Med Term Ch3 and Ch4

Medical LanguageMedical LanguageImmerse YourselfImmerse Yourself

CHAPTER

THIRD EDITION

Medical Language, Third Edition Susan M. Turley

Gastroenterology

Learning ObjectivesLearning Objectives

1. Identify the structures of the gastrointestinal system.

2. Describe the process of digestion.3. Describe common gastrointestinal

diseases, laboratory and diagnostic procedures, medical and surgical procedures, and drug categories.

4. Give the medical meaning of word parts and abbreviations related to the gastrointestinal system.

5. Build gastrointestinal words from word parts and divide and define gastrointestinal words.

6. Spell and pronounce gastrointestinal words.

7. Analyze the medical content and meaning of a gastroenterology report.

8. Dive deeper into gastroenterology by reviewing the activities at the end of this chapter and online at www.MyMedicalTerminologyLab.com.

Multimedia DirectoryMultimedia DirectorySlide 10Digestive System AnimationSlide 48Digestive System AnimationSlide 73GERD VideoSlide 79Appendicitis AnimationSlide 113Sigmoidscopy VideoSlide 167Medical Assisting Video

GastroenterologyGastroenterology

• The medical specialty that studies the anatomy and physiology of the gastrointestinal system and uses diagnostic tests, medical and surgical procedures, and drugs to treat gastrointestinal diseases.

Anatomy and PhysiologyAnatomy and Physiology

• Gastrointestinal (GI) System Begins at the mouth, continues through

the thoracic cavity, and fills much of the abdominal cavity

Upper gastrointestinal system includes the structures from the mouth through the stomach.

• Gastrointestinal (GI) System Lower gastrointestinal system includes

the structures from the small intestine through the anus.

Purpose of GI system is to digest food, absorb nutrients, and remove undigested material (waste) from the body.

Figure 3-1 Gastrointestinal system.

Digestive System AnimationDigestive System Animation

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Anatomy of theAnatomy of theGastrointestinal SystemGastrointestinal System

• Oral Cavity and Pharynx The GI system begins in the mouth, or

oral cavity The oral cavity contains the teeth,

gums, tongue, hard palate, and soft palate with its fleshy, hanging uvula.

Figure 3-2 Oral cavity and pharynx.

• Oral Cavity and Pharynx The oral cavity is lined with mucosa, a

mucous membrane that produces thin mucus.

Receptors on the tongue perceive taste and send this sensory information to the gustatory cortex in the brain.

• Oral Cavity and Pharynx The sight, smell, and taste of food cause

the salivary glands to release saliva into the mouth; this moistens foods as they are chewed and swallowed.

Saliva also contains an enzyme that begins the process of digestion.

• Oral Cavity and Pharynx There are three pairs of salivary glands:

the parotid glands, the sublingual glands, and the submandibular glands.

The teeth tear, chew, and grind the food during the process of mastication.

Figure 3-3 Salivary glands.

• Oral Cavity and Pharynx The tongue moves food toward the

teeth and mixes food with saliva. Swallowing or deglutition moves food

into the pharynx (throat).

• Oral Cavity and Pharynx When food is swallowed, muscles in the

neck pull the larynx upward to close against the epiglottis, so that food in the pharynx does not enter the larynx, trachea, and lungs. If the larynx is not closed, food in the back of the pharynx pressing on the uvula initiates the gag reflex.

• Esophagus A flexible, muscular tube that connects

the pharynx to the stomach. Lined with mucosa that produces mucus By coordinated contractions of its wall—

the process of peristalsis—food moves toward the stomach

• Stomach A large, elongated sac in the upper

abdominal cavity that receives food from the esophagus

Divided into four areas: the cardia, fundus, body, and pylorus

• Stomach The gastric mucosa is arranged in thick,

deep folds known as rugae which expand as the stomach fills with food.

The mucosa produces mucus that protects the lining of the stomach from the acid the stomach produces.

• Stomach Two sphincters (muscular rings) keep food

in the stomach. The lower esophageal sphincter is located

in the distal esophagus. The pyloric sphincter is located in the

distal end of the stomach. Chyme is a semisolid mixture of partially

digested food, saliva, and digestive enzymes in the stomach.

Figure 3-4 Stomach.

• Small Intestine A long, hollow tube that receives chyme

from the stomach Is divided into three parts: the

duodenum, jejunum, and ileum

Figure 3-5 Small and large intestines.

• Large Intestine A larger tube that receives undigested

material and some water from the small intestine.

Consists of the cecum, colon, rectum, and anus.

The walls contain haustra (puckered pouches) that can greatly expand, as needed.

• Large Intestine Waves of peristalsis slowly move

undigested wastes through the large intestine as water is absorbed through the intestinal wall and into the blood.

The colon is the longest part. Colon travels through all four quadrants

of the abdomen as the ascending colon, transverse colon, descending colon, and sigmoid colon.

• Large Intestine The sigmoid colon bends toward the

midline as an S-shaped curve that joins the rectum.

The rectum is a short, straight segment that connects to the outside of the body.

• Large Intestine The anus, the external opening of the

rectum, is located between the buttocks. The anal sphincter is a muscular ring

whose opening and closing is under conscious, voluntary control.

• Abdomen and Abdominopelvic Cavity Contains the largest organs (viscera) of

the gastrointestinal system. The walls of the abdominopelvic cavity

are lined with peritoneum, a membrane that secretes peritoneal fluid.

This watery fluid fills the spaces between the organs and allows them to slide past each other during the movements of digestion.

• Abdomen and Abdominopelvic Cavity The peritoneum extends into the center

of the abdominopelvic cavity as the omentum.

The omentum supports the stomach and hangs down as a fatty apron to cover and protect the small intestine.

The peritoneum also becomes the mesentery, a thick, fan-shaped sheet that supports the jejunum and ileum.

• The blood supply to the stomach, small intestine, liver, gallbladder, and pancreas comes from the celiac trunk (a branch of the aorta, the largest artery in the body).

• Liver The largest solid organ in the body Located in the upper right abdominal

cavity An accessory organ of digestion that

contributes to, but is not physically involved in, the process of digestion

Liver cells (hepatocytes) continuously produce bile, a yellow-green, bitter-tasting, thick fluid.

• Liver Bile produced by the liver flows through

the common hepatic duct and into the common bile duct toward the duodenum. When that duct is full, bile flows into the cystic duct and gallbladder.

All of the ducts that carry bile are collectively known as the biliary tree.

Figure 3-6 Biliary tree.

• Gallbladder An accessory organ of digestion

posterior to the liver. Concentrates and stores bile The presence of fatty chyme in the

duodenum causes the gallbladder to contract, sending bile from the common bile duct into the duodenum to digest fats

• Pancreas An accessory organ of digestion

posterior to the stomach. Presence of food in the duodenum

causes the pancreas to secrete digestive enzymes through the pancreatic duct and into the duodenum

Also functions as an organ of the endocrine system

Physiology of DigestionPhysiology of Digestion

• There are two parts to digestion: Mechanical Chemical

• Mechanical digestion involves mastication, deglutition, and peristalsis to break down foods.

• Mechanical digestion also involves breaking apart fats in the duodenum.

• Fatty chyme stimulates the duodenum to secrete the hormone cholecystokinin, which stimulates the gallbladder to contract and release bile.

• Bile breaks apart large globules of fat during the process of emulsification.

• Chemical digestion uses enzymes and acid to break down foods.

• The enzyme amylase in saliva begins to break down carbohydrate foods in the mouth.

• The stomach secretes the following substances that continue the process of chemical digestion: Hydrochloric acid Pepsinogen Gastrin

• The stomach secretes a substance known as intrinsic factor, which helps vitamin B12 be absorbed from the intestine into the blood.

• When the stomach does not produce enough intrinsic factor, vitamin B12 is not absorbed.

• Chemical digestion continues in the small intestine.

• Cholecystokinin stimulates the pancreas to secrete digestive enzymes into the duodenum: Amylase Lipase Other enzymes that break down

proteins

• The villi of the small intestine produce digestive enzymes such as lactase to break down the sugar in milk.

• The sugars in carbohydrates, starches, and milk are broken down to the simple sugar glucose which is the only source of energy that body cells can use.

• Absorption of nutrients and water through the intestinal wall into the blood takes place in the small intestine.

• Absorption of water continues in the large intestine.

• Absorbed nutrients are carried by blood to the liver.

• The liver plays an important role in regulating nutrients such as glucose and amino acids.

• Excess glucose in the blood is stored in the liver as glycogen and released when the blood glucose level is low.

• The liver uses amino acids to build plasma proteins and clotting factors for the blood.

• Elimination occurs when undigested materials and water are eliminated from the body in a solid waste form known as feces or stool.

• The process of elimination is a bowel movement or defecation.

Figure 3-7 Gastrointestinal system.(Sergiy Bykhunenko/Fotolia)

Digestive System AnimationDigestive System Animation

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Classroom Response System

The gag reflex is initiatedThe gag reflex is initiatedby food touching the:by food touching the:

A. soft palate.B. mouth.C. uvula.D. lips.

The gag reflex is initiatedThe gag reflex is initiatedby food touching the:by food touching the:

A. soft palate.B. mouth.C.uvula.D.lips.

The word deglutition refers to:The word deglutition refers to:

A. chewing, grinding, and tearing food.B. swallowing food.C. contractions of the esophagus.D.partially undigested food.

The word deglutition refers to:The word deglutition refers to:

A. chewing, grinding, and tearing food.B.swallowing food.C. contractions of the esophagus.D.partially undigested food.

The large intestine includes:The large intestine includes:

A. the cecum, ileum, colon, and rectum.B. the cecum, colon, rectum, and anus.C. the duodenum, rectum, and anus.D.none of the above.

The large intestine includes:The large intestine includes:

A. the cecum, ileum, colon, and rectum.B.the cecum, colon, rectum, and

anus.C. the duodenum, rectum, and anus.D.none of the above.

Is the liver physically involvedIs the liver physically involvedin the process of digestion?in the process of digestion?

A. yes.B. no.

Is the liver physically involvedIs the liver physically involvedin the process of digestion?in the process of digestion?

A. yes.B.no.

Sugar in milk is broken downSugar in milk is broken downin the small intestine by the enzyme:in the small intestine by the enzyme:A. amylase.B. protease.C. lipase.D. lactase.

Sugar in milk is broken downSugar in milk is broken downin the small intestine by the enzyme:in the small intestine by the enzyme:A. amylase.B. protease.C. lipase.D.lactase.

The process of eliminationThe process of eliminationis called:is called:

A. feces.B. defecation.C. meconium.D.chyme.

The process of eliminationThe process of eliminationis called:is called:

A. feces.B.defecation.C. meconium.D.chyme.

Peristalsis occurs in all of the following Peristalsis occurs in all of the following gastrointestinal structures and organs EXCEPT gastrointestinal structures and organs EXCEPT

the:the:

A. stomach.B. small intestine.C. colon.D.oral cavity.

Peristalsis occurs in all of the following Peristalsis occurs in all of the following gastrointestinal structures and organs EXCEPT gastrointestinal structures and organs EXCEPT

the:the:

A. stomach.B. small intestine.C. colon.D.oral cavity.

The word cardia refers to the:The word cardia refers to the:

A. heart.B. pharynx.C. salivary glands.D.stomach.

The word cardia refers to the:The word cardia refers to the:

A. heart.B. pharynx.C. salivary glands.D.stomach.

The internal open area withinThe internal open area withinthe intestine is known as the:the intestine is known as the:

A. lumen.B. villi.C. perineum.D.sphincter.

The internal open area withinThe internal open area withinthe intestine is known as the:the intestine is known as the:

A.lumen.B. villi.C. perineum.D.sphincter.

DiseasesDiseases

• Eating Anorexia Dysphagia Polyphagia phag/o-

poly- = many; much

= eating; swallowing

= condition; state; thing

DiseasesDiseases

• Mouth and Lips Cheilitis Sialolithiasis Stomatitis Glossitis

Figure 3-8 Glossitis.(Centers for Disease Control and Prevention [CDC])

DiseasesDiseases

• Esophagus and Stomach Dyspepsia Esophageal varices Gastritis Gastroenteritis Gastroesophageal reflux disease (GERD)

Figure 3-9 Esophageal varix.(David M. Martin, M.D./Photo Researchers, Inc.)

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DiseasesDiseases

• Esophagus and Stomach Heartburn Hematemesis Nausea and vomiting (N&V) Peptic ulcer disease (PUD) Stomach cancer

Figure 3-10 Gastric ulcer. (David M. Martin, M.D./Photo Researchers, Inc.)

DiseasesDiseases

• Duodenum, Jejunum, Ileum Ileus Intussusception Volvulus

Figure 3-11 Intussusception and volvulus of the intestine.

DiseasesDiseases

• Cecum and Colon Appendicitis Colic Colon cancer Diverticulum Dysentery

Appendicitis AnimationAppendicitis Animation

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Figure 3-12 Diverticula.(Science Photo Library/Custom Medical Stock Photo)

Figure 3-13 Diverticulitis and polyposis.

DiseasesDiseases

• Cecum and Colon Gluten sensitivity enteropathy Inflammatory bowel disease (IBD) Irritable bowel syndrome (IBS) Polyp

Figure 3-14 Crohn’s disease.

Figure 3-15 Colonic polyps. (Staats/Custom Medical Stock Photo, Inc.)

DiseasesDiseases

• Rectum and Anus Hemorrhoids Proctitis Rectocele rect/o-

= rectum

= hernia

DiseasesDiseases

• Defecation and Feces Constipation Diarrhea Flatulence Hematochezia Incontinence Steatorrhea

DiseasesDiseases

• Abdominal Wall and Abdominal Cavity Adhesions Hernia Peritonitis

Figure 3-16 Hernia.(Wellcome Trust Library/Custom Medical Stock Photo)

Figure 3-17 Peritonitis.(English/Custom Medical Stock Photo, Inc.)

DiseasesDiseases

• Liver Ascites Cirrhosis Hepatitis Hepatomegaly Jaundice Liver cancer

Figure 3-18 Fatty liver disease and cirrhosis of the liver.(Arthur Glauberman/Photo Researchers, Inc.)

DiseasesDiseases

• Hepatitis is the most common chronic liver disease. Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E

Figure 3-19 Blood transfusion.(PhotoDisc/Getty Images)

Figure 3-20 Jaundice.(Dr. M.A. Ansary/Photo Researchers, Inc.)

Figure 3-21 Liver cancer.(GCa/Photo Researchers, Inc.)

DiseasesDiseases

• Gallbladder and Bile Ducts Choledocholithiasis Cholangitis Cholecystitis Cholelithiasis

Figure 3-22 Cholelithiasis.

Figure 3-23 Gallstones in the biliary and pancreatic ducts.

DiseasesDiseases

• Pancreas Pancreatic cancer Pancreatitis pancreat/o-

= pancreas

= inflammation of; infection of

Laboratory and Diagnostic Laboratory and Diagnostic ProceduresProcedures

• Blood Tests Albumin Alkaline phosphatase (ALP) ALT and AST Bilirubin GGT gamma-glutamyl transferase or

GGTP gamma-glutamyl transpeptidase Liver function tests (LFTs)

• Gastric and Feces Specimen Tests CLO test Culture and sensitivity (C&S) Fecal occult blood test Gastric analysis Ova and parasites (O&P)

• Radiologic Procedures Barium enema (BE) Cholangiography Computerized axial tomography (CAT,

CT) Flat plate of the abdomen

• Radiologic Procedures Gallbladder ultrasound Magnetic resonance imaging (MRI) scan Oral cholecystography (OCG) Upper gastrointestinal series (UGI)

Figure 3-24 Barium enema.(Medical Body Scans/Photo Researchers, Inc.)

Figure 3-25 Endoscopic retrograde cholangiopancreatography.

Medical and Surgical ProceduresMedical and Surgical Procedures

• Medical Procedures Insertion of nasogastric tube

Figure 3-26 Nasogastric tube.

• Surgical Procedures Abdominocentesis Appendectomy Biopsy Bowel resection and anastomosis Cholecystectomy Choledocholithotomy Colostomy Endoscopy

Figure 3-27 Laparoscopic cholecystectomy.(Geoff Tompkinson/Photo Researchers, Inc.)

Figure 3-28 Colostomy and stoma.

• Surgical Procedures Esophagoscopy Gastroscopy Esophagogastroduodenoscopy (EGD) Sigmoidoscopy Colonoscopy

Figure 3-29 Colonoscopy.(A. Benoit/AGE Fotostock)

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Medical and Surgical Medical and Surgical ProceduresProcedures

• Surgical Procedures Exploratory laparotomy Gastrectomy Gastroplasty Gastrostomy Hemorrhoidectomy

Medical and Surgical Medical and Surgical ProceduresProcedures

• Surgical Procedures Herniorrhaphy Jejunostomy Liver transplantation Polypectomy

Figure 3-30 PEG tube.

An upper GI seriesAn upper GI seriesis also known as a/an:is also known as a/an:

A. colostomy.B. esophagoscopy.C. hemoccult test.D.barium swallow.

An upper GI seriesAn upper GI seriesis also known as a/an:is also known as a/an:

A. colostomy.B. esophagoscopy.C. hemoccult test.D.barium swallow.

Which abbreviation is aWhich abbreviation is atest for parasites in the stool?test for parasites in the stool?

A. O&PB. LFTC. UGID.N&V

Which abbreviation is aWhich abbreviation is atest for parasites in the stool?test for parasites in the stool?

A.O&PB. LFTC. UGID.N&V

An exploratory laparotomyAn exploratory laparotomymakes an incision in the: makes an incision in the:

A. stomach.B. mouth.C. abdominal wall.D.colon.

An exploratory laparotomyAn exploratory laparotomymakes an incision in the: makes an incision in the:

A. stomach.B. mouth.C.abdominal wall.D.colon.

Which of these surgeries is used toWhich of these surgeries is used tocreate a permanent opening in the abdomen in create a permanent opening in the abdomen in order to feed a patient through a feeding tube? order to feed a patient through a feeding tube?

A. cholecystectomyB. gastrostomyC. gastrectomyD.colonoscopy

Which of these surgeries is used toWhich of these surgeries is used tocreate a permanent opening in the abdomen in create a permanent opening in the abdomen in order to feed a patient through a feeding tube? order to feed a patient through a feeding tube?

A. cholecystectomyB.gastrostomyC. gastrectomyD.colonoscopy

Which of the following correctlyWhich of the following correctlyseparates the medical word colonoscopy into its separates the medical word colonoscopy into its

component word parts?component word parts?

A. prefix col/o-, combining form noscop/o-, suffix -y

B. prefix colon/o-, suffix -scopyC. combining form col/o-, suffix -noscopyD.combining form colon/o-, suffix -scopy

Which of the following correctlyWhich of the following correctlyseparates the medical word colonoscopy into its separates the medical word colonoscopy into its

component word parts?component word parts?

A. prefix col/o-, combining form noscop/o-, suffix -y

B. prefix colon/o-, suffix -scopyC. combining form col/o-, suffix -noscopyD.combining form colon/o-, suffix -

Which is the medical wordWhich is the medical wordfor a surgically created opening? for a surgically created opening? A. stomach.B. cavity.C. stomatitis.D.stoma.

Gastroenteritis is anGastroenteritis is aninflammation of the: inflammation of the:

A. liver and gallbladder.B. stomach and duodenum.C. pharynx and esophagus.D.stomach and intestines.

Gastroenteritis is anGastroenteritis is aninflammation of the: inflammation of the:

A. liver and gallbladder.B. stomach and duodenum.C. pharynx and esophagus.D.stomach and intestines.

Ascites is a disease of the:Ascites is a disease of the:

A. stomach.B. intestines.C. liver.D.mouth.

Ascites is a disease of the:Ascites is a disease of the:

A. stomach.B. intestines.C.liver.D.mouth.

Vomiting blood is known as: Vomiting blood is known as:

A. emesis.B. GERD.C. anorexia.D.hematemesis.

Vomiting blood is known as: Vomiting blood is known as:

A. emesis.B. GERD.C. anorexia.D.hematemesis.

Passing dark or black bloodPassing dark or black bloodthrough the rectum is known as:through the rectum is known as:

A. incontinence.B. diarrhea.C. melena.D.GERD.

Passing dark or black bloodPassing dark or black bloodthrough the rectum is known as:through the rectum is known as:

A. incontinence.B. diarrhea.C.melena.D.GERD.

Hepatitis is anHepatitis is aninflammation of the: inflammation of the:

A. colon.B. liver.C. gallbladder.D.rectum.

Hepatitis is anHepatitis is aninflammation of the: inflammation of the:

A. colon.B.liver.C. gallbladder.D.rectum.

Which word is misspelled?Which word is misspelled?

• hepatosplenomegaly (enlargement of the liver and spleen)

• choledocholithiasis (condition of a stone in the common bile duct)

• cirrosis (chronic liver degeneration)• jaundice (yellow discoloration of the

skin from liver disease)

Which word is misspelled?Which word is misspelled?

• hepatosplenomegaly (enlargement of the liver and spleen)

• choledocholithiasis (condition of stones in the gallbladder)

• cirrosis (Cirrhosis)(chronic liver degeneration)

• jaundice (yellow discoloration of the skin from liver disease)

Difficult or painful eatingDifficult or painful eatingis known as dysphagia. is known as dysphagia.

A. trueB. false

Difficult or painful eatingDifficult or painful eatingis known as dysphagia. is known as dysphagia.

A. trueB. false

Dysphagia is the medicalDysphagia is the medicalword for indigestion. word for indigestion.

A. trueB. false

Dysphagia is the medicalDysphagia is the medicalword for indigestion. word for indigestion.

A. trueB.false

Emesis is another word for Emesis is another word for vomiting.vomiting.

A. trueB. false

Emesis is another word for Emesis is another word for vomiting.vomiting.

A.trueB. false

The word glossal refers to:The word glossal refers to:

A. the tongue.B. the stomach.C. the salivary glands.D.all of the above.

The word glossal refers to:The word glossal refers to:

A.the tongue.B. the stomach.C. the salivary glands.D.all of the above.

The combining formThe combining formsial/o- means: sial/o- means:

A. saliva.B. eating.C. mouth.D.stomach.

The combining formThe combining formsial/o- means: sial/o- means:

A.saliva.B. eating.C. mouth.D.stomach.

The combining formThe combining formproct/o- means:proct/o- means:

A. liver.B. stomach.C. intestines.D.rectum.

The combining formThe combining formproct/o- means:proct/o- means:

All of these combiningAll of these combiningforms mean forms mean abdomenabdomen EXCEPT: EXCEPT:A. enter/o-B. celi/o-C. abdomin/o-D. lapar/o-

All of these combiningAll of these combiningforms mean forms mean abdomenabdomen EXCEPT: EXCEPT:A.enter/o-B. celi/o-C. abdomin/o-D. lapar/o-

Which of the following Which of the following suffixes means suffixes means enzymeenzyme? ?

A. -tionB. -acC. -iveD.-ase

Which of the following Which of the following suffixes means suffixes means enzymeenzyme? ?

A. -tionB. -acC. -iveD.-ase

Both gloss/o- and lingu/o-Both gloss/o- and lingu/o-mean mouth.mean mouth.

A. trueB. false

Both gloss/o- and lingu/o-Both gloss/o- and lingu/o-mean mouth.mean mouth.

A. trueB.false

The combining formThe combining formcholecyst/o- means: cholecyst/o- means:

A. bile ducts.B. liver.C. gallbladder.D. intestine.

The combining formThe combining formcholecyst/o- means: cholecyst/o- means:

A. bile ducts.B. liver.C.gallbladder.D.intestine.

The combining formThe combining formhepat/o- means:hepat/o- means:

A.liver.B. stomach.C. intestines.D.rectum.

Drug CategoriesDrug Categories

• These categories of drugs are used to treat gastrointestinal diseases: Antacid drugs Antibiotic drugs Antidiarrheal drugs Antiemetic drugs

• These categories of drugs are used to treat gastrointestinal diseases: Gallstone drugs H2 blocker drugs Laxative drugs Proton pump inhibitor drugs

AbbreviationsAbbreviations

• ABD abdomen• a.c. before meals (Latin, ante cibum)• ALP alkaline phosphatase• ALT alanine aminotransferase• AST aspartate aminotransferase• BE barium enema• BM bowel movement• BRBPR bright red blood per rectum• BS bowel sounds• CBD common bile duct• EGD esophagogastroduodenoscopy• ERCP endoscopic retrograde

cholangiopancreatography• GERD gastroesophageal reflux disease• GI gastrointestinal• HAV hepatitis A virus• HBV hepatitis B virus• HCl hydrochloric acid• HCV hepatitis C virus• IBD inflammatory bowel disease• IBS irritable bowel syndrome• IVC intravenous cholangiogram; intravenous

cholangiography

• LES lower esophageal sphincter• LFTs liver function tests• LLQ left lower quadrant• LUQ left upper quadrant• N&V nausea and vomiting• NG nasogastric• NPO (n.p.o.) nothing by mouth (Latin, nil per os)• O&P ova and parasites• OCG oral cholecystogram; oral cholecystography• p.c. after meals (Latin, post cibum)• PEG percutaneous endoscopic gastrostomy• PEJ percutaneous endoscopic jejunostomy• PO (p.o.) by mouth (Latin, per os)• PTC percutaneous transhepatic cholangiography• PUD peptic ulcer disease• RLQ right lower quadrant• RUQ right upper quadrant• SGOT serum glutamic-oxaloacetic transaminase

(older name for AST)• SGPT serum glutamic-pyruvic transaminase

(older name for ALT)• UGI upper gastrointestinal (series)

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Combining Forms Match UpCombining Forms Match Up

1. celi/o-2. cheil/o-3. enter/o-4. gloss/o-5. or/o-

a. intestineb. lipc. tongued. abdomene. mouth

Medical LanguageMedical LanguageImmerse YourselfImmerse Yourself

CHAPTER

THIRD EDITION

Pulmonology

1. Identify the structures of the respiratory system.

2. Describe the process of respiration.3. Describe common respiratory

diseases, laboratory and diagnostic procedures, medical and surgical procedures, and drug categories.

4. Give the medical meaning of word parts and abbreviations related to the respiratory system.

5. Build respiratory words from word parts and divide and define respiratory words.

6. Spell and pronounce respiratory words.

7. Analyze the medical content and meaning of a pulmonology report.

8. Dive deeper into pulmonology by reviewing the activities at the end of this chapter and online at www.myMedicalTerminologyLab.com.

Multimedia DirectoryMultimedia DirectorySlide 9 Respiratory System AnimationSlide 68 Asthma AnimationSlide 69 Asthma VideoSlide 70 Alternative Asthma Treatments VideoSlide 71 Bronchitis AnimationSlide 73 Stridor Lung SoundsSlide 76 Cystic Fibrosis VideoSlide 86 Tuberculosis VideoSlide 94 Tuberculosis Testing VideoSlide 98 Incentive Spirometry VideoSlide 100 Oxygen Mask Video

Multimedia DirectoryMultimedia DirectorySlide 149 Respiratory Therapy Career VideoSlide 150 Respiratory Therapy and Ethical Issues VideoSlide 151 Respiratory Therapy and Professional

Organizations Video

PulmonologyPulmonology

• The medical specialty that studies the anatomy and physiology of the respiratory system and uses diagnostic tests, medical and surgical procedures, and drugs to treat respiratory diseases.

Figure 4-1 Respiratory system.

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• Consists of the right and left lungs and the air passageways that connect the lungs to the outside of the body

• The upper respiratory system in the head and neck includes the nose, nasal cavity, and pharynx (throat).

• The upper respiratory system shares structures with the ears, nose, and throat (ENT) system.

• The lower respiratory system includes the larynx (voice box) and trachea (windpipe) in the neck and the bronchi, bronchioles, and alveoli in the lungs.

• The lungs fill much of the thoracic cavity.

• Purpose of respiratory system is to bring oxygen into the body and expel the waste product carbon dioxide.

Anatomy of the Respiratory Anatomy of the Respiratory SystemSystem

• Nose and Nasal Cavity The nose contains the nasal cavity,

which is divided in the center by the nasal septum.

On each side of the cavity are three long, bony projections: the superior, middle, and inferior turbinates, or nasal conchae. These jut into the nasal cavity and slow down inhaled air so that it can be warmed and moistened.

• The nasal cavity is lined with mucosa, a mucous membrane that humidifies the air and produces mucus.

• Mucus and hairs in the nose trap inhaled particles of dust, pollen, smoke, and bacteria and keep them from entering the lungs.

Figure 4-2 Nasal cavity.

• Pharynx Mucous membranes of the pharynx

warm and moisten inhaled air and trap particles.

A common passageway for inhaled air, exhaled air, and food

• Larynx (voice box) At its inferior end, the pharynx divides

into two parts: the larynx which leads to the trachea and the esophagus which leads to the stomach.

Remains open during respiration and speech, allowing air to pass in and out through the vocal cords

• Larynx During swallowing, muscles in the neck

pull the larynx up to meet the epiglottis, which seals off the larynx entrance, so that swallowed food moves across the epiglottis and into the esophagus, not into the trachea.

Figure 4-3 Larynx.

• Trachea (windpipe) Below the vocal cords, the larynx

merges into the trachea, which is about 1 inch in diameter and 4 inches in length.

A passageway for inhaled and exhaled air

• Trachea (windpipe) A column of C-shaped rings of cartilage

provide support to the trachea. On the posterior surface where there is

no cartilage, the trachea is flexible and can flatten to make room when food passes through the esophagus.

• Bronchi The inferior end of the trachea splits to

become the right and left primary bronchi.

The primary bronchi contain cartilage rings that provide support.

Each primary bronchus enters a lung and branches into smaller bronchioles.

• Bronchi The smallest bronchioles (diameter 1

mm or less) have smooth muscle around them, but no cartilage.

The lumen is the central opening in the bronchi and bronchioles through which air passes.

Bronchopulmonary refers to the bronchi and the lungs.

• Bronchi The bronchial tree includes the trachea,

bronchi, and bronchioles. The bronchial tree is lined with cilia,

small hairs that move in coordinated waves to carry mucus and trapped particles toward the throat where they can be expelled.

Figure 4-4 Trachea, lung, bronchi, bronchioles, and alveoli.

• Lungs Spongy, air-filled structures. Each lung contains lobes, large divisions

whose dividing lines are visible on the outer surface of the lung.

• Lungs The right lung, which is larger, has three

lobes:• The right upper lobe (RUL)• The right middle lobe (RML)• The right lower lobe (RLL)

The left lung has two lobes:• The left upper lobe (LUL) • The left lower lobe (LLL)

• Lungs The rounded top of each lung is the

apex. The base of each lung lies along the

diaphragm.

• Lungs A bronchus enters the lung at the hilum

(an indentation on the medial surface of the lung).

Inside the lung, the bronchus branches into bronchioles, which branch into alveoli.

• Lungs Oxygen and carbon dioxide are

exchanged between the alveolus and a nearby small blood vessel (capillary).

Alveolus secretes surfactant, a protein-fat compound that reduces surface tension and keeps the walls of the alveolus from collapsing with each exhalation.

• Lungs Collectively, the alveoli are the

pulmonary parenchyma, the functional part of the lung, as opposed to the connective tissue framework around it.

• Thoracic Cavity The thorax is a bony cage that consists

of the sternum (breast bone), the ribs, and bones of the spine; it surrounds and protects the thoracic cavity.

The mediastinum, an irregularly shaped area between the lungs, contains the trachea (and the heart and esophagus).

• Thoracic Cavity The diaphragm, a sheet of skeletal

muscle, is active during normal or forceful inhalation.

Figure 4-5 Diaphragm and pleura.

• Thoracic Cavity Each lung is surrounded by the pleura, a

double-layered serous membrane. The visceral pleura is the layer next to

the lung surface, while the parietal pleura is the layer next to the wall of the thorax.

• Thoracic Cavity The pleura secretes pleural fluid, a

slippery, watery fluid that allows the two layers to slide smoothly past each other as the lungs expand and contract during respiration.

The respiratory system is divided intoThe respiratory system is divided intothe upper and lower portion. The lower portion the upper and lower portion. The lower portion includes the nose, nasal cavity, and pharynx.includes the nose, nasal cavity, and pharynx.

A. TrueB. False

The respiratory system is divided intoThe respiratory system is divided intothe upper and lower portion. The lower portion the upper and lower portion. The lower portion includes the nose, nasal cavity, and pharynx.includes the nose, nasal cavity, and pharynx.

A. TrueB.False

The purpose of the respiratory system isThe purpose of the respiratory system isto bring oxygen into the body and expel the to bring oxygen into the body and expel the

waste product carbon dioxide.waste product carbon dioxide.

A. TrueB. False

The purpose of the respiratory system isThe purpose of the respiratory system isto bring oxygen into the body and expel the to bring oxygen into the body and expel the

waste product carbon dioxide.waste product carbon dioxide.

A.TrueB. False

The epiglottis seals off the pharynxThe epiglottis seals off the pharynxso that food moves into the esophagus.so that food moves into the esophagus.

A. TrueB. False

The epiglottis seals off the pharynxThe epiglottis seals off the pharynxso that food moves into the esophagus.so that food moves into the esophagus.

A. TrueB.False

A muscular tube containing C-shapedA muscular tube containing C-shapedrings of cartilage that is a passageway for both rings of cartilage that is a passageway for both

inhaled and exhaled air is called the:inhaled and exhaled air is called the:

A. larynx.B. trachea.C. pharynx.D.esophagus.

A muscular tube containing C-shapedA muscular tube containing C-shapedrings of cartilage that is a passageway for both rings of cartilage that is a passageway for both

inhaled and exhaled air is called the:inhaled and exhaled air is called the:

A. larynx.B.trachea.C. pharynx.D.esophagus

The smallest passagewaysThe smallest passagewaysin the lungs are called the:in the lungs are called the:

A. alveoli.B. bronchi.C. bronchioles.D. lumen.

The smallest passagewaysThe smallest passagewaysin the lungs are called the:in the lungs are called the:

A. alveoli.B. bronchi.C.bronchioles.D.lumen.

Small hairs that move in coordinatedSmall hairs that move in coordinatedwaves and carry mucus and trapped particles waves and carry mucus and trapped particles

back to the throat are called:back to the throat are called:

A. cilia.B. bronchioles.C. alveoli.D.trachea.

Small hairs that move in coordinatedSmall hairs that move in coordinatedwaves and carry mucus and trapped particles waves and carry mucus and trapped particles

back to the throat are called:back to the throat are called:

A.cilia.B. bronchioles.C. alveoli.D.trachea.

The right lung has threeThe right lung has threelobes, and the left lung has two.lobes, and the left lung has two.A. TrueB. False

The right lung has threeThe right lung has threelobes, and the left lung has two.lobes, and the left lung has two.A.TrueB. False

The form in which oxygenThe form in which oxygentravels in the blood is:travels in the blood is:

A. oxyhemoglobin.B. deoxyhemoglobin.C. carboxyhemoglobin.D.hemoglobin.

The form in which oxygenThe form in which oxygentravels in the blood is:travels in the blood is:

A.oxyhemoglobin.B. deoxyhemoglobin.C. carboxyhemoglobin.D.hemoglobin

The substance that keeps the walls of the The substance that keeps the walls of the alveolus from collapsing with each exhalation is alveolus from collapsing with each exhalation is

called:called:

A. mucus.B. surfactant.C. oxygen.D.carbon dioxide.

The substance that keeps the walls of the The substance that keeps the walls of the alveolus from collapsing with each exhalation is alveolus from collapsing with each exhalation is

called:called:

A. mucus.B.surfactant.C. oxygen.D.carbon dioxide.

Physiology of RespirationPhysiology of Respiration

• Respiration consists of breathing in and breathing out.

• Breathing in is inhalation or inspiration. • Breathing out is exhalation or

expiration.

• Breathing is normally an involuntary process.

• The respiratory control centers in the brain regulate the depth and rate of respiration.

• Receptors in large arteries in the chest and neck send these centers information about the blood level of oxygen; receptors in the brain send information about the blood level of carbon dioxide.

• The respiratory control centers send nerve impulses to the phrenic nerve, causing the diaphragm to contract and begin inspiration.

• At the same time, the intercostal muscles pull the ribs up and out.

• A normal depth and rate of respiration is known as eupnea.

• Respiration involves five separate processes:1. Ventilation―Movement of air in and

out of the lungs.

• Respiration involves five separate processes:2. External respiration―Movement of

oxygen from inhaled air into the alveoli and then into the blood and the movement of carbon dioxide from the blood into the alveoli and then into exhaled air. External respiration is the exchange of these gases in the alveolus.

• Respiration involves five separate processes:3. Gas transport―Blood transports

oxygen and carbon dioxide; oxygenated blood travels from lungs to heart, where it is pumped throughout the body.

• Respiration involves five separate processes:4. Internal respiration―Movement of

oxygen from blood into cells and movement of carbon dioxide from cells into blood.

5. Cellular respiration―Oxygen is used by the cells to produce energy in the process of metabolism.

Figure 4-6 Exhalation.gemphotography/Fotolia

Figure 4-7 Gas exchange.

DiseasesDiseases

• Nose and Pharynx Upper respiratory infection (URI)

• Trachea, Bronchi, and Bronchioles Asthma Bronchitis Bronchiectasis bronchi/o-

-ectasis

= bronchus

= condition of dilation

Figure 4-8 Upper respiratory infection.CMSP

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DiseasesDiseases

• Lungs Abnormal breath sounds Adult respiratory distress syndrome

(ARDS) Atelectasis Chronic obstructive pulmonary disease

(COPD) Cystic fibrosis (CF)

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Figure 4-9 Adult respiratory distress syndrome.

Figure 4-10 Cystic fibrosis.

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Figure 4-11 Postural drainage and percussion.Hattie Young/Photo Researchers, Inc.

DiseasesDiseases

• Lungs Empyema Influenza Legionnaires’ disease Lung cancer Occupational lung diseases

Figure 4-12 Tar deposits in the lung.SPL/Photo Researchers, Inc.

Figure 4-13 Lung cancer.St. Bartholomew’s Hospital/Photo Researchers, Inc.

DiseasesDiseases

• Lungs Aspiration pneumonia Bacterial pneumonia Bronchopneumonia Double pneumonia Lobar pneumonia

DiseasesDiseases

• Lungs Pneumococcal pneumonia Pneumocystis jiroveci pneumonia Viral pneumonia Walking pneumonia

Figure 4-14 Pneumonia.(left) rvvelde/Fotolia; (right) BATES, M.D./Custom Medical Stock Photo, Inc.

DiseasesDiseases

• Lungs Pulmonary edema Pulmonary embolism Severe acute respiratory syndrome

(SARS) Tuberculosis (TB)

Figure 4-15 Pulmonary embolus.

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DiseasesDiseases

• Pleura and Thorax Hemothorax Pleural effusion Pleurisy Pneumothorax

pneumo/o-

-thorax

= lung; air

= thorax (chest)

DiseasesDiseases

• Respiration Apnea Bradypnea Cough Dyspnea Orthopnea Tachypnea

DiseasesDiseases

• Oxygen and Carbon Dioxide Levels Anoxia Asphyxia Cyanosis Hypercapnia Hypoxemia

• Arterial blood gases (ABG)• Carboxyhemoglobin• Oximetry• Pulmonary function test (PFT)• Sputum culture and sensitivity (C&S)• Tuberculosis tests

Figure 4-16 Oximeter.O ’Brien/Custom Medical Stock Photo, Inc.

Figure 4-17 Pulmonary function test.EDWIGE/AGE Fotostock America Inc.

Figure 4-18 Culture and sensitivity.Science Heritage/Custom Medical Stock Photo, Inc.

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• Radiology and Nuclear Medicine Procedures Chest radiography CT scan and MRI scan Lung scan

• Medical Procedures Auscultation and percussion Cardiopulmonary resuscitation (CPR) Endotracheal intubation Heimlich maneuver Incentive spirometry Oxygen therapy Vital signs

Figure 4-19 Endotracheal intubation.

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Figure 4-20 Nasal cannula.CMSP

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Figure 4-21 Endotracheal tube and Ambu bag.

• Surgical Procedures Bronchoscopy Chest tube insertion Lung resection Thoracentesis Thoracotomy Tracheostomy

Figure 4-22 Lobectomy.

Figure 4-23 Tracheostomy.

Which of the following measureWhich of the following measurethe oxygen level in the blood?the oxygen level in the blood?

A. Chest x-ray and auscultationB. Culture and sensitivityC. Oximeter and arterial blood gasD.Spirometry and carboxyhemoglobin

Which of the following measureWhich of the following measurethe oxygen level in the blood?the oxygen level in the blood?

A. Chest x-ray and auscultationB. Culture and sensitivityC.Oximeter and arterial blood gasD.Spirometry and carboxyhemoglobin

Which instrument is used to visualizeWhich instrument is used to visualizethe area when endotracheal intubation is the area when endotracheal intubation is

performed?performed?

A. bronchoscope.B. laryngoscopeC. lung scan.D.nasal cannula.

Which instrument is used to visualizeWhich instrument is used to visualizethe area when endotracheal intubation is the area when endotracheal intubation is

performed?performed?

A. bronchoscope.B.laryngoscope.C. lung scan.D.nasal cannula.

A lobectomy is the surgical A lobectomy is the surgical removal of: removal of:

A. the tracheaB. the mediastinumC. the larynxD.a part of the lung

A lobectomy is the surgical A lobectomy is the surgical removal of: removal of:

A. the tracheaB. the mediastinumC. the larynxD.a part of the lung

Endotracheal intubation is used toEndotracheal intubation is used toestablish an airway for the patient who is not establish an airway for the patient who is not

breathing.breathing.

A. TrueB. False

Endotracheal intubation is used toEndotracheal intubation is used toestablish an airway for the patient who is not establish an airway for the patient who is not

breathing.breathing.

A.TrueB. False

A pneumonectomy is a surgery A pneumonectomy is a surgery to treat patients with asthma. to treat patients with asthma.

A. TrueB. False

A pneumonectomy is a surgery A pneumonectomy is a surgery to treat patients with asthma. to treat patients with asthma.

A. TrueB.False

Emphysema is part of which Emphysema is part of which disease?disease?

A. SIDSB. RDSC. COPDD.TB

Emphysema is part of which Emphysema is part of which disease?disease?

A. SIDSB. RDSC.COPDD.TB

Which respiratory disease is foundWhich respiratory disease is foundalmost exclusively in patients with AIDS? almost exclusively in patients with AIDS?

A. Pneumocystic jiroveci pneumoniaB. COPDC. AnthracosisD.Eupnea

Which respiratory disease is foundWhich respiratory disease is foundalmost exclusively in patients with AIDS? almost exclusively in patients with AIDS?

A.Pneumocystic jiroveci pneumoniaB. COPDC. AnthracosisD.Eupnea

Empyema is:Empyema is:

A. Extra air filling the alveoliB. A bluish discoloration of the skinC. An occupational lung diseaseD. Pus in the thoracic cavity

Empyema is:Empyema is:

A. Extra air filling the alveoliB. A bluish discoloration of the skinC. An occupational lung diseaseD.Pus in the thoracic cavity

The medical word for aThe medical word for acollapsed lung is: collapsed lung is:

A. Aspiration pneumoniaB. Cystic fibrosisC. AtelectasisD. Apnea

The medical word for aThe medical word for acollapsed lung is: collapsed lung is:

A. Aspiration pneumoniaB. Cystic fibrosisC.AtelectasisD.Apnea

Patients who have to sitPatients who have to situpright to sleep have:upright to sleep have:

A. TuberculosisB. Pulmonary embolismC. CyanosisD.Orthopnea

Patients who have to sitPatients who have to situpright to sleep have:upright to sleep have:

A. TuberculosisB. Pulmonary embolismC. CyanosisD.Orthopnea

Which is the misspelled word?Which is the misspelled word?

A. PneumonectomyB. EupneaC. PnumoniaD.Tachypnea

Which is the misspelled word?Which is the misspelled word?

A. PneumonectomyB. EupneaC.Pnumonia (Pneumonia)D.Tachypnea

Chronic bronchitis plus emphysema equals Chronic bronchitis plus emphysema equals chronic obstructive pulmonary disease. chronic obstructive pulmonary disease.

A. TrueB. False

Chronic bronchitis plus emphysema equals Chronic bronchitis plus emphysema equals chronic obstructive pulmonary disease. chronic obstructive pulmonary disease.

A.TrueB. False

Tuberculosis is caused by a virus.Tuberculosis is caused by a virus.

A. TrueB. False

Tuberculosis is caused by a virus.Tuberculosis is caused by a virus.

A. TrueB.False

The combining form cyan/o- The combining form cyan/o- means:means:

A. BlueB. Carbon dioxideC. InhaleD.Rib

The combining form cyan/o- The combining form cyan/o- means:means:

A.BlueB. Carbon dioxideC. InhaleD.Rib

The combining form spir/o- means:The combining form spir/o- means:

A. BreatheB. ExhaleC. InhaleD.Process of having

The combining form spir/o- means:The combining form spir/o- means:

A.BreatheB. ExhaleC. InhaleD.Process of having

The combining form cost/o- The combining form cost/o- means:means:

A. To suck inB. RibC. LungsD.Heart and vessels

The combining form cost/o- The combining form cost/o- means:means:

A. To suck inB.RibC. LungsD.Heart and vessels

Cardiopulmonary refers to the:Cardiopulmonary refers to the:

A. HeartB. Heart and lungsC. LungsD.Heart and vessels

Cardiopulmonary refers to the:Cardiopulmonary refers to the:

A. HeartB.Heart and lungsC. LungsD.Heart and vessels

All of the following combiningAll of the following combiningforms mean breath or air EXCEPT:forms mean breath or air EXCEPT:

A. Spir/o-B. Hal/o-C. Pne/o-D.Steth/o-

All of the following combiningAll of the following combiningforms mean breath or air EXCEPT:forms mean breath or air EXCEPT:

A. Spir/o-B. Hal/o-C. Pne/o-D.Steth/o-

The suffix -pnea means breathing.The suffix -pnea means breathing.

A. TrueB. False

The suffix -pnea means breathing.The suffix -pnea means breathing.

A.TrueB. False

• These categories of drugs are used to treat respiratory diseases: Antibiotic drugs Antitubercular drugs Antitussive drugs Antiviral drugs Bronchodilator drugs Corticosteroid drugs

• These categories of drugs are used to treat respiratory diseases: Expectorant drugs Leukotriene receptor blocker drugs Mast cell stabilizer drugs Stop smoking drugs

Figure 4-24 Metered-dose inhaler.Custom Medical Stock Photo, Inc.

ABG arterial blood gasesAFB acid-fast bacillusA&P auscultation and percussionAP anteroposterior (view on chest x-ray)ARDS acute respiratory distress syndrome;adult respiratory distress syndromeBS breath soundsC&S culture and sensitivityCF cystic fibrosisCO carbon monoxideCO2 carbon dioxideCOPD chronic obstructive pulmonary disease

MDI metered-dose inhalerO2 oxygenPA posteroanterior (view on chest x-ray)PCO2 partial pressure of carbon dioxide (also

pCO2)PCP* Pneumocystis carinii pneumoniaPFT pulmonary function testPND paroxysmal noctural dyspneaPO2 partial pressure of oxygen (also pO2)PPD packs per day (of cigarettes);purified protein derivative (TB test)RA room air (no supplemental oxygen)RDS respiratory distress syndrome

CPAP continuous positive airway pressure (“SEE-pap”)CPR cardiopulmonary resuscitationCXR chest x-rayDOE dyspnea on exertionETT endotracheal tubeFEV1 forced expiratory volume (in one second)FiO2 fraction (percentage) of inspired oxygenFVC forced vital capacityHMD hyaline membrane diseaseLLL left lower lobe (of the lung)LUL left upper lobe (of the lung)

RLL right lower lobe (of the lung)RML right middle lobe (of the lung)RRT registered respiratory therapistRUL right upper lobe (of the lung)SARS severe acute respiratory syndromeSIDS sudden infant death syndromeSOB** shortness of breathTB tuberculosisTPR temperature, pulse, and respirationURI upper respiratory infectionV/Q ventilation-perfusion (scan)

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Combining Forms Match UpCombining Forms Match Up

1. pector/o-2. cost/o-3. cyan/o-4. coni/o-5. spir/o-

a. blueb. ribc. chestd. duste. breathe

Med Term Ch3 and Ch4

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