increase blood pressure by constricting arterioles.
2. Oxytocin - stimulates the uterus to contract during childbirth and maintains labour during childbirth. Oxytocin is also secreted during suckling,
and causes the production of milk from the mammary glands.
Thymus and Pineal Gland (Cerebral Epiphysis)
Both the thymus and pineal glands are regarded as endocrine glands,
because they are ductless. However, little is known about their endocrine
function in the human organism.
The thymus gland is an unpaired organ located in the upper mediastinal
cavity, anterior to and above the heart. It consists of two flattened symmetrical lobes, each enclosed in a capsule. The thymus gland is prominent in the
child but tends to a trophy in the adult. Since the function of the thymus is
concerned with immunity, its major contribution is stimulation of the lymphoid
organs to produce T-lymphocytes for immunological activity.
The pineal gland is shaped like a pine con e and is attached to the posterior part of the third ventricle of the brain. Although the exact functions of this
gland have not been established, there is evidence that it secretes the melatonin hormone. It is believed that melatonin may inhibit the activities of the
ovaries. When melatonin production is high, ovulation is b locked, and there
may be a delay in puberty development. The pineal gland starts to degenerate
at about 7 years of age and in the adult it consists mostly of fibrous tissue.
Sex Glands (Gonads)
The ovaries are the female sex organs. They produce estrogen, which aids
in the development of secondary sex characteristics. Ovaries also produce
progesterone, which assists in the normal development of pregnancy.
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The male sex glands, or testes, produce testosterone. This hormone aids
in the development of secondary sex characteristics in the male.
For quick reference please refer to the table below:
Comparison Between the Endocrine and Nervous Systems
Endocrine System
Secretes hormones that are carried
in body fluids
Nervous System
Transmits nerve impulses via nerve
fibres
Key Terms
antagonistic acting in opposition; mutually opposing g
catecholamines hormones derived from an amino acid and secreted by
the adrenal medulla (e.g. epinephrine)
corticosteroids hormones produced by the adrenal cortex (e.g.
glucocorticoids)
homeostasis a constant internal environment
hormone a substance produced by an endocrine gland and carried
through the blood to a target organ
sella turcica (Turkish saddle) a cavity in the skull where the pituitary
gland is located
steroid a complex chemical related to fats (oil) and derived from a
sterol (e.g. cholesterol)
sympathomimetic an agent that mimics or copies the effect of the
sympathetic nervous system (e.g. adrenaline)
target a structure, organ or tissue to which something is directed.
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Terminology
aden/o
gland
adren/o
adrenal/o
adrenal
gland
andr/o
male
cortic/o
crin/o
secrete
dips/o
thirst
estr/o
female
gluc/o
glyc/o
Glycos/o
sugar,
sweetness
kal/i
potassium
(an
electrolyte)
lact/o
milk
myx/o
mucus
natr/o
sodium (an
electrolyte)
phys/o
physi/o
growth,
natural
process
somat/o
body
toc/o
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usually indicate benign growths; cold nodules can be either benign or malignant.
Parathyroids
Hypoparathyroidism or hyposecretion of the parathyroids results in neuromuscular hyperexcitability manifested by convulsions, muscle twitches and
spasms (tetany). Blood calcium decreases and blood phosphorus rises. The
decrease of calcium in the bones results in increased bone fragility. Other
symptoms include cataract, teeth defects, bone lesions, maldevelopment of
hair and nails and skin disturbances.
Hyperparathyroidism causes demineralization of bones (osteitis fibrosa
cystic, or von Recklinghausen disease of bone). The parathyroid hormone draws
calcium from bones marking them highly susceptible to fracture and deformity.
This condition can be the result of a benign tumour of the parathyroid gland
(adenoma) and is treated by surgical removal.
Adrenals
Adrenal cortex
Addison disease results from a deficiency in the secretion of adrenocortical
hormones (adrenal cortical hypofunction). Although it is known to be due to
a failure of the adrenal glands, the cause of this failure is not always certain.
Tuberculosis of the adrenals accounts for less than half the cases and idiopathic atrophy of the glands for the remainder. If untreated, the disease will
continue a chronic course with progressive but relatively slow deterioration. In
some patients the deterioration may be repaid. Patients treated early, usually
with adrenocortical hormones, have an excellent prognosis.
Cushing syndrome is caused by hypersecretion of the adrenal cortex and
results in excessive production of glucocorticoids. This overactivity is commonly
due to an abnormal growth of the adrenal cortices. It may also be caused by a
benign or malignant tumour of one of the adrenal glands. Symptoms include
fatigue, weakness, edema, excessive hair growth in unusual places (hirsutism)
in females, high blood pressure, and purplish markings (striae) of
the skin. Treatment of the disorder is partial removal of the adrenal gland
(adrenalectomy) or removal of the tumour, if that is the source of the problem.
Adrenal Medulla
Pheochromocytoma is a tumour occurring in the adrenal medulla. The
tumour cells (which stain dark) produce excess secretion of the epinephrine
and norepinephrine. The excess catecholamines produce hypertension, palpi167
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Pancreas
Diabetes mellitus is a disorder of carbohydrate metabolism, characterized
by increased blood sugar (hyperglycemia) and the presence of glucose in the
urine (glycosuria).
In most cases diabetes mellitus is the result of a genetic disorder. The
basic cause is still unknown but the direct cause is failure of the pancreas
to secrete an adequate amount of insulin (hypoinsulinism). Another cause of
diabetes may be an inadequate utilization of insulin. Besides hyperglycemia
and glycosuria other symptoms include excessive urine production (polyuria),
increase in food intake (polyphagia), and excessive thirst (polydipsia).
When severe diabetes is allowed to progress without proper treatment, a
sweet breath odour may be noted along with other progressive symptoms of
intoxication and delirium. All of these are followed by a deep coma and finally
death.
There are two major types of diabetes mellitus:
Type I diabetes, insulin dependent (IDDM or juvenile-onset diabetes), seen
mostly in children and adolescents, involves destruction of the beta cells of the
islets of Langerhans with complete deficiency of insulin in the body. Patients
are usually thin and require frequent injections of insulin to maintain a normal
level of glucose in the blood.
Type II diabetes, non-insulin dependent (NIDDM or adult- onset diabetes),
is a separate disease from Type I, with a different inheritance pattern. Patients
are usually older, and obesity is very common. The islets of Langerhans are
not destroyed, and there is a relative deficiency of insulin secretion with resistance of target tissue to the action of insulin. Treatment is with diet, body weight
reduction, and, when necessary, administration of insulin or oral hypoglycemic agents that can stimulate the release of insulin from the pancreas and
improve the bodys sensitivity to insulin.
Diabetes is associated \with both primary and secondary complications:
Primary complications include ketoacidosis (fats are improperly burned
leading to accumulation of ketons in the body) and hyperosmolar coma, a condition when blood sugar concentration (osmolarity) gets too high or the patient
receives insufficient amounts of insulin. Hypoglycemia can occur when too
much insulin is taken by the patient.
Secondary (long-term) complications occur many years after the patient
develops diabetes. These include destruction of the blood vessels of the retina
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of the eyes (diabetic retinopathy), causing visual loss and blindness; destruction of the kidneys (diabetic nephropathy), causing renal insufficiency and often
requiring haemodialysis or renal transplantation; destruction of blood vessels,
with atherosclerosis; and destruction of nerves (diabetic neuropathy) involving
pain or loss of sensation, most commonly in the extremities.
Hyperinsulinism is an excess of insulin. This condition may be caused by a
tumour of the pancreas (benign adenoma or carcinoma) or overdose of insulin.
Excess insulin draws sugar out of the bloodstream, resulting in hypoglycemia.
Fainting spells, convulsions, and loss of consciousness are common because
a minimum level of blood sugar is necessary for proper mental functioning.
Reactive hypoglycemia occurs after ingestion of glucose or a meal. This is
due to an abnormality in the timing of insulin secretion in response to a meal,
and is distinct from the type of hypoglycemia seen with hyperinsulinism.
Other Related Terms
diuresis
hirsutism
hypervolemia
insulinoma
obesity
thyroid storm
virilism
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EXERCISES
1.1. The endocrine system is made up of the following glands: ...............................
..........................................................................................................................................................................
glands.
5. 3. myxedema ......................................................................................................................................
5. 4. Cushing disease ..........................................................................................................................
5. 5. diabetes mellitus ........................................................................................................................
5. 6. progesterone .................................................................................................................................
5. 7. vasopressin ....................................................................................................................................
5. 8. acromegaly ....................................................................................................................................
5. 9. thymitis .............................................................................................................................................
5.10. exacerbation ................................................................................................................................
6. Provide the adjective form for each of the following:
6.1. hormone ...................................................
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CHAPTER 13
The female reproductive system consists of organs that produce ova and
provide a place for the growth of the embryo. In addition, the female reproductive organs supply important hormones that contribute to the development
of secondary sex characteristics (body hair, breast development, structural
changes in bones and fat).
Ova are produced by the ovary from the onset of puberty (beginning of
the fertile period when secondary sex characteristics develop) to menopause
(cessation of fertility and diminishing of hormone production). If fertilization
occurs at any time during the years between puberty and menopause, the
fertilized egg may grow and develop within the uterus. Various hormones are
secreted from the ovary and from a blood-vessel-filled organ, placenta, that
grows in the wall of the uterus during pregnancy. If fertilization does not occur,
hormone changes result in the shedding of the uterine lining, and bleeding,
or menstruation, occurs.
Ovarian hormones that play important role in the process of menstruation
and pregnancy, and in the development of secondary sex characteristics, are
estrogen and progesterone. Other hormones that arc responsible for the functions of the ovaries, breasts and uterus, are secreted by the pituitary gland.
Gynecology is the study of the female reproductive system (organs,
hormones, and diseases); obstetrics is a specialty concerned with pregnancy
and delivery of the baby; and neonatology is the study and treatment of the
newborn child.
2. Major Organs of the Female Reproductive System
The female reproductive system consists of internal and external organs
of reproduction. The internal or essential organs for reproduction are the
ovaries, fallopian tubes, uterus, and vagina or birth canal. The external genitalia include the labia majora, labia minora, clitoris, vestibule of the vagina,
and the greater vestibular glands or Bartholin glands. The combined structures of the external genitalia are known as the vulva.
Both the cervix of the uterus and vagina are lubricated by the mucous secretions of Bartholin glands. A fold of membrane, the hymen, is sometimes found
partially covering the orifice of the virginal vagina. A hymen may be ruptured
at the first sexual intercourse, even though there have been cases in which
pregnancies have occurred without any ruptures.
Ovaries
The reproductive system is linked to the bodys system of endocrine glands
by the ovaries. Besides producing the ova, the ovaries secrete the female sex
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Fallopian tubes
Fallopian tubes, oviducts, salpinges (sg. salpinx), or uterine tubes, extend
laterally from superior angles of the uterus. They transport the ovum from the
ovary to the uterus by rhythmic contractions of the tube walls and by the cilia of
the mucous membrane lining. The opening of the tubes near the ovaries o pens
directly into the uterus. Each oviduct is a muscular tube and consists of the
same three layers found in the uterus: mucosa, serosa and a layer of smooth
muscle. In addition to conveying the ovum, an oviduct provides a passageway
through which sperm travel from the uterus toward the ovary. It is within the
uterine tube that fertilization takes place while the ovum is moving through
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the tube. It usually takes the ovum about 5 days to pass through the uterine
tube. If coitus takes place near the time of ovulation and no contraception is
used, there is a likelihood that sperm cells will be in the uterine tube when
the egg cell is passing through. If fertilization has not occurred, the ovum
remains unfertilized and, after a day or two, disintegrates.
Uterine tubes and ovaries are called the adnexa (accessory structures) of
the uterus.
Uterus and Vagina
Uterus is a hollow muscular pear-shaped organ, with muscular walls and
mucous membrane lining filled with a rich supply of blood vessels. This organ
is capable of stretching to contain a fertilized ovum as it grows through the
9 months of pregnancy. The uterus is located in the pelvic area between the
bladder and rectum. The rounded upper portion of the uterus is called the
fundus, while the larger central section is the corpus (body of the organ). The
specialized epithelial mucosa of the uterus is called the endometrium; the
middle, muscular layer is the myometrium; and the outer membraneous tissue
layer is the perimetrium. The uterus is also adapted to hold the unborn infant
securely and to nourish it. When the ovum arrives, the hormones estrogen and
progesterone produced in the ovary have previously stimulated the uterus to
prepare its lining with extra blood. If the egg has not been fertilized it loses
its vitality, the hormone supply ceases, and the extra blood and tissues are
discharged from the body through the vagina in the menstrual flow. The lower
end of the uterus forms an opening called the cervix, or neck, which protrudes
into the birth canal or vagina.
Vagina is a muscular tube about seven and one-half cm long, and its lining
consists of a mucous membrane fold that gives the organ its elastic quality.
It extends from the cervix to the exterior of the body. Besides serving as the
organ of sexual intercourse, and receptor of semen, the vagina discharges
the menstrual flow. Like the uterus, the vagina undergoes changes during
pregnancy that enable it to stretch to many times its usual size, allowing the
infant to pass through it in childbirth (parturition).
3. Breasts - Accessory Organ of Reproduction
The breasts or mammary glands are located in the upper anterior aspect
of the chest. During puberty the glands begin to develop as they are exposed
to periodic stimulation of two ovarian hormones, estrogen and progesterone.
Estrogen is responsible for the fatty growth and increased size of the mammary
glands as they reach full maturity. The size of the breast is basically determined by the amount of fat around the glandular tissue and is not indicative
179
of its functional ability. The other ovarian hormone progesterone forms the
lobules that are present in the breast. Each mammary gland has approximately
20 lobes of glandular tissue. These lobes raise nipple. Circling the nipple, there
is a border of slightly darker skin referred to as the areola.
Full development of the breasts is achieved by the time female reaches
the age of sixteen. The main purpose of the mammary glands is secretion of
milk for nourishment of the newborn infant. During pregnancy, the hormones
from the ovaries and the placenta stimulate glandular tissue in the breasts to
their full development. After parturition (childbirth) hormones from the pituitary gland stimulate the production of milk (lactation).
Figure 13.2. View of sagittal cut through breast
lized ovum implants itself upon the uterine wall and continues to develop
within the uterus.
Menopause is the span of time during which the menstrual cycle diminishes and gradually stops. It is also called climacteric. During this period the
ovaries stop functioning and therefore menstruation and childbearing cease.
It is a natural physiologic process that results from the normal aging of the
ovaries and occurs when the ovaries can no longer perform the function of
ovulation and estrogen production. It usually begins between 40 and 50 years
of age and its duration varies from 6 months to 3 years.
5. Pregnancy and Labour
If fertilization does occur in the uterine tube, the fertilized egg begins to
change immediately after. Soon the egg is dividing into a cluster of two, then
four, then more cells, as it makes its way down the uterine tube toward the
uterus for implantation. By the time the egg reaches the uterus, in 3 to 5 days,
the cells are formed in the shape of a minute ball, hollow on the inside with
an internal bump at one side where the embryo will form. This aggregation
of cells, called a blastocyst, quickly buries itself in the lining of the uterus,
which is the process known as implantation.
As soon as the blastocyst is implanted, its wall begins to change into a
structure that eventually develops into the placenta. Through the placenta the
fetus secures nourishment from the mother and rids itself of waste products.
Essentially the placenta is a filtering mechanism by which mothers blood is
brought close to the fetal blood without the actual mixing of blood cells.
The outermost membrane which surrounds the developing embryo is called
the chorion and the innermost is the amnion. The amnion contains the fetus
surrounded by the amniotic fluid. The amnion and fluid are sometimes known
as the bag of water which breaks to signal the onset of labour.
The placenta, also known as the afterbirth because it becomes detached
from the uterus after delivery, produces its own hormone as it develops in the
uterus. This hormone is called human chorionic gonadotropin HCG, or pregnancy hormone, and it stimulates the corpus luteum to continue producing
hormones until about the third month of pregnancy, when the placenta itself
takes over the endocrine function and releases estrogen and progesterone.
During the early stages of pregnancy, the future child grows at an extremely
rapid rate. The mothers body must undergo profound changes to support
this organism. The muscles of the uterus grow, the blood volume expands,
the work of the heart increases, the breasts prepare for lactation and other
adjustments are made throughout the mothers body.
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The average duration of pregnancy or the gestation period is about 280 days,
or 9 calendar months, although it may vary considerably from that average.
The events of menstruation and pregnancy are dependent not only upon
hormones from the ovary (estrogen and progesterone) but also on hormones
from the pituitary gland. These pituitary gland hormones are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones
stimulate the development of the ovum and ovulation. After ovulation, LH in
particular influences the maintenance of the corpus luteum and its production of estrogen and progesterone.
Labour, or childbirth, is the physiologic process by which the fetus is
expelled from the uterus. It occurs in three stages: (l) opening or dilation of
the cervix is the time from the onset of labour to complete dilation of the cervix
(about 10 cm); (2) the second stage is called the expulsion stage during which
the baby must be pushed through and out of the vagina; (3) the third stage is
the stage of separation and expulsion of the placenta; in this final stage the
placenta detaches itself from the uterine wall and is expelled.
Key Terms
adnexa accessory parts of the uterus: the fallopian tubes and the
ovaries
amnion the innermost membrane around the developing embryo
areola dark-pigmented area around the breast nipple
chorion outermost layer of the two membranes surrounding the
embryo; it is part of the placenta
cyesis - pregnancy
embryo stage in development from fertilization of the ovum through
the 2nd month of pregnancy
endometrium the inner mucous membrane lining the uterus
estrogen ovarian hormone responsible for secondary sex
characteristics
fallopian tubes ducts through which the egg travels after its release
from the ovary (oviducts, uterine tubes, salpinges)
fertilization union of the sperm and the ovum (fusion of two nuclei
occurs)
fetus the embryo from the 3rd month (after 8 weeks) to birth
fimbriae (pl. fimbria) finger-like ends of the fallopian tubes)
gamete sex cell; the sperm and the ovum
gestation pregnancy
gonads organs in the male and female that produce gametes; ovaries
and testes
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graafian follicle developing sac enclosing each ovum within the ovary;
only about 400 of these sacs will mature in a womans lifetime
lactiferous ducts tubes that carry milk within a breast
menarche the beginning of the first menstrual period during puberty
myometrium the muscle layer lining the uterus
ovaries female gonads
ovulation release of the ovum from the ovary
ovum (pl. ova) egg cell; female gamete
parturition the act of giving birth
perimetrium the membrane surrounding the uterus
perineum in females, the area between the anus and the vagina
placenta vascular organ that develops during pregnancy in the uterine
wall and serves as a communication between the maternal and the fetal
bloodstream
progesterone hormone produced by the corpus luteum in the ovary and
the placenta of pregnant women
puberty beginning of the fertile period when gametes are produced and
secondary sex characteristics appear
tocia - childbirth
uterus womb; muscular organ in which the embryo develops
vagina birth canal; a tube extending from the uterus to the exterior of
the body
Combining Forms Meaning
Terminology
amni/o
amnion
colp/o
vagin/o
vagina
galact/o
lact/o
milk
gynec/o
woman,
female
hyster/o
metr/o
metri/o
uter/o
womb,
uterus
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mamm/o
mast/o
breast
men/o
myom/o
muscle
tumour
nat/o
birth
obstetr/o
midwife
o/o
ov/o
ovul/o
egg
oophor/o
ovari/o
ovary
salping/o
breast cancer
cervical cancer
cervicitis
painful menstruation
fibroids
menorrhagia
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metrorrhagia
ovarian carcinoma
ovarian cysts
pelvic inflammatory
disease (PID)
abruption placentae
breech presentation
caesarean section
Down syndrome
trisomy 21
dystocia
difficult labour
eclampsia
ectopic pregnancy
fetal erythroblastosis
gravida
pregnant woman
hydrocephalus
kernicterus
placenta praevia
premature birth
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puerperium
pyloric stenosis
EXERCISES
1.1. The main functions of the female reproductive system are:
..........................................................................................................................................................................
2.2. The germ cells are the male ....................... and the.......................................... female
2.3. Beside producing the ova, the ovaries secrete ..........................................................
2.4. The study of female reproductive system is called .................................................
2.5. Julius Cesar is said to have been born by ....................................................................
3. Give the opposite of each term:
3.1. similar ........................................................
186
187
188
The effects of drugs in the fetus depend upon the particular drug (or combination of drugs), the dosage, and most importantly, the stage of fetal development. Embryonic cells multiply and grow rapidly while food exchange and
waste elimination occur through simple diffusion. Therefore, drugs capable
of rapid cellular diffusion introduced during this period may cause significant
embryonic alterations. Between the fifth and eighth weeks, drug action can
cause abnormal tissue and/or organ differentiation. Timing is vital, with the
most severe effects occurring in the nervous system between days fifteen to
twenty-five; in the heart between days twenty to forty; in the legs between days
twenty-four to thirty-six; and in the eyes between days twenty-four to forty. The
major parts of the body have usually been differentiated by the eight week of
pregnancy, and the danger of drugs diminishes. Some effects, like smoking,
are cumulative, however. Most authorities now recommend that the ingestion of all drugs and medications, including over-the-counter and prescription
drugs, be kept to a minimum or totally eliminated during all stages of pregnancy, unless such medications are considered necessary by the physician.
Pharmacogenetics, the study of the interrelationship of hereditary constitution and drug responses, has become an important specialty as a result of
these concerns.
(From: Carrol Ch. and Miller D.: Health, the Science of Human Adaptation.)
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CHAPTER 14
191
Identical twins are formed from the fertilization of a single egg cell by
a single sperm. As the fertilized egg cell divides and forms many cells, it
somehow comes a part and each part continues separately to undergo further
division, each producing an embryo. Both embryos share the same placenta.
Identical twins are always of the same sex and very similar in form and feature
(physique).
All body organs contain parenchyma (parenchymal cells or tissue) which
perform the essential functions of the organ. Organs also contain supportive,
connective, and framework tissue, such as blood vessels, connective tissues,
and sometimes muscles as well. This supportive tissue is called stroma
(stromal tissue).
Anatomy of the Male Reproductive System
The male gonads consist of a pair of testes, also called testicles, which
develop in the kidney region of the body before descending during fetal development into the scrotum, a sac enclosing the testes on the outside of the body.
The testes produce the sperm cells and the male hormone testosterone, which
gives a sexually mature male his distinctively masculine characteristics and
his sexual energy and drive (libido). The interior of a testis is composed of a
large mass of narrow, coiled tubules called the seminiferous tubules. These
tubules contain cells which manufacture spermatozoa.
The seminiferous tubules are the parenchymal tissue of the testis, which
means that they perform the essential work of the organ. Other cells in the
testis, called interstitial cells, manufacture the male hormone testosterone.
As soon as they are formed, sperm cells move through the seminiferous
tubules and are collected in ducts which lead to a large tube at the upper part
of each testis. This is the epididymis. The spermatozoa become motile in the
epididymis and are temporarily stored there. The epididymis runs down the
length of the testicle and then turns upward again and becomes a narrow,
straight tube called the vas deferens (seminal duct or ductus deferens). The
vas deferens carries the sperm up into the pelvic region, around the urinary
bladder, and then into a duct leading toward the urethra. It is the vas deferens that is cut or tied off when a sterilization procedure called a vasectomy
is performed.
The seminal vesicles are glands which are located at the base of the bladder
and they open into the vas deferens as it joins the urethra. The seminal vesicles secrete a thick, yellowish substance that nourishes the s perm cells and
forms much of the volume of ejaculated semen. Semen is a combination of
fluid and spermatozoa which is ejected from the body through the urethra.
192
In the male, as opposed to the female, the genital orifice combines with the
urinary opening (meatus).
Figure14.1. The Male Reproductive System
thral glands, are located just below the prostate and they secrete an alkaline
fluid into the urethra that is necessary for the viability of the sperm.
The urethra expels both semen and urine from the body, but during ejaculation, the sphincter at the base of the bladder is closed. This not only stops
the urine from being expelled with the semen, but also prevents the s perm
from entering the bladder.
The penis is the organ through which semen is transferred into the female
during coitus. The tissues that form the mass of the penis are called erectile tissue. This tissue is spongy in nature and filled with innumerable hollow
spaces. There is also a network of arteries and veins within the penis. Its tip
expands and forms a soft, sensitive region called the glans penis. Circumcision is the process whereby the foreskin is removed, leaving the glans penis
visible at all times.
Figure 14.2. The passage of sperm from the seminiferous
tubules in the testes to the outside of the body
Key Terms
flagellum (pl. flagella) hair-like process on a sperm cell enabling its
motility
parenchyma tissue composed of essential cells of an organ
194
perineum area between the anus and the scrotum in the male (vulva in
the female)
semen spermatozoa and fluid
seminiferous sperm-producing
sterilization any procedure rendering an individual incapable of
reproduction
stroma supportive, connective tissue of an organ.
Combining Forms Meaning
Terminology
cry/o
cold; ice
crypt/o
hidden
gon/o
seed
gonad/o
sex glands
olig/o
scanty
orch/o
orchi/o
orchid/o
test/o
testis (pl.
testes)
prostat/o
prostate
gland
py/o
pus
sperm/o
spermat/o
terat/o
monster
varic/o
dilated vein
vas/o
vessel, duct
zo/o
animal life
195
anorchidism
(anorchia)
balanitis
benign prostatic
hyperplasia
(hypertrophy)
cryptorchism,
cryptorchidism
epispadia
hydrocele
hypospadia
phimosis
196
genital herpes
gonorrhoea
197
trichomoniasis
198
EXERCISES
1.1. The organs of the male reproductive system are:.....................................................
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2.2. If more than one egg is passing down the uterine tube when s perm are
present.............................................................................................................................are possible.
2.3. Seminiferous tubules contain cells which produce ................................................
2.4. In the male the genital orifice combines with the ....................................................
2.5. The ejaculatory duet passes through the ......................................................................
and joins with the ..................................................................................................................................
3. Give the opposite of each term:
3.1. remember ................................................
b) prepuce
c) scanty sperm
d) a hormone produced by
interstitial cells in testes
e) a narrowing or stenos is of
theprepuce
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200
8.3. the area between the anus and the scrotum at the floor of the pelvic
cavity..............................................................................................................................................................
8.4. the tubules containing cells which manufacture spermatozoa
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CHAPTER 15
204
enabling the light rays to focus upon the retina. This process is called accommodation. The second major humour of the eye is the vitreous humour. This
clear jellylike fluid occupies the entire orbit of the eye behind the lens. The
vitreous humour, the lens and the aqueous humour are the refractive structures of the eye. They are responsible for the bending of light rays so that the
rays focus sharply upon the retina. If any of these structures do not function
properly, vision is impaired.
Figure 15.1. Components of the eye
OPTIC NERVE
RETINA
OPTIC DISC
CHOROID
SCLERA
IRIS
CORNEA
PUPIL
PATH OF LIGHT
MACULA
LENS
FOVEA
RETINAL ARTERIES
AND VEINS
VITREOUS CHAMBER
INSET
EYELID
SCLERA
PUPIL
IRIS
Six muscles control the movement of the eye: the superior, inferior, lateral
and medial rectus muscles, and the superior and inferior oblique muscles.
These muscles are coordinated to move both eyes in a synchronized manner.
The front of the eye is protected by two movable folds of skin, the eyelids.
Their edges are lined with two or three rows of eye lashes, which protect the
surface of the eye.
A thin mucous membrane called conjunctiva lines the inner surface of the
eyelids and passes over the cornea. Lying superior and to the outer edges of
each eye are the lacrimal glands. They produce tears to bathe and lubricate
the eyes. The tears collect at the inner edges of the eyes, the canthi (singular:
canthus), and pass through pinpoint openings, the lacrimal canaliculi, of the
nose.
The Ear
The ear is the sense organ of hearing. It consists of three major sections:
the external or outer ear; the middle ear or tympanic cavity; and the inner ear
or labyrinth. Although each of these sections transmits sound waves, each
accomplishes the task in a different way. The external ear conducts sound
waves through air; the middle ear, through bone; and the inner ear through
fluid. As will be subsequently explained, this series of transmissions play an
integral part in hearing.
The external ear is designed to channel sound waves from the environment to the middle and inner ears. An auricle or pinna is the external structure designed to collect waves travelling through air. The auricle channels
the waves through the ear canal, or slender tube that leads to the middle ear.
The canal is lined with glands that produce a waxy secretion called cerumen.
Cerumen prevents foreign particles from entering the ear. A flat membranous structure, the tympanum (tympanic membrane or eardrum), is drawn
over the end of the canal. Sound waves that enter ear canal strike against the
tympanum.
In the middle ear, vibrations of the tympanum are picked up by three
tiny bones called ossicles. They are responsible for transmission of sound
waves through the middle ear. The three articulating bones are the malleus
(hammer), the incus (anvil), and the stapes (stirrups). These bones form a
chain that stretches from the inner surface of the tympanum to an inner ear
structure called the cochlea.
A tube, called the Eustachian tube, connects the nose and the throat with
the cavity of the middle ear. Its purpose is to equalize pressure on the outer
and inner surfaces of the eardrum. In situations in which sudden pressure
changes occur, equalization of pressure is achieved by deliberate swallowing.
206
INCUS
AURICLE
MALLEUS
SEMICIRCULAR CANALS
VESTIBULOCOCHLEAR NERVE
SEMICIRCULAR CANALS
VESTIBULE
EXTERNAL AUDITORY
CANAL
EUSTACHIAN TUBE
STAPES
OVAL WINDOW
TYMPANIC
MEMBRANE
COCHLEA
The inner ear, sometimes referred to as the labyrinth because of its complicated mazelike design, is composed of three structures: a snail-shaped
cochlea, the semicircular canals, and the vestibule, a chamber that joins the
cochlea and the semicircular canals. The cochlea is a triple-looped tube that is
filled with fluid. Lining its inner surface are tiny nerve endings called the hairs
of Corti. There is a membrane-covered opening on the external surface of the
cochlea called the oval window. That is precisely where the stapes is attached
to the cochlea. Transmission of sound along the ossicles in the middle ear
causes the stapes to exert a gentle pumping action against the oval window.
The pumping action forces the cochlea fluid to move. Disturbances of the fluid
stimulates the hairs of Corti, causing them to generate a series of nervous
impulses. The impulses are transmitted to the brain by way of the auditory
nerve, where they are interpreted as sound.
Key Terms the Eye
accommodation adjustment of the eye for seeing objects at various
distances
acuity clearness or sharpness of a sensory function
adnexa adjacent structures, e.g. extra ocular muscles, eyelids,
conjunctiva, orbits, lacrimal apparatus
207
Terminology
ambly/o
dull, dim
aque/o
water
blephar/o
palpebr/o
eyelid
core/o
pupill/o
pupil
corne/o
kerat/o
cornea
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cycl/o
dacry/o
lacrim/o
goni/o
angle
ir/o
irid/o
iris
mydr/o
widen,
enlarge
ocul/o
ophthalm/o
eye
opt/o
optic/o
eye, vision
phac/o
phak/o
lens
phot/o
light
presby/o
old age
retin/o
retina
scler/o
white of the
eye (sclera)
scot/o
darkness
uve/o
uvea;
uveitis = inflammation of part or all of
vascular
the uvea
layer of the
eye (choroid;
retina)
vitr/o
glassy
209
Terminology
acous/o
audi/o
audit/o
hearing
aur/o
auricul/o
ot/o
ear
myring/o
tympan/o
eardrum
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salping/o
staped/o
stapes
The increased intraocular pressure is due to the failure of the aqueous humour
to drain from the eye through a tiny duct called the canal of Schlemm. Treatment for glaucoma involves the use of medications that cause the pupils to
constrict (myotics). This permits the escape of aqueous humour. If this treatment proves ineffective, surgery may be necessary. Three possible kinds of
surgery for glaucoma include puncturing of the cornea (paracentesis of the
cornea); the excision of a small portion of the iris (partial iridectomy); or separating the iris from its attachment (iridodialysis, coredialysis).
Glaucoma is diagnosed by the use of an instrument that measures internal
pressure of the eye (tonometer). This procedure is a simple, painless technique
and should be performed on all patients after the age of 35 during routine
eye examinations.
Strabismus
Strabismus is a condition in which the eyes turn from the normal position
so that they are not aimed in the same direction. If the eyes deviate outward
(exotropia), causing a divergent squint, the individual is said to be wall-eyed.
If the eyes turn toward each other (esotropia), causing a convergent squint,
the individual is said to be cross-eyed.
Strabismus may be due to poor vision (decreased visual acuity), un equal
ocular muscle tone, or an oculomotor nerve lesion. Eye testing (refraction) and
prescribing of corrective lenses, eye exercise (orthoptic training) and surgery
(strabotomy) in which the ocular tendons are cut, are the usual methods of
treatment.
Presbyopia
Impairment of vision due to old age. With increasing age, loss of elasticity
of the ciliary body impairs its ability to adjust the lens for accommodation to
near vision. The lens
of the eye cannot become fat to bend the rays coming from near objects
(less than 20 feet). The light rays focus behind the retina, as in hyperopia.
Therefore, a convex lens is needed to refract the rays coming from objects
closer than 20 feet.
Other Conditions and Related Terms
achromatopsia
chalaizon
212
conjunctivitis
diabetic
retinopathy
epiphora
exophthalmos
hemianopia
hordeolum (stye)
macular
degeneration
metamorphopsia
nyctalopia
nystagmus
retinal detachment two layers of the retina separate from each other as a
result of trauma to the eyeball, head injuries, bleeding,
scarring from infection, shrinkage of the vitreous
humour
retinitis
pigmentosa
scotoma
trachoma
213
The Ear
Otitis Media
Otitis media is an infection of the middle ear, found most commonly in
infants and young children. It is frequently associated with an upper respiratory
infection (URI). Symptoms may include earache (otodynia, otalgia), draining of
pus from the ear (otopyorrhea), or rupturing of the eardrum (tympanorrhexis
or myringorrhexis). Treatment consists of bed rest, medications to relieve pain
(analgesics) and antibiotics. Occasionally, an incision of the eardrum (myringotomy, tympanotomy) may be necessary to relieve pressure and promote
draining of pus from the middle ear. If left untreated, otitis media may lead
to infection of the mastoid process (mastoiditis) or inflammation of the brain
tissue near the middle ear (otoencephalitis).
Otosclerosis
Otosclerosis is a condition characterized by the hardening of spongy bone
around the oval window. This decreases the ability of the stapes to move the
oval window (ankylosis). Consequently, there is a hearing loss. Occasionally the
individual perceives a ringing sound (tinnitus) within the ear. Surgical correction involves the removal of the stapes (stapedectomy) and reconstruction of
the oval window. Sometimes insertion of an artificial stapes is necessary in
order to restore hearing.
Other Conditions and Related Terms
acoustic neuroma
Meniere disease
noise induced
loss of hearing due to excessive exposure to sounds
hearing loss (NIHL) that are too long, too loud and too close
214
presbycusis
tinnitus noise
vertigo, dizziness
EXERCISES
1. Explain how the eye functions: ...................................................................................................
2. The ear consists of the following three major sections: ................................................
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215
b) nearsightedness
216
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SUPPLEMENT
CHAPTER 16
219
BEHAVIOUR
BENIGN
MALIGNANT
carcinoma
adenocarcinoma
fibrosarcoma
chondrosarcoma
osteosarcoma
liposarcoma
hemangiosarcoma
lymphangiosarcoma
leiomyosarcoma
rhabdomyosarcoma
myelocytic leukemia
erythroleukemia
multiple myeloma
plasmocytoma
glioma
meningeal sarcoma
meningioma
221
nerve cells
neuroma,
ganglioneuroma
nevus (nevocytoma)
neurilemoma
neuroectoderm
nerve sheaths
retina
adrenal medulla
neuroblastoma,
melanoma
neurolymphoma
neurilemmic sarcoma
retinoblastoma
pheochromocytoma
cystosarcoma
nephroblastoma
choriocarcinoma
mixed mesodermal
fungating
inflammatory
medullar
necrotic
222
polypoid
ulcerating
verrucous
Microscopic Descriptions
alveolar
carcinoma in situ localized tumour that has not invaded the adjacent
structures
diffuse
dysplastic
epidermoid
follicular
nodular
papillary
pleomorphic
scirrhous
undifferentiated
Treatment
Malignant tumours cancers, are usually treated by three standard
methods either singly or in combination. These are: surgery, radiation and
chemotherapy. Besides these, new methods of treatment are being extensively
tested and gradually introduced. These include biological agents, e.g. mono223
clonal antibodies, and differentiating agents, e.g. those that cause tumour
cells to differentiate stop growing and die.
EXERCISES
1.1. What is oncology? ........................................................................................................................
1.2. Name four tissues from which the tumour originates...........................................
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225
226
CHAPTER 17
227
For recumbent patients a serviette is placed under the chin and the head is
raised by placing the hand beneath the pillow, not under the neck. The patient
is fed at his own pace. Liquids may be taken through a straw. The diet should
be adequate in joules, fat, protein, vitamins and minerals.
Moving the Patient
The patient who is weak or unable to move should be lifted, not dragged,
into position in bed. Dragging causes friction between the skin and the sheet
and predisposes to bedsores. Before lifting, the pillows should be tidied and
the bedclothes loosened. The nurse should not attempt to lift a heavy patient
without assistance, either from the patient, if permitted, or from a second
nurse. There are several ways of lifting. In the Australian lift each nurse places
her shoulder under the patients axilla and the arm below the thigh, grasping
the other nurses wrist. The nurse should keep her back straight, bending
from the hips so as to prevent injury to her back. To turn a patient the nurse
stands at the side to which the patient is to be turned; places his arm across
his chest and crosses his legs, reaches over him, and with one hand around
the pelvis and the other below the shoulder, turns him towards her.
To move a patient from a trolley to a bed, the two are placed at right angles
to each other, the head of one near the foot of the other. Three persons stand
on the same side of the patient and lift together.
Bathing in Bed (Blanket Bath)
Procedure: Explain the procedure to the patient. Screen the bed. Ask the
patient if he wishes to use a bedpan or urinal. Place clean nightwear on a
nearby radiator to warm. Turn the bedclothes back, leaving the patient covered
with his top sheet. A large bath towel is placed beneath him to prevent the
bedding from getting wet. Remove the patients nightwear, drape a blanket
over him if he is likely to feel cold, and wash him with soap and hot water,
starting with the face and neck, using the face flannel and towel, allowing the
patient to wash and dry his own face, if able. A second flannel is used for the
remainder of the body, only exposing those parts of the patient which are being
washed. When the arms, chest and abdomen have been washed and dried, the
water in the bowl is changed and the lower limbs, genitals and buttocks are
washed. The patient should wash and dry his own pubic area, if able. The feet
should be placed in the bowl of water, if possible. During bathing the patient is
unobtrusively examined, and any skin rashes, bruises, sacral edema or other
abnormality reported. The pressure areas are massaged during the bed bath,
the patient dressed in the warmed nightwear, the nails trimmed if necessary,
228
and the hair brushed or combed. The teeth or dentures are cleaned (the patient
may do this), and a mouthwash is given.
The bed is made with clean linen and the patient repositioned and asked
if he is comfortable.
Female patients may be helped with their cosmetics.
Care of the Skin (Pressure Areas)
Bedsores are gangrenous ulcers due to ischemic death of the skin. Causes:
exclusion of blood from the skin by prolonged pressure caused by immobility
(paralysis, stiff joints, sedation), lying or sitting on creases of linen, crumbs, or
hard pads, or a moist skin, e. g. incontinence of urine or feces, local sweating
(sitting on plastic). Rough handling easily damages skin which is inelastic
(elderly patients), has a poor circulation (atheroma), or is poorly nourished.
Edema and congestion prevent the exchange of metabolites between the blood
and the tissues. The areas to be treated are the elbows, shoulder blades, tips
of the shoulders, occiput, vertebrae, iliac crest, buttocks, knees, ankles and
heels.
Reassure the patient and explain the reason for the procedure. Close the
windows and screen the patient. Turn back the bedclothes, leaving a sheet
covering the patient. Clean the area with a damp wipe, especially the buttocks
if the patient is incontinent. Wash with soap and water, dry the area thoroughly but gently. Sparingly apply fine talcum powder or cream. Remake the
bed. Creams or sprays do not prevent bedsores, but if they are used the area
must be thoroughly washed and dried before they are applied or reapplied.
Pressure areas are treated two-hourly if the patient is confined to bed
or is incontinent. The patient is encouraged to move in bed and his position
should be regularly altered by turning. The sheet must be free from creases
and crumbs. Decubitus pads are aids to the prevention of pressure sores,
but the above procedure must also be used. Any indication of a pressure sore
commencing must be reported immediately to the sister in charge. The first
sign is a reddening of the skin, a burning feeling or irritation.
Care of the Nails and Hair
Fingernails should be trimmed with scissors to the shape of the fingertips. Toenails should be cut straight across (if cut short and curved, the free
margin of the nail may dig into the tissues as it grows, producing an ingrowing
nail). Nails are cut more easily after soaking in warm water. The hair should
be brushed or combed daily and washed weekly, observing for parasites and
229
nits. If a man is too ill to shave himself, he may be shaved by a visiting barber,
convalescent patient, or the nurse.
(Harrison, R. Textbook of Medicine with Relevant Physiology and Anatomy)
EXERCISES
1. Fill in the correct term:
1.1. The nurse should ............................................................................................ the patients
name, age and address upon admission to the hospital.
1.2. Bed rest ................................................. the elderly to .............................................. joints.
1.3. Each morning the patient should be .............................................................. and the
bed .................................................................................................................................................................
1.4. An elderly, poorly ................................................................................... patient will need
frequent ......................................................................................................................................................
1.5. Only one course should be ................................................................................ at a time.
1.6. The patient is fed at his own .................................................................................................
1.7. Dragging causes ................................................................................and predisposes to
1.8. The nurse should not attempt to .................................................................................... a
heavy patient without .........................................................................................................................
1.9. During bathing the patient is ......................................................................... examined.
1.10. Decubitus .........................................................................are aids to the prevention of
................................................................................................................. sores.
230
2. 8. screening ........................................................................................................................................
2. 9. (o)edema ..........................................................................................................................................
2.10. metabolite .....................................................................................................................................
3. Provide the plural form of the following nouns:
3.1. tissue ..................................................................................................................................................
3.2. extremity ...........................................................................................................................................
3.3. vertebra .............................................................................................................................................
3.4. ankle ....................................................................................................................................................
3.5. toenail .................................................................................................................................................
3.6. spray ....................................................................................................................................................
3.7. occiput.................................................................................................................................................
3.8. pelvis....................................................................................................................................................
3.9. trolley ..................................................................................................................................................
3.10. glass .................................................................................................................................................
4. Provide the adjective form for the following nouns:
4.1. muscle ...............................................................................................................................................
4.2. artery ..................................................................................................................................................
4.3. constipation ....................................................................................................................................
4.4. lifting ...................................................................................................................................................
4.5. abdomen ...........................................................................................................................................
4.6. joint ......................................................................................................................................................
4.7. gangrene ...........................................................................................................................................
4. 8. ulcer ...................................................................................................................................................
4. 9. congestion ......................................................................................................................................
4.10. incontinence .................................................................................................................................
5. Give appropriate medical term for the following:
5.1. a mass of plaque of degenerated, thickened arterial intima occurring in
atherosclerosis........................................................................................................................................
231
232
CHAPTER 18
233
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235
Apart from these requirements, the NMC (Nursing and Midwifery Council)
requests that nurses complete at least 6 months of nursing work in their home
country to consolidate their education experience. Nurses trying to obtain UK
registration without 6 months experience in their home country might experience problems getting onto the register.
(Joy Parkinson & Chris Brooker: Everyday English for International Nurses
- a guide to working in the UK. Churchill Livingstone, 2004)
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CHAPTER 19
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1. The individual smoker who becomes hooked after taking 60.000 or more
puffs a year on a cigarette. The minor vice of smoking- that silly little ha
bit- has been well learned through repetitive practice. Habits well learned
are hard to break!
2. Our society at large which finds itself hooked - burdened with a king-sized
tobacco industry, mammoth agricultural enterprise, a considerable source
of governmental revenues, and a significant customer of the communications media.
Thus, we identify sociocultural and economic factors, in addition to personal
gratification, in the perpetuation of a learned, adaptive behaviour that is also
a primary health risk.
Prevalence of smoking
From its introduction into Western civilization by explorers returning
from the New World, smoking, until recently, was viewed almost exclusively
as a masculine activity. Before World War I, a woman who smoked usually
demeaned her femininity. During the past sixty years, however, women have
gradually cast aside the moral and social stigmas surrounding cigarette use,
and since World War II they have been smoking more and more like men- and
dying like men! Statistics for the United States show that for the generation
born between 1951 and 1960, the percentages of men and women smokers
are almost equal. Women are not only starting to smoke at younger age but
are also becoming heavier smokers. While many smokers eventually give up
the practice, once a woman takes up smoking, she is less likely to quit than a
man. According to the US government surveys, the number of men smokers
dropped from 53 percent in 1964 to 37 percent currently, but women smokers
declined from 32 percent in 1964 to only 28 percent at present.
It appears that attitudes toward smoking are becoming increasingly negative, even among smokers themselves. More than 70 percent of smokers
currently agree that smoking is harmful to their health and could lead to
disease and death. In addition, an estimated nine out of ten smokers would
like to quit, and a large percentage of smokers think that there should be some
regulations against smoking. At the same time, non-smokers are becoming
more and more forceful in their demands for pollution-free public environments. Evidently both smokers and non-smokers are becoming somewhat
less tolerant of smoking.
Surveys of teenage smokers reveal that nearly 12 percent of young persons
between twelve and eighteen years of age are current, regular smokers, i.e.,
they smoke at least weekly. This figure represents an actual decline over a
recent five-year period. But for the first time, more female than male teen238
Not to be overlooked as a factor in cigarette consumption are the persistent promotional activities of tobacco companies and their advertising agencies. Agencies long ago discovered through motivational research that sales
could be increased if products were linked with basic human desires and
drives. Not content with assertions of mildness and good taste, advertisements soon depicted smokers as models of sophistication, eternal youth,
handsome ruggedness, enduring beauty, alluring sexuality, and determined
individualism, and with athletic prowess sufficient to walk at least a mile for
a favourite cigarette.
Smoking: An Adaptive Behaviour
These phenomena alone do not explain why people begin and continue
to smoke, especially when they frankly admit awareness of possible health
hazards. Many smokers express a desire to quit, but they just cannot manage
to do so. A consideration of smoking as adaptive behaviour may illuminate
the reasons and motivations involved in the use of cigarettes.
A Learned Behaviour
Smoking is a learned behaviour. No one is born a smoker, although the
new baby may interact with smokers and with smoke early in infancy - often
on the way home from the hospital after delivery. Curiosity and the desire to
imitate adults, especially smoking parents, probably encourage many children to experiment. The initial reaction, however, is likely to be unpleasant,
and usually there is no social approval forthcoming. It is not until adolescence
that smoking becomes a live option for most young persons. More time is now
spent away from home with peers; there is increased freedom from authority
figures who often discourage or forbid smoking; needs for security and acceptance through group conformity grow; and the demand or need for immediate
gratification flourishes. The psychological stage for smoking has been set
and is fertile enough to generate millions of new young smokers each year.
Psychological Rewards
The search for adulthood or maturity through the act of smoking appears
to be a primary factor in the initiation of cigarette use. Following the example
set by many adults and parents, adolescents partake of adulthood by smoking
- they feel older, more mature, and more important. Smoking may also help
them to overcome feelings of uncertainty and embarrassment in situations
that they find awkward. Thus, security is enhanced. There are other psychological rewards for the new smoker. Smoking may be the passport to acceptance
among ones peers; it may represent freedom or independence from restric240
tive home life or revolt against parental authority; it may be the result of an
unconscious desire to imitate esteemed smokers; it may be nothing more than
a soothing and pleasurable way to contract boredom. Because of the handto-mouth motions associated with lighting up, the cigarette may amount to a
convenient psychological recycling centre that provides a socially approved
and refreshing activity between environmental challenges. Some people like
the taste and smell of cigarettes, and a few get a kick out of watching the
smoke. In essence, the cigarette provides a smoker with a readily available
way to deal with a host of personal problems and needs.
Factors in Smoking Behaviour
1. Stimulation- If you score high or fairly high on this factor, it means that
you are one of those smokers who gets a lift from smoking - you feel that it
helps wake you up, organize your energies, and keep you going. The perkingup effect is due to nicotines temporary stimulation, which briefly relieves
fatigue. If you try to give up smoking, you may want a safe substitute: a brisk
walk or moderate exercise whenever you feel the urge to smoke.
2. Handling - Oral Gratification - Having something to handle, manipulate,
or fondle can be very satisfying. Additionally, having something in your mouth
to chew on, such as a toothpick, straw, or pencil, can fulfil certain emotional
needs. From a Freudian perspective, cigarette smoking may be seen as a
satisfaction of infantile needs to suck or chew - a fixation or libidinal energy
at the oral or mouth level. Why not try with a pen or pencil? Try doodling or
play with a coin, a piece of jewellery, or some other harmless object. If you
must put something in your mouth, use candy cigarettes or even a real cigarette if you can trust yourself not to light it.
3. Pleasurable Relaxation -About two-thirds of smokers score rather high
on the accentuation of pleasure. You smoke for positive feelings of contentment, achievement, victory, and satisfaction - such as upon completion of a
job well done or after a delicious, mouth-watering meal. Those who do get
real pleasure out of smoking often find that an honest consideration of the
harmful effect of their habit is enough to help them quit. They substitute eating,
drinking, social activities, and physical activities - within reasonable bounds
- and find they do not seriously miss their cigarettes.
4. Crutch-Tension Reduction - Many smokers use the cigarette to manage
negative effects, such as stressful situations and feelings of anger, fear, and
anxiety. Sometimes the cigarette is used as a tranquilizer or as an escape
vehicle from cares and worries. Thus, smoking represents a tension- reducing
activity. When the going gets rough, cigarettes can be a crutch, a comfort, and
a consolation. When it comes to quitting, this kind of smoker may find it easy
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to stop when everything is going well but may be tempted to start again in a
time of crisis. Again, physical exertion, eating, drinking, or social activity - in
moderation - may serve as useful substitutes in times of tension.
5. Craving- Psychological and Physical Addiction- Quitting smoking is difficult for the person who scores high on the factor of craving. For such an individual, the overpowering desire for the next cigarette begins to build up the
moment the old one is put out. A dependent or addicted smoker must have
a cigarette after a short period of time or otherwise experiences mild withdrawal symptoms - a nicotine fit with its uneasiness, restlessness, nervousness, anxiety, headache, digestive disturbances, and impairment of concentration, judgment, and psychomotor performance.
Peculiarly, the dependent smoker craves a cigarette, as in chain-smoking,
first to increase positive feelings and then to decrease negative feelings of
withdrawal. In essence, the smoker satisfies a need to smoke - a physical
need for more nicotine. Contrary to popular belief, research now suggests
that smoking does not reduce anxiety or calm nerves. Under stress, smokers
consume cigarettes heavily because stress depletes the bodys nicotine. Thus,
nicotine-deficient smokers smoke more under stress to maintain their usual
nicotine level.
Tapering off is not likely to work for dependent smokers. They must go
cold turkey. It may be helpful for them to smoke more than usual for a day
or two, so that the taste of cigarettes is spoiled, and then isolate themselves
completely from cigarettes until the craving is gone. Giving up cigarettes may
cause so much discomfort that once these persons quit, they will find it easy
to resist a return to smoking. Otherwise, they know that some day they will
have to go through the same agony again.
6. Habit-A behavioural pattern has been established almost involuntarily
by the habit smoker. This individual responds automatically to some cue - a
cup of coffee, getting into a car, or nearing the vicinity of an ashtray. Once
regarded as psychologically significant, smoking loses its former functions of
fulfilling status, relaxation, security, or other needs. Such a smoker no longer
gets much satisfaction from cigarettes.
Smoking: Agent of Maladaptation and Disease
From health point of view, personal gratification is acceptable for most
persons as long as it does not injure the individual or cause harm to other
persons. Unfortunately, smoking is now seen as a health threat to both.
Smokers, non-smokers, and even unborn children are caught up in this multifaceted problem leading to self indicated morbidity and premature mortality,
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tobacco
amblyopia
bronchitis
emphysema
coronary
heart disease
cirrhosis
of the liver
decreased
birth weight
lip, tongue,
gum cancer
larynx cancer
lung cancer
peptic ulcer
bladder cancer
accidents
Buerger's disease
peripheral
vascular
disease
Many diseases and conditions are associated with smoking. Not all are
causally related, but they should not be overlooked. For instance, accident
rates are higher for smokers than non-smokers. This includes fires in the
home caused by the smoker who dozes off with a lighted cigarette in hand.
The blood level of carbon monoxide is higher in smokers during the time they
are smoking. Increasing attention is being given to the question of whether
this carbon monoxide in the blood may be dulling the alertness of drivers to
the point where this is a contributory factor in auto accidents.
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oxygen by heart muscle. Because of its blood vessel narrowing effect, nicotine can also decrease peripheral blood flow, thus placing added stress on the
smokers heart. In its adaptive response to smoking the heart requires more
oxygen for its function. But carbon monoxide from cigarette smoke tends to
displace oxygen from hemoglobin, thus interfering with the transportation of
oxygen and depriving the heart muscle of its needed oxygen supply.
Recent evidence suggests that absorbed nicotine and carbon monoxide
contribute to the development of atherosclerosis (clogging of the arteries
with fatlike substances). Cigarette smoking may also be a factor in increased
platelet adhesiveness, which predisposes to blood clot formation.
Smoking and Chronic Obstructive Lung Diseases (COLD)
Pulmonary emphysema and chronic bronchitis, two diseases that until
recently were infrequently reported in the population, today are reaching
epidemic proportions. They are jointly referred to as COLD and are an adaptive response to inhaled irritants and a maladaptation to smoking.
Cigarette smoking has been identified as the most important cause of
COLD and increases greatly the risk of dying from pulmonary emphysema
and chronic bronchitis. While other factors, including hereditary predisposition, may contribute to COLD, cigarette smoking is now recognized as the
major factor in the promotion of pulmonary patients.
Chemicals in inhaled cigarette smoke irritate the bronchial tubes and alveolar sacs over and over again with each puff. In time, the tissues lining the
bronchi thicken, the mucous glands enlarge, and the normal cleansing system
of the lungs, especially ciliary function, is impaired. The smoker is now more
predisposed to respiratory infectious and aggravation of existing ones than
is the non-smoker.
Smoking and Lung Cancer
Most lung cancers originate in the lining or epithelium of the bronchi.
Normal epithelium cleanses the lungs of foreign matter such as dust or smoke
particles. Mucus secreted onto the surface of the epithelium, traps foreign
substances. Cilia, extending from the columnar cells, continually move the
mucus from the bronchi, through the trachea, and into the mouth, where it is
either swallowed or expectorated.
Tobacco smoke contains, in addition to tumour initiators and promoters,
substances that affect the cleansing action of the bronchial cells, and thus
indirectly influence the induction of lung cancer. These agents may impair
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and destroy cilia and may affect the mucus layer so that smoke particles are
retained in the bronchi.
In lung cancer victims, cures are rare, and 95 out of 100 persons who
develop lung cancer will be dead within five years. In fact, the survival rate for
the first year after diagnosis of lung cancer is only 25 percent.
Studies of the frequency, distribution, causes, and control of cigaretterelated diseases have led an overwhelming number of scientists to conclude
that smoking is the major cause of lung cancer in men. It is also a cause of lung
cancer in women, but for a variety of possible reasons - genetic, hormonal,
and differences in dose and frequency of exposure - it accounts for a smaller
proportion of cases in women than in men. However, the percentage of women
is steadily increasing and it is expected that lung cancer will soon surpass
breast cancer as the leading cancer peril to women. It is estimated that the
risk of death from this disease is nearly ten times greater for smokers than
for those who do not use cigarettes.
This uncontrolled growth or malignant neoplasm in the lungs is termed
bronchogenic carcinoma because it arises in the lining of the bronchial tubes
through which air passes inwardly to various parts of the lungs. The chances
of sustaining lung cancer are enhanced with increased numbers of cigarettes
smoked per day, with the duration or length of smoking, and with earlier initiation of use. The risks are reduced when smoking ceases. Apparently, cigarette
smoking triggers a disease process (via the tobacco tars) in which continual
repair and recovery are possible up to some critical point. Beyond this point,
the process is not reversible.
EXERCISES
1. Review Questions:
1.1. How has smoking helped humans adapt to their environment?
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1.3. According to health statistics, how do men and women differ in smoking
habits? .........................................................................................................................................................
1.4. How do cigarettes provide the smoker with personal gratifications that
are not found in other tobacco forms? .....................................................................................
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1.8. How does cigarette smoking account for the higher incidence of
cardiovascular disease?.....................................................................................................................
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1.9. What is pulmonary emphysema? How does it affect airflow within the
lungs?...........................................................................................................................................................
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1.10. What are the effects of chronic bronchitis? Is this more serious than
emphysema?............................................................................................................................................
1.11. How does cigarette smoking promote the development of cancer in
various parts of the body? ...............................................................................................................
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1.12. Do you think that risk-taking behaviour is a valid excuse for smoking?
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2.2. Two areas have often been ............................ in which remedial .............................
is more difficult to ..........................................................
2.3. Women are not only starting to smoke ................................................................... but
are also becoming ...................................................... smokers.
2.4. It appears that ............................................ toward ................................. are becoming
increasingly ...................................................................................
2.5. Many smokers ........................................... a desire to .................................................. but
they just cannot .................................................. to do so.
2.6. It is not until ................................................................... that smoking becomes a live
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CHAPTER 20
AIDS
Acquired immune deficiency syndrome, or AIDS, is a recently recognized
disease entity. It is caused by infection with the human immunodeficiency virus
(HIV), which attacks selected cells in the immune system and produces defects
in its function. These defects may not be apparent for years. They lead in a
relentless fashion, however, to a severe suppression of the immune systems
ability to resist harmful organisms. This leaves the body open to an invasion
by various infections, which are therefore called opportunistic diseases, and
to the development of unusual cancers. The virus also tends to reach certain
brain cells. This leads to the so-called neuropsychiatric abnormalities, or
psychological disturbances caused by physical damage to nerve cells.
Since the first AIDS cases were reported in 1981, through mid-1992, more
than 190,000 AIDS cases and more than 152,000 deaths had been reported
in the United States alone. This is only the top of the iceberg of HIV infection,
however. It is estimated that between 1 million and 1.5 million Americans had
been infected with the virus by the early 1990s but had not yet developed clinical symptoms. In addition, although the vast majority of documented cases
have occurred in the United States, AIDS cases have been reported in about
162 countries worldwide. Sub-Saharan Africa in particular appears to suffer
a heavy burden of this illness.
No cure or vaccine now exists for AIDS. Many of those infected with HIV
may not even be aware that they carry and can spread the virus. It is evident
that HIV infection represents an epidemic of serious proportions. Combating
it is a major challenge to biomedical scientists and health-care providers. HIV
infection and AIDS represent one of the most pressing public policy and public
health problems worldwide.
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Definition of AIDS
The U. S. CENTER FOR DISEASE CONTROL has established criteria for
defining cases of AIDS that are based on laboratory evidence, the presence
of certain opportunistic diseases, and a range of other conditions. The opportunistic diseases are generally the most prominent and life-threatening clinical manifestations of AIDS. It is now recognized, however, that neuropsychiatric manifestations of HIV infection of the brain are also common. Other
complications of HIV infection include fever, diarrhea, severe weight loss, and
swollen lymph nodes.
When HIV-infected persons experience some of the above symptoms but
do not meet full criteria for AIDS, they are given the diagnosis of AIDS-related
complex, or ARC. The growing feeling is that asymptomatic HIV infection and
ARC should not be viewed as distinct entities but, rather, as stages of an irreversible progression toward AIDS.
Historical Background
In the late 1970s, certain rare types of cancer and a variety of serious
infections were recognized to be occurring in increasing numbers of previously healthy persons. Strikingly, these were disorders that would hardly ever
threaten persons with normally functioning immune systems. First formally
described in 1981, the syndrome was observed predominantly to be affecting
homosexual and bisexual men. Soon thereafter, intravenous drug users,
hemophiliacs, and recipients of blood transfusions were recognized as being
at increased risk for disease as well. It was also noted that sexual partners
of persons displaying the syndrome could contract the disease.
Further study of AIDS patients revealed marked depletion of certain
white blood cells, called T4 lymphocytes. These cells play a crucial role in
orchestrating the bodys immune defences against invading organisms. It
was presumed that this defect in AIDS patients was acquired in a common
manner. Then, in 1983, a T-cell lymph tropic virus was separately discovered
by Robert Gallo at the U. S. National Institutes of Health and Luc Montaigne at
Frances Pasteur Institute. The virus was at first given various names: human
lymphotropic virus (HTLV) III, lymphadenopathy-associated virus (LAV), and
AIDS -associated retrovirus (ARV). It is now officially called human immunodeficiency virus (HIV), and considerable evidence demonstrates that it is indeed
the causative agent for AIDS. A second strain that has been identified, HIV-2,
is thus far relatively rare outside of Africa.
Little is known about the biological and geographical origins of HIV. Apparently, however, this is the first time in modern history that the virus has spread
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widely among human beings. Related viruses have been observed in animal
populations, such as certain African monkeys, but these do not produce
disease in humans.
The Nature of the Virus
HIV is an RNA RETROVIRUS. Viewed in an electron microscope, it has a
dense cylindrical core that encases two molecules of viral RNA genetic material. A spherical outer envelope surrounds the core.
Like all retroviruses, HIV possesses a special enzyme, called reverse transcriptase, which is able to make a DNA copy of the viral DNA. This enables the
virus to reverse the normal flow of genetic information and to incorporate its
viral genes into the genetic material of its host. The virus may then remain
in a latent form for a variable and often lengthy period of time until it is reactivated. Further knowledge of the mechanisms and triggers of the activation
process is important to the efforts being made to control HIV infection.
A critical step in HIV infection is the binding of the virus to a host-cell
receptor, enabling it to gain entrance into the cell. Studies have demonstrated
that a molecule called CD4, expressed predominantly on the surface of the T4
cell, serves as this receptor. Although the T4 cell is a major HIV target, virtually any other cell also expressing the CD4 surface molecule is able to become
infected with HIV. Thus cells of the monocyte and macrophage type are very
important additional targets.
Modes of Transmission
Researchers have isolated HIV from a number of body fluids, including
blood, semen, saliva, tears, urine, cerebrospinal fluid, breast milk, and certain
cervical and vaginal secretions. Strong evidence indicates, however, that HIV
is transmitted only through three primary routes: sexual intercourse, whether
vaginal or anal, with an infected individual; nondigestive exposure to infected
blood or blood products; and from an infected mother to her child before or
during birth.
At least 97 percent of U.S. AIDS cases have been transmitted through one
of these routes, with transmission between homosexual men accounting for
about 60 percent of the cases. Heterosexual transmission in the United States
accounts for only about 5 percent of cases but is a significant mode of transmission in Africa and Asia. About 21 percent of AIDS cases occur in intravenous drug abusers exposed to HIV-infected blood through shared needles.
Current practices of screening blood donors and testing all donated blood
and plasma for HIV antibodies have reduced the number of cumulative cases
due to transfusion to about 1 percent.
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Many AIDS patients develop cancers, including Kaposi sarcoma (KS), nonHodgkin lymphoma, and Hodgkin disease. KS occurs in patients who manifest hardly any evidence of immunological impairment, indicating that other
factors may also be at work in the development of such cancers. Among the
non-Hodgkin lymphomas are immunoblastic and Burkitt-type lymphomas as
well as primary brain lymphomas. These tumours tend to be unusually aggressive and poorly responsive to chemotherapy, particularly in AIDS patients who
have already experienced opportunistic infections.
Other HIV-Related Disorders and Co-Factors
Neuropsychiatric manifestations occur in about 60 percent of HIV-infected
persons. It is now well established that HIV can exist and proliferate within
the brain, spinal cord, and peripheral nerves. This results in a broad range of
symptoms, including meningoencephalitis and dementia. Evidence thus far
indicates that circulating HIV-infected monocytes may be responsible for the
initiation of infection in the brain, with little evidence to support direct infection of neuron tissue by HIV.
Blood-cell abnormalities of HIV patients include anemia, reduced white
blood-cell counts, and platelet deficiencies. Researchers have also been able
to show direct infection of bone-marrow cells--the precursors of circulating
blood cells-- and the proliferation of the virus within these cells. Thus bone
marrow may represent an important reservoir of HIV in an infected person
and provide a potential mechanism for dissemination of the virus through
the body. Other HIV-related syndromes include nephritis, arthritis, and lung
inflammation (pneumonitis).
Certain co-factors appear to play an important role in HIV infection and
AIDS by increasing susceptibility to infection and by enhancing viral-disease
activity. Other sexually transmitted diseases appear to be of particular significance. Damage to genital skin and mucous membranes may facilitate transmission of the virus. In addition, laboratory studies show that certain microbes
frequently found in AIDS patients, such as mycoplasmas, also probably act
as co-factors.
Treatment of HIV
Two major avenues are being pursued by biomedical scientists in the fight
against HIV infection and AIDS One strategy is to develop a vaccine that can
induce neutralizing antibodies against HIV and protect uninfected individuals
if exposed to the virus itself. The second approach involves the discovery and
development of therapeutic agents against HIV infection and AIDS.
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The slow process of FDA approval of new AIDS drugs has developed into a
political issue. AIDS activists are demanding that the government speed up
authorization by postponing certain tests comparing efficacy and ability to
prolong life until after the drug is on the market. While a faster approval rate
may expose patients to unforeseen side effects, activists argue that patients
with life-threatening diseases who have no alternative therapy should still be
entitled to choose these drugs.
Efforts at Prevention
In the absence of an effective vaccine or therapy, education and risk reduction remain the most powerful tools in the fight against AIDS. Because of the
limited number of transmission routes, the further spread of AIDS could virtually be stopped by avoiding behaviours that place persons at risk. Education
can help to achieve this, through development and dissemination of materials
by local community groups, statewide organizations, and national governments. In 1988, for example, the U.S. Public Health Service produced a simple,
straightforward brochure containing information about HIV infection and AIDS.
The brochure was mailed to every household in the U.S.A.
A test to screen blood directly for antibodies to HIV was developed and
made available. The presence of antibodies, which generally takes weeks
or months to develop, means only that an individual has been exposed to the
virus. It does not indicate whether that individual has or will develop AIDS,
although this is almost certain.
All blood intended for use in transfusion or manufacture of blood products is now tested for the antibody. The standardized procedure involves the
use of the ELISA (enzyme-linked immunosorbent assay) screening test, with
confirmation of positive results with a more specific test known as the Western
Blot. Blood that tests positive on any of these is absolutely eliminated from
the blood-donation pool. Tissue and organ banks use a similar process. Blood
donations themselves pose no risk of HIV infection at all, because sterile equipment is always used.
Conclusion
The AIDS epidemic is having a profound impact on many aspects of medicine and health care. The U.S. Public Health Service estimates that the annual
cumulative lifetime cost of treating all persons with AIDS in the United States
in 1991 is $5.3 billion; this is expected to reach $7.8 billion by 1993. The Public
Health Service budget for AIDS research was $849 million in 1991. Persons
exposed to HIV are having difficulties in obtaining adequate health insurance
coverage. Year AZT expenses, for example, can average approximately $6,000,
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although in 1989 the drugs maker did offer to distribute AZT freely to HIVinfected children. The yearly expense for DDI is somewhat less at $2,000.
The effects of the epidemic on society at large are increasingly evident. AIDS
tests are now required in the military services. Various proposals have been
made for mandatory screening of other groups such as health-care workers,
especially since a Florida dentist who died of AIDS in 1990 is believed to have
infected five patients. A number of nations, including the United States, have
instituted stringent rules for testing long-term foreign visitors or potential
immigrants for AIDS, as well as testing returning foreign nationals. In the
United States one frequent phenomenon is the effort to keep school-age children with AIDS isolated from their classmates, if not out of school altogether.
Governmental and civil rights organizations have countered restrictive moves
with a great deal of success. There is little doubt that the ultimate physical
toll of the AIDS epidemic will be high, as will be its economic costs, however
the social issues are resolved. Concerted efforts are under way to address
the problem at many levels, and they offer hope for successful strategies to
combat HIV-induced disease.
Margaret A. Hamburg, M.D.
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CHAPTER 21
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3. Relaxation/Meditation
Another way to reduce stress in the body is through certain disciplines
which fall under the heading of relaxation techniques. Just as we are all
capable of mounting and sustaining a stress reaction, we have also inherited
the ability to put our bodies into a state of deep relaxation which Dr. Herbert
Benson of Harvard University has named the relaxation response. In this
state, all the physiologic events in the stress reaction are reversed: pulse
slows, blood pressure falls, breathing slows and muscles relax.
Where the stress reaction is automatic, however, the relaxation response
needs to be brought forth by intention. Fortunately, there are many ways of
doing this. Sitting quietly by a lake or fireplace, gently petting the family cat,
lying on a hammock and other restful activities can generate this state. There
also are specific skills that can be learned which are efficient and beneficial.
A state of deep relaxation achieved through meditation or self-hypnosis is
actually more physiologically restful than sleep. These techniques are best
learned through formal training courses which are taught in a variety of places.
Books and relaxation tapes can be used when courses are not available or are
beyond the patients budget.
I can attest to the benefits of regular meditation from personal experience. And on days when exercise is not possible, relaxation techniques are an
excellent way to bring down the bodys stress level. Whereas exercise dissipates stress energy, relaxation techniques neutralize it, producing a calming
effect. As little as 20 minutes once or twice per day confers significant benefit.
4. Sleep
As mundane as it sounds, sleep is an important way of reducing stress.
Chronically stressed patients almost all suffer from fatigue (in some cases
resulting from stress-induced insomnia), and people who are tired do not cope
well with stressful situations. These dynamics can create a vicious cycle. When
distressed patients get more sleep, they feel better and are more resilient and
adaptable in dealing with day-to-day events. I always ask patients how much
sleep they are getting, whether they wake up rested or tired, and how much
sleep they generally need to function well. Most people know what their usual
sleep requirement is (the range is five to 10 hours per night; the average being
seven to eight), but a surprisingly large percentage of the population is chronically sleep deprived. I urge patients to go to bed 30 to 60 minutes earlier and to
monitor the results after a few days or a week. If they are still tired, I suggest
a bedtime 30 minutes earlier than this. Eventually, they find what works for
them. The three criteria of success are waking refreshed, good daytime energy
and waking naturally before the alarm goes off in the morning.
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Sleeping-in is fine but if you sleep too long, it throws off your body rhythms
during the following day. It is better to go to bed earlier. Daytime naps are an
interesting phenomenon. They can be valuable if they are short and timed
properly (i.e., not in the evening). The power nap or catnap is a short sleep
(five to 20 minutes) that can be rejuvenating. A nap lasting more than 30
minutes can make you feel groggy. Patients with insomnia should be discouraged from daytime naps. Beyond these cautionary notes, sleep can be key in
reducing stress and helping patients cope and function better.
5. Time-outs and Leisure
No one would expect a hockey player to play an entire game without taking
breaks. Surprisingly though, many otherwise rational people think nothing of
working from dawn to dusk without taking intermissions, and then wonder
why they become distressed. The two major issues are pacing and work/
leisure balance.
Pacing has two components: monitoring your stress and energy level, and
then pacing yourself accordingly. It is about awareness and vigilance; knowing
when to extend yourself and when to ease up. It is also about acting on the
information your body gives you. A diagram designed by Dr. Peter Nixon, a
British cardiologist, illustrates some important points:
Increased stress produces increased performance, initially.
Once you pass a certain point (the hump), any more stress results in
decreased performance. Trying harder at this point is unproductive or
even counterproductive. The only sensible move is to take a break.
We need a certain amount of stress to function well (healthy tension) this is called eustress (good stress). However, stress becomes harmful
(distress) when there is too much, when it lasts too long or when it
occurs too often.
One of the first symptoms of distress is fatigue, which we tend to ignore.
Dr. Nixon advocates a healthy respect for fatigue and doing something
about it before it becomes exhaustion.
An important key to pacing is taking periodic time-outs. Too many people
go far too long without breaks. Dr. Ernest L. Rossi wrote The 20-Minute Break,
an excellent book extolling the virtues of a short recess every couple of hours
throughout the day. Just as we all have cycles of deep sleep and dream sleep
throughout the night (at roughly 90- to 120-minute intervals), we also have
cycles through the day: peaks of energy and concentration interspersed with
troughs of low energy and inefficiency. These cycles are called ultradian
rhythms because they happen many times per day (as opposed to the 24-hour
circadian rhythm with which we are all familiar). The main point of the book
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is that we need to watch for these troughs and take 20 minute ultradian
healing breaks when they occur, as opposed to working through them and
building up stress.
It is not always convenient for people to take time-outs when nature tells
us to but we can all become better at this. A mid morning break, lunch, a mid
afternoon break and supper divide the day into roughly two-hour segments.
These time-outs can include power naps, meditation, daydreaming, a social
interlude, a short walk, a refreshment break, a change to low-concentration
tasks or listening to music. Since I (and some of my patients) have started to
work with this biologic pattern (instead of resisting it), the results have been
pleasing. Like the catnap, it is simply a good investment of time that pays itself
back quickly in increased productivity and reduced stress.
Work-leisure balance. Despite all our labour-saving devices, leisure is
still an elusive commodity for most people. Statistics show that the average
American (and probably Canadian) is working an extra three hours per week
compared with 20 years ago. That translates into an extra month of work each
year. Add to that the phenomenon of the two career family (which makes family
and leisure time even more scarce) and you start to get a picture of society on
an accelerating treadmill.
Leisure time and levels of distress are inversely proportional - the less
leisure, the more stress. I ask patients to fill in a chart so we can both see what
their work/leisure ratio looks like. I ask them to think of their lives (excluding
sleep time) in four compartments (work, family, community and self) and then
to assess what percentage of their time and energy in an average week goes
into each part. There is no normal range but I become concerned when work
is over 60% and/or when self is less than 10%. We all require time to meet
our own needs (self-care, self-nurturing, etc.) and when that is neglected,
trouble usually follows. Self directed activities can include exercise or recreation, relaxation, socializing, entertainment and hobbies. The word leisure
is derived from the Latin word licere which means permission. The main
reason so many people do not have enough leisure is that they are not giving
themselves permission to make the time to enjoy it.
Leisure is one of the most pleasant stress relievers ever invented. It is
strange that people resist it so much (e.g., feeling selfish, guilty). I am not
preaching hedonism - just a healthy amount of necessary respite from the
days pressures. We as doctors can give patients permission if they will not
give it to themselves. Once they experience a payoff, the benefits will reinforce
the behaviour. After that, they are usually able to give themselves permission.
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6. Realistic Expectations
A common source of stress is unrealistic expectations. People often become
upset about something, not because it is innately stressful, but because it
does not concur with what they expected. Take, for example, the experience
of driving in slow-moving traffic. If it happens at rush hour, you may not like
it but it will not surprise or upset you. However, if it occurs on a Sunday afternoon, especially if it makes you late for something, you are more likely to be
stressed by it.
When expectations are realistic, life feels more predictable and therefore
more manageable. There is an increased feeling of control because you can
plan and prepare yourself (physically and psychologically). For example, if you
know in advance when you have to work overtime or stay late, you will take it
more in stride than when it is dropped on you at the last minute.
There is much we can do to help patients by letting them know when their
expectations (of themselves and others) are unrealistic. I remember a patient
berating himself and feeling guilty because he did not love his stepdaughter
as much as his own biologic children. Blended families are common and I
suspect many people struggle with this issue of love and loyalty. I asked this
man where he got the idea that he would love his second wifes children as
if they were his own. He did not know. I suggested to him that his expectation was probably unrealistic, especially early in the new marriage. He felt
relieved by this idea and stopped putting pressure on himself to feel something he did not feel.
As for expectations of others, another patient said: Expect less from people
who cannot give you what you want. It makes it easier - not great, just less
upsetting.
7. Reframing
This is one of the most powerful and creative stress reducers of which I
know. Reframing is a technique used to change the way you look at things
in order to feel better about them. We all do this inadvertently at times. For
example, many people viewed the baseball, or football strikes as a personal
disaster whereas others immediately realized they were going to save a lot
of time and money by not hotfooting it down to the ballpark whenever their
favourite teams were in town.
The key to reframing is to recognize that there are many ways to interpret
the same situation. It is like the age-old question: Is the glass half empty or
half full? The answer of course is that it is both or either, depending on your
point of view. As Dr. Joel Goodman put it at The Power of Laughter and Play
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Conference, Toronto, 1986: There is more than one meaning to the same
reality. However, if you see the glass as half full, it will feel different than
seeing it as half empty because the way we feel almost always results from
the way we think. The message of reframing, then, is that there are many
ways of seeing the same thing - so you might as well pick the one you like.
One of the things we can do with patients is help them reframe stressful
situations. This most often involves helping them see positives in a negative
situation and assisting them in understanding the behaviour of other people.
It is best to get the patient to provide the input first (to which you can add
later) by asking certain questions. The information is more meaningful when
it comes from them. For example, I had a patient who lost her job because of
a chronic, though not life-threatening illness. I asked if anything positive had
come out of this experience and she came up with several things, including
It will make me a stronger person, I never liked the work I was doing
before. This gives me the chance to do what I really want to do, It has made
my marriage stronger, It has brought me closer to my family, and I have
learned to watch my money and spend more carefully, which I never had to
do before. I then asked her to focus on what is there (what she can still do)
rather than what is missing (due to the restrictions of her illness). She replied,
Most things - my hobbies, watch television, go to the cottage, socialize, go
out; although some things are still (physically) uncomfortable. By asking her
to think about her illness from a different perspective, she was encouraged to
reframe the situation and she felt better emotionally as a result.
In terms of reframing the behaviour of other people, ask patients why they
think someone did what they did. For example, a womans boss was acting
critical and domineering towards her. I said, Assuming your boss is not just
evil or malicious, why do you think she might be acting like this? Answers
included, She is probably insecure, She is under a lot of pressure2, and
She is having personal problems. Performing this exercise helped the patient
step outside herself and look at other possible interpretations of her bosss
behaviour. After that, her upset was considerably decreased. In fact, after such
a discussion some patients feel more compassion than anger for the person
who is bothering them.
Notice that reframing does not change the external reality but simply helps
people view things differently (and less stressfully). It should be done with a
bit of preamble to explain the premise (e.g., using the glass half empty as an
illustration) and only after you have acknowledged the validity of the patients
initial (stressful) interpretation. You are not trying to disrespect their point of
view but only to suggest there are other, less stressful ways of looking at the
same thing.
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8. Belief Systems
A lot of stress results from our beliefs. We have literally thousands of premises and assumptions about all kinds of things that we hold to be the truth
- everything from, You cant fight City Hall and The customer is always
right, to Men shouldnt show their emotions and Children should make
their beds. We have beliefs about how things are, how people should behave
and about ourselves (I can never remember peoples names). Most of our
beliefs are held unconsciously so we are unaware of them. This gives them
more power over us and allows them to run our lives.
Beliefs cause stress in two ways. The first is the behaviour that results from
them. For example, if you believe that work should come before pleasure, you
are likely to work harder and have less leisure time than you would otherwise.
If you believe that people should meet the needs of others before they meet
their own, you are likely to neglect yourself to some extent. Several patients
tell me, If you want something done right, you have to do it yourself They do
not delegate well and tend to get overloaded.
In the above three cases, the beliefs are expressions of peoples philosophy or value system, but all lead to increased effort and decreased relaxation - a formula for stress. There is no objective truth to begin with. These
are really just opinions but they lead to stressful behaviour. Helping patients
uncover the unconscious assumptions behind their actions can be helpful in
getting them to change.
The second way beliefs cause stress is when they are in conflict with those
of other people. One of my patients had a fight with his son because the child
wore the same clothes several days in a row. I asked why it bothered him
and he replied, Because you should change your clothes every day. I asked
him where this idea originated: Well, my mother taught me that. Everyone
knows you should change your clothes every day. I told him that this was not
the truth, but merely his opinion based on the way he was raised. I said I
had lived in cultures where people did not change clothes often and nothing
bad happened to them. I helped him see that this was a premise he held but
one which was not shared by his son. The argument was not over the clothes
themselves but merely about a difference of opinion. Once he recognized his
belief was not true, his anger diminished.
We can do much for patients by getting them to articulate their beliefs
and then to label them as such. Next, we need to help them acknowledge
that their assumptions are not truth but rather opinions and, therefore, they
can be challenged. Lastly, we can help patients revise their beliefs or at least
admit that the beliefs held by the other person may be just as valid as their
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own. This is a mind-opening exercise and usually diminishes the upset the
patient was experiencing.
9. Ventilation/Support System
We have all had patients who come into the office upset, talking incessantly about a problem, and feeling better when they are finished. They have
told their story, cried or made some admission, and the act of doing so in the
presence of a trusted and empathic listener has been therapeutic. We often
do not have to say much. We just have to be there, listen attentively and show
our concern and caring. On other occasions we might offer validation, encouragement or advice. But the combination of the patient being able to ventilate
and our support can be profoundly beneficial.
There is an old saying that a problem shared is a problem halved. People
who keep things to themselves carry a considerable and unnecessary burden.
We can do much for patients by allowing them to ventilate or encouraging
them to do so. We can also help by urging them to develop a support system
(a few trusted relatives, co-workers or friends to talk to when they are upset
or worried).
Another form of ventilation that many patients find helpful is writing, for
example in a private journal at home. Former tennis star Guillermo Vilas once
said: When my life is going well, I live it. When its not going well, I write it.
When patients are angry, I often suggest they write a letter to the person
at whom they are vexed. These letters are not for sending; they should be
destroyed once they are written- unread. The value is in expressing the feelings and getting them out. Rereading the letter just reinforces the upset and
fans the flames of anger all over again.
10. Humour
Humour is a wonderful stress reducer, an antidote to upsets. Laughter
relieves tension. In fact, we often laugh hardest when we have been feeling
most tense.
One of my patients was lamenting the 15 pounds she gained over the winter
and the fact that she could not get into her bathing suit. She had always
been sensitive about her weight. While talking about her upset she suddenly
stopped, her face softened and a smile came to her lips. You know what?
Ive just decided, she said. Ill swim in the dark this year. Another case
involved a man who worked in a busy company dealt with customers at the
counter, customers on the phone and staff members who needed his help.
He felt besieged often from several directions at once. He told me he started
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using a phrase which helped him cope and gave him a laugh; I love it when
they fight over me. In both cases, patients generated their own humour and
reduced their upset.
Humour is an individual thing- what is funny to one individual may be hurtful
to another. It is wonderful when patients can poke fun at themselves. We can
also do this with patients, but we have to be careful and respectful in what
we say. If you think of something funny that may help the patient, say it if you
feel it will ease their tension and not be offensive. I will often throw in a quip
or joke when I think it is appropriate. When it is done sensitively, laughter is
a great gift to people you care about.
Conclusion
One of the most important things we can do for patients is teach them about
stress management. Even better, we can learn these lessons ourselves and
then model them for our patients. Although there are many approaches to
stress management, this article has listed 10 ways for reducing stress that are
practical, beneficial and which even busy physicians can start implementing
immediately - for their patients and for themselves.
Reference
1. Schor, JB: The Overworked American. Basic Books, New York, 1991, p. 11.
Suggested Reading
1. Watzlawick, P, Weakland, J, Fisch, R: Change. Norton, New York, 1974.
2. Selye, H: Stress Without Distress. Signet, Scarborough, 1975.
3. Benson, H: The Relaxation Response. Avon, New York, 1975.
4. Freudenberger, HJ: Bum-Out. Bantam, NewYork,1980.
5. Eliot, RS: Is it Worth Dying For? Bantam, New York, 1984.
6. Borysenko, J: Minding the Body, Mending the Mind. Addison-Wesley, 1987.
7. Schor, JB: The Overworked American. Basic Books, New York, 1991.
8. Dominguez, J, Robin, V: Your Money or Your Life. Viking, New York, 1992.
9. Prochaska, J, Norcross, J, DiClemente, C: Changing For Good. Morrow,
New York, 1994.
10. Rainham, DC: Winning Your Battle With Stress. Optimum Health Resources,
900 King Street, W., Kitchener, Ontario, N2G 1G5,I994.
11. Posen, DB: Always Change a Losing Game. Key Porter, Toronto, 1994.
12. Presented at Tri-University Winter Medical Symposium St. Petersburg,
Florida March 11, 1995.
13. Dr. Posen practiced family medicine in Oakville, Ontario until 1985, when he
gave up his family practice to devote his time exclusively to stress manage271
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CHAPTER 22
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2. Nuclear Medicine
Radioactivity and radionuclides
The emission of energy in the form of particles or rays coming from the
interior of a substance is called radioactivity. A radionuclide or radioisotope
is a substance that gives off high-energy particles or rays as it disintegrates.
Half-life is the time required for a radio-substance to lose half of its radioactivity by disintegration. The half-life must be long enough to allow for diagnostic imaging but as short as possible to minimize patients exposure to radiation. Radionuclides emit three types of radioactivity: alpha particles, beta
particles, and gamma rays. Gamma rays, which have greater penetrating
ability than alpha and beta particles, and more ionizing power, are especially
useful in both the diagnosis and the treatment of disease. Technetium-99m
is a pure gamma emitter with a half-life of 6 hours. Its properties make it the
most frequently used radionuclide in diagnostic imaging.
Nuclear medicine physicians use two types of tests in the diagnosis of
disease: in vitro (in the test tube) and in vivo (in the body). In vitro procedures
involve analysis of blood and urine specimens using radioactive chemicals.
RIA (radioimmunoassay) is an in vitro procedure to detect hormones and drugs
in a patients blood. In vivo tests trace the amounts of radioactive substance
within the body.
Examples of diagnostic procedures that utilize radionuclides.
1. Bone scan. 99mTc(technetium) is used to label phosphate substances and
is injected intravenously. The scan is useful in demonstrating malignant
metastasis to the skeleton.
2. Gallium scan. The radioisotope gallium-67 is injected intravenously and
has an affinity for tumours and non-neoplastic lesions such as abscesses.
3. Liver and spleen scan. To visualize the liver and spleen, a radiopharmaceutical (99mTc and sulphur colloid) is injected intravenously, and images
are taken with a scintiscanner (gamma camera).
4. Positron emission tomography (PET scan). Radioactive substances are
given intravenously and then emit positrons which create a cross-sectional
image of the metabolism of the body. PET scanning has determined that
schizophrenics do not metabolize glucose equally in all parts of the brain
and that drug treatment can bring improvement to these organs.
5. Single-photon emission computed tomography (SPECT). Clinical application includes detecting liver tumours, detecting cardiac ischemia, and
evaluating bone diseases of the spine.
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AP - anteroposterior
Ba - barium
CT - computerized tomography
DI - diagnostic imaging
LAT - lateral
PA - posteroanterior
Tomography.
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CHAPTER 23
PHARMACOLOGY
Introduction
Drugs (medicines) are substances used to prevent or treat a condition or
disease. Drugs are obtained from parts of plants, such as the roots, leaves, and
fruit. An example of a plant-derived drug is a cardiac medicine, digitalis (from
the foxglove plant). Other drugs (antibiotics such as penicillin) are obtained
from yeast, moulds, and fungi. Drugs are also obtained from animals; for
example, hormones are secretions from the glands of animals. Some drugs
are synthesized in a laboratory. Anticancer drugs, such as methotrexate and
prednisone, are laboratory synthesized drugs. Vitamins are drugs that are
isolated from plant or animal sources and are contained in foods.
A pharmacist prepares and dispenses drugs through a pharmacy (drugstore) on written orders from a physician. Currently, most schools/colleges
of pharmacy offer a Pharm. D. (Doctor of Pharmacy) degree after six or seven
years of study. As a health care professional, a pharmacist cooperates with,
and sometimes advices licensed practitioners concerning drugs. In addition,
the pharmacist answers patients questions concerning their prescription
needs.
Pharmacology is the study of the preparation, properties, uses, and action
of drugs. A pharmacologist is either an M.D.(Medical Doctor) or a Ph.D.(Doctor
of philosophy) who specializes in pharmacology. Pharmacology contains many
subdivisions of study: medicinal chemistry, pharmacodynamics, pharmacokinetics, molecular pharmacology, chemotherapy, and toxicology.
Medicinal chemistry is the study of new drug synthesis and the relationship between chemical structure and biological effect. Pharmacodynamics
involves the study of drug effects in the body. The mathematical description
of drug disposition (appearance and disappearance) in the body over time is
pharmacokinetics. Molecular pharmacology involves the interaction of drugs
and subcellular entities, such as DNA, RNA, and enzymes.
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Chemotherapy is the study of drugs that destroy microorganisms, parasites, or malignant cells within the body.
Toxicology is the study of the harmful effects of drugs and chemicals on
the body. A toxicologist is also interested in finding proper antidotes to any
harmful effects of drugs.
A drug can have three different names. The chemical name is the chemical formula for the drug; the generic name (shorter and less complicated)
identifies the drug legally and scientifically; the brand name or trademark is
the private property of the individual drug manufacturer
Chemical Name Generic Name Brand Name
Derivative of 6-aminopenicillanic acid ampicillin Omnipen
Polycillin
Principen
Totacillin
Administration of Drugs
How a drug is introduced into the body:
Oral administration. Drugs given by mouth are slowly absorbed into the
bloodstream through the stomach or intestinal wall. This method although
convenient for the patient, has several disadvantages: it can be destroyed in
the digestive tract or cannot pass through the intestinal mucosa. It is also not
good in case when time is an important factor in therapy.
Sublingual administration. Drugs placed under the tongue dissolve in the
saliva. Nitro-glycerine is administered in this way.
Rectal administration. Suppositories and aqueous solutions are inserted
into the rectum. Drugs are given by rectum when oral administration presents
difficulties, as when the patient is nauseated and vomiting.
Parenteral administration. Injection of drug from a syringe through a
hollow needle placed under the skin, into a muscle, vein, or body cavity. There
are several types of parenteral injections:
1. Intracavitary injection. This injection is made into a body cavity, such as
the peritoneal or pleural cavity.
2. Intradermal injections. This shallow injection is made into the upper layers
of the skin and is used chiefly in skin testing for allergic reactions.
3. Intramuscular injection (IM). The buttock or upper arm is usually the site
for this injection.
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4. Intrathecal injection. This injection is made into the space under the
membranes (meninges) surrounding the spinal cord and brain. Methotrexate is injected intrathecally for treatment of leukemia.
5. Intravenous injection. This injection is made directly into a vein. It is used
when an immediate effect from the drug is desired.
6. Subcutaneous injection. Introduction of a hypodermic needle under the
skin, usually on the upper arm, thigh, or abdomen.
Inhalation. Vapours, or gases, taken into the nose or mouth are absorbed
into the bloodstream through the thin walls of air sacs in the lungs.
Topical Application. Drugs are locally applied on the skin or mucous
membranes of the body. Antiseptics (against infection) and antipruritics
(against itching) are commonly used as ointments, creams, and lotions.
Terminology of Drug Action
When a drug enters the body, the target substance with which the drug
interacts to produce its effects is called a receptor. The following terms
describe the action and interaction of drugs in the body after they have been
absorbed into the bloodstream:
Additive Action. If the combination of two similar drugs is equal to the sum
of the effects of each, then the drugs are called additive. If two drugs give less
than an additive effect, they are called antagonistic. If they produce greater
than additive effect, they are called synergistic.
Synergism. A combination of two drugs can sometimes cause an effect that
is greater than the sum of the individual effects of each drug given alone. For
example penicillin and streptomycin produce a synergistic effect.
Tolerance. Tolerance is a feature of addiction to drugs such as morphine.
Addiction is the physical and psychological dependence on and craving for a
drug.
Drug Toxicity
Drug toxicity is the poisonous and potentially dangerous effect of some
drugs. Idiosyncrasy is an example of an unpredictable type of drug toxicity.
This is an unexpected effect that appears in the patient following administration of a drag. In some patients penicillin causes an idiosyncratic reaction,
such as anaphylaxis (acute hypersensitivity with asthma and shock).
Iatrogenic (produced by treatment) disorders can occur, however, as a
result of mistakes in drug use or in individual sensitivity to a given agent.
Side effects are toxic effects that routinely result from the use of a drug. For
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example, nausea, vomiting, and alopecia are common side effects of chemotherapeutic drugs used to treat cancer. Contraindications are factors in a
patients condition that make the use of a drug dangerous and ill advised.
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CHAPTER 24
PSYCHIATRY
Psychiatry (psych/o means mind, iatr/o means treatment) is the branch of
medicine that deals with the diagnosis, treatment, and prevention of mental
illnesses.
Psychiatrists complete the same medical training as other physicians and
receive an M.D. degree. Then they spend a varying number of years training in
the methods and practice of psychotherapy and drug therapy. Psychiatrists
can also take additional years of training to specialize in various aspects of
psychiatry. Child psychiatrists specialize in the treatment of children; forensic
psychiatrists specialize in the legal aspects of psychiatry, such as the determination of mental competence in criminal cases. Psychoanalysts complete 3
to 5 years of training in a special psychotherapeutic technique called psychoanalysis in which the patient freely relates her or his thoughts to the analyst,
who does not interfere in the flow of thoughts.
A psychologist is a non medical person who is trained in methods of psychotherapy, analysis, and research. A clinical psychologist, like a psychiatrist, can
use various methods of psychotherapy to treat patients, but, unlike the psychiatrists, cannot prescribe drugs or electroconvulsive therapy. Other nonphysicians trained in the treatment of mental illness are licensed clinical social
workers and psychiatric nurses. Clinical psychologists are trained in the use of
tests to evaluate various aspects of a patients mental health and intelligence.
Psychiatric Clinical Symptoms
These terms describe abnormalities in behaviour that are evident to an
examining mental health professional.
amnesia
Loss of memory.
anxiety
Varying degrees of uneasiness, apprehension, or dread often
accompanied by palpitations, tightness in the chest, breathlessness, and choking sensations.
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apathy
Absence of emotions ; lack of interest or emotional involvement.
autism
Severe lack of responsiveness to others, preoccupation with
inner thoughts; withdrawal and retarded language development.
compulsion
Uncontrollable urge to perform an act repeatedly.
conversion
Anxiety becomes a bodily symptom, such as blindness, deafness, or paralysis, that does not have an organic basis.
delusion
A fixed, false belief that cannot be changed by logical reasoning or evidence.
dissociation
Uncomfortable feelings are separated from their real object.
In order to avoid mental distress, the feelings are redirected
toward a second object or behaviour pattern.
dysphoria
Sadness, hopelessness; depressive mood.
euphoria
Exaggerated feeling of well-being (high).
hallucination
False or unreal sensory perception as, for example, hearing
voices none are present.
labile
Unstable; undergoing rapid emotional change.
mania
State of excessive excitability; hyperactivity and agitation.
mutism
Nonreactive state; stupor.
obsession
An involuntary, persistent idea or emotion.
paranoia
Delusions persecution or grandeur or combination of the
two.
Psychiatric Disorders
Anxiety Disorders
These disorders are characterized by anxiety-the experience of unpleasant
tension, distress, troubled feelings, and avoidance behaviour. A panic attack,
marked by intense fear or discomfort and symptoms such as palpitations,
sweating, trembling, and dizziness, can occur on its own with no symbolic
meaning for the patient(i.e., it occurs out of the blue), or it can occur in
the context of the following anxiety disorders: phobic disorders, obsessivecompulsive disorder, and post-traumatic stress disorders.
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Phobic disorders are characterized by irrational or debilitating fears associated with a specific object or situation. The patient with a phobic disorder
goes to extreme lengths to avoid the object of her or his fear. Panic attacks
can occur in anticipation of the phobic situation.
Agoraphobia is the fear of being alone or in open, crowded, public places
from which escape would be difficult or in which help might not be available.
They may feel comfortable only by remaining at home or in the company of a
friend or relative.
A social phobia (social anxiety disorder) is the fear of situations in which
the individual is open to public scrutiny which could result in possible embarrassment and humiliation. Fear of speaking in public, using public lavatories,
or eating in public are examples of social phobias.
Other specific phobias are claustrophobia (fear of closed-in places); acrophobia (fear of heights); zoophobia (fear of animals).
O b s e s s i v e co m p u l s i v e d i s o rd e r ( O C D ) i n v o lv e s re c u r re n t
thoughts(obsessions) and repetitive acts (compulsions) that dominate the
patients behaviour. The patient experiences anxiety if he or she is prevented
from performing special rituals, which are used to shield against overwhelming
anxiety or fear. Often the OCD consumes time and significantly interferes with
the individuals social or occupational functioning.
Post-traumatic stress disorder is the development of symptoms (intense
fear, helplessness, insomnia, nightmares etc.) following exposure to a traumatic event. Many survivors of the September 11 attack experienced posttraumatic stress disorder.
Delirium and Dementia
Delirium and dementia are both disorders of abnormal cognition (mental
processes of thinking, perception, reasoning, judgement).
Delirium is acute, temporary disturbance of consciousness and mental
confusion. It is characterized by rambling, irrelevant, or incoherent speech,
sensory misperceptions, and disorientation as to time, place, or person and by
memory impairment. Delirium is caused by a variety of conditions, including
drug intoxication or withdrawal, seizures or head trauma, and metabolic
disturbances such as hypoxia, hypoglycemia, electrolyte imbalances, or hepatic
or renal failure. Delirium tremens is brought on by withdrawal after prolonged
periods of heavy alcohol ingestion.
Dementia is a general more gradual loss of intellectual abilities that
involves impairment of judgement, memory, and abstract thinking as well as
changes in personality. Dementia may be caused by conditions, some revers287
ible and some progressive, involving damage to the brain. The most common
cause is Alzheimer disease, but others are cerebrovascular disease (stroke),
central nervous system infection, brain trauma, tumours, and Parkinson and
Huntington disease.
Dissociative Disorders
Dissociative disorders are chronic or sudden disturbances of memory, identity, consciousness, or perception of the environment that are not caused by
the direct effects of brain damage or drug abuse. Symptoms hide the pain
and anxiety of unconscious conflicts. Examples of dissociative disorders are
dissociative identity disorder, which is the existence within the individual of
two or more distinct personalities that take hold of the individuals behaviour
(illustrated in literature by Dr. Jekyll and Mr. Hyde); dissociative amnesia
(inability to remember important personal information that is too extensive to
be explained by ordinary forgetfulness); and dissociative fugue (sudden, unexpected travel away from home or customary work locale). The fugue (flight)
disorder includes the assumption of a new identity and inability to recall ones
previous identity.
Eating Disorders
Eating disorders are severe disturbances in eating behaviour. Examples
are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a refusal to
maintain a minimally normal body weight. An individual is intensely afraid of
gaining weight and has a disturbance in the perception of the shape or size
of her or his body. The condition predominantly affects adolescent females,
and its principal symptom is a conscious, relentless attempt to diet along with
excessive, compulsive overactivity, such as exercise, running, or gymnastics.
Most postmenarchal females with this disorder are amenorrheic.
Bulimia nervosa (bulimia means abnormal increase in hunger) is characterized by binge eating (uncontrolled indulgence in food) followed by
purging(eliminating food from the body). Bulimic individuals maintain normal
or nearly normal weight because after binging they engage in inappropriate
purging. Examples are self-induced vomiting and the misuse of laxatives or
enemas.
Mood Disorders
A mood disorder is prolonged emotion such as depression or mania (elation)
that dominates a patients entire mental life. Examples of mood disorders are
bipolar disorders and depressive disorders. Bipolar disorders (bi - two; pol/o
extreme) are characterized by one or more manic episodes alternating with
288
depressive episodes. A manic episode is a period during which the predominant mood is excessively elevated (euphoria), expansive, or irritable. Associated symptoms include inflated self-esteem, or grandiosity, decreased need
for sleep, nearly continuous flow of rapid speech with quick changes of topic,
distractibility, an increase in goal-directed activity, and excessive involvement
in pleasurable activities that have a high potential for painful consequences.
Often there is increased sociability and participation in multiple activities
marked by intrusive, domineering, and demanding behaviour. Hypomania
describes a mood resembling mania, but of lesser intensity. Bipolar I is one
or more manic episodes, often alternating with major depressive episodes.
Bipolar II is recurrent major depressive episodes alternating with hypomanic
episodes.
Cyclothymic disorders (cycl/o cycle; thym/o mind) is a mild form
of bipolar disorder characterized by at least two years of hypomania and
numerous depressive episodes that do not meet the criteria that define a
major depressive episode.
Depressive disorders are marked by one or more major depressive
episodes without a history of mania or hypomania. Major depression involves
episodes of severe dysphoria (sadness, helplessness, worry, discouragement). Other symptoms are appetite disturbances and changes in weight,
sleep disorders such as insomnia or hypersomnia, fatigue or low energy, feelings of worthlessness, hopelessness, or excessive or inappropriate guilt, difficulty thinking or concentrating, and recurrent thought of death or suicide.
Dysthymia is a depressive disorder involving depressed mood that persists
over a 2-year period but is not as severe as major depression. Also there
are no psychotic features (delusion, hallucinations, incoherent thinking) as
are sometimes found in major depression. Dysthymic disorder can be very
impairing but commonly responds well to medications.
Physicians have noted a relationship between the onset of an episode
of depressive disorder and a particular 60-day period of the year. A regular
appearance of depression may occur between the beginning of October and
the end of November every year. This is referred to as a seasonal affective
(mood) disorder (SAD). A change from depression to mania or hypomania also
may occur within a 60-day period from mid-February to mid-April.
Personality Disorders
Personality traits are established patterns of thinking and ways of relating
to and perceiving the environment and ones self; however, when these traits
become inflexible and rigid, causing impairment of functioning, distress, and
289
conflict with others, they constitute personality disorders. Examples of personality disorders are as follows:
antisocial
No loyalty to or concern for others, and without moral standards; acts only in response to desires and impulses; cannot
tolerate frustration and blames others when he or she is at
false.
borderline
Instability in interpersonal relationships and sense of self;
characterized by alternating involvement with and rejection
of people. Frantic efforts are made to avoid real or imagined
abandonment.
histrionic
Emotional, attention-seeking, immature, and dependent; irrational outbursts and tantrums; flamboyant and theatrical;
having general dissatisfaction with ones self and angry feelings about the world
narcissistic
Grandiose sense of self-importance or uniqueness and preoccupation with fantasies of success and power. Narcissism is
a pervasive interest in ones self with a lack of empathy for
others.
paranoid
Continually suspicious and mistrustful of other people but not to
a psychotic or delusional degree; jealous and overly concerned
with hidden motives of others; quick to take offense.
schizoid
Emotionally cold and aloof; indifferent to praise or criticism or
to the feelings of others; few friendships and rarely appears to
experience strong emotions, such as anger or joy.
IV. Therapeutic Terminology
Psychotherapy
This is the treatment of emotional problems by using psychological techniques. The following are psychological techniques used by psychiatrists,
psychologists, and other mental health professionals.
Cognitive Behaviour Therapy (CBT). Conditioning (changing behaviour
patterns and responses by training and repetition) is used to relieve anxiety
and treat phobias and other disorders.
Family Therapy. Treatment of an entire family to resolve and understand
their conflicts and problems.
290
Group Therapy. A group of patients with similar problems gains insight into
their own personalities through discussions and interaction with each other.
In psychodrama, patients express their feelings by acting out roles along with
other patients-actors on a stage. After a scene has been presented, the audience (composed of other patients)is asked to make comments and offer interpretations about what they have observed.
Hypnosis. A trance (state of altered consciousness) is created to increase
the speed of psychotherapy or to help recovery of deeply repressed memories.
Insight-Oriented Psychotherapy. Face-to-face discussion of life problems
and associated feelings.
Play Therapy. Therapy in which a child, through play, uses toys to express
conflicts and feelings that he or she is unable to communicate in a direct
manner.
Psychoanalysis. Developed by Sigmund Freud, this long-term and intense
form of psychotherapy seeks to influence behaviour and resolve internal
conflicts by allowing patients to bring their unconscious emotions to the
surface.
Sex Therapy. This form of therapy helps individuals overcome sexual
dysfunctions such as frigidity, impotence and premature ejaculation.
Supportive Psychotherapy. Offering encouragement, support, and hope to
patients facing difficult life transitions and events.
Electroconvulsive Therapy
A treatment in which an electric current is applied to the brain while the
patient is anesthetized, paralyzed, and being ventilated. This produces convulsions (involuntary muscular contractions) which, with modern techniques,
are usually observable only in the form of a twitching of the toe. It is chiefly
used for serious depression and depressive phase of bipolar (manic-depressive) disorder.
Drug Therapy
The following are categories of drugs used to treat psychiatric disorders.
Antianxiety and antipanic agents. These drugs lessen anxiety, tension, and
agitation, especially when they are associated with panic attacks. Example
benzodiazepines(BZDs).
Antidepressants. These drugs gradually reverse depressive symptoms
and produce feelings of well-being. The basis of depression is thought to be
an imbalance in the levels of neurotransmitters in the brain.
291
hallucin/o hallucination
hallucinogen .............................................
hypn/o
sleep
hypnosis ......................................................
iatr/o
ment/o
phil/o
phren/o
psych/o
mind
psychosis ....................................................
schiz/o
split
schizoid ........................................................
somat/o
paraphilia ...................................................
2. Suffixes
-genic
292
produced by
psychogenic ..............................................
-leptic
to seize hold of
-mania
obsessive preoccupation
kleptomania ..............................................
agoraphobia ..............................................
euphoria ......................................................
-thymia mind
cyclothymia ...............................................
dysthymia ...................................................
3. Prefixes
a-, an- no,not
apathy ...........................................................
cata-
down
hypomania .................................................
hypochondriasis .....................................
para-
--------------------------------------------
293
Glossary
A
abdomen
abdominal
trbuni
abduction
odmicanje
ability
abnormal
nenormalan, neprirodan
abnormality
nenormalnost, neprirodnost
abortion
pobaaj, abortus
abrupt
abruptio placentae
abscess
apsces
absorb
apsorbirati
absorption
apsorpcija
accelerate
acceleration
ubrzanje
accessory
accommodation
accumulate
nakupiti, skupiti
accumulation
nakupljanje, skupljanje
acetylcholine
acetikolin
achlorhydria
294
acid
kiselina
acidic
kiseo
acidity
kiselost, aciditet
acidosis
acidoza
acne vulgaris
acne vulgaris
acoustic neuroma
acquired
steen
acromegaly
akromegalija
acromion
akromion lopatice
act
action
acuity
acute
akutan
adenomatous goitre/goiter
Adams apple
Adamova jabuica
Addison disease
Addisonova bolest
aduction
primicanje
adenocarcinoma
adenohypophysis
adenohipofiza
adenoids
adenopathy
adhere
adhesion
prianjanje, adhezija
adipose tissue
adjacent
susjedan, oblinji
administration of drugs.
davanje lijekova
adnexa
adolescence
mladost, adolescencija
adolescent
adrenal gland
nadbubrena lijezda
295
adrenalectomy
adrenaline
adrenalin
adrenocorticotropic
hormone (acth)
adult
albuminurija
adulthood
advancing age
adverse
affect
afferent
dovodan, aferentan
afterbirth
babinje, puerperij
agent
agglutination (clumping)
aglutinacija; nakupljanje
agglutinin (antibody)
aglutinin; protutijelo
agglutinogen
aging
starenje
aid
aids acquired
imunodeficiency syndrome
ailment
bolest, tegoba
albinism
albinizam
albino
albino
albuminuria
albuminurija
alcohol abuse
alcoholism
alkoholizam
aldosterone
aldosteron
alimentary
probavni
alkaline
allergen
alergen
allergic
alergian
296
allergologist
alergolog
allergology
alergologija
allergy
alergija
allopurinol
alopecia
elavost
alpha cell
alfa stanica
alter
promijeniti, izmijeniti
alteration
promjena, izmjena
Alzheimer disease /
presenile dementia
ameba
am(o)ebic
amebni
amenorrh(o)ea
ametropia
amino acid
aminokiselina
ammonia
amonijak
amniocentesis
amount
koliina, iznos
amyotrophic
an(a)esthesia
anestezija
anabolism
anal
marni, analni
anal canal
marni kanal
anal fistula
marna fistula
297
analgesic
anastomosis
anastomoza, premosnica
anatomy
anatomija
anchor, n.
anchor, vb.
usidriti se
aneurysm/aneurism
aneurysmectomy
angina pectoris
angiorrhexis
angle
kut (geometrijski)
angulation
nagib
ankle
ankylosing spondylitis
anomaly
anomalija, nenormalnost
anorexia
anosmia
antagonistic
suprotan, antagonistiki
anterior
prednji
anthracosis
anti-inflammatory
protuupalan
antibiotic
antibody
protutijelo
anticoagulant
antidiuretic hormone
antidiuretski harmon
antigen
antitoxin
protuotrov
baza eluca
anus
mar, anus
anvil
298
anxiety
tjeskoba, anksioznost
aorta
aortic
aortni
aortic valve
aortni zalistak
vrh, apeks
aphasia
aphonia
aplastic an(a)emia
aplasticna anemija
apn(o)ea
aponeurosis
apoplexy (stroke)
appendectomy
appendicitis
crvuljak
application
primjena
aqueous humo(u)r
ona vodica
arachnoid
arch
luk
area
podruje, regija
areola (dojke)
arise
armpit
pazuh, aksila
arrhythmia
arteriole
arteriosclerosis
arterioskleroza
artery
arterija
arthritis
arthrodesis
arthrotomy
articular
zglobni
articulation
zglob
299
artifical
umjetan
asbestosis
ascending
uzlazan
ascites
assimilation
asimilacija, upijanje
associated
asthenia
asthma
astma
astigmatism
astigmatizam
astrocyte
astrocytoma
B
bacillary
bacilni
bacil
backbone
kraljenica, hrptenica
backflow
bakterija
bacteriuria
balance
ravnotea
kuglasti zglob
balloon, vb.
napuhati
band
barium swallow/meal
barijeva kasa
bark
barking cough
barrier
zapreka, prepreka
Bartholin glands
300
basin
zdjelica, pelvis
basophil
basophilia
bat-shaped
bath
kupka, kupelj
bean-shaped
bed rest
mirovanje u postelji
belching
podrigavanje
Bell palsy/paralysis
belly out
bend
bending
svijanje, fleksija
benign
dobroudan, benigni
bent adj.
svijen, flektiran
bent n.
benzene
beta blocker
beta cell
biceps brachii
bicuspid valve
bile
bilirubin
uni pigment
bile pigment
bilirubin
bind
vezivati, spajati
biopsy
biopsija
birth canal
birthmark
bite
bizarre
udan, neobian
blackhead
sujedica, komedon
301
bladder
mjehur
bladder outlet
blastocyst
bleed
krvariti
bleeding, haemorrhage
krvarenje
blepharoptosis
blind spot
slijepa pjega
blindness
sljepoa
blink reflex
blister
bloating
napuhnutost (eluca)
blockage
blood
krv
blood clot
krvni ugruak
blood clotting
blood count
krvna slika
blood group/type
krvna grupa
blood plasma
krvna plazma
blood pressure
krvni tlak
blood serum
krvni serum
blood sugar
blood transfusion
transfuzija krvi
blood vessel
krvna ila
blood volume
volumen krvi
bloodletting
putanje krvi
bloodstream
optok krvi
blotchy
mrljast
bolus
bond
prianjati, vezati se
302
bone
kost
bone cell
bone head
glava kosti
bone process
kotani nastavak
bone projection
izboenje na kostima
bony tissue
kotano tkivo
borborygmus, pl.
borborygmi
kruljenje (crijeva)
border
rub, granica
bowel
crijevo
braces
proteza
bradycardia
bradypn(o)ea
brain
mozak
brain stem
modano deblo
branch
ogranak, grana
branch, vb.
break off
break, n
break, vb
breakdown
razgradnja, propadanje
breast
dojka
breast plate
prsna kost
sternum, breastbone
prsna kost
breath
dah
breath odo(u)r
zadah
breathing
disanje, respiracija
breech birth
hrbat nosa
bright light
jaka svjetlost
Bright disease
Brightova bolest
bring about
prouzroiti
303
bronchiectasis
bronchiole
bronhiola
bronchodilator
bronhopneumonija
bronchostomy
bronhostomija
bronchus,bl.bronchi
dunica,bronh
bruise
bruising
nagnjeenje, oteenje
bucca, pl.buccae
obraz
buccal
bulbourethral
bulla, pl. bullae
bump
bulbouretralan
mjehuri, bula
oteklina (od udarca), kvrga, voruga,
ispupenje
bundle of His
Hisov snop
bunion
bunionectomy
bunionektomija
burden
teret, optereenje
Burkitt lymphoma
Burkittov limfom
burn, n.
opeklina
burn, vb.
burning
bursitis
burst forth
bursting
rasprsnuce, probijanje
buttocks
stranjica
bypass
byssinosis
304
C
c(a)ecum, pl. c(a)eca
slijepo crijevo
c(a)esarean section
carski rez
cachexia
petna kost
calcification
ovapnjenje, kalcifikacija
calcify
ovapniti, kalcificirati
calcitonin
calcium
kalcij
kamenac
canal
kanal
canal of Schlemm
canaliculus, pl. canaliculi
schlemmov kanal
kanali
cancellous
cancer
rak, karcinom
cancerous
kancerozan
ugao
capillary
kapilara
capsule
ahura
carbon
ugljik
carbon dioxide
ugljini dioksid
carbonic
ugljikov
carcinoma
rak, karcinom
carcinoma in situ
cardiac
srani
cardiac valve
srani zalistak
cardiocairograph
cardiologist
kardiolog
cardiology
kardiologija
305
cardioversion
caries
karijes, kvarenje
carpal
carpopedal spasm
cartilage
hrskavica
cartilage ring
hrskavini prsten
cartilaginous
hrskavian
cast
gipsani zavoj
catabolism
cataract
mrena, katarakta
catecholamine
cathartic
catheter
kateter
caudal
kaudalan, repni
cavity
upljina
cell
stanica
cell body
stanino tijelo
cell membrane
cell-mediated immunity
stanina imunost
cellular
stanini
cellulitis
celulitis
cementum
zubni cement
cephalic
mali mozak
cerebral
modan, cerebralan
cerebral contusion
306
cerebral palsy
cerebrospinal fluid
modanokraljenika (cerebrospinalna)
tekuina, likvor
cerebrovascular accident
cerebrum,pl. cerebra
veliki mozak
cerumen
una mast
cervical
vratni
cessation
prestanak, prekid
chain
lanac
kalazion, jemenac
chalicosis
chamber
komora, klijetka
chancre
ir, ankir
channel
kanal
cheek
obraz
chemonucleolysis
chemotherapy
kemoterapija
chest
chew
vakati
chewing, mastication
vakanje, mastikacija
childbirth, partus,
parturition, delivery
poroaj,raanje, partus
chill
zimica, tresavica
chloasma
chloramphenicol
kloramfenikol
chloremia
kloremija, kloroza
307
cholecystectomy
choledocholithotomy
cholelithiasis
cholesteatoma
cholesterol
kolesterol
cholinesterase
chorea
choriocarcinoma
chorion
choroid
ilnica (oka)
chromosome
kromozom
chronic
kronian
chyme
oiljak, brazgotina
ciliary muscle
cilijarni mii
circle
circuit
circular
kruan
circulate
kolati, cirkulirati
circulation
circumcision
obrezivanje
circumscribed
zaokruen
cirrhosis
claustrophobia
308
clavicle
clavicular
kljuni, klavikularni
cleanse
proistiti, oistiti
cleansing
proiavanje, isenje
cleft palate
rascijepljeno nepce
climacteric
klimakterij,menopauza
clitoris
draica
closure
zatvaranje
clot, n.
ugruak krvi
clot, vb.
clotting
zgruavanje, koagulacija
clubfoot
clumping
aglutinacija, nakupljanje
cluster
nakupina, grozd
coagulate
coagulation
zgruavanje, koagulacija
coat
ovojnica, omota
kok
coccygeal
trtini
cochlea
punica
coitus
odnoaj
colchicine
colitis
collagen
collapse
collar bone
collect
skupljati, sabirati
collecting tubule
collection
skupljanje, nakupljanje
309
colon
colonic polyposis
polipoza kolona
colpoplasty
coma
comatose
komatozan
combat
comedo, pl.comedones
sujedica, komedon
comminuated
glavni uovod
compact
vrst, kompaktan
compensation
nadoknada, kompenzacija
complement
composition
compound
spoj (kemijski)
compound fracture
compress, n.
oblog, kompresa
compress, vb.
stisnuti, komprimirati
compression
pritisak, kompresija
concave
udubljen, konkavan
conception
zaee, zanoenje
potres mozga
condition
stanje, bolest
conduct
provoditi, voditi
conduction
provoenje, voenje
conductive
provodan
condyle
vor, kondil
cone
stoac, unj
congenital
prirodan, kongenitalan
srana dekompenzacija
conization
konizacija
conjunctiva
spojnica oka
connection
veza, spoj
310
connective
vezivan
conscious
consciousness
svijest, svjesnost
constipation
constitutent
constrict
stezati
constriction
contagious
zarazan, infektivan
contagiousness
zaraznost, infektivnost
contraceptive
kontracepcijsko sredstvo
contract
contraction
stezanje, kontrakcija
contusion
nagnjeenje, kontuzija
conversely
conversion
pretvorba
convert
pretvoriti
convex
convey
prenositi, odailjati
conveyance
prijenos, odailjanje
convolution
vijuga
convulsion
Cooley an(a)emia
Cooleyeva slabokrvnost
coordinate
uskladiti
coordination
usklaivanje
copulation
snoaj, kopulacija
cor pulmonale
pluno srce
core
jezgra
coredialysis
iridodijaliza
corium
cornea
ronica
coronary artery
311
corpus callosum,
pl. corpora callosa
uljevito tijelo
corpus luteum,
pl. corpora lutea
uto tijelo
corpuscle
tjelece
kora, korteks
cortical
corticosteroid
cortisol
kortizol, hidrokortizon
cortisone
kortizon
cough, n. (bf)
kaalj
kaljati
coughing
kaljanje
covering
ovojnica, omota
Cowper glands
crackling
pucketanje (kostiju)
cramp
gr
cramping
grenje
cranial
lubanjski, kranijalni
lubanja
creatinine
kreatinin
crepitation
crest
greben, krista
cretinism
cripple
onesposobiti, osakatiti
crippling
invalidnost, onesposobljavanje
Crohn disease
cross-section
presjek
crossmatching
unakrsna reakcija
312
croup
crushed
crust
krasta
cryocauterization
kriokauterizacija
cryoextraction
krioekstrakcija
cryoprobe
kriosonda
cul-de-sac
curative
cure
curettage
kiretaa, struganje
current
struja
curvature
zakrivljenost
curve
krivulja, zavoj
Cushing syndrome
Cushingov sindrom
cushion, n.
jastui
cushion, vb.
cuspid
onjak
cutaneous
koni, kutani
cuticle
pokoica, eponihij
cyanoderma
cijanoderma
cyanopia
cijanopija
cycle
cyclic
kruan, ciklican
cyst
cista, mjehur
cystadenocarcinoma
cistadenokarcinom
cystadenoma
cistadenom
313
cystic
cistian
cystic duct
cistiki vod
cystoscopy
cytologist
citolog
cytoplasm
citoplazma
cytotoxin
citotoksin
D
damage, n.
oteenje, teta
damage, vb.
otetiti, nakoditi
damaged
oteen
deaf
gluh
deafness
gluhoa
debris
decay
raspadanje, truljenje
decelerate
usporiti
decline
decompose
razgraditi, raspasti se
decomposition
razgradnja, propadanje
decrease, n.
decrease, vb.
decubitus
def(a)ecation
defibrillation
defibrilacija
defibrillator
defibrilator
deficiency
pomanjkanje, manjak
deficient
manjkav
deflection
otklon, pomak
deformation
izoblienje, deformacija
deformity
nakaznost, izoblienost
degenerated
degeneriran
degeneration
degeneracija
314
degenerative
degenerativan
deglutition
gutanje, degluticija
degrade
deliberate
hotimian, namjeran
delirium
delirij
demineralization
demineralizacija
demyelination
demijelinizacija
dendrite
dendrit
dense
gust, vrst
density
gustoa, vrstoa
dentin
dentin
denture
umjetno zubalo
deoxyribonucleic acid
depletion
iscrpljenje, ispranjenje
depolarization
deposit
depositing
depository
spremite, skladite
depress
usporiti, smanjiti
depression
udubljenje, uleknue
dermatitis
dermis
descending
silazan
destruction
unitenje, razaranje
detach
detachment
odvajanje, otkidanje
detect
otkriti
detection
otkrivanje, detekcija
deteriorate
deteriorated
pogoran
deterioration
pogoranje
development
razvoj
315
device
devour
progutati, prodrijeti
diabetes insipidus
diabetes insipidus
diabetes mellitus
seerna bolest
diabetic nephropathy
dijabetika nefropatija
diabetic neuropathy
dijabetika neuropatija
diabetic retinopathy
dijabetika retinopatija
dijagnoza
diagnostic
dijagnostiki
diagnostics
dijagnostika
dijaliza
diameter
promjer, dijametar
diaphoresis
diaphragm
diarrh(o)ea
proljev
diastole
diencephalon
meumozak
diet
prehrana, dijeta
digestion
probava, probavljanje
digestive
probavan, digestivan
digitalis
dilated
proiren, dilatiran
dilation
irenje, dilatacija
dim light
prigueno svjetlo
diminished
smanjen, snien
diphtheria
difterija
disc/disk
kolut, disk
discharge
discolo
promjena boje
discomfort
nelagoda, tegoba
discontinue
prekinuti, prestati
316
disease
bolest
disintegrate
disintegration
razgradnja, raspadanje
dislocation
iaenje, dislokacija
dislodged
disorder
poremeaj
dispose
disproportion
nerazmjer, nesklad
disrupt
prekinuti
dissection
seciranje, sekcija
dissolution
distal
distalan, udaljen
distensible
rastezljiv
distention
distortion
uganue, distorzija
distress
disturbance
poremeaj, smetnja
diuretic
diverticulectomy
diverticulitis
divertikul
division
dizziness
vrtoglavica
dizzy
donour
dormant
pritajen, latentan
dorsal
leni, dorzalan
dorsiflexion
dorzifleksija
dosage
doziranje, dozaa
dose, n.
doza (lijeka)
dose, vb.
317
Down syndrome
drag
dragging
povlaenje, potezanje
drain
draining
drop
kap, kaplja
droplet
kapljica
dropsy
drug
drug-induced
Duchenne disease
Duchenneova bolest
duct
vod
duodenal
duodenalni
dvanaesnik
dura mater
dwarf
patuljak
dwarfism
dye
dysentery
dizenterija
dysgerminoma
dysmenorrhea
dyspareunia
dysphagia
dysphasia
dysplasia
dyspn(o)ea
dysrhythmia
disritmija
dystocia
dystrophy
distrofija
dysuria
318
E
ear
uho
ear canal
zvukovod
earache
uhobolja
eardrum, tympanum
bubnji
eklampsija
ectopic pregnancy
eczema
ekcem
edema
oteklina, edem
efferent
odvodan, eferentan
effusion of blood
izljev krvi
egg, ovum
jajace, ovum
ejaculation
ejakulacija
ejaculatory duct
ejakulatorni vod
ejection
izbacivanje
electric pacemaker
electrical charge
elektrini naboj
electrocardiogram
elektrokardiogram
electrocardiograph
elektrokardiograf
electrolyte
elephantiasis
elevated
elevation
elimination
embedded
embolism
embolija
embolus
embryo
zametak, embrij
emerge
izlaziti, izranjati
emergency
hitan sluaj
emulsify
emulgirati, razgraditi
emulsion
emulzija
enamel
caklina
encapsulation
uahurenje, inkapsulacija
encase
omatati, obavijati
encephalitis
end product
endanger
ugroziti
endemic goitre/goiter
endocarditis
endocardium
endocervicitis
endocrine
endometriosis
endometrioza
endometritis
endometritis
endometrium
endoscope
engorgement
zaepljenje, opstrukcija
engulf
progutati
enlarged
povean, proiren
enlargement
poveanje, proirenje
enterolysis
entity
bie; sutina
envelop
omatati, obavljati
environment
okoli, sredina
enzyme
enzim
eosinophil
eozinofil
eosinophilia
eozinofilija
320
ependymoma, pl.
ependymomata,
ependymomas
ependimom
epidermis
pokoica, epiderma
epididymis
pasjemenik, epididimis
epiglottis
poklopac (grkljana)
epilepsy
padavica, epilepsija
epinephrine
adrenalin
epiphora
suzenje (oiju)
epiphyseal line/plate
epistaxis
epithelium
epitel
eponychium
equalization
izjednaenje, izjednaavanje
equalize
izjednaiti
ravnotea, ekvilibrij
erect
erectile tissue
erektilno tkivo
erection
erode
erosion
error of refraction
eructation
podrigivanje
erupt
eruption
erythema
erythroblast
321
erythroblastosis
erythrocyte
erythropoietin
escape, n.
istjecanje (tekuine)
escape, vb.
istjecati, izlaziti
esophageal varices
esophagus/oesophagus,
pl. esophagi; gullet
jednjak
essential hypertension
estrogen/oestrogen
ethmoid bone
etiology/aetiology
etiologija
eupnea
Eustachian tube
evacuate
isprazniti
evacuation
pranjenje, ispranjavanje
evidence
dokaz
Ewing sarcoma
Ewingov sarkom
exacerbation
pogoranje (bolesti)
exanthem
egzantem
excess
viak, prekomjernost
exchange
izmjena, razmjena
excitation
excrete
izluiti, izbaciti
excretion
izluivanje, izbacivanje
excretory
exert
obavljati, naprezati se
exertion
exhalation
izdisaj, izdisanje
exhale
izdahnuti, izdisati
322
exit, n.
izlaz; smrt
exit, vb.
izai
exocrine
exophthalmic goitre/goiter
exophthalmos
buljookost, egzoftalmus
exostosis
expandable
rastezljiv
expectorant
sredstvo za iskaljavanje
expectoration
iskaljavanje
expel
izbaciti, istjerati
expiration
izdisaj, izdisanje
expire
exposure
izlaganje, otkrivanje
expulsion of placenta
extension
external
vanjski
extract
extraction
extradural
extremity
exudate
izljev, eksudat
eye
oko
eye orbit/socket
ona upljina
eyeball
ona jabuica
eyebrow
obrva
eyelash
trepavica
eyelid
eyesight
vid
F
f(a)eces
stolica, fekalije
f(o)etus
edo, fetus
323
facilitate
olakati, omoguiti
facilitation
olakavanje, olakanje
failure
faint
fainting
nesvjestica
fallacious
fallopian tube
farsightedness
dalekovidnost
fascia
fat
fatal
smrtonosan, letalan
fatigue
umor, klonulost
fatty
mastan
fatty acid
masna kiselina
febrile
female, adj.
enski
female, n.
ena
femur
bedrena kost
fertile
plodan, fertilan
fertilization
oplodnja
fertilize
oploditi
fever
groznica, vruica
fibre/fiber
vlakno, nit
fibril
vlakance
fibrillation
treperenje, fibrilacija
fibrin
fibrinogen
fibroadenoma
fibroadenom
fibroblast
324
fibroid
fibrosarcoma
fibrosis
fibrous
vlaknast, fibrozan
lisna kost
filtrate
filtrat
trepetljika, resa
fissure
fist-sized
veliine pesnice
flagellum, pl.flagella,
flagellums
flank
slabina
flatus
flavour
flax
lan
flexibility
flexion
flexure
pregib, fleksura
flow of air
struja zraka
flushing
flutter
focal
arini
arite
focus, vb.
fold
nabor
folic acid
folna kiselina
follicle
mjehuri, folikul
follow-up
praenje (bolesnika)
325
fontanelle
fontanela
otvor
force
sila
forehead
elo
foreskin
jama
fracture
fragile
lomljiv, krhak
fragility
lomljivost, krhost
framework
okosnica, okvir
fraternal twins
dvojajni blizanci
freckle
friction
trenje
fringe
resica, fimbrija
front
frontal
frontal bone
eona kost
frostbite
ozeblina
fulguration
fullness
fundus
dno, pod
svod eluca
fungal
gljivini
gljivica, gljiva
funnel
ljevak
funnel-shaped
ljevkast
furrow
brazda
fused
sraten (kost)
fusion
326
G
gait
gall
gallbladder
uni mjehur
gallstones
uni kamenci
gamete
gangrene
gangrena
gas
plin
gaseous
plinovit
gasp
gastric juice
eluani sok
gastritis
gastroscope
gastroskop
gastroscopy
gelatinous
elatinozan
gene
gen
genesis
geneza
genetic
genetski, genetiki
genetics
genetika
genital
genitalia
germ cell
German measles
crvenka, rubeola
gestation
trudnoa, gestacija
gigantism
gingiva
girdle
obru, pojas
gland
lijezda
glandular
ljezdast
glaucoma
glia
glial tissue
glijalno tkivo
327
glioblastoma multiforme
multiformni glioblastom
globulin
glomerulonephritis
glucagon
glucocorticoid
glucose
glue
ljepilo
gluelike
glycogen
glycogenesis
glycosuria
goitre/goiter
gonad
gonadotropic hormone
gonadotropni hormon
gonadotropin
gonokok
gonorrh(o)ea
gout
graafian follicle
grading
stupnjevanje, gradiranje
graft
grafting
presaivanje, transplantacija
grain
zrno
328
granule
zrnce, granula
granulocyte
granulocytosis
Graves disease
gravity
gray matter
siva tvar
greenstick fracture
grind
groin
prepona
groove
brazda, lijeb
gross appearance
grow
rasti, razvijati se
growth
rast
growth hormone
growth rate
brzina rasta
guaiac
guanethidine sulphate/
sulfate
guard
tititi, uvati
gullet
jednjak
gums
gyn(a)ecologist
ginekolog
gyn(a)ecology
ginekologija
gynandroblastoma
ginandroblastom
H
h(a)emangioma
h(a)emarthrosis
329
h(a)ematocrit
hematokrit
h(a)ematopoiesis
h(a)ematosalpinx
h(a)ematuria
h(a)emianopia/h(a )
emianopsia
h(a)emodialysis
hemodijaliza
h(a)emoglobin
hemoglobin
h(a)emolysis
hemolitika anemija
h(a)emophilia
h(a)emoptysis
h(a)emorrhoidectomy
h(a)emorrhoids
uljevi, hemoroidi
h(a)emothorax
hair
hair shaft
hairs of Corti
Cortijeve dlaice
hammer
eki, malleus
hard palate
tvrdo nepce
hardening
otvrdnue, skleroza
haversian canals
haversovi kanali
hazard
hazardous
headache
glavobolja
heal
zacijeliti, izlijeiti
healing
cijeljenje, zacjeljenje
hearing
sluh
heart
srce
heart action
rad srca
heart block
330
heart failure
heart murmur
srani um
heart rate
heart valve
srani zalistak
heartburn
garavica
heel
peta
heel bone
helping
porcija obroka
hemisphere
polutka (mozga)
hemp
konoplja
heparin
hepatitis
hepatocyte
hepatomegaly
hereditary
nasljedan, hereditaran
heredity
nasljednost, nasljee
kila, hernija
herpes
herpes, (virus)
herpes zoster
herpes zoster
hiatal hernia
hiatus
hidrosis
hilusni tumor
hilum/hilus
hinge
arka, arnir
hinge joint
hip
kuk
hip bone
zdjelina kost
hirsutism
histamine
331
histogenesis
histological makeup
histology
histologija
hives
koprivnjaa, urtikarija
Hodgkin disease
Hodgkinova bolest
hollow
upalj
homeostasis
hordeolum, stye
hormone
hormon
horn
rog, roevina
horny cells
ronate stanice
humerus
nadlaktina kost
humo(u)r
tekuina, vodica
humoral immunity
humoralna imunost
humpback
grbavost, kifoza
hunchback
grbavost, kifoza
Huntington chorea
Huntingtonova koreja
hyaline
hydroc(o)ele
hydrocephalus
hydrochloric acid
hydrocortisone
hidrokortizon
hydrogen
vodik
hydronephrosis
hydrophobia
hydrothorax
hymen
djevinjak, himen
hyper(a)esthesia
332
hypercalc(a )emia
hyperexcitability
hyperfunction
hyperglyc(a)emia
hyperinsulinism
hiperinzulinizam
hypernephroma
hyperopia;hypermetropia
dalekovidnost, hipermetropija
hyperosmia
hyperparathyroidism
hiperparatiroidizam
hyperpituitarism
hyperplasia
hypersecretion
hypertension
hyperthyroidism
hypertrophy
hyperuric(a)emia
hypoalbumin(a)emia
hipoalbuminemija
hypochromic an(a)emia
hipokromna anemija
hypofunction
hypoglyc(a)emia
hypoinsulinism
hipoinzulinizam
hypoparathyroidism
hipoparatiroidizam
hypophyseal stalk
hypophysis
hypopituitarism
hipopituitarizam
333
hyposecretion
hypospadia
hypotension
hypothalamus
hipotalamus
hypothyroidism
hipotiroidizam
hypox(a)emia
hysterectomy
I
iatrogenic
icterus
utica, ikterus
identical twins
idiopathic
ileoc(a)ecal
ileus
iliac
iliac crest
ill
illegitimate
nezakonit
illicit
nedoputen
illness
bolest
illuminate
osvijetliti; razjasniti
image
imaging technique
imbalance
neravnotea
334
imitation
oponaanje
immature
nezreo; preuranjen
immediate
neposredan, izravan
immense
beskrajan, neizmjeran
imminent
prijetei, neizbjean
immobile
nepokretan, ukoen
immobilize
immovable
nepomian, nepokretan
immune
immune response
immunity
immunodeficiency
immunodiffusion
imunodifuzija
immunoglobulin
imunoglobulin
immunologist
imunolog
immunology
imunologija
impacted fracture
impair
impairment
impalpable
neopipljiv, sitan
impermeable
nepropustan
impetigo
implant
implantation
usaivanje, implantacija
impulse
in situ
inability
nesposobnost, nemonost
inacidity
inaction
nepokretnost, mirovanje
inactivate
inactivation
inaktivacija
335
inanimate
neiv
incapacitated
onesposobljen
incarcerated
uklijeten, inkarceriran
inch
incidence
pojavnost, rasprostranjenost
incision
incisor
sjekuti, inciziv
inclination
sklonost; nagnutost
incompatibility
nespojivost, nepristajanje
incompatible
inconclusive
incontinence
incudal
incus, pl. incudes
indeks finger
kaiprst
kazalo, pokazatelj
indicate
indication
indict
optuiti
individual
pojedinac; pojedinani
induce
izazvati; potaknuti
induction
inevitably
neizbjeno
infancy
novoroenaka dob
infant
infarct
infarction
infect
zaraziti, inficirati
infection
zaraza, infekcija
infectious
infective
336
inferior
infertility
neplodnost
infestation
infiltrating
infiltrirajui; prodirui
infiltration
prodiranje; infiltracija
inflame
upaliti
inflammmable
upaljiv, zapaljiv
inflammation
inflammatory
upalni
inflation
napuhavanje
inflexible
neelastian
influence
utjecaj
influenza
gripa, influenza
inframammary
ispod dojke
infusion
ulijevanje; infuzija
ingest
ingestion
ingrained
ukorijenjen
ingredient
sastojak
inguinal
preponski, ingvinalni
inhalation
udisanje, inhalacija
inhale
udisati, inhalirati
inherit
naslijediti
inheritance
batina, nasljee
inhibit
sprijeiti, zaustaviti
inhibition
sprjeavanje, koenje
initial
poetni, inicijalni
injection
utrcavanje, injekcija
injurious
tetan, poguban
injury
ozljeda, trauma
innate
uroen, priroen
337
innocent
innominate bone
inoculation
cijepljenje, inokulacija
inorganic
anorganski, beivotan
insect
kukac
insecticide
insekticid
insemination
osjemenjivanje
insertion
insidious
insipid
insolation
insoluble
netopiv
insomnia
nesanica
inspection
nadziranje; razgledanje
inspiration
udisanje; nadahnue
inspire
udahnuti; nadahnuti
instant
trenutak, as
instantaneous
trenutan; istovremen
instinct
nagon; instinkt
instrument
sredstvo; instrument
insufficiency
insulate
odvojiti, izolirati
insulation
odvajanje, izoliranje
insulator
izolator, lo vodi
insulin
inzulin
insusceptibility
neosjetljivost
intake
integument
integumentary
ovojni, pokrovni
intensive care
intenzivna njega
inter-
meu, izmeu
338
interact
meusobno djelovati
interaction
interbrain
meumozak, diencefalon
intercellular
meustanini
intercostal
meurebreni
intercourse
snoaj
interdigital
izmeu prstiju
interferon
interferon
interior
unutranjost
intermediate
internal
unutranji, interni
internal medicine
interna medicina
interpretation
tumaenje, objanjenje
interseptal
meupregradni, interseptalni
interstitial fluid
intersticijska tekuina
interstitial nephritis
interstitium
intestinal
crijevni, utrobni
intestine
crijevo
intima
intoxication
trovanje, intoksikacija
intra-
unutar, unutra
intracellular
unutarstanini
intracranial
intracutaneous
intraocular pressure
tlak u oima
intrauterine
intravenous
intrinsic factor
introduce
uvesti, uvoditi
intussusception
invaginacija, intususcepcija
339
invade
invasive
involuntary
involvement
ukljuenost, zahvaenost
iodine
jod
ion
iridectomy
iridodialysis
arenica
iron
eljezo
irradiation
obasjavanje, ozraivanje
irrational
neracionalan
irritant
irritate
iritirati, nadraivati
irritation
nadraenost; upala
isch(a)emia
isch(a)emic
ischiatic, ischial
isolate
izolirati, odvojiti
isolation
izolacija; karantena
isomer
izomer
isomerism
isoniazid
isotope
izotop
issue
isthmic
isthmus
itch mite
340
itching
J
jaundice
utica, ikterus
jaw
eljust
jawbone
jejunum
jelly
jerk
trzaj; trzanje
joint capsule
zglobna ahura
judge
jugular
vratni, jugularni
juice
sok
junction
juncture line
juvenile
K
kapok
Kaposi sarcoma
karyoplasm
karioplazma, nukleoplazma
karyotype
kariotip
keloid
keratin
keratinized
keratiniziran
keratitis
upala ronice
keratosis
keratoza
341
kernicterus
ketoacidosis
ketosis
kick
kidney
bubreg
killer cells
stanice ubojice
kin
srodan, blizak
kinesi(o)therapy
kineziterapija
kinesiology
kineziologija
kinetic
knee
koljeno
knee cap
iver, patela
knock
knot
knuckle
kophemia
gluhoa, kofemija
grbavost, kifoza
L
labium majus, pl. labia
majora
velika usna
mala usna
labo(u)r
trudovi (poroajni)
labo(u)r pains
poroajne boli
labyrinth
lacrimal
suzni
lactation
dojenje, laktacija
lactiferous duct
mlijeni vod
laden
optereen, pun
342
laminectomy
laminektomija
laparoscope
laryngitis
laryngopharynx
grkljan i drijelo
laryngoscopy
larinks, grkljan
lateral
boni, lateralni
laxative
layer
sloj
lead
olovo
leak out
leaky
leg
noga
leiomyoma
lens
lea
lesion
lethal
smrtan, smrtonosan
leuk(a)emia
leukemija
leuk(c)ocyte
leuk(c)ocytic
leukocitni
leuk(c)ocytosis
leuk(c)openia
leuk(c)oplakia
leukoplakija
leuk(c)orhea
leukoreja
leuk(c)otaxis
libidinal
343
libido
lid
poklopac, zatvara
life-threatening
ligament
ligation
vezanje, podvezivanje
light rays
svjetlosne zrake
limb
ud, ekstremitet
lime stone
kamen vapnenac
line
linger
oklijevati, zaostajati
lingual tonsil
jezini krajnik
lining
ovojnica, prevlaka
lipid
mast, lipid
lipocyte
lipoid
lipoidan
lipom
liposarcoma
liposarkom
lithoid
poput kamena
lithotomy
live
iv
liver
jetra
load of life
lobby
potajno se zalagati
lobe
reanj, resa
lobotomy
lobster
jastog
locomotion
loin
slabine, kriza
loop of henle
henleova petlja
loose
loosening
lordosis
lordoza
344
lubricate
mazati, podmazivati
lubricating fluid
tekuina za podmazivanje
lues
lues, sifilis
lumbar
slabinski, lumbalni
upljina, lumen
lump
lumpectomy
uklanjanje kvrice
lung
plua
lung cancer
rak plua
lupus
luteinizing hormone, lh
luteinizirajui harmon, lh
lymph
limfa
lymph(o)edema
lymphadenitis
lymphatic, adj., n.
lymphocyte
limfocit
lymphocytosis
lymphoid cancer
lymphokine
limfokin
lymphoma
lymphotoxin
limfotoksin
lyse
lysin
lizin
lytic
M
macrocytic an(a)emia
makrocitna anemija
345
macrophage
macrotia
macula lutea
uta pjega
macule
major
maladaptation
malaise
slabost, mlitavost
maldevelopment
male, adj., n.
muko, mukarac
malformation
nakaznost, malformacija
malfunction
nepravilan rad
malignant
zloudni, maligni
mamma, pl -ae
dojka
mammary gland
mlijena zlijezda
mammectomy
mammillary
mammography
mammoth
mamut
mandible
donja eljust
margin
marrow
masculine
muki
mass
mnotvo, masa
massive
mast cell
mastocit
mastectomy
mastication
vakanje
mastitis
mastoid process
mastoidni nastavak
mastoiditis
346
matter
tvar, materija
mattress
strunjaa, madrac
maturation
dozrijevanje, sazrijevanje
maturity
zrelost
gornja eljust
maxillary
maksilaran
measles
ospice, morbilli
meatus
meconium
medial
srednji, medijalni
median
medication
lijek; lijeenje
medicine
produena modina
modina, sr
medullary
medularan
medulloblastoma
melanin
melanin
melanocyte
melanocit
melanoderma
melanoderma
melanoma
melanom
melatonin hormone
harmon melatonin
melena
membrane
opna, membrana
membraneous
opneni, membranski
memory cells
menarche
347
Meniere syndrome
meningeal sarcoma
meningealni sarkom
meningioma
meningitis
meningoc(o)ele
meningococcus
meningomyeloc(o)ele
menopause
meonopauza, klimakterij
menorrh(o)ea
mjesenica, menstruacija
menorrhagia
menstrual
menstruacijski, menstrualni
menstruation
mjesenica, menstruacija
mental
umni, duevni
mesencephalon
srednji mozak
mesenchyme
mesentery
mesoderm
metabolism
metabolite
metabolit
metacarpal
metastasize
metastazirati
metastatic
metastatski
metatarsal
metronidazol
metroptosis
metrorrhagia
348
microbe
microbiology
mikrobiologija
microglia
microorganism
mikroorganizam
microscope
mikroskop
microstaging method
microtia
micturition
mokrenje
midbrain
middle ear
srednje uho
midline
midstagittal plane
midwife
primalja, babica
mildness
blagost
milk teeth
mlijeni zubi
mind
um, svijest
mineral
ruda, mineral
mineralocorticoid
minor, adj., n.
minute
malen, siuan
miscarriage
pobaaj (spontani)
mite
grinja; svrabac
mitochondrion, pl. -a
mitohondrij
mitral
mo(u)ld
mo(u)ld spore
modifier
modifikator, izmjenjiva
moist
vlaan, mokar
molar
kutnjak (zub)
mole
349
molecule
molekula
mongolism (obsolete)
monitoring
praenje
monocyte
monocit
mononucleosis, infective
mononukleoza, infektivna
(uzronik Epstein-Barr virus)
monoxide
mood
raspoloenje
morbid
morbidity
pobol, morbiditet
morbilli
ospice, morbilli
mortality
smrtnost
morula
motile
gibljiv, pokretan
motility
gibljivost, pokretnost
motivation
motivacija
motivational
motivacijski
motor
mounting
mouth
usta
mucolytic
mucorrh(o)ea
mucosa
sluznica
mucous, adj.
sluzav, mukozan
mucus, n.
sluz
multicentric
multifaceted
multiform
350
multiple sclerosis
multipla skleroza
multiple, adj., n.
viestruk; viekratnik
multipotent
mumps
zaunjaci
murine
miji
murmur
um (srani)
muscle
mii
muscular
miini, miiav
musculoskeletal
miinokotani
mushroom
gljiva
myalgia
myasthenia gravis
mijastenija gravis
myasthenic
mycosis
myelin
myelocytic leukemia
granulocitna leukemija
myeloma, multiple
myocardial
myocarditis
myocardium
myomectomy
myometrium
myoneural
myoneural junction
mioneuralni spoj
myopia
kratkovidnost, miopija
myringotomy
myx(o)edema
N
nail
nokat
narcotic
351
narcotism
nosnica
suenje, konstrikcija
nasal
nosni
nasopharynx
munina
pupak
nearsightedness
kratkovidnost, miopija
neck
necrotic
need
potreba
negligible
neonatal
novoroenaki, neonatalan
neonate
novoroene
neonatology
neoplasm
tumor, neoplazma
neoplastic
neoplastian, tumorski
neostigmine
nephrolithiasis
nephrologist
nephrology
nefrologija
nephron
nephropathy
nephrosclerosis
nefroskleroza
nephrosis
nephrotic syndrome
nephrotomy
nefrotomija
352
nerve
ivac
nervous
gnijezdo; ugnijezditi se
neural
neuralgija
neurilemma, neurolemma
neurilemmoma
neuritis
neuroblastoma
upala ivca
neuroblastom
neurocytoma
neurocitom
neuroectoderm
neuroektoderma
neuroglia
neurohypophysis
neurohipofiza
neurologist
neurolog
neurology
neurologija
neuroma
neuron
neurosis
neuroza
neurosurgeon
neurokirurg
neurotoxin
neurotransmitter
neuroprijenosnik
neurotripsy
neutrophil
neutrofil
nickel
nicotine
nikotin
nipple
bradavica, mamilla
nit
nitrogen
duik
nitrogenous
353
nitroglycerine
nitroglicerin
node
vor
nodular goitre/goiter
nodule
vori
nonmalignant
nonsmoker
nepua
nonsuppurative
noradrenaline
noradrenalin
norepinephrine
nos
nourish
nourishment
nuclear
nucleoplasm
nukleoplazma, karioplazma
jezgra
numbness
nurse
medicinska sestra
nursemaid
dadilja, njegovateljica
nursery
nursing
nutrition
prehrana; hranjenje
nyctalopia
nono sljepilo
nystagmus
O
oat cell carcinoma
oath
zakletva, prisega
obese
obesity
354
oblique muscles
kosi miii
obstetrician
porodniar, opstetriar
obstetrics
porodnitvo, opstetricija
obtrusive
nametljiv
occipital
occiput
zatiljak
occlusion
occur
ocular tendon
ona tetiva
odo(u)r
miris, zadah
offending agent
oil glands
lijezde lojnice
ointment
olecranon
vrh lakta
olfactory
oligodendroglia
oligodendroglioma
oligodendrogliom
oligospermia
oncogenic
oncologist
oncology
onkologija
onset
onychia
oophoritis
upala jajnika
opacity
neprozirnost, zamuenje
opaque
neproziran, zamuen
operable
operating theatre/room
ophthalmologic
oni, oftalmoloki
ophthalmologist
ophthalmology
oftalmologija
355
ophthalmoscopy
oftalmoskopija
optic disc/disk
optic nerve
vidni ivac
option
oral
oral cavity
usna upljina
orbit
orchi(d)opexy
orchitis
ordinary
organ
organ
organic
organski
organism
organizam
orifice
otvor, ue
origin
podrijetlo, ishodite
originate
oropharynx
orthop(a)edic
orthop(a)edics
ortopedski
ortopedija
orthopnea
orthoptic training
orthosis, brace, splint
osmolarity
osseous
kotan; koat
ossicle
ossification
okotavanje, osifikacija
osteitis
osteoarthritis
356
osteoblast
osteochondroma
osteoclasis
osteoclast
osteolytic
osteoma
osteomalacia
osteomyelitis
osteoporosis
osteosarcoma
otalgia, otodynia
uhobolja
otitis media
otoencephalitis
otoencefalitis
Otopyorrh(o)ea
otosclerosis
otoskleroza
outbreak
oval window
ovarian
ovary
jajnik
overcome
prevladati, nadjaati
overgrowth
prekomjeran rast
overpowering
overwhelming
oviduct
jajovod
ovulation
jaje, jajace
oxide
oksid
oxidization
oksidacija; izgaranje
oxidize
oksidirati
357
oxigenate
oxygen
kisik
oxygenation
oxytocin
oksitocin
oyster
otriga (kamenica)
ozone
ozon
P
p(a)ediatric
pedijatrijski
p(a)ediatrician
pedijatar
p(a)ediatrics
pedijatrija
pace
pacemaker, SA node
pad
pain
bol
palate
nepce
palatine
nepani
pale
blijed
paleness
bljedilo, bljedoa
palliative
pallor
palm
dlan
palpation
palpitation
palsy
panacea
pancreas
guteraa
pancreatitis
358
papillary dermis
papilarni dermis
papule
paralysis
paranasal
paranazalni
paraplegia
parasite
nametnik, parazit
parasitic
nametniki
parasympathetic
parasimpatiki
parathyroid gland
parenchymal
parenhimni
parenchyme
parietal
zidni, parijetalni
parietal bone
tjemena kost
parietal pleura
Parkinson disease
Parkinsonova bolest
paronychial
parotid
parotitis
paroxysm
particle
estica
particulate matter
partition
dijeljenje, pregrada
parturition
poroaj, raanje
partus
poroaj
partus agrippinus
atch
patella, knee cap
pathogen
359
pathologic
bolestan, patoloki
pathologist
patolog
patient
bolesnik
pattern
peak
pectoral
prsni
peculiar
peer
pellucid
zdjelica
pemphigus
ir, pemfigus
penicillin
penicilin
penis
peptic ulcer
perceive
perception
opaanje, percepcija
percussion
percutaneous
perianal
pericarditis
pericardium
osrje, perikard
peril
opasnost, pogibelj
perimetrium
perimisium
perinatal
perinatalni
perineal
perineum, pl. -a
meica
periosteum, pl. -a
pokosnica
perish
peristalsis
peristaltika
360
peristaltic
peristaltiki
peritoneum
potrbunica
peritonitis
peritubular
peritubularni
perk up
pernicious an(a)emia
perpetuation
persistent
ustrajan, tvrdokoran
perspiration
znoj, znojenje
pertussis
hripavac
pessary
petehija
petit mal
phagocyte
phagocytic
fagocitni
phagocytosis
fagocitoza
lanak (prsta)
pharyngeal tonsils
drijelni krajnici
drijelo
phenol
phenomenon, pl. -a
pojava, fenomen
phenotype
fenotip
phenylketonuria
pheochromocytoma
phimosis
phlebitis
phlebotomy
phlegm
phobia
361
phonation
phosphorus
fosfor
physical
physician
lijenik
physiologic/al
fizioloki
physiology
fiziologija
pia mater
pigmentation
pigmentacija
pigmented
pigmentiran
piles
uljevi, hemoroidi
pillow
pilonidal cyst
pilonidna cista
pimple
bubuljica
pineal gland
cerebralna epifiza
pinkeye
pituitary cachexia
pituitary gland
lijezda hipofiza
placenta
posteljica
placenta praevia
placenta previja
placental
plant
biljka; postrojenje
plantar flexion
plaque
ploa; naslaga
plasma
plazma (krvna)
platelet
pleasurable
plegia
pleomorphic
pleural effusion
362
pleurisy, pleuritis
upala porebrice
pneumoconiosis
pneumonia
pneumothorax
podagra
poison
otrov
polio
pollen
polycentric
polycythemia
polydipsia
prekomjerna e
polyp
polyphagia
polyuria
most
poppy
pore
pora
portal vein
vena vratarnica
positioning
namjetanje
posterior
stranji
posture
potassium
kalij
potential
pouch
vreica
pound
practice
predisposition
sklonost, predispozicija
preeminence
pregnancy
trudnoa
premature birth
prijevremeni poroaj
363
prepuce
presby(a)cusis
presbyopia
prescribe
propisati
prescription
primipara
probe, cryoprobe
probing
pretraivati sondom
process
nastavak, izdanak
productive cough
produktivni kaalj
profuse
obilan
progesterone
prognosis
predvianje, prognoza
progressive
prolapse
proliferate
rasti, mnoiti se
proliferation
prominence
isticanje, izboina
pronation
prone
propel
propelling pressure
prophylactic
zatitan, profilaktian
propulsion
prostate gland
prostatectomy
364
prostatic hypertrophy
hipertrofija prostate
protect
zatititi
protection
zatita
protein
bjelanevina
proteinuria
bjelanevine u mokrai
prothrombin
protoplasm
protoplazma
protrusion
izboenje, strenje
prowess
proximal
blii, proksimalan
pruritus
svrbe
psoriasis
psorijaza
psyche
dua, psiha
psychiatrist
psihijatar
psychiatry
psihijatrija
psychologist
psiholog
psychology
psihologija
psychosis
psihoza
ptosis
puberty
doraslost, pubertet
pubic
puerperal
babinji, puerperalni
puerperium
babinje, puerperij
pulmonary
pluni
pulmonary emphysema
pluni emfizem
pulp
pulse
bilo, puls
puncture
punkcija, ubod
pupil
zjenica
365
purification
proiavanje, ienje
purity
istoa, jasnoa
purpura
purulent
gnojan
pus
gnoj
pustular
gnojan
pustule
putrefaction
truljenje, gnjiljenje
pyelonephritis
pijelonefritis
pyeloplasty
pyloric valve
pylorospasm
pilorospazam
pylorus
vratarnik, pilorus
pyogenic
gnojan, piogen
pyothorax
pyrosis, heartburn
garavica
pyuria
Q
quadrant
kvadrant
quadruplets
etvorke
quality
kakvoa, kvaliteta
quantity
koliina, kvantitet
quarter
questionable
quinsy
quit
quotient
kolinik, kvocijent
R
race
366
rachitis, rickets
rahitis
radial
zrakast, radijalan
radiate
radiation
zraenje, isijavanje
radical
radiologist
radiolog
radiology
radiologija
radiotherapy
radioterapija
raised
rale
hroptanje
random
sluajan
range
rarely
rijetko, neobino
rash
osip
rate
rather
raw
Raynauds phenomenon
re-establish
reach
rear
receive
recent
receptor
prihvata, receptor
recipient
primatelj
Recklinghausen disease
recognition
record, n.
record, vb.
biljeiti, zapisivati
367
recourse
rjeenje, izlaz
recovery
oporavak, rekonvalescencija
rectal
rektalan
ravno crijevo
rectus
ravan mii
recumbent
recurrent
povratan, recidivan
reduce
reduction
refer to
refine
reflux
refractive
refrakcijski
refracturing
regard
regarding
regenerate
obnavljati, regenerirati
region
regress
regression
regurgitation
rehabilitation
reinforce
pojaati
relapse
relapsing
relax
relay
prenositi (impulse)
release
relevance
znaajnost, vanost
relief
olakanje, smirenje
368
relieve
reluctance
remain
preostati, ostati
remainder
remarkable
remedy
lijek
remission
remote
udaljen, dalek
removal
uklanjanje, odstranjenje
remove
ukloniti, odstraniti
renal
bubreni, renalan
bubreni kamenac
renal pelvis
bubrena zdjelica
renal vein
bubrena vena
renew
obnavljati se
renewed
renin
renin
repair
obnavljanje, regeneracija
repetitive
replacement
repolarization
repolarizacija
reproduction
reproductive
rasplodni, reprodukcijski
require
resection
resemblance
slinost
resemble
reserpine
reservoir
spremite, spremnik
369
residual
preostali
residue
ostatak
resilient
resin
smola
resistance
resolve
respectively
odnosno, dotino
respiration
disanje
respiratory
dini
respond
odgovoriti, reagirati
response
odgovor, reakcija
responsible
odgovoran
restful
restoration
restore
restrictive
retain
zadravati
retardation
zaostajanje, retardacija
retention
reticuloendothelial
retikuloendotelni
retikulum, mreica
mrenica
retinitis
upala mrenice
retinitis pigmentosa
retinoblastoma
retraction
retrograde
reveal
otkriti, pokazati
revenue
prihod, dohodak
370
reverse adj.
reverse, vb.
okrenuti, promijeniti
rhabdomyoma
rhabdomyosarcoma
rabdosarkom
rhesus factor
rheumatic fever
reumatska groznica
rheumatoid arthritis
reumatoidni artritis
rhinitis
rhinology
rinologija
rib
rebro
rib cage
prsni ko
ribonucleic acid
ribonukleinska kiselina
ribosome
ribosom
rickets
rahitis
ridge
rigidity
ring
ringworm
ripening
sazrijevanje
risk
rod
tapi
rod-shaped
tapiast
rodent ulcer
roentgen
rendgen
roentgenology
rendgenologija
role
funkcija, uloga
root
korijen, ila, sr
rosacea
rotation
371
rough
rubella
crvenka, rubeola
rubeola
trodnevne ospice
nabor, bora
ruggedness
hrapavost
rumbling
kruljenje
rupture
prsnue, ruptura
S
sac
vrea
saclike
vreast
sacral
sacroiliac
sakroilijakalni
krina kost
safe
sagittal
saliva
slina
salivary glands
lijezde slinovnice
salpingectomy
salpingitis
upala jajovoda
salpinx
salt
sol
sample
uzorak
sane
saphenous vein
sarcolemma
sarcoma,pl.
sarcomas,sarcomata
sarkom
saturated
zasien, ispunjen
372
scab
krasta
scabies
svrab
scale
ljuska, ljuskica
scalelike
ljuskav
scaling
scalp
scan, vb.
scar
oiljak
scar tissue
oiljno tkivo
scarcity
arlah, skarlatina
scarring
scheme
Schwann sheath
sciatica
bjeloonica
scleroderma
sklerodermija
skleroza
scotoma
scrape
strugati, ostrugati
scraping away
abrazija
screen
monje
seal off
search
traiti, istraivati
sebacious glands
lijezde lojnice
sebum
loj (ljudski)
secrete
izluivati
373
secretion
izluivanje
section
securely
sigurno, vrsto
sedation
seek
traiti, potraiti
seemingly
prividno
seep out
iscuriti, cijediti se
seizure
napadaj bolesti
self-limiting disease
sella turcica
tursko sedlo
sjeme
semicircular
polukruan
semilunar valve
polumjeseasti zalistak
seminal
sjemenski
seminal vesicle
sjemenski mjehuri
seminiferous tubules
seminoma
senescent
staraki
senile
staraki, senilan
sensation
osjet, osjeaj
sense organ
sensitivity
osjetljivost, njenost
sensitized
osjetljiv, senzibiliziran
sensory
osjetni, osjetilni
separate
separation
sequence of involvement
redoslijed ukljuivanja
serosa
serosal
374
serous
serous fluid
serumska tekuina
krvni serum
serve
serviette
ubrus
sesame
sezam
sesamoid bone
sezamska kost
set off
several
nekoliko, nekolicina
sever
severity
sew
ivati, saiti
sex cord
sex glands
sex linked
spolno vezan
sexual climax
sexual intercourse
odnoaj
shaft
shallow
plitak
shape
oblik
sharp
otar
sheath
ovojnica, omotac
shedding
ljutenje (koe)
sheet
plahta, ploha
shell-fish
shepherd
pastir, ovar
shield, n.
titnik, zastita
shield, vb.
tititi, braniti
igela
shin bone
cjevasta kost
shingles
herpes zoster
375
shock
ok, udarac
shortsightedness
kratkovidnost, miopija
shoulder
rame
shoulder blade
lopatica, skapula
shoulder bone
lopatica, skapula
shrink
shrinkage
shuffling gate
teturav hod
shunt
sickle-cell an(a)emia
sieve
sito, reeto
sigmoid colon
sign
znak
significant
signify
silica
silicijski dioksid
silicon
silicij
silicon dioxide
silicijski dioksid
silvery
similarity
slinost, istovrsnost
Simmonds disease
simple fracture
simultaneous
istodoban
single
jednostruk, pojedinacan
sinister
lijevi; zlokoban
sinistral
sinotrial node
376
sinus
zaton, sinus
sinusitis
upala sinusa
sip, n.
gutljaj, srkanje
sip, vb.
gucnuti, srknuti
sister in charge
site
size
veliina
skeletal
kosturni, skeletni
skeleton
kostur, skelet
skin
oteenje koe
skin rash
osip na koi
skull
lubanja
slant
kosa crta
slender
slipped disk
iskliznue diska
slit
slitlike
slope-away
slough
ljutiti se
slow-motion
small intestine
tanko crijevo
smallpox, variola
smell
smooth muscle
glatki mii
snail -shaped
snare
soak
socket
sodium
natrij
soft palate
meko nepce
377
softening
sole
potplat, on
taban
solely
solid
krut, vrst
solidify
soluble
topiv
solution
otopina; rjeenje
somatic
tjelesan, somatian
somatotropin
somatotropin
somewhat
neto
somnolent
sore
sore throat
sound
sound production
sound wave
zvuni val
source
space
prostor, svemir
span, n.
span, vb.
premostiti
sparingly
umjereno, tedljivo
spark
iskra, varnica
spasm
spastic
grevit, spastiki
spastic colon
spastiki kolon
spasticity
zgrenost, spastinost
specialized
poseban, specijaliziran
speck
mrlja, tokica
spell
spelling
sricanje, pravopis
sperm
sjeme, sperma
378
sperm viability
spermatic cord
sjemeni snop
spermatozoon, pl.
spermatozoa
sphenoid bone
sphincter
sphygmomanometer
tlakomjer, sfigmomanometar
spider-web
spina bifida
spinal
kraljenini
spinal cord
kraljenina modina
spine
kraljenica
spinous process
spirochete
spiroheta
spit
ispljunuti, pljuvati
spleen
slezena
splenectomy
splenodynia
bolovi u slezeni
splenomegaly
splenopexy
splenopeksija
splenorrhaphy
splenorafija
splint
longeta, imobilizacija
splinter
smrskati, razmrviti
split
rascjep (usne)
spongy
spuvast, spongiozan
spontaneous
spot
sprain
spread
sputum
ispljuvak
ljuska
379
squamous
ljuskav, plosnat
squint
stabilization
uvrenje, stabilizacija
stable
stage
stain
obojiti, bojati
stalk
stapedectomy
stafilokok
star-shaped
zvjezdolik
starch
krob
steatorrh(o)ea
stem
stem cell
suenje, stenoza
step
korak
sterilization
sterilizacija
prsna kost
steroid
steroid
stethoscope
stetoskop
stiffen
stiffening
stiffness
ukoenost
podraaj
stirrup
stremen
stomach
eludac
stones
kamenci
380
stool
stolica, feces
store
strabismus
strabotomy
straighten out
izravnati
strain
strand
vlakno, pramen
strangulated
uklijeten, udavljen
sloj
ronati sloj
straw
slama, slamica
strengthen
pojaati, uvrstiti
streptococcal
streptokokni
streptococcus, pl.
streptococci
streptokok(i)
stress
stretch
stretching
rastezanje, istezanje
pruga, strija
striated muscle
stricture
suzenje
stridor
strike
udariti, pogoditi
stringy
strip
stroke
structure
stupor
tupost, stupor
stye
jemenac, halazion
381
subarchnoid
subclavian vein
potkljuna vena
subcutaneous
potkoan, supkutan
subsequent
subside
substance
tvar
suckling
dojene
sudor
znoj
sudoriferous glands
lijezde znojnice
suffer from
suffice
dostajati, zadovoljavati
sufficient
dostatan, dovoljan
suffocating
suitable
brazda, lijeb
superficial
povrinski
supination
supine
supply
snabdijevati, opskrbiti
support
suppository
suppurative
gnojan
suprapubic
suprapubian
suprarenal gland
nadbubrena lijezda
supress
surface
povrina
surge of blood
navala krvi
surgeon
kirurg
surgery
382
surgical
kirurki
surrounded
surroundings
okolina, okoli
survival
preivljavanje, opstanak
survival rate
stopa preivljenja
susceptibility
susceptible
suspect, v.
suspended
lebdeci, suspendiran
suspension
sustain
suture, n.
suture, v.
swallow
gutati
swallowing
gutanje
sweat glands
lijezde znojnice
sweat, s.
znoj
sweat, vb.
znojiti se
sweating
znojenje
swelling
swollen
oteen
sympathetic
sympodia
synapse
synarthrosis
syncope
nesvjestica, sinkopa
synovial
synovial capsule
zglobna ahura
synovial fluid
sinovijalna tekuina
synovial membrane
383
synthesize
sintetizirati; proizvesti
syphilis
sifilis, lues
syphilitic
sifilitian
syringe
trcaljka
system
sustav
systemic circulation
veliki krvotok
systole/sistole
systolic
sistoliki
T
tachycardia
tachypn(o)ea
tag
tail
rep, kauda
tailbone
trtina kost
take over
preuzeti (funkciju)
take place
dogoditi se
talipes
tap
lupkati, perkutirati
tapper off
tar
katran, smola
target tissue
ciljno tkivo
tarsal
task
zadatak, zadaa
taste
okus
taste buds
okusni pupoljci
tax
tear gland
suzna lijezda
tear, n.
suza
tear, vb.
kidati, cijepati
technique
telescope
teleskopirati
384
telescoping
teleskopiranje
temporal
sljepooni
temporal bone
sljepoona kost
temporary
privremen, prolazan
temporomandibular joint
eljusni zglob
tendency
tender
tenderness
osjetljivost, mekoa
tendon
tetiva
tension
teratocarcinoma
teratokarcinom
tertiary
test tube
epruveta
testicle
testicular
testicular carcinoma
rak sjemenika
sjemenik, mudo
testosterone
tetanus
tetanus
tetany
tetanija
thalamotomy
talamotomija
thalamus
thalassemia
thick
thickened
thickness
thigh
bedro
thin
thin sore
plitka ranica
385
thinness
thinning
thirst
thoracic
prsni ko
thought
thread
threat
thrive
rasti, razvijati se
throat
grlo, grkljan
thrombm:yte
thrombophlebitis
thrush
thumb
palac na ruci
thymectomy
thymitis
thymoma
thymus
thyroid gland
thyroidectomy
thyrotoxicosis
tireotoksikoza, hipertireoza
thyroxine
tick
krpelj
tied off
podvezan
timing
vremensko usklaivanje
tinea pedis
386
tinge
tinnitus
um u uhu
tiny
tip
tiredness
tissue
tkivo
titre/er
titar
tobacco
duhan
toe
prst stopala
toenail
toll
tongue
jezik
tonometar
tonsil
tonsillectomy
tonsillitis
tooth removal
vaenje zuba
zub
toothpick
akalica
tough
tox(a)emia
toxic
otrovan, toksian
toxin
otrov
trachea
dunik
tract
trait
tranquillizer
transaminase
transaminaza
transient
prolazan, kratkotrajan
translucent
proziran, providan
387
transmit
transparent
proziran, providan
transplant, n.
kalem, transplantat
transplant, vb.
presaditi, transplantirati
transurethral resection
transuretralna resekcija
transverse colon
transverse process
trap
uhvatiti, uloviti
ozljeda, trauma
travel
putovati, kretati se
treatment
treponema pallidum
triangular
trichomonas vaginalis
trihomonas vaginalis
trichomoniasis
trihomonijaza
tricuspid valve
trigger
izazvati, prouzrociti
triglyceride
triglicerid
trigone
triiodothyronine
triple-looped
trostruko zavijen
triplets
trojke
trochanter
kvrga
true ribs
prava rebra
trunk
trup, stablo
tube
cijev
tubercle
kvrica, tuberkulum
tuberculosis
suica, tuberkuloza
tuberosity
hrapavost
tubes
jajovodi
tubular
cjevast
388
tubule
tuft of capillaries
mreza kapilara
tumo(u)r
turkey
puran, purica
twin
blizanac, dvojnik
twist
zavijati
twisted
twitches
twitching
tympanic cavity
bubnjite
tympanorrhexis
tyrosine
tirozin
U
ulcer
ulcerate
ulceration
ulcerative
gnojan, ulcerozan
ulcerative colitis
ulcerlike
poput ira
ulcerous
zahvaen ulceracijom
lakatna kost
ultrasound
ultrazvuk
ultraviolet
ultraljubiast
ultraviolet radiation
ultraljubiasto zraenje
umbilical
pupan
umbilical cord
umbilical hernia
umbilicus
pupak
unable
nesposoban
unblinking
koji ne trepe
uncertainty
389
uncondensed
nekondenziran
unconscious
nesvjestan, onesvijeten
unconsciousness
nesvjestica
undergo
underlying
underneath
dolje, ispod
undescending
koji se ne sputa
undesirable
nepoeljan, neugodan
undifferentiated
nediferenciran
unequal
nejednak, nerazmjeran
unfortunately
naalost
unicellular
jednostanian
unilateral
jednostran
union
veza, spoj
unit
jedinica, ureaj
unobtainable
unobtrusively
nenametljivo, edno
unossified
neokotan
unpaired
unpleasant
neugodan, odvratan
unpolluted
ist, nezagaen
unresponsitivity
unspecialized
untwist
unusual
neobian, izvanredan
upper
vii, gornji
upper back
uppermost
najvisi, gornji
390
urban
gradski
urea
mokraevina, urea
uremia
ureter
mokraovod, ureter
urethra
urethritis
urge
uric acid
mokrana kiselina
urinary
mokrani
urinary bladder
mokrani mjehur
urinary meatus
mokrani prolaz
urinary passages
mokrani putovi
urinary retention
urination
mokrenje, mikcija
urine
mokraa, urin
urinogenital
mokrano-spolni, urogenitalni
urogenital
urogenitalni
urologist
urolog
urology
urologija
urticaria
koprivnjaa, urtikarija
use, n.
use, vb.
usual
usually
uterine
maternica
utilization
resica, uvula
V
vaccinate
cijepiti, vakcinirati
391
vaccination
cijepljenje, vakcinacija
vaccine, n.
cjepivo, vakcina
rodnica
vaginal
vaginismus
vaginitis
upala rodnice
valve
zalistak
malen zalistak
valvular
vapour
variable
varicella
varices
varicoc(o)ele
varicose vein
vary
vascular
vascularity
prokrvljenost
vascularize
snabdjeti krvlju
vasectomy
vasoconstriction
vasodilator
vasopressin
vast
vein
vena
vena cava
uplja vena
392
venous
venozan
ventral
trbuni
ventricle
venule
verruca
kraljeak
vertebral
vertebral arch
luk kraljeka
vertebral body
tijelo kraljeka
vertebral column
kraljenica
vertigo
vrtoglavica
vesicle
mjehuri, vezikula
vesicular
mjehurast, mjehuricast
vessel
(krvna) ila
vestibule
predvorje, vestibulum
vestige
vestigial
rudimentaran, zakrljao
viability
viable
vibrate
vice
vicinity
victim
rtva, stradalnik
victory
pobjeda
view
vigorous
crijevna resica
vinegar
ocat, kvasina
violent
viral
virusni
393
virgin
djevica
virginal
djevianski, ist
virginity
djevianstvo
virilism
virtue
krijepost, vrlina
virus
virus
visceral pleura
visceropexy
viscosity
viskoznost
visible
vision
vid
visual
vidni, oni
vital
ivotni, vitalan
vitality
vitamin
vitamin
vitiligo
vitreous
staklast, staklen
vitreous humour
vocal
vocal cords
glasnice
voice box
grkljan, larinks
void
voiding
volcanoconiosis
voluntary
voljan, namjeran
voluntary muscle
prugasti mii
volvulus
zapletaj crijeva
394
vomer
ralo, leme
vomit
povraati
vomiting
povraanje
voracious
vowel
samoglasnik, vokal
stidnica
vulvovaginitis
W
wall
stijenka, zid
wall-eyed
kiljav, razrok
wane
ward
bolniki odjel
ward off
warm, adj.
topao, zagrijan
warm, vb.
wart
bradavica
waste-product
otpadni proizvod
watch for
pripaziti (na)
wave
val
wavelike
valovit
wax
vosak
weakened
weakness
wealth
wedge
wedged
uklijeten
weed
weigh
teiti
395
weight
teina
weight gain
weight loss
welfare
wet
mokar, vlaan
wheal
urtika
wheeze
wheezing
whiplike
u obliku bia
whir
zujanje, cvranje
whirl
vrtnja, okretanje
white matter
bijela tvar
whitish
bjelkast
wide
irok
Wilms tumour
Wilmsov tumor
windpipe
dunik, traheja
wipe
wishful
withdraw
within
u, unutra, u opsegu
womb
maternica, utroba
word root
korijen rijei
wormlike
crvolik
worn-out
wound
rana, ozljeda
wrapping
ovojnica, omota
wrist
wrong
X
x-ray, v.
396
rentgenski snimiti
x-rays, n.
xanthemia
xenograft, heterofgraft
xiphoid
xiphoid appendage
Y
yawning
yaws
zijevanje
frambezija (endemska tropska kona
bolest), malinaste tropske boginje
yeast
yellow body
yellow fever
yellow marrow
yield
proizvesti, ostvariti
yolk
umanjak, umanjce
yolk sac
umanjana vrea
Z
zone
sponina kost
zygomatic
zygote
sponini, zigomatini
oploeno jajace; stanica koja je rezultat
spajanja muke i enske spolne stanice
397
References
1. blakistons Gould Medical Dictionary, 4th ed., McGraw-Hill Book Company,
New York 1979
2. Bujas : Veliki hrvatsko-engleski i englesko hrvatski rjenik, 2. Izdanje,
Zagreb Globus 2001
3. Caroll, Ch. i Miller, D. Health, the Science of Human Adaptation, WBC, New
York, 1983
4. Chabner, D.E. The Language of Medicine, 5th and 7th eds., Saunders, Philadelphia 2001, 2004
5. Dorlands Illustrated Medical Dictionary, 30th ed., Saunders, Philadelphia 2003
6. Ellis, J.W. Medical Symptoms and Treatments, Beekman House, New York
1986
7. Gylys, B.A. & Wedding, M.W. Medical Terminology: A Systems Approach, 6th
ed., F.A. Davis, Philadelphia 2009
8. Keros, P., Bagi, . i Peina, M. Temelji anatomije ovjeka, Medicinski fakultet
Sveuilita u Zagrebu, Zagreb 1987
9. Loknar, V. Teme iz medicinskog nazivlja, Jumena, Zagreb, 1988.
10. Medicinski leksikon, Leksikografski zavod Miroslav Krlea, Zagreb
11. Merriam-Websters Collegiate Dictionary
12. Miller, B.F. & Keane, C.B. Encyclopedia and Dictionary of Medicine, Nursing
and Allied Health, W.B. Saunders Company
13. Mosbys Dictionary of Medicine, Nursing & Health Professions, Mosby
Elsevier, 2009
14. Parkinson, J. A Manual of English for the Overseas Doctor, 3rd ed., Churchill
Livingstone, Edinburgh, 1985
15. Parkinson J. & Brooker C: Everyday English for International Nurses A
guide to working in the UK. Churchill Livingstone 2004.
16. Websters Medical Desk Dictionary, Merriam-Webster, Inc., Springfield,
Mass.
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