ZDRAVSTVENO VELEUČILIŠTE, ZAGREB

Petar Režić
Srebrenka Žurić Havelka
 Izdavač
ZDRAVSTVENO VELEUČILIŠTE
Mlinarska cesta 38, 10000 Zagreb
http://www.zvu.hr
Za izdavača
Prof. dr. sc. Mladen Havelka
Biblioteka
"Udžbenici i priručnici Zdravstvenog veleučilišta”
Svezak 42.
Urednik biblioteke
Prof. dr. sc. Predrag Keros
Lektor
Nitor usluge d.o.o.
Recenzenti
Prof. dr. sc. Miljenko Marotti
Prof. dr. sc. Marija Frković

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II
 Petar Režić
Srebrenka Žurić Havelka

Introduction to Basic
Medical Terminology
for Health Professions
A textbook for students of health studies

ZDRAVSTVENO VELEUČILIŠTE
Zagreb, 2013
Contents
PREDGOVOR.................................................................................................. VII

INTRODUCTION - Hypocratic Oath����������������������������������������������������������������� 1

About the English Language..................................................................... 3

01. Basic elements of a medical word Grammar revision

– the passive voice..................................................................................... 6
02. The Most Common Suffixes and Prefixes................................................ 12
03. Body as a Whole
For further practice: translate into English (the cell)............................. 22
04. Integumentary System............................................................................. 35
05. Musculoskeletal System.......................................................................... 49
06. Gastrointestinal System........................................................................... 70
07. Respiratory System.................................................................................. 87
08. Cardiovascular System............................................................................ 98
09. Urinary System...................................................................................... 111
10. Nervous System..................................................................................... 121
11. Blood and Lymphatic System................................................................. 138
12. Endocrine System.................................................................................. 158
13. Female Reproductive System................................................................ 176
14. Male Reproductive System.................................................................... 191
15. Sense Organs......................................................................................... 204

SUPPLEMENT
16. Oncology – Cancer Medicine.................................................................. 219
17. General Care of the Patient .................................................................. 227

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18. British Medical Training and Registration ............................................ 233
19. Smoking – Hazardous Adaptation......................................................... 237
20. AIDS........................................................................................................ 253
21. Stress Management .............................................................................. 261
22. Radiology and Nuclear Medicine .......................................................... 275
23. Pharmacology ....................................................................................... 281
24. Psychiatry............................................................................................... 285

GLOSSARY.................................................................................................... 296

REFERENCES.............................................................................................. 398

VI
Predgovor
Ovaj je udžbenik - priručnik namijenjen studentima preddiplomskih i speci-
jalističkih diplomskih studija stručnih zdravstvenih studijskih programa –
medicinskim sestrama, fizioterapeutima, radnim terapeutima, radiološkim
inženjerima, medicinsko-laboratorijskim inženjerima, sanitarnim inženje-
rima, primaljama i drugim zdravstvenim strukama, npr. liječnicima. Udžbenik
obuhvaća tematske nastavne jedinice utvrđene nastavnim programom za
predmet Engleski jezik na zdravstvenim studijima, a temelji se na tjelesnim
sustavima.
Većina poglavlja uključuje leksičko-gramatičke skupine zadataka vezane
uz određeni tjelesni sustav te skraćene popularne i stručne tekstove koje
studenti trebaju prevesti s engleskog na hrvatski ili s hrvatskog na engleski
jezik. Sastavni dio udžbenika su sadržaji vezani uz tvorbu (morfologiju) medi-
cinskog nazivlja pomoću prefiksa i sufiksa latinskog odnosno grčkog podrijetla
te njihovi ekvivalenti u engleskom strukovnom i kolokvijalnom nazivlju. Glavni
izvor za engleske tekstove poslužio je udžbenik “The Language of Medicine”,
autorice D. A. Chabner, 5. i 7. izdanje, kao i “Medical English”, treće izdanje iz
1982. godine (autorice: V. Momčinović, V. Tanay i S. Žurić Havelka).
Dodatak ovom udžbeniku (Supplement) su tekstovi koji bi studentima mogli
biti zanimljivi kao dopunske teme u slučaju njihova posebnog interesa.
Nadamo se da će priručni Glosar biti od pomoći našim studentima i svima
zainteresiranima za sadržaje iz ovog priručnika.

Autori

VII
Introduction

HIPPOCRATIC OATH

“Life is short, and the Art long; the occasion fleeting;

experience fallacious, and judgment difficult. The
physician must not only be prepared to do what is right
himself, but must also make the patient, the attend-
ants, and externals cooperate.”
(Hippocrates: Aphorisms)

HIPPOCRATES (late 5th century B.C.), generally regarded as the “Father

of Medicine”, son of a priest-physician, was born on the island of Cos. By
stressing that there is a natural cause for disease he did much to dissociate
the care of the sick from the influence of magic and superstition. His care-
fully kept records of treatment and solicitous observation of the ill provided
a foundation for clinical medicine in the case report; and by reporting also
unsuccessful methods of treatment he anticipated the modern scientific atti-
tude. The way for the professional nurse was prepared by his emphasis on
the importance of skilled bedside care, and his bedside care example demon-
strated the value of clinical instruction.
Many of the writings of Hippocrates and his school have survived - it is the
so-called Corpus Hippocraticum, although it is not certain which parts were
written by Hippocrates himself. These writings are usually characterized by
the stress laid on treatment and prognosis. A moral code for medicine has
been established by his ideal of ethical conduct and practice as embodied in
the Oath, generally taken by students receiving a medical degree. The Oath
sets forth an ethical code for medical profession.

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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.”

1
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 uter-
us or rectum or as a contraceptive device.

2
For further reading:

ABOUT THE ENGLISH LANGUAGE

English is not the language that has always been spoken in the British
Isles, nor indeed is it the only language that is spoken there today. English was
originally a foreign language, imported by foreign invaders. These invaders
were two Germanic tribes living in what is now Northern Germany, along the
North Sea coast. They were called the Angles and the Saxons, and they spoke
different dialects of the same language. It is from these dialects that modern
English has descended.
Anglo-Saxon, or Old English, as historians of the language prefer to call
it, remained the language of England from about A.D. 450 to about A.D. 1150.
The reason why it is not still the language of England is that there were two
more foreign invasions of the island by people speaking different tongues –
first the Northmen or Vikings from Denmark, and then the Normans from
Normandy in France.
The result of these further invasions, particularly the second by the French-
speaking Normans in A.D. 1066 (William the Conqueror), was to modify Old
English very considerably, and turn it, in the course of the next three centu-
ries, into a compound language which we know as Middle English. Middle
English is recognizably the ancestor of the English we speak today (which Old
English is not), and it was the common tongue of the inhabitants of England
from about A.D. 1150 to about A.D. 1500.
As there were no more foreign conquests of the island the language was
thenceforward able to develop – as it were – under its own impetus. There
were no more radical changes and so Middle English merged imperceptibly
into the Early Modern English of Shakespeare’s age and then into the language
we speak now.
The reference has so far been made only to England and not to Britain. The
distinction is important because England is only a part of Britain - the biggest
part, it is true, but still only a part – whereas Britain includes also Wales and
Scotland. The Anglo-Saxons after conquering England never succeeded in
penetrating to these remote parts of Britain, so that the English language was
never implanted there. The inhabitants, known as Celts, who were independent
of the English for many years, kept their own language, Celtic, various dialects
of which are still spoken today in these parts of Britain and in Ireland. Welsh
is spoken in Wales, Gaelic in Scotland, and Erse in Ireland. A fourth Celtic
dialect, Cornish, used to be spoken in the south-west corner of England, the
Cornwall, but it became extinct about 200 years ago.

3
 Anglo-Saxon is now, of course, a dead language, but a good deal of its
vocabulary has survived, in one form or another, to the present day. Most of
the very common words in modern English are Anglo-Saxon in origin: nouns
like father, mother, food, drink, bed, most of the prepositions and conjunctions,
and nearly all of the strong verbs. When it was mixed with Norman French
there were three main results: the grammar was simplified, the pronunciation
and spelling became (and still are) much more complicated, and the vocab-
ulary was enormously extended. French is a Latin language, so the part of
our vocabulary is now Latin in origin. That is also one reason why we have so
many synonyms. In pair of words like “wed” and “marry”, “fat” and “corpu-
lent”, “lively” and “vivacious”, the first word is derived from Anglo-Saxon, the
second from Latin.
A language never stands still. It is always changing and developing. These
changes are rapid in primitive societies, but slow in advanced ones, because
the invention of printing and the spread of education have fixed a traditional
usage. The only important change that English has undergone since the
sixteenth century is a very large increase in its vocabulary. It is interesting
to trace the different ways in which new words are adopted or invented. Let
us take just four English words and see how they were made; admiral, yacht,
sandwich, and television.
Admiral was introduced into England from France in the fifteenth century.
It was then spelt “amiral” and was derived by the French from a compound
Arabic word “amir-al-bahr” meaning “Prince of the Sea”. Some time later
certain misguided English scholars, looking at this word, assumed that it was
a corruption of Latin word “admirare”, meaning “to wonder at”, and proceeded
to replace- as they thought- the “d” in first syllable. So out of this confusion,
involving three languages, we have the present word admiral.
Yacht is a Dutch word, which accounts for its unusual spelling. The first
yacht was given by the Dutch to King Charles II as a wedding present in 1662.
The name is derived from the Dutch word for hunting (Germ. Jagd), and yachts
were so named for their speed. As a matter of fact many nautical words come
from Dutch, just as many words connected with music and painting come
from Italian.
Sandwich, which is now no longer a purely English word, but almost inter-
national, comes from the fourth Earl of Sandwich (died 1792), who invented
this particular form of quick meal so that he could go on gambling all through
the nights without stopping for dinner. Many names of things are, in fact, taken
from the names of their first inventors, e.g. the electrical terms watt and volt.

4
 Television is typical of many new scientific words which are deliberately
invented from Old Greek and Latin words. In this case the prefix “tele” is Greek
and means “far” (cf. telephone, telegram), while the root “vision” is derived
from the Latin verb meaning “to see”.

Answer these questions:

1. When was Anglo-Saxon spoken in England?
2. Why is Anglo-Saxont not like modern English?
3. What happened to the language as a result of Norman Conquest?
4. Which countries form part of the British Isles?
5. Which other languages are spoken in Britain today?
6. Why is English not spoken as a first language in parts of Wales and Scot-
land?
7. Why does language tend to change more rapidly in a primitive society than
in an advanced one?
8. What kind of words in modern English are derived from Anglo-Saxon?
9. Why does English have such a large vocabulary?
10. What is the origin of the word yacht?

From: D.H. Spencer & A.S. Hornby: An Intermediate English Course for
Adult Learners. Oxford University Press.

5
CHAPTER 1

BASIC ELEMENTS OF A MEDICAL WORD:

WORD ROOTS, COMBINING FORMS, SUFFIXES, PREFIXES
There are several important reasons for studying word elements related
to medical terminology:
1. To be able to analyze all elements of a specific word and understand more
complex terminology and expressions used in medicine and other allied
health professions.
2. Define and provide several examples of word roots, combining forms,
suffixes, and prefixes.
3. Divide the words into their component parts.
4. Describe and explain how medical and other words are formed.

To analyze words mostly used in medical and allied health professions, the
four elements that may be used to form a word need to be identified.

1. WORD ROOTS
The main part or stem of a word is called a word root (WR). A WR is usually
derived from the Greek or Latin language and frequently indicates a body
part. The words can be composed of one, two, or more roots. When a term
is composed of more than one word root it is referred to as a combined or a
compound word.

Examples of Word Roots

Greek Word Word Root Meaning
kardia (heart) cardi heart
gaster (stomach) gastr stomach
hepat (liver) hepat liver
nephros (kidney) nephr kidney
osteon (bone) oste bone

6
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 = Combining Form Meaning
cardi o cardi/o heart
gastr o gastr/o stomach
arthr o arthr/o joint
derm o derm/o skin
cyt o cyt/o cell
cephal o cephal/o head
cerebr o cerebr/o 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 = Medical Word Meaning
arthr/o -centesis arthrocentesis puncture of a joint
(joint) (puncture)
thorac/o -tomy thoracotomy incision of the chest
(chest) (incision)
gastr/o -megaly gastromegaly enlargement of the
(stomach) (enlargement) stomach
erythr/o -cyte erythrocyte red blood cell
(red) (cell)
cyt/o -logy cytology study of a cell
(cell) (study)

4. PREFIXES
A prefix is a word element located at the beginning of a word. When a
medical word contains a prefix, the meaning of the word is changed. The prefix
usually indicates a number, time, position, direction, colour, or negation.

7
Examples of Prefixes
Prefix + Word Root + Suffix = Medical Word Meaning
hyper therm -ia hyperthermia condition of
(excessive) (heat) (condition) excessive heat
intra muscul -ar intramuscular within the muscles
(in, within) (muscle) (relating to)
macro gloss -ia macroglossia condition of a large
(large) (tongue) (condition) tongue
micro card -ia microcardia condition of a small
(small) (heart) (condition) heart

Defining Medical and Other Words

The word is usually defined by first identifying its suffix, or ending, then
the prefix, or word beginning, and finally the middle part, i.e. the word root.
For Example:
gastr/o enter/ itis
stomach intestine inflammation
(2) (3) (1)
Read as follows:
1. Inflammation of (suffix)
2. Stomach and (first part of the word)
3. Intestine (middle)

GRAMMAR REVISION: THE PASSIVE VOICE

Elementary
Note: appropriate tense of verb “to be” with the past participle of the main
verb.
Example: Someone has stolen my books – My books have been stolen.
No agents with “by” are required in the following sentences.

Turn the following sentences into the passive voice:

1. People always admire this picture.
2. He hurt his leg in an accident.
3. No one has opened that box for the last hundred years.
4. People formerly used the Tower of London as a prison.
5. Someone has broken two of my dinner plates.
6. They fought a big battle here two hundred years ago.
7. People will forget this play in a few years’ time.

8
8. No one has ever beaten my brother at tennis.
9. People speak English all over the world.
10. Did anyone ask any questions about me?
11. People mustn’t take these books away
12. They punished me for something I didn’t do.
13. Someone wants you to help lay the table.
14. Somebody left the dog in the garden.
15. We shall discuss the matter tomorrow.
16. Nobody heard a sound.
17. What have people done about this?
18. Has anybody answered your question?
19. They made this gun in Birmingham.
20. They make a book of paper.

Elementary and intermediate

Note: When the verb in the active voice has two objects, it is more usual in
English to have the personal object as the subject of the passive voice.
Example: Someone gave me a book. --- I was given the book.

Put the following sentences into the passive voice with a personal subject:
1. They gave my little sister a ticket, too.
2. People will show the visitors the new buildings.
3. Someone has already paid the electrician for his work.
4. They promise us higher wages.
5. They will allow each boy a second plate of ice-cream.
6. They will ask us all several questions.
7. Someone will read you another chapter next time.
8. They have made my uncle a captain.
9. The others told the new students where to sit.
10. They still deny women the right to vote in some countries.
11. Somebody will tell you what time the train leaves.
12. Somebody has recommended me another doctor.
13. Someone taught him French and gave him a dictionary.
14. They asked the rest of us to be there at eight o’clock.

Note: The use of “by” with an agent should always be avoided, except when
it is necessary to complete the sense of the sentence. For example: This poem
was written by Shakespeare.
Note: Prepositions or adverb particles must not be left out with verbs
requiring them. For example: They will look after you well --- You will be well
looked after

9
Intermediate and advanced

Turn the following sentences into the passive voice as appropriate:

1. Someone has asked the student a very difficult question.
2. We must look into this matter.
3. People speak well of my friend Peter.
4. Someone reads to the old lady every evening.
5. You must work for success.
6. They gave me two shillings change at the shop.
7. She promised him a book.
8. It is time they brought the cows in.
9. Nobody has slept in that room for years.
10. The teacher promised Mary a prize if she worked well.
11. A friend told me the news this morning.
12. Unkind remarks easily upset my friend Maisie.
13. What ought we to do about this?
14. What questions did the examiner set?
15. Nobody has made any mistakes.
16. Beethoven composed this piece.
17. A guide pointed out the Pyramids to me.
18. Somebody must do something for these poor men.
19. Nobody has answered my question properly.
20. They didn’t tell me the truth about the situation.
21. People ought not to speak about such things in public.
22. An unseen hand opened the window.
23. They had eaten all the dinner before they finished the conversation.
24. Somebody left the light on all night.
25. We shall lock the house up for the summer and the old gardener will look
after it.
26. Has someone mended that chair yet?
27. Nobody has ever spoken to me like that before.
28. Didn’t they tell you to be here by six o’clock?
29. I’d like someone to read to me.
30. No one has drunk out of this glass.
31. The fire destroyed many valuable paintings.
32. I hate people looking at me.
33. Do you intend us to take your remark seriously?
34. This is a good idea, but one cannot carry it out in practice.
35. People shan’t speak to me as if I were a child.
36. Somebody has locked the box and I cannot open it.

10
37. Somebody must have taken it while I was out.
38. Did the noise frighten you?
39. Don’t let the others see you.
40. Did anybody ever teach you how to behave?
41. They did nothing until he came.
42. I can assure you I will arrange everything in time.
43. A sudden increase in water pressure would break the dam.
44. One cannot eat an orange if nobody has peeled it.
45. Her beauty struck me deeply.
46. People generally assume that money brings happiness.
47. You must account for every penny.
48. People say tortoises live longer than elephants.
49. I should love to be taken out to dinner.
50. Naturally one expects you to interest yourself in the job they have offered
you.
51. It must have disappointed him terribly that people told him they didn’t
want him.
52. They must have given you the paper (that) they meant for the advanced
candidates.
53. Someone had already promised me a watch for my birthday when they
presented me with one as a prize.
54. It surprised me to hear someone had robbed you.
55. People say that figs are better for us than bananas.
56. We haven’t moved anything since they sent you away to cure you.
57. Nobody would have stared at him if they had told him beforehand what
clothes one had to wear in such a place.
58. People will laugh at you if you wear that silly hat.
59. People ought to tell us how much they expect of us.
60. When I was a child, people used to read to me out of a book of fairy tales
someone had given me for my birthday.

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

11
CHAPTER 2

THE MOST COMMON SUFFIXES AND PREFIXES

1. SURGICAL PROCEDURE SUFFIXES

a) Incision
• -ectomy – surgical removal, excision; example: appendectomy,
hemorrhoidectomy
• -centesis – surgical puncture; example: amniocentesis, arthrocentesis
• -stomy – forming an opening; example: bronchostomy
• -tome – instrument used for cutting; example: osteotome
• -tomy – cutting; example: gastrotomy

b) Plastic operation, reconstruction, loosening, refracturing

• -clasis – breaking, refracturing; example: osteoclasis
• -desis – bindig, stabilization; example: arthrodesis
• -lysis – loosen, free from adhesions, destruction; example: enterolysis,
thrombolysis
• -pexy – fixation, suspension; example: nephropexy
• -plasty– plastic repair; example: rhinoplasty
• -rrhaphy – suture; example: splenorrhaphy
• -tripsy – to crush; example: neurotripsy, lithotripsy

2. DIAGNOSTIC, SYMPTOMATIC AND OTHER COMMON SUFFIXES

• -algia – pain; example: myalgia, dorsalgia, gastralgia
• -cele – hernia, swelling; example: nephrocele, cystocele, rectocele
• -dyna – pain; example: splenodynia, otodynia
• -ectasis – dilatation, expansion; example: bronchiectasis
• -emia – blood condition; example: leukemia
• -gen – beginning, origin; example: pathogen- any disease–producing
microorganism
• -gram – a writing, record; example: cardiogram (written record of the
heart rate)

12
• -graph – to write, record; example: cardiograph (an instrument for the
measurement of heart rate)
• -iasis – condition, formation of, presence of; example: nephrolithiasis
(kidney stones)
• -sis – state of, condition; example: prognosis (foreknowledge)
• -itis – inflammation; example: nephritis
• -logy – study of; example: biology
• -malacia – softening; example: osteomalacia
• -megaly – enlargement; example: acromegaly (enlargement of the
extremities)
• -oid – resemble; example: rheumatoid
• -oma – tumour; example: hepatoma
• -osis – abnormal condition; example: neurosis
• -pathy – disease; example: adenopathy
• -penia – decrease, deficiency; example: erythropenia
• -phagia – eating; example: polyphagia
• -plegia – paralysis, stroke; example: paraplegia
• -phobia – morbid fear; example: claustrophobia
• -rrhea – discharge, flow; example: diarrhea
• -sclerosis – hardening; example: arteriosclerosis
• -scope – instrument to visually examine; example: gastroscope
• -scopy – examination, view; example: gastroscopy

3. ADJECTIVE ENDINGS
The most common adjective endings (meaning related to or pertaining to)
are the following:
• -ac – cardiac
• -al – carpal
• -ary – hereditary
• -ical – physiological
• -ous – serous
• -tic – mycotic
• -ic – splenic

13
4. PLURAL ENDINGS
RULE EXAMPLE
Singular Plural Singular Plural
• -ae Retain a and add e pleura pleurae
• -ax Drop x and add ces thorax thoraces
• -en Drop en and add ina lumen lumina
• -ex Drop ex and add ices apex apices
• -is Drop is and add es diagnosis diagnoses
• -ix Drop ix and add ices appendix appendices
• -ma Retain ma and add ta carcinoma carcinomata
• -on Drop on and add a ganglion ganglia
• -um Drop um and add a bacterium bacteria
• -us Drop us and add i bronchus bronchi
• -y Drop y and add ies 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

• ab- (away from)
• ad- (toward, near)
• ambi- (both)
• ante- (in front of, before)
• antero- (the front, toward the front side)
• circum- (around)
• dextro- (right, to the right side)
• dia- (through)
• dorso- (back)
• ec-, ecto- (out, outside)
• endo- (in, within)
• epi- (above)
• ex-, exo-, extra- (out, outside, outward)
• hyper- (above)

14
• hypo-, infra-, sub- (deficient, under, below)
• inter- (between)
• intra- (inside)
• latero- (side)
• meso-, medio- (middle)
• meta (change, beyond)
• para- (near, beside)
• per- (through)
• peri- (around)
• post-, postero- (after, behind)
• pre- (before)
• retro- (behind, backward)
• sinistro- (left)
• super-, supra- (upper, above)
• trans- (across)
• ultra- (beyond, excess)

b) Prefixes of colour
• albino-, albumino-, leuko- (white)
• chloro- (green)
• cirrho-, jaundo-, xantho- (yellow)
• cyano- (blue)
• erythro-, roseo- rubeo- (red)
• glauco-, polio- (grey)
• melano- (black)

c) Prefixes of number and measurement

• primi- (first)
• uni-, mono- (one)
• bi-, di- (two)
• hemi-, semi- (half)
• macro- (large)
• micro- (small, minute)
• multi-, pan-, poly- (many, all, much)
• tri- (three)
• quadri- (four)

d) Prefixes of negation
• a-, an-, ar- (without, not)
• im-, in- (no, not)

15
e) Miscellaneous prefixes
• anti-, contra- (against)
• brady- (slow)
• dys- (painful, difficult)
• eu- (good)
• hetero- (different)
• hydro- (water)
• homeo-, homo- (same)
• neo- (new)
• mal- (bad, insufficient)
• pseudo- (false)
• sym-, syn- (together)
• tachy- (rapid)

EXERCISES -suffixes
1. Find the suffixes in the following words and give the meaning of the entire term:
1.1. leukemia............................................................................................................................................
1.2. gastrectomy.....................................................................................................................................
1.3. hematoma.........................................................................................................................................
1.4. nephritis.............................................................................................................................................
1.5. gastroscope......................................................................................................................................
1.6. dermatosis........................................................................................................................................
1.7. psychogenic.....................................................................................................................................
1.8. neuralgia............................................................................................................................................

2. Define the suffixes for the following terms and give example of a medical term:
2.1. inflammation...................................................................................................................................
2.2. resection or surgical removal...............................................................................................
2.3. section.................................................................................................................................................
2.4. condition (usually abnormal).................................................................................................
2.5. process of study.............................................................................................................................
2.6. instrument to examine visually............................................................................................
2.7. instrument to cut..........................................................................................................................
2.8. one who specializes in...............................................................................................................

16
2.9. pertaining to.....................................................................................................................................
2.10. blood condition............................................................................................................................
2.11. tumour..............................................................................................................................................
2.12. pain.....................................................................................................................................................
2.13. record ...............................................................................................................................................
2.14. cell......................................................................................................................................................
2.15. process of viewing ....................................................................................................................

3. Test your knowledge by giving the meaning of the following suffixes:

3.1. -gram........................................................... 3.11. -coccus.....................................................

3.2. -plasty..........................................................
3.3. -osis..............................................................
3.4. -itis................................................................
3.5. -genic...........................................................
3.6. -graphy........................................................
3.7.-oma..............................................................
3.8. -tome...........................................................
3.9. -graph..........................................................
3.10. -emia.........................................................
3.12. -trophy......................................................
3.13. -tomy.........................................................
3.14. -ectomy ...................................................
3.15. -stomy.......................................................
3.16. -megaly....................................................
3.17.-malacia....................................................
3.18. -dynia........................................................
3.19. -poiesis.....................................................
3.20. -centesis..................................................

4. Construct medical words:

4.1. earache...............................................................................................................................................
4.2. enlargement of the liver...........................................................................................................
4.3. incision of the chest....................................................................................................................
4.4. deficiency of white blood cells .............................................................................................
4.5. softening of the brain.................................................................................................................
4.6. one who specializes in the study of the eye..................................................................
4.7. new opening of the kidney.......................................................................................................
4.8. fear of light.......................................................................................................................................

17
4.9. formation of red blood cells (RBCs)..................................................................................
4.10. prolapse of the kidney.............................................................................................................
4.11. fixation of the internal organs (viscera)........................................................................
4.12. formation of bone.......................................................................................................................
4.13. condition of hardening of arteries....................................................................................
4.14. removal of tonsils......................................................................................................................
4.15. resembling a stone...................................................................................................................
4.16. small vein.......................................................................................................................................
4.17. small artery...................................................................................................................................
4.18. small bronchus...........................................................................................................................
4.19. tumour of the liver.....................................................................................................................
4.20. surgical repair of nerves........................................................................................................

EXERCISES - prefixes
1. Define the prefix and give the meaning of the entire term:
1.1. inter/dental between..................................................................................................................
1.2. hypodermic.......................................................................................................................................
1.3. sinistrocardia...................................................................................................................................
1.4. epigastrium......................................................................................................................................
1.5. dorsalgia............................................................................................................................................
1.6. retrocervical.....................................................................................................................................
1.7. subnasal.............................................................................................................................................
1.8. cyanoderma.....................................................................................................................................
1.9. albuminosis......................................................................................................................................
1.10. melanocarcinoma......................................................................................................................
1.11. quadriplegia..................................................................................................................................
1.12. hyperliposis...................................................................................................................................
1.13. primipara........................................................................................................................................
1.14. ultraviolet........................................................................................................................................
1.15. polydipsia........................................................................................................................................

18
1.16. suprasternal..................................................................................................................................
1.17. perirenal..........................................................................................................................................
1.18. anacidity..........................................................................................................................................
1.19. macrocephaly...............................................................................................................................
1.20. cirrhotic...........................................................................................................................................

2. Fill in the correct medical word that matches the definitions below:
2.1. ........................................................... morbid fear of water.
2.2. ........................................................... abnormally slow breathing.
2.3. ........................................................... rapid breathing.
2.4. ........................................................... difficult or bad breathing.
2.5. ........................................................... condition of hardening.
2.6. ........................................................... poor or bad nutrition.
2.7. ........................................................... good, easy breathing.
2.8. ........................................................... condition of sweating.
2.9. ........................................................... false encephalitis.
2.10. ......................................................... abnormal fear of everything.

3. Fill in the correct medical term for the definitions below:

3.1. ........................................................... left-footed.
3.2. ........................................................... vision in which objects appear blue.
3.3. ............................................................ located behind and at the inner side of a part.
3.4. ........................................................... destroying (poisoning).
3.5. ........................................................... back of the colon.
3.6. ........................................................... abnormal redness of skin.
3.7. ........................................................... pertaining to both sides.
3.8. ........................................................... before birth.
3.9. ........................................................... below the axilla.
3.10. ......................................................... pain in the back.
3.11. ......................................................... black tumour.

19
3.12. ......................................................... between the ribs.
3.13...................................................... near the middle.
3.14...................................................... in the middle of the sternum.
3.15. ......................................................... pertaining to the region above the stomach.

4. Give the meaning of the following prefixes:

4.1. anti- .............................................................
4.2. pro- ..............................................................
4.3. sub-...............................................................
4.4. ab- ................................................................
4.5. para- ............................................................
4.6. retro- ...........................................................
4.7. contra- .......................................................
4.8. amphi- ........................................................
4.9. semi- ...........................................................
4.10. poly- ..........................................................
4.11. hypo- ........................................................
4.12. peri- ..........................................................
4.13. im- .............................................................
4.14. dia- ............................................................
4.15. endo- ........................................................
4.16. ecto- ..........................................................
4.17. brady- ......................................................
4.18. syn- ...........................................................
4.19. homo- ......................................................
4.20. primi-........................................................

FURTHER PRACTICE
1. Give the meaning of the following combining forms:

1.1. aden/o ........................................................ 1.12. physi/o .....................................................

1.2. leuk/o ..........................................................
1.3. cephal/o ....................................................
1.4. arthr/o ........................................................
1.5. cerebr/o .....................................................
1.6. cyt/o .............................................................
1.7. oste/o ..........................................................
1.8. dermat/o ...................................................
1.9. erythr/o ......................................................
1.10. encephal/o ............................................
1.11. bi/o .............................................................
1.13. path/o .......................................................
1.14. rhin/o ........................................................
1.15. nephr/o ...................................................
1.16. carcin/o ...................................................
1.17. gnos/o ......................................................
1.18. onc/o .........................................................
1.19. tom/o ........................................................
1.20. gynec/o ....................................................
1.21. hepat/o ....................................................
1.22. cyst/o ........................................................

20
2. Build medical terms for the following:
2.1. blood mass (tumour) .................................................................................................................
2.2. inflammation of a gland ..........................................................................................................
2.3. record of the electricity of the heart ................................................................................
2.4. abnormal condition of clotting cells
(slight increase in numbers) .................................................................................................
2.5. pertaining to across the stomach ......................................................................................
2.6. study of the skin (and its diseases) ...................................................................................
2.7. head pain ..........................................................................................................................................
2.8. instrument to cut bone .............................................................................................................
2.9. removal of the stomach ...........................................................................................................
2.10. instrument to visually examine the eye .......................................................................
2.11. to view life (removal of living tissue
for microscopic examination) ............................................................................................
2.12. inflammation of bones and joints ....................................................................................
2.13. one who specializes in the study of tumours ...........................................................
2.14. pertaining to producing disease ......................................................................................
2.15. incision of the stomach .........................................................................................................
2.16. process of viewing the urinary bladder .......................................................................

3. Give the meaning for the following terms:

3.1. autopsy ...................................................... 3. 8. cystitis......................................................

3.2. nephrotomy..............................................
3.3. erythremia................................................
3.4. oncogenic..................................................
3.5. cephalic......................................................
3.6. gastric incision.......................................
3.7. gastric excision......................................
3.9. hepatoma.................................................
3.10. anemia....................................................
3.11. leukemia................................................
3.12. carcinoma.............................................
3.13. thrombosis...........................................
3.14. sarcoma ................................................

21
CHAPTER 3

BODY AS A WHOLE
1. Structural Organization
Cell
The cell is the fundamental structural and functional unit of every living
being. The study of cells is called cytology. Cells are everywhere - every organ
is made up of these individual units. They are responsible for all activities asso-
ciated 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 envi-
ronment 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 deter-
mines 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. Chro-
mosomes contain regions known as genes which determine our hereditary
makeup. The DNA within chromosomes regulates the activities of each cell
by guiding the formation of another substance called RNA, which can leave
the cell nucleus, enter the cytoplasm, and direct the activities of the cell.
In the human there are about 31 000 genes that determine unique human
characteristics.
Chromosomes can be studied and classified as to size, arrangement,
and number. This classification is called a karyotype. Karyotyping of chro-

22
 mosomes is useful in determining whether chromosomes are normal in
number and structure.
4. Cytoplasm. Cytoplasm is all the protoplasmic material outside the nucleus.
It carries on the work of the cell and contains various structures called orga-
nelles (in a muscle cell, it does the contracting; in a nerve cell, it transmits
impulses). Nucleus is the largest cell organelle. Some other organelles
are:
a) Mitochondria (sg. mitochondrion) - small bodies which carry on the
production of energy in the cell by burning food in the presence of oxygen.
This process is called catabolism. During catabolism complex food mate-
rials are broken down into simpler substances and energy is released.
b) Endoplasmic reticulum - a series of canals within the cell. Some canals
contain small bodies called ribosomes which help make substances
(proteins) for the cell. This synthesizing (building-up) process is called
anabolism.
c) Golgi apparatus (complex, or body) – among other functions serves as
a site of formation of primary lysosomes, which are responsible for the
breakdown of particles entering the cell.
d) Centrioles – participate in cell division.
Together the processes of catabolism and anabolism constitute the total
metabolism of the cell. Metabolism means the sum of the building-up
processes (anabolism) and breaking-down processes (catabolism) in a cell.

Figure 3.1. The Cell

23
Tissue
A tissue is a group of similar cells working together to do a specific job.
The study of tissues is called histology. A histologist is one who specializes
in the study of tissues. More than 200 cell types compose four major tissues
of the body:
Epithelial Tissue. Epithelial tissue is located all over the body as lining for
internal organs, cavities and canals, as secreting portions of exocrine and
endocrine glands, at the outer surfaces of the skin covering the body. It is
composed of cells arranged in sheets consisting of one or more layers.
Muscle Tissue. Voluntary, or skeletal, muscles are groups of muscles
attached to bones and they are responsible for the movement of the body in
its external environment. Involuntary, or visceral muscles are those muscles
responsible for the movement of internal organs and their functioning is said
to be involuntary, i.e. not under conscious control. Basic function of muscle
tissue is to provide for the contraction and relaxation of all muscle groups.
Connective Tissue. This is the tissue that supports and connects other
tissues and organs. It is composed of different cell types, e.g. fibroblasts, fat
cells, bone and cartilage cells, blood cells.
Nerve Tissue. Nerve tissue conducts electrical impulses as it relays infor-
mation throughout the entire body.

Organ
These structures can be made of several types of tissue. For example,
an organ like the stomach is composed of muscle tissue, nerve tissue, and
glandular epithelial tissue. The medical term for internal organs is viscera
(singular: viscus). Examples of abdominal viscera (organs located in the
abdomen) are the liver, stomach, intestines, pancreas, spleen, and gallbladder.

System
These can be briefly defined as groups of organs working together to
perform complex functions. For example, the mouth, esophagus, stomach,
and small and large intestines are organs of the digestive system. Here follows
the list of body systems and their major organs:
1. Gastrointestinal, or digestive system - mouth, pharynx, esophagus,
stomach, intestines (small and large), liver, gallblader, pancreas.
2. Urinary, or excretory - kidneys, ureters, urinary bladder, urethra.
3. Respiratory – nose, pharynx, larynx, trachea, bronchi, left and right lung
lobes, alveoli.
4. Musculoskeletal – muscles, bones, joints, tendons, ligaments.
5. Integumentary – skin, sebaceous and sweat glands, hair, nails.

24
6. Cardiovascular – heart, blood vessels (arteries, veins capillaries), lymphatic
vessels and nodes, spleen.
7. Endocrine – endocrine glands (hypophysis, thyroid g., parathyroid g.,
adrenal, gonads, pancreas – islets of Langerhans, thymus, pineal g.).
8. Nervous – neurons and neuroglial cells (brain, spinal cord, nerves, collec-
tions of nerves)
9. Reproductive
a) Female: ovaries, fallopian tubes, uterus, vagina, mammary g.
b) Male: testes and associated tubes, urethra, penis, prostate g.
10. Special senses – the eye and the ear.

Organism
Organism is defined as the highest level of organization i.e. as a complete
living entity capable of independent existence. All complex organisms,
including humans, are made up of several body systems that work together
to sustain life.

2. Body cavities
A body cavity is a space within the body which contains internal organs
(viscera). The names of the body cavities and important organs contained
within them are listed below.
Cavity Organs
1. Cranial Brain
2. Thoracic 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.
3. Abdominal 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 Urinary bladder, urethra, ureters; uterus and vagina in the
female.
5. Spinal Spinal cord and spinal nerve roots.

The cranial and spinal cavities are considered dorsal body cavities because
of their location on the back portion of the body. The thoracic, abdominal, and
pelvic cavities are considered ventral body cavities because they are on the
front, or belly side, of the body.
The thoracic and abdominal cavities are separated by a muscular partition
called the diaphragm. The abdominal and pelvic cavities are not separated by a
partition and together they are usually referred to as the abdominopelvic cavity.

3. Anatomical divisions of the abdomen – 9 regions and 4 quadrants

These divisions are used in anatomy texts to describe the regions in which
organs and structures are found. The following are 9 abdominal regions
1. Hypochondriac regions (two upper lateral regions beneath the ribs)
2. Epigastric region (region of the stomach)
3. Lumbar regions (two middle lateral regions)
4. Umbilical region (region of the navel or umbilicus)
5. Inguinal (iliac) regions (two lower lateral regions)
6. Hypogastric region (lower middle region, below the umbilicus)

Figure 3.2. Anatomical divisions of the abdomen – 9 regions & 4 quadrants

Right Left
Epigastric
hypochondriac hypochondriac
region
region region
Right upper Left upper
quadrant quadrant
Right lumbar Umbilical Left lumbar
region region region
Right lover Left lover
quadrant quadrant
Right inguinal Hypogastric Left inguinal
(iliac) region region (iliac) region

26
4. Anatomical division of the back (spinal column)
The back is divided into segments that correspond to regions of the spinal,
or vertebral,column. The spine is composed of a series of bones extending
from the neck to the tail bone (coccyx). Each bone is called a vertebra (plural:
vertebrae).
Division of the back Abbreviation Location
1. Cervical C Neck region. There are 7 cervical
vertebrae (Cl-C7).
2. Thoracic T or D Chest region. There are 12 thoracic
(D = dorsal) vertebrae (T1-T12). Each bone is
joined to a rib.
3. Lumbar L Loin or flank region (between the
ribs and the hip bone). There are
5 lumbar vertebrae (L1-L5).
4. Sacral S Five bones (s1-S5) are fused to
form one bone – the sacrum.
5. Coccygeal Cg The coccyx (tailbone) is a small
bone composed of 4 fused pieces.

An important distinction should be made

between the spinal column (the vertebrae) and
the spinal cord (nerves running through the
column). The former is bone tissue, while the
latter is composed of nerve tissue.
The spaces between the vertebrae (interver-
tebral spaces) are identified according to the two
vertebrae between which they lie; e. g. LS-Sl
lies between the 5th lumbar and the 1st sacral
vertebrae. An intervertebral cartilaginous (made
of cartilage) disk (or disc) lies between each
vertebra and acts as a pad to absorb shock and
make movement easier.

Figure 3.3. Anatomical divisions of the back

(spinal column)

27
5. Positional and directional terms

afferent Conducting toward a structure. Example: veins are

called afferent vessels since they take blood toward
the heart.
efferent Conducting away from a structure. Example: arteries
are efferent blood vessels since they take blood away
from the heart.
anterior (ventral) Front of the body. Example: the abdomen is located
anterior to the spinal cord. Ventral and anterior mean
the same position in the human.
posterior (dorsal) Back of the body. Example: the posterior lobes of the
brain are in the back of the head and are called the
occipital lobes. Dorsal means the same position as
posterior.
central Pertaining to the centre. Example: the heart is located
in the central portion of the thoracic cavity – between
the lungs and the mediastinum.
deep Away from the surface. Example: the lesion penetrated
deep into the abdomen, away from the surface of the
body.
superficial Near the surface. Example: the wound was a superfi-
cial one, just penetrating the skin.
distal Away from the beginning of a structure; away from
the centre. Example: at its distal end, the thigh bone
(femur) joins with the knee cap (patella).
proximal Pertaining to the beginning of a structure. Example:
the proximal proximal end of the femur joins with the
pelvic (hip) bone.
inferior (caudal) Away from the head; situated below another structure.
Example: the feet are the caudal parts of the human
body.
superior (cephalic) Pertaining to the head; situated above another struc-
ture. Example: in a cephalic presentation of the fetus,
the head comes through the birth canal first.
lateral Pertaining to the side. Example: the little toes are
lateral to the big toes.

28
medial Pertaining to the middle or nearer the median plane of
the body. Example: in the anatomical position the palms
of the hands are facing outward and the fifth finger lies
medial to the other fingers.
supine Lying on the back – facing upward.
prone Lying on the belly (abdomen) – facing downward.

6. Planes of body
A plane is an imaginary flat surface that anatomists use to identify different
sections of the body. The following are the most commonly used body planes
and their anatomical divisions.
1. frontal – coronal – vertical plane dividing the body or structure into ante-
rior and posterior portions
2. midsagittal – median – lengthwise vertical plane dividing the body or struc-
ture into right and left portions or into right and left halves.
3. transverse - horizontal - Plane running across the body parallel to the
ground (horizontal).

It divides the body or structure into upper and lower portions.

Figure 3.4 Planes of the Body

29
7. Medical word elements
Combining form Meaning Terminology
acr/o extremity acromegaly = enlargement of extremities
adip/o fat adipose = pertaining to fat (tissue)
chondr/o cartilage chondritis = inflammation of cartilage
cyt/o cell cytology = the study of cells
eti/o cause etiology = study of the cause of diseases
hist/o tissue histology = the study of tissues
idi/o unknown idiopathic = of unknown cause
kary/o nucleus karyolysis = destruction of the nucleus
morph/o shape, form morphology = the study of shape, form,
or structure
nucle/o nucleus nuclear = pertaining to the nucleus
path/o disease pathology = the study of diseases
somat/o body somatic = pertaining to the body
son/o sound sonography = the process of recording
sound
viscer/o int. organ visceral = pertaining to internal organs

8. Diagnostic and Therapeutic Procedures and Related Terms

Terms Definition
adhesion fibrous band holding together tissues that are normally
separated
dehiscence bursting open of a wound
febrile pertaining to a fever; feverish
homeostasis relative balance of internal environment of the body
inflammation body defence against injury, infection etc.
morbid pertaining to a diseases (morbus = lat. disease)
sepsis the presence of pathological microorganisms or their
toxins in the bloodstream
suppurative associated with the production of pus (purulent)

Procedures
anastomosis surgical joining of two ducts, vessels, bowel segments, etc.
biopsy removal of living tissue for microscopic examination
cauterize destroy tissue by electricity, freezing, corrosive chemicals
or heat
endoscopy visual examination of a hollow organ or body cavity with a
specialized instrument called an endoscope
resection partial excision of a bone, organ or other structure

30
EXERCISES
1. Answer the following questions:
1.1. Where is the mediastinum?
..........................................................................................................................................................................

What organs are contained within the mediastinum?

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

1.2. What does sacroiliac mean? .................................................................................................

1.3. Where are the inguinal regions of the abdomen? ....................................................
1.4. What is adipose tissue? ...........................................................................................................
1.5. What is epithelial tissue? ........................................................................................................
1.6. What is the endoplasmic reticulum? ...............................................................................
1.7. What are ribosomes? ................................................................................................................
1.8. Describe the location and function of chromosomes.
..........................................................................................................................................................................

2. Give the opposites of the following terms:

2.1. deep.............................................................. 2.5. posterior.....................................................

2.2. afferent....................................................... 2.6. caudal..........................................................
2.3. proximal..................................................... 2.7. supine..........................................................
2.4. ventral.........................................................

3. Identify the following planes:

3.1. Which plane divides the body into anterior and posterior portions?
..........................................................................................................................................................................

3.2. Which plane divides the body into upper and lower portions?
..........................................................................................................................................................................

3.3. Which plane divides the body into left and right halves?
..........................................................................................................................................................................

31
4. Complete the following sentences using medical terms expressing position or
direction:
4.1. The left lung lies ........................................................... to the heart.
4.2. The upper arm (humerus) joins at its ................................. end with the elbow.
4.3. The humerus joins at its............................................... end with the shoulder.
4.4. The pelvic cavity is ................................................................ to the abdominal cavity.
4.5. The head is .................................................................... to the feet.
4.6. The chest is bordered on the ..................................................... region by vertebral
column and associated muscles.
4.7. The fingers are found at the ............................................................. end of the hand.
4.8. A tube within the liver is called the ..................................................... hepatic duet.
4.9. In the abdominal position the thumb is on the ................................................ side
of the hand.
4.10. The fluid between cells is called ...................................................... cellular fluid.
4.11. The stomach is situated ........................................................................... to the heart.

5. From the following list of terms, pick the one, which fits the definition best:
ribosomes pleural cavity anabolism
mediastinum endoplasmic reticulum metabolism
mitochondria chromosomes
diaphragm catabolism

Structures in the cytoplasm of the cell which produce energy by chemically

burning food in the presence of oxygen.

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

Contains the hereditary material (DNA) of the cell.

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

Building-up, or synthesizing, process in the cell.

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

32
Contains the heart and other structures between the lungs in the thoracic
cavity.

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

Process in the cell whereby food is burned to release energy.

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

Structures in cytoplasm of cell which are the site of protein synthesis.

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

Surrounds the lungs in the thoracic cavity.

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

Network of canals in the cytoplasm of a cell.

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

Total of building-up and breaking-down processes in the cell.

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Muscular wall dividing the abdominal and thoracic cavities.

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6. Translate the following text into English: the Cell

Proučavanje bolesnih stanja živih orrganizama temelji se na istraživanju
promjene oblika pojedinih njihovih sastavnih dijelova. Razvoj različitih bioloških
znanosti međusobno je usko povezan, pa je tako otkriće mikroskopa (17.
stoljeće) omogućilo spoznaju da su svi živi organizmi građeni od mikroskopski
vidljivih sastavnih dijelova, koji su nazvani stanicama (R. Hooke, 1635-1703).
U drugoj polovici 19. stoljeća, uz daljnji razvoj fizike i kemije, proučavanje
stanica postaje predmet medicinskog istraživanja i tako nastaje znanost koja
se naziva citologija (gr. xutos /kitos/ = šupljina; grč. logos = govor, raspravl-
janje, izučavanje).
R. Virchow (1821-1902), njemački liječnik i istraživač, osnivač je tzv. celu-
larne patologije (lat. cellula = stanica), koja smatra da patološke promjene
stanica dovode do pojave bolesti tkiva i organa, odnosno da su patološka stanja

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organizma posljedica patoloških promjena na stanicama. Proučavanje izgleda
stanice može, prema tome, poslužiti u svrhu postavljanja dijagnoze; radi toga
se citodijagnostika primjenjuje u različitim medicinskim područjima.
Za promatranje stanica najčešće služi običan svjetlosni mikroskop. Osim
njega upotrebljava se i mikroskop s faznim kontrastom te fluorescentni i
elektronički mikroskop.
Napredak kemije doveo je do razvitka posebne grane citologije, citokemije,
koja omogućuje prikazivanje pojedinih kemijskih elemenata. Ova grana
citologije omogućuje prikazivanje pojedinih kemijskih elemenata ili reakcija
unutar stanica.
Za promatranje stanica može poslužiti materijal izlučen iz pojedinih dijelova
tijela, u kojem se nalaze stanice odljuštene s površine različitih organa – to
je tzv. citodijagnostika.

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CHAPTER 4

SKIN - INTEGUMENTARY SYSTEM

Skin is the outer covering of the body. Skin and its accessory organs
comprising hair, nails and glands, are known as the integumentary system
of the body. The word “integument” stems from the Latin word which means
a covering. Skin is the largest organ of the body and it performs a number of
vital functions. It is a complex system of specialized tissues. It contains glands
which secrete several types of fluids, nerves which carry impulses, and blood
vessels which aid in the regulation of body temperature. The main functions
of the skin are as follows:
−− it serves as a protective barrier against microorganisms due to the
acidity of its secretions;
−− it helps shield the delicate, sensitive tissues underneath from
mechanical and other injuries;
−− it acts as an insulator against heat and cold, and helps eliminate body
wastes in the form of perspiration;
−− it guards against excessive exposure to the ultraviolet rays of the sun by
producing a protective pigmentation, and it helps produce the body’ s
supply of vitamin D;
−− its sense receptors enable the body to feel pain, cold, heat, touch and
pressure.

Structure of the Skin

The skin consists of two main layers and a subcutaneous fat layer:
(1) Epidermis - the outermost layer of the skin which is a thin cellular
membrane made up of several layers of different kinds of cells, is composed
of squamous epithelium. The cells of squamous epithelium are flat and scale-
like and are arranged in several layers (strata), therefore called stratified squa-
mous epithelium. The deepest layer is called basal layer. The cells in this layer
are constantly growing and multiplying and give rise to all other cells in the
epidermis. As the basal layer cells divide they are pushed upward toward

35
the most superficial layer of the epidermis, called the stratum corneum. On
this way they become flatten, lose their nuclei and die, becoming filled with
a protein called keratin. Then these cells are called horny cells, because of
the hard protein material they are composed of. Finally, within 3 to 4 weeks
after beginning as a basal cell in the bottom part of the epidermis, the horny,
keratinized cell is sloughed off or shedded from the surface of the skin. In
this way the epidermis is constantly renewing itself, cells dying at the same
rate at which new cells are born. The cells of the protective, horny layer are
nonliving and require no supply of blood for nourishment. As long as the horny
outer layer remains intact, microorganisms cannot enter.
The basal layer of the epidermis contains special cells called melanocytes
which form and contain a black pigment melanin. The amount of melanin
accounts for the colour differences among the races. Also, the presence of
melanin in the epidermis is vital for the protection against the harmful effects
of ultraviolet radiation which can manifest themselves as skin cancer.
(2) Corium, or dermis, is the thicker part of the skin underneath the
epidermis and is made up of connective tissue that contains blood vessels and
nerves. The corium projects into the epidermis in ridges called papillae of the
corium. Lymph vessels and the accessory organs of the skin, which are hair
follicles, sebaceous glands and sweat glands are also located in the dermis.
There are several types of connective tissue cells in the dermis; fibroblasts-
cells 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 manu-
facture 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
Adipose tissue tissue

Papilla Nerve Sudoriferous

Arteriole Venule (sweat) gland

Accessory Organs of the Skin

Hair
Hair is distributed over the entire body, except the bottom of the feet (soles)
and palms of the hands. The roots of the hair lie in follicles, or pockets of
epidermal cells situated in the corium. At the bottom of the follicle is a loop
of capillaries enclosed in a covering called the papilla. The cluster of epithe-
lial cells lying over the papilla reproduces and is responsible for the eventual
formation of the hair shaft – a visible part of the hair. As long as these cells
remain alive, hair will regenerate even though it is cut or plucked or other-
wise removed.
Hair is kept soft and flexible by sebaceous glands which secrete varying
amounts of oily sebum into the upper part of hair follicle located near the
surface of the skin. The growth of hair is similar to the growth of the epidermal
layer of the skin: deep-lying cells in the hair root produce horny cells which
move upward through the hair follicles which hold the hair fibres. Melano-
cytes are located at the root of the hair follicle, and they support the melanin
pigment for the horny cells of the hair fibre. Hair turns gray when the melano-
cytes stop producing melanin.

37
Nails
Nails are hard keratin plates covering the dorsal surface of the most distal
phalanges of each finger and toe. They are composed of horny cells that are
cemented together tightly and can extend (grow) indefinitely unless cut or
broken. The nails grow in much the same way as the hair. The nail bed, like
the hair root, is situated in the corium. The pink colour of the nails is due to
their translucent quality which allows the underlying vascular tissue to show
through.
The semilunar (half-moon) white region at the base of the nails is called
lunula. It has a whitish appearance because the vascular tissue underneath
does not show through. The narrow band of epidermis that extends from nail
wall on to the surface is called the cuticle or eponychium (onych means nail).
The average growth rate for fingernails is around l mm per week and it is
somewhat slower for toenails. The major function of the nails is to protect the
tips of the fingers and toes from bruises and other kinds of injuries.

Glands
1. Sebaceous Glands
The sebaceous glands produce on oily secretion called the sebum and
are located in the corium layer of the skin. These glands are filled with cells,
the centres of which are saturated with fatty droplets. As these cells disinte-
grate they yield the sebum. They are closely associated with hair follicles and
their ducts open into the hair follicle through which the sebum is released.
The acidic nature of sebum helps destroy harmful organisms on the surface
of the skin and, thus, prevents infection. Sebum also lubricates the skin and
minimizes water loss.
Sebaceous glands are present over the entire body except the soles of the
feet and palms of the hands. They are influenced by sex hormones, which
cause them to hypertrophy at puberty and atrophy in old age.

2. Sweat Glands
Sweat glands are also called sudoriferous glands (sudor - sweat). They
are located deep in the corium and are found on almost all body surfaces.
They collect fluid containing water, salt and waste products from the blood
and carry it away in canals that end in pores on the skin surface, where it is
deposited as sweat.
The milk producing mammary gland is another type of modified sweat
gland; it secretes milk only after the birth of a child.

38
 Sweat, or perspiration, helps regulate body temperature as well, because
cooling of the skin occurs when sweat evaporates. The odour produced when
sweat accumulates on the skin is due to the action of bacteria on sweat.

Key Terms
• albino – a person with deficient pigment in skin, hair and eyes.
• basal layer – the deepest layer of the epidermis.
• collagen – structural protein found in the skin and connective tissue.
• corium – the middle layer of the skin.
• cuticle – band of epidermis at the base and side of the nail plate.
• dermis – the corium.
• epidermis – the outermost layer of the skin.
• epithelium – the layer of skin cells forming the outer and inner surfaces
of the body.
• hair follicle – the sac or tube within which each hair grows.
• horny cell – a keratin-filled cell in the epidermis.
• keratin – hard protein material found in the epidermis, hair, and nails;
commonly found in the horns of animals.
• lesion – pathological alteration of tissue.
• lipocyte – a fact cell.
• lunula – the half-moon-shaped white area at the base of the nail
(crescent).
• melanin – black pigment formed by melanocytes in the epidermis.
• sebum – an oily substance produced by sebaceous glands.
• squamous epithelium – flat, scale-like cells composing the epidermis.
• stratum (pl: strata); stratified – a layer of cells; arranged in layers.
• stratum corneum – horny layer; outermost layer of the epidermis.
• subcutaneous tissue – innermost layer of the skin, containing fat tissue.
• sudor – sweat, a product of sweat (sudoriferous) glands.

Combining Forms Meaning Terminology

adip/o adiposis
lip/o fat lipocele
steat/o steatoma
cutane/ subcutaneous
dermat/o skin dermatology
derm/o hypodermic
hidr/o hidroadenitis
sweat
sudor/o sudoresis (diaphoresis)

39
Combining Forms Meaning Terminology
ichthy/o ichthyosis
dry, scaly
xer/o xeroderma
kerat/o horny tissue keratosis
melan/o black melanoma
myc/o fungus dermatomycosis
onych/o onychomycosis
nail
ungu/o subungual
phyt/o plant dermatophytosis
pil/o pilonidal
hair
trich/o trichopathy
scler/o hardening scleroderma
seb/o sebum seborrhea
squam/o scale squamous
xanth/o yellow xanthemia
xen/o foreign xenograft

Disorders of the Skin

1. Cutaneous Lesions
A lesion is a pathological or traumatic alteration of tissue. The following
terms describe the most common skin lesions;

macule nonpalpable, discoloured (especially reddened) flat spots or

patches (examples: measles, rash, flat moles, freckles.)
papule small, solid, circumscribed raised areas of skin (examples:
warts, pimples)
wheal vascular eruption of the skin often characterized by smooth,
slightly elevated, edematous area that is redder or paler than
the surrounding skin usually accompanied by itching (exam-
ples: allergic reactions to insect bites, hives)
vesicle circumscribed collection containing serous fluid (blisters)
(examples: burns, dermatitis, scabies, smallpox) bullae
(singular: bulla) are large blisters.
pustule circumscribed collection of pus (abscess of the skin); (exam-
ples: vesicles that contain pus; the term vesicopustular is
common).

40
polyp a mushroom-like growth extending on a stalk from the
surface of a mucous membrane; polyps are most frequently
found in the uterus, nose, mouth, urinary bladder, and tubes
of the digestive tract.
ulcer an open sore or erosion of the skin or mucous membrane;
ulcers usually involve loss of tissue substance and formation
of pus (abscess).
cyst a closed sac or pouch containing fluid or semisolid material.
(examples: pilonidal cyst, follicular cyst).
fissure a groove or cracklike sore resembling ulcer-like sores can
occur in the anal region (naturally occurring fissures are
found in the brain, the spinal cord and liver).

Figure 4.2. Lesions of the Skin

2. Symptoms and Pathological Skin Conditions

acne a chronic inflammatory disease of the sebaceous
glands and hair follicles of the skin characterized by
papular and pustular eruptions of the skin.
acne vulgaris a common variety of acne. It is characterized by
(ordinary) the formation of blackheads (comedones, singular:
comedo); papules, nodules and pustules usually
appear on the face, neck and upper part of the trunk.

41
albinism absence of pigment in the skin, hair and eyes.
alopecia natural or abnormal baldness or deficiency of hair,
partial or complete, localized or generalized.
athlete ‘s foot fungal infection of the foot; also called tinea pedis.
basal cell carcinoma malignant tumour of the basal cell layer of the
epidermis. This is the most frequent type of skin
cancer. It is a slow- growing tumour of the basal
layer of the epidermis and usually occurs on
the upper half of the face, near the nose, and is
nonmetastasizing.
Bowen disease intraepidermal carcinoma (squamous cell)
characterized by red-brown scaly or crusted lesions
that resemble a patch of psoriasis or dermatitis
(precancerous dermatosis).
burns thermal injuries to the outer surfaces of the body.
They are usually classified into three types: first
degree burns (no blisters; superficial lesions mainly
in the epidermis; hyperesthesia and erythema);
second degree burns (damage to the epidermis and
corium, blisters, erythema, hyperesthesia); and third
degree burns (both the epidermis and corium are
destroyed and subcutaneous layer is damaged; scar
formation results; if more than two thirds of the skin
is destroyed death is the most probable outcome).
cellulitis a spreading infection, especially of the subcutaneous
tissue.
chloasma pigmentary skin discolorations, usually those
occurring in yellowish-brown patches or spots.
cicatrix scar left by a healed wound; keloids are abnormally
raised, thickened scars that form in the skin after
trauma or surgical incision.
comedo typical small skin lesion of acne vulgaris caused
by accumulation of keratin, bacteria, and dried
sebum plugging an excretory duct of the skin. (pl.
comedones)
decubitus ulcer decubitus means “lying down”; ulcers occur over
(bedsore) bony areas that have been subjected to pressure
against a hard external object such as a bed.

42
dermatitis inflammation of the skin.
discoid lupus benign dermatitis confined to the skin, marked by
a scaly rash, usually in a butterfly pattern over the
nose and cheeks, sometimes extending to the scalp
and causing baldness.
ecchymosis a bruise or purple spot on the skin caused by escape
of blood from injured vessels.
eczema a chronic moist dermatitis caused by a number
of external and internal factors acting singly or
in combination; these areas may be dry or have a
watery discharge; it is a common allergic reaction
in children, but can also occur in adults; often, it is
accompanied by pruritus.
eschar damaged tissue following a severe burn.
exanthematous viral eruption (exanthema) of the skin due to a viral
disease infection; examples are: rubeola-measles; rubella -
German measles; and varicella-chickenpox.
gangrene death of tissue associated with loss of blood supply.
In this condition, ischemia resulting from injury,
inflammation, frostbite, diseases such as diabetes,
or arteriosclerosis can lead to necrosis of tissue,
followed by bacterial invasion and putrefaction.
hemangioma an area in which the blood vessels form an
abnormally excessive network in the skin. They
usually occur as birthmarks and some disappear
with age; others can be treated surgically, with
medications or with irradiation.
hirsutism condition characterized by the excessive growth of
hair in unusual places, especially in women.
impetigo bacterial inflammatory skin disease marked by
isolated vesicles, pustules and crusted-over lesions.
keratosis thickened areas of the epidermis; some keratoses
are pigmented and due to excessive exposure to
sunlight (actinic keratosis); seborrheic keratoses are
called senile warts and occur in older patients.

43
lentigo small brown macules (esp. on the face and arms)
caused by sun exposure; it is a benign lesion
requiring no treatment.
leukoplakia white, thickened patches on mucous membrane
tissue of the tongue or cheek; this may be a
precancerous lesion; it is common in smokers, and
may be caused by chronic inflammation.
pediculosis infestation with lice, transmitted by personal contact
or common use of brushes, combs, or headgear.
systemic lupus a chronic inflammatory disease of the joints and
erythematosus collagen of the skin and other organs of the body; it
(SLE) is commonly marked by erythematous rash on the
face and other areas exposed to sunlight; it involves
the vascular and connective tissues of many organs,
resulting in a multiplicity of local and systemic
manifestations; etiology is unknown, but incidence is
highest in females between puberty and menopause;
it is an autoimmune condition and often fatal.
melanoderma abnormal brown or black pigmentation of the skin.
melanoma, cancerous tumour composed of melanocytes;
malignant the tumours often metastasize to the lungs, liver,
and brain after arising in areas of the body where
pigmented cells occur.
nevus; nevi congenital proliferation of blood vessels or
pigmented cells on the skin surface (moles and
hemangiomas are examples).
onychia inflammation of the nail bed, frequently with loss of
the nail.
pemphigus blistering (bullous) eruptions affecting the skin
and mucous membranes of unknown etiology; the
disease may be acute or chronic and affects adults;
the lesions appear asymptomatically and leave
pigmented spots.
petechiae small, purplish, hemorrhagic spots on the skin;
smaller versions of ecchymoses.
pruritus itching, associated with most forms of dermatitis and
other conditions as well.

44
psoriasis a discrete pink or dull red lesion surmounted by
characteristic silvery scaling; the condition may
begin at any age as flat-topped papules covered with
thin, greyish- white scales; under the dry scales
are red bleeding points; its etiology is not yet fully
explained.
purpura merging ecchymoses and petechiae over any part of
the body.
rash an outbreak of lesions on the skin.
scabies a contagious parasitic infection of the skin with
intense pruritus caused by scabies mite (itch mite).
scleroderma a chronic disease of the skin caused by infiltration
of fibrous or scar tissue into the skin; scleroderma
leads to hardening, pigmentation, and atrophy of the
skin and internal organs, such as the kidneys, lungs,
and esophagus.
squamous cell malignant tumour of the squamous epithelial cells of
carcinoma the epidermis; the tumour may grow in places other
than the skin and can metastasize to lymph nodes.
tinea any fungal skin disease, especially ringworm,
occurring in various parts of the body.
urticaria hives; this condition is basically a localized edema
(swelling) in association with itching; etiology may be
allergy to foods or drugs or psychological stimuli.
vitiligo loss of pigment in areas of the skin (milk -white
patches). The condition is often found in the tropics
and the etiology is unknown.
wart (verruca) epidermal growth caused by a virus.

EXERCISES
1. a) The functions of the integumentary system are: ....................................................
b) The accessory organs of the skin are: ...........................................................................

2. Complete the following sentences:

2.1. A fat cell is known as a .............................................................................................................

45
2.2. The half-moon-shaped white area at the basis of a nail is called the
..........................................................................................................................................................................

2.3. The sebaceous glands are located in the.......................................................................

2.4. Sweat, or ............................................................... helps regulate body temperature.
2.5. Hair is distributed over .......................................... except .................................................
and ...............................................................................................

3. Give the opposite of each term:

3.1. animate ...................................................... 3.6. life .................................................................

3.2. material ..................................................... 3.7. thin ...............................................................
3.3. organic ....................................................... 3.8. upward .......................................................
3.4. visible .......................................................... 3.9. rational ......................................................
3.5. sensitive .................................................... 3.10. hard ...........................................................

4. Match the following terms with their meanings:

4.1. alopecia ..................................................... a) inflammation of the nail bed
4.2. impetigo .................................................... b) eponychium
4.3. onychia ....................................................... c) baldness
4.4. scabies ....................................................... d) skin infection marked by pustular
vesicles
4.5. cuticle ......................................................... e) contagious skin disease
transmitted by the itch mite

5. Give the meaning of the following terms:

5.1. acne .....................................................................................................................................................
5.2. albinism ............................................................................................................................................
5.3. eczema ...............................................................................................................................................
5.4. epidermis .........................................................................................................................................
5.5. basal layer .......................................................................................................................................
5.6. horny cells .......................................................................................................................................
5.7. mast cells .........................................................................................................................................

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5.8. melanocytes ...................................................................................................................................
5.9. macule ...............................................................................................................................................
5.10. ulcer ..................................................................................................................................................

6. Provide the plural form for the following nouns:

6.1.keratosis .................................................... 6.6. epithelium ................................................

6.2. bacillus ...................................................... 6.7. stratum ......................................................
6.3. louse ............................................................ 6.8. fungus ........................................................
6.4. nevus ........................................................... 6.9. squama ......................................................
6.5. petechia ..................................................... 6.10. papilla ......................................................

7. Provide the noun form for the following adjectives:

7.1. allergic ....................................................... 7.6. effective .....................................................

7.2. epithelial ................................................... 7.7. present .......................................................
7.3. bullous ....................................................... 7.8. dermal ........................................................
7.4. scaly ............................................................. 7.9. distant ........................................................
7.5. ulcerative .................................................. 7.10. superficial .............................................

8. Give appropriate medical word for the following skin conditions:

8.1. bullous eruptions on the skin ..............................................................................................
8.2. bedsore ..............................................................................................................................................
8.3. necrosis of skin tissue resulting from ischemia .......................................................
8.4. cancerous tumour composed of melanocytes ...........................................................
8.5. fungal skin infection ..................................................................................................................
8.6. abnormal brown or black pigmentation of the skin ...............................................
8.7. absence of pigment in the skin ...........................................................................................
8.8. fungus infection of the foot ....................................................................................................
8.9. excessive growth of hair ..........................................................................................................
8.10. severe itching of the skin .....................................................................................................

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9. Translate into Croatian:
Disease Descriptions
1. Candidiasis (Candida is a yeastlike fungus): This fungus is normally found
on mucous membranes, skin, and vaginal mucosa. Under certain circum-
stances (excessive warmth, administration of birth control pills, antibiotics and
corticosteroids, debilitated states, infancy) it can change to a pathogen and
cause localized or generalized mucocutaneous disease. Examples are paro-
nychial lesions, lesions in areas of the body where rubbing opposed surfaces
is common (groin, perianal, axillary, inframammary, and interdigital), and
vulvovaginitis.
2. Cellulitis: This is a common nonsuppurative infection of connective tissue
with severe inflammation of the dermal and subcutaneous layers of the skin.
Cellulitis appears on an extremity as a reddish brown area of edematous skin.
A surgical wound, puncture, skin ulcer, or patch of dermatitis is the usual
means of entry for bacteria (most cases are caused by streptococci). Therapy
entails rest, elevation, hot wet packs, and penicillin. Any cellulitis on the face
should be given special attention because the infection may extend directly
to the brain.

(From: D. E. Chabner: The Language of Medicine)

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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 attach-
ment 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 loca-
tion 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 imma-
ture 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

ULNA
ILIUM
ISCHIUM SACRUM
PUBIS 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, osteo-
blastic activity produces an enzyme that causes the formation of a calcium-
phosphate compound giving bone its characteristic hard quality.
Not only are calcium and phosphorus part of the hard structure of bone
tissue, but calcium is also stored in bones and small quantities are present in
the blood. If the proper amount of calcium is lacking in the blood, nerve fibers
are unable to transmit impulses effectively to muscles; heart muscle becomes
weak and muscles attached to bones undergo spasms. The necessary level of
calcium in the blood is maintained by the parathyroid gland, which secretes
a hormone to release calcium from bone storage. Excess of the hormone
(caused by tumour or other pathological process) will raise blood calcium at
the expense of the bones, which become weakened by the loss of calcium.

3. Types of bones
Bones all over the body are of several different types.
−− Long bones are found in the thigh, lower leg, and upper and lower arm.
These bones are very strong, are broad at the ends where they join with
other bones, and have large surface areas for muscle attachment.
−− Short bones are found in the wrist and ankle and have small, irregular
shapes.
−− Flat bones are found covering soft body parts. These are the shoulder
bone, ribs, and pelvic bones.
−− Sesamoid bones are small, rounded bones resembling a grain of sesame
in shape. They are found near joints; the knee cap is the largest example
of this type of bone.

The shaft, or middle region, of a long bone is called the diaphysis. Each end
of a long bone is called an epiphysis. The epiphyseal line or plate represents an
area of cartilage tissue which is constantly being replaced by new bony tissue
as the bone grows. Cartilage cells at the edges of the epiphyseal plate form
new bone and this is responsible for the lengthening of bones during child-
hood 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 carti-
lage called articular cartilage. It cushions the bones at the place they meet
with other bones (joints).

51
 Figure 5.2. Structure of a long bone

EPIPHYSIS

SHAFT
DIAPHYSIS
(CORPUS)

EPIPHYSIS

Compact (cortical) bone is a layer of hard, dense tissue that lies under the
periosteum in all bones and chiefly around the diaphysis of long bones. Within
the compact bone is a system of small canals containing blood vessels that
bring oxygen and nutrients to the bone and remove waste products such as
carbon dioxide. These channels are called haversian canals. Compact bone
is tunnelled out in the shaft of the long bones by a central medullary cavity
which contains yellow bone marrow. Yellow bone marrow is chiefly composed
of fat cells.
Cancellous bone, sometimes called spongy bone, is much more porous and
less dense than compact bone. The mineral matter in it is laid down in a
series of separated bony fibres called a spongy latticework or trabeculae. It is
found largely in the epiphyses of long bones and in the middle portion of most
other bones of the body as well. Spaces in cancellous bone contain red bone
marrow. This marrow, as opposed to a yellow marrow which is fatty tissue, is
richly supplied with blood and consists of immature and mature blood cells
in various stages of development. In an adult, the ribs, pelvic bone, sternum
(breastbone) and vertebrae, as well as the epiphyses of long bones, contain
red bone marrow within cancellous tissue. The red marrow in the long bones
is plentiful in young children, but decreases through the years and is replaced
by yellow marrow.

52
4. Processes and Depressions in Bones
Bone processes are enlarged tissues which normally extend out from bones
to serve as attachments for muscles and tendons. The shapes of some of the
common bony processes are:
1. bone head - rounded end of a bone separated from the body of the bone
by a neck.
2. tubercle - small, rounded process for attachment of tendons or muscles.
3. trochanter - large process on the femur for attachment of muscles.
4. tuberosity - large, rounded process for attachment of muscles or tendons.
5. condyle - rounded, knuckle-like process at the joint.

Bone depressions are the openings or hollow regions in a bone which help
to join one bone to another and serve as passageways for blood vessels and
nerves. The names of some common depressions in bone are:

1. fossa (pl. fossae) - depression or cavity in or on a bone.

2. foramen (pl. foramina) - opening for blood vessels and nerves.
3. fissure - a narrow, deep, slitlike opening.
4. sulcus (pl. sulci) - a groove or furrow.
5. sinus - cavity within a bone.

5. Cranial Bones
The bones of the skull, or cranium, protect the brain and its related struc-
tures, such as the sense organs. Muscles for controlling head movements
and chewing motions are attached to the cranial bones. The cranial bones of
a newborn child are not completely joined. There are gaps of unossified tissue
in the skull at birth. These are called soft spots, or fontanelles (little foun-
tains). The pulse of blood vessels can be felt under the skin in those areas.
Here is a list of major cranial bones:
1. frontal bone - forms the forehead and bony sockets that contain the eyes.
2. parietal bone - there are two parietal bones which form the roof and upper
part of the sides of the cranium.
3. temporal bone - two temporal bones form the lower sides and base of the
cranium. Each bone encloses an ear and contains a fossa for joining with
the mandible (lower jaw bone). The mastoid process is a round process of
the temporal bone behind the ear.
4. occipital bone - forms the back and base of the skull and joins the parietal
and temporal bones, forming a suture (juncture line of cranial bones). The
inferior portion of the occipital bones has an opening called the foramen
magnum through which the spinal cord passes.

53
5. sphenoid bone - this bat-shaped bone extends behind the eyes and forms
part of the base of the skull. Because it joins with the frontal, occipital, and
ethmoid bone, it serves as an anchor to hold those skull bones together
(sphen/o means wedge.)
6. ethmoid bone - this thin, delicate bone is composed primarily of spongy,
cancellous bone. It supports the nasal cavity and forms part of the orbits
of the eyes (ethm/o means sieve).

6. Facial Bones
All of the facial bones, except one, are joined together by sutures so that
they are immovable. The mandible (lower jaw bone) is the only facial bone
capable of movement. This ability is necessary for activities such as mastica-
tion (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 verte-
brae 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 clav-
icle 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 clav-
icle 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 ante-
riorly through cartilaginous attachments called costal cartilages. Ribs 1-7
are called true ribs. They join with the sternum anteriorly and with the
vertebral column in the back. Ribs 8-10 are called false ribs. They join with
the vertebral column in the back but join the 7th rib anteriorly, instead of
attaching to the sternum. Ribs 11 and 12 are the floating ribs because they
are completely free at their anterior extremity.

55
Bones of the arm and hand
1. humerus – upper arm bone; the large head of the humerus is rounded and
joins with the scapula and clavicle.
2. ulna – medial lower arm bone; the proximal bony process of the ulna at the
elbow is called the olecranon (elbow bone).
3. radius – lateral lower arm bone.
4. carpals – wrist bones; there are two rows of four bones each in the wrist.
5. metacarpals – these are five radiating bones to the fingers.
6. phalanges (singular: phalanx) - finger bones, each finger (except the thumb)
has three phalanges; a proximal, middle and distal phalanx. The thumb has
only two phalanges.

Bones of the pelvis

The pelvic girdle, or hip bone, supports the trunk of the body and articu-
lates with the thigh bone and sacrum. The adult pelvic bone is composed of
three pairs of fused bones: the ilium, ischium, and pubis.
1. ilium is the uppermost and largest portion. Dorsally, the two parts of
the ilium do not meet. Rather, they join the sacrum on either side. The
connection between the iliac bones and the sacrum is so firm that they
are commonly spoken of as one bone: the sacroiliac. The superior part of
the ilium is known as the iliac crest. It is filled with red bone marrow, and
serves as an attachment for abdominal wall muscles.
2. ischium is the posterior part of the pelvis. The ischium and the muscles
attached to it are what you sit on (Lat. gluteus = buttocks).
3. pubis is the anterior part and contains suture marks where the two pubes
join by way of a cartilaginous disk. This area of fusion is called the pubic
symphysis.

The region within the ring of bone formed by the pelvic girdle is called the
pelvic cavity. The rectum, sigmoid colon, bladder, and female reproductive
organs lie within the pelvic cavity.

Bones of the leg and foot

1. femur- thigh bone; this is the longest bone in the body. At its proximal end it
has a rounded head which fits into a depression, or socket, in the hip bone.
This socket is called the acetabulum. The acetabulum was named because
of its resemblance to a rounded cup the Romans used for vinegar (acetum).
2. patella - kneecap; this is a small, flat bone which lies in front of the articula-
tion between the femur and one of the lower leg bones called the tibia. It is
surrounded by protective tendons and held in place by muscle attachments.

56
3. tibia -largest of two lower bones of the leg; the tibia (meaning “flute”)
runs under the skin in the front part of the leg. It joins with the femur
at the patella, and at its distal end (ankle) forms a swelling which is the
bony prominence (medial malleolus) at the inside of the ankle. The tibia is
commonly called the shin bone.
4. fibula - smaller of two lower leg bones; this thin bone, well hidden under
the leg muscles, joins at its proximal end with the tibia laterally, and joins
at its distal end with the tibia and ankle bones to form the bony prominence
(lateral malleolus) on the outside of the ankle.
5. tarsals - ankle bones; these are seven short bones which resemble the
carpal bones of the wrist but are larger. The calcaneus is the largest of
these bones and is also called the heel bone.
6. metatarsals - there are five metatarsal bones- each leads to the phalanges
of the toes.
7. phalanges of the toes - there are two phalanges in the big toe and three in
each of the other four toes.

9. Joints
1.Types of Joints
A joint (articulation) is a place in the body where two or more bones come
together. Some joints are immovable, such as the suture joints between the
skull bones. Other joints, such as those between the vertebrae, are partially
movable. Most joints, however, allow considerable movement. These freely
movable joints are called synovial joints. Examples of synovial joints are the
ball and socket type (hip joint; the head of the femur fits into the acetabular
fossa of the ilium) and hinge type (elbow, knee, and ankle joints). The bones in
a synovial joint are separated by a joint capsule composed of fibrous cartilage
tissue. Ligaments (fibrous bands, or sheets, of connective tissue) often anchor
the bones together around the joint capsule to strengthen it. The surface of
the bones at the joint is covered with a smooth cartilage called the articular
cartilage.
The synovial membrane lies under the joint capsule and lines the syno-
vial cavity between the bones. The synovial fluid contains water and nutrients
which nourish and lubricate the joints so that friction on the articular carti-
lage is minimal.

2. Bursae
Bursae are closed sacs of synovial fluid lined with a synovial membrane.
They are formed in the spaces between tendons (connective binding bones to
bones), and bones. Bursae lubricate these areas where friction would normally

57
develop close to the joint capsule. Some common bursae locations are at the
elbow joint (olecranon bursa), knee joint (patellar bursa), and shoulder joint
(subacromial bursa).

Figure 5.3. a synovial joint

10. Muscles
There are three types of muscles in the body. Striated muscles, also called
voluntary or skeletal muscles, are the muscle fibres that move all bones, as
well as the face and eyes. We have conscious control over the activity of this
type of muscle.
Striated muscle fibres (cells) have a pattern of dark and light bands,
or fibrils, in their cytoplasm. A delicate membrane called a sarcolemma
surrounds each skeletal muscle fibre. Fibrous tissue that envelops muscles
is called fascia.
Smooth muscles, also called involuntary or visceral muscles, are those
muscle fibres which move our internal organs such as digestive tract, blood
vessels, and secretory ducts leading from glands. We have no conscious control
over these muscles. They are called “smooth” because they have no dark and
light fibrils in their cytoplasm. While skeletal muscle fibres are arranged in
bundles, smooth muscle forms sheets of fibres as it wraps around tubes and
vessels.

58
 Cardiac muscle is striated in appearance but like smooth muscle in its
action. Its movement cannot be consciously controlled. The fibres of cardiac
muscle are branching fibres and are found in the heart.

Figure 5.4. selected muscles of the body

ORBICULARIS OCULI
MASSETER
STERNOCLEIDOMASTOID

PectoraLIS MAJOR

Triceps brachii
Biceps brachii

rectus abdominus

11. Actions of Skeletal Muscles

Skeletal (striated) muscles are the muscles that move the bones of our
body. When a muscle contracts, one of the bones to which it is joined remains
virtually stationary as a result of other muscles that hold it in place. The point
of attachment of the muscle to the stationary bone is called the origin (begin-
ning) of that muscle. However, when the muscle contracts, another bone to
which it is attached does move. The point of junction of the muscle to the bone
that moves is called the insertion of the muscle.

59
 There can be more than one origin for a muscle, as is the case with the
upper arm muscle (biceps brachii) where one origin is at the upper end of the
humerus near the shoulder joint and a second origin is above the scapula. The
insertion of the biceps brachii is at the upper end of the radius near the elbow.
Near the point of insertion, a muscle narrows and is connected to the bone by
way of a tendon. One type of tendon that helps attach muscles to larger bone
areas is called an aponeurosis.
Muscles can perform a variety of actions. Some of the terms used to
describe them are listed below:
abduction - movement away from the midline of the body
adduction - movement toward the midline of the body
dorsiflexion - bending foot backward, decrease the angle of the ankle
joint
extension - straightening out a limb, increase the angle between two
bones
plantar flexion - extending the foot downward, as when pointing the toes
pronation - facing downward
rotation - circular movement around an axis
supination - facing upward
torsion - a rotary movement of the trunk; twisting.

Key Terms
• appendage – any body part attached to a main structure
• articulation – place of union between two or more bones; a joint
• bursa – a fluid filled sac near a joint
• calcium – one of the mineral constituents of bones
• cancellous – spongy or porous structure
• cartilage – flexible connective tissue found on joint surfaces and
embryonic skeleton
• cranium – a skull
• diaphysis – shaft, corpus, or midportion of a long bone
• disk (disc) – flat, plate-like structure of fibrocartilagenous substance
between the vertebrae
• epiphysis – the end of a long bone
• fascia – fibrous membrane separating and enveloping muscles
• hematopoiesis – production and development of blood cells, usually in
the bone marrow
• fissure – narrow, slit-like opening between bones

60
• fontanelle – soft spot (incomplete bone formation) between the skull
bones of an infant
• foramen – opening or passage in bones where blood vessel and nerves
enter and exit an organ
• fossa – shallow cavity in a bone
• ligament – connective tissue bands binding bones to other bones,
supporting and strengthening the joint
• medullary cavity – central hollowed-out area in the shaft of a long bone
• ossification – the process of bone formation
• osteoblast – bone cell that helps form bone tissue
• osteoclast – bone cell that absorbs and removes excess bone tissue
• periosteum – membrane surrounding bone
• red bone marrow – site of hemopoiesis in cancellous bone
• sequestrum – a fragment of necrosed bone
• sinus – cavity within a bone
• sternum – breastbone
• sulcus – groove-like depression
• synovial fluid – viscous fluid within the synovial cavity produced by
synovial membrane and contained in joint cavities, bursae and tendon
sheath
• tendon – connective tissue that binds muscles to bones
• vertebra – back bone
• yellow bone marrow – fatty tissue found in the diaphyses of long bones

Combining Forms Meaning Terminology

ankyl/o stiff, bent ankylosis = abnormal condition of stiffness
articul/o joint articular = pertaining to a joint
arthr/o arthritis = inflammation of a joint
burs/o bursa bursitis = inflammation of a bursa
calc/o calcium hypercalcemia = excess calcium (in
calci/o bloodstream) decalcification = loss of
calcium
chondr/o cartilage chondroma = tumour of a cartilage
cost/o rib costal= pertaining to a rib
dactyl/o finger, toe dactylitis = inflammation of fingers or toes
fasci/o band fascioplasty = surgical repair of fascia
kyph/o humpback kyphosis = a humpback posture (posterior
curvature in the thoracic region)

61
Combining Forms Meaning Terminology
leiomy/o smooth leiomyoma = tumour of a smooth muscle
muscle
lord/o swayback lordosis = a swayback posture (anterior
curvature in the lumbar region)
muscul/o muscle muscular = pertaining to a muscle
my/o myoma = tumour of a muscle
myos/o myositis = inflammation of a muscle
myel/o bone myelopoiesis = formation of bone marrow
marrow,
spinal cord
orth/o straight orthopaedics = specialty for bone diseases
osse/o bone osseous = pertaining to bone
oste/o osteitis = inflammation of bone
rachi/o spine rachitis = inflammation of the spine
rhabd/o striated rhabdomyoma = tumour of a striated
muscle
scoli/o crooked, scoliosis = lateral bent of the spine
bent
spondyl/o vertebra spondylosis = degeneration of
intervertebral disks
syndesm/o ligament syndesmoplasty = surgical repair of a
ligament
ten/o, tend/o tendon ten(din)oplasty = surgical repair of a
tendin/o tendon tendinitis = inflammation of a
tendon

Disorders of the Musculoskeletal System

Pathological Conditions of the Skeletal System and Fractures
ankylosing spondylitis chronic, progressive arthritis with stiffening of joints,
primarily of the spine
arthritis inflammation of joints
bunion abnormal prominence with bursal swelling at the
metatarsophalangeal joint near the base of the big
toe

62
bursitis inflammation of bursae
crepitation crackling sensation felt and heard when the ends of
a broken bone move together
Ewing sarcoma malignant bone tumour involving the shaft of a long
bone
exostoses bony growths (benign tumours) arising from the
surface of the bone
fracture sudden breaking of a bone. Some terms describing
fractures and related injuries are:
a) closed f.: a bone is broken but there is no open
wound in the skin (simple fracture)
b) open f.: a broken bone with an open wound in the
skin (compound fracture)
c) complicated f.: a broken bone has injured an
internal organ
d) comminuted f.: a bone has broken, splintered, into
pieces
e) impacted f.: one end of a broken bone is wedged
into the interior of another bone
f) incomplete f.: fracture line does not transverse the
entire bone
g) g reenstick f.: a bone is partially broken and
partially bent
h) Colles f.: a break at the lower end of the radius
(typical radial f.)
Treatment of fractures involves reduction, which is
the restoration of the fracture to its normal position.
A closed reduction is manipulative reduction without
an incision; in an open reduction an incision is made
into the fracture site. A cast (solid mould of the body
part) is applied to fractures to immobilize the injured
area.
dislocation displacement of a bone from its joint
gouty arthritis (gout) inflammation of joints caused by excessive uric acid
in the body. An inherited defect in metabolism causes
too much uric acid to accumulate in blood (hyper-
uricemia), joints, and soft tissues near joints. The
uric acid crystals destroy the articular cartilage and
damage the synovial membrane. A joint

63
 chiefly affected is the big toe; hence the condition is
often known as podagra (pod = foot -agra = exces-
sive pain). Treatment consists of drugs to lower uric
acid production and prevent inflammation, and a diet
avoiding foods rich in uric acid (red meat).
osteitis fibrosa cystica inflammation of bone with fibrous changes in the
bone tissue When the parathyroid gland produces
an excess of parathyroid hormone (hyperparath-
yroidism), calcium is removed from the bones and
appears in the blood. The bones become porous
(osteoporosis) and decalcified, leading to curva-
ture and cyst formation as well as fractures. Blood
calcium accumulation may lead to renal and cystic
calculi (stones).
osteoarthritis chronic inflammation of bones and joints due to
degenerative changes in cartilage
osteoporosis decrease in bone density; thinning and weakening of
bone due to loss of calcium salts
osteogenic sarcoma malignant tumour arising from bone. Osteoblasts
multiply without control and form large tumours,
especially at the ends of long bones.
osteomyelitis inflammation of the bone and bone marrow due to a
pyogenic infection
sprain trauma to a joint, with pain, swelling, and injury to
ligaments; sprains may also involve damage to blood
vessels, muscles, tendons and nerves
strain less serious injury with overstretching of muscles
protrusion of an abnormal extension of cartilaginous intervertebral
intervertebral disc pad into the neural canal (slipped disc)
rickets (rachitis) inflammation of the spinal column characterized
by osteomalacia (softening of bone tissue) due to
improper absorption of calcium and phosphorus.

Disorders of the spine and muscles

Because of various conditions, the normal curvature of the s pine may
become abnormally bent or slope away. These cases are referred to as curva-
tures of the spine. When a lateral curvature (usually consisting of two curves)

64
of the spine takes place, the disorder is identified as scoliosis (bent). Scoliosis
may be congenital, or it may develop in the early teens. Poor posture over a
long period of time is a contributing factor, and it may be accompanied by
lack of muscle tone and general physical inactivity. Surgery, braces, casts and
corrective exercises may eliminate this condition.
Abnormally increased convexity in the curvature of the thoracic spine as
viewed from the side is referred to as kyphosis (hunchback or humpback). This
condition may be caused by rheumatoid arthritis, rickets, chronic respiratory
diseases or a congenital disorder. It never develops from poor posture. There
are no specific symptoms of kyphosis besides back pain and increasing immo-
bility 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 involve-
ment of the nervous system.
Pseudohypertrophic (Duchenne) muscular dystrophy is the most common
form. Muscles enlarge as fat replaces functional muscle cells that have atro-
phied.
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 junc-
tion where the nerve enters the muscle fibre to stimulate muscle contrac-
tion. There is either a lack of acetylcholine to help transmit the impulse across
the myoneural junction or an increase in cholinesterase, which is an enzyme
released at the junction to destroy whatever acetylcholine remains after the
impulse has passed. Treatment consists of giving a drug to interfere with
cholinesterase production. Some cases are associated with benign tumours
of the thymus (thymoma), and thymectomy is found to be beneficial.

65
 Polymyalgia rheumatica is characterized by muscle pain, primarily of the
shoulder and pelvis, with absence of arthritis and signs of muscle distress.
Treatment with low doses of corticosteroids may relieve symptoms.

Other related terms

Claudication = lameness, limping
Contracture = fibrosis of connective tissue in the skin, fascia, muscles or joint
capsule
Exacerbation = increase in severity of a disease or symptoms (aggravation)
Ganglion cyst = tumour of tendon sheath of joint capsule (commonly in the
wrist)
Hemarthrosis = effusion of blood into a joint cavity
Hypotonia = loss or diminishing of muscle tone
Multiple myeloma = primary malignant tumour that infiltrates the bone and red
bone marrow Osteophyte = bony outgrowth, also called
bony spur
Phantom limb = perceived sensation, following amputation of a limb, that it
still exists
Prosthesis = r eplacement of a missing part by an artificial substitute
Subluxation = p  artial or incomplete dislocation

EXERCISES
1. List some functions of the skeletal system:
...................................................................................................................................................................................

2. Fill in the correct term:

2.1. The inner core of bones is composed of ........................................................ tissue.
2.2. Spongy or ................................................. bone is less dense than compact bone.
2.3. Freely movable joints are called ........................................................................... joints.
2.4. A delicate membrane surrounding each skeletal muscle is referred to
as a........................................................................................................................................................
2.5. The point of attachment of the muscle to the stationary bone is the
..........................................................................................................................................................................

3. Give the opposite of each term:

3.1. abduction .................................................. 3.6. anterior ......................................................

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3.2. pronation .................................................. 3.7. backward ..................................................
3.3. distal ............................................................ 3.8. superior .....................................................
3.4. depression ............................................... 3.9. normal ........................................................
3.5. movable ..................................................... 3.10. malignant ..............................................

4. Match the following terms with their meanings:

4.1. costal .......................................................... a) a type of tendon that helps attach
muscles to bones
4.2. fossa ............................................................ b) inflammation of joints
4.3. fracture ...................................................... c) pertaining to the ribs
4.4. arthritis ...................................................... d) a broken bone
4.5. aponeurosis ............................................ e) a depression in a bone surface

5. Give the meanings of the following terms:

5.1. ossification .......................................................................................................................................
5.2. osteoblasts ......................................................................................................................................
5.3. insertion ............................................................................................................................................
5.4. diaphysis ...........................................................................................................................................
5.5. exostoses ..........................................................................................................................................
5.6. bursitis ...............................................................................................................................................
5.7. haversian canals ..........................................................................................................................
5.8. sprain ..................................................................................................................................................
5.9. kyphosis .............................................................................................................................................
5.10. acetabulum ...................................................................................................................................

6. Provide the plural form of the following nouns:

6.1. vertebra ..................................................... 6.6. diaphysis ...................................................

6.2. pelvis ........................................................... 6.7. toe .................................................................
6.3. foramen ..................................................... 6.8. radius...........................................................
6.4. phalanx ...................................................... 6.9. fossa.............................................................
6.5. process ...................................................... 6.10. femur.........................................................

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7. Provide the adjective form for the following nouns:

7.1. muscle ....................................................... 7.6. fibre ..............................................................

7.2. joint .............................................................. 7.7. ilium ............................................................
7.3. bone ............................................................. 7.8. patella ........................................................
7.4. skeleton ..................................................... 7.9. humerus ...................................................
7.5. pubis ............................................................ 7.10. cranium ..................................................

8. Give appropriate term for the following:

8.1. decrease in bone density ........................................................................................................
8.2. the shaft of the long bone .......................................................................................................
8.3. t he extension of the scapula which joins with the clavicle to form the
joint of the shoulder....................................................................................................................
8.4. the second cervical vertebra ................................................................................................
8.5. the posterior bone of the pelvis............................................................................................
8.6. large process on the femur for attachment of muscle .........................................
..........................................................................................................................................................................

8.7. fibrous tissue that envelops muscles ..............................................................................

8.8. a fibrous attachment spanning over a large area of bone ..................................
..........................................................................................................................................................................

8.9. malignant bone tumour involving the entire shaft of a long bone
......................................................................................................................................................................... .

8.10. lack of muscle strength marked by paralysis...........................................................

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

9. Translate into Croatian:

Backache is one of the most common physical complaints, experienced by
millions of people every day. Many victims of lower back pain - spasmodic pain
near the inward curve of the back above the base of the spine - are stricken
while simply reaching to pick something up. The pain may disappear as spon-
taneously as it came, or last for days, and commonly it will reappear periodi-
cally. Almost anything can cause pain in the back, from sudden stop in a car,
to athletic overexertions, to a reflex action like sneezing. The lower portion of

68
the spine is the site of most back pain which may simply develop from over-
worked 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 contrac-
tion - 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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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 triglyc-
erides. 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 struc-
tures 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, salti-
ness, 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 parti-
tion 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 esoph-
agus. 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 semi-
creamy fluid called chyme.
There are two valves in the stomach. The first valve is called the cardiac
valve, or cardiac sphincter, and is located at the top or fundus of the stomach. It
connects the esophagus to the stomach. The second valve is called the pyloric
valve, or pyloric sphincter, and is located at the base or antrum of the stomach.
It connects the stomach to the small intestine. Both valves are composed of a
round band of muscles called sphincters which contract and expand to allow
food to enter and leave the stomach.

72
 Figure 6.2. Organs of the digestive system

Parotid gland
Tongue Submandibular
Salivary
Mouth (oral cavity) gland
gland
Sublingual gland

Pharynx
Esophagus
Food bolus

Liver
Stomach
Gallbladder

Spleen
Duodenum
Hepatic flexure Splenic flexure

Pancreas Transverse colon

Jejunum
Descending colon
Ascending colon
Ileum
Cecum
Sigmoid colon
Appendix
Rectum
Anus

Small Intestine (Small Bowel)

The small intestine is approximately one inch in diameter and is a contin-
uation of the gastrointestinal tube. It extends from the pyloric sphincter to
the first part of the large intestine. The small intestine is 20 feet long and has
three parts:
1. The duodenum, the uppermost division which is about ten inches long.
2. The jejunum, which is approximately eight feet long.
3. The ileum, which is about twelve feet long.

Most of the absorption of food takes place in the ileum by tiny fingerlike
projections called villi. Inside the villi one finds a network of fine capillaries,
veins, and arteries. There are also many other digestive glands located in the
mucous membrane lining of the small intestine. These microscopic glands
secrete additional digestive juices.
The pancreas and liver produce digestive secretions, and these secretions
are added to the chyme at the beginning of the small intestine. With the excep-
tion of some forms of fat, water, and waste products, all food ingested into the
body is absorbed through the walls of the small intestine.

73
Large Intestine (Large Bowel)
The large intestine extends from the end of the ileum to the anus. It is
divided into four parts: cecum, colon, sigmoid colon, and rectum. The large
intestine is a continuation of the gastrointestinal tube and is attached to the
ileum by ileocecal valve. This valve is composed of sphincter muscles that
serve to close the ileum at the point at which the small intestine is connected
to the colon. The large intestine has an average diameter of two-and-half
inches and is approximately five feet long. The cecum is the first two or three
inches of the large intestine. It is a pouch on the right side. Attached to the
cecum is a wormlike (vermiform) projection - the appendix, which performs
no function in the digestive tract and only causes problems when infected.
The colon consists of the following parts:
1. The ascending colon, which extends from the cecum to the lower border of
the liver - hepatic flexure
2. The transverse colon, which passes horizontally across the abdomen to the
left toward the spleen - splenic flexure
3. The descending colon, which continues down to form the sigmoid colon
(shaped like an S - sigma).
4. The rectum, which serves as a storage area for the waste products of diges-
tion, and is approximately five inches long. The terminal inch of the rectum
is referred to as the anal canal. The canal is kept closed by internal and
external sphincters except during the process of defecation (elimination
of feces).

Three important additional organs of the digestive system are the liver,
pancreas, and gallbladder. Although food does not pass through these organs,
each plays a crucial role on the pro per digestion and absorption of nutrients.

Liver
The liver is the largest glandular organ in the body and weighs approxi-
mately three to four pounds. It is located beneath the diaphragm in the right
upper quadrant (RUQ) of the abdominal cavity. The liver produces so many vital
functions that the human organism cannot survive without it. The following
are some of its more important functions:
1. Produces bile, which is used in the small intestine to emulsify and absorb
fats. Bile is a thick, yellowish brown, sometimes greenish, fluid. It contains
cholesterol (a fatty substance), bile acids, and several bile pigments. One of
these pigments is called bilirubin. Bilirubin is a waste product of hemoglobin
destruction (which occurs in the liver as red blood cells are destroyed).
2. Removes glucose (sugar) from blood, which it synthesizes and stores as
glycogen (starch) in liver cells. This is called glycogenesis.

74
3. Stores vitamins, such as B12, A, D, E, and K.
4. Breaks down or transforms some toxic products into less harmful
compounds.
5. Maintains normal level of glucose in the blood.
6. Destroys old erythrocytes and ingests bacteria and foreign particles from
the blood by phagocytes.
7. Produces various blood proteins, such as prothrombin and fibrinogen, which
aid in the clotting of blood (coagulation).

Pancreas
The pancreas secretes and produces pancreatic juices that help break down
all types of food during the digestive process. These juices empty into the
pancreatic duct and eventually are absorbed by the small intestine. Insulin is
another hormone that is secreted by the pancreas and exerts major control
over carbohydrate metabolism or the utilization of sugar in the body. Insulin
is produced by the cells located within the tissue of the pancreas. These cells
are called the islands of Langerhans. The pancreas is both an exocrine and
endocrine organ. It is also discussed in chapter 13 - The Endocrine System.

Gallbladder
The gallbladder serves as the storage area for bile. It is a pear-shaped sac
under the liver. During the process of digestion, when there is a need for some
bile, gallbladder releases it into the duodenum through the common bile duct.
Bile is also drained from the liver through the hepatic ducts. The hepatic ducts
connect with the cystic duct from gallbladder and form the common bile duct
(choledochus).

Figure 6.3. liver, pancreas and gallbladder

75
Key Terms
• absorption – passage of materials through the intestinal walls into the
bloodstream
• alimentary canal – the digestive tract
• amino acids – building blocks of proteins, produced when proteins are
digested
• amylase – pancreatic enzyme for digestion of starch
• bile – digestive juice produced by the liver and stored in the gallbladder
• bilirubin – pigment resulting from destruction of hemoglobin, released
by the liver
• bolus – mass of masticated food ready to be swallowed
• bowel – intestine
• canine teeth – pointed dog-like teeth
• cecum (blind) – first part of the large intestine
• colon – large intestine
• deglutition – swallowing
• dentin – basic tissue composing the tooth
• digestion – breakdown of complex foods into smaller forms
• emulsification – breakdown of large fat globules into smaller ones
• enamel – hard outer covering of a tooth
• enzyme – a chemical that speeds up digestion
• esophagus – gullet
• fatty acids – substances produced when fats are digested
• feces – solid wastes; stools
• gingiva – gums
• glucose – simple sugar; blood sugar
• glycogen – animal starch; glucose is stored in the form of glycogen in
liver cells
• hydrochloric acid – a substance produced by the gastric mucosa
necessary for digestion of food
• incisors – front teeth in the dental arch (cutters)
• insulin – pancreatic hormone important for carbohydrate metabolism
• lipase – pancreatic enzyme needed in the digestion of fats
• mastication – chewing
• palate – roof of the mouth
• papilla(e) – small elevations on the surface of the tongue; any nipple-like
elevation
• parotid gland – salivary gland near the ear
• peristalsis – rhythmic contractions of digestive tubes and other tubular
structures

76
• pharynx – throat
• pulp – soft inner part of a tooth containing blood vessels and nerves
• ruga(e) – folds on the hard palate and gastric walls
• saliva – digestive juice produced by the salivary glands
• sphincter – circular muscles inside a tube
• triglycerides – large fat molecules
• villi (sg. villus) – microscopic projections in the walls of the small
intestine (blood vessels) through which nutrients are absorbed into the
bloodstream

Combining Forms Meaning Terminology

an/o anus perianal = around the anus
append/o appendix appendectomy = removal of the appendix
bucc/o cheek buccal = pertaining to the cheek
celi/o abdomen celiac = pertaining to the abodmen
lapar/o laparoscopy = endoscopic examination
of parts of the abdominal cavity
cheil/o lip cheiloplasty = surgical repair of lips
labi/o labial = pertaining to the lips
cholecyst/o gallbladder cholecystectomy = removal of the gall-
bladder
choledoch/o bile duct choledochotomy = incision into the bile
duct
col/o large colonic = pertaining to the large intestine
colon/o intestine colonoscopy = visual examination of the
colon
dent/o tooth dental = pertaining to teeth
odont/o orthodontist = dental specialist for
correction and prevention of dental
abnormalities
enter/o small enteropathy = disease of the small intes-
intestine tine
faci/o face facial = pertaining to the face
gastr/o stomach gastralgia = pain in the stomach
(stomach-ache)
gingiv/o gums gingivitis = inflammation of the gingiva

77
Combining Forms Meaning Terminology
gloss/o tongue hypoglossal = under the tongue
lingu/o sublingual = “
hepat/o liver hepatomegaly = enlargement of the liver
mandibul/o lower jaw submandibular = under the lower jaw
(mandible)
or/o mouth oral = pertaining to the mouth
stomat/o stomatitis = inflammation of oral mucosa
proct/o anus, proctologist = specialist in the diseases of
rectum the anorectal region
sial/o saliva, sali- sialolith = calculus formed in a salivary
vary gland duct or gland

Disorders of the Gastrointestinal System

Hemorrhoids
The enlargement of the veins of the anal canal causes hemorrhoids or piles.
The two kinds of hemorrhoids involving the anal canal are internal and external
hemorrhoids. These are the enlarged veins in the mucous membrane, either
inside or just outside the rectal area.
Hemorrhoids are usually caused by straining to evacuate hard, dry stools.
They sometimes occur in pregnancy because of pressure on the veins caused
by the enlarged uterus. They may also result from pressure on the veins caused
by a disorder of the liver or the heart or may be symptomatic of a tumour that
may exert pressure against the veins.
Temporary relief from hemorrhoids can usually be obtained by cold
compresses, sitz baths, fecal softeners, or analgesic ointment. Treatment
of an advanced hemorrhoidal condition is by surgical removal (hemorrhoid-
ectomy).

Hernias
A hernia is an abnormal protrusion or projection of an organ or tissue
through the structures that normally contain them. They may be abdom-
inal, inguinal, or umbilical. Even though hernias occur most commonly in the
abdominal region, they may develop in the diaphragm (diaphragmatic) or in
the form of a hiatus. When this condition occurs, the lower end of the esoph-
agus and the adjacent part of the stomach herniate into the thorax (gastroe-
sophageal). The strangulated hernia cuts off circulation and the herniated
blood vessel is likely to become gangrenous. This is also known as an incar-

78
cerated hernia, as it result in complete bowel obstruction. The inguinal hernia
occurs in the groin where the abdominal folds of flesh meet the thighs. Inguinal
hernias account for about 80 percent of all hernias. In the initial stages such
a hernia may be hardly noticeable and appears as a soft lump under the skin,
no larger than a marble. There may be little pain. As time passes, the pres-
sure of the contents of the abdomen against the weak abdominal wall may
increase the size of the opening and accordingly, the size of the hernia lump.
The protrusion of part of the intestine at the navel (umbilical hernia) is more
frequent in women than men and is treated surgically. Hernias may also be
found in newborns (congenital) or can be acquired at an early age.

Ulcers
An open sore or the lesion of the skin or mucous membrane, producing loss
of substance, and sometimes accompanied by formation of pus, is character-
istic of ulcers. The peptic ulcers occur in the digestive tube that is exposed to
the action of the acidic gastric juice. It is noted that peptic ulcers occur most
commonly in the first portion of the duodenum, next most frequently in the
stomach, and rarely in the lower portion of the esophagus.
They may be of long duration (chronic) or arise suddenly (acute). It is also
observed that chronic ulcers are more common in the duodenum, while acute
ulcers are usually found in the stomach.
Inflammation of the colon, with formation of ulcers in the lining of the
intestine (ulcerative colitis), can occur at any age but is most common in young
adults. The chief symptom is severe diarrhea, which is often accompanied by
blood and mucus in the stool. The patient may feel very weak, lose weight, and
sometimes experience anemia. He may also suffer from pains in the joints
(arthralgia).

Other terms related to pathology of the digestive system:

achlorhydria lack of hydrochloric acid in the stomach. This condition
may be produced by chronic gastritis or carcinoma of
the stomach.
anal fistula abnormal tubelike passageway near the anus which
may communicate with the rectum
anorexia lack or loss of appetite
ascites abnormal accumulation of fluid in the peritoneal cavity
borborygmus the rumbling and gurgling sound made by the
movement of gas in the intestine

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cachexia general ill health, wasting of tissues, malnutrition,
profound and marked state of constitutional disorder
cholelithiasis presence and formation of gallstones in the gallbladder
cirrhosis chronic disease of the liver with degeneration of liver
cells
cleft palate congenital split in the roof of the mouth; lip may also be
affected
colic spasm in any hollow or tubular soft organ
colonic polyposis polyps (small growths) protrude from the mucous
membrane of the colon
constipation difficult and delayed defecation (opstipation)
Crohn disease Inflammation of the intestinal tract, commonly of the
terminal (end)portion of the ileum. Crohn disease
is a chronic relapsing inflammation with diarrhea,
abdominal cramping, and fever. It is similar to
ulcerative colitis and both are considered types of
inflammatory bowel diseases (IBD). Crohn disease,
believed to be caused by virus or autoimmunity
(antibodies attack the body’s own cells), is treated with
drugs (anti- inflammatory steroids) to promote healing
of lesions. Surgical removal of the diseased portion,
with anastomosis of the remaining intestinal parts, may
be needed.
dental caries tooth decay
diverticula abnormal side pockets in a hollow structure such as
(sg.diverticulum) the intestine common sites are the sigmoid colon and
duodenum.
dysentery severe bacterial (shigellae) infection of the large
intestine
dyspepsia difficult digestion, indigestion
dysphagia difficulty or inability in swallowing
eructation belching or raising from the stomach
esophageal swollen, twisted veins around the distal end of the
varices esophagus
flatus gas expelled through the anus

80
gallstones hard collections of bile that form in the gallbladder and
bile ducts
gastroesopha- backflow of gastric contents into the esophagus due to
geal reflux disease a malfunction of the sphincter muscle at the inferior
(GERD) portion of the esophagus
halitosis offensive, or “bad,” breath
heartburn a burning sensation caused by reflux (backflow) of acid
(pyrosis) from the stomach into the esophagus
hematemesis vomiting blood
hepatitis inflammation of the liver caused by virus or damage
to the liver from toxic substances. There are 3 most
common types of viral hepatitis:
Hepatitis A (caused by type A virus and formerly called
infectious hepatitis) is spread through water and food,
and the virus is excreted in feces.
Hepatitis B (caused by type B virus and formerly called
serum hepatitis) is acquired from transfusions and via
body fluids such as tears, saliva, and semen.
Hepatitis C is transmitted by blood or blood products
and close personal contact.
icterus jaundice
ileus intestinal obstruction
intussusception telescoping of the intestines
irritable bowel a group of symptoms associated with stress and
syndrome tension; spastic colon
jaundice (icterus) yellow-orange discoloration of skin or other tissues; it
results from excessive accumulation of bilirubin in the
bloodstream and can occur in three major ways:
1. obstruction of bile passageways prevents bilirubin
from leaving the body in bile (i.e. cholelithiasis);
2. malfunction of liver cells, as in cirrhosis, hepatitis,
or hepatic carcinoma, impairs the liver’s ability to
combine bilirubin with bile; bilirubin thus remains in
the bloodstream;
3. excessive destruction of erythrocytes, as in
erythroblastosis fetalis and other anemias, creates
abnormally high levels of bilirubin in the blood.

81
laxative a medication promoting defecation
melena black stools; feces containing blood
nausea unpleasant sensation from the stomach with a
tendency to vomit
oral leukoplakia white plaques on the oral mucosa; a precancerous
lesion
pancreatitis inflammation of the pancreas
regurgitation return of solids and fluids to the mouth from the
stomach (vomiting)
steatorrhea excessive amount of fat in the feces, often seen in
pancreatic disease
volvulus twisting of the intestine upon itself; an operation can be
performed to untwist the loop of the bowel.

EXERCISES
1. What are the three functions of the digestive system?
1.1. .................................................................................................................................................................
1.2. .................................................................................................................................................................
1.3...................................................................................................................................................................

2. Fill in the correct term:

2.1. One of the main functions of the tongue is swallowing or ................................. .
............................................ speech production and ..................................................... of taste.
2.2. The incisors and ......................................... cut and ......................................... the food
into small pieces.
2.3. The teeth are embedded in pink fleshy tissue known as gums or
..........................................................................................................................................................................

2.4. Within the stomach there are many folds called ......................................................
2.5. Bile is also .............................. from the liver through the ............................................

3. Give the opposite of each term:

3.1. hard palate .............................................. 3.6. rough ...........................................................

3.2. floor of the mouth ............................... 3.7. bitter ............................................................

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3.3. upper ........................................................... 3.8. empty ..........................................................
3.4. descending .............................................. 3.9. harmful ......................................................
3.5. innermost ................................................. 3.10. sufficient ................................................

4. Match the following terms with their meanings:

4.1. chyme ......................................................... a) the inner part of the tooth
4.2. bolus ............................................................ b) a semi-creamy fluid formed in the
stomach when food is mixed with
gastric juices and HCl
4.3. taste buds ................................................. c) a round, sticky mass formed after
the food is chewed
4.4. peristalsis ................................................ d) rough elevations on the surface of
the tongue
4.5. pulp .............................................................. e) wavelike movement of digestive
tubes

5. Give the meanings of the following terms:

5.1. colitis .......................................................... 5.6. anorexia .....................................................

5.2. hernia ......................................................... 5.7. ascites ........................................................
5.3. umbilical ................................................... 5.8. hypoglycemia .........................................
5.4. hemorrhoidectomy ............................. 5.9. constipation ............................................
5.5. melena ....................................................... 5.10. ileus ..........................................................

6. Provide the adjective form for each of the following:

6.1. abdomen ................................................... 6.6. stomach .....................................................

6.2. ulcer ............................................................ 6.7. saliva ...........................................................
6.3. liver .............................................................. 6.8. bucca ...........................................................
6.4. intestine .................................................... 6.9. face ...............................................................
6.5. tongue ........................................................ 6.10. pain ............................................................

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7. Give the plural of the following nouns:

7.1. trachea ....................................................... 7.6. bucca ...........................................................

7.2. ruga ............................................................. 7.7. cavity ...........................................................
7.3. villus ............................................................ 7.8. appendix ....................................................
7.4. tooth ............................................................ 7.9. speech ........................................................
7.5. calculus ..................................................... 7.10. mass .........................................................

8. Give appropriate medical terms for the following:

8.1. complete process of changing the chemical and physical composition of
food.................................................................................................................................................................
8.2. enlargement of the spleen .....................................................................................................
8.3. process of visually examining the stomach .................................................................
8.4. enzyme to digest fats ................................................................................................................
8.5. congenital split in the roof of the mouth .......................................................................
8.6. the musculomembranous partition separating the abdominal and
thoracic cavities .....................................................................................................................................
8.7. abnormal frequency and liquidity of fecal discharges............................................
8.8. the major fuel-regulating hormone in humans ........................................................
8.9. a practitioner who specializes in diseases of the digestive tract
..........................................................................................................................................................................

8.10. pertaining to the stomach and the heart ....................................................................

9. Translate into Croatian:

Appendicitis is an inflammation of the appendix resulting from a bacte-
rial infection. Located at the juncture of the small and large intestines, the
appendix is a small, worm-like piece of intestinal tissue with no known func-
tion in humans. It is called a vestigial organ because, although it may have
previously served some function, it has no function now. The appendix can
be the source of a serious or, at times, even fatal illness. When it becomes
swollen and filled with pus from bacteria, it may form an abscess or may
break, allowing the infection to spread to the surrounding organs. Rupture
may lead to peritonitis, an inflammation of the lining of the abdominal cavity

84
(peritoneum). The infection can spread so quickly that gangrene and rupture
may occur within a matter of hours from the first symptoms.

(From: Ellis, J. W. Medical Symptoms and Treatments)

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10. Translate into English

Bol u trbuhu: je li riječ o bolesti?
Boli u trbuhu mogu nastati naglo (akutno) ili traju dugo, mjesecima pa čak
i godinama. Važno je također znati opetuje li se bol u pravilnim ili nepravilnim
vremenskim razmacima, te postoje li uz bol još i druge tegobe, primjerice
mučnina, povraćanje, proljev, začep, ili vrućica.
Nagla bol u trbuhu može biti uzrokovana različitim bolestima trbušnih
organa. Takva bol često je uzrokovana bolešću koja zahtijeva hitnu liječničku
pomoć jer može biti ugrožen bolesnikov život.
Akutna upala crvuljka (akutni apendicitis) bolest je na koju uvijek valja
pomisliti pri boli u trbuhu, napose u mlađih ljudi. Napadaj boli zbog upale
crvuljka najčešće započne u gornjem dijelu trbuha ili oko pupka. Bol može
biti grčevita (kolike) i u naletima se pojačava i slabi. Nakon nekoliko sati bol
se spušta u donji desni dio trbuha, gdje je i smješten crvuljak. Bolesnici često

85
povraćaju zbog podražaja potrbušnice, a često postoji i malo povišena tjelesna
temperatura. Neki bolesnici i stariji ljudi mogu imati manje izražene znakove
upale crvuljka, što može stvoriti teškoće u pravodobnu prepoznavanju bolesti.

(From: Željko Reiner, Praktična medicina)

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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 inspira-
tion (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 capil-
lary 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 respira-
tion), 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.

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Anatomy and Physiology of Respiration

Figure 7.1. Respiratory tract

Adenoids
Nasal cavity
Nasopharynx
Nose
Oropharynx
Palatine tonsils Laryngopharynx
Epiglottis Larynx
Glottis and vocal cords
Thyroid cartilage
Trachea
Apex of lung Bronchi

Mediastinum Bronchiole

Right lung
Left lung
Visceral pleura Base of lung
Diaphragm
Pleural cavity
Parietal pleura

During the breathing process, air from the environment is drawn in through
the nose and passes through the nasal cavity to the pharynx (throat). The nasal
cavity is lined with a mucous membrane and fine hairs (cilia) to help filter out
foreign bodies, as well as to warm and moisten the air. Paranasal sinuses are
hollow, air-containing spaces within the skull that communicate with the nasal
cavity. They also have a mucous membrane lining and function to provide the
lubricating fluid mucus, to lighten the bones of the skull and help produce
sound. The pharynx is a muscular tube and consists of three major divisions:
1. the nasopharynx, or epipharynx, posterior to the nose and the nearest to
the nasal cavity;
2. the oropharynx or mesopharynx, posterior to the mouth;
3. the laryngopharynx (also called hypopharynx), posterior to the larynx.

Within the nasopharynx there is a collection of lymphatic tissue known as

adenoids or pharyngeal tonsils. They are more prominent in children, and if

88
enlarged can obstruct air passageways. Another collection of lymphatic tissue
called palatine tonsils, or more commonly tonsils are located in the oropharynx.
It is in the hypopharyngeal region that the pharynx, serving as a common
passageway for food from the mouth and air from the nose, divides into two
branches, the larynx (voice box) and the esophagus. The larynx is responsible
for sound production or phonation. It contains vocal cords and is surrounded
by pieces of cartilage for support. Sounds are produced as air is expelled past
the vocal cords and the cords vibrate. The tension of the vocal cords deter-
mines the high or low pitch of the voice.
A leaf-shaped structure in the larynx, the epiglottis, seals off the air passage
to the lungs during swallowing. This structure insures that food or liquids
do not obstruct the flow of air and thus cause the individual to choke. The
epiglottis is attached to the root of the tongue and acts like a lid over the larynx.
On its way to the lungs, air passes from the larynx to the trachea (wind pipe),
a vertical tube about 4.12 inches long and an inch in diameter. The trachea is
kept open by 16 to 20 C-shaped cartilage rings separated by fibrous connec-
tive tissue which stiffen the front and sides of the tube. In the region of the
mediastinum the trachea divides into two branches called bronchi. One bron-
chus leads to the right lung and the other to the left lung. Like the trachea,
the bronchi contain C-shaped cartilage rings. These rings provide the neces-
sary rigidity to keep air passage open at all times. Without them the trachea
or bronchi may possibly collapse and endanger life.
Each bronchus divides into smaller and finer tubes, somewhat like the
branches of a tree, called bronchioles (little bronchi). At the end of them are
clusters of air sacs called alveoli. An alveolus resembles a small balloon
because it expands and contracts with inflow and outflow of air. Capillary
beds of the circulatory system lie adjacent to the thin tissue membranes of the
alveoli. Carbon dioxide passes from the red blood cells of the pulmonary capil-
laries into the alveolar spaces, while O2 from the alveoli passes into the blood.
After the blood becomes oxygenated, it returns to the heart. The heart pumps
blood to all body tissues. At the tissue level O2 from the blood is exchanged for
tissue CO2. This exchange of gases is called internal respiration.
The lungs are divided into lobes: three lobes in the right lung and two lobes
in the left lung. It is possible for one lobe of the lung to be removed without
damage to the rest, which can continue to function normally. The uppermost
part of the lung is called the apex, and the lower area is the base. The haulm
of the lung is the midline region where blood vessels, nerves, and bronchial
tubes enter and exit the organ. The space between the right and left lung is the
mediastinum. It contains the heart, aorta, esophagus (gullet) and the bronchi.

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 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 abdom-
inal 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

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Combining Forms Meaning Terminology
adenoid/o adenoids adenoidectomy = surgical removal of
adenoids
alveol/o alveolus alveolar = pertaining to the alveoli
bronch/o bronchial tube bronchospasm = spasm of the bronchi
bronchi/o bronchiectasis = dilation of the bronchi
capno/o carbon dioxide hypercapnia = excessive amount of CO2
in the blood
coni/o dust coniosis = lodging of dust particles in
the lungs
lob/o lobe of the lung lobectomy = removal of a lung lobe
nas/o nose nasal = pertaining to the nose
rhin/o rhinoplasty = repair of the nose
pector/o chest pectoral = pertaining to the chest
steth/o stethoscope = instrument for
thorac/o examining the chest
thoracodynia = pain in the chest
phon/o voice (sound) dysphonia = voice impairment
phren/o diaphragm; phrenic = pertaining to the diaphragm
mind or the mind
pneum/o air, lung pneumothorax = air in the chest cavity
pneumon/o pneumonitis = inflammation of the
lung; pneumonia
pulmon/o pulmonary = pertaining to the lungs
spir/o breathing spirometer = instrument for the
measurement of breathing, or lung,
capacity

Disorders of the Respiratory System

Atelectasis is a condition in which the lung is collapsed, or more simply,
in an airless state. The prefix atel- means incomplete - hence the definition
of imperfect expansion of the air sacs, functionless, airless lung or portion
of a lung. The bronchioles and alveoli (pulmonary parenchyma) resemble a
collapsed balloon. Common causes of atelectasis include blockage of a bron-
chus or smaller bronchial tube after general anesthesia for surgery and a
chest wound that permits air to leak into the pleural cavity. Acute atelec-
tasis requires removal of the underlying cause (tumour, foreign body, exces-
sive secretions) and therapy to open airways. Chronic atelectasis may neces-

91
sitate lobectomy and antibiotics to combat infection of the lung. Atelectasis
may occur at birth (congenital) when the lungs fail to inflate properly in the
newborn infant (neonate).

Chronic Obstructive Lung Disease (COLD)

Chronic obstructive lung disease or chronic obstructive pulmonary disease
(COPD) includes respiratory diseases characterized by obstructions in the
bronchi or bronchioles that inhibit the flow of air into and out of the alveoli.
These diseases include bronchial asthma, chronic bronchitis, pulmonary
emphysema, and bronchiectasis. Chronic obstructive lung disease cause diffi-
culty in breathing (dyspnea) and is associated with and overdevelopment of tissue
(hyperplasia) within the lungs and bronchi.

Bronchial asthma often results as a response to an allergen. Etiology may

involve infection, or be related to nervous tension and emotional problems.
With this condition there is a narrowing or constriction of the bronchi, accom-
panied by a sudden or violent attack (paroxysm) of dyspnea, wheezing, gasps,
and cough. Treatment includes the use of agents that loosen and break down
mucus (mucolytics) in order to facilitate the obstructed air passages. Oxygen
therapy may be also needed.

Chronic bronchitis is an infection of the bronchi. A thickening of the bron-

chial walls occurs, decreasing the inner diameter (lumen) of the bronchi. Asso-
ciated with chronic bronchitis is a heavy and productive cough which facilitates
the expelling of mucus from the lungs (expectoration of sputum).

Pulmonary emphysema is a disease in which the alveoli lose elasticity. The

air sacs expand (dilate) but are unable to contract to their initial form. Air is
trapped in the alveoli, and many bronchioles are obstructed by mucorrhea.
Consequently, the patient must actively engage in exhaling (expiration) in order
to force the air from the lungs. Frequently, the patient experiences discom-
fort in breathing in any but the erect, sitting or standing positions (orthopnea).
As a result of dyspnea and hypoxemia, the heart must work harder to pump
blood and this leads to right-sided heart failure (cor pulmonale).

In bronchiectasis there is a dilation of the bronchus or bronchi that results

in the production of large amounts of sputum mixed with pus (purulent
sputum). Treatment of this condition includes the use of agents that relax
the smooth muscles of the bronchi (bronchodilators) and loosen sputum in
the chest (expectorants).

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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 (grinder’s disease)
• anthracosis - coal dust (black-lung disease in coal miners)
• asbestosis - asbestos particles (in shipbuilding and construction
industry)
• byssinosis - cotton, flax, and hemp (brown-lung disease)
• chalicosis - lime stone
• siderosis - iron
• volcanoconiosis -volcanic ash

Pneumonia is an inflammatory disease of the lungs and infection of the

alveoli. It may be caused by a variety of agents including bacteria, viruses,
chemicals, or other substances. Infection damages alveolar membranes so
that fluid, blood cells, and debris consolidate in the alveoli. Chest pain (thora-
codynia), 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 anti-
biotics are important in therapy.

Other Pathological and Related Terms

anosmia absence or lack of the sense of smell
apnea temporary loss of breathing
asphyxia insufficient supply of oxygen
atelectasis airless state of lungs
auscultation listening to sounds in the chest cavity
bronchogenic cancerous tumour arising from a bronchus; lung
carcinoma cancer

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compliance ease with which lung tissue can be stretched
coryza head cold; upper respiratory infection (URI)
crackle abnormal respiratory sound; rale
croup acute respiratory syndrome in children and
infants; characterized by obstruction of the larynx,
barking cough, and stridor
cystic fibrosis hereditary disorder of exocrine glands causing
the secretion of thick mucus that clogs ducts of
respiratory and digestive tracts
diphtheria acute bacterial infection of the throat and upper
respiratory tract
epistaxis nasal hemorrhage; nosebleed
hypoxemia oxygen deficiency in the blood
hypoxia oxygen deficiency in tissues – sign of respiratory
insufficiency
pertussis whooping cough – a contagious bacterial infection
of the upper respiratory tract
pleurisy inflammation of the pleural membrane
pulmonary abscess localized area of pus in the lungs
pulmonary edema swelling and fluid in the air sacs and bronchioles
pulmonary embolism floating clot (embolus) or other material blocking
the blood vessels of the lung
sputum material expelled from the chest by coughing or
clearing the throat
stridor a strained, high-pitched noisy breathing associ-
ated with obstruction of the larynx and bronchus
sudden infant death unexpected and unexplained death of an appar-
syndrome (SIDS) ently normal, healthy infant usually less than 12
months of age; crib death
tuberculosis an infectious disease due to Mycobacterium tuber-
culosis
wheeze whistling or sighing sound heard on auscultation
resulting from narrowing of the lumen of respira-
tory passageways

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EXERCISES
1.1. The main organs in the respiratory system are: .......................................................
1.2. The respiratory system provides the following functions:
..........................................................................................................................................................................

2. Fill in the correct term:

2.1. Within the nasopharynx there is a collection of lymphatic tissue known
as adenoids or ........................................................................................................................................
2.2. A leaf-shaped structure in the larynx the......................................... seals off the
air passage to the lungs during ...................................................................................................
2.3. A double-fold serous membrane that surrounds the lungs is called
..........................................................................................................................................................................

2.4. A large muscular partition, the ...................................... lies between the chest
cavity and abdominal cavity.
2.5. Pulmonary emphysema is a ................................................... in which alveoli lose
..........................................................................................................................................................................

3. Give the opposite of each term:

3.1. external ..................................................... 3.6. single ..........................................................

3.2. receive ........................................................ 3.7. inhibit ..........................................................
3.3. posterior ................................................... 3.8. palpable .....................................................
3.4. rigidity ........................................................ 3.9. frequent .....................................................
3.5. expand ........................................................ 3.10. always ......................................................

4. Match the following terms with their meanings:

4.1. dyspnea ..................................................... a) lodging of small particles of dust

in the lungs
4.2. bronchodilator ....................................... b) coughing up of blood
4.3. empyema (pyothorax) ....................... c) accumulation of pus in the
thoracic cavity
4.4. hemoptysis .............................................. d) an agent that causes relaxation of
the smoothmuscles of the bronchi

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4.5. pneumoconiosis ................................... e) difficulty in breathing

5. Give the meanings of the following terms:

5.1. orthopnea ................................................. 5.6. pleurisy ......................................................

5.2. pertussis ................................................... 5.7. embolism .................................................
5.3. epistaxis .................................................... 5.8. pneumoconiosis ...................................
5.4. pleura ......................................................... 5.9. mediastinum ..........................................
5.5. alveolus ..................................................... 5.10. larynx .......................................................

6. Provide the singular form of the following nouns

6.1. lumina ........................................................ 6.6. feet ...............................................................

6.2. sputa ........................................................... 6.7. allergies ....................................................
6.3. thoraces .................................................... 6.8. pharynges ................................................
6.4. alveoli ......................................................... 6.9. chalicoses ................................................
6.5. bronchi ....................................................... 6.10. pleurae ....................................................

7. Provide the noun form for the following adjectives:

7.1. hyperplastic ............................................ 7.6. removed ....................................................

7.2. orthopnic .................................................. 7.7. oxygenated ..............................................
7.3. pulmonary ................................................ 7.8. pharyngeal ...............................................
7.4. purulent ..................................................... 7.9. cartilagenous .........................................
7.5. environmental ....................................... 7.10. costal ........................................................

8. Give appropriate medical term for the following:

8.1. breathing is only possible in an upright position ......................................................
8. 2. coughing up of blood ................................................................................................................
8. 3. condition of pus in a pleural cavity ..................................................................................
8. 4. high pitched, harsh sound heard during inspiration .............................................
8. 5. listening to sounds with a stethoscope .........................................................................

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8. 6. incision of a bronchus .............................................................................................................
8. 7. surgical repair of the nose ....................................................................................................
8. 8. absence of the sense of smell ............................................................................................
8. 9. normal (good) breathing ........................................................................................................
8.10. surgical puncture of the chest ..........................................................................................

9. Translate into Croatian:

Pleurisy is a general term for any inflammation of the pleura, the membrane
that covers the outside of the lungs and lines the chest cavity. The more
common simple inflammation of the pleura is called dry pleurisy. When the
inflamed pleura also has fluid oozing from it, the condition is called wet pleu-
risy. The fluid produced in wet pleurisy often compresses the lungs. Pleurisy
may be a complication of other diseases such as an upper respiratory tract
infection, pneumonia, tuberculosis, or a tumour. Dry pleurisy can be caused
by any type of infection of the lungs; however, it most often follows viral or
bacterial pneumonia. It may also accompany acute bronchitis, or be a compli-
cation of tuberculosis or tumour. Wet pleurisy can also be caused by infec-
tion, tuberculosis, or tumour, as well as by injury or liver disease. Certain liver
diseases may inflame the diaphragm and thus inflame the part of the pleura
that covers the diaphragm.

(From: Ellis, J.W. Medical Symptoms and Treatments)

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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, capil-
laries 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 Excre-
tory 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). Capil-
laries 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 trans-
ported 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 cham-
bers of the heart and valves and is continuous with the arteries and veins;
2. the myocardium, the muscular, middle layer of the heart;
3. the epicardium, the outermost (external) layer of the heart.

The heart is divided into four chambers. These chambers are the right
atrium, right ventricle, left atrium and left ventricle. The two upper chambers,

99
the atria, collect blood. The two lower chambers, the ventricles, pump blood
from the heart. The right side of the heart provides for oxygenation of blood
(pulmonary circulation), and the left side is responsible for transportation of
blood to and from body cells (systemic circulation). The muscular wall dividing
the right side of the heart from the left is called the septum. Body cells produce
waste substances during metabolism. These waste products include carbon
dioxide (CO2), a gas that must be removed from the cells or tissue death will
occur. Red blood cells accept the CO2 from body cells and transport it to the
heart by way of two large veins: the superior vena cava, a vein which collects
and carries blood from the top portion of the body, and the inferior vena cava,
a vein that collects and carries blood from the lower portion of the body. The
presence of CO2 gives the blood in veins a purple-red colour.
Blood is collected in the top right chamber of the heart, the right atrium.
From the right atrium blood passes through the tricuspid valve to the right
ventricle. The tricuspid valve prevents blood from returning to the right atrium
during contraction of the ventricles. When the heart contracts, blood leaves
the right ventricle by way of the pulmonary artery. This artery branches into
millions of capillaries within the lungs. At this point, CO2 in the red blood cells
is replaced by O2 that has been drawn into the lungs during inspiration. The
oxygenated blood takes on a bright red appearance.
The pulmonary capillaries unite to form the pulmonary veins which carry
blood back to the heart. The right and left pulmonary veins enter the left
atrium of the heart carrying oxygenated blood. This blood passes from the
left atrium through the bicuspid valve (also called the mitral valve) to the left
ventricle. Upon contraction of the heart, the oxygenated blood leaves the left
ventricle through the largest artery of the body, the aorta. Within the aorta
is a valve called the semilunar valve or aortic valve. This valve permits blood
to flow in only one direction - from the left ventricle to the aorta. The aorta
branches into many smaller arteries that carry blood to all parts of the body.
Some arteries derive their name from the organs or areas of the body they
vascularize. For example, the coronary arteries vascularize the heart muscle,
the renal arteries vascularize the kidneys, and so on.
It is important to note that the O2 present in the blood passing through the
chambers of the heart cannot be used by the myocardium. Consequently, an
arterial system called the coronary arteries, which branch from the aorta,
provides the heart with its own blood supply. If, for any reason, the flow of
blood in the coronary arteries is diminished, myocardial damage may result.
If severe damage occurs, death results.

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 Figure 8.1. The heart and its components.

Blood Pressure (BP)

Each heartbeat is composed of two phases, the contraction, phase, or
systole, when the blood is forced out of the heart, and the relaxation phase,
or diastole. A blood pressure measures the force exerted by the blood against
the artery walls during these two phases. Systole indicates the maximum
force exerted by the blood against the artery walls; diastole, the weakest.
These are recorded as two figures separated by a slant (/); the systolic pres-
sure is given first, followed by the diastolic pressure. For example, a blood
pressure may be recorded as 120/80; 120 is the systolic pressure, and 80 is
the diastolic pressure.
Blood pressure is measured by a device called a sphygmomanometer.
Several factors influence the blood pressure, including the resistance of blood
flow in the blood vessels, the pumping action of the heart, the viscosity or
thickness of blood, the elasticity of the arteries, and the quantity of blood, in
the vascular system. An elevated pressure is called hypertension; a decreased
pressure is called hypotension.

The Conductive System of the Heart

Within the heart there is a specialized cardiac tissue known as conduc-
tive tissue. Its sole function is the initiation and propagation of contraction
impulses. The conductive tissue consists of four masses of highly special-
ized cells:
1. sinoatrial node (S-A node)
2. atrioventricular node (A-V node)

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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 pace-
maker. This rate may be altered, however, by impulses from the autonomic
nervous system. Such an arrangement allows outside influences to accel-
erate 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 respon-
sible 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 elec-
trical currents which can be detected on the surface of the body. These elec-
trical 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 elec-
trical event (impulse). The P wave is the depolarization of the atria, and the
QRS complex is the depolarization of the ventricles. The T wave, which appears
a short time later, is the repolarization of the ventricles.

Key Terms
• aorta – largest artery in the body
• arteriole – small artery
• atrium (pl. atria) – upper chamber of the heart
• capillary – smallest blood vessel
• coarctation – narrowing (of the aorta)
• cor – the heart
• coronary arteries – blood vessels that carry oxigen-rich air to the heart
• diastole – relaxation phase of the heartbeat
• endocardium – inner lining of the heart
• endothelium – innermost lining of blood vessels
• infarction – area of dead tissue
• mitral valve – a valve between the left atrium and the left ventricle of the
heart
• murmur – abnormal heart sound
• myocardium – muscle layer of the heart
• occlusion – closure of a blood vessel
• pacemaker – special tissue in the right atrium that begins the heartbeat
(SA node)
• palpitation – uncomfortable sensation in the chest related to cardiac
arrhythmia
• patent - open
• pericardium – sac-like membrane surrounding the heart
• pulmonary circulation – the flow of blood from the heart to the lungs and
back to the heart
• pulse – heartbeat
• systemic circulation – the flow of blood from body cells to the heart and
back, i.e. from the heart to the body cells
• systole – contraction phase of the heartbeat
• valve – a structure in the heart and in veins that temporarily closes an
opening so that blood flows in one direction only
• ventricle – lower and larger chamber of the heart
• venule – small vein

103
Combining Forms Meaning Terminology
angi/o vessel (artery) angioplasty = repair of a severed blood
vessel
aort/o aorta aortostenosis = narrowing of the aorta
arter/o artery arteriosclerosis = hardening of an
arteri/o artery
atrio/o atrium atrial = pertaining to the atrium
brachi/o arm brachial artery = artery in the upper
arm
cardi/o heart cardiomegaly = abnormally large heart
coron/o coronary artery arteries supplying the heart muscle
with blood
hemangi/o blood vessel hemangiona = tumour of a blood vessel
phleb/o vein phlebitis = inflammation of a vein
ven/o venous = pertaining to a vein
scler/o hardening arteriosclerosis = hardening of an
artery
sphygm/o pulse sphygmomanometer = instrument for
the measurement of blood pressure
sten/o narrowing aortostenosis = narrowing or stricture
of the aorta
steth/o chest stethoscope = instrument for the
listening of sounds in the chest cavity
thromb/o clot thrombolysis = destruction of a blood
clot
valvul/o valve valvuloplasty = repair of a valve
valv/o valvotomy = incision into a valve
vas/o vessel vasodilation = expanding of blood
vascul/o vessel
vascular = pertaining to blood vessel
ven/o vein venous = pertaining to a vein
ventricul/o chamber of the ventricular = pertaining to the chamber
heart or brain of the heart or brain
(also: stomach)

104
Pathological Conditions of the Cardiovascular System
Coronary Artery Disease (CAD)
Coronary artery disease is a condition in which the coronary arteries fail to
deliver the amount of blood that is required by the heart muscle. As a result,
localized areas of the heart experience a decrease in blood supply (ischemia).
Usually, coronary artery disease is a result of a thickening and hardening of
the inner wall of the coronary arteries (arteriosclerosis). Myocardial ischemia
causes the patient to experience a suffocating chest pain (angina pectoris or
angina) and difficulty in breathing (dyspnea). An attack of angina is generally
associated with physical exertion or emotional stress. It generally lasts about
five minutes and is relieved upon resting. The use of nitroglycerine, a medi-
cation that dilates the blood vessels (vasodilator), also brings relief. If pain
cannot be controlled with medication, a surgery designed to circumvent the
obstruction (by-pass surgery) may be required. Coronary artery disease may
ultimately produce an acute myocardial infarction (AMI). In this life-threatening
condition, blood supply in the coronary artery is totally suppressed, causing
tissue death (necrosis or infarction) in a portion of the myocardium.

Valvular Heart Disease

The valves of the heart are generally thin, smooth structures that permit
the flow of blood through the chambers of the heart. Birth defects or certain
infections, especially those caused by scarlet fever or rheumatic fever, may
produce scarring of the valves. When this occurs, there may be a narrowing
of the valves (stenosis) or an inability of the valves to close properly, which is
referred to as valvular insufficiency.

Varicose Veins
Varicose veins develop when damage occurs to the valves of the veins. A
backflow of blood, especially in the legs, causes the veins to enlarge. Stag-
nation of the blood in varicose veins may cause the formation of a blood clot
(thrombus). A more serious condition may subsequently develop when the
thrombus breaks loose from the vein wall and begins to travel in the vascular
system (embolism). Death may result if the embolus lodges in a vital organ.
In extreme cases, the affected vein is tied off (ligated) and removed (stripped).
Occasionally, varicose veins lead to a condition called phlebitis. If the infec-
tion occurs in a deep vein and involves the inner layer of vein tissue, clots may
form resulting in a condition known as thrombophlebitis.

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Other Related Terms
aneurysm – localized abnormal dilation of an arterial blood vessel
angina pectoris – chest pain
arrest – loss of effective cardiac function; cessation of blood circulation
arrhythmia – abnormal heart rhythm; some examples are:
1. heart block (atrioventricular block)
2. flutter (up to 260 beats per minute)
3. fibrillation (350 and more beats per minute)
bruit – heart murmur
cardiomyopathy – any disease or weakening of heart muscle that diminishes
its function
congenital heart disease – abnormalities in the heart at birth; some exam-
ples are:
1. coarctation of the aorta (narrowing of the aorta)
2. patent ductus arteriosus (small duct between the aorta and pulmonary
artery remains open after birth)
3. septal defects (small holes in the septa between the atria or the ventricles)
congestive heart failure – failure of the heart to supply adequate amount of
blood to tissues and organs
heart murmur – an extra heart sound heard between normal sounds of the
heart
hemostasis – arrest of bleeding or blood circulation
hyperlipidemia – excessive amounts of lipids in the blood
hypertension – elevated blood pressure; essential and secondary
hypertensive heart disease – heart disorder caused by prolonged hypertension
infarct (infarction) – area of tissue that undergoes necrosis as a result of cessa-
tion of blood supply
ischemia – local and temporary deficiency of blood supply resulting from circu-
latory obstruction
perfusion – circulation of blood or fluids through vessels of tissues and organs
Raynaud phenomenon - short episodes of pallor and numbness in the fingers
and toes due to temporary constriction of arterioles in the skin.

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rheumatic heart disease – heart disease caused by rheumatic fever
stent – slender device used to support, or hold open tubular structures or
arteries
tetralogy of Fallot – a congenital malformation of the heart involving four
distinct defects (1. pulmonary artery stenosis; 2. ventricular septal defect; 3.
shift of the aorta to the right; 4. hypertrophy of the right ventricle)
vegetations – collections of platelets, clotting proteins, microorganisms, and
red blood cells that attach to the endoradium in conditions such as bacterial
endocarditis and rheumatic heart disease.

EXERCISES

1. The cardiovascular system is composed of: ............................................................................

2. What are the arteries, capillaries and veins responsible for? ......................................

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

3. Fill in the correct term:

3.1. Blood that is rich in O2 is referred to as ............................................................. blood.
3.2. The vas t number of capillaries makes their combined ................................... so
great that blood tend to flow through them very ...................................................................
3.3. The extensive network of capillaries throughout the body absorbs the
.......................................................................................................... pressure exerted by the heart.
3.4. Within the aorta is a valve called the ..................................................................... valve.
3.5. An elevated blood pressure is called ....................................................................................

4. Match the following terms with their meanings:

4.1. pericardium ............................................. a) inflammation of a vein
4.2. S-A node ................................................... b) slow heart action
4.3. bradycardia .............................................. c) a fibroserous sac enclosing the
heart
4.4. diaphoresis .............................................. d) profuse sweating
4.5. phlebitis ..................................................... e) pacemaker

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5. Give the meanings of the following terms:
5.1. systole ................................................................................................................................................
5.2. ischemia ............................................................................................................................................
5.3. angina pectoris .............................................................................................................................
5.4. fibrillation..........................................................................................................................................
5.5. arteriosclerosis ............................................................................................................................
5.6. arrhythmia .......................................................................................................................................
5.7. sphygmomanometer .................................................................................................................
5.8. heart murmur ................................................................................................................................
5.9. bacterial endocarditis ...............................................................................................................
5.10. aneurysm .......................................................................................................................................

6. Provide the plural form of the following nouns:

6.1. atrium ......................................................... 6.6. vena cava ..................................................

6.2. aorta ............................................................ 6.7. thrombus ..................................................
6.3. stenosis ..................................................... 6.8. artery ..........................................................
6.4. embolus .................................................... 6.9. ventricle ....................................................
6.5. capillary ..................................................... 6.10. emphysema ..........................................

7. Provide the adjective form for the following nouns:

7.1. vein ............................................................... 7.6. breathing ..................................................

7.2. insufficiency ............................................ 7.7. inflation .....................................................
7.3. artery .......................................................... 7.8. heart ............................................................
7.4. dilation ....................................................... 7.9. inflammation ..........................................
7.5. lungs ........................................................... 7.10. constriction ...........................................

8. Give appropriate medical term for the following:

8.1. short episodes of pallor and numbness in the fingers and toes .....................
..........................................................................................................................................................................

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8.2. the varicose vein which is tied off ......................................................................................
..........................................................................................................................................................................

8.3. a medication that dilates the blood vessels ................................................................

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

8.4. an electrical device used to restore normal heart rhythm..................................

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

8.5. failure of proper conduction of impulses through the A-V node to the
bundle of His ............................................................................................................................................
8. 6. drugs promoting loss of fluid ..............................................................................................
8. 7. surgical removal of an aneurysm .....................................................................................
8. 8. tissue death ...................................................................................................................................
8. 9. the external layer of the heart ............................................................................................
8.10. the valve which prevents blood from returning to the right atrium
during contraction of the ventricles .........................................................................................
..........................................................................................................................................................................

9. Translate into Croatian:

“The metal-and-plastic heart whirred and clicked in an eerie, mechanical
rhythm as Dr. William DeVries, 40, removed the tracheal tube from his patient’s
throat. For the first time since his artificial heart has been implanted about 36
hours earlier, William Schroeder, 52, could breathe on his own and speak.”
Can I get you something to drink?” the doctor asked. Replied Schroeder: ‘’I’d
like a beer.” It was, De Vries admitted afterward, one of the high points of the
tension-filled hours following his second successful attempt to implant an arti-
ficial heart. By week’s end the world’s second recipient of an artificial heart
was getting out of bed and sitting in a chair, eating solid foods and sipping
that longed-for beer. On Friday Schroeder tested a new portable power system
for the artificial heart. For 22 minutes in the afternoon, and an hour later that
evening, he was free of the 323-1 b. air-driven unit that normally runs the
heart, and was hooked up to small, 11-lb. device encased in a leather shoulder
bag. The portable system worked flawlessly though there were two breath-
less 3-sec. intervals when the heart stopped beating, as technicians switched
from one system to the other. Afterward, Schroeder thanked the inventor of
the device, Engineer Peter Heimes of Aachen, West Germany, and shook his
hand. From the beginning, Schroeder’s treatment seemed to go more smoothly

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than that of his predecessor, Seattle Dentist Barney Clark, the world’s first
recipient of a permanent artificial heart. Clark’ s surgery and his 112 days of
life with the man-made pump were fraught with life-and-death crises. “I felt
certain that he would die on the operating table”, reflected Dr. Robert Jarvik,
38, designer of the Jarvik-7 heart used in both patients. “This time”, he said,
“I felt the opposite.”

(TIME, No. 50, December 10, 1984)

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CHAPTER 9

URINARY SYSTEM
In both males and females the urinary system consists of four major struc-
tures 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 blood-
stream 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 break-
down 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.

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 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 func-
tion 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, neces-
sary for the absorption of calcium from the intestine. In addition, hormones
such as insulin and parathyroid hormone are degraded and extracted from
the bloodstream by the kidney.

Figure 9.1. Anatomy of the major organs of the urinary system

112
Kidneys and Associated Tubes
(the macroscopic structures of the urinary system)
Two kidneys, each about the size of a fist, are located in the retroperito-
neal area of the abdominal cavity on either side of the vertebral column in
the lumbar region of the spine. A concave medial borders gives the kidney
its beanlike shape. The kidneys are embedded in a cushion of adipose tissue
and surrounded by fibrous connective tissue for protection. They weigh about
half a pound each. Near the medial border is a slitlike aperture, the hilus or
hilum. It serves as an opening for a renal vein and a renal artery to enter the
kidney. The renal artery carries the blood that is laden with waste products
to the microscopic filtering tubules located within the kidney for purification.
After the blood is cleansed, it leaves the kidney by way of the renal vein. The
waste material now in the form of urine, is carried to a hollow chamber, the
renal pelvis, that is located at the hilus. The chamber is an enlarged funnel-
shaped extension of the ureter at the entrance to the kidney.
The kidneys consist of an outer cortex region (cortex means outer portion
or bark, as in bark of a tree) and an inner medulla region (medulla means
marrow or inner portion).
Each ureter is a slender tube about ten to twelve inches in length and
conveys urine, in peristaltic waves, to the bladder. Urinary bladder is an expand-
able (distensible) hollow, muscular sac in the pelvic cavity. It serves as a
temporary reservoir for urine.
The trigone is a triangular space at the base of the bladder where the
ureters and the urethra lead out.
Urethra is membranous tube through which urine is discharged from the
urinary bladder. The process of expelling (voiding) urine through the urethra
is called micturition. The external opening of the urethra is called the urethral
or urinary meatus. The urethra is approximately one and one-half inches in
the female and about seven inches in the male.

Nephrons (the microscopic structures of the urinary system)

Microscopic examination of the kidney reveals the presence of approxi-
mately one million tiny funnel-shaped structures called nephrons. Nephrons
are responsible for maintaining homeostasis or a stable optimal internal envi-
ronment by continually adjusting the conditions that are necessary for survival.
When the level of various products in the blood elevates beyond a normal
range, nephrons selectively remove them from the blood and re-establish a
level that can sustain life. The substances that are removed by nephrons are
the end products of metabolism - urea, uric acid, and creatinine.

113
 Nephrons also extract any excess sodium, chloride, and potassium ions
which are referred to as electrolytes. Some pathological states may cause the
appearance in the blood of certain undesirable substances which may also be
removed by the nephrons. For example, when the blood sugar level becomes
elevated, as in diabetes mellitus, the excess sugar is filtered from the blood
and is removed from the body in the urine.

Figure 9.2. Glomerulus and Bowman’s Capsule

Each nephron includes a renal corpuscle and a renal tubule. The renal
corpuscle is composed of a tuft of capillaries, the glomerulus, and a modified,
funnel-shaped end of the renal tubule, Bowman’s capsule. This capsule encases
the glomerulus. An afferent vessel (arteriola glomerularis afferens) conveys
blood to the glomerulus and a smaller efferent vessel (arteriola glomeru-
laris efferens) carries blood away from the glomerulus. As the efferent vessel
passes behind the renal corpuscle, it forms the peritubular capillaries. Each
renal tubule consists of four sections: the proximal tubule, followed by the
narrow loop of Henle; then, a larger portion, the distal tubule, and finally the
collecting tubule.
Removal of waste products from the blood by the nephron is accomplished
by three physiological activities: filtration, absorption, and secretion. All of these
activities are performed by different sections of the nephron.
The first phase of urine production, filtration, occurs in the renal corpuscle.
Here, water, electrolytes, sugar, amino acids, and other compounds pass from
the blood plasma in the glomerulus into Bowman’s capsule. The fluid that is
formed is called filtrate. The next phase of urine production starts with passing

114
of filtrate through the four sections of the tubule. As it travels the long and
twisted pathways, most of the water and some of the electrolytes and amino
acids are absorbed by the peritubular capillaries, and thus re-enter the circu-
lating 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)

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Combining Forms Meaning Terminology
cali/o calyx caliectasis (dilation of the kidney calices)
calic/o caliceal (pertaining to the kidney calyx)
cyst/o urinary cystitis (inflammation of urinary bladder)
vesic/o bladder perivesical (around the urinary bladder)
lith/o stone, lithotripsy (crushing of a stone)
calculus
nephr/o kidney nephritis (inflammation of the kidney)
ren/o renal (pertaining to the kidney)
pyel/o renal pyelolithotomy (removal of calculus that
pelvis blocks the flow of urine)
ur/o urine, urolith (stone formation in the urinary
urinary tract)

Disorders of the Urinary System and Other Pathology Related Terms

anuria absence of urine production or urinary output
azotemia (uremia) retention of excessive amounts of nitrogenous
compounds in the blood
bacteriuria presence of bacteria in the urine
bladder neck occurs when there is a blockage of the bladder
obstruction (BNO) outlet; the obstruction may be the result of an
enlarged prostate gland (prostatic hypertrophy),
or the presence of any obstructive masses
(calculi, blood clots, tumour)
dysuria difficult or painful urination
enuresis (incontinence) involuntary discharge of urine
essential hypertension high blood pressure without an apparent cause
leading to the narrowing and thickening of
arterial walls in the kidney
frequency voiding urine at frequent intervals
glomerulonephritis inflammation of the kidney glomerulus (Bright
disease)
hematuria presence of blood in the urine
hesitancy involuntary delay in initiating urination

116
 hydronephrosis enlarged and distended kidney resulting from the
obstruction of urine flow (water in the kidney)
interstitial nephritis inflammation of connective tissue between the
renal tubules (renal interstitium)
nephrolithiasis kidney stones, usually composed of uric acid or
(renal calculi) calcium salts
nephritic syndrome a group of symptoms caused by excessive protein
(nephrosis) loss in the urine
nocturia excessive or frequent urination after going to bed
oliguria diminished urine production
polycystic kidney multiple fluid-filled sacs (cysts) within and upon
the kidney
pyelonephritis inflammation of the renal pelvis
renal failure failure of the kidney to excrete urine
renal hypertension high blood pressure resulting from kidney
disease; the most common type of secondary
hypertension
urgency feeling of the need to void immediately
urinary retention blockage in the passage of urine from the
bladder

EXERCISES
1.1. List some functions of the urinary system: ..........................................................................
...................................................................................................................................................................................

1.2. What are the macroscopic structures of this system? ..........................................

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

2. Fill in the correct term:

2.1 After the blood is ................................................ , it leaves the kidneys by way of
the renal vein.
2.2. The renal pelvis is located at the.........................................................................................
2.3. When .......................................... or a desire to urinate is experienced, the urine
is expelled from the .............................................................................. through the urethra.
2.4. Nephrons are responsible for maintaining ..................................................................

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2.5. Glomerulonephritis is an .......................................................................... of the kidney

3. Give the opposite of each term:

3.1. soluble ....................................................... 3.6. sufficiency ................................................

3.2. eventually ................................................. 3.7. common ....................................................
3.3. failure ......................................................... 3.8. loss ...............................................................
3.4. destruction .............................................. 3.9. widening ....................................................
3.5. outside ....................................................... 3.10. accelerate ..............................................

4. Match the following terms with their meanings:

4.1. hematuria ................................................. a) a slitlike aperture
4.2. glycosuria ................................................. b) protein in the urine
4.3. pyuria .......................................................... c) blood in the urine
4.4. proteinuria ............................................... d) sugar in the urine
4.5. hilus ............................................................. e) pus in the urine

5. Give the meanings for the following terms:

5.1. nephrorraphy ......................................... 5.6. essential hypertension .....................

5.2. pyeloplasty ............................................... 5.7. hematuria .................................................
5.3. nephrectomy .......................................... 5.8. polydipsia .................................................
5.4. albuminuria ............................................ 5.9. micturition ...............................................
5.5. uremia ........................................................ 5.10. urethra ....................................................

6. Provide the adjective form for each of the following:

6.1. meatus ....................................................... 6.6. glomerulus ..............................................

6.2. tube .............................................................. 6.7. night ............................................................
6.3. nephrosis .................................................. 6.8. excess .........................................................
6.4. urine ............................................................ 6.9. blockage ....................................................
6.5. ischemia .................................................... 6.10. acid ............................................................

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7. Provide the plural form of the following nouns:

7.1. calyx/calix ................................................. 7.6. nephrosclerosis ....................................

7.2. proteinuria ............................................... 7.7. abscess ......................................................
7.3. glomerulus .............................................. 7.8. nephroma .................................................
7.4. kidney ......................................................... 7.9. biopsy ..........................................................
7.5. nephropexy .............................................. 7.10. meatus ....................................................

8. Give appropriate medical term for the following:

8.1. inflammation of the walls of the glomeruli .................................................................
8.2. kidney stones .................................................................................................................................
8.3. surgical removal of renal calculi ........................................................................................
8.4. inflammation of the renal interstitium ...........................................................................
8.5. thickening of the arteriole walls of the kidney ...........................................................
8.6. cup-shaped capsule surrounding each glomerulus ...............................................
8.7. a small molecule that carries an electrical charge ................................................
8.8. opening or canal............................................................................................................................
8.9. central collecting region in the kidney ............................................................................
8.10. sac which holds urine ............................................................................................................

9. Translate into Croatian:

Urination is a complex process controlled by several sets of muscles,
including the internal and external sphincters, which are circular muscles
surrounding the urethra; they have the power to contract and prevent flow
through it. The internal sphincter is at the outlet of the bladder and works
automatically. The external sphincter, situated along the urethra below the
prostate in males and at an equivalent position in females, is controlled volun-
tarily. As the bladder fills, the bladder muscles tend to contract automati-
cally. The urge to urinate enters consciousness, but voiding may be controlled
consciously to some extent. When the person decides to urinate, the bladder
muscle contracts and both sphincters relax.

(From: Miller & Keane: Encyclopedia and Dictionary of Medicine, Nursing

and Allied Health)

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CHAPTER 10

NERVOUS SYSTEM
The nervous system is one of the most complicated systems in both struc-
ture 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.

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 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 volun-
tary or somatic nerves. If the response is involuntary or nonthinking, such as
digesting food or secreting hormones, the impulse is relayed by autonomic
nerves.

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 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 intes-
tines, 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 initi-
ated 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 prin-
cipal 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, neuro-
glia 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,

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injured nerves in the system cannot regenerate. Their nerve function is perma-
nently 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.

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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

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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 respon-
sible 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 inter-
pretation, 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 initi-
ates muscular movement, the cerebellum coordinates and refines the move-
ment. 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 trans-
mitted 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 func-
tion 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 (mesen-
cephalon). In general, the brain stem serves as a pathway for impulse conduc-
tion 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 interverte-
bral spaces almost throughout the entire length of the spinal column. Unlike
the cranial nerves, which have specific names, the spinal nerves are known
by the region of the vertebral column from which they exit.

Meninges
Both the brain and the spinal cord are protected against injury by bones.
The brain is enclosed within the skull and the spinal cord is enclosed within
the vertebral column. In addition, both the brain and spinal cord receive limited
protection from a set of three coverings called meninges (singular: meninx).
The outermost coat, the dura mater, is tough and fibrous. Immediately beneath
the dura mater is a cavity called the subdural space. It is filled with serous
fluid. The next layer of the meninges is the arachnoid. As its name suggests,
the arachnoid has a spider-web appearance. A subarachoid space, filled with
cerebrospinal fluid, provides additional protection for the brain and spinal cord
by acting as a shock absorber. Finally, the innermost layer, the pia mater,
contains numerous blood vessels and lymphatics, which provide nourishment
for the underlying tissues.
Cerebrospinal fluid circulates around the spin al cord and the brain and
through spaces called ventricles. These ventricles are located within the inner
portion of the brain.

Key Terms
• acetylcholine – neurotransmitter chemical released at the ends of some
nerve cells
• afferent nerves – nerves that carry impulses toward the brain and spinal
cord; sensory nerves
• blood-brain barrier – blood vessels that selectively let certain
substances enter the brain tissue and keep other substances out
• cauda equina – horse’s tail; a collection of spinal nerves below the end of
the spinal cord at the level of the second lumbar vertebra
• cell body – part of the nerve cell that contains the nucleus
• cerebral cortex – outer region of the cerebrum; the gray matter of the
brain
• cerebrospinal fluid (CSF) – liquid that circulates throughout the brain
and the spinal cord
• convolution – elevated portion of the cerebral cortex; gyrus
• efferent nerves – nerves that carry impulses away from the brain and
spinal cord to the muscles, glands, and organs; motor nerves

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• ependyma – a membrane lining the fluid-filled cavities of the brain
ventricles and central canal of the spinal cord
• gait – a manner of walking
• microglial cell – one type of neurglial cell
• neurotransmitter – a chemical substance (chemical messenger)
released at the end of a nerve cell, that stimulates or inhibits another
cell
• palliative – relieving symptoms but not curing
• plexus – a large interlacing network of nerves
• receptor – an organ that receives a nervous stimulation and passes it on
to nerves within the body
• stimulus (pl. stimuli) – a change in the internal or external environment
that can evoke a response
• ventricles of the brain – canals (reservoirs) in the interior of the brain
that are filled with cerebrospinal fluid

Combining Forms Meaning Terminology

alges/o pain analgesia = no sensitivity to pain
cerebr/o cerebrum cerebrotomy = incision of the cerebrum
crani/o skull craniomalacia = softening of skull bones
(cranium)
dendr/o tree dendroid = resembling a branching tree
esthesi/o nervous anesthesia = no nervous sensation (no
sensation feeling)
feeling
encephal/o brain encephalitis = inflammation of the brain
gli/o glu; glioma = tumour of neuroglial tissue
neuroglia
kinesi/o movement bradykinesia = condition of slow move-
ment
lept/o thin, slender leptomeningitis = inflammation of the pia
and the arachnoid membranes
lex/o word, dyslexia = difficulty or inability in using
phrase words when reading or writing
mening/o membranes meningocele = herniation of the
covering meninges
brain and
spinal cord

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myel/o spinal cord myelocele = herniation of the spinal cord
narc/o stupor; narcotic = pertaining to or producing
numbness; narcosis
sleep narcolepsy = uncontrollable compulsion
to sleep
neur/o nerve neurology = the study of nerves
radicul/o nerve root radiculopathy = disease of the nerve
root(s)
sthen/o strength asthenia = lack of strength
tax/o order, ataxia = persistent unsteadiness on the
coordination feet
vag/o vagus nerve vagotomy = incision of the vagus nerve
(10th cranial nerve)

Disorders and Pathological Conditions of the Nervous System

agnosia inability to comprehend auditory, visual, spatial, or
other sensation
Alzheimer disease brain disorder marked by deterioration of mental
capacity beginning at middle age; the disorder
develops gradually, and early signs are loss of
memory for recent events followed by impairment
of judgment, comprehension, and intellect.
amyotrophic lateral progressive disorder characterized by degeneration
sclerosis (ALS) of motor neurons in the spinal cord and brain stem
(Lou Gehrig Disease).
ataxia failure of muscular coordination; irregularity of
muscular action.
aura premonitory awareness of an approaching physical
or mental disorders; particularly sensation
preceding seizures.
autism developmental disorder characterized by extreme
withdrawal and an abnormal absorption of fantasy;
inability to communicate even on a basic level.

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Bell palsy facial paralysis due to a functional disorder of
the seventh cranial nerve; it produces weakness
(asthenia) and numbness (anesthesia) of the face,
corneal infection (keratitis), speech difficulties
(dysphasia), pain behind the ear or in the face,
overflow of tears down the cheek (epiphora) due
to keratitis; often there appears grotesque facial
disfigurement and facial spasms; it may result in
unilateral paralysis (plegia) of facial muscles and
distortion of taste perception.
cerebral palsy partial paralysis and lack of muscular coordination
due to damage to the cerebrum during gestation or
in the perinatal period
cerebrovascular damage to the brain caused by a disorder within
accident (CVA) the blood vessels of the cerebrum, also known as a
stroke or apoplexy; it is the result of a localized area
of ischemia,in the brain; it may be caused by:
1. thrombosis - blood clot (thrombus) in the
arteries leading to the brain, resulting in occlusion
(blocking) of the vessel. This is the most common
type of stroke, and may lead to paralysis. 2.
embolism - a piece of clot (embolus) breaks off from
its place or origin and occludes a cerebral artery.
This type of stroke occurs very suddenly.
cerebral contusion bruising of brain tissue as a result of direct trauma
to the head; neurological deficits persist longer
than 24 hours; a contusion is usually associated
with a fracture of the skull.
coma a state of unconsciousness from which the patient
cannot be aroused; irreversible coma is one in
which there is complete unresponsitivity to stimuli,
no spontaneous breathing or movement – brain
death.
concussion of the temporary brain dysfunction after injury, usually
brain clearing within 24 hours; there is no evidence
of structural damage to the brain tissue; severe
concussions may lead to coma.

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convulsion any sudden and violent contraction of one or more
muscles.
dementia a broad term referring to cognitive deficit, including
memory impairment.
dyslexia inability to learn and process written language.
epilepsy sudden transient brain dysfunction due to
disturbances in discharging electrical brain
impulses; two main types are: 1. grand-mal
seizures, or tonic-clonic seizures that are
manifested by severe convulsions and
unconsciousness; and 2. petit-mal seizures, or
absence seizures, characterized by momentary
lapse of consciousness.
glioma malignant tumour of the brain arising from glial
cells.
Guillain-Barré autoimmune condition that causes acute
syndrome inflammation of peripheral nerves in which myelin
sheaths are destroyed, resulting in decreased
nerve impulses, loss of reflex response and sudden
muscle weakness.
hemorrhage bursting forth of blood from a cerebral artery.
(bleeding)
herpes zoster viral disease affecting peripheral nerves.
(shingles)
Huntington chorea hereditary nervous disorder involving bizarre,
abrupt, involuntary movement.
hydrocephalus abnormal accumulation of fluid in ventricles of the
brain.
lethargy abnormal inactivity or lack of response to normal
stimuli.
meningioma benign tumours of the brain.
meningitis inflammation of brain meninges caused by viruses
or bacteria.
multiple sclerosis destruction of myelin sheath (demyelination)
(MS) and replacement by neurological scar tissue that
prevents the conduction of nerve impulses.

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myasthenia gravis neuromuscular disorder characterized by relapsing
weakness of skeletal muscles; it is a chronic
autoimmune disorder in which the ability of
acetylcholine (a neurotransmitter) is blocked
neuroblastoma malignant tumour arising from immature nerve
cells.
neurosis non-psychotic mental illness that triggers feelings
of distress and anxiety and impairs normal
behaviour.
paralysis loss or impairment of motor, or also sensory,
function due to lesion of neural or muscular
mechanism.
paraplegia paralysis of the lower limbs or lower trunk.
paresis slight or incomplete paralysis.
Parkinson disease degeneration of nerves in the brain, occurring in
later life, leading to tremors, weakness of muscles,
and slowness of movement.
poliomyelitis viral inflammation of the gray matter of the spinal
cord.
Reye syndrome acute encephalopathy and fatty infiltration of the
brain, liver and lymph nodes (at times pancreas
heart, kidney and spleen are involved).
sciatica severe pain in the leg along the course of the sciatic
nerve felt at the base of the spine, down the thigh,
and radiating down the leg due to a compressed
nerve.
seizure sudden attack or recurrence of a disease.
spina bifida congenital defect of the spinal column due to
imperfect union of the vertebral parts; the most
common types are: spina biffida occulta - vertebral
lesion covered with skin and evident only on x-ray
spina bifida with meningocele – meninges protrude
through the vertebral defect spina bifica with
meningomyelocele – the spinal cord and meninges
herniated through the vertebral lesion
syncope fainting; sudden loss of consciousness.

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Tourette syndrome neurological disorder marked by involuntary,
spasmodic, twitching movements; uncontrollable
vocal sounds and inappropriate words.
transient ischemic temporary interference with blood supply to the
attack brain lasting (TIA) from a few minutes to a few
hours.

EXERCISES
1.1. The functions of the nervous system are:......................................................................
..........................................................................................................................................................................

1.2. The nervous system is divided as follows: ...................................................................

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

2. Complete the following sentences:

2.1. Sensory nerves ......................................................................... from the sense organs.
2.2. Motor nerves ......................................................................................away from the CNS.
2.3. The autonomic nervous system is responsible for ..................................................
2.4. The two principal types of nerve cells are ....................................................................
2.5. The brain is composed of ........................................................................................................

3. Give the opposite of each term:

3.1. peripheral ................................................ 3.6. convergence ............................................

3.2. voluntary ................................................... 3.7. attraction ..................................................
3.3. afferent ...................................................... 3.8. ancestry .....................................................
3.4. ascending ................................................. 3.9. elastic .........................................................
3.5. progress .................................................... 3.10. proceed ...................................................

4. Match the following terms with their meanings:

4.1. thalamotomy .......................................... a) neurotoxin
4.2. asthenia ..................................................... b) trembling
4.3. tremor ........................................................ c) incision into the thalamus
4.4. clonic spasm .......................................... d) weakness

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4.5. nerve poison ........................................... e) excessive loss of muscle tone

5. Give the meanings of the following terms:

5.1. anesthesia .......................................................................................................................................
5.2. apoplexy ............................................................................................................................................
5.3. encephalocele ................................................................................................................................
5.4. neuralgia ..........................................................................................................................................
5.5. craniomalacia ................................................................................................................................
5.6. neurotripsy ......................................................................................................................................
5.7. gangliectomy ..................................................................................................................................
5.8. dysrhythmias ..................................................................................................................................
5.9. ataxia ..................................................................................................................................................
5.10. hemiplegia ....................................................................................................................................

6. Provide the plural forms of the following nouns:

6.1. meningococcus ..................................... 6.6. sulcus .........................................................

6.2. cranium ..................................................... 6.7. gyrus ...........................................................
6.3. cerebellum .............................................. 6.8. cortex ..........................................................
6.4. cerebrum .................................................. 6.9. equilibrium ..............................................
6.5. nucleus ...................................................... 6.10. epilepsy ...................................................

7. Provide the noun form for the following adjectives:

7.1. neural ......................................................... 7.6. sensory ......................................................

7.2. cerebral ..................................................... 7.7. neuroglial .................................................
7.3. spinal .......................................................... 7.8. fibrous ........................................................
7.4. autonomic ................................................ 7.9. emotional .................................................
7.5. central ........................................................ 7.10. cranial ......................................................

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8. Give appropriate medical word for the following terms:
8.1. inflammation of the meninges ............................................................................................
8.2. abnormal accumulation of fluid in the brain ..............................................................
8.3. muscle weakness marked by progressive paralysis ..............................................
8.4. inability to speak ..........................................................................................................................
8.5. slowness of movement ............................................................................................................
8.6. inflammation of nerves ............................................................................................................
8.7. measurement of the skull ......................................................................................................
8.8. hardening of the spinal cord .................................................................................................
8.9. x-ray picture of the brain ......................... : .............................................................................
8.10. softening of nerve tissue ......................................................................................................

9. Translate into Croatian:

Case Report
The patient was admitted on January 14 with a history of progressive right
hemiparesis for the previous l to 2 months, fluctuating numbness of the right
arm, thorax and buttocks, jerking of the right leg, periods of speech arrest,
diminished comprehension in reading, and recent development of a spastic
hemiplegic gait (partial hemiplegia with spasmodic contractions of muscles
when walking). He is suspected of having a left parietal tumour.
Examinations done prior to hospitalization included skull films, EEG, brain
scan and CSF analysis, which were all normal. Following admission the brain
scan was abnormal in the left parietal region, as was the EEG.
Left percutaneous common carotid angiographywas attempted, but the
patient became progressively more restless and agitated after receiving the
sedation, so that it was impossible to do the procedure. During the recovery
phase from the sedation the patient was alternatively somnolent and violent,
but it was later apparent that he had developed almost a complete aphasia
and right hemiplegia. In the next few days he became more alert although he
remained dysarthric and hemiplegic.
Bilateral carotid angiograms under general anesthesia on January 19
showed complete occlusion of the left internal carotid artery with cross-filling
of the left anterior and middle cerebral arteries from the right internal carotid
circulation.

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 Final diagnosis: Left cerebral infarction due to left internal carotid artery
occlusion.

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Autopsy Report: Brain and Meninges

Meninges were clear and adherent to underlying brain. The brain was
grossly without evidence of metastases. There was questionable evidence of
herniation bilaterally over the sphenoid ridge and herniation of the cerebellum.
The brain was edematous. On the lateral surface of the pons there is small
(less than l cm), brownish-red lesion located below the arachnoid thought to
be hemorrhage vs. metastasis. Microscopically, the cerebral cortex over the
sphenoid ridge did not demonstrate evidence of herniation; however, grossly
nonpigmented area of necrosis in the cerebellum revealed metastatic mela-
noma. On the right lateral surface of the pons, the grossly pigmented lesion
was on microscopic examination metastatic melanoma.

Diagnosis:
1. Brain, edema.
2. Metastatic melanoma, pons, cerebellum.

(From: Chabner D. E.: The Language of Medicine)

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CHAPTER 11

BLOOD AND LYMPHATIC SYSTEMS

Blood and lymph are specialized liquid tissues of the body. They circulate
through the whole body and thus represent the chief means of transport within
the body. Each is composed of cells that are suspended in a liquid medium. The
blood and lymphatic systems have many functions. Blood transports oxygen
from the lungs to the body tissues, and carbon dioxide from the tissues to the
lungs. It carries nutrients and hormones to the tissues, removes waste prod-
ucts to the kidneys and carries fluid to and from the tissues, helping to main-
tain the fluid balance of the body. Lymph transports needed proteins that have
leaked out of the blood capillaries back to the bloodstream via the veins. Both
blood and lymph protect the body by carrying disease-fighting cells (phago-
cytes) and protein substances called antibodies that combat infection. Also,
plasma proteins and blood clotting cells (platelets) contribute in the impor-
tant coagulation (clotting) function of the blood.

1. Blood System
Blood is composed of a liquid medium called plasma and a solid portion
that consists of three major blood cells: red blood cells (erythrocytes), white
blood cells (leukocytes) and platelets (thrombocytes). Blood cells account for
about 45 percent and plasma accounts for about 55 percent of the total blood
volume.
All blood cells originate from unspecialized, immature cells called stem
cells or hemocytoblasts (hemoblast or formative cell). They mature in the red
bone marrow of adults (ribs, stern um, skull, vertebrae, pelvic bone and the
ends of the long bones of the limbs) and the liver and spleen of the fetus. From
the initial undifferentiated form blood cells change into specialized or differ-
entiated cells which involves alterations in their size and shape. They change
from large (immature cells) to small or mature forms; the size of the cell
nucleus decreases (in red cells, the nucleus practically disappears).

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 Blood plasma consists mainly of water in which are dissolved the substances
carried by the blood to and from the tissues.

Erythrocytes (Red Blood Cells)

The great majority of the cells in the blood are red blood cells. There are
about 5 million red blood cells in a s peck of blood the size of a pin-head, and
about 35 trillion of them in the average adult. Although microscopic in size,
these cells have a total surface area almost the size of a football field. This
vast surface area is important in the blood’s task of carrying oxygen from the
lungs to the tissues, because the exchange of oxygen in both places takes
place across the cell surface and must be accomplished quickly as the blood
flows by.

Figure 11.1. The maturation of blood cells-hematopoiesis

Stem cell

Megakaryoblast
Monoblast Lymphoblast
Myeloblast
Erythroblast
Bone marrow

Myelocyte
Megakaryocyte
Normoblast
Prolymphocyte
Promonocyte
Metamyelocytes

Reticulocyte Band cells

Platelets
bloodstream

Mature cells

Segmented Monocyte Lymphocyte

Circulating

Erythrocyte

Basophilic Eosinophilic
granulocyte granulocyte Agranulocytes
Neutrophilic
granulocyte

The erythrocytes owe their oxygen-carrying ability to the nonprotein heme,

which contains iron and gives the blood its red colour. Heme combines with
another protein, globin, and forms hemoglobin, a major part of the red blood
cell. Hemoglobin has the special ability of attracting and forming a loose
connection with free oxygen, and its presence enables blood to absorb about
60 times the amount of oxygen that the plasma by itself absorbs.

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 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 retic-
uloendothelial cells and they live on the average about 110 to 120 days. Then
red blood cells disintegrate and are removed in the spleen and the liver. About
180 million red blood cells are destroyed every minute. Since the number of
cells in the blood remains more or less constant, this means that about 180
million red blood cells are manufactured every minute. The hemoglobin of
destroyed cells is decomposed and carried to the liver. There the iron is stored
and the rest of the chemicals are passed on to be excreted from the body in
the bile, the feces and the urine.

Leukocytes (White Blood Cells)

The leukocytes are the body’s primary defence against infections. They
have no hemoglobin and thus are colourless and, unlike red blood cells, they
can move about under their own power. White blood cells are larger than red
blood cells and fewer in number. Normally the blood has about 8000 white
blood cells per cubic millimeter. Leukocytes also play a role in tissue repair
but this activity is not yet fully understood.
Leukocytes are classified into granulocytes (those with granules in the cyto-
plasm) 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.

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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 fibrin-
ogen. 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 inher-
ited. These antigen (also called agglutinogen) and antibody (also called agglu-
tinin) factors of the various blood types are:
• Type A, containing A antigen and anti-B antibody
• Type B, containing B antigen and anti-A antibody
• Type AB, containing A and B antigens and no anti-A or anti-B antibodies
• Type O, containing no A or B antigens and both anti-A and anti-B
antibodies.

The ABO blood typing system was first introduced in 1900 by Karl Land-
steiner and is still generally used today as the basis for transfusing whole
blood. It is now known, however, that many different antigens exist in the red
blood cells, and that as many as 11 or more different antigenic systems of
grouping blood can be recognized. Correct typing and cross-matching of blood
are extremely important clinically in the prevention of transfusion reaction. The
adverse reaction is called agglutination, or clumping, of the recipient’s blood.

141
Damage to the erythrocytes also occurs, so that hemoglobin leaks out of the
cell (hemolysis). The agglutination is fatal to the recipient because it stops the
flow of blood. Similar problems can occur in other transfusions if the donor’s
antigens are incompatible with the recipient’s antibodies.
People with type O blood are known as universal donors because their
blood contains neither A nor B antigens. Those with type AB blood are known
as universal recipients because their blood contains neither anti-A nor anti-B
antibodies. Another important factor, called the Rh factor (named so because
it was first found in the blood of a rhesus monkey) must also be considered
in blood typing. This is a very complex system: eight principal variants of the
Rh factor are known, and there are others not yet identified and grouped. For
practical purposes there are two main groups of Rh types. Persons with the
Rh factor present in the blood are referred to as Rh positive those without are
Rh negative. This particular factor may be involved in hemolytic diseases of the
newborn because of an incompatibility existing between the maternal blood
and the fetal blood.

Figure 11.2. Composition of blood

Blood clotting
Blood clotting or coagulation, is a complicated process involving many
different substances and chemical reactions. The end result of the process
is the formation of a fibrin clot from the plasma protein fibrinogen. Platelets
are important in initiating the process, which, stated more simply, involves
the following steps:
1. When a blood vessel is damaged or breaks, a prothrombin activator is
released into the blood in response to special factors from platelets and
tissues. One of these factors is the protein that is missing in patients
suffering from hemophilia.
2. The prothrombin activator, along with calcium and other plasma factors,
helps to convert prothrombin (a plasma protein) into an enzyme called
thrombin.

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3. Thrombin then couverts fibrinogen, a soluble blood protein, into fibrin
threads (insoluble protein) which trap red blood cells, platelets, and plasma
to form the clot.

Normally clots (thrombi) do not form in blood cells unless the vessel is
damaged or the flow ofblood is impeded. Anticoagulant substances in the
bloodstream inhibit blood clotting so thrombi or emboli (floating dots) do not
form. Heparin, produced by specialized tissue cells, is an example of an anti-
coagulant.

Figure 11.3. General sequence of events in blood clotting

2. Lymphatic System
Lymphatic system is composed of lymph fluid, lymph capillaries, lymphatic
vessels, lymphatic ducts and lymph nodes. The main function of this system is
to transport fluid from the tissues back to the bloodstream. It also aids in the
control of infection caused by microorganism and in conveyance of lipids or
fats away from the digestive organs. Lymph originates from blood plasma. It is
clear and colourless and contains less protein than blood plasma. Other non-
cellular 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.

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 The fluid filling the spaces between the tissue cells is called the intersti-
tial 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 cardiovas-
cular 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 lympho-
cytes 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 breast-
bone and between the lungs. It plays an important role in the body’s immuno-
logic 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 anti-
gens.
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 protec-
tion 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. Inter-
feron 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 pharyn-
geal 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 circu-
lating lymph of bacteria and any other foreign material that may enter the
body, especially through the mouth and nose. In the process of fighting infec-
tion 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 recipient’s blood cells when incompatible
bloods are mixed
• albumin – protein found in blood; also called serum albumin
• antibody – a protein substance developed by lymphocytes in the presence
of antigen
• antigen – foreign material causing the production of an antibody
• cell-mediated immunity – an immune response involving T cell
lymphocytes
• coagulation – the process of blood clotting
• corpuscle – little body (refers to a blood cell)
• cytotoxic cells – T cells that directly kill foreign cells (killer cells); also
called T8 cells
• fibrin – protein threads that form the basis of a blood clot
• fibrinogen – plasma protein that is converted to fibrin in the clotting
process
• globin – the protein part of haemoglobin
• globulin – plasma protein (alpha, beta, gamma)
• helper cells – T cells that aid B cells in recognizing antigens and
stimulating antibody production; also called T4 cells
• heme – iron-containing non-protein portion of the haemoglobin molecule
• haemoglobin – blood protein enabling the red blood cell to carry oxygen
• heparin – an anticoagulant produced by liver cells and found in blood and
tissues
• humoral immunity – immune response in which B cells transform into
plasma cells and secrete antibodies
• immune reaction – reaction between an antigen and an antibody
• immune response or immunity – the body’s capacity to resist all types of
organisms and toxins that can damage tissue and organ
• immunoglobulin – a protein (globulin) with antibody activity
• interferons – antiviral proteins secreted by T cells
• interleukins – proteins that stimulate the growth of T cell lymphocytes
• macrophages – large phagocytes that destroy old red blood cells
• megakaryocyte – platelet precursor (forerunner) formed in the bone
marrow
• myeloid – derived from bone marrow cells
• natural immunity – one’s own genetic ability to fight off disease
• plasma – liquid portion of blood

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• platelet – smallest formed element in the blood; a thrombocyte
• reticulocyte – developing red blood cell
• serum – plasma minus clotting proteins in cells
• stem cell – a cell in bone marrow that gives rise to different types of
blood cells
• suppressor cells – T cell lymphocytes that inhibit the activity of B cell
lymphocytes
• T cells – lymphocytes formed in the thymus gland
• thrombin – an enzyme that helps convert fibrinogen to fibrin during
coagulation
• thromboplastin – a clotting factor that promotes the formation of a fibrin
clot.

Combining Forms Meaning Terminology

chrom/o colour hypochromia = reduction in haemoglobin
in red blood cells
coagul/o clotting coagulation = blood clotting
hem/o blood hemolysis = destruction of red blood cells
hemat/o hematology = the study of blood
sanguin/o sanguinous = pertaining to blood
(haemic)
immun/o protection immunology = the study of immune
system
lymphaden/o lymph node lymphadenitis = inflammation of a lymph
lymph gland gland
lymphangi/o lymph vessel lymphangiogram = radiography of lymph
vessels
phag/o eat, swallow phagocyte = a cell capable of ingesting
particulate matter
poikil/o varied, poikilocytosis = irregularity in the shape
irregular of red blood cells
sider/o iron sideropenia = iron deficiency (anemia)
spher/o globe, round spherocytosis = a round shape of eryth-
rocytes
splen/o spleen splenectomy = removal of the spleen
thym/o thymus gland thymoma = tumour of the thymus gland
tox/o poison toxic = poisonous

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Disorders of the Blood and Lymphatic Systems
AIDS (acquired a disease marked by a decrease in the immune
immunodeficiency response (for more detailed description see the
syndrome) Chapter on AIDS in the Supplement)
anemia deficiency in erythrocytes or haemoglobin; it
implies reduction in red blood cells; the most
common type is iron deficiency, or sideropenic,
anemia caused by a lack of iron; some other
types include:
• aplastic anemia – results from bone marrow failure;
pancytopenia occurs as stem cells fail to produce leukocytes,
platelets and erythrocytes; it is treated with blood transfusions
and bone marrow transplants (usually conducted with marrow
from an identical twin);
• haemolytic anemia – reduction in red cells due to excessive
destruction; hemolysis may be due to exposure to chemicals
and toxic substances, or it may be congenital; jaundice may be
a symptom in addition to usual symptoms of anemia; treatment
includes blood transfusions and sometimes splenectomy;
• pernicious anemia (macrocytic) – a deficiency in the absorption of
vitamin B12 or folic acid; vitamin B12 is a common constituent
of food but it cannot be absorbed into the bloodstream without
the aid of a special substance called intrinsic factor, which
is normally found in gastric juice. Individuals with pernicious
anemia lack this factor in their gastric juice, and the result
is unsuccessful maturation of red cells, with an excess of
large, immature, nucleated, and poorly functioning red cells
(megaloblasts) in the circulation; the treatment consists in the
administration of vitamin B12 for life;
• sickle-cell anemia - a genetically determined defect of
hemoglobin synthesis associated with poor physical
development and skeletal anomalies, occurring usually in
Negroes;
• thalassemia – an inherited defect in the ability to produce
hemoglobin, usually seen in persons of Mediterranean
background; this condition, consisting of various forms and
degrees of severity (the most severe form is called Cooley
anemia), usually leads to hypochromic anemia (diminished
hemoglobin content in red cells).

148
graft rejection Destruction of transplanted organ or tissue by
the recipient’s immune system.
graft-versus-host Condition that occurs following bone marrow
disease (GVHD) transplant or blood transfusion; in this
condition the immune cells in the transplanted
marrow produce antibodies against the host’s
tissues; the condition may be acute or chronic.
granulocytosis abnormal increase in granulocytes in the blood
as a response to infection or inflammation.
haemophilia Excessive bleeding caused by a congenital
lack of substance necessary for blood clotting.
The disease is sex-linked and is most often
found in males. The female is the carrier of the
trait and generally does not have symptoms
of the disease; while the platelet count of a
hemophiliac is normal, there is a marked
deficiency in a plasma clotting factor (factor VIII)
which results in a very prolonged coagulation
time; in addition to excessive bleeding, joints
and muscles may likewise be affected; if blood
collects in the joints (hemarthrosis), permanent
crippling may result.
Hodgkin disease Malignant tumour arising in lymphatic
tissue such as lymph nodes and spleen.
This disease of unknown origin produces
lymph node enlargement, and weight loss. A
malignant cell, called a Reed-Stenberg cell,
is characteristically found in the lymph nodes.
There may be metastases to other organs in the
more advanced stages of the disease. Radiation
and chemotherapy are effective methods of
treatment.
leukemia Leukemias are malignant disease of the blood-
forming 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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 the leukemic process drastically reduces the
ability of the body to produce normal blood cells,
it results in anemia and increased susceptibility
to infections. There are many clinical
manifestations in leukemia. The major treatment
for leukemia is chemotherapy. Four major types
of leukemia are:
•a  cute myelogenous (myelocytic) leukemia (AML) – immature
granulocytes predominate; platelets and erythrocytes are
diminished;
•a  cute lymphocytic leukemia (ALL) – immature lymphocytes
predominate this form is seen most often in children and
adolescents; the onset is sudden;
• c hronic myelogenous leukemia (CML) - mature and immature
granulocytes are present in the marrow and bloodstream; this
is a slowly progressive illness;
• c hronic lymphocytic leukemia (CLL) – abnormal numbers of
relatively mature lymphocytes predominate in the marrow,
lymph nodes and spleen; it occurs later in life and follows a
slowly progressive course.
lymphadenitis inflammation of lymph nodes, usually due to
infection.
lymphocytosis increased number of lymphocytes in the blood
and bone marrow.
lymphosarcoma Malignant tumour of lymph nodes which closely
(lymphoma) resembles Hodgkin’s disease. It affects the
lymph nodes, spleen, bone marrow and other
organs. There are several types of lymphoma
(lymphocytic, histiocytic, etc.). Chemotherapy
and radiation are used in treatment.
mononucleosis Acute infectious disease with enlarged lymph
nodes and spleen and increased numbers of
lymphocytes and monocytes in bloodstream. The
disease is caused by virus. Lymphadenopathy is
present, with sore throat and enlarged, tender
nodes in the cervical and sometimes axillary and
inguinal regions, splenomegaly, hepatomegaly,
and marked asthenia (weakness) are also
present.

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multiple myeloma A primary malignant tumour of bone marrow.
This is a progressive malignancy of antibody-
producing cells. The condition often leads to
osteolytic lesions, anemia, hypercalcemia,
renal damage, and increased susceptibility to
infection. Treatment is with analgesics,
radiotherapy, chemotherapy, and special
orthopedic supports.
polycythemia Abnormal increase in the erythrocyte count
(primary or vera) or in hemoglobin concentration. The cause of
the disease is not fully understood. There is
hyperplasia of the cell-forming tissues of the
bone marrow, with resultant elevation of the
erythrocyte count and hemoglobin level, and
platelets. The condition has been compared
to leukemia and regarded as a malignant
neoplastic disease. Treatment is aimed at
reducing the red cell count and decreasing
the blood volume. It includes both the modern
techniques of radiation therapy and the ancient
practice of bloodletting.
purpura A hemorrhagic disease characterized by
extravasation of blood into the tissues, under the
skin and through the mucous membranes, and
producing spontaneous ecchymoses (bruises)
and petechiae (small red patches) on the skin.
The disorder is accompanied by a marked
decrease in circulating platelets and hence is
sometimes called thrombocytopenic purpura.
Primary or idiopathic purpura is of unknown
cause while the secondary or symptomatic
purpura may be associated with exposure
to drugs or other chemical agents, systemic
diseases such as anemia and leukemia, diseases
affecting the bone marrow or spleen and
infectious diseases such as rubeolla. Treatment
is aimed at the cause of disease. Splenectomy
and drug therapy are used.

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 sarcoidosis Inflammatory disease of unknown etiology in
which small nodules, or tubercles, form in lymph
nodes and other organs. Besides spleen and
lymph nodes, lesions also develop in lungs and
liver.
septicemia Serious life-threatening bloodstream infection
that may arise from other infections in the
body; also called sepsis, blood infection, blood
poisoning.

EXERCISES
1.1. The main functions of the blood are: ...............................................................................
1.2. The function and the accessory organs of the lymphatic system are as
follows: ........................................................................................................................................................

2. Fill in the correct term:

2.1. Blood is composed of ............................. called .......................................................... and
.................................................... that consists of .................................................................................
2.2. The erythrocytes owe their ...................................................... ability to the protein
............................................................. which contains .........................................................................
2.3. Leukocytes also play a role in ...................................................... but this activity is
2.4. Lymph .................................................................................................... from blood plasma.
2.5. The fluid between the tissue cells is called..................................................................

3. Give the opposite of each term:

3.1. early ............................................................. 3.6. continuance .............................................

3.2. past .............................................................. 3.7. conversion ................................................
3.3. permanence ............................................ 3.8. strong .........................................................
3.4. sharp ........................................................... 3.9. fertile ..........................................................
3.5. cause ........................................................... 3.10. dry ..............................................................

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4. Match the following terms with their meanings:
4.1. albumin ..................................................... a) red blood cell
4.2. thrombocyte ............................................ b) iron-containing non-protein
portion of the hemoglobin
molecule
4.3. heme ........................................................... c) antiviral protein secreted by
T-cells and other cells

4.4. interferon .................................................. d) platelet

4.5. erythrocyte .............................................. e) protein found in blood

5. Give the meanings of the following terms:

5.1. antigen ...............................................................................................................................................
5. 2. antibodies .......................................................................................................................................
5. 3. cell-mediated immunity..........................................................................................................
5. 4. interstitial fluid ............................................................................................................................
5. 5. globin .................................................................................................................................................
5. 6. bilirubin ............................................................................................................................................
5. 7. coagulation ....................................................................................................................................
5. 8. fibrinogen ........................................................................................................................................
5. 9. globulin ............................................................................................................................................
5.10. immune reaction .......................................................................................................................

6. Provide the plural forms of the following nouns:

6.1. thymus ....................................................... 6.6. hematoma ................................................

6.2. nucleus ...................................................... 6.7. antigen .......................................................
6.3. edema ......................................................... 6.8. lymphadenoma .....................................
6.4. serum ......................................................... 6.9. anemia .......................................................
6.5. hemolysis ................................................. 6.10. albumin ...................................................

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7. Provide the adjective form of the following nouns:

7.1. spleen ......................................................... 7.6. thymus .......................................................

7.2. blood ............................................................ 7.7. albumin .....................................................
7.3. hemostasis .............................................. 7.8. fibre ..............................................................
7.4. lymph .......................................................... 7.9. cell ................................................................
7.5. nucleus ...................................................... 7.10. genesis ....................................................

8. Give appropriate medical term for the following:

8.1. stringy substance in clots .......................................................................................................
8.2. liquid part of blood without fibrinogen ...........................................................................
8.3. provide cell-mediated immunity ........................................................................................
8.4. inflammation of lymph nodes ..............................................................................................
8.5. increased numbers of lymphocytes in the blood and bone marrow
..........................................................................................................................................................................

8.6. removal of the thymus ..............................................................................................................

8.7. inflammation of the thymus ..................................................................................................
8.8. deficiency in erythrocytes or hemoglobin .....................................................................
8.9. disease-fighting cells ...............................................................................................................
8.10. deficiency in the absorption of vitamin B12 ..............................................................

9. Translate into Croatian:

Allergy
Allergy is usually defined as abnormal and individual hypersensitivity to
substances that are ordinarily harmless. Basically it develops like immunity
to disease, which is one of the natural defence mechanisms of the human
body resulting in antigen-antibody reaction, but to an exaggerated degree.
An allergy cannot occur on the first contact with a potential allergen, i.e. a
substance capable of inducing hypersensitivity, because antibodies have not
yet been produced by the body. It may occur on the second contact, when anti-
bodies have been produced and are in reserve in the body tissues, but it does
not necessarily do so. In some cases it may not occur until late in life when,
after repeated contact with the allergen, a person suddenly develops a sensi-

154
tivity. Although anyone can develop an allergy after repeated exposure to some
offending allergen, it is believed that some individuals inherit the tendency
or predisposition.
In addition to microorganisms, dust, dog dander, pollens, grasses, mol
d spores, and practically any substances in the environment - collectively
termed allergens - may function as antigens and stimulate the production
of antibodies within the host. Allergens can enter the body by being inhaled,
swallowed, touched or injected. The allergen is not directly responsible for the
allergic reaction, but sets off the chain of events that brings it about.
A variety of allergic reactions can take place almost anywhere in the body;
the cell affected may be destroyed or injured, and they release powerful defen-
sive 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 varie-
ties 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, choco-
late, nuts, spices, eggs, milk and grains.
skin contact plastics, certain metals, rubber, fabrics, dyes,
substances: cosmetics, resins, drugs, and plant foliage.
injected drugs: antibiotics, certain serums, hormones, liver extract,
and insulin.
drugs given by aspirin, laxatives, sedatives, sleeping pills, tran-
mouth: quilizers, and antibiotics.

(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 recog-
nition 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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4. Pancreas (islands of Langerhans)
5. Pituitary gland (hypophysis)
6. Thymus and pineal gland
7. Ovaries in female (one pair)
8. Testes in male (one pair)

The last two glands are called sex glands or gonads. The pineal and thymus
gland, are included as endocrine glands because they are ductless, although
little is known about their endocrine function in the human body.

Thyroid Gland
The largest gland of the endocrine system is the thyroid gland. It is located
in the neck just below the larynx. This gland is composed of two fairly large
lobes - a right and left lobe that are separated by a strip of tissue called an
isthmus. The thyroid gland is located on either side of the trachea, below a
large piece of cartilage called the thyroid cartilage. This cartilage covers the
larynx and produces the prominence on the neck known as the Adam’s apple.
The main function of the thyroid gland is to produce the hormones thyroxine
and triiodothyronine. These hormones are synthesized in the thyroid gland from
iodine, which is picked up from the blood circulating through the gland, and
from an amino acid called tyrosine. Thyroxine is vital in maintaining normal
growth and metabolism. It is responsible for a person’s energy level. This
gland also influences skeletal growth and sexual development. A more recently
discovered hormone produced by the thyroid gland is called calcitonon (thyro-
calcitonin). Calcitonin is secreted when calcium levels in the blood are high. It
stimulates the passage of calcium into bones from the blood.

Parathyroid Glands
The parathyroid glands are four small oval bodies located on the dorsal
aspect of the thyroid gland or are embedded within it. They occur in a vari-
able number of pairs, commonly two. Parathyroid glands secret e a parathy-
roid hormone (PTH), which regulates calcium and phosphorus metabolism fur
blood, bones, and teeth. Normally, calcium in the food we eat is absorbed from
the intestine and carried, by the blood, to the bones, where it is stored. The
adjustment of the level of calcium in the blood is a good example of the way
hormones in general control the homeostasis (equilibrium or constancy in the
internal environment) of the body. If there is a decrease in blood calcium (as
in pregnancy or rickets, a vitamin D deficiency disease), parathyroid hormone
is secreted in larger amounts to cause calcium to leave the bones and enter
the bloodstream. Thus, blood calcium levels are brought back to normal.

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Conversely, any situation of increase in calcium in the bloodstream, such as
excess quantity of calcium or vitamin D in the diet, will lead to decreased para-
thyroid hormone secretion, decreasing blood calcium so that homeostasis is
again achieved.

Adrenal Glands
The adrenal glands, also called the suprarenal glands, are two small glands
situated one on top of each kidney. Each gland consists of two parts, an outer
portion called the adrenal cortex and an inner portion called the adrenal
medulla. The cortex and medulla are two glands in one, each secreting its
own different endocrine hormones. The cortex secretes hormones called ster-
oids (complex chemicals derived from cholesterol), and the medulla secretes
hormones called catecholamines (chemicals derived from an amino acid).

The adrenal cortex secretes three types of steroid hormones:

1. Mineralocorticoids - these hormones are essential to life because they regu-
late the amounts of mineral salts (also called electrolytes) that are retained
in the body. A proper balance of water and salts in the blood and tissues is
essential to the normal functioning of the body.
The most important mineralocorticoid is called aldosterone. The secretion
of aldosterone by the adrenal cortex increases the reabsorption of sodium
(a mineral electrolyte commonly found in salts) by the kidney tubules. At
the same time, aldosterone stimulates the excretion of another electrolyte
called potassium. The secretion of aldosterone increases manyfold in the
face of a severe sodium restricted diet, thereby enabling the body to hold
needed salt in the bloodstream.
2. Glucocorticoids - these hormones have an important influence on the
metabolism of sugars, fats, and proteins within all body cells.
Cortisol (also called hydrocortisone ) is the most important glucocorticoid
hormone. Cortisol increases the ability of cells to make new sugars out of
fats and proteins (gluconeogenesis) and regulates the quantity of sugars,
fats, and proteins in the blood and cells.
Cortisone is a hormone very similar to cortisol and can be prepared synthet-
ically.
Cortisone is useful in treating inflammatory ailments such as rheumatoid
arthritis.
3. Androgens, Estrogens, and Progestins - these are male and female hormones
that maintain the secondary sex characteristics, such as beard and breast
development, and are necessary for reproduction. Most of these hormones
are also produced in the ovaries and testes. Excess adrenal androgen secre-

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 tion in females leads to virilism (development of male characteristics),
and excess adrenal estrogen and progestin secretion in males produces
abnormal feminine characteristics (feminism).

The adrenal medulla secretes two types of catecholamine hormones:

1. Epinephrine (adrenaline) - this hormone increases cardiac activity, dilates
bronchial tubes, and stimulates the production of glucose from a storage
substance called glycogen when glucose is needed by the body. Epineph-
rine is often referred to as the fight or flight hormone, because of its effect
during stress. Epinephrine causes the involuntary muscles to contract and
produces an increase in blood pressure. It converts glycogen into blood
sugar for use by the voluntary muscles to perform extra work.
2. Norepinephrine (noradrenaline) - this hormone constricts vessels and raises
blood pressure.
Both epinephrine and norepinephrine are called sympathomimetic agents
because they mimic, copy, the actions of the sympathetic nervous system.
During times of stress, these hormones are secreted by the adrenal medulla
in response to nervous stimulation. They help the body respond to crisis
situation by raising blood pressure, increasing heartbeat and respiration,
and bringing sugar out of storage in the cells.

Pancreas (Islands of Langerhans)

The pancreas, located behind the stomach in the region of the 1st and 2nd
lumbar vertebrae, produces both external and internal secretions. The external
secretion, called pancreatic juice, is produced by the cells of the acini. Pancre-
atic juice passes through the pancreatic ducts into the duodenum where it
plays an important role in the digestion of various foods.
The specialized cells in the pancreas that produce hormones are called the
islets of Langerhans. They produce two hormones called insulin and glucagon.
Both of these hormones play a role in the proper metabolism of sugars and
starches in the body. Insulin is necessary in the bloodstream so that sugars can
pass from the blood into the cells of the body where they are burned to release
energy. When blood sugar (glucose) is above normal, insulin is released by the
island cells of the pancreas. The insulin causes sugar to enter body cells to
be burned and stimulates the conversion of glucose (a starch-storage form of
sugar) in the liver. Thus, sugar can leave the blood to be stored (as glycogen)
or used to release energy. Glucagon, the opposite “twin” of insulin, is released
into the blood when sugar levels are below normal. It causes the breakdown
of liver glycogen to sugar (glucose), so that there is a rise in the sugar content
of blood leaving the liver.

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 The islands of Langerhans include two major types, containing granules
that stain differently. The alpha cells (10 to 30 percent of the cells) stain red
and produce glucagon. The beta cells (60 to 90 percent of the cells) stain blue
and produce insulin. While the islands of Langerhans carry on the endocrine
functions of the pancreas, other cells within the organ carry on its exocrine
functions. These cells secrete digestive enzymes and juices into the gastro-
intestinal tract.

Pituitary Gland (Hypophysis)

All the endocrine glands interact with one another to some extent, but
only the pituitary gland has the special function of stimulating other endo-
crine glands to produce their own particular hormones. Because of this, the
pituitary gland (also called hypophysis) is known as the master gland. It is
small, no larger than a pea, and is attached to the base of the brain in a small
pocket-like depression of the skull called the sella turcica. The pituitary gland
is connected to the hypothalamus by the hypophyseal stalk.
Even though the pituitary gland looks like a single gland, it actually consists
of two separate glands the adenohypophysis, or anterior lo be; and the neurohy-
pophysis or posterior lobe. These two glands are formed from different embry-
onic structures and secrete different hormones. Signals transmitted from the
hypothalamus control almost all secretions by the pituitary gland. Secretion
from the neurohypophysis is controlled by nerve fibers originating in the hypo-
thalamus and ending in the neurohypophysis. Secretion by the adenohypoph-
ysis is controlled by special hormones called releasing and inhibiting factors.
These hormones are secreted by the hypothalamus and pass to the adeno-
hypophysis by way of special capillaries.

The adenohypophysis produces several hormones:

1. Growth hormone (GH or HGH in humans, also called somatotropin) - this
hormone acts on bone tissue to accelerate its growth in the body.
2. Thyroid-stimulating hormone (TSH, also called thyrotropin) - this hormone
stimulates the growth of the thyroid gland and its secretion of thyroxine.
3. Adrenocorticotropic hormone (ACTH) - this hormone stimulates the growth
of the adrenal cortex and increases its secretion of steroid hormones
(primarily cortisol).
4. Gonadotropic hormones - there are several gonadotropic hormones that
influence the growth and hormone secretion of the ovaries in females and
testes in males. In the female, follicle-stimulating hormone (FSH) stimu-
lates the growth of eggs in the ovaries, and luteinizing hormone (LH) induces
the secretion of progesterone (pregnancy-sustaining hormone) from the

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 ovaries. In the male, gonadotropins (FSH and LH) from the adenohypoph-
ysis 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, stim-
ulates 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 main-
tains 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 symmet-
rical 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 poste-
rior 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 mela-
tonin 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 Nervous System

Secretes hormones that are carried
in body fluids
Causes changes in the metabolic
activities of target tissues
Effects exerted relatively slowly
Effects generally prolonged
Transmits nerve impulses via nerve
fibres
Causes muscles to contract or
glands to secrete
Effects exerted relatively rapidly
Effects generally brief

Key Terms
• antagonistic – acting in opposition; mutually opposing g
• catecholamines – hormones derived from an amino acid and secreted by
the adrenal medulla (e.g. epinephrine)
• corticosteroids – hormones produced by the adrenal cortex (e.g.
glucocorticoids)
• homeostasis – a constant internal environment
• hormone – a substance produced by an endocrine gland and carried
through the blood to a target organ
• sella turcica (Turkish saddle) – a cavity in the skull where the pituitary
gland is located
• steroid – a complex chemical related to fats (oil) and derived from a
sterol (e.g. cholesterol)
• sympathomimetic – an agent that mimics or copies the effect of the
sympathetic nervous system (e.g. adrenaline)
• target – a structure, organ or tissue to which something is directed.

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Combining Forms Meaning Terminology
aden/o gland adenectomy = removal of a gland
adren/o adrenal adrenal = pertaining the adrenal gland
adrenal/o gland adrenalectomy = removal of the adrenal
gland
andr/o male androgen = male sex hormone
cortic/o cortex, outer cortical = pertaining to the outer region
region
crin/o secrete endocrine = internally secreting (gland)
dips/o thirst polydipsia = excessive thirst
(e.g. in diabetes mellitus)
estr/o female estrogen = female sex hormone
gluc/o sugar, glucogenesis = producing sugar
glyc/o sweetness hypoglicemia = lower than normal blood
Glycos/o sugar
glycosuria = abnormal amount of glucose
in the urine
kal/i potassium hypokalema = decrease in blood potas-
(an sium level
electrolyte)
lact/o milk prolactin = a hormone that promotes
lactation
myx/o mucus myxedema = decreased thyroid function
natr/o sodium (an hyponatremia = decreased sodium
electrolyte) content in the blood
phys/o growth, hypophysis = growing from the undersur-
physi/o natural face of the brain
process physiology = the study of natural
processes
somat/o body somatotropin = growth hormone
toc/o childbirth dystocia = difficult childbirth.

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Disorders of the Endocrine System
Disorders of the endocrine system are based on underproduction (hypose-
cretion) or overproduction (hypersecretion) of hormones. Most deficiencies
result from genetic disorders, surgical removal of the gland, or production of
poor-quality hormones.

Thyroid Gland
Thyrotoxicosis (exophthalmic goitre) is a condition marked by protrusion
of the eyeballs, increased heart action, enlargement of the thyroid gland,
weight loss, and nervousness. This condition is due to hypersecretion of
thyroxine, a thyroid hormone. One of the early symptoms of this disorder is an
enlarged thyroid (goitre) and edema behind the eye, which causes the protru-
sion of the eyes, (exophthalmos). Exophthalmic goitre is also known as Graves
disease. Thyrotoxicosis is usually treated by administering drugs that suppress
thyroxine synthesis or by surgically removing part of the gland (thyroidectomy).
Thyroid deficiency during adulthood (myxedema) results in physical changes
such as puffiness of the skin, swollen lips, thickened nose, and loss of hair.
Hyposecretion of the thyroxine, especially during infancy, results in cretinism.
With this disorder, every aspect of the child’s development is affected. The
child exhibits dwarfism and mental retardation. Both cretinism and myxe-
dema can also occur when the thyroid gland atrophies or when it is surgi-
cally removed.
Thyroid gland enlargement may be a symptom of many different condi-
tions. Examples of two types of goitre are:
Endemic goitre - This condition, prevalent in certain regions and peoples
and marked by accumulation of colloid (gluelike or gelatinous) material in the
thyroid gland, causes hypertrophy of the thyroid. The etiology is deficiency of
iodine in the diet, which causes the thyroid to work harder to make hormone
and thus enlarge as compensation for the scarcity of iodine. Treatment is to
increase the supply of iodine in the diet.
Nodular or adenomatous goitre - This form of goitre is marked not only by
enlargement (hyperplasia) of the thyroid, but by the formation of nodules or
adenomas. Some patients develop hyperthyroidism with the symptoms such as
rapid pulse, tremors, nervousness, and excessive sweating. Treatment consists
of use of thyroid hormone to suppress the normal thyroid gland functioning.
Thyroid carcinoma - cancer of the thyroid gland. Some tumours are very
slow in growing and others may metastasize widely. Adenomas (noncancerous
growths) are distinguished from carcinomas in radioactive tracer studies. Hot
tumour areas (those collecting more radioactivity than surrounding tissues)

166
usually indicate benign growths; cold nodules can be either benign or malig-
nant.

Parathyroids
Hypoparathyroidism or hyposecretion of the parathyroids results in neuro-
muscular 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 idio-
pathic 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, palpi-

167
tations, severe headaches, sweating, flushing of face, and muscle spasms.
Surgery to remove the tumour and administration of antihypertensive drugs
are possible courses of treatment.

Pituitary Gland (Hypophysis)

Adenohypophysis
The anterior the adenohypophysis, produces a number of hormones that
directly control the activities of other endocrinc glands. However, human
growth hormone (HGH) is produced in the anterior lobe and does not control
the activities of other glands. Instead, HGH is the hormone that builds bone
tissue during the growth years. If there is hypersccretion of HGH before the
closure of epiphyseal plates a generalized increase in body size takes place,
particularly in the long bones of children (gigantism). This condition is also
known as hyperpituitarism. It can be correctcd by early diagnosis in childhood.
On the other hand, excessive HGH secretion after the epiphyseal closure
will cause a chronic disease characterized enlargements of bones and soft
tissues of the extremities (acromegaly).
If HGH is normal childhood hut low in adult life (hypopituitarism ), the
individual will not receive enough hormone needed to stimulate the protein
building activities of the body. This results in wasting away of tissues (atrophy),
which may lead to a rare condition called Simmond disease, or pituitary cachexia.

Neurohypophisis
The principal abnormality associated with the dysfunction of the posterior
lobe, the neurohypophysis, is diabetes insipidus. Damage of the hypothalamus
can result in hyposecretion of ADH - antidiuretic hormone, or vasopressin.
Deficient antidiuretic hormone causes the tubules to fail in reabsorbing the
needed water and salts. Clinical symptoms include excretion of large amounts
of urine (polyuria) and subsequent excessive thirst Treatment includes admin-
istration of synthetic preparations of ADH into the nose several times a day.
This disease should not be confused with diabetes a disorder of the pancreas
which involves sugar metabolism.
Inappropriate ADH (IADH,) or excessive secretion of antidiuretic hormone
produces excess water retention in the body. Treatment consists of dietary
water restriction. Tumour, drug reactions, and head injury are some of the
possible factors.

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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 resist-
ance of target tissue to the action of insulin. Treatment is with diet, body weight
reduction, and, when necessary, administration of insulin or oral hypogly-
cemic agents that can stimulate the release of insulin from the pancreas and
improve the body’s sensitivity to insulin.

Diabetes is associated \with both primary and secondary complications:

Primary complications include ketoacidosis (fats are improperly burned

leading to accumulation of ketons in the body) and hyperosmolar coma, a condi-
tion when blood sugar concentration (osmolarity) gets too high or the patient
receives insufficient amounts of insulin. Hypoglycemia can occur when too
much insulin is taken by the patient.
Secondary (long-term) complications occur many years after the patient
develops diabetes. These include destruction of the blood vessels of the retina

169
of the eyes (diabetic retinopathy), causing visual loss and blindness; destruc-
tion of the kidneys (diabetic nephropathy), causing renal insufficiency and often
requiring haemodialysis or renal transplantation; destruction of blood vessels,
with atherosclerosis; and destruction of nerves (diabetic neuropathy) involving
pain or loss of sensation, most commonly in the extremities.
Hyperinsulinism is an excess of insulin. This condition may be caused by a
tumour of the pancreas (benign adenoma or carcinoma) or overdose of insulin.
Excess insulin draws sugar out of the bloodstream, resulting in hypoglycemia.
Fainting spells, convulsions, and loss of consciousness are common because
a minimum level of blood sugar is necessary for proper mental functioning.
Reactive hypoglycemia occurs after ingestion of glucose or a meal. This is
due to an abnormality in the timing of insulin secretion in response to a meal,
and is distinct from the type of hypoglycemia seen with hyperinsulinism.

Other Related Terms

diuresis increased formation and secretion of urine
hirsutism abnormal hairiness, especially in women
hypervolemia abnormal increase in the volume of circulating fluid in
the blood
insulinoma tumour of the islets of Langerhans of the pancreas
obesity excessive accumulation of fat above the body’s physical
standards
thyroid storm crisis of uncontrolled hyperthyroidism; thyrotoxic crisis
virilism masculinisation in a woman; development of male
secondary sex characteristics in a woman.

170
 For brief reference to abnormal conditions of the endocrine glands, refer
to the table below.

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EXERCISES
1.1. The endocrine system is made up of the following glands: ...............................
..........................................................................................................................................................................

1.2. Make a comparison between the endocrine and nervous systems:

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

2. Fill in the correct term:

2.1. Some examples of exocrine glands are sweat, digestive, and .........................
........................................................................................................................................................ glands.
2.2. The ............................................................ gland is referred to as the master gland.
2.3. Ovaries produce .......................................... while the testes secrete ..........................
2.4. The thymus gland is an ................................................ organ located in the upper
mediastinal ...............................................................................................................................................

3. Give the opposite of each term:

3.1. hypersecretion ...................................... 3.6. infancy ........................................................

3.2. endocrine ................................................. 3.7. deterioration ...........................................
3.3. prolonged ................................................. 3.8. to lose .........................................................
3.4. goitre ........................................................... 3.9. complicated ............................................
3.5. inhibit .......................................................... 3.10. minimum ................................................

4. Match the following terms with their meanings:

4.1. hypoparathyroidism ........................... a) protrusion of the eyes
4.2. hirsutism .................................................. b) removal of the adrenal gland
4.3. adrenalectomy ....................................... c) hyposecretion of the parathyroids
4.4. exophthalmos ........................................ d) excessive hair growth
4.5. pheochromocytoma ........................... e) tumour occurring in the adrenal
medulla

5. Give the meanings for the following terms:

5.1. hirsutism ..........................................................................................................................................
5. 2. cretinism .........................................................................................................................................

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5. 3. myxedema ......................................................................................................................................
5. 4. Cushing disease ..........................................................................................................................
5. 5. diabetes mellitus ........................................................................................................................
5. 6. progesterone .................................................................................................................................
5. 7. vasopressin ....................................................................................................................................
5. 8. acromegaly ....................................................................................................................................
5. 9. thymitis .............................................................................................................................................
5.10. exacerbation ................................................................................................................................

6. Provide the adjective form for each of the following:

6.1. hormone ................................................... 6.6. exophthalmos ........................................

6.2. metabolism ............................................. 6.7. cretinism ...................................................
6.3. responsibility .......................................... 6.8. fatigue ........................................................
6.4. resorption ................................................. 6.9. kidney .........................................................
6.5. pancreas ................................................... 6.10. diabetes ..................................................

7. Provide the singular form of the following nouns:

7.1. hormones ................................................. 7.6. striae ...........................................................

7.2. ovaries ........................................................ 7.7. adenomata ...............................................
7.3. medullae ................................................... 7.8. leaves ..........................................................
7.4. cortices ...................................................... 7.9. negroes ......................................................
7.5. thyroidectomies .................................... 7.10. hypophyses ...........................................

8. Give appropriate medical term of the following:

8.1. inflammation of the adrenal glands .................................................................................
8.2. any disease of the adrenal glands .....................................................................................
8.3. pertaining to the formation of glycogen .........................................................................
8.4. excessive presence of hair in unusual places ............................................................
8.5. an excessive amount of insulin in the blood ................................................................

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8.6. surgical fixation of an enlarged thymus in a new position ..................................
8.7. increase in food intake .............................................................................................................
8.8. excessive urine production ....................................................................................................
8.9. a test measuring the glucose levels in a blood sample from a fasting
patient ..........................................................................................................................................................
8.10. pictures obtained from ultrasound waves .................................................................

9. Translate into Croatian:

Hypoglycemia is an abnormally low level of sugar (glucose) in the blood.
Anyone who has not eaten for quite a while may experience the symptoms o
flow blood sugar. True chronic hypoglycemia, however, is not very common.
There are two types of hypoglycemia. The most common form is reactive
hypoglycemia. In this condition, the blood sugar level drops sharply several
hours after a large portion of sugar or starches has been consumed. When
sugar is eaten, the pancreas is normally stimulated to produce the hormone
insulin which enables the body to use the sugar. However, in reactive hypo-
glycemia the pancreas continues to produce insulin long after the need has
passed. The result is abnormally low blood sugar levels.
The other type of hypoglycemia, fasting hypoglycemia, may occur during
pregnancy, strenuous exercise, and infectious accompanied by fever. All of
these situations increase the body’s need for sugar; if sugar intake is not
increased, temporary hypoglycemia may result. Disorders of the liver may
also lead to fasting hypoglycemia. This is especially common in heavy drinkers,
since alcohol upsets the sugar release response in the liver. Consequently,
alcoholics are at a greater risk of developing fasting hypoglycemia.

(From: Ellis, J. W. Medical Symptoms and Treatments)

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CHAPTER 13

FEMALE REPRODUCTIVE SYSTEM

1. Reproduction
Reproduction means the process by which a living entity or organism
produces a new individual of the same kind. The gonads, or sex glands - the
ovaries in the female and the testes in the male - produce the germ cells
(gametes) that unite and grow into a new individual. Reproduction begins when
the germ cells unite, which is a process called fertilization.
The germ cells are the male spermatozoon and the female ovum, or egg.
These are specialized cells differing primarily from normal body cells in one
important way. Each sex cell contains exactly half the number of chromo-
somes that a normal body cell contains. When the ovum and spermatozoon
unite, the cell produced receives half of its genetic material from its female
parent, and half from its male parent; thus it contains a full, normal comple-
ment of hereditary material.
Maturation of an ovum is a process controlled by hormones secreted by the
female’s endocrine glands. An ovum, after leaving the ovary, travels down a
duct (uterine or fallopian tube) leading to the uterus (womb). If coitus (copu-
lation, sexual intercourse) has occurred and sperm cells are present in the
uterine tube, union of the ovum and spermatozoon may take place. Ordinarily
only one ovum matures alternatively from each ovary during one menstrual
cycle. However, if by chance two eggs have been released and are fertilized
by two sperm, fraternal twins are formed. Identical twins are reproduced by
a single fertilized egg that divides into two eggs early in its development.
Fertilization can occur only on the average of 4 days of every menstrual
cycle. The mature ovum lives only l or 2 days after ovulation, and the sperm
have about the same amount of time before they perish in the female repro-
ductive tract. The fertilized egg, which is now called the embryo (and fetus
after the second month) then begins a 9-month period of development (gesta-
tion, pregnancy) within the uterus.

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 The female reproductive system consists of organs that produce ova and
provide a place for the growth of the embryo. In addition, the female repro-
ductive 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 func-
tions 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 geni-
talia include the labia majora, labia minora, clitoris, vestibule of the vagina,
and the greater vestibular glands or Bartholin glands. The combined struc-
tures of the external genitalia are known as the vulva.
Both the cervix of the uterus and vagina are lubricated by the mucous secre-
tions of Bartholin glands. A fold of membrane, the hymen, is sometimes found
partially covering the orifice of the virginal vagina. A hymen may be ruptured
at the first sexual intercourse, even though there have been cases in which
pregnancies have occurred without any ruptures.

Ovaries
The reproductive system is linked to the body’s system of endocrine glands
by the ovaries. Besides producing the ova, the ovaries secrete the female sex

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hormones estrogen and progesterone. These hormones influence the body’s
development and general functioning as well as the sexual function.
The two ovaries, each about the size of a small plum, lie on each side of
the pear-shaped uterus at its wider upper part. Within each ovary are thou-
sands of small sacs called graafian follicles. Each graafian follicle contains an
ovum. When an ovum is mature, the graafian follicle ruptures to the surface
of the ovary, breaks through its own outer covering, and is released. Release
of an egg cell, called ovulation, occurs about once in 28 days. The ruptured
follicle fills first with blood, and then with a yellow fatlike material. It is then
called the corpus luteum (yellow body).

Figure 13.1. Female reproductive organs

Fallopian tubes
Fallopian tubes, oviducts, salpinges (sg. salpinx), or uterine tubes, extend
laterally from superior angles of the uterus. They transport the ovum from the
ovary to the uterus by rhythmic contractions of the tube walls and by the cilia of
the mucous membrane lining. The opening of the tubes near the ovaries o pens
directly into the uterus. Each oviduct is a muscular tube and consists of the
same three layers found in the uterus: mucosa, serosa and a layer of smooth
muscle. In addition to conveying the ovum, an oviduct provides a passageway
through which sperm travel from the uterus toward the ovary. It is within the
uterine tube that fertilization takes place while the ovum is moving through

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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 deter-
mined 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 pitui-
tary gland stimulate the production of milk (lactation).

Figure 13.2. View of sagittal cut through breast

4. Menstrual Cycle and Menopause

The menstrual cycle consists of a series of events that are associated with
the maturation of the ovum. Approximately every 28 days the endometrium,
the lining of the uterus, is prepared to receive a fertilized egg. If no fertiliza-
tion, or conception occurs, the endometrium along with the unfertilized ovum
is released from the body. The periodic discharge from the vagina of blood
and tissues from a nonpregnant uterus is called menstruation. Menstruation
occurs monthly, actually every 28 days or so from puberty to menopause. If
the mature egg is fertilized, menstruation will not take place and the ferti-

180
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 dimin-
ishes and gradually stops. It is also called climacteric. During this period the
ovaries stop functioning and therefore menstruation and childbearing cease.
It is a natural physiologic process that results from the normal aging of the
ovaries and occurs when the ovaries can no longer perform the function of
ovulation and estrogen production. It usually begins between 40 and 50 years
of age and its duration varies from 6 months to 3 years.

5. Pregnancy and Labour

If fertilization does occur in the uterine tube, the fertilized egg begins to
change immediately after. Soon the egg is dividing into a cluster of two, then
four, then more cells, as it makes its way down the uterine tube toward the
uterus for implantation. By the time the egg reaches the uterus, in 3 to 5 days,
the cells are formed in the shape of a minute ball, hollow on the inside with
an internal bump at one side where the embryo will form. This aggregation
of cells, called a blastocyst, quickly buries itself in the lining of the uterus,
which is the process known as implantation.
As soon as the blastocyst is implanted, its wall begins to change into a
structure that eventually develops into the placenta. Through the placenta the
fetus secures nourishment from the mother and rids itself of waste products.
Essentially the placenta is a filtering mechanism by which mother’s blood is
brought close to the fetal blood without the actual mixing of blood cells.
The outermost membrane which surrounds the developing embryo is called
the chorion and the innermost is the amnion. The amnion contains the fetus
surrounded by the amniotic fluid. The amnion and fluid are sometimes known
as the “bag of water” which breaks to signal the onset of labour.
The placenta, also known as the “afterbirth” because it becomes detached
from the uterus after delivery, produces its own hormone as it develops in the
uterus. This hormone is called human chorionic gonadotropin – HCG, or preg-
nancy hormone, and it stimulates the corpus luteum to continue producing
hormones until about the third month of pregnancy, when the placenta itself
takes over the endocrine function and releases estrogen and progesterone.
During the early stages of pregnancy, the future child grows at an extremely
rapid rate. The mother’s body must undergo profound changes to support
this organism. The muscles of the uterus grow, the blood volume expands,
the work of the heart increases, the breasts prepare for lactation and other
adjustments are made throughout the mother’s body.

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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-stim-
ulating 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 produc-
tion 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 woman’s lifetime
• lactiferous ducts – tubes that carry milk within a breast
• menarche – the beginning of the first menstrual period during puberty
• myometrium – the muscle layer lining the uterus
• ovaries – female gonads
• ovulation – release of the ovum from the ovary
• ovum (pl. ova) – egg cell; female gamete
• parturition – the act of giving birth
• perimetrium – the membrane surrounding the uterus
• perineum – in females, the area between the anus and the vagina
• placenta – vascular organ that develops during pregnancy in the uterine
wall and serves as a communication between the maternal and the fetal
bloodstream
• progesterone – hormone produced by the corpus luteum in the ovary and
the placenta of pregnant women
• puberty – beginning of the fertile period when gametes are produced and
secondary sex characteristics appear
• tocia - childbirth
• uterus – womb; muscular organ in which the embryo develops
• vagina – birth canal; a tube extending from the uterus to the exterior of
the body

Combining Forms Meaning Terminology

amni/o amnion amniocentesis = surgical puncture of
amniotic sac
colp/o vagina colposcopy = visual examination of birth
vagin/o canal
vaginocele = vaginal hernia
galact/o milk galactorrhea = persistent discharge of
lact/o milk
lactogen = forming or producing milk
gynec/o woman, gynecology = specialisation in female
female reproductive system
hyster/o womb, hysterectomy = removal of the uterus
metr/o uterus metrorrhagia = excessive uterine
metri/o bleeding
uter/o uterine = pertaining to the uterus

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mamm/o breast mammogram = radiograph of the breast
mast/o mastitis = inflammation of breast tissue
men/o menstruation menorrhagia = escessive menstrual flow
myom/o muscle myomectomy = removal of fibroids from
tumour uterus
nat/o birth prenatal = before birth
obstetr/o midwife obstetric = pertaining to midwifery
o/o egg oogenesis = formation of an egg cell
ov/o ovum = egg
ovul/o ovulation = release of the egg
oophor/o ovary oophorectomy = removal of the ovary
ovari/o ovarian = pertaining to the ovary
salping/o uterine tubes salpingoplasty = surgical repair of a fallo-
oviducts pian tube
fallopian
tubes

Disorders of the Female Reproductive System

1. Breast and Gynecological Conditions
amenorrhea absence of menstrual flow
breast cancer malignant tumour of the breast; the most common
type of canceramong women
cervical cancer malignant tumour of the uterine cervix; one of the
most common malignancies affecting women
cervicitis inflammation of the cervix
chronic cystic mastitis inflammation of the breast tissue; fibrocystic
breast disease
dysmenorrhea painful menstruation
endometrial carcinoma malignant tumour of the inner lining of the uterus
endometriosis endometrial tissue found in abnormal locations
(e.g. ovaries, cul-de-sac, pelvic peritoneum, small
intestine)
fibroids benign tumours of the uterus; leiomyomas
menorrhagia excessive bleeding during regular menstrual flow

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metrorrhagia significant uterine bleeding between menstrual
periods
ovarian carcinoma malignant tumour of the ovary
ovarian cysts collections of fluid within a sac (cyst) in the ovary
pelvic inflammatory inflammation of the pelvic region; salpingitis
disease (PID)

2. Pregnancy and Childbirth

abortion termination of pregnancy before the embryo or
fetus is capable o of surviving outside the uterus
abruption placentae premature separation of a normally situated
placenta
breech presentation abnormality of delivery in which the fetal buttocks
or feet present first rather than the head
caesarean section removal of the fetus by abdominal incision into the
uterus
Down syndrome congenital condition characterized by physical
trisomy 21 malformations and certain degree of mental retar-
dation (three rather than two copies of chromo-
some 21)
dystocia difficult labour
eclampsia serious form of toxaemia during pregnancy
ectopic pregnancy implantation of the fertilized egg in any site other
than the normal uterine lining
fetal erythroblastosis haemolytic disease of the newborn due to Rh
incompatibility
gravida pregnant woman
hydrocephalus accumulation of fluid in brain ventricles (cham-
bers)
kernicterus high levels of bilirubin in the bloodstream of
neonates
placenta praevia placental implantation over the cervical opening
or the lower region of the uterine wall
premature birth when a live infant is born between 20th and 35th
week of pregnancy

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puerperium the period of 42 days following childbirth and
expulsion of the placenta and membranes
pyloric stenosis narrowing of the pyloric sphincter

3. Other Related Terms

atresia congenital absence or closure of a normal body
opening
dyspareunia painful sexual intercourse
infertility inability or diminished capacity to produce
offspring
oligomenorrhea scanty or infrequent menstrual flow
parturition, partus childbirth, the process of giving birth; delivery
pyosalpinx pus in the fallopian tube
sterility inability of the female to become pregnant or the
male to impregnate the female

EXERCISES
1.1. The main functions of the female reproductive system are:
..........................................................................................................................................................................

1.2. The function of the breasts is ...............................................................................................

2. Complete the following sentences:

2.1. Fertilization can occur only on the average of 4 days of every .........................
..........................................................................................................................................................................

2.2. The germ cells are the male ....................... and the.......................................... female
2.3. Beside producing the ova, the ovaries secrete ..........................................................
2.4. The study of female reproductive system is called .................................................
2.5. Julius Cesar is said to have been born by ....................................................................

3. Give the opposite of each term:

3.1. similar ........................................................ 3.6. give ...............................................................

3.2. resemble ................................................... 3.7. complete ...................................................
3.3. young .......................................................... 3.8. careful ........................................................
3.4. male ............................................................. 3.9. complicated ............................................

186
3.5. health .......................................................... 3.10. wealth ......................................................

4. Match the following terms with their meanings:

4.1. mastitis ...................................................... a) muscular layer of the uterus
4.2. myometrium ........................................... b) release of egg from ovary
4.3. menorrhagia ........................................... c) union of egg and sperm cells
4.4. fertilization .............................................. d) inflammation of the breast
4.5. ovulation ................................................... e) excessive bleeding during
menstruation

5. Give the meaning of the following terms:

5. 1. ectopic pregnancy ......................................................................................................................
5. 2. placenta ...........................................................................................................................................
5. 3. breech presentation .................................................................................................................
5. 4. C-section .........................................................................................................................................
5. 5. areola ................................................................................................................................................
5. 6. menopause ....................................................................................................................................
5. 7. dystocia..............................................................................................................................................
5. 8. amnion ..............................................................................................................................................
5. 9. salpingitis .......................................................................................................................................
5.10. perineum .......................................................................................................................................

6. Provide the plural form of the following nouns:

6.1. ovum ............................................................ 6.6. placenta .....................................................

6.2. uterus ......................................................... 6.7. corpus ........................................................
6.3. salpinx ........................................................ 6.8. endometrium .........................................
6.4. fetus ............................................................. 6.9. body .............................................................
6.5. cervix ........................................................... 6.10. amnion ....................................................

187
7. Provide the adjective forms of the following nouns:

7.1. uterus ......................................................... 7.6. amnion .......................................................

7.2. ovum ............................................................ 7.7. ovary ............................................................
7.3. menstruation ......................................... 7.8. cervix ...........................................................
7.4. breast .......................................................... 7.9. cortex ..........................................................
7.5. gamete ....................................................... 7.10. labium ......................................................

8. Give appropriate medical word for the following:

8.1. pregnancy sustaining hormone ..........................................................................................
8.2. finger-like processes surrounding the abdominal opening of each
uterine tube ..............................................................................................................................................
8.3. removal of an ovary ....................................................................................................................
8.4. yellow body ......................................................................................................................................
8.5. mongolism .......................................................................................................................................
8.6. inflammation of an ovary ........................................................................................................
8.7. innermost embryonic membrane ......................................................................................
8.8. accessory parts of the uterus ..............................................................................................
8.9. cessation of a woman’s reproductive function ...........................................................
8.10. the embryo from the beginning of the third month...............................................

9. Translate into Croatian:

Drugs in Pregnancy
Since the tragic crippling of thousands of unborn children in the late 1950s
by the tranquilizer “thalidomide”, the use of drugs during pregnancy has
become a highly controversial issue. Thalidomide was prescribed as a mild
sedative for pregnant women until its disastrous side effects became obvious.
The history of this drug has shown why it is impossible to rely solely on animal
tests in studying the effects of drugs in pregnant women. Humans were found
to be over 700 times more sensitive to thalidomide than hamsters, for example.
Even enormous doses of the drug given to several species of animals failed to
produce the severe crippling, disfigurement, and limb deletion that the drug
causes in humans.

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 The effects of drugs in the fetus depend upon the particular drug (or combi-
nation of drugs), the dosage, and most importantly, the stage of fetal devel-
opment. 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 inges-
tion of all drugs and medications, including over-the-counter and prescription
drugs, be kept to a minimum or totally eliminated during all stages of preg-
nancy, unless such medications are considered necessary by the physician.
Pharmacogenetics, the study of the interrelationship of hereditary constitu-
tion 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

MALE REPRODUCTIVE SYSTEM

Introduction
The male reproductive organs consist of the external genitalia: a pair of
testes, scrotum and penis; accessory glands that secrete special fluids: the
prostate, two seminal vesicles, a pair of bulbourethral glands known also as
Cowper’s glands, and the ducts through which these organs and glands are
connected to each other and through which the spermatozoa are ejaculated
during coitus, seminiferous tubules, epididymis, vasa deferentia and urethra.
Apart from providing structures necessary to transport and maintain sperm
viable, the male reproductive system produces the male sex cells, sperma-
tozoa or sperm, which contain one half of the genetic material necessary to
produce a living being.
The male sex cell, the spermatozoon (pl. spermatozoa = sperm cells) is
a microscopic, relatively uncomplicated cell, composed of a head region,
which contains nuclear hereditary material (chromosomes), and a tail region,
consisting o a flagellum, or a long whiplike tail used for locomotion. The s
perm cell contains relatively little food and cytoplasm, for it needs to live only
enough to travel from its point of release from the male to where the egg
cell lies within the female (uterine tube). Only one spermatozoon of about
200 to 500 million s perm cells which may be released during a single ejac-
ulation (ejection of sperm and fluid from the male urethra) can penetrate a
single ovum and produce fertilization of the ovum. If more than one egg is
passing down the uterine tube when sperm are present, multiple fertiliza-
tions are possible, and twins, triplets, quadruplets, and so forth may occur.
Twins resulting from the fertilization of separate ova by separate sperm cells
are called fraternal twins. Fraternal twins, developing “in utero” with separate
placentas, have individual patterns of inheritance and resemble each other
no more than ordinary brothers and sisters.

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 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 devel-
opment 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 defe-
rens 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 vesi-
cles 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.

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In the male, as opposed to the female, the genital orifice combines with the
urinary opening (meatus).

Figure14.1. The Male Reproductive System

Each epididymis is connected to a vas deferens, a part of the spermatic cord

that conducts the spermatozoa to the duet lying close to the bladder. The vasa
deferentia join with ducts leading from the seminal vesicles just before the
urethra. The combined duet is called the ejaculatory duct. This duct passes
through the prostate and joins with the urethra. The urethra then conducts
the semen through the penis.
The prostate gland secretes a thick fluid which, as part of semen, aids the
motility of the sperm. This gland is also supplied with muscular tissue which
aids in the expulsion of sperm during ejaculation. Cowper glands, or bulboure-

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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 ejac-
ulation, 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 erec-
tile 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. Circumci-
sion 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

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• perineum – area between the anus and the scrotum in the male (vulva in
the female)
• semen – spermatozoa and fluid
• seminiferous – sperm-producing
• sterilization – any procedure rendering an individual incapable of
reproduction
• stroma – supportive, connective tissue of an organ.

Combining Forms Meaning Terminology

cry/o cold; ice cryogenic surgery = surgical method
employing freezing
crypt/o hidden cryptorchism = undescended testicles
gon/o seed gonorrhoea = sexually transmitted
bacterial infection
gonad/o sex glands gonadopathy = disease of the sex glands
olig/o scanty oligospermia = decreased production of
sperm cells
orch/o testis (pl. orchitis = inflammation of testes
orchi/o testes) orchialgia = pain in the testes
orchid/o orchidoptosis = prolapsed of the testes
test/o testectomy = surgical removal of a testis
prostat/o prostate prostatomegaly = enlargement of the
gland prostate gland
py/o pus pyorrhoea = flow or discharge of pus
sperm/o spermatozoa, spermic = pertaining to sperm cell
spermat/o semen spermatocele = swelling containing
spermatozoa
terat/o monster teratoma = a tumour composed of
different types of tissue (e.g. bone, hair,
cartilage, skin)
varic/o dilated vein varicocele = collection of varicose veins
above the testes
vas/o vessel, duct vasectomy = removal of vas deferens
zo/o animal life azoospermia = absence of sperm cells in
the semen

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Disorders and Pathological Conditions of the Male Reproductive System and
Sexually Transmitted Diseases
adenocarcinoma malignant tumour of the prostate; this is the most
of the prostate common cause of cancer in men over 50 years of age;
radical prostatectomy and radiotherapy are common
methods of treatment
anorchidism congenital absence of one or more testes
(anorchia)
balanitis inflammation of the skin covering the glans penis
benign prostatic overgrowth of glandular tissue of the prostate, often
hyperplasia associated with the aging process; as urethral lumen
(hypertrophy) is decreased causing a number of urinary problems
(cystitis, nephritis, etc.); surgical methods of removal
of the prostate gland include:
1. perineal prostatectomy (removal through the
perineum)
2. transurethral resection (TUR – excision through the
urethra)
3. suprapubic prostatectomy (removal through the
opening in the upper bladder)
cryptorchism, undescended testicles; the testes descend into the
cryptorchidism scrotal sac normally about 2 months before birth;
if not, the condition is referred to as chriptorchism;
if they do not descend on their ownby the end of a
child’s first year of life, correction involves surgical
suspension (orchyopexy) of the testes in the scrotum;
the condition may be unilateral or bilateral
epispadia congenital opening of the urethra on the upper
surface of the penis
hydrocele sac (hernia) of clear fluid in the scrotum or in the
tubes leading from the testes
hypospadia congenital opening of the urethra on the
undersurface of the penis
phimosis narrowing or stenosis of the opening of the foreskin
over the glans penis; the condition may interfere with
urination; treatment is by circumcision

196
testicular carcinoma malignant tumour of the testes and ovaries; these
tumours are classified according to the type of tissue
that is involved in the disease; examples of testicular
carcinomas are seminoma, embryonal carcinoma,
choriocarcinoma, and teratocarcinoma (malignant
teratoma); the last one is composed of embryonic
tissue such as bone, hair, cartilage, and skin cells
and has an unpleasant or monster-like appearance;
the tumours are treated by surgery, radiotherapy and
chemotherapy
varicocele swollen, enlarged, herniated veins near the testicles;
the condition is often associated with oligospermia
and infertility; oligospermic men with varicoceles
and scrotal pain should have a varicocelectomy; in
this procedure, the internal spermatic vein is ligated
(piece is cut out and ends are tied off), leading to a
marked increase in fertility.

Sexually Transmitted Diseases (STD, Venereal Diseases)

The following conditions, occurring in both men and women, are the most
communicable diseases in the world and are transmitted by sexual inter-
course:
chlamydial bacterial infection of the urethra of men and the vagina
infection and cervix in women; men may experience dysuria and
a white or clear discharge from the penis; women may
develop a yellowish endocervical discharge, but often
the disease is asymptomatic
genital herpes infection of the skin and mucosa of the genitals caused
by herpes virus (HSV) type II and sometimes type I; after
primary infection, numerous recurrent episodes of the
disease often follow; in more severe cases lesions may
occur within the vagina and cervix, with ulceration or
necrosis of tissue; in such cases there is higher inci-
dence of cervical cancer; the disease is self-limiting and
there is no drug known to be effective as cure.
gonorrhoea inflammation of the genital tract mucous membranes
caused by infection with gonococcus; other areas of the
body such as eye, oral mucosa, rectum, and joints may

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 also be affected; symptoms include dysuria and yellow
mucopurulent discharge in men; some women carry
the disease asymptomatically, while others have pain,
vaginal and urethral discharge and salpingitis.
syphilis (lues) chronic infectious disease affecting any organ of the
bodycaused by a spirochete Treponema pallidum
(spiral-shaped bacterium); it enters the body through
a break in the skin or mucous membrane; at the initial
stage the disease is referred to as primary syphilis;
about three weeks after exposure there is a devel-
opment of a chancre, or a firm, hard, ulcerlike lesion;
in women the chancre usually appears on the labia or
within the vagina; secondary syphilis occurs about four
months after the disappearance of a chancre, which
may also appear on the lip, tongue, eyelid, or anus; the
secondary stage is characterized by a blotchy red rash
over the body; thin white sores appear on the mucosa
of the mouth, throat, and genital area; contagiousness
at this time is extremely high; tertiary syphilis, also
called late syphilis, may develop after the symptoms
of secondary syphilis disappear or it may lie dormant
for many years. Later stages include damage to the
brain, spinal cord, and heart. Syphilis (named after a
shepherd in an Italian poem) can be congenital in the
fetus if transmitted from the mother during pregnancy.
trichomoniasis infection of the genitourinary tract of either sex, caused
by Trichomonas vaginalis, a one-celled organism. This
condition is more commonly found in women and causes
vaginitis, urethritis, and cystitis. In men, it causes pros-
tatitis, cystitis, and urethritis, but most infected males
are asymptomatic carriers who are infectious to their
partners. Several medications are available for the
treatment of Trichomonas.

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EXERCISES
1.1. The organs of the male reproductive system are:.....................................................
..........................................................................................................................................................................

1.2. The main functions of the male reproductive system are:...................................

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2. Complete the following sentences:

2.1. Identical twins are formed from the fertilization of.................................................
.......................................................................................................................................................... sperm.

2.2. If more than one egg is passing down the uterine tube when s perm are
present.............................................................................................................................are possible.
2.3. Seminiferous tubules contain cells which produce ................................................
2.4. In the male the genital orifice combines with the ....................................................
2.5. The ejaculatory duet passes through the ......................................................................
and joins with the ..................................................................................................................................

3. Give the opposite of each term:

3.1. remember ................................................ 3.6. humble .......................................................

3.2. start ............................................................. 3.7. attach ..........................................................
3.3. guilt .............................................................. 3.8. true ...............................................................
3.4. accept ......................................................... 3.9. identical .....................................................
3.5. implicit ....................................................... 3.10. possible ...................................................

4. Match the following terms with their meanings:

4.1. testosterone ............................................ a) removal of the prepuce
4.2. circumcision ........................................... b) prepuce
4.3. phimosis ................................................... c) scanty sperm
4.4. oligospermia .......................................... d) a hormone produced by
interstitial cells in testes
4.5. foreskin ...................................................... e) a narrowing or stenos is of
theprepuce

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5. Give the meaning of the following terms:
5.1. stroma ................................................................................................................................................
5.2. the prostate gland .......................................................................................................................
5.3. sperm cell ........................................................................................................................................
5.4. scrotum .............................................................................................................................................
5.5. Cowper glands ..............................................................................................................................
5.6. hypospadias ....................................................................................................................................
5.7. seminiferous tubules.................................................................................................................
5.8. teratocarcinoma of the testes ..............................................................................................
5.9. cryptorchism....................................................................................................................................
5.10. varicocele........................................................................................................................................

6. Provide the plural forms of the following nouns:

6.1. scrotum ..................................................... 6.6. testis ............................................................

6.2. placenta ..................................................... 6.7. vas deferens ...........................................
6.3. hernia ......................................................... 6.8. teratoma ...................................................
6.4. epididymis ................................................ 6.9. flagellum ..................................................
6.5. spermatozoon ........................................ 6.10. semen ......................................................

7. Provide the adjective form of the following nouns:

7.1. embryo ....................................................... 7.6. testis ............................................................

7.2. maturation ............................................... 7.7. prostate .....................................................
7.3. hernia ......................................................... 7.8. syphilis .......................................................
7.4. ejaculation ............................................... 7.9. semen .........................................................
7.5. perineum .................................................. 7.10. urethra ....................................................

8. Give appropriate medical word for the following:

8.1. nuclear hereditary material ..................................................................................................
8.2. twins resulting from the fertilization of separate ova by separate sperm
cells................................................................................................................................................................

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8.3. the area between the anus and the scrotum at the floor of the pelvic
cavity..............................................................................................................................................................
8.4. the tubules containing cells which manufacture spermatozoa
..........................................................................................................................................................................

8.5. large tube at the upper part of each testis ...................................................................

8.6. a combination of fluid and spermatozoa which is ejected from the body
through the urethra .............................................................................................................................
8.7. congenital opening of the male urethra on the upper surface of the
penis .............................................................................................................................................................
8.8. a sac of fluid in the tubes leading from the testes ..................................................
8.9. chronic infectious disease caused by Treponema pallidum ..............................
..........................................................................................................................................................................

8.10. infection of the genitourinary tract caused by Trichomonas ..........................

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9. Translate into Croatian:

The Controversy of Sexually Transmitted Disease (STD)
Few diseases raise as much controversy as do the sexually transmitted
ones. In the mind of the general public, STD has become confused with the
method of its transmission. Indeed, “we have so consistently identified this
disease with illegimate sex that anybody who gets it feels as though he were a
criminal, no matter how he got it.” Some people claim there is never an “inno-
cent party” to STD. But how else could we classify the husbands and wives
who contract STD from a “cheating spouse”? Some infected persons develop
so much guilt that they do not seek medical care. Others fear the public or
private censure sometimes dispensed by health professionals so they avoid
treatment. The tragedy of STD is two-fold: while many of the STDs are both
curable and preventable, they are not being cured in millions of cases, and
they are not being adequately prevented!
Many people are convinced that the epidemic of STD throughout the world
is evidence of widespread immorality and the decline of civilization. Some
are more concerned that hundreds of thousands of untreated individuals are
harbouring dangerous and damaging pathogens that possibly will be trans-
mitted to unsuspected victims. Other view the increasing numbers of STD

201
cases reported to public officials as evidence of increased personal and social
responsibility. It is hoped that infected people seek help because they want to
be cured and do not wish to give the disease to someone else. Still others look
upon the alarming statistics of incidence and attribute the current epidemic
to better case- finding and reporting techniques. Perhaps all viewpoints have
some merit. One thing is certain: most people are not going to stop having
sexual relations. If they do get STD and are not treated early, they are likely
to suffer severe physical damage, perhaps even death.

STD Warning Signals for Females

−− discharge: abnormal yellow or white vaginal discharge that causes
irritation or itching
−− burning upon urination: painful and frequent urination
−− sores: painless as well as painful sores or blisters in or around the
vagina, external sex organs, mouth, and rectum
−− bumps and lumps: painless vaginal warts, sometimes irritated by a
heavy discharge from the vagina
−− itching: intense itching in the genital area that may result in the
appearance of bumps and lumps
−− lower abdominal pain: with or without fever, this condition may indicate
serious pelvic inflammatory disease (PID)

STD Warning Signals for Males

−− - discharge: white, clear, or often thick yellowish discharge of pus from
the penis or from the rectum following anal intercourse
−− - burning upon urination: painful and frequent urination
−− - sores: painless as well as painful sores or blisters on the penis, around
the genital area, mouth, and rectum
−− - bumps and lumps: bumpy, painless warts; body rash; pimplelike
bumps on the penis, swelling of lymph nodes in the groin
−− - itching: intense itching particularly in the genital area.

(American Medical Association)

(From: Carrol Ch. and Miller D.: Health, the Science of Human Adaptation)

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CHAPTER 15

SENSE ORGANS – THE EYE AND THE EAR

Both the eye and the ear are highly specialized sense organs. They provide
information regarding the external environment. The eye is the receptor for
light stimulation and is responsible for vision. The ear is the receptor of sound
stimulation and is responsible for hearing.

The Eye
The eye functions in a manner similar to that of a camera. Light rays
pass through a small opening and are focused by a lens upon photorecep-
tive surface. In a camera this surface is photographic film. In the eye, it is the
retina. The eye is a globe-shaped organ that is composed of three distinct
layers. Its outermost layer is the sclera. As the name suggests, it is a tough
fibrous tissue and serves as a protective shield for the more sensitive struc-
tures beneath.
The sclera is also known as the white of the eye. A highly vascular middle
layer, the choroid, provides a blood supply for the entire eye. The retina is the
innermost layer. It is chiefly composed of nerve endings that are responsible
for the reception and transmission of light impulses. A specialized portion of
the sclera, the cornea, passes in front of the lens. Rather than being opaque,
it is transparent in order to permit entrance of light into the interior of the eye.
One of the two major humours, or fluids of the eye is the aqueous humour.
The iris divides the aqueous humour into two small chambers, the anterior
chamber and the posterior chamber. A coloured, contractile membrane, the
iris, functions as a sphincter. Its perforated centre is the pupil. The amount of
light entering the eye is regulated by the size of the pupil. As the environmental
light increases, the pupil constricts; as the light decreases, the pupil dilates.
Located behind the posterior chamber is the lens. This crystalline structure
is suspended between the ciliary muscles. As the muscles relax or contract,
they alter the shape of the lens making it thicker or thinner, respectively, thus

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enabling the light rays to focus upon the retina. This process is called accom-
modation. 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 struc-
tures 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

CHOROID
RETINA
OPTIC NERVE SCLERA
IRIS
CORNEA
OPTIC DISC

PUPIL
MACULA PATH OF LIGHT
FOVEA LENS
RETINAL ARTERIES
AND VEINS
VITREOUS CHAMBER

INSET

EYELID PUPIL
SCLERA IRIS

The retina is an extremely delicate eye membrane. It is continuous with

the optic nerve and has two types of light receptors upon its surface, rods and
cones. Rods function in dim light and provide black and white vision. Cones
function in bright light and provide colour vision. Rods and cones contain
chemicals called photo pigments. As light strikes the pigments, a chemical
change occurs that produces a nervous impulse. These impulses are then
transmitted to the brain through the optic nerve. The brain interprets them as
vision. Both the optic nerve and the blood vessels of the eye enter the eyeball
at the optic disc. Its centre is referred to as the blind spot, because the area
has neither rods nor cones.

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 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 environ-
ment to the middle and inner ears. An auricle or pinna is the external struc-
ture 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 membra-
nous 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.

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 Figure: Structures of the external, middle, and inner ear

MALLEUS
INCUS
AURICLE

SEMICIRCULAR CANALS
VESTIBULOCOCHLEAR NERVE
SEMICIRCULAR CANALS

VESTIBULE
EXTERNAL AUDITORY
CANAL COCHLEA

MEMBRANE

OVAL WINDOW
STAPES
TYMPANIC

EUSTACHIAN TUBE

The inner ear, sometimes referred to as the labyrinth because of its compli-
cated 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

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• aqueous humour – fluid in the anterior and posterior chambers of the
eye
• biconvex – having two rounded sides, like part of a sphere, e.g. the lens
of the eye
• chiasm – crossing
• choroid – the middle vascular layer of the eye; a dark brown membrane
• cones – photosensitive receptors; responsible for colour and central
vision
• fovea – tiny depression; in the eye it is the region of clearest vision
• humour – any fluid or semi fluid of the body
• lacrimal – tear producing; pertaining to tears
• lens – a transparent biconvex body behind the pupil of the eye; it bends
light rays
• optic – pertaining to the eye
• opaque – substance that does not allow the passage of light; not
transparent
• photo pigment – light-sensitive pigment in the retinal cones and rods;
visual pigment
• pupil – the dark opening of the eye surrounded by the iris
• refraction – bending of light rays by the cornea, lens, and fluids of the
eye to bring the rays into focus on the retina
• rods – photosensitive receptors responsible for peripheral vision and
vision in dim light
• sclera – tough, white, outer coat of the eyeball
• tunic(a) – layer of coat or tissue; a membrane layer
• visual field – area within which objects may be seen when the eye is in a
fixed position
• vitreous humour – soft, jelly-like material behind the lens

Combining Forms Meaning Terminology

ambly/o dull, dim amblyopia = partial loss of vision
aque/o water aqueous = pertaining to water
blephar/o eyelid blepharitis = inflammation of the eyelid
palpebr/o palpebral = pertaining to the eyelid
core/o pupil coreometer = instrument for measuring
pupill/o the pupil
pupillography = recording eye movement
corne/o cornea corneal = pertaining to the cornea
kerat/o keratotomy = incision of the cornea

208
cycl/o ciliary body or cycloplegia = paralysis of the ciliary body
muscle of the
eye
dacry/o tear; lacrimal dacryoma = tumourlike edema of lacri-
lacrim/o apparatus mal duct
lacrimotomy = incision of the lacrimal
duct
goni/o angle goniometry = examination of the angle
ir/o iris iritis = inflammation of the iris
irid/o iridoplegia = paralysis of the iris
mydr/o widen, mydriasis = enlargement of pupils
enlarge

ocul/o eye oculomycosis = fungal infection of the

ophthalm/o eye
ophthalmologist = eye specialist
opt/o eye, vision optometry = measuring vision
optic/o optical = pertaining to the eye or vision
phac/o lens phacocele = herniation (protrusion) of
phak/o the lens
aphakia = absence of lens
phot/o light photophobia = fear of light
presby/o old age presbyopia = poor vision due to old age
retin/o retina retinosis = abnormal condition of the
retina
scler/o white of the scleromalacia = softening of the sclera
eye (sclera)
scot/o darkness scotoma = area of diminished vision;
blind spot
uve/o uvea; uveitis = inflammation of part or all of
vascular the uvea
layer of the
eye (choroid;
retina)
vitr/o glassy vitrectomy = removal of the vitreous
chamber (its contents)

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Key Terms – the Ear
• auditory – pertaining to hearing
• auricle – the flap of the ear; also called pinna
• cerumen – a waxy substance secreted by the external ear; ear wax
• cochlea – a shell-shaped tube in the inner ear
• endolymph – fluid within the labyrinth of the inner ear
• Eustachian tube – auditory tube
• incus – the second ossicle of the middle ear; the anvil
• labyrinth – a series of intricate communicating passages
• malleus – the first ossicle of the middle ear; the hammer
• organ of Corti – sensitive auditory receptor in the cochlea of the inner
ear
• ossicle – small bone
• oval window – a membrane between the middle and the inner ears
• perilymph – fluid contained in the labyrinth of the inner ear
• pinna – auricle
• saccule – little bag; organ in the inner ear associated with maintaining
equilibrium
• semicircular canals – passages in the inner ear associated with
maintaining equilibrium
• stapes (pl. stampedes) – the third ossicle of the middle ear; stirrup
• tympanic membrane – a membrane between the outer and the middle
ear; the eardrum
• utricle – a tiny sac-like structure in the inner ear; associated with
maintaining equilibrium

Combining Forms Meaning Terminology

acous/o hearing acoustic = pertaining to hearing
audi/o audiometer = instrument to measure
audit/o hearing
auditory = pertaining to hearing
aur/o ear aural = pertaining to the ear
auricul/o auricular = pertaining to an auricle or
ot/o the ear
otalgia = earache
myring/o eardrum myringitis = inflammation of the
tympan/o eardrum
tympanotomy = incision in the tympanic
membrane

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salping/o auditory tube salpingoscopy = examination of the
Eustachian tube
staped/o stapes stapedectomy = excision of the stapes

Pathological Conditions of the Sense Organs

The Eye
Errors of Refraction
An error of refraction (ametropia) is caused when light rays are not brought
into proper focus upon the retina. This may be due to a defect in the lens or
cornea or a defect in the shape of the eyeball. If the eyeball is too long, the
image falls in front of the retina. This condition is called nearsightedness
(myopia). Correction is made by employing a concave lens. Farsightedness
(hyperopia, hypermetropia) is the opposite of myopia. In farsightedness the
eyeball is too short and causes the image to fall behind the retina. Correction
involves the use of a convex lens.
Another form of ametropia is a condition in which the cornea or lens has a
defective curvature. This causes the light rays to diffuse over a large area of
the retina, rather than being sharply focused on a given point. This gives rise
to a condition known as astigmatism. Lenses that compensate for the imper-
fect curvature of the cornea or lens are used to correct astigmatism.

Cataracts
Cataracts are opacities that form on the lens or the capsule that encloses
the lens. These opacities are produced by a build-up of protein, layer by layer,
until there is a loss of vision. The only effective treatment is removal of the
lens or capsule. Several techniques may be employed for cataract removal.
In one method, a super-cooled metal probe (cryoprobe) is placed upon the
cataract. The cataract bonds to the cold probe and the cataract and lens are
gently lifted from the eye (cryoextraction).
Another method of treatment is the removal of the entire Jens and its
capsule (intracapsular cataract extraction). This is usually the method of
choice when the cataract develops as a result of old age (senescent or senile
cataract).

Glaucoma
Glaucoma is an eye disease characterized by increased pressure within the
eyeball (intraocular pressure). This pressure leads to degeneration (atrophy) of
the optic nerve. Glaucoma may result in blindness if not successfully treated.

211
The increased intraocular pressure is due to the failure of the aqueous humour
to drain from the eye through a tiny duct called the canal of Schlemm. Treat-
ment for glaucoma involves the use of medications that cause the pupils to
constrict (myotics). This permits the escape of aqueous humour. If this treat-
ment 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 sepa-
rating the iris from its attachment (iridodialysis, coredialysis).
Glaucoma is diagnosed by the use of an instrument that measures internal
pressure of the eye (tonometer). This procedure is a simple, painless technique
and should be performed on all patients after the age of 35 during routine
eye examinations.

Strabismus
Strabismus is a condition in which the eyes turn from the normal position
so that they are not aimed in the same direction. If the eyes deviate outward
(exotropia), causing a divergent squint, the individual is said to be wall-eyed.
If the eyes turn toward each other (esotropia), causing a convergent squint,
the individual is said to be cross-eyed.
Strabismus may be due to poor vision (decreased visual acuity), un equal
ocular muscle tone, or an oculomotor nerve lesion. Eye testing (refraction) and
prescribing of corrective lenses, eye exercise (orthoptic training) and surgery
(strabotomy) in which the ocular tendons are cut, are the usual methods of
treatment.

Presbyopia
Impairment of vision due to old age. With increasing age, loss of elasticity
of the ciliary body impairs its ability to adjust the lens for accommodation to
near vision. The lens
of the eye cannot become fat to bend the rays coming from near objects
(less than 20 feet). The light rays focus behind the retina, as in hyperopia.
Therefore, a convex lens is needed to refract the rays coming from objects
closer than 20 feet.

Other Conditions and Related Terms

achromatopsia severe congenital deficiency in colour perception;
colour blindness
chalaizon small, hard, cystic mass on the eyelid as a result of
chronic inflammation of a sebaceous gland

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conjunctivitis inflammation of the conjunctiva producing a red or
pink eye
diabetic disorder occurring with the diabetes and
retinopathy characterized by small haemorrhages, edema and
neovascularisation near the optic disc, leading to
scarring and eventual loss of vision
epiphora abnormal overflow of tears
exophthalmos protrusion of one or both eyeballs
hemianopia loss of one half of the visual field, usually due to a
stroke or damage to a portion of the optic nerve or its
fibres
hordeolum (stye) localized, circumscribed, purulent, inflammatory
bacterial infection of a sebaceous gland in the eyelid
macular deterioration of the macula lute of the retina; the
degeneration condition may be inherited, drug induced, or age
related and leads to severe loss of central vision;
peripheral vision is retained
metamorphopsia visual distortion of objects
nyctalopia impaired vision in dim light; night blindness
nystagmus involuntary, rapid, rhythmic movement of the eyeball
retinal detachment two layers of the retina separate from each other as a
result of trauma to the eyeball, head injuries, bleeding,
scarring from infection, shrinkage of the vitreous
humour
retinitis progressive retinal sclerosis, pigmentation and
pigmentosa atrophy, characterized by the deposition of pigmented
scar on the retina
scotoma area of depressed vision surrounded by an area of
normal vision caused by damage to the retina or optic
nerve
trachoma chronic, contagious form of conjunctivitis usually
leading to blindness

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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 (myrin-
gotomy, 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 correc-
tion involves the removal of the stapes (stapedectomy) and reconstruction of
the oval window. Sometimes insertion of an artificial stapes is necessary in
order to restore hearing.

Other Conditions and Related Terms

acoustic neuroma benign tumour arising from the acoustic nerve in
the bran; it causes tinnitus, vertigo and decreased
hearing
anacusia (anacusis) complete deafness; it may be unilateral or bilateral
cholesteatoma collection of skin cells and cholesterol in a sac within
the middle ear
Meniere disease disorder of the labyrinth in the inner ear due to
elevated endolymph pressure within the cochlea
leading to progressive loss of hearing; symptoms
include tinnitus, headache, hyper-sensitivity to loud
sounds nausea and vertigo
noise induced loss of hearing due to excessive exposure to sounds
hearing loss (NIHL) that are too long, too loud and too close

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otitis media (serous, non-infectious inflammation of the middle
or suppurative) ear characterized by accumulation of serum;
inflammation of the middle ear caused by bacterial
infection and with pus formation (suppurative)
otosclerosis hardening of the bony tissue of the labyrinth of the
ear
presbycusis hearing loss occurring with old age; it is the most
common form of nerve deafness resulting from
the physiological process of aging; hearing loss is
irreversible; sudden deafness may occur as a result
of in infectious illness, e.g. mumps or measles
tinnitus noise (ringing, buzzing, roaring) sound in the ears
vertigo, dizziness sensation of irregular or whirling motion either of
oneself or of external objects; it is often associated
with nausea and is due to a severe disturbance of
equilibrium organs in the labyrinth

EXERCISES
1. Explain how the eye functions: ...................................................................................................

2. The ear consists of the following three major sections: ................................................

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

3. Fill in the correct term:

3.1. A highly vascular middle layer of the eye, the ..................................... provides a
blood .............................................................................................................................. for entire eye.
3.2. One of the two major fluids of the eye is the ............................................ humour.
3.3. The ................................................................. tube connects the nose and the throat
with the cavity of the middle ear.
3.4. Lining the inner surface of the cochlea are tiny nerve endings called the
..........................................................................................................................................................................

3.5. A pinna or an .................................................is the external structure designed to

.......................................................................................... sound waves travelling through air.

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4. Match the following terms with their meanings:
4.1. myopia ........................................................ a) the third ossicle of the middle ear
4.2. stapes ......................................................... b) nearsightedness
4.3. esotropia ................................................... c) hearing loss occurring with old
age
4.4. myringotomy .......................................... d) an incision of the eardrum
4.5. presbycusis ............................................. e) a convergent squint (cross-eyed)

5. Define the following terms:

5.1. otodynia .............................................................................................................................................
5.2. intraocular pressure ..................................................................................................................
5.3. paracentesis of the cornea ....................................................................................................
5.4. cerumen ............................................................................................................................................
5.5. oval window .....................................................................................................................................
5.6. cochlea ...............................................................................................................................................
5.7. blind spot ..........................................................................................................................................
5.8. lacrimal canaliculi ......................................................................................................................
5.9. chalazion ..........................................................................................................................................
5.10. microtia ...........................................................................................................................................

6. Provide the plural form of the following nouns:

6.1. disc ............................................................... 6.6. iris .................................................................

6.2. auricle ........................................................ 6.7. tympanum ................................................
6.3. sclera .......................................................... 6.8. pinna ...........................................................
6.4. canthus ...................................................... 6.9. lens ..............................................................
6.5. Conjunctiva .............................................. 6.10. focus .........................................................

7. Provide the adjective form for the following nouns:

7.1. vision ........................................................... 7.6. correction .................................................

7.2. receptor ..................................................... 7.7. divergence ...............................................

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7.3. cerumen .................................................... 7.8. capsule .......................................................
7.4. refraction .................................................. 7.9. impairment ..............................................
7.5. ophthalmology ...................................... 7.10. crystal ......................................................

8. Translate into Croatian:

Conjunctivitis
Conjunctivitis is an infection or an inflammation of the conjunctiva, the deli-
cate membrane that lines the eyelids and continues over the exposed surface
of the eye. Although conjunctivitis will generally run its course in about two
weeks and not cause permanent damage, some untreated cases of conjuncti-
vitis may lead to more serious eye problems. Such complications may include
ulcers on the cornea, the transparent covering across the front of the eye. A
corneal ulcer is an eroded area of the cornea, which, if untreated, may leave
a scar that interferes with vision.
Most cases of conjunctivitis are caused by bacteria, viruses, or fungi. Aller-
gies, chemicals, dust smoke, or foreign objects may also irritate the conjunc-
tiva and lead to conjunctivitis. Measles, a childhood illness, is often accompa-
nied by conjunctivitis. In addition, both children and adults who swim a great
deal may contract conjunctivitis - either from chlorine in the pool or from
contaminated water.
Symptoms
The symptoms of conjunctivitis include redness (pinkeye), burning, itching,
tearing, discharge (sometimes containing pus ), pain and sensitivity to light.
Sometimes the symptoms last a few days; at other times a severe case may
linger for two weeks.
Treatment
Treatment can range from symptom-relieving measures (symptomatic
therapy) to medication. Rest and shielding the eyes from bright light are often
helpful. If the conjunctivitis is caused by environmental irritants, eliminating
such factors may be sufficient. Antibiotic drops (or antiseptic, germ-killing)
may be prescribed.

(Ellis, J. W. Medical Symptoms and Treatments)

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SUPPLEMENT

CHAPTER 16

ONCOLOGY – CANCER MEDICINE

Oncology is the study of tumours. It includes both malignant and non-
malignant growths, or neoplasms. Cancer is a disease generally character-
ized by uncontrolled and excessive growth of body cells. It may develop in
any body tissue and at any age, although more frequently in older people and
rarely in the young ones. As cancerous cell grow they eventually destroy their
surrounding normal tissue and they have also the ability to spread throughout
the body, either by bloodstream or by lymphatic system, and forms distant
sites of malignant growths, which often causes death.
Lung, breast and colorectal cancers rank highest in the percentage of
deaths for women, while lung, colorectal and prostate cancers are highest in
percentage of deaths for men.

Neoplasms
In healthy individuals cell division is an orderly process in which body cells
are produced for growth of the individual or for replacement of cells that are
destroyed or worn out. In some instances, however, cell division is without
purpose. The newly formed cells increase at an uncontrolled rate, producing a
lump or swelling known as a tumour or neoplasm. Neoplasms may be either
benign or malignant.

Benign neoplasms
Benign neoplasms are growths that occur in body tissues. They are
composed of the same cells as the tissue in which they are growing. For
example, a benign tumour of a gland is composed of the glandular tissue from
which it is developing. Benign neoplasms are contained within a capsule and
do not invade the surrounding tissue. They harm the individual only insofar
as they place pressure on surrounding structures. If the benign neoplasm

219
remains small and places no pressure on adjacent structures, it is not often
removed. If it becomes enlarged or places pressure on other organs or struc-
tures, it must be removed. Benign brain tumours are always very serious, since
the cranial cavity is enclosed and pressure on other parts of the brain inevi-
tably results. As a general rule, however, benign tumours are not life-threat-
ening. Once they are removed, they do not regrow.

Malignant neoplasms
The cells that compose a malignant neoplasm often do not resemble the
tissue in which they are growing. In such cases the tumour is said to be undif-
ferentiated. The tumour cells lack specialization in both structure and func-
tion. More significantly, however, the cells of the malignant neoplasm are not
encapsulated and are able to spread to normal tissues. This invasive growth
occurs by direct extension or metastasis. In direct extension, the tumour grows
directly into normal tissue. This is called proliferation. With metastasis the
malignant cells from the primary tumour site find their way into lymph chan-
nels or blood vessels and are carried to remote body structures in which
secondary malignant neoplasms develop.

Nomenclature of Tumours
Tumour nomenclature is based, in part, upon the tissue from which the
tumour originates. This is referred to as histogenesis. For purpose of tumour
nomenclature, four types of tissue are identified: epithelial, connective
(including muscle), hematopoietic (blood and lymph), and nervous tissue. To
indicate a benign tumour that arises from epithelial or connective tissue add
the suffix -oma to the word root. An exception to this rule is melanoma, which
is a malignant tumour of epithelial origin.
There are certain characteristics of a tumour that help in diagnosing
whether it is benign (noncancerous) or malignant (cancerous). A benign
tumour is usually enclosed within a capsule, grows slowly, and does not invade
surrounding tissue (metastasize). A malignant tumour is not encapsulated,
grows rapidly, and metastasizes.

Staging
Staging is an attempt to define the extent of cancer by classifying it into
three categories: T, N and M. T represents the primary tumour site or place of
origin; N represents local or regional node involvement; and M tells whether
or not there is metastasis. When the primary site contains classifications of
Tl, T2, T3, or T4, the higher numbers would indicate progressive increase in
tumour size and involvement. Similarly, NO, Nl, N2, or N3 represents progres-

220
sively advancing nodular involvement. Finally, MO or M+ defines absence or
presence of metastasis, respectively.

Grading
Grading of a malignant tumour is an evaluation of the histological makeup
of the neoplasm. Generally, four grades are employed, Grade l to Grade 4.
Neoplasms that are composed of cells that closely resemble the tissue
from which they arise are given a Grade l rating. The tissue demonstrates a
minimum amount of anaplasia.
At the other extreme is Grade 4 in which there is a great deal of anaplasia
within the tumour. Such tumours are more serious and prognosis is very poor.
Grades 2 and 3 are intermediate grades between these two extremes.

HISTOGENESIS OF BENIGN AND MALIGNANT NEOPLASMS

HISTOGENESIS BEHAVIOUR
TISSUE OF ORIGIN BENIGN MALIGNANT
1. Epithelial Tissue Tumours:
surface epithelium
glandular papilloma carcinoma
epithelium adenoma adenocarcinoma
2. Connective Tissue Tumours:
fibrous tissue fibroma fibrosarcoma
cartilage chondroma chondrosarcoma
bone osteoma osteosarcoma
fat lipoma liposarcoma
blood vessels hemangioma hemangiosarcoma
lymph vessels lymphangioma lymphangiosarcoma
smooth muscle leiomyoma leiomyosarcoma
striated muscle rhabdomyoma rhabdomyosarcoma
3. Hematopoietic Tissue Tumours:
lymphoid tissue myelocytic leukemia
granulocytic tissue erythroleukemia
erythrocytic tissue multiple myeloma
plasma cells plasmocytoma
4. Nerve Tissue Tumours:
glial tissue glioma
meninges meningioma meningeal sarcoma

221
nerve cells neuroma, neuroblastoma,
ganglioneuroma melanoma
neuroectoderm nevus (nevocytoma) neurolymphoma
nerve sheaths neurilemoma neurilemmic sarcoma
retina retinoblastoma
adrenal medulla pheochromocytoma
5. Tumours Consisting of More than One Tissue:
breast fibroadenoma cystosarcoma
embryonic kidney nephroblastoma
multipotent cells teratoma choriocarcinoma
uterus mixed mesodermal
6. Tumours that do not Fit into One of the Above Groups:
melanoblasts pigmented nevus melanoma
placenta hydatidiform mole choriocarcinoma
ovary cystosarcoma
cell tumours
testis teratoma
thymus thymoma

The terms that are listed below describe the appearance of a malignant
tumour either on gross (visual) or on microscopic examination

Gross Descriptions
cystic forming large open spaces filled with fluid; mucinous
tumours are filled with mucus, while serous tumours
are filled with watery fluid resembling serum; the most
common site is in ovaries
fungating a mushroom-like pattern of growth during which
tumour cells pile one on top of the other; usually found
in colon
inflammatory - having the features of inflammation: redness, swelling,
heat; usually occur in the breast
medullar large soft fleshy tumours; usually occurring in the
thyroid and the breast
necrotic containing dead tissue; any type of tumour can outgrow
its blood supply and undergo necrosis

222
polypoid projections extending outward from a base, like
extending from a stem or stalk
ulcerating characterized by an open, i.e. exposed surface resulting
from death of the overlying tissue; often found in the
stomach breast, colon, skin
verrucous resembling a wart-like growth; tumours of the gingival
are usually of the verrucous type.

Microscopic Descriptions
alveolar tumour cells look like microscopic sacs; commonly
found in tumours of the muscle, bone, fat and cartilage
carcinoma in situ – localized tumour that has not invaded the adjacent
structures
diffuse spreading evenly throughout the affected tissue; e.g.
malignant lymphomas areknown to have such spread
dysplastic pertaining to abnormal cell formation, not clearly
cancerous; examples are dysplastic nevi
epidermoid resembling squamous epithelial cells, often occurring
in the respiratory tract
follicular forming small microscopic, gland-type sacs; e.g. the
thyroid cancer
nodular forming multiple areas of tightly placked clusters of
cells (nodules); e.g. malignant lymphomas
papillary small finger-like or nipple-like projections of cells; e.g.
bladder cancer
pleomorphic composed of a variety of types of cells; e.g. mixed-cell
tumours
scirrhous densely packed, hard tumours, overgrown with fibrous
tissue; e.g. breast or stomach cancers
undifferentiated – lacking microscopic structures typical of normal
mature cells.

Treatment
Malignant tumours – cancers, are usually treated by three standard
methods either singly or in combination. These are: surgery, radiation and
chemotherapy. Besides these, new methods of treatment are being extensively
tested and gradually introduced. These include biological agents, e.g. mono-

223
clonal antibodies, and differentiating agents, e.g. those that cause tumour
cells to differentiate stop growing and die.

EXERCISES
1.1. What is oncology? ........................................................................................................................
1.2. Name four tissues from which the tumour originates...........................................
..........................................................................................................................................................................

2.1. In healthy ................................. cell division is an ............................................ process.

2.2. Benign neoplasms are ................................... within a ......................................................
2.3. Benign brain tumours are always very ..................................... : ...................................
2.4. Staging is an ................................................. to define the ............................ of cancer.
2.5. N represents ................................................. or ................................ node involvement.

3. Match the following terms with their meanings:

3.1. proliferation ............................................ a) a new growth of tissue
3.2. staging ....................................................... b) spread of malignant cells into the
surrounding tissue
3.3. sarcoma .................................................... c) a method of classifying malignant
spread
3.4. neoplasm .................................................. d) malignancy of connective tissue
origin

4. Give the meaning of the following term:

4.1. lethal ........................................................... 4.6. lipoma ........................................................

4.2. oncologist ................................................. 4.7. meninges ..................................................
4.3. multicentric ............................................ 4.8. hemangioma ..........................................
4.4. dormant ..................................................... 4.9. melanoma ................................................
4.5. fibroma ...................................................... 4.10. necrotic ...................................................

5. Give appropriate medical word for the following:

5. 1. the newly formed cells.............................................................................................................
5. 2. an undifferentiated tumour ..................................................................................................

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5. 3. an attempt to define the extent of cancer ....................................................................
5. 4. an evaluation of the histological makeup of the neoplasm ...............................
5. 5. epithelial tissue having velvety appearance ...............................................................
5.6. penetrating the spaces within tissues ............................................................................
5. 7. a cancerous tumour composed of cells of epithelial tissue .............................
..........................................................................................................................................................................

5. 8. tumour of a smooth muscle ................................................................................................

5. 9. pertaining to the marrow .......................................................................................................
5.10. tumour of the skeletal muscle ..........................................................................................

6. Provide the adjective forms of the following nouns:

6.1. cancer ......................................................... 6.6. multiplication .........................................

6.2. lymph .......................................................... 6.7. genesis .......................................................
6.3. glioma ........................................................ 6.8. ability ..........................................................
6.4. structure ................................................... 6.9. neoplasm ..................................................
6.5. predomination ....................................... 6.10. granulocyte ...........................................

7. Provide the plural form of the following nouns:

7.1. melanoma ................................................ 7.6. tremor ........................................................

7.2. nevus ........................................................... 7.7. loss ...............................................................
7.3. axilla ............................................................ 7.8. neurosurgeon ........................................
7.4. radiotherapy ........................................... 7.9. disk ...............................................................
7.5. area .............................................................. 7.10. month .......................................................

8. Translate into Croatian:

A 37-year-old male underwent abdominal resection for a malignant mela-
noma arising in a nevus. One year later, he underwent bilateral axillary node
dissection, which indicated 2 of 23 left axillary nodes positive for tumour. Two
months later, his bone scan was positive at the right proximal humerus, and
a biopsy revealed metastatic melanoma. The patient began having symptoms

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of involvement of the fourth lumbar nerve roots and received radiotherapy to
the L-4 spine and the humerus with good response.
However, several weeks later, he noted progressive right leg weakness
and left leg sensory loss. Myelogram demonstrated two metastatic lesions
at 7 -12/L-1 and L-4 that were not thought to be accessible surgically. The
patient received further radiotherapy to the affected vertebral areas. The
patient received one course of BCNU (a chemotherapeutic drug) from another
physician who noted some optic disk edema. The patient was placed on dexa-
methasone (Decadron) therapy for 2 weeks, after which his course deterio-
rated progressively with numbness in his upper extremities bilaterally, left leg
hyperesthesia, and tremors. Decadron was continued and a neurosurgeon felt
that little could be done surgically to reverse the deficits.

(From “The Language of Medicine” Davi-Ellen Chabner)

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CHAPTER 17

GENERAL CARE OF THE PATIENT

The patient admitted to hospital enters a strange world and is apprehen-
sive in case he or she has cancer or is to undergo an operation, and worries
about his family at home. The nurse should introduce herself and deal with
the patient calmly, tactfully, pleasantly and reassuringly. The patient should
be made comfortable. His/her name, age, address and the name, address
and telephone number of next-of-kin should be recorded. Rest in bed helps
to combat disease but predisposes, especially in the elderly, to stiff joints,
weak muscles, bedsores, constipation and venous thrombosis, which must all
be prevented. Noise disturbs rest and should be avoided. Cupboards, doors,
bedpans and trolleys should not be allowed to bang, and nurses’ shoes should
have rubber soles and heels.

Daily Routine
Each morning the patient should be bathed and the bed made. The hands
are washed in the middle of the day, after defecation and at night, and the hair
is brushed. The mouth, skin and bowels are cared for. The patient is assessed
for the intensity of treatment required on the grounds of age, general condi-
tion, degree of arterial disease and the disease causing admission. Thus an
elderly, poorly nourished patient with paralysis will need frequent turning and
care to pressure areas, whereas a young person with appendicitis will need
less intensive nursing.

Feeding
The patient should be positioned comfortably and be allowed to wash his/
her hands. The nurse washes her hands before handling crockery or cutlery or
serving food. Everything should be within easy reach of the patient. Helpings
should be small; more being given later if required. Only one course should
be served at a time. Plates, glasses and cups should not be too full.

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 For recumbent patients a serviette is placed under the chin and the head is
raised by placing the hand beneath the pillow, not under the neck. The patient
is fed at his own pace. Liquids may be taken through a straw. The diet should
be adequate in joules, fat, protein, vitamins and minerals.

Moving the Patient

The patient who is weak or unable to move should be lifted, not dragged,
into position in bed. Dragging causes friction between the skin and the sheet
and predisposes to bedsores. Before lifting, the pillows should be tidied and
the bedclothes loosened. The nurse should not attempt to lift a heavy patient
without assistance, either from the patient, if permitted, or from a second
nurse. There are several ways of lifting. In the Australian lift each nurse places
her shoulder under the patient’s axilla and the arm below the thigh, grasping
the other nurse’s wrist. The nurse should keep her back straight, bending
from the hips so as to prevent injury to her back. To turn a patient the nurse
stands at the side to which the patient is to be turned; places his arm across
his chest and crosses his legs, reaches over him, and with one hand around
the pelvis and the other below the shoulder, turns him towards her.
To move a patient from a trolley to a bed, the two are placed at right angles
to each other, the head of one near the foot of the other. Three persons stand
on the same side of the patient and lift together.

Bathing in Bed (“Blanket Bath”)

Procedure: Explain the procedure to the patient. Screen the bed. Ask the
patient if he wishes to use a bedpan or urinal. Place clean nightwear on a
nearby radiator to warm. Turn the bedclothes back, leaving the patient covered
with his top sheet. A large bath towel is placed beneath him to prevent the
bedding from getting wet. Remove the patient’s nightwear, drape a blanket
over him if he is likely to feel cold, and wash him with soap and hot water,
starting with the face and neck, using the face flannel and towel, allowing the
patient to wash and dry his own face, if able. A second flannel is used for the
remainder of the body, only exposing those parts of the patient which are being
washed. When the arms, chest and abdomen have been washed and dried, the
water in the bowl is changed and the lower limbs, genitals and buttocks are
washed. The patient should wash and dry his own pubic area, if able. The feet
should be placed in the bowl of water, if possible. During bathing the patient is
unobtrusively examined, and any skin rashes, bruises, sacral edema or other
abnormality reported. The pressure areas are massaged during the bed bath,
the patient dressed in the warmed nightwear, the nails trimmed if necessary,

228
and the hair brushed or combed. The teeth or dentures are cleaned (the patient
may do this), and a mouthwash is given.
The bed is made with clean linen and the patient repositioned and asked
if he is comfortable.
Female patients may be helped with their cosmetics.

Care of the Skin (Pressure Areas)

Bedsores are gangrenous ulcers due to ischemic death of the skin. Causes:
exclusion of blood from the skin by prolonged pressure caused by immobility
(paralysis, stiff joints, sedation), lying or sitting on creases of linen, crumbs, or
hard pads, or a moist skin, e. g. incontinence of urine or feces, local sweating
(sitting on plastic). Rough handling easily damages skin which is inelastic
(elderly patients), has a poor circulation (atheroma), or is poorly nourished.
Edema and congestion prevent the exchange of metabolites between the blood
and the tissues. The areas to be treated are the elbows, shoulder blades, tips
of the shoulders, occiput, vertebrae, iliac crest, buttocks, knees, ankles and
heels.
Reassure the patient and explain the reason for the procedure. Close the
windows and screen the patient. Turn back the bedclothes, leaving a sheet
covering the patient. Clean the area with a damp wipe, especially the buttocks
if the patient is incontinent. Wash with soap and water, dry the area thor-
oughly 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 finger-
tips. 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

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nits. If a man is too ill to shave himself, he may be shaved by a visiting barber,
convalescent patient, or the nurse.

(Harrison, R. Textbook of Medicine with Relevant Physiology and Anatomy)

EXERCISES
1. Fill in the correct term:
1.1. The nurse should ............................................................................................ the patient’s
name, age and address upon admission to the hospital.
1.2. Bed rest ................................................. the elderly to .............................................. joints.
1.3. Each morning the patient should be .............................................................. and the
bed .................................................................................................................................................................
1.4. An elderly, poorly ................................................................................... patient will need
frequent ......................................................................................................................................................
1.5. Only one course should be ................................................................................ at a time.
1.6. The patient is fed at his own .................................................................................................
1.7. Dragging causes ................................................................................and predisposes to
1.8. The nurse should not attempt to .................................................................................... a
heavy patient without .........................................................................................................................
1.9. During bathing the patient is ......................................................................... examined.
1.10. Decubitus .........................................................................are aids to the prevention of
................................................................................................................. sores.

2. Define the following terms:

2.1. hospitalization ...............................................................................................................................
2.2. next-of-kin .......................................................................................................................................
2.3. appendicitis .....................................................................................................................................
2.4. intensive nursing .........................................................................................................................
2. 5. helping(s) ........................................................................................................................................
2. 6. recumbent patient .....................................................................................................................
2. 7. joule ....................................................................................................................................................

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

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5.2. an ulceration caused by prolonged pressure in a patient lying still in bed
for a long period of time ...................................................................................................................
5.3. a vessel for urine .........................................................................................................................
5.4. stools ..................................................................................................................................................
5.5. sweating ............................................................................................................................................
5.6. pain in a joint/joints ....................................................................................................................
5.7.lack of muscle strength ............................................................................................................
5.8. deficiency of blood in a body part.......................................................................................
5.9. reddening of the skin ................................................................................................................
5.10. any joint disease.........................................................................................................................

6. Circle the correct spelling:

6.1. tromboses ............................... thrombosis .......................... thrombozis ........................
6.2. peristalsis ............................... perastalsis ........................... parastalsis .........................
6.3. seedation ................................. cedation ................................ sedation...............................
6.4. convalescent .......................... convalesent ......................... konvalescent ...................
6.5. iritation ..................................... irritation ................................ eerritation .........................
6.6. symdrone ................................. sindrome .............................. syndrome ...........................
6.7. periferal .................................... peripheral ............................ peripherel .........................
6.8. appendix ................................... apendix .................................. appendiks ..........................
6.9. paralisis .................................... paralysis ............................... parelysis .............................
6.10. sweat ....................................... swet ......................................... swat ..................................... .

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CHAPTER 18

BRITISH MEDICAL TRAINING AND REGISTRATION

1. Undergraduate Training
There are not enough places at British medical schools for all those who
wish to study medicine. Consequently competition for places is very great and
it is almost impossible for a student from another country to get a place. The
study period normally lasts about six years. For the first three years of pre-
clinical studies, the student is taught the scientific basis of his profession. He
is trained in such subjects as human anatomy, physiology, biology, biochem-
istry, bacteriology, elementary psychology and so on. Then follow three years
of clinical training during which time the student not only attends lectures
and classes but also progresses through a whole series of practical clinical
clerkships. In these clinical clerkships, he helps in hospital wards and out-
patient clinics under the guidance of hospital doctors. He learns and prac-
tices the careful examination of patients, writes up their case histories and -
under supervision - learns the technique of a wide variety of diagnostic and
therapeutic procedures. He also has to attend the teaching ward rounds of
the consultant in charge of the department, help the surgeon in the oper-
ating theatre and be present, and help, at a required number of confinements
(births). At the end of his clinical years, he takes examinations which include
written, practical and oral examinations, known as the Finals. If successful,
he may acquire a University degree or one of the other, but lesser, basic regis-
trable qualifications or licenses. He is then granted Provisional British Medical
Registration as a doctor. This newly qualified U. K. Doctor must then complete
satisfactorily two scheduled House Officer appointments as a resident hospital
doctor in medicine and surgery (or obstetrics and gynaecology) lasting six
months each before he can get Full British Medical Registration. Only after
he is fully registered may he enter any other form of medical employment,
become a trainee in general practice or start working towards any specialist
diploma.

233
 In Britain the University Diploma of M. D. (Doctor of Medicine) is not a basic
medical qualification but is a higher specialist degree in Internal Medicine
which is gained several years after getting a basic University medical degree.
The candidate must pass a difficult examination and/or write an acceptable
thesis. Normally an M. D. degree can only be gained at the same university
where the doctor gained his basic degree.

2. Medical Registration for Overseas Doctors

An overseas-qualified doctor must apply to the general Medical Council
for registration before engaging in any professional employment in the United
Kingdom. Registration gives a doctor the legal status necessary for carrying
out his professional duties.
There are three types of registration - full, provisional and limited. Full
registration may be granted by the General Medical Council if the doctor holds
qualifications recognized by the G.M.C. for the purpose. A doctor with such
qualifications may be granted provisional registration if, in the view of the
G.M.C., he lacks the necessary professional experience for full registration.
However, the number of posts in the U.K. suitable for doctors with provisional
registration is so limited that doctors from overseas are urged to gain the
required experience before coming to this country.
Limited registration may be granted to a doctor who holds a qualifica-
tion, obtained overseas, which is accepted by the G.M.C. for this purpose.
Such registration may be held only in respect of supervised appointments in
approved hospitals or institutions and may be granted in relation to one partic-
ular employment or specified range of employment. Limited registration for
new entrants is subject to a time limit of five years.
The majority of overseas doctors who wish to apply for limited registra-
tion for the first time will be required to take and pass the PLAB test (Profes-
sional and Linguistic Assessments Board) which comprises both medical and
linguistic components. Limited registration is now granted, in the main, only
for employment in hospital posts or departments which have been approved
for educational and training purposes by one of the Royal Colleges or faculties.

3. Postgraduate Training in the UK

Overseas doctors should be fully medically qualified and registered in their
own country and must speak and write English fluently. They should not come
to Britain until they have completed at least two years of post qualification resi-
dent hospital appointments in their own country. Many British higher diplomas
prescribe definite periods of resident hospital appointments in recognized

234
hospitals which must be served before the examination can be attempted.
Very few overseas hospitals are recognized.
The amount of postgraduate medical training in Britain consisting of full-
time teaching courses is limited. Places on such courses are usually awarded
by selection to graduates who are fluent in English and who also have consid-
erable recent clinical experience in major hospitals. Doctors accepted for
British Medical Registration who work in the British hospital service receive
postgraduate guidance and training and by using the postgraduate training
facilities available at the nearest Postgraduate Medical Centre, they can gain
considerable further training in the common specialties, internal medicine,
general surgery and so on. Over 260 large General Hospitals are graded as
District General Hospitals and have good libraries and Postgraduate Centres
where regular programmes of lectures, case-demonstrations and so on are
held. At many District General Hospitals, regular one-day-a-week courses,
known as day-release courses, are also held in preparation for a number of
postgraduate diplomas. To work in a small hospital, therefore, does not mean
that the graduate will be cut off from postgraduate training opportunities.

(Joy Parkinson: A Manual of English for the Overseas Doctor)

4. Nurse education programmes – conditions required for UK registration

• Duration of at least 3 years of full-time nursing studies and which
included at least 4600 hours of nursing education. This means that
unrelated subjects, such as foreign languages, sport or philosophy, do
not count towards the nursing education hours but applied subjects such
as healthcare ethics would be relevant.
• The nursing programme does not have to be delivered at a degree
level, but it should be undertrained after completion of full secondary
education and after reaching the age of 17.
• The nursing programme needs to be equally divided between theory and
practice and the programme must cover five main areas i.e. medical,
surgical. Women and children, mental health and community.
• Upon completion of the nursing education programme, nursing students
should be considered to be fully qualified registerable first-level nurses
and fully capable of obtaining the nursing diploma and right to practise.
This implies that the nursing education programme is considered to
be complete in itself and without additional practice periods and/or
supervision, and that until nursing students obtain the nursing diploma
they are not considered to be fully qualified first-level nurses.

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 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 expe-
rience problems getting onto the register.

(Joy Parkinson & Chris Brooker: Everyday English for International Nurses
- a guide to working in the UK. Churchill Livingstone, 2004)

236
CHAPTER 19

SMOKING - HAZARDOUS ADAPTATION

Since the beginning of time, human beings have searched for substances
that would not only sustain and protect them but also would act on their
nervous systems to produce pleasurable sensations. Among the things that
have been found to have a psychoactive effect - a temporary change in mood,
though t, feeling, or behaviour – are ethyl alcohol, hemp and cactus plants,
mushrooms, poppies, and tobacco, a herb that has been smoked and sniffed
for more than 400 years.
People have been attracted to these psychoactive substances because they
have been useful in helping individuals adapt to an ever-changing environment.
Indeed, smoking, drinking, and drug taking have lightened the load of life;
reduced tensions, anxieties, and frustrations; counteracted boredom as well
as fatigue; enhanced the pleasures of the moments; and in some instances,
provided an escape from the harsh realities of existence. Chemical mood and
behaviour modifiers have also been employed to enhance self-image, build
confidence, gain approval or acceptance, and heal psychological hurts.
Use of substances for such personal gratification and temporary adapta-
tion often carries a high price tag, such as various forms of drug dependency,
personal and social disorganization, and predisposition to serious and some-
times fatal diseases. These undesirable and health-threatening consequences
of adaptive and adjustive behaviour are referred to as maladaptations, which
usually occur as the remote consequences of behaviour that has an imme-
diate beneficial effect.
Such is the case with cigarette smoking, now characterized as one of the
most serious and yet preventable health problems, a major international
threat, and “suicide in slow motion”. The dimensions of this adaptive, yet
disease-producing, activity are more easily recognized when one examines
the reasons for the inability to stop smoking. Two areas have often been cited
in which remedial action is more difficult to initiate.

237
1. The individual smoker who becomes “hooked” after taking 60.000 or more
puffs a year on a cigarette. The minor vice of smoking- that silly little ha
bit- has been well learned through repetitive practice. Habits well learned
are hard to break!
2. Our society at large which finds itself “hooked” - burdened with a king-sized
tobacco industry, mammoth agricultural enterprise, a considerable source
of governmental revenues, and a significant customer of the communica-
tions 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 nega-
tive, 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 environ-
ments. 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 teen-

238
agers are smoking, perhaps as an early sign of female social emancipation.
Surveys also indicate that nearly a million teenagers in the United States take
up smoking each year. The influence of peers who smoke and the role model
of smoking parents continue to attract new smokers despite the real health
hazards. In fact, most teenagers who smoke regularly are from families where
one or both parents smoke.

Personal Use vs. the Non-smoker

Until the invention of the cigarette manufacturing machine after the Civil
War, tobacco was principally consumed in pipes and cigars and in chewing
and sniffing. Once mass production of cigarettes was a reality and production
cost decreased, cigarettes became readily available Their pre-eminence as a
tobacco form has been traced to World War I where they found the favour of
the doughboys (soldiers).
Cigarettes have enjoyed an immense popularity because they provide the
user with certain personal gratifications unobtainable in other tobacco forms.
They can be smoked easily and quickly; they can be in haled; they are readily
available and relatively inexpensive; and they have been socially accepted or
at least tolerated.
Smoking has long been considered an individual right. However, little
thought or consideration has been given to what right the non-smoker has
to live and work in areas free from air polluted by smoke. It would seem as
though the non-smoker has a right to travel in an airplane, bus, or train; to
listen to a lecture or attend a concert in an auditorium; to work; or to eat at
a restaurant, without being exposed to air filled with the smoke from ciga-
rettes, pipes or cigars. This calls for major changes as separate areas for the
smoker and the non-smoker arc increasingly demanded.
Recently the silent majority of non-smokers have become assertive in its
demands for plain, unpolluted air. Tired of being assaulted by tobacco smoke,
the vocal and visible non-smokers now proclaim that the smoker’s liberty ends
where their noses begin. Considerable number of organized groups of non-
smokers together with professional medical and dental associations, have
been successful in restricting smoking in public areas and in establishing the
legal right of non-smokers to be free of others’ cigarette smoke.
The non-smokers’ liberation movement has been successful in banning
cigarette commercials on television, limiting smoking in certain hospitals,
lobbying for laws and regulations that require health warnings on cigarette
packages and separate smoking and non-smoking sections on commercial
airlines and buses, and prohibiting smoking in trams, elevators, indoor thea-
tres, libraries, art galleries, museums, and dining cars of passenger trains.

239
 Not to be overlooked as a factor in cigarette consumption are the persis-
tent promotional activities of tobacco companies and their advertising agen-
cies. 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, advertise-
ments 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 chil-
dren 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 accept-
ance 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 psycholog-
ical rewards for the new smoker. Smoking may be the passport to acceptance
among one’s peers; it may represent freedom or independence from restric-

240
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 hand-
to-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 perking-
up effect is due to nicotine’s temporary stimulation, which briefly relieves
fatigue. If you try to give up smoking, you may want a safe substitute: a brisk
walk or moderate exercise whenever you feel the urge to smoke.
2. Handling - Oral Gratification - Having something to handle, manipulate,
or fondle can be very satisfying. Additionally, having something in your mouth
to chew on, such as a toothpick, straw, or pencil, can fulfil certain emotional
needs. From a Freudian perspective, cigarette smoking may be seen as a
satisfaction of infantile needs to suck or chew - a fixation or libidinal energy
at the oral or mouth level. Why not try with a pen or pencil? Try doodling or
play with a coin, a piece of jewellery, or some other harmless object. If you
must put something in your mouth, use candy cigarettes or even a real ciga-
rette 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 content-
ment, achievement, victory, and satisfaction - such as upon completion of a
job well done or after a delicious, mouth-watering meal. Those who do get
real pleasure out of smoking often find that an honest consideration of the
harmful effect of their habit is enough to help them quit. They substitute eating,
drinking, social activities, and physical activities - within reasonable bounds
- and find they do not seriously miss their cigarettes.
4. Crutch-Tension Reduction - Many smokers use the cigarette to manage
negative effects, such as stressful situations and feelings of anger, fear, and
anxiety. Sometimes the cigarette is used as a tranquilizer or as an escape
vehicle from cares and worries. Thus, smoking represents a tension- reducing
activity. When the going gets rough, cigarettes can be a crutch, a comfort, and
a consolation. When it comes to quitting, this kind of smoker may find it easy

241
to stop when everything is going well but may be tempted to start again in a
time of crisis. Again, physical exertion, eating, drinking, or social activity - in
moderation - may serve as useful substitutes in times of tension.
5. Craving- Psychological and Physical Addiction- Quitting smoking is diffi-
cult for the person who scores high on the factor of craving. For such an indi-
vidual, 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 with-
drawal symptoms - a “nicotine fit” with its uneasiness, restlessness, nervous-
ness, anxiety, headache, digestive disturbances, and impairment of concen-
tration, judgment, and psychomotor performance.
Peculiarly, the dependent smoker craves a cigarette, as in chain-smoking,
first to increase positive feelings and then to decrease negative feelings of
withdrawal. In essence, the smoker satisfies a need to smoke - a physical
need for more nicotine. Contrary to popular belief, research now suggests
that smoking does not reduce anxiety or calm nerves. Under stress, smokers
consume cigarettes heavily because stress depletes the body’s nicotine. Thus,
nicotine-deficient smokers smoke more under stress to maintain their usual
nicotine level.
Tapering off is not likely to work for dependent smokers. They must go
“cold turkey”. It may be helpful for them to smoke more than usual for a day
or two, so that the taste of cigarettes is spoiled, and then isolate themselves
completely from cigarettes until the craving is gone. Giving up cigarettes may
cause so much discomfort that once these persons quit, they will find it easy
to resist a return to smoking. Otherwise, they know that some day they will
have to go through the same agony again.
6. Habit-A behavioural pattern has been established almost involuntarily
by the habit smoker. This individual responds automatically to some cue - a
cup of coffee, getting into a car, or nearing the vicinity of an ashtray. Once
regarded as psychologically significant, smoking loses its former functions of
fulfilling status, relaxation, security, or other needs. Such a smoker no longer
gets much satisfaction from cigarettes.

Smoking: Agent of Maladaptation and Disease

From health point of view, personal gratification is acceptable for most
persons as long as it does not injure the individual or cause harm to other
persons. Unfortunately, smoking is now seen as a health threat to both.
Smokers, non-smokers, and even unborn children are caught up in this multi-
faceted problem leading to self indicated morbidity and premature mortality,

242
increased health and welfare cost, added irritating effects of cigarette-induced
air pollution, and the mounting threat of home, commercial, and forest fires
caused by discarded cigarettes.

Figure 19.1. Diseases and conditions associated with smoking

tobacco
amblyopia
lip, tongue,
bronchitis gum cancer
emphysema
larynx cancer
coronary
heart disease lung cancer

cirrhosis peptic ulcer

of the liver
decreased
birth weight bladder cancer

accidents

Buerger's disease
peripheral
vascular
disease

Many diseases and conditions are associated with smoking. Not all are
causally related, but they should not be overlooked. For instance, accident
rates are higher for smokers than non-smokers. This includes fires in the
home caused by the smoker who dozes off with a lighted cigarette in hand.
The blood level of carbon monoxide is higher in smokers during the time they
are smoking. Increasing attention is being given to the question of whether
this carbon monoxide in the blood may be dulling the alertness of drivers to
the point where this is a contributory factor in auto accidents.

243
Components of Cigarette Smoke
The starches, proteins, sugars, and hydrocarbons of the tobacco leaf, when
burned, are converted into a complex aerosol mixture of gases, uncondensed
organic vapours, and particulate matter. The temperature of the smoke at
the burning zone is nearly 900ºC, although that which reaches the smoker’s
mouth is in a temperature range from 30-50ºC.
While scientists estimate the number of cigarette smoke components to be
several thousands, only 1,200 have been identified to date. These components
of smoke are sufficient to produce an extremely dense “respiratory environ-
ment”, more concentrated than the air pollution of major urban centres. The
smoke from an average, nonfiltered cigarette is composed of several types
of chemicals.
Gaseous Elements and Compounds - These elements and compounds,
notably nitrogen and its oxides, carbon dioxide, oxygen, and carbon monoxide,
combine with the hemoglobin in red blood cells and thereby reduce the oxygen-
carrying capacity of the blood. Also isolated in the fraction of smoke from
cigarettes arc small amounts of toxic chemicals, particularly acetaldehyde,
acetone, and hydrogen cyanide.
Particulate Matter - Particulate matter, containing tiny particles of tobacco
smoke, is a respiratory tract irritant. Investigations have shown that more
than 90 percent of these particles remain in the lungs of the smoker who
inhales. When condensed, the particles- regarded as lung-damaging in size
- form a yellowish brown sticky mass known as tobacco tar, The tar contains
several carcinogenic (cancer producing) hydrocarbons, especially benzopyrene
and chrysene; nitrosamines; nickel compounds; fatty acids; phenols, which have
tumour-promoting activity in addition to being toxic to the cilia; and nicotine,
a colourless, oily compound in commercial insecticides.
Nicotine - Identified as the addictive or dependency- producing compo-
nent in tobacco smoke, nicotine is responsible for the temporary stimulation
following smoking. Nicotine initiates a series of nervous and endocrine func-
tions that result in a release of glycogen from the liver. This causes the brief
“kick” and reduction of fatigue often reported by smokers. Once absorbed into
the bloodstream, nicotine is also responsible for raising blood pressure and
heart rate, causing the heart to work harder, and for vasoconstriction (blood
vessel narrowing) that in turn lowers skin temperature.
The list of serious health risks should be sufficient to discourage smokers
from continuing their life-threatening form of adaptive behaviour and to deter
new smokers. But the mere presentation of facts has little effect upon all but
a few smokers – those who are highly motivated to reduce their exposure

244
to smoking or to quit smoking entirely. Persistence in smoking might seem
contradictory in this enlightened, scientific area, but it is due in part to the
effectiveness of early learning reinforced thousands of times, puff after puff.
As a result of so many rewarding interactions with cigarettes, smoke, and
other smokers, the individual’s personal values and basic attitudes about life
become so ingrained and inflexible that they cannot be cast aside, even when
the person recognizes and openly admits the errors of prior learning.
Other considerations play a role in maintaining the conflict between
smoking behaviour and possible health hazards. One, of course, is the fact
that not everyone who smokes becomes ill, incapacitated, or dies. Indeed,
certain of the cigarette-related diseases may require some genetic, biolog-
ical, chemical, or physical factor to be operable before smoking takes its toll.
Then, too, rationalization is commonly employed to justify the smoker’s
action. We often hear these replies to probing inquiries: “Just one cigarette
never hurts anybody”. “It won’t happen to me because I’m lucky’.” “Why should
I quit since I don’t feel sick?” Many of these excuses are based on the remote-
ness, the delayed action of the possible harmful effects of smoking. If one
cigarette caused serious, immediate illness or instant death, smoking would
rapidly decline or become extinct.
Risk taking, a necessary component of daily living, compounds the smoking
problem. Certainly, people should avoid certain risks, but sometimes risks are
taken if they seem negligible or remote in anticipation of the possible, imme-
diate rewards. Not to be overlooked as a further explanation for perpetuating
a disease and death-inducing adaptive behaviour is the very real reluctance
of individuals to acknowledge that their actions are stupid, irrational, or inju-
rious to themselves.
There are many authors nowadays who have raised another dimension of
cigarette problem suggesting that some smokers really do not care if their
life expectancy is reduced. Such dangerous indifference may reflect an insen-
sitivity to the “fragility and preciousness of life” and may correlate with the
spread of violence and our life-style of abundance. In essence, the real danger
beyond smoking may be a crisis in basic human values.

Cardiovascular Diseases and Smoking

Cigarette smoking is now recognized as a significant risk factor contributing
to the development of specific cardiovascular diseases, namely, coronary heart
disease, atherosclerosis, and peripheral blood vessel disease. It is an established
fact that nicotine is responsible for the near-instantaneous increase in heart
rate, blood pressure, cardiac output, heart contractions, and consumption of

245
oxygen by heart muscle. Because of its blood vessel narrowing effect, nico-
tine can also decrease peripheral blood flow, thus placing added stress on the
smoker’s heart. In its adaptive response to smoking the heart requires more
oxygen for its function. But carbon monoxide from cigarette smoke tends to
displace oxygen from hemoglobin, thus interfering with the transportation of
oxygen and depriving the heart muscle of its needed oxygen supply.
Recent evidence suggests that absorbed nicotine and carbon monoxide
contribute to the development of atherosclerosis (clogging of the arteries
with fatlike substances). Cigarette smoking may also be a factor in increased
platelet adhesiveness, which predisposes to blood clot formation.

Smoking and Chronic Obstructive Lung Diseases (COLD)

Pulmonary emphysema and chronic bronchitis, two diseases that until
recently were infrequently reported in the population, today are reaching
epidemic proportions. They are jointly referred to as COLD and are an adap-
tive 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 predispo-
sition, 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 alve-
olar sacs over and over again with each puff. In time, the tissues lining the
bronchi thicken, the mucous glands enlarge, and the normal cleansing system
of the lungs, especially ciliary function, is impaired. The smoker is now more
predisposed to respiratory infectious and aggravation of existing ones than
is the non-smoker.

Smoking and Lung Cancer

Most lung cancers originate in the lining or epithelium of the bronchi.
Normal epithelium cleanses the lungs of foreign matter such as dust or smoke
particles. Mucus secreted onto the surface of the epithelium, traps foreign
substances. Cilia, extending from the columnar cells, continually move the
mucus from the bronchi, through the trachea, and into the mouth, where it is
either swallowed or expectorated.
Tobacco smoke contains, in addition to tumour initiators and promoters,
substances that affect the cleansing action of the bronchial cells, and thus
indirectly influence the induction of lung cancer. These agents may impair

246
and destroy cilia and may affect the mucus layer so that smoke particles are
retained in the bronchi.
In lung cancer victims, cures are rare, and 95 out of 100 persons who
develop lung cancer will be dead within five years. In fact, the survival rate for
the first year after diagnosis of lung cancer is only 25 percent.
Studies of the frequency, distribution, causes, and control of cigarette-
related 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 initia-
tion of use. The risks are reduced when smoking ceases. Apparently, cigarette
smoking triggers a disease process (via the tobacco tars) in which continual
repair and recovery are possible up to some “critical point”. Beyond this point,
the process is not reversible.

EXERCISES
1. Review Questions:
1.1. How has smoking helped humans adapt to their environment?
..........................................................................................................................................................................

1.2. Explain what is meant by “smoking is suicide in slow motion”.

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

1.3. According to health statistics, how do men and women differ in smoking
habits? .........................................................................................................................................................
1.4. How do cigarettes provide the smoker with personal gratifications that
are not found in other tobacco forms? .....................................................................................
..........................................................................................................................................................................

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1.5. How has motivational research increased the sale of cigarettes?
..........................................................................................................................................................................

1.6. Explain some of the psychological rewards obtained by smoking.

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

1.7. What physiological effects does nicotine have on the body?

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

1.8. How does cigarette smoking account for the higher incidence of
cardiovascular disease?.....................................................................................................................
..........................................................................................................................................................................

1.9. What is pulmonary emphysema? How does it affect airflow within the
lungs?...........................................................................................................................................................
..........................................................................................................................................................................

1.10. What are the effects of chronic bronchitis? Is this more serious than
emphysema?............................................................................................................................................
1.11. How does cigarette smoking promote the development of cancer in
various parts of the body? ...............................................................................................................
..........................................................................................................................................................................

1.12. Do you think that risk-taking behaviour is a valid excuse for smoking?
..........................................................................................................................................................................

1.13. Discuss the advantages of smoking vs. non-smoking.

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

1.14. Although there is no safe way to smoke, discuss the recommendations

made to make cigarette use less hazardous?
..........................................................................................................................................................................

1.15. Discuss the many possible alternatives to smoking.

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

2. Fill in the missing word(s):

2.1. Indeed, smoking, ................................. and ........................................... have lightened
the .............................................................. life.

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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
......................................................................................... for most young persons.
2.7. Thus, smoking ......................................... a tension-reducing .........................................
2.8. In essence, a smoker .................................................................... a need to smoke- a
physical need for more ......................................................................................................................
2.9. Such a smoker no ....................................... gets much .......................................... from
cigarettes.
2.10. The smoke of an average ................................................... cigarette is composed
of .....................................................................................

3. Define the meaning of the following terms:

3.1. gratification ............................................. 3.9. tar .................................................................

3.2. maladaptation .......................................
3.3. prevalence ................................................
3.4. sociocultural ..........................................
3.5. perpetuation ...........................................
3.6. craving .......................................................
3.7. hazard .........................................................
3.8. carbon monoxide .................................
3.10. alertness ................................................
3.11. aerosol ....................................................
3.12. irritant .....................................................
3.13. nicotine ...................................................
3.14. vasoconstriction ................................
3.15. cardiac output .....................................

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4. Explain the following phrases.·

4.1. psychoactive effect ............................. 4.9. psychological recycling centre

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

4.2. load of life ................................................ 4.10. the perking-up effect ......................

4.3. to become “hooked” ..........................
4.4. adaptive behaviour ..............................
4.5. to call for ...................................................
4.6. to lobby for ...............................................
..................................................................................
4.11. psychological and physical
addiction .............................................................
4.12. escape vehicle .....................................
4.13. a live option ..........................................
4.14. handsome ruggedness ..................
..................................................................................

4.7. when the going gets rough ............ 4.15. cold turkey ............................................
..................................................................................

4.8. to get a kick out of something .....

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

5. Find verbs and adjectives of the following nouns:

5.1. preference ........................................................................................................................................
5.2. initiation ............................................................................................................................................
5.3. risk .......................................................................................................................................................
5.4. estimate ............................................................................................................................................
5.5. deprivation .......................................................................................................................................
5.6. abundance .......................................................................................................................................
5.7. value ....................................................................................................................................................
5.8. interference ....................................................................................................................................
5.9. addiction ...........................................................................................................................................
5.10. affection ..........................................................................................................................................

6. Provide the nouns of the following adjectives:

6.1. morbid ........................................................ 6.6. alveolar ......................................................

6.2. libidinal ...................................................... 6.7. ciliary ..........................................................

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6.3. bronchial ................................................... 6.8. adaptive .....................................................
6.4. pulmonary ................................................ 6.9. perilous .....................................................
6.5. foreign ........................................................ 6.10. genetic .....................................................

7. Translate into Croatian:

If you smoke and you still don’t believe that there’s a definite link between
smoking and bronchial troubles, heart disease and Jung cancer, then you arc
certainly deceiving yourself. No one will accuse you of hypocrisy. Let us just
say that you are suffering from a bad case of wishful thinking. This needn’t
make you too uncomfortable because you are in good company. Whenever
the subject of smoking and health is raised, the governments of most coun-
tries hear no evil, see no evil and smell no evil. Admittedly, a few governments
have taken timid measures. In Britain, for instance, cigarette advertising has
been banned on television. The conscience of the nation is appeased, while
the population continues to puff its way to smoky, cancerous death. You don’t
have to look very far to find out why the official reactions to medical findings
have been so lukewarm. The answer is simply money. Tobacco is a wonderful
commodity to tax. It’s almost like a tax on our daily bread. In tax revenue alone,
the government of Britain collects enough from smokers to pay for its entire
educational facilities. So while the authorities point out ever so discreetly that
smoking may, conceivably, be harmful, it doesn’t do to shout too loudly about
it. This is surely the most short-sighted policy you could imagine. While money
is eagerly collected in vas t sums with one hand, it is paid out in increasingly
vaster sums with the other. Enormous amounts are spent on cancer research
and on efforts to cure people suffering from the disease. Countless valuable
lives are lost. In the long run, there is no doubt that everybody would be much
better off if smoking were banned altogether.

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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 system’s
ability to resist harmful organisms. This leaves the body open to an invasion
by various infections, which are therefore called opportunistic diseases, and
to the development of unusual cancers. The virus also tends to reach certain
brain cells. This leads to the so-called neuropsychiatric abnormalities, or
psychological disturbances caused by physical damage to nerve cells.
Since the first AIDS cases were reported in 1981, through mid-1992, more
than 190,000 AIDS cases and more than 152,000 deaths had been reported
in the United States alone. This is only the top of the iceberg of HIV infection,
however. It is estimated that between 1 million and 1.5 million Americans had
been infected with the virus by the early 1990s but had not yet developed clin-
ical symptoms. In addition, although the vast majority of documented cases
have occurred in the United States, AIDS cases have been reported in about
162 countries worldwide. Sub-Saharan Africa in particular appears to suffer
a heavy burden of this illness.
No cure or vaccine now exists for AIDS. Many of those infected with HIV
may not even be aware that they carry and can spread the virus. It is evident
that HIV infection represents an epidemic of serious proportions. Combating
it is a major challenge to biomedical scientists and health-care providers. HIV
infection and AIDS represent one of the most pressing public policy and public
health problems worldwide.

253
Definition of AIDS
The U. S. CENTER FOR DISEASE CONTROL has established criteria for
defining cases of AIDS that are based on laboratory evidence, the presence
of certain opportunistic diseases, and a range of other conditions. The oppor-
tunistic diseases are generally the most prominent and life-threatening clin-
ical manifestations of AIDS. It is now recognized, however, that neuropsy-
chiatric 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 irre-
versible 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 previ-
ously healthy persons. Strikingly, these were disorders that would hardly ever
threaten persons with normally functioning immune systems. First formally
described in 1981, the syndrome was observed predominantly to be affecting
homosexual and bisexual men. Soon thereafter, intravenous drug users,
hemophiliacs, and recipients of blood transfusions were recognized as being
at increased risk for disease as well. It was also noted that sexual partners
of persons displaying the syndrome could contract the disease.
Further study of AIDS patients revealed marked depletion of certain
white blood cells, called T4 lymphocytes. These cells play a crucial role in
orchestrating the body’s immune defences against invading organisms. It
was presumed that this defect in AIDS patients was acquired in a common
manner. Then, in 1983, a T-cell lymph tropic virus was separately discovered
by Robert Gallo at the U. S. National Institutes of Health and Luc Montaigne at
France’s Pasteur Institute. The virus was at first given various names: human
lymphotropic virus (HTLV) III, lymphadenopathy-associated virus (LAV), and
AIDS -associated retrovirus (ARV). It is now officially called human immunode-
ficiency 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. Appar-
ently, however, this is the first time in modern history that the virus has spread

254
widely among human beings. Related viruses have been observed in animal
populations, such as certain African monkeys, but these do not produce
disease in humans.

The Nature of the Virus

HIV is an RNA RETROVIRUS. Viewed in an electron microscope, it has a
dense cylindrical core that encases two molecules of viral RNA genetic mate-
rial. A spherical outer envelope surrounds the core.
Like all retroviruses, HIV possesses a special enzyme, called reverse tran-
scriptase, 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 reac-
tivated. 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, virtu-
ally 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 trans-
mission in Africa and Asia. About 21 percent of AIDS cases occur in intrave-
nous drug abusers exposed to HIV-infected blood through shared needles.
Current practices of screening blood donors and testing all donated blood
and plasma for HIV antibodies have reduced the number of cumulative cases
due to transfusion to about 1 percent.

255
 The number of new cases of AIDS in women of reproductive age is increasing
at an alarming rate. AIDS has become the leading cause of death for women
between the ages of 20 and 40 in the major cities of North and South America,
Western Europe, and sub-Saharan Africa. In the United States, AIDS has hit
hardest among black and Hispanic women. These women represent 17 percent
of the female population but make up 73 percent of women with AIDS. AIDS
is also having a devastating impact on infant mortality, since over 80 percent
of HIV-infected children under the age of 13 acquired HIV from their infected
mothers. Between 24 and 33 percent of children born to infected women will
develop the disease.
No scientific evidence supports transmission of AIDS through ordinary
nonsexual conduct. Careful studies demonstrate that despite prolonged
household contact with infected individuals, family members have not become
infected--except through the routes described above. Health-care workers
have been infected with HIV from exposure to contaminated blood or by acci-
dentally sticking themselves with contaminated needles.

Clinical Signs
Following infection with HIV, an individual may show no symptoms at all,
or may develop an acute but transient mononucleosis-like illness. The period
between initial infection and the development of AIDS can vary greatly, appar-
ently from about 6 months to 11 years. Various estimates indicate that some-
where between 26 to 46 percent of infected individuals will go on to develop
full-blown AIDS within a little more than 7 years following infection. Once AIDS
sets in, the clinical course generally follows a rapid decline; and most people
with AIDS die within 3 years.

Opportunistic Infections and Cancers

Because the T4 cell is involved in almost all immune responses, its deple-
tion renders the body highly susceptible to opportunistic infections and
timorous growths. The most predominant and threatening is Pneumocystic
carinii PNEUMONIA, which is frequently the first infection to occur and is the
most common cause of death. Other infections include the parasites Toxo-
plasma gondii (TOXOPLASMOSIS) and Cryptosporidiosis; fungi such as Candida
(CANDIDIASIS) and Cryptococcus (FUNGUS DISEASES); mycobacteria such as
Mycobacterium avium, intracellulare, and tuberculosis (TUBERCULOSIS); and
viruses such as cytomegalovirus and herpes simplex and zoster. Increased
susceptibility to bacterial infection is noted particularly among children with
AIDS.

256
 Many AIDS patients develop cancers, including Kaposi sarcoma (KS), non-
Hodgkin lymphoma, and Hodgkin disease. KS occurs in patients who mani-
fest 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 aggres-
sive 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 infec-
tion 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 signif-
icance. Damage to genital skin and mucous membranes may facilitate trans-
mission 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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 At present no vaccine exists to protect against infection, although recent
advances have led some experts to predict that a vaccine should be available
within the next 10 years. Obstacles still remain, however, primarily due to
the variability of the virus itself. Many different strains of HIV exist, and even
within a given individual’s body the virus can undergo mutations rapidly and
easily. A number of candidate vaccines were in the early phases of testing in
human volunteers by the early 1990s around the world.
Dramatic strides are also being made in the treatment of HIV infection and
its complications. Efforts are being focused on two major areas: antiviral drugs
with a direct effect against the causative agent, and immunomodulators that
act to reconstitute or enhance immune-system function. Efforts to develop
and improve treatments of specific opportunistic infections and neoplasms
are also being made.
Because of the complex life cycle of HIV, however, the successful develop-
ment of antiviral and immune-enhancement therapies represents an enor-
mous scientific challenge. Unlike most known pathogens, HIV infects the very
cells that are intended to orchestrate and lead the immune system’s attack
against invaders. This makes it technically very hard to kill the virus without
destroying the already threatened immune system. Furthermore, there may
be several important reservoirs in the body for HIV that will be difficult to deal
with while not causing fundamental damage to the host cells involved. For
example, macrophage cells can support HIV replication while harbouring the
virus from the body’s immune surveillance. Circulating macrophages appear to
play an important role in the propagation of HIV throughout the body, including
the brain.
In seeking effective therapies, other important considerations are involved.
Thus, since the brain is an important target of HIV infection, an effective anti-
HIV agent should be able to cross the blood-brain barrier. It would also be
desirable if therapies could be taken orally, since it is likely that AIDS drugs
would have to be taken for a long period and perhaps a lifetime. Dozens of
agents have been tested in humans, but only two have been licensed by the
U.S. Food and Drug Administration (FDA): azidothymidine (AZT) and dideox-
yinosine (DDI). AZT interferes with virus replication and has been found to
prolong life significantly in some patients and delay the onset of full-blown
AIDS in persons with no symptoms, but its potentially toxic side effects may
preclude uses in many cases. DDI acts similarly but is recommended for those
who cannot tolerate AZT. Other promising drugs are in clinical trials. Some
drugs are available to fight major opportunistic illnesses. Eye infections can
be treated with ganciclovir or foscarnet, which also helps patients live longer,
while aerosolized pentamidine fights Pneumocystis carinii pneumonia and
protects the patient from AIDS dementia.

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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 reduc-
tion remain the most powerful tools in the fight against AIDS. Because of the
limited number of transmission routes, the further spread of AIDS could virtu-
ally 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 govern-
ments. 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 prod-
ucts 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 equip-
ment is always used.

Conclusion
The AIDS epidemic is having a profound impact on many aspects of medi-
cine 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 drug’s maker did offer to distribute AZT freely to HIV-
infected 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 chil-
dren with AIDS isolated from their classmates, if not out of school altogether.
Governmental and civil rights organizations have countered restrictive moves
with a great deal of success. There is little doubt that the ultimate physical
toll of the AIDS epidemic will be high, as will be its economic costs, however
the social issues are resolved. Concerted efforts are under way to address
the problem at many levels, and they offer hope for successful strategies to
combat HIV-induced disease.

Margaret A. Hamburg, M.D.

(Copyright - 1993 Grolier Electronic Publishing, Inc.)

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CHAPTER 21

STRESS MANAGEMENT FOR PATIENT AND PHYSICIAN

By David B. Posen, MD
The Canadian Journal of Continuing Medical Education, April 1995
One of the most important things we can do for patients is teach them
about stress management. Even better, we can learn these lessons ourselves
and then model them for our patients. Although there are many approaches
to stress management, this article lists 10 ways for reducing stress that are
practical, beneficial and which even busy physicians can start implementing
in their patients’ and their own lives.

Main Article
Stress is the most common cause of ill health in our society, probably
underlying as many as 70% of all visits to family doctors. It is also the one
problem that every doctor shares with every patient. This presents physicians
with two advantages:
• It is an issue we can relate to experientially so we can use ourselves as a
reference point
• In studying and better understanding stress, we can derive personal as
well as professional benefits.

The manifestations of stress are legion. Early in the 20th century, medical
students were taught that “if you know syphilis (the great masquerader), you
know medicine.” One could say the same about stress. It can contribute to or
mimic just about any symptom you can think of. However, the main presen-
tations can be summarized under four headings: physical, mental, emotional
and behavioural.
The causes of stress are multiple and varied but they can be classified in two
general groups: external and internal. External stressors can include relatives
getting sick or dying, jobs being lost or people criticizing or becoming angry.

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However, most of the stress that most of us have is self-generated (internal).
We create the majority of our upsets, indicating that because we cause most
of our own stress, we can do something about it. This gives us a measure of
choice and control that we do not always have when outside forces act on us.
This also leads to my basic premise about stress reduction: to master
stress, you must change. You have to figure out what you are doing that is
contributing to your problem and change it. These changes fall into four cate-
gories: change your behaviour, change your thinking, change your lifestyle
choices and/or change the situations you are in. By getting to the root causes
of your stress, you can not only relieve current problems and symptoms but you
can also prevent recurrences. For example, if you keep becoming frustrated
over arguments with your children, you might discover that the cause of your
upset is not their behaviour but your unrealistic expectations. By modifying
your standards, you might find the children’s actions no longer bother you.
There are many ways to relieve stress, from going for a walk to quitting your
job. Here follows a list of 10 practical and down-to-earth strategies which I
have found helpful over the years for both myself and my patients. Some are
simple and can be implemented quickly; others are a bit more involved. All
are feasible and beneficial.

1. Decrease or Discontinue Caffeine

In terms of “bang for the buck,” it is hard to beat this simple intervention.
Most patients do not realize that caffeine (coffee, tea, chocolate and cola) is a
drug, a strong stimulant that actually generates a stress reaction in the body.
I tell patients that the best way to observe the effect of caffeine is to get it
out of the system long enough to see if there is a difference in how they feel.
Three weeks is adequate for this purpose and all my patients accept this
suggestion, especially
when I frame it as an experiment. (“If you don’t notice a difference, you can
go back to it; but if you feel better without it, you will probably want to stay
off it.”) I would guess that 75% to 80% of my patients notice a benefit. They
feel more relaxed, less jittery or nervous, sleep better, have more energy (a
paradox, since you are removing a stimulant), less heartburn and fewer muscle
aches. Many patients feel dramatically better and cannot believe the difference.
One warning, however. Patients must wean themselves gradually or they
will get migraine-type withdrawal headaches. I suggest decreasing by one
drink per day until they are down to zero, then they should abstain for three
weeks. When they feel better, they will thank you. In fact, you will be a hero
because it is such an easy thing to do and delivers a big payoff Incidentally,

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I do not believe caffeine is a highly addictive substance. I have never met a
patient in 10 years who could not give it up within one week.

2. Regular Exercise
As a way of draining off stress energy, nothing beats aerobic exercise. To
understand why, we need to review what stress is. People often think of stress
as pressure at work, a demanding boss, a sick child or rush-hour traffic. All
these may be triggers but stress is actually the body’s reaction to factors such
as these. Stress is the fight-or-flight response in the body, mediated by adren-
aline and other stress hormones, and comprised of such physiologic changes
as increased heart rate and blood pressure, faster breathing, muscle tension,
dilated pupils, dry mouth and increased blood sugar. In other words, stress
is the state of increased arousal necessary for an organism to defend itself
at a time of danger.
The stress reaction is in us, not “out there.” It provides us with the strength
and energy to either fight or run away from danger and is therefore self-
protective. There is only one problem: unlike a caveman being attacked by
a wild animal or warring tribesman, fighting and running away are rarely
appropriate responses to stressful situations in the modern world. The result
is that our bodies go into a state of high energy but there is usually no place
for that energy to go; therefore, our bodies can stay in a state of arousal for
hours at a time.
Exercise is the most logical way to dissipate this excess energy. It is what
our bodies are trying to do when we pace around or tap our legs and fingers. It
is much better to channel it into a more complete form of exercise like a brisk
walk, a run, a bike ride or a game of squash. During times of high stress, we
could benefit from an immediate physical outlet - but this often is not possible.
However, regular exercise can drain off ongoing stress and keep things under
control. I recommend physical activity every day or two. At the very least, it is
important to exercise three times per week for a minimum of 30 minutes each
time. Aerobic activities like walking, jogging, swimming, bicycling, racquet
sports, skiing, aerobics classes and dancing are suitable. Choose things you
like or they will feel like a chore and you will begin to avoid them. It is also
beneficial to have a variety of exercise outlets. I have never met a patient who
did not feel better with some form of regular exercise- and I know I could not
exist without it. For chronic or acute stress, exercise is an essential ingredient
in any stress reduction program.

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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 patient’s budget.
I can attest to the benefits of regular meditation from personal experi-
ence. And on days when exercise is not possible, relaxation techniques are an
excellent way to bring down the body’s stress level. Whereas exercise dissi-
pates 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 chroni-
cally 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 discour-
aged from daytime naps. Beyond these cautionary notes, sleep can be key in
reducing stress and helping patients cope and function better.

5. Time-outs and Leisure

No one would expect a hockey player to play an entire game without taking
breaks. Surprisingly though, many otherwise rational people think nothing of
working from dawn to dusk without taking intermissions, and then wonder
why they become distressed. The two major issues are pacing and work/
leisure balance.
Pacing has two components: monitoring your stress and energy level, and
then pacing yourself accordingly. It is about awareness and vigilance; knowing
when to extend yourself and when to ease up. It is also about acting on the
information your body gives you. A diagram designed by Dr. Peter Nixon, a
British cardiologist, illustrates some important points:
• Increased stress produces increased performance, initially.
• Once you pass a certain point (the hump), any more stress results in
decreased performance. Trying harder at this point is unproductive or
even counterproductive. The only sensible move is to take a break.
• We need a certain amount of stress to function well (healthy tension) -
this is called eustress (good stress). However, stress becomes harmful
(distress) when there is too much, when it lasts too long or when it
occurs too often.
• One of the first symptoms of distress is fatigue, which we tend to ignore.
Dr. Nixon advocates a healthy respect for fatigue and doing something
about it before it becomes exhaustion.
An important key to pacing is taking periodic time-outs. Too many people
go far too long without breaks. Dr. Ernest L. Rossi wrote The 20-Minute Break,
an excellent book extolling the virtues of a short recess every couple of hours
throughout the day. Just as we all have cycles of deep sleep and dream sleep
throughout the night (at roughly 90- to 120-minute intervals), we also have
cycles through the day: peaks of energy and concentration interspersed with
troughs of low energy and inefficiency. These cycles are called “ultradian
rhythms” because they happen many times per day (as opposed to the 24-hour
circadian rhythm with which we are all familiar). The main point of the book

265
is that we need to watch for these troughs and take 20 minute “ultradian
healing breaks” when they occur, as opposed to working through them and
building up stress.
It is not always convenient for people to take time-outs when nature tells
us to but we can all become better at this. A mid morning break, lunch, a mid
afternoon break and supper divide the day into roughly two-hour segments.
These time-outs can include power naps, meditation, daydreaming, a social
interlude, a short walk, a refreshment break, a change to low-concentration
tasks or listening to music. Since I (and some of my patients) have started to
work with this biologic pattern (instead of resisting it), the results have been
pleasing. Like the catnap, it is simply a good investment of time that pays itself
back quickly in increased productivity and reduced stress.
Work-leisure balance. Despite all our labour-saving devices, leisure is
still an elusive commodity for most people. Statistics show that the average
American (and probably Canadian) is working an extra three hours per week
compared with 20 years ago. That translates into an extra month of work each
year. Add to that the phenomenon of the two career family (which makes family
and leisure time even more scarce) and you start to get a picture of society on
an accelerating treadmill.
Leisure time and levels of distress are inversely proportional - the less
leisure, the more stress. I ask patients to fill in a chart so we can both see what
their work/leisure ratio looks like. I ask them to think of their lives (excluding
sleep time) in four compartments (work, family, community and self) and then
to assess what percentage of their time and energy in an average week goes
into each part. There is no normal range but I become concerned when work
is over 60% and/or when self is less than 10%. We all require time to meet
our own needs (self-care, self-nurturing, etc.) and when that is neglected,
trouble usually follows. Self directed activities can include exercise or recre-
ation, relaxation, socializing, entertainment and hobbies. The word leisure
is derived from the Latin word licere which means “permission.” The main
reason so many people do not have enough leisure is that they are not giving
themselves permission to make the time to enjoy it.
Leisure is one of the most pleasant stress relievers ever invented. It is
strange that people resist it so much (e.g., feeling selfish, guilty). I am not
preaching hedonism - just a healthy amount of necessary respite from the
day’s pressures. We as doctors can give patients permission if they will not
give it to themselves. Once they experience a payoff, the benefits will reinforce
the behaviour. After that, they are usually able to give themselves permission.

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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 after-
noon, especially if it makes you late for something, you are more likely to be
stressed by it.
When expectations are realistic, life feels more predictable and therefore
more manageable. There is an increased feeling of control because you can
plan and prepare yourself (physically and psychologically). For example, if you
know in advance when you have to work overtime or stay late, you will take it
more in stride than when it is dropped on you at the last minute.
There is much we can do to help patients by letting them know when their
expectations (of themselves and others) are unrealistic. I remember a patient
berating himself and feeling guilty because he did not love his stepdaughter
as much as his own biologic children. Blended families are common and I
suspect many people struggle with this issue of love and loyalty. I asked this
man where he got the idea that he would love his second wife’s children as
if they were his own. He did not know. I suggested to him that his expecta-
tion was probably unrealistic, especially early in the new marriage. He felt
relieved by this idea and stopped putting pressure on himself to feel some-
thing 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 woman’s boss was acting
critical and domineering towards her. I said, “Assuming your boss is not just
evil or malicious, why do you think she might be acting like this?” Answers
included, “She is probably insecure,” “She is under a lot of pressure2“, and
“She is having personal problems.” Performing this exercise helped the patient
step outside herself and look at other possible interpretations of her boss’s
behaviour. After that, her upset was considerably decreased. In fact, after such
a discussion some patients feel more compassion than anger for the person
who is bothering them.
Notice that reframing does not change the external reality but simply helps
people view things differently (and less stressfully). It should be done with a
bit of preamble to explain the premise (e.g., using the glass half empty as an
illustration) and only after you have acknowledged the validity of the patient’s
initial (stressful) interpretation. You are not trying to disrespect their point of
view but only to suggest there are other, less stressful ways of looking at the
same thing.

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8. Belief Systems
A lot of stress results from our beliefs. We have literally thousands of prem-
ises and assumptions about all kinds of things that we hold to be the truth
- everything from, “You can’t fight City Hall” and “The customer is always
right,” to “Men shouldn’t show their emotions” and “Children should make
their beds.” We have beliefs about how things are, how people should behave
and about ourselves (“I can never remember people’s names”). Most of our
beliefs are held unconsciously so we are unaware of them. This gives them
more power over us and allows them to run our lives.
Beliefs cause stress in two ways. The first is the behaviour that results from
them. For example, if you believe that work should come before pleasure, you
are likely to work harder and have less leisure time than you would otherwise.
If you believe that people should meet the needs of others before they meet
their own, you are likely to neglect yourself to some extent. Several patients
tell me, “If you want something done right, you have to do it yourself” They do
not delegate well and tend to get overloaded.
In the above three cases, the beliefs are expressions of people’s philos-
ophy or value system, but all lead to increased effort and decreased relax-
ation - 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 inces-
santly 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, encour-
agement or advice. But the combination of the patient being able to ventilate
and our support can be profoundly beneficial.
There is an old saying that “a problem shared is a problem halved.” People
who keep things to themselves carry a considerable and unnecessary burden.
We can do much for patients by allowing them to ventilate or encouraging
them to do so. We can also help by urging them to develop a support system
(a few trusted relatives, co-workers or friends to talk to when they are upset
or worried).
Another form of ventilation that many patients find helpful is writing, for
example in a private journal at home. Former tennis star Guillermo Vilas once
said: “When my life is going well, I live it. When it’s not going well, I write it.”
When patients are angry, I often suggest they write a letter to the person
at whom they are vexed. These letters are not for sending; they should be
destroyed once they are written- unread. The value is in expressing the feel-
ings and getting them out. Rereading the letter just reinforces the upset and
fans the flames of anger all over again.

10. Humour
Humour is a wonderful stress reducer, an antidote to upsets. Laughter
relieves tension. In fact, we often laugh hardest when we have been feeling
most tense.
One of my patients was lamenting the 15 pounds she gained over the winter
and the fact that she could not get into her bathing suit. She had always
been sensitive about her weight. While talking about her upset she suddenly
stopped, her face softened and a smile came to her lips. “You know what?
I’ve just decided,” she said. “I’ll swim in the dark this year.” Another case
involved a man who worked in a busy company dealt with customers at the
counter, customers on the phone and staff members who needed his help.
He felt besieged often from several directions at once. He told me he started

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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 manage-

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 ment, lifestyle counselling and psychotherapy. He has given seminars for
IBM, Motorola, Bell Canada, Peat Marwick and the
14. Royal Bank of Canada. His first book, Always Change a Losing Game, was
published in 1994 by Key Porter Books, and became a Canadian best seller.
He also presents seminars about stress management for McMaster Univer-
sity medical school and has given presentations for the Ontario Medical
Association and the Ontario College of Family Physicians. He received his
medical degree from University of Toronto in 1967.

INFORMATION FOR PATIENTS - STRESS MANAGEMENT

WHAT IS STRESS?
Dr. Hans Selye, the father of stress theory, defined stress as “the nonspe-
cific response of the body to any demand made upon it.” The “demand” can be
a threat, a challenge or any kind of change which requires the body to adapt.
The response is automatic, immediate. Stress can be good (called “eustress”)
when it helps us perform better, or it can be bad (“distress”) when it causes
upset or makes us sick.

What Does the Stress Reaction Consist of?

The stress reaction results from an outpouring of adrenaline, a stimulant
hormone, into the bloodstream. This, with other stress hormones, produces a
number of changes in the body which are intended to be protective. The result
often is called “the fight-or-flight response” because it provides the strength
and energy to either fight or run away from danger. The changes include an
increase in heart rate and blood pressure (to get more blood to the muscles,
brain and heart), faster breathing (to take in more oxygen), tensing of muscles
(preparation for action), increased mental alertness and sensitivity of sense
organs (to assess the situation and act quickly), increased blood flow to the
brain, heart and muscles (the organs that are most important in dealing with
danger) and less blood to the skin, digestive tract, kidneys and liver (where
it is least needed in times of crisis). In addition, there is an increase in blood
sugar, fats and cholesterol (for extra energy) and a rise in platelets and blood
clotting factors (to prevent hemorrhage in case of injury).

What Are Common Symptoms of Stress?

Manifestations of stress are numerous and varied but they generally fall
into four categories (this is only a partial list of most common symptoms):
Physical: fatigue, headache, insomnia, muscle aches/stiffness (especially
neck, shoulders and low back), heart palpitations, chest pains, abdominal

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cramps, nausea, trembling, cold extremities, flushing or sweating and frequent
colds.
Mental: decrease in concentration and memory, indecisiveness, mind
racing or going blank, confusion, loss of sense of humour.
Emotional: anxiety, nervousness, depression, anger, frustration, worry,
fear, irritability, impatience, short temper.
Behavioural: pacing, fidgeting, nervous habits (nail-biting, foot-tapping),
increased eating, smoking, drinking, crying, yelling, swearing, blaming and
even throwing things or hitting.

What Are the Causes of Stress?

Dr. Selye called the causes of stress “stressors” or “triggers.” There are
two kinds of stressors: external and internal.
External stressors include:
• Physical environment: noise, bright lights, heat, confined spaces.
• Social (interaction with people): rudeness, bossiness or aggressiveness
on the part of someone else.
• Organizational: rules, regulations, “red tape,” deadlines.
• Major life events: death of a relative, lost job, promotion, new baby.
• Daily hassles: commuting, misplacing keys, mechanical breakdowns.

Internal stressors include:

• Lifestyle choices: caffeine, not enough sleep, overloaded schedule.
• Negative self-talk: pessimistic thinking, self-criticism, over-analyzing.
• Mind traps: unrealistic expectations, taking things personally, all-or-
nothing thinking, exaggerating, rigid thinking.
• Stressful personality traits: Type A, perfectionist, workaholic, pleaser.

It is important to note that most of the stress that most of us have is actu-
ally self-generated. This is a paradox because so many people think of external
stressors when they are upset (it is the weather, the boss, the children, the
spouse, the stock market). Recognizing that we create most of our own upsets,
however, is an important first step to dealing with them.

What Are Some Ways to Master Stress?

The following are some categories that can be helpful in mastering stress:

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 Change lifestyle habits
• Decrease caffeine (coffee, tea, cola, chocolate).
• Well-balanced diet.
• Decrease consumption of junk food.
• Eat slowly.
• Regular exercise (at least 30 minutes, three times per week).
• Adequate sleep (figure out what you need, then get it).
• Leisure time (do something for yourself everyday).
• Relaxation exercises (e.g., meditation, self-hypnosis).

Change stressful situations

• Time and money management.
• Assertiveness.
• Problem-solving.
• Possibly leaving a job or a relationship.

Change your thinking

• Look at things more positively.
• See problems as opportunities.
• Refute negative thoughts.
• Keep a sense of humour.

Diversion and distraction. Take a time-out (anything from a short walk to

a vacation) to get away from the things that are bothering you. This will not
resolve the problem, but it gives you a break and a chance for your stress levels
to decrease. Then, you can return to deal with issues feeling more rested and
in a better frame of mind.

Prepared by Dr. David B. Posen Lifestyle Counsellor and Psychotherapist,

and Author of “Always Change a Losing Game” Oakville, Ontario
May be copied and distributed to patients
Internet Mental Health (www.mentalhealth.com) copyright© 1995-1996
by Phillip W. Long,
M.D.

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CHAPTER 22

RADIOLOGY AND NUCLEAR MEDICINE

Introduction
Radiology (also called roentgenology after its discoverer, Wilhelm Conrad
Roentgen) is the medical specialty concerned with the study of x-rays. X-rays
are invisible waves of energy that are produced by an energy source (x-ray
machine) and are useful in diagnosis and treatment of disease.
Nuclear medicine is the medical specialty that studies the characteris-
tics and uses of radioactive substances in the diagnosis of disease. Radio-
active substances are materials that emit high-speed particles and energy-
containing rays from the interior of their matter. The emitted particles and
rays are called radioactivity and can be of three types: alpha particles, beta
particles, and gamma rays. Gamma rays are similar to x-rays in that they
have no mass and are used effectively as a diagnostic label to trace the path
and uptake of chemical substances in the body.
A radiologist is a physician who specialises in the practice of diagnostic,
therapeutic, and interventional radiology. A nuclear physician is physician
who specializes in the practice of administering diagnostic nuclear medicine
procedures.
Allied health care professionals who work with physicians in the field of
radiology and nuclear medicine are radiologic technologists. Types of radio-
logic technologists are: radiographers (aid physicians in administering diag-
nostic x-ray procedures) and nuclear medicine technologists, (attend to
patients undergoing nuclear medicine procedures and operate devices under
the direction of a nuclear physician).

1. Radiology
Several characteristics of x-rays are useful to physicians in the diagnosis
and treatment of disease.

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1. Ability to cause exposure of a photographic plate. If a photographic plate
is placed in front of a beam of x-rays, the x-rays, travelling unimpeded
through the air, will expose the silver coating of the plate and cause it to
blacken
2. Ability to penetrate different substances to varying degrees. If the x-rays
are absorbed (stopped) by the denser body substance (e.g. calcium in the
bones ), they do not reach the photographic plate held behind the patient,
and white areas are left in the x-ray film.
3. A substance is said to be radiolucent if it permits passage of most of the
x-rays. Radiopaque substances (bones) are those that absorb most of the
x-rays they are exposed to.
4. Invisibility. X-rays cannot be detected by sight, sound, or touch. Workers
exposed to x-rays must wear a film badge to detect and record the amount
of radiation to which they have been exposed.
5. Travel in straight lines. This property allows the formation of precise
shadow images on the x-ray plate and also permits x-ray beams to be
directed accurately at a tissue site during radiotherapy.
6. Scattering of radiation. Scattering occurs when x-rays come in contact
with any material. Greater scatter occurs with dense objects. Scatter can
blur images so a grid is placed in front of the film to absorb scattered radi-
ation before it strikes the x-ray film.
7. Ionization. X-rays have the ability to ionize substances through which they
pass. Ionization is a chemical process in which the energy of an x-ray beam
causes rearrangement and disruption within a substance. In x-ray therapy,
the ionizing effect of x-rays can help kill cancerous cells and stop tumour
growth. Ionizing x-rays can also affect normal body cells, leading to tissue
damage and malignant changes. Thus, persons exposed to high doses of
x-rays are at risks of developing leukemia, thyroid tumours, breast cancer,
or other malignancies.

Diagnostic Techniques
X-rays
X-rays are used in a variety of ways to detect pathological conditions. The
most common use of the diagnostic x-ray is dental, to locate cavities in teeth.
Other areas examined include the digestive, nervous, reproductive, and endo-
crine systems and the chest and bones. Some special diagnostic x-ray tech-
niques are the following:
Computed Tomography or Computerized Axial Tomography(CT, CAT).
Machines called CT scanners beam x-rays at multiple angles through a section
of a patient’s body. A computer creates a cross-sectional picture of the body

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section examined. The CT scanners are highly sensitive in detecting diseases
in bony structures and can provide images of internal organs that are impos-
sible to visualize with ordinary x-ray technique.
Contrast Studies. In x-ray film, the natural differences in the density of
body tissues (e.g. air in lung) produce contrasting shadow images on the x-ray
film; however, when x-rays pass through two adjacent body parts composed
of substances of the same density, their images cannot be distinguished on
the film or on the screen. It is necessary, then, to inject a contrast medium
into the structure or fluid so that a specific part, organ, tube, or liquid can be
visualized.
The following are artificial materials used in diagnostic radiological studies.
Barium Sulphate. Barium sulphate is a metallic powder that is mixed in
water and used for examination of the upper and lower gastrointestinal tract.
An upper GI series involves oral ingestion of barium sulphate so that the
esophagus, stomach, and duodenum can be visualized. A small bowel follow-
through traces the passage of barium in a sequential manner as it passes
through the small intestine. A barium enema (lower GI series) opacifies the
lumen of the large intestine. A double-contrast study uses both a radiopaque
and a radiolucent contrast medium. For example, the walls of the stomach or
intestine are coated with barium and the lumen is filled with air.
Iodine Compounds. Radiopaque fluids containing up to 50 percent iodine
are used in the following tests:
Angiography An x-ray image of blood vessels and heart chambers.
Arthrography Contrast or air, or both, is injected into a joint, and x-rays
are taken of the joint.
Pyelography X-ray images are made of the renal pelvis.
Fluoroscopy. This x-ray procedure uses a fluorescent screen instead of a
photographic plate to derive a visual image from the x-rays that pass through
the patient. The fact that ionizing radiation can produce fluorescence is the
basis for fluoroscopy. A major advantage of fluoroscopy over normal radiog-
raphy is that internal organs, such as the heart and digestive tract organs,
can be observed in motion.
Interventional Radiology. Interventional radiologists perform invasive
procedures (therapeutic or diagnostic) under fluoroscopic, CT, and more
recently MR (magnetic resonance) guidance. Procedures include placement
of drainage catheters, drainage of abscesses, occlusion of bleeding vessels,
and installation of antibiotics or chemotherapy through catheters. In addition,
interventional radiologists perform thermal(heating or freezing) radiofre-
quency, and ultrasound ablation(destruction) of benign and malignant lesions.

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 Ultrasound This technique employs high-frequency, inaudible sound waves
that bounce off the body tissues and are then recorded to give information
about the anatomy of an internal organ. An instrument called a transducer
or probe is placed near or on the skin, which is covered with a thin coating of
gel to assure good transmission of sound waves.
Ultrasound is used as a diagnostic tool not only by radiologists but also by
neurosurgeons and ophthalmologists to detect intracranial and ophthalmic
lesions, by cardiologists to detect heart valve and blood vessel disorders as
well as gastroenterologists, obstetricians and gynecologists. It is important
to know that sound waves are nonionizing and noninjurious to tissues.
Two ultrasound techniques, Doppler ultrasound and colour-flow imaging,
make it possible to record blood velocity, and to image major blood vessels in
patients at risk for stroke.
Magnetic Imaging or Magnetic Resonance Imaging This is a type of diag-
nostic radiography that uses electromagnetic energy rather than x-rays. The
technique produces sagittal, coronal (frontal), and axial(cross-sectional)
images.
MR examinations are performed with and without contrast. The contrast
agent most commonly used for MRI is gadolinium(Gd)..MRI is used for providing
soft- tissue images, detecting edema in the brain, projecting a direct image of
the spinal cord, detecting tumours in the chest and the abdomen, and visual-
izing the cardiovascular system.

X-Ray Positioning
In order to take the best view of the part of the body being radiographed,
the patient, film, and x-ray tube must be positioned in the most favourable
alignment possible. There are special terms used by radiologists to refer to
the direction of travel of x-ray through the patient.
1. Posteroanterior (PA) view. In this most commonly requested chest x-ray
view, x-rays travel from a posteriorly placed source to an anteriorly placed
detector.
2. Anteroposterior (AP) view. X-rays travel from an anteriorly placed source
to a posteriorly placed detector
3. Lateral view. In a left lateral view, x-rays travel from a source located to
the right of the patient to a detector placed to the left of the patient
4. Oblique view. X-rays travel in a slanting direction at an angle from the
perpendicular plane. Oblique views show regions ordinarily hidden and
superimposed in routine PA and AP views.

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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 radio-
activity by disintegration. The half-life must be long enough to allow for diag-
nostic imaging but as short as possible to minimize patient’s exposure to radi-
ation. Radionuclides emit three types of radioactivity: alpha particles, beta
particles, and gamma rays. Gamma rays, which have greater penetrating
ability than alpha and beta particles, and more ionizing power, are especially
useful in both the diagnosis and the treatment of disease. Technetium-99m
is a pure gamma emitter with a half-life of 6 hours. Its properties make it the
most frequently used radionuclide in diagnostic imaging.
Nuclear medicine physicians use two types of tests in the diagnosis of
disease: in vitro (in the test tube) and in vivo (in the body). In vitro procedures
involve analysis of blood and urine specimens using radioactive chemicals.
RIA (radioimmunoassay) is an in vitro procedure to detect hormones and drugs
in a patient’s blood. In vivo tests trace the amounts of radioactive substance
within the body.

Examples of diagnostic procedures that utilize radionuclides.

1. Bone scan. 99mTc(technetium) is used to label phosphate substances and
is injected intravenously. The scan is useful in demonstrating malignant
metastasis to the skeleton.
2. Gallium scan. The radioisotope gallium-67 is injected intravenously and
has an affinity for tumours and non-neoplastic lesions such as abscesses.
3. Liver and spleen scan. To visualize the liver and spleen, a radiopharma-
ceutical (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 appli-
cation includes detecting liver tumours, detecting cardiac ischemia, and
evaluating bone diseases of the spine.

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6. 99mTechnetium sestamibi scan. It is injected intravenously to study the
motion of the heart wall muscle and the ventricle’s ability to eject blood
(ejection fraction).
7. Thallium scan (TL). It is injected intravenously to allow for myocardial
perfusion. Infarcted or scarred myocardium does not extract any Tl, showing
up as cold spots.
8. Thyroid scan. Hyper functioning thyroid nodules (adenomas) accumulate
higher amounts of 131I radioactivity and are termed “hot”. Thyroid carci-
noma does not concentrate radioiodine well and is seen as a “cold” spot
on the scan.

Abbreviations
Angio - angiography AP - anteroposterior
Ba - barium CAT- computerized axial tomography
CT - computerized tomography CXR – chest x-ray
Decub - lying down, decubitus DI - diagnostic imaging
FDG - fluorodeoxyglucose (radiopharmaceutical)
67Ga - radioactive gallium 131 I radioactive iodine
IVP - intravenous pyelogram KUB – kidneys, ureters, bladder
LAT - lateral MR or MRI – magnetic resonance
MRA - magnetic resonance PA - posteroanterior
angiography
PET – positron emission SPECT – single photon emission
tomography computed
Tomography.
201Tl - radioisotope (thallium) UGI - upper gastrointestinal (series)
US, U/S – ultrasound VQ scan – ventilation perfusion scan of
the lungs

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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 (drug-
store) on written orders from a physician. Currently, most schools/colleges
of pharmacy offer a Pharm. D. (Doctor of Pharmacy) degree after six or seven
years of study. As a health care professional, a pharmacist cooperates with,
and sometimes advices licensed practitioners concerning drugs. In addition,
the pharmacist answers patient’s questions concerning their prescription
needs.
Pharmacology is the study of the preparation, properties, uses, and action
of drugs. A pharmacologist is either an M.D.(Medical Doctor) or a Ph.D.(Doctor
of philosophy) who specializes in pharmacology. Pharmacology contains many
subdivisions of study: medicinal chemistry, pharmacodynamics, pharmacoki-
netics, molecular pharmacology, chemotherapy, and toxicology.
Medicinal chemistry is the study of new drug synthesis and the relation-
ship 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, para-
sites, 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 chem-
ical 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. Metho-
trexate 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 administra-
tion 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 chem-
otherapeutic drugs used to treat cancer. Contraindications are factors in a
patient’s 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 deter-
mination of mental competence in criminal cases. Psychoanalysts complete 3
to 5 years of training in a special psychotherapeutic technique called psycho-
analysis 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 psycho-
therapy, analysis, and research. A clinical psychologist, like a psychiatrist, can
use various methods of psychotherapy to treat patients, but, unlike the psychi-
atrists, cannot prescribe drugs or electroconvulsive therapy. Other nonphy-
sicians trained in the treatment of mental illness are licensed clinical social
workers and psychiatric nurses. Clinical psychologists are trained in the use of
tests to evaluate various aspects of a patient’s mental health and intelligence.

Psychiatric Clinical Symptoms

These terms describe abnormalities in behaviour that are evident to an
examining mental health professional.
amnesia Loss of memory.
anxiety 
Varying degrees of uneasiness, apprehension, or dread often
accompanied by palpitations, tightness in the chest, breath-
lessness, and choking sensations.

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apathy 
Absence of emotions ; lack of interest or emotional involve-
ment.
autism 
Severe lack of responsiveness to others, preoccupation with
inner thoughts; withdrawal and retarded language develop-
ment.
compulsion 
Uncontrollable urge to perform an act repeatedly.
conversion 
Anxiety becomes a bodily symptom, such as blindness, deaf-
ness, or paralysis, that does not have an organic basis.
delusion 
A fixed, false belief that cannot be changed by logical reason-
ing 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, obsessive-
compulsive disorder, and post-traumatic stress disorders.

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 Phobic disorders are characterized by irrational or debilitating fears asso-
ciated 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 embar-
rassment 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); acro-
phobia (fear of heights); zoophobia (fear of animals).
O b s e s s i v e co m p u l s i v e d i s o rd e r ( O C D ) i n v o lv e s re c u r re n t
thoughts(obsessions) and repetitive acts (compulsions) that dominate the
patient’s behaviour. The patient experiences anxiety if he or she is prevented
from performing special rituals, which are used to shield against overwhelming
anxiety or fear. Often the OCD consumes time and significantly interferes with
the individual’s social or occupational functioning.
Post-traumatic stress disorder is the development of symptoms (intense
fear, helplessness, insomnia, nightmares etc.) following exposure to a trau-
matic event. Many survivors of the September 11 attack experienced post-
traumatic 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 revers-

287
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, iden-
tity, consciousness, or perception of the environment that are not caused by
the direct effects of brain damage or drug abuse. Symptoms hide the pain
and anxiety of unconscious conflicts. Examples of dissociative disorders are
dissociative identity disorder, which is the existence within the individual of
two or more distinct personalities that take hold of the individual’s behaviour
(illustrated in literature by Dr. Jekyll and Mr. Hyde); dissociative amnesia
(inability to remember important personal information that is too extensive to
be explained by ordinary forgetfulness); and dissociative fugue (sudden, unex-
pected travel away from home or customary work locale). The fugue (flight)
disorder includes the assumption of a new identity and inability to recall one’s
previous identity.

Eating Disorders
Eating disorders are severe disturbances in eating behaviour. Examples
are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a refusal to
maintain a minimally normal body weight. An individual is intensely afraid of
gaining weight and has a disturbance in the perception of the shape or size
of her or his body. The condition predominantly affects adolescent females,
and its principal symptom is a conscious, relentless attempt to diet along with
excessive, compulsive overactivity, such as exercise, running, or gymnastics.
Most postmenarchal females with this disorder are amenorrheic.
Bulimia nervosa (bulimia means abnormal increase in hunger) is char-
acterized by binge eating (uncontrolled indulgence in food) followed by
purging(eliminating food from the body). Bulimic individuals maintain normal
or nearly normal weight because after binging they engage in inappropriate
purging. Examples are self-induced vomiting and the misuse of laxatives or
enemas.

Mood Disorders
A mood disorder is prolonged emotion such as depression or mania (elation)
that dominates a patient’s entire mental life. Examples of mood disorders are
bipolar disorders and depressive disorders. Bipolar disorders (bi - two; pol/o
–extreme) are characterized by one or more manic episodes alternating with

288
depressive episodes. A manic episode is a period during which the predomi-
nant mood is excessively elevated (euphoria), expansive, or irritable. Associ-
ated 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, discourage-
ment). Other symptoms are appetite disturbances and changes in weight,
sleep disorders such as insomnia or hypersomnia, fatigue or low energy, feel-
ings of worthlessness, hopelessness, or excessive or inappropriate guilt, diffi-
culty thinking or concentrating, and recurrent thought of death or suicide.
Dysthymia is a depressive disorder involving depressed mood that persists
over a 2-year period but is not as severe as major depression. Also there
are no psychotic features (delusion, hallucinations, incoherent thinking) as
are sometimes found in major depression. Dysthymic disorder can be very
impairing but commonly responds well to medications.
Physicians have noted a relationship between the onset of an episode
of depressive disorder and a particular 60-day period of the year. A regular
appearance of depression may occur between the beginning of October and
the end of November every year. This is referred to as a seasonal affective
(mood) disorder (SAD). A change from depression to mania or hypomania also
may occur within a 60-day period from mid-February to mid-April.

Personality Disorders
Personality traits are established patterns of thinking and ways of relating
to and perceiving the environment and one’s self; however, when these traits
become inflexible and rigid, causing impairment of functioning, distress, and

289
conflict with others, they constitute personality disorders. Examples of person-
ality disorders are as follows:
antisocial 
No loyalty to or concern for others, and without moral stand-
ards; 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; irra-
tional outbursts and tantrums; flamboyant and theatrical;
having general dissatisfaction with one’s self and angry feel-
ings about the world
narcissistic 
Grandiose sense of self-importance or uniqueness and preoc-
cupation with fantasies of success and power. Narcissism is
a pervasive interest in one’s self with a lack of empathy for
others.
paranoid 
Continually suspicious and mistrustful of other people but not to
a psychotic or delusional degree; jealous and overly concerned
with hidden motives of others; quick to take offense.
schizoid 
Emotionally cold and aloof; indifferent to praise or criticism or
to the feelings of others; few friendships and rarely appears to
experience strong emotions, such as anger or joy.

IV. Therapeutic Terminology

Psychotherapy
This is the treatment of emotional problems by using psychological tech-
niques. 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 audi-
ence (composed of other patients)is asked to make comments and offer inter-
pretations 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 convul-
sions (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-depres-
sive) disorder.

Drug Therapy
The following are categories of drugs used to treat psychiatric disorders.
Antianxiety and antipanic agents. These drugs lessen anxiety, tension, and
agitation, especially when they are associated with panic attacks. Example –
benzodiazepines(BZDs).
Antidepressants. These drugs gradually reverse depressive symptoms
and produce feelings of well-being. The basis of depression is thought to be
an imbalance in the levels of neurotransmitters in the brain.

291
 Anti-obsessive-compulsive disorder agents.(OCD). These drugs are
prescribed to relieve the symptoms of obsessive-compulsive disorder.
Antipsychotics (neuroleptics). These drugs modify psychotic symptoms and
behaviour. Examples are phenothiazines, which are tranquilizers that reduce
the anxiety, tension, agitation, and aggressiveness associated with psychoses
and modify psychotic symptoms such as delusions and hallucinations.
Hypnotics. These drugs are used to produce sleep and relieve insomnia.
Examples are sedatives and benzodiazepines.
Mood stabilizers. These drugs treat the manic episodes of bipolar illness.
Lithium is commonly used to reduce the levels of manic symptoms, such
as rapid speech, hyperactive movements, grandiose ideas, poor judgement,
aggressiveness, and hostility. Lithium is a simple salt that is thought to stabi-
lize nerve membranes.
Stimulants. These drugs(amphetamines) are prescribed for attention-
deficit hyperactivity disorder in children. Common symptoms of ADHD are
having a short attention span and being easily distracted, emotionally unstable,
impulsive, and moderately to severely hyperactive.

Some Common Combining Forms, Suffixes, Prefixes, and Terminology

1.Combining forms:
anxi/o uneasy, anxious, distressed anxiolytic .....................................................
hallucin/o hallucination hallucinogen .............................................
hypn/o sleep hypnosis ......................................................
iatr/o treatment psychiatrist ................................................
ment/o mind mental ..........................................................
phil/o attraction to, love paraphilia ...................................................
phren/o mind schizophrenia ...........................................
psych/o mind psychosis ....................................................
schiz/o split schizoid ........................................................
somat/o body psychosomatic ........................................
somatoform disorder ..........................

2. Suffixes
-genic produced by psychogenic ..............................................

292
-leptic to seize hold of neuroleptic drugs ..................................
-mania obsessive preoccupation kleptomania ..............................................
-phobia fear (irrational and disabling) agoraphobia ..............................................
-phoria feeling, bearing euphoria ......................................................
-thymia mind cyclothymia ...............................................
dysthymia ...................................................

3. Prefixes
a-, an- no,not apathy ...........................................................
cata- down catatonic stupor ......................................
hypo- deficient, less than, below hypomania .................................................
hypochondriasis .....................................
para- abnormal paranoia ......................................................

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

293
Glossary

A
abdomen trbuh, trbušna šupljina
abdominal trbušni
abduction odmicanje
ability sposobnost, vještina, umijeće
abnormal nenormalan, neprirodan
abnormality nenormalnost, neprirodnost
abortion pobačaj, abortus
abrupt nagao, žestok, iznenađen
abruptio placentae abrupcija (odvajanje) posteljice
abscess apsces
absorb apsorbirati
absorption apsorpcija
accelerate ubrzati, povećati brzinu
acceleration ubrzanje
accessory dodatan, dopunski, pomoćni
accommodation akomodacija, prilagodba oka za gledanje
na daljinu
accumulate nakupiti, skupiti
accumulation nakupljanje, skupljanje
acetabulum, pl. acetabula acetabulum, čašica zdjelične kosti
acetylcholine acetikolin
achlorhydria aklorhidija (nestvaranje želučane kiseline)

294
acid kiselina
acidic kiseo
acidity kiselost, aciditet
acidosis acidoza
acinus, pl. acini acinus, bobica; plućna jedinica
acne vulgaris acne vulgaris
acoustic neuroma neurom (tumor) slušnog živca
acquired stečen
acromegaly akromegalija
acromion akromion lopatice
act djelovati, funkcionirati; čin djelo
action djelovanje, rad, utjecaj
acuity oštrina (vida), zaoštrenost
acute akutan
adenomatous goitre/goiter adenomska gušavost (struma)
Adam’s apple Adamova jabučica
Addison disease Addisonova bolest
aduction primicanje
adenocarcinoma adenokarcinom (zloćudni žljezdani tumor)
adenohypophysis adenohipofiza
adenoids polipi (u nosu), adenoidi
adenopathy adenopatija (bolest žlijezda)
adhere prijanjati, držati se (čega)
adhesion prianjanje, adhezija
adipose tissue masno (adipozno) tkivo
adjacent susjedan, obližnji
administration of drugs. davanje lijekova
adnexa privjesci maternice, adneksa
(jajovodi i jajnici)
adolescence mladost, adolescencija
adolescent mladić, djevojka, adolescent
adrenal gland nadbubrežna žlijezda

295
adrenalectomy adrenalektomija (kirurško uklanjanje
nadbubrežne žlijezde)
adrenaline adrenalin
adrenocorticotropic adrenokortikotropni hormon, kortikotropin
hormone (acth)
adult albuminurija
adulthood odrasla životna dob
advancing age poodmakla životna dob
adverse suprotan, oprecan; štetan
affect utjecati, štetno djelovati, zahvatiti
afferent dovodan, aferentan
afterbirth babinje, puerperij
agent uzrocnik, lijek; agens
agglutination (clumping) aglutinacija; nakupljanje
agglutinin (antibody) aglutinin; protutijelo
agglutinogen aglutinogen; tvar koja potiče stvaranje
protutijela
aging starenje
aid pomoći, omogućiti, olakšati
aids – acquired sindrom stečene imunodeficijencije
imunodeficiency syndrome
ailment bolest, tegoba
albinism albinizam
albino albino
albuminuria albuminurija
alcohol abuse prekomjerno uživanje alkohola
alcoholism alkoholizam
aldosterone aldosteron
alimentary probavni
alkaline lužina, baza, lužnat
allergen alergen
allergic alergičan

296
allergologist alergolog
allergology alergologija
allergy alergija
allopurinol alopurinol; sredstvo za snižavnje razine
mokraćne kiseline(kod gihta i sl.)
alopecia ćelavost
alpha cell alfa stanica
alter promijeniti, izmijeniti
alteration promjena, izmjena
alveolus, pl. alveoli plućni mjehurić; zubna šupljina
Alzheimer disease / Alzheimerova bolest; predsenilna demencija
presenile dementia
am(o)eba, pl. am(o)ebae, ameba
am(o)ebas
am(o)ebic amebni
amenorrh(o)ea amenoreja, izostanak mjesečnice
ametropia ametropija, poremećaj u lomu svjetlosnih
zraka
amino acid aminokiselina
ammonia amonijak
amniocentesis amniocenteza, perkutana punkcija uterus
radi uzimanja plodne vode
amnion, pl. amnia, vodenjak, plodni mjehur
amnions
amount količina, iznos
amyotrophic amiotrofni, koji se odnosi na atrofiju
mišićnog tkiva
an(a)esthesia anestezija
anabolism anabolizam, gradbeni, ili pretvorbeni,
metabolički proces
anal čmarni, analni
anal canal čmarni kanal
anal fistula čmarna fistula

297
analgesic analgetik, sredstvo protiv boli
anastomosis anastomoza, premosnica
anatomy anatomija
anchor, n. sidro, kotva, držac
anchor, vb. usidriti se
aneurysm/aneurism aneurizma, proširenje (arterije)
aneurysmectomy aneurizmektomija; kirurško uklanjanje
aneurizme
angina pectoris angina pectoris; bol u prsištu
angiorrhexis angioreksija; prsnuće krvne žile
angle kut (geometrijski)
angulation nagib
ankle nožni zglob, gležanj
ankylosing spondylitis ankilozni spondilitis; ukočenost kralješnice
anomaly anomalija, nenormalnost
anorexia anoreksija, manjak apetita
anosmia anosmija, odsustvo osjeta mirisa (njuha)
antagonistic suprotan, antagonistički
anterior prednji
anthracosis antrakoza (bolest crnih pluća)
anti-inflammatory protuupalan
antibiotic antibiotic, protubakterijski lijek
antibody protutijelo
anticoagulant antikoagulant, sredstvo protiv zgrušavanja
krvi
antidiuretic hormone antidiuretski harmon
antigen antigen, bilo koja tvar koja potiče
obrambenu reakciju
antitoxin protuotrov
antrum of the stomach baza želuca
anus čmar, anus
anvil nakovanj; lat. incus

298
anxiety tjeskoba, anksioznost
aorta, pl. aortae. aorta
aortic aortni
aortic valve aortni zalistak
apex, pl. apices vrh, apeks
aphasia afazija, nemogućnost govora ili
razumijevanja govora
aphonia afonija, gubitak glasa
aplastic an(a)emia aplasticna anemija
apn(o)ea apneja, zastoj disanja
aponeurosis aponeuroza, široka plosnata tetiva
apoplexy (stroke) moždani udar, apopleksija, kap
appendectomy apendektomija, uklanjanje crvuljka
appendicitis upala crvuljka, apendicitis
appendix, pl. appendices crvuljak
application primjena
aqueous humo(u)r očna vodica
arachnoid paučinasta ovojnica, arahnoidea
arch luk
area područje, regija
areola, pl. areolae, areolas areola (dojke)
arise nastati, proistjecati, potjecati
armpit pazuh, aksila
arrhythmia aritmija, poremećaj ritma (srčanog)
arteriole Arteriola, mala arterija
arteriosclerosis arterioskleroza
artery arterija
arthritis artritis, upala zglobova
arthrodesis artrodeza, fiksiranje nestabilnog zgloba
arthrotomy artrotomija, punkcija zglobne tekućine
articular zglobni
articulation zglob

299
artifical umjetan
asbestosis azbestoza, nakupljanje azbestne prašine u
plućima
ascending uzlazan
ascites ascites, nakupljanje tekućine u trbušnoj
šupljini
assimilation asimilacija, upijanje
associated povezan, pripadajući, pridružen
asthenia astenija, tjelesna slabost
asthma astma
astigmatism astigmatizam
astrocyte astrocit, jedan tip neuroglijalnih stanica
astrocytoma Astrocitom, primarni moždani tumor koji se
sastoji od astrocita

B
bacillary bacilni
bacillus, pl. bacilli bacil
backbone kralješnica, hrptenica
backflow vraćanje, refluks (krvi, mokraće, itd.)
bacterium, bl. bacteria bakterija
bacteriuria bakteriurija; bakterije u mokraći
balance ravnoteža
ball and socket joint kuglasti zglob
balloon, vb. napuhati
band mišićna tetiva, trak, vrpca, zavoj za rane
barium swallow/meal barijeva kasa
bark kora, npr. drveta; pseći lavež
barking cough kašalj poput psećeg laveža
barrier zapreka, prepreka
Bartholin glands Bartholinove velike žlijezde predvorja
rodnice
basal cell carcinoma bazaliom, rak bazalnih stanica

300
basin zdjelica, pelvis
basophil bazofil, zrnati (granularni) leukocit
basophilia bazofilija, znatan porast broja bazofila u krvi
bat-shaped nalik krilima šišmiša
bath kupka, kupelj
bean-shaped graholik, nalik zrnu graha
bed rest mirovanje u postelji
belching podrigavanje
Bell palsy/paralysis Bellova kljenut (paraliza)
belly out izbočiti se, napuhati se
bend svijati (se), flektirati, pognuti
bending svijanje, fleksija
bending of light rays lom (refrakcija) svjetlosnih zraka
benign dobroćudan, benigni
bent adj. svijen, flektiran
bent n. skolioza, lateralna svijenost (kralješnice)
benzene benzol, bezbojna hlapljiva tekućina
beta blocker beta blokator, regulator srčanog ritma
beta cell beta stanica Langerhansovih otočića
u gušterači (izlučuje inzulin)
biceps brachii dvoglavi mišić nadlaktice
bicuspid valve bikuspidni (mitralni) zalistak
bile žuč
bilirubin žučni pigment
bile pigment bilirubin
bind vezivati, spajati
biopsy biopsija
birth canal porođajni kanal, rodnica
birthmark znamenka od rođenja, hemangiom
bite ubod (kukca); ugriz (npr. psa)
bizarre čudan, neobičan
blackhead sujedica, komedon

301
bladder mjehur
bladder outlet otvor mokraćnog mjehura
blastocyst blastocista, rani stadij (postmorularni)
razvitka oplođene stanice u sisavaca
blastoma, pl. blastomata blastom, tumor koji je građen od zametnih
stanica
bleed krvariti
bleeding, haemorrhage krvarenje
blepharoptosis blefaroptoza, spuštene vjeđe
blind spot slijepa pjega
blindness sljepoća
blink reflex refleks treptanja (vjeđom)
blister plik, mjehurić, žulj
bloating napuhnutost (želuca)
blockage zastoj, zaustavljanje, blokada
blood krv
blood clot krvni ugrušak
blood clotting zgrušavanje krvi, koagulacija
blood count krvna slika
blood group/type krvna grupa
blood plasma krvna plazma
blood pressure krvni tlak
blood serum krvni serum
blood sugar šećer (glukoza) u krvi
blood transfusion transfuzija krvi
blood vessel krvna žila
blood volume volumen krvi
bloodletting puštanje krvi
bloodstream optok krvi
blotchy mrljast
bolus bolus, homogeni zalogaj stvoren žvakanjem
hrane
bond prianjati, vezati se

302
bone kost
bone cell koštana stanica, osteocit
bone head glava kosti
bone process koštani nastavak
bone projection izbočenje na kostima
bony tissue koštano tkivo
borborygmus, pl. kruljenje (crijeva)
borborygmi
border rub, granica
bowel crijevo
braces proteza
bradycardia bradikardija,usporen rad srca
bradypn(o)ea bradipneja, usporeno disanje
brain mozak
brain stem moždano deblo
branch ogranak, grana
branch, vb. granati se, razgranati se, proširiti se
break off osloboditi se, odvojiti se
break, n lom (kostiju); ranica
break, vb slomiti, prelomiti, razbiti, raskinuti
breakdown razgradnja, propadanje
breast dojka
breast plate prsna kost
sternum, breastbone prsna kost
breath dah
breath odo(u)r zadah
breathing disanje, respiracija
breech birth porođaj (novorođenčeta) na zadak
bridge of the nose hrbat nosa
bright light jaka svjetlost
Bright disease Brightova bolest
bring about prouzročiti

303
bronchiectasis bronhiektazija, proširenost bronha
bronchiole bronhiola
bronchodilator bronhodilatator, sredstvo za širenje bronha
bronhopneumonija upala bronha i pluća
bronchostomy bronhostomija
bronchus,bl.bronchi dušnica,bronh
bruise modrica, krvni podljev
bruising nagnječenje, oštećenje
bucca, pl.buccae obraz
buccal obrazni, bukalni, koji se odnosi na usnu
šupljinu
bulbourethral bulbouretralan
bulla, pl. bullae mjehurić, bula
bump oteklina (od udarca), kvrga, čvoruga,
ispupčenje
bundle of His Hisov snop
bunion izraslina na palcu ili stopalu
bunionectomy bunionektomija
burden teret, opterećenje
Burkitt lymphoma Burkittov limfom
burn, n. opeklina
burn, vb. sagorijevati, peći, žariti
burning pečenje, žarenje, žgaravica
bursa, pl. bursae bursa, vrećica ili mjehurić ispunjen
želatinoznom tekućinom
bursitis bursitis, upala burse
burst forth izbiti, izaći, probiti
bursting rasprsnuce, probijanje
buttocks stražnjica
bypass premosnica (npr. začepljene arterije)
byssinosis bisinoza, bolest dišnih organa izazvana
prašinom od vune i pamuka

304
C
c(a)ecum, pl. c(a)eca slijepo crijevo
c(a)esarean section carski rez
cachexia kaheksija, opća slabost i atrofija
calcaneus, pl. calcanei petna kost
calcification ovapnjenje, kalcifikacija
calcify ovapniti, kalcificirati
calcitonin kalcitonin, tirokalcitonin; hormon štitnjače
calcium kalcij
calculus, pl. calculi kamenac
calyx/calix, pl. calyces/ vrč, čašica (bubrežna)
calices
canal kanal
canal of Schlemm schlemmov kanal
canaliculus, pl. canaliculi kanalić
cancellous spužvast, spongiozan, porozan
cancer rak, karcinom
cancerous kancerozan
canthus, pl. canthi ugao
capillary kapilara
capsule čahura
carbon ugljik
carbon dioxide ugljični dioksid
carbonic ugljikov
carcinoma rak, karcinom
carcinoma in situ lokaliziran rak (karcinom)
cardiac srčani
cardiac valve srčani zalistak
cardiocairograph kardiokairograf, tehnika rendgenskog
snimanja srca u svakoj fazi otkucaja
cardiologist kardiolog
cardiology kardiologija

305
cardioversion kardioverzija, vraćanje srčanog ritma
u normalu
caries karijes, kvarenje
carpal karpalan, koji se odnosi na zapešće
carpopedal spasm karpopedalni spazam (zahvaća zapešće
i stopalo)
carrier of the trait nositelj znakova ili svojstava
cartilage hrskavica
cartilage ring hrskavični prsten
cartilaginous hrskavičan
cast gipsani zavoj
catabolism katabolizam, razgradbeni metabolički
proces
cataract mrena, katarakta
catecholamine katekolamin (dopamin, noradrenalin,
adrenalin); simpatomimetici
cathartic katartik, sredstvo za pražnjenje crijeva
catheter kateter
caudal kaudalan, repni
cavity šupljina
cell stanica
cell body stanično tijelo
cell membrane stanična opna (membrana)
cell-mediated immunity stanična imunost
cellular stanični
cellulitis celulitis
cementum zubni cement
cephalic cefaličan, kranijalan, koji se odnosi na glavu
cerebellum, pl. cerebella, mali mozak
cerebellums
cerebral moždan, cerebralan
cerebral contusion nagnječenje (kontuzija) mozga

306
cerebral palsy cerebralna kljenut (paraliza)

cerebrospinal fluid moždanokralješnička (cerebrospinalna)

tekućina, likvor
cerebrovascular accident moždani udar, cerebrovaskularni inzult,
apopleksija
cerebrum,pl. cerebra veliki mozak
cerumen ušna mast
cervical vratni
cervix, pl. cervices grlo (npr. maternice), vrat
cessation prestanak, prekid
chain lanac
chalazion, pl. chalazia kalazion, ječmenac
chalicosis kalikoza, kamena prašina u plućima
chamber komora, klijetka
chancre čir, čankir
channel kanal
cheek obraz
chemonucleolysis kemonukleoliza, vraćanje iskliznutog
međukralješničnog diska u normalan
položaj
chemotherapy kemoterapija
chest prsni koš, toraks
chew žvakati
chewing, mastication žvakanje, mastikacija
childbirth, partus, porođaj,rađanje, partus
parturition, delivery
chill zimica, tresavica
chloasma kloazma, smeđe pigmentne pjege po licu
(u trudnoći i kaheksiji)
chloramphenicol kloramfenikol
chloremia kloremija, kloroza

307
cholecystectomy kolecistektomija, odstranjenje žučnog
mjehura
choledocholithotomy koledokolitotomija, incizija glavnog
žučovoda (radi odstranjenja žučnog
kamenca)
cholelithiasis kolelitijaza, stvaranje kamenca u žučnom
mjehuru
cholesteatoma kolesteatom, cistična tvorba ilia benigni
tumor koji se razvija iz keratiniziranih
epidermalnih stanica
cholesterol kolesterol
cholinesterase kolinesteraza, enzim prisutan u jetri,
krvnom serumu i gušterači
chorea korea, diskinezija, nekontrolirani pokreti
choriocarcinoma koriokarcinom, zloćudna tvorba koja nastaje
iz placentalnog epitela
chorion korion, vanjska ovojnica (omotač) zametka
choroid žilnica (oka)
chromosome kromozom
chronic kroničan
chyme kaša (probavljene hrane u želucu), kimus
cicatrix, pl. cicatrices ožiljak, brazgotina
ciliary muscle cilijarni mišić
cilium, pl. cilia trepetljika, bič, cilija, trepavica
circle kružnica, krug, ciklus
circuit krug (npr. strujni)
circular kružan
circulate kolati, cirkulirati
circulation optjecaj (krvi), cirkulacija
circumcision obrezivanje
circumscribed zaokružen
cirrhosis ciroza, bolest jetre
claustrophobia klaustrofobija, strah od zatvorenog prostora

308
clavicle ključna kost, klavikula
clavicular ključni, klavikularni
cleanse pročistiti, očistiti
cleansing pročišćavanje, čisćenje
cleft palate rascijepljeno nepce
climacteric klimakterij,menopauza
clitoris dražica
closure zatvaranje
clot, n. ugrušak krvi
clot, vb. zgrušavati se, koagulirati
clotting zgrušavanje, koagulacija
clubfoot zgrčeno stopalo (prirođena deformacija),
talipes
clumping aglutinacija, nakupljanje
cluster nakupina, grozd
coagulate zgrušavati se, koagulirati
coagulation zgrušavanje, koagulacija
coat ovojnica, omotač
coccus, pl. cocci kok
coccygeal trtični
coccyx, pl. coccyges trtična kost, trtica
cochlea pužnica
coitus odnošaj
colchicine kolhicin, biljni preparat za liječenje gihta
colitis kolitis, upala debelog crijeva
collagen Kolagen, izvanstanični protein – glavni
sastojak vezivnog tkiva
collapse kolaps, urušavanje, opći pad
collar bone ključna kost, klavikula
collect skupljati, sabirati
collecting tubule sabirni kanalić (tubul)
collection skupljanje, nakupljanje

309
colon debelo crijevo, kolon
colonic polyposis polipoza kolona
colpoplasty kolpoplastika, plastična operacija rodnice
coma koma, nepovratni gubitak svijesti
comatose komatozan
combat boriti se, suzbijati
comedo, pl.comedones sujedica, komedon
comminuated kominutivan (lom kosti)
common bile duct glavni žučovod
compact čvrst, kompaktan
compensation nadoknada, kompenzacija
complement potpuni broj (količina), potpunost
composition sastav, sastavljanje, uređenje
compound spoj (kemijski)
compound fracture složen (kompliciran) lom
compress, n. oblog, kompresa
compress, vb. stisnuti, komprimirati
compression pritisak, kompresija
concave udubljen, konkavan
conception začeče, zanošenje
concussion of the brain potres mozga
condition stanje, bolest
conduct provoditi, voditi
conduction provođenje, vođenje
conductive provodan
condyle čvor, kondil
cone stožac, čunj
congenital prirodan, kongenitalan
congestive heart failure srčana dekompenzacija
conization konizacija
conjunctiva spojnica oka
connection veza, spoj

310
connective vezivan
conscious svjestan, pri svijesti
consciousness svijest, svjesnost
constipation zatvor (stolice), opstipacija
constitutent (bitan) sastavni dio, element
constrict stezati
constriction stezanje, suženje, konstrikcija
contagious zarazan, infektivan
contagiousness zaraznost, infektivnost
contraceptive kontracepcijsko sredstvo
contract stegnuti se, kontrahirati; navući na se
bolest, oboljeti
contraction stezanje, kontrakcija
contusion nagnječenje, kontuzija
conversely obratno, protivno, suprotno
conversion pretvorba
convert pretvoriti
convex izbočen, ispupčen, konveksan
convey prenositi, odašiljati
conveyance prijenos, odašiljanje
convolution vijuga
convulsion grčenje, grč, konvulzija
Cooley an(a)emia Cooleyeva slabokrvnost
coordinate uskladiti
coordination usklađivanje
copulation snošaj, kopulacija
cor pulmonale plućno srce
core jezgra
coredialysis iridodijaliza
corium usmina, korij, derma, koža
cornea rožnica
coronary artery vjenčasta (koronama) arterija

311
corpus callosum, žuljevito tijelo
pl. corpora callosa
corpus luteum, žuto tijelo
pl. corpora lutea
corpus, pl. corpora tijelo, trup, korpus
corpuscle tjelešce
cortex, pl. cortices kora, korteks
cortical čvrst kompaktan (kost)
corticosteroid kortikosteroid, hormon kore nadbubrežne
žlijezde (adrenalni korteks)
cortisol kortizol, hidrokortizon
cortisone kortizon
cough, n. (bf) kašalj
cough, vb. (bf) kašljati
coughing kašljanje
covering ovojnica, omotač
Cowper glands bulbouretralne (Cowperove) žlijezde
crackling pucketanje (kostiju)
cramp grč
cramping grčenje
cranial lubanjski, kranijalni
cranium, pl. crania lubanja
creatinine kreatinin
crepitation pucketanje, krepitacija (kostiju)
crest greben, krista
cretinism kretenizam, kronično stanje koje je
posljedica prirođenog teškog hipotiroidizma
cripple onesposobiti, osakatiti
crippling invalidnost, onesposobljavanje
Crohn disease Crohnova bolest, regionalni enteritis ili
ileitis
cross-section presjek
crossmatching unakrsna reakcija

312
croup krup, akutna djelomična opstrukcija gornjih
dišnih putova
crushed zgnječen, zdrobljen, smrvljen
crust krasta
cryocauterization kriokauterizacija
cryoextraction krioekstrakcija
cryoprobe kriosonda
cryptorchism/cryptorchidism kriptorhizam, nespušteni testisi
crystalline kristalan, poput kristala
cul-de-sac bilo koji oblik slijepog crijeva (cecum)
ili vrećice; tobolac
curative ljekovit, kurativan, izlječiv
cure liječenje, ozdravljenje, lijek
curettage kiretaža, struganje
current struja
curvature zakrivljenost
curve krivulja, zavoj
Cushing syndrome Cushingov sindrom
cushion, n. jastučić
cushion, vb. štititi, zaštititi, ublažiti (udarac)
cuspid očnjak
cutaneous kožni, kutani
cuticle pokožica, eponihij
cyanoderma cijanoderma
cyanopia cijanopija
cycle ciklus, krug, razdoblje
cyclic kružan, ciklican
cyst cista, mjehur
cystadenocarcinoma cistadenokarcinom
cystadenoma cistadenom

313
cystic cističan
cystic duct cistički vod
cystoscopy cistoskopija, endoskopski pregled mjehura
cytologist citolog
cytoplasm citoplazma
cytotoxin citotoksin

D
damage, n. oštećenje, šteta
damage, vb. oštetiti, naškoditi
damaged oštećen
deaf gluh
deafness gluhoća
debris otpad, otpadni proizvod
decay raspadanje, truljenje
decelerate usporiti
decline opadanje, propadanje, pad
decompose razgraditi, raspasti se
decomposition razgradnja, propadanje
decrease, n. smanjenje, sniženje, opadanje
decrease, vb. smanjiti, sniziti, opasti
decubitus dekubitus, rane od ležanja
def(a)ecation pražnjenje stolice, defekacija
defibrillation defibrilacija
defibrillator defibrilator
deficiency pomanjkanje, manjak
deficient manjkav
deflection otklon, pomak
deformation izobličenje, deformacija
deformity nakaznost, izobličenost
degenerated degeneriran
degeneration degeneracija

314
degenerative degenerativan
deglutition gutanje, degluticija
degrade umanjiti, opasti, sniziti se, razgraditi
deliberate hotimičan, namjeran
delirium delirij
demineralization demineralizacija
demyelination demijelinizacija
dendrite dendrit
dense gust, čvrst
density gustoća, čvrstoća
dentin dentin
denture umjetno zubalo
deoxyribonucleic acid deoksiribonukleinska kiselina (dnk)
depletion iscrpljenje, ispražnjenje
depolarization depolarizacija, neutralizacija polariteta
deposit pohraniti, odložiti, uskladištiti
depositing pohranjivanje, odlaganje, uskladištenje
depository spremište, skladište
depress usporiti, smanjiti
depression udubljenje, uleknuće
dermatitis dermatitis, upala kože
dermis usmina, derma, korij, koža
descending silazan
destruction uništenje, razaranje
detach odvojiti se, odijeliti se, otkinuti
detachment odvajanje, otkidanje
detect otkriti
detection otkrivanje, detekcija
deteriorate pogoršati se, pokvariti se
deteriorated pogoršan
deterioration pogoršanje
development razvoj

315
device naprava, sprava, uređaj, sredstvo
devour progutati, proždrijeti
diabetes insipidus diabetes insipidus
diabetes mellitus sećerna bolest
diabetic nephropathy dijabetička nefropatija
diabetic neuropathy dijabetička neuropatija
diabetic retinopathy dijabetička retinopatija
diagnosis, pl. diagnoses dijagnoza
diagnostic dijagnostički
diagnostics dijagnostika
dialysis, pl. dialyses dijaliza
diameter promjer, dijametar
diaphoresis dijaforeza, pojačano znojenje
diaphragm ošit, pregrada, dijafragma
diaphysis, pl. diaphyses srednji dio, tijelo, duge kosti, dijafiza
diarrh(o)ea proljev
diastole dijastola, opuštanje srčanog mišića
diencephalon međumozak
diet prehrana, dijeta
digestion probava, probavljanje
digestive probavan, digestivan
digitalis digitalis, sredstvo za jačanje srčanog mišića
dilated proširen, dilatiran
dilation širenje, dilatacija
dim light prigušeno svjetlo
diminished smanjen, snižen
diphtheria difterija
disc/disk kolut, disk
discharge iscjedak; otpust bolesnika
discolo promjena boje
discomfort nelagoda, tegoba
discontinue prekinuti, prestati

316
disease bolest
disintegrate razgraditi se, raspasti se
disintegration razgradnja, raspadanje
dislocation iščašenje, dislokacija
dislodged izbačen, istisnut, istjeran
disorder poremećaj
dispose ukloniti, odložiti, odbaciti
disproportion nerazmjer, nesklad
disrupt prekinuti
dissection seciranje, sekcija
dissolution rastvaranje, otapanje, otopina
distal distalan, udaljen
distensible rastezljiv
distention širenje, rastezanje, napuhanost
distortion uganuće, distorzija
distress tegoba, klonulost, bol
disturbance poremećaj, smetnja
diuretic sredstvo za izmokrivanje, diuretik
diverticulectomy divertikulektomija, kirurško uklanjanje
divertikula
diverticulitis divertikulitis, upala divertikula
diverticulum, pl. diverticula divertikul
division dioba, podjela, dio
dizziness vrtoglavica
dizzy koji osjeća vrtoglavicu
donour davatelj (krvi, organa)
dormant pritajen, latentan
dorsal leđni, dorzalan
dorsiflexion dorzifleksija
dosage doziranje, dozaža
dose, n. doza (lijeka)
dose, vb. dozirati, davati u dozama

317
Down syndrome Downov sindrom, trisomija 21
drag vući, povlačiti, potezati
dragging povlačenje, potezanje
drain odvoditi, istjecati, prazniti se, drenirati
draining odvodenje, praznjenje, dreniranje
drop kap, kaplja
droplet kapljica
dropsy otok, edem; ascites
drug lijek, droga (narkotik, opijat)
drug abuser/drug addict ovisnik o narkoticima/lijekovima (narkoman)
drug-induced prouzročen (izazvan) lijekovima
Duchenne disease Duchenneova bolest
duct vod
duodenal duodenalni
duodenum, pl. duodena dvanaesnik
dura mater tvrda (moždana) ovojnica
dwarf patuljak
dwarfism patuljast stas, nanosomija
dye boja (sredstvo za bojenje)
dysentery dizenterija
dysgerminoma disgerminom, maligna neoplazma jajnika
dysmenorrhea dismenoreja, bolna mjesečnica
dyspareunia dispareunija, bol pri snošaju
dysphagia disfagija, otezano gutanje
dysphasia disfazija, poremećaj govora
dysplasia displazija, nenormalan razvoj (u veličini,
obliku i organizaciji tjelesnih stanica)
dyspn(o)ea zaduha, dispneja, otežano disanje
dysrhythmia disritmija
dystocia distocija, otežan porođaj
dystrophy distrofija
dysuria dizurija, bolno ili otežano mokrenje

318
E
ear uho
ear canal zvukovod
earache uhobolja
eardrum, tympanum bubnjić
ecchymosis, pl. ecchymoses ehimoza, krvni podljev u koži
eclampsia eklampsija
ectopic pregnancy ektopijska (izvanmaterična) trudnoća
eczema ekcem
edema oteklina, edem
efferent odvodan, eferentan
effusion of blood izljev krvi
egg, ovum jajašce, ovum
ejaculation ejakulacija
ejaculatory duct ejakulatorni vod
ejection izbacivanje
electric pacemaker električni stimulator srčanog ritma
electrical charge električni naboj
electrocardiogram elektrokardiogram
electrocardiograph elektrokardiograf
electrolyte elektrolit, element s električnim nabojem
elephantiasis elefantijaza (tropska parazitarna bolest)
elevated povećan, povišen, podignut
elevation povećanje, povišenje, podizanje
elimination otklanjanje, odstranjivanje, izbacivanje
embedded usađen, uložen, ugrađen
embolism embolija
embolus, pl. emboli embolus
embryo zametak, embrij
emerge izlaziti, izranjati
emergency hitan slučaj
empyema, pl. empyemata empijem, nakupina gnoja u tjelesnoj šupljini

319
emulsify emulgirati, razgraditi
emulsion emulzija
enamel caklina
encapsulation učahurenje, inkapsulacija
encase omatati, obavijati
encephalitis encefalitis, upala mozga
end product krajnji (finalni) proizvod
endanger ugroziti
endemic goitre/goiter endemska guša(vost), struma
endocarditis endokarditis, upala endokarda
endocardium usrčnica, endokard, unutarnja srčana
ovojnica
endocervicitis endocervicitis, upala sluznice grlića
maternice
endocrine endokrini, s unutarnjim izlučivanjem
endometriosis endometrioza
endometritis endometritis
endometrium endometrij, sluznica maternice
endoscope endoskop, instrument za vizualni pregled
unutrašnjosti bilo kojeg šupljeg organa
engorgement začepljenje, opstrukcija
engulf progutati
enlarged povećan, proširen
enlargement povećanje, proširenje
enterolysis enteroliza, oslobađanje od crijevnih
priraslica
entity biće; suština
envelop omatati, obavljati
environment okoliš, sredina
enzyme enzim
eosinophil eozinofil
eosinophilia eozinofilija

320
ependymoma, pl. ependimom
ependymomata,
ependymomas
epidermis pokožica, epiderma
epididymis pasjemenik, epididimis
epiglottis poklopac (grkljana)
epilepsy padavica, epilepsija
epinephrine adrenalin
epiphora suzenje (očiju)
epiphyseal line/plate epifizna crta (ploča)
epiphysis, pl. epiphyses okrajina (kosti), epifiza
epispadia, pl. epispadias epispadija, uretralni otvor na gornjoj strani
penisa
epistaxis krvarenje iz nosa, epistaksa
epithelium epitel
eponychium epitelna pokožica, eponihij
equalization izjednačenje, izjednačavanje
equalize izjednačiti
equilibrium, pl. equilibria ravnoteža, ekvilibrij
erect uspravan, ravan, uzdignut
erectile tissue erektilno tkivo
erection podizanje, ukručenje, erekcija
erode nagrizati, izjedati, razarati, erodirati
erosion nagrizanje, izjedanje, erozija (kože, sluznice)
error of refraction pogreška refrakcije, ametropija
eructation podrigivanje
erupt izbiti, nicati, probiti
eruption izbijanje, nicanje (zubi), provala, osipanje,
osip
erythema crvenilo kože, eritem
erythroblast eritroblast, nukleizirana crvena krvna
stanica

321
erythroblastosis eritroblastoza, povećan broj nukleiziranih
eritrocita
erythrocyte crvena krvna stanica, eritrocit
erythropoietin eritropoetin, hormon koji stimulira stvaranje
krvnih stanica
escape, n. istjecanje (tekućine)
escape, vb. istjecati, izlaziti
esophageal varices proširenost (varikozitet) vena jednjaka
esophagus/oesophagus, jednjak
pl. esophagi; gullet
essential hypertension esencijalna hipertenzija (povišen krvni tlak)
estrogen/oestrogen estrogen, ženski spolni hormon
ethmoid bone rešetnica, etmoidna (sitasta) kost
etiology/aetiology etiologija
eupnea normalno disanje, eupneja
Eustachian tube slušna (Eustahijeva) cijev
evacuate isprazniti
evacuation pražnjenje, ispražnjavanje
evidence dokaz
Ewing sarcoma Ewingov sarkom
exacerbation pogoršanje (bolesti)
exanthem egzantem
excess višak, prekomjernost
exchange izmjena, razmjena
excitation razdraženost, uzbuđenje, podraživanje
excrete izlučiti, izbaciti
excretion izlučivanje, izbacivanje
excretory koji izlučuje, ekskretoran
exert obavljati, naprezati se
exertion naprezanje, napor, obavljanje
exhalation izdisaj, izdisanje
exhale izdahnuti, izdisati

322
exit, n. izlaz; smrt
exit, vb. izaći
exocrine egzokrini, s vanjskim izlučivanjem
exophthalmic goitre/goiter tirotoksikoza, guša, struma
exophthalmos buljookost, egzoftalmus
exostosis koštana izraslina, egzostoza
expandable rastezljiv
expectorant sredstvo za iskašljavanje
expectoration iskašljavanje
expel izbaciti, istjerati
expiration izdisaj, izdisanje
expire izdahnuti, izdisati, umrijeti, ugasiti se
exposure izlaganje, otkrivanje
expulsion of placenta istiskivanje (ekspulzija) posteljice
extension rastezanje, sirenje, ispružanje; nastavak
external vanjski
extract izvući, izvaditi, ekstrahirati, izlučiti
extraction vađenje (zubi), izlučivanje, ekstrakcija
extradural izvan tvrde moždane ovojnice (dure mater)
extremity ud, ekstremitet; kraj, vrh
exudate izljev, eksudat
eye oko
eye orbit/socket očna šupljina
eyeball očna jabučica
eyebrow obrva
eyelash trepavica
eyelid očna vjeđa, kapak
eyesight vid

F
f(a)eces stolica, fekalije
f(o)etus čedo, fetus

323
facilitate olakšati, omogućiti
facilitation olakšavanje, olakšanje
failure zatajenje, poremećaj, izostanak, propust,
neuspjeh
faint onesvijestiti se, klonuti
fainting nesvjestica
fallacious varljiv, lažan, koji obmanjuje
fallopian tube fallopijeva cijev, jajovod
farsightedness dalekovidnost
fascia vezivna ovojnica, fascija
fat mast, masnoća, lipid
fat cell, lipocyte masna stanica, lipocit
fatal smrtonosan, letalan
fatigue umor, klonulost
fatty mastan
fatty acid masna kiselina
febrile koji ima groznicu, febrilan
female, adj. ženski
female, n. žena
femur bedrena kost
fertile plodan, fertilan
fertilization oplodnja
fertilize oploditi
fever groznica, vrućica
fibre/fiber vlakno, nit
fibril vlakance
fibrillation treperenje, fibrilacija
fibrin fibrin, netopiv protein - osnovica
za stvaranje krvnog ugruška
fibrinogen fibrinogen, faktor zgrušavanja
fibroadenoma fibroadenom
fibroblast fibroblast, stanica vezivnog tkiva

324
fibroid fibroid, koji ima strukturu vezivnog trkiva
fibrosarcoma fibrosarkom, zloćudni tumor sastavljen
od stanica vezivnog tkiva
fibrosis fibroza, stvaranje vezivnog tkiva
fibrous vlaknast, fibrozan
fibula, pl. fibulae lisna kost
filtrate filtrat
fimbria, pl. fimbriae trepetljika, resa
firing of nerve impulses okidanje živčanih impulsa
fissure pukotina, rascjep, fisura
fist-sized veličine pesnice
flagellum, pl.flagella, bić:, rep (spermatozoida)
flagellums
flank slabina
flatus crijevni vjetar, plin
flavour okus, vrsta okusa, miris, začin
flax lan
flexibility savitljivost, elastičnost, fleksibilnost
flexion svijanje, pregibanje, fleksija
flexure pregib, fleksura
floor of the mouth dno usne šupljine
flow of air struja zraka
flushing rumenilo, crvenjenje (lica), crvenilo
flutter treperenje, vibriranje; undulacija
(pretklijetke ili klijetke)
focal žarišni
focus, pl. foci, focuses žarište
focus, vb. skupiti u žarištu, fokusirati
fold nabor
folic acid folna kiselina
follicle mjehurić, folikul
follow-up praćenje (bolesnika)

325
fontanelle fontanela
foot, pl. feet stopalo; stopa (30,48 cm)
foramen, pl. foramina otvor
force sila
forehead čelo
foreskin prepucij, kožna navlaka penisa
fossa, pl. fossae jama
fracture lom, prijelom (kosti)
fragile lomljiv, krhak
fragility lomljivost, krhost
framework okosnica, okvir
fraternal twins dvojajni blizanci
freckle pjega, mrlja (na koži)
friction trenje
fringe resica, fimbrija
front čelo; prednja strana
frontal čeoni, frontalan, prednji
frontal bone čeona kost
frostbite ozeblina
fulguration paljenje (električnom strujom), fulguracija
fullness ispunjenost, punoća, sitost
fundus dno, pod
fundus of the stomach svod želuca
fungal gljivični
fungus, pl. fungi, funguses gljivica, gljiva
funnel ljevak
funnel-shaped ljevkast
furrow brazda
fused srašten (kost)
fusion srastanje (cijeljenje) kostiju, spajanje, fuzija

326
G
gait hod, način hoda
gall žuč
gallbladder žučni mjehur
gallstones žučni kamenci
gamete gameta, zametna stanica
gangrene gangrena
gas plin
gaseous plinovit
gasp dahtanje, soptanje, dahtaj, soptaj
gastric juice želučani sok
gastritis gastritis, upala želučane sluznice
gastroscope gastroskop
gastroscopy gastroskopija, endoskopski pregled želuca
gelatinous želatinozan
gene gen
genesis geneza
genetic genetski, genetički
genetics genetika
genital genitalni, spolni; spolni organ
genitalia spolni organi, genitalije
germ cell zametna stanica, gameta
German measles crvenka, rubeola
gestation trudnoća, gestacija
gigantism divovski stas, makrosomija
gingiva desni, zubno meso
girdle obruč, pojas
gland žlijezda
glandular žljezdast
glaucoma zelena mrena, glaukom
glia glija, potporno živčano tkivo
glial tissue glijalno tkivo

327
glioblastoma multiforme multiformni glioblastom
glioma, pl. gliomata, gliomas gliom, tumor sastavljen od glijalnih stanica
globin globin, proteinski sastojak hemoglobina
globulin globulin, svaki tip iz skupine porteina
netopivih u vodi
glomerulonephritis glomerulonefritis, nefritis s upalom
kapilarnih petlji bubrežnih glomerula
glomerulus, pl. glomeruli glomerul, skupina kapilarnih krvnih žila
(npr. bubrežni glomerul)
glucagon glukagon, hormon alfa stanica
Langerhansovih otočića
glucocorticoid glukokortikoid, steroidni hormon
glucose glukoza, krvni šećer
glue ljepilo
gluelike ljepljiv, poput ljepila
glycogen glikogen, ugljikohidratna rezerva
pohranjena u jetri
glycogenesis glikogeneza, stvaranje glikogena
glycosuria glikozurija, šećer u mokraći
goitre/goiter guša, gušavost, struma
gonad spolna žlijezda, gonada
gonadotropic hormone gonadotropni hormon
gonadotropin Gonadotropin, hormon koji stimulira rad
spolnih žlijezda
gonococcus, pl. gonococci gonokok
gonorrh(o)ea kapavac, triper, gonoreja
gout ulozi, podagra, giht
graafian follicle graafov (ovarijalni) folikul
grading stupnjevanje, gradiranje
graft kalem, presadak, transplantat
grafting presađivanje, transplantacija
grain zrno
grand mal seizure toničko-klonički epileptički napadaj

328
granule zrnce, granula
granulocyte granulocit, stanica koja sadrži zrnca (npr.
granularni leukocit)
granulocytosis granulocitoza, nenormalno velik broj
granulocita u krvi
Graves disease Gravesova bolest, bazedov, tirotoksikoza
gravity sila teža, gravitacija
gray matter siva tvar
greenstick fracture lom mlade (rahitične) kosti
grind mrviti, mljeti, smrviti
groin prepona
groove brazda, žlijeb
gross appearance opći izgled (npr. tumora)
grow rasti, razvijati se
growth rast
growth hormone hormon rasta, somatotropin
growth rate brzina rasta
guaiac smola trospkog stabla – reagens za
testiranje krvi u stolici
guanethidine sulphate/ gvanetidinski sulfat – lijek protiv visokog
sulfate krvnog tlaka
guard štititi, čuvati
gullet jednjak
gums desni, zubno meso
gyn(a)ecologist ginekolog
gyn(a)ecology ginekologija
gynandroblastoma ginandroblastom
gyrus, pl. gyri vijuga (kore velikog mozga)

H
h(a)emangioma hemangiom, benigna tvorba mreže krvnih
žila
h(a)emarthrosis hemartroza, krvarenje u zglobu

329
h(a)ematocrit hematokrit
h(a)ematopoiesis hematopoeza, tvorba krvnih stanica
h(a)ematosalpinx hematosalpinks, krv u jajovodu
h(a)ematuria hematurija, krv u mokraći
h(a)emianopia/h(a ) hemianopsija, ispad polovice vidnog polja
emianopsia
h(a)emodialysis hemodijaliza
h(a)emoglobin hemoglobin
h(a)emolysis hemoliza, razgradnja crvenih krvnih stanica
h(a )emolytic an(a)emia hemolitička anemija
h(a)emophilia hemofilija, bolest zgrušavanja krvi
h(a)emoptysis hemoptiza, iskašljavanje krvi
h(a)emorrhoidectomy odstranjenje hemoroida (šuljeva),
hemoroidektomija
h(a)emorrhoids šuljevi, hemoroidi
h(a)emothorax hemotoraks, krv u pleuralnoj šupljini
hair kosa, vlas, dlaka
hair shaft vlas (vidljivi dio vlasi)
hairs of Corti Cortijeve dlačice
hammer čekić, malleus
hard palate tvrdo nepce
hardening otvrdnuće, skleroza
haversian canals haversovi kanali
hazard opasnost, pogibelj, rizik
hazardous opasan, pogibeljan, riskantan
headache glavobolja
heal zacijeliti, izliječiti
healing cijeljenje, zacjeljenje
hearing sluh
heart srce
heart action rad srca
heart block srčani blok, atrioventrikularni blok

330
heart failure zastoj (arest) srca
heart murmur srčani šum
heart rate brzina otkucaja srca
heart valve srčani zalistak
heartburn žgaravica
heel peta
heel bone petna kost, calcaneus
helping porcija obroka
hemisphere polutka (mozga)
hemp konoplja
heparin heparin, sredstvo protiv zgrušavanja krvi
hepatitis hepatitis, upala jetre
hepatocyte hepatocit, jetrena stanica
hepatomegaly hepatomegalija, povećanje jetre
hereditary nasljedan, hereditaran
heredity nasljednost, nasljeđe
hernia, pl. herniae hernias kila, hernija
herpes herpes, (virus)
herpes zoster herpes zoster
hiatal hernia hijatalna kila (hernija)
hiatus otvor (nepravilnog oblika)
hidrosis hidroza, prekomjerno znojenje
hilar cell tumour hilusni tumor
hilum/hilus vratnica; udubljenje u dijelu organa gdje
ulaze krvne žile i živci
hinge šarka, šarnir
hinge joint kutni (valjkasti) zglob
hip kuk
hip bone zdjelična kost
hirsutism hirzutizam, povećana dlakavost (npr. u žena)
histamine histamin, produkt histidina (esencijalna
amino kiselina)

331
histogenesis histogeneza, nastank ili razvitak tkiva
histological makeup histološki sastav (građa)
histology histologija
hives koprivnjača, urtikarija
Hodgkin disease Hodgkinova bolest
hollow šupalj
homeostasis homeostaza, stabilnost tjelesnih funkcija
hordeolum, stye ječmenac, stafilokokna infekcija vjeđe
hormone hormon
horn rog, roževina
horny cells rožnate stanice
humerus nadlaktična kost
humo(u)r tekućina, vodica
humoral immunity humoralna imunost
humpback grbavost, kifoza
hunchback grbavost, kifoza
Huntington chorea Huntingtonova koreja
hyaline hijalin, prozirna, staklasta opna
hydroc(o)ele hidrokela, vodena kila
hydrocephalus vodena glava, zastoj cerebrospinalne
tekućine u moždanim komorama
hydrochloric acid solna (klorovodična) kiselina
hydrocortisone hidrokortizon
hydrogen vodik
hydronephrosis hidronefroza, širanje bubrežnihn čašica
i zdjelice zbog zadržavanja mokraće uslijed
opstrukcije u mokraćovodu
hydrophobia hidrofobija, strah od vode
hydrothorax hidrotoraks, nakupljanje sukrvice
u pleuralnoj šupljini
hymen djevičnjak, himen
hyper(a)esthesia hiperestezija, preosjetljivost na podražaj

332
hypercalc(a )emia hiperkalcemija, povišena razina kalcija
u krvi
hyperexcitability prekomjerna razdražljivost (podražljivost)
hyperfunction prekomjerna (povećana) funkcija,
hiperfunkcija
hyperglyc(a)emia hiperglikemija, povećan sadržaj šećera
u krvi
hyperinsulinism hiperinzulinizam
hypernephroma hipernefrom, karcinom bubržnih stanica
hyperopia;hypermetropia dalekovidnost, hipermetropija
hyperosmia prekomjerna osjetljivost na mirise
hyperparathyroidism hiperparatiroidizam
hyperpituitarism hiperpituitarizam, prekomjerno izlučivanje
hiofiznih hormona
hyperplasia hiperplazija, povećanje broja tkivnih stanica
ili organa
hypersecretion prekomjerno izlučivanje, hipersekrecija
hypertension hipertenzija, povećan arterijski krvni tlak
hyperthyroidism hipertiroidizam, prekomjerno izlučivanje
hormona štitnjače
hypertrophy hipertrofija, nenormalno povećanje ili rast
tkiva odnosno organa
hyperuric(a)emia hiperurikemija, prekomjerno povećanje
mokraćne kiseline u krvi
hypoalbumin(a)emia hipoalbuminemija
hypochromic an(a)emia hipokromna anemija
hypofunction smanjena funkcija, hipofunkcija
hypoglyc(a)emia hipoglikemija, smanjen sadržaj šećera
u krvi
hypoinsulinism hipoinzulinizam
hypoparathyroidism hipoparatiroidizam
hypophyseal stalk ljevkasti držak, infundibulum (hipofize)
hypophysis hipofiza, moždani privjesak
hypopituitarism hipopituitarizam

333
hyposecretion smanjeno izlučivanje, hiposekrecija
hypospadia hipospadija, urođena anomalija mokraćne
cijevi – mokraćni otvor na donjoj površini
penisa
hypotension hipotenzija, smanjen arterijski krvni tlak
hypothalamus hipotalamus
hypothyroidism hipotiroidizam
hypox(a)emia hipoksemija, smanjena oksigenacija krvi
hysterectomy histerektomija, kirurško uklanjanje
maternice

I
iatrogenic jatrogeni, koji je posljedica (nuspojava)
liječenja
icterus žutica, ikterus
identical twins jednojajni (identični) blizanci
idiopathic spontan, primaran, etiološki nepoznat,
idiopatski
ileoc(a)ecal Ileocekalan, koji se odnosi na tanko i prvi
dio debelog crijeva (cekuma)
ileum, pl. ilea tanko (vito) crijevo, ileum
ileus zapletaj crijeva, ileus
iliac koji se odnosi na bočnu kost, ilijakalni
iliac crest ilijačna krijesta (crista iliaca)
ilium, pl. ilia bočna kost, greben bočne kosti
ill bolestan; loš; pokvaren
illegitimate nezakonit
illicit nedopušten
illness bolest
illuminate osvijetliti; razjasniti
image predodžba, slika, lik
imaging technique tehnika snimanja
imbalance neravnoteža

334
imitation oponašanje
immature nezreo; preuranjen
immediate neposredan, izravan
immense beskrajan, neizmjeran
imminent prijeteći, neizbježan
immobile nepokretan, ukočen
immobilize učiniti nepokretnim, imobilizirati
immovable nepomičan, nepokretan
immune otporan, zaštićen, imun
immune response reakcija protutijela na antigen
immunity otpornost na bolest, imunost
immunodeficiency manjak imunosti, imunodeficijencija
immunodiffusion imunodifuzija
immunoglobulin imunoglobulin
immunologist imunolog
immunology imunologija
impacted fracture ukliješten lom kosti
impair oštetiti; pogoršati; naškoditi
impairment oštećenje; slabljenje; pogoršanje
impalpable neopipljiv, sitan
impermeable nepropustan
impetigo impetigo, zarazna gnojna bakterijska
infecija kože
implant usađen dio; usaditi
implantation usađivanje, implantacija
impulse podražaj, impuls, poticaj
in situ na svom mjestu; in situ
inability nesposobnost, nemoćnost
inacidity manjak kiseline, osobito želučane (hcl)
inaction nepokretnost, mirovanje
inactivate učiniti nedjelotvornim, inaktivirati
inactivation inaktivacija

335
inanimate neživ
incapacitated onesposobljen
incarcerated ukliješten, inkarceriran
inch inč, palac (2,54 cm)
incidence pojavnost, rasprostranjenost
incision rez, rezanje, incizija
incisor sjekutić, inciziv
inclination sklonost; nagnutost
incompatibility nespojivost, nepristajanje
incompatible nespojiv; koji ne pristaje
inconclusive neuvjerljiv, bez dokazane snage
incontinence nesposobnost zadržavanja mokraće
ili stolice, inkontinencija
incudal koji se odnosi na nakovanj, inkudalni
incus, pl. incudes nakovanj
indeks finger kažiprst
indeks, pl. indices kazalo, pokazatelj
indicate pokazati, oznaćiti, navesti
indication znak; simptom; ukazivanje
indict optužiti
individual pojedinac; pojedinačni
induce izazvati; potaknuti
induction uvod; navodenje; indukcija
inevitably neizbježno
infancy novorođenačka dob
infant malo dijete; dojenče
infarct kljenut, infarkt; nekrotizirano tkivo
infarction proces nastajanja infarkta; infarkt
infect zaraziti, inficirati
infection zaraza, infekcija
infectious zarazan (npr. bolest)
infective zarazan (npr. mikroorganizam)

336
inferior niži, donji, inferioran
infertility neplodnost
infestation napad, napadnutost (gamad i sl.),
zagađenost
infiltrating infiltrirajući; prodirući
infiltration prodiranje; infiltracija
inflame upaliti
inflammmable upaljiv, zapaljiv
inflammation upala, upalni proces
inflammatory upalni
inflation napuhavanje
inflexible neelastičan
influence utjecaj
influenza gripa, influenza
inframammary ispod dojke
infusion ulijevanje; infuzija
ingest uzimati (gutati) hranu
ingestion uzimanje hrane (na usta ili umjetno)
ingrained ukorijenjen
ingredient sastojak
inguinal preponski, ingvinalni
inhalation udisanje, inhalacija
inhale udisati, inhalirati
inherit naslijediti
inheritance baština, nasljeđe
inhibit spriječiti, zaustaviti
inhibition sprječavanje, kočenje
initial početni, inicijalni
injection uštrcavanje, injekcija
injurious štetan, poguban
injury ozljeda, trauma
innate urođen, prirođen

337
innocent nedužan, nevin; dobroćudan
innominate bone zdjelična kost, bezimena kost
inoculation cijepljenje, inokulacija
inorganic anorganski, beživotan
insect kukac
insecticide insekticid
insemination osjemenjivanje
insertion hvatište (mišića); umetak
insidious podmukao, koji vreba
insipid bez okusa, bljutav
insolation izlaganje suncu; sunčanje
insoluble netopiv
insomnia nesanica
inspection nadziranje; razgledanje
inspiration udisanje; nadahnuće
inspire udahnuti; nadahnuti
instant trenutak, čas
instantaneous trenutan; istovremen
instinct nagon; instinkt
instrument sredstvo; instrument
insufficiency manjkavost, slabost, nepravilan rad organa,
nedostatnost
insulate odvojiti, izolirati
insulation odvajanje, izoliranje
insulator izolator, loš vodič
insulin inzulin
insusceptibility neosjetljivost
intake unos, uzimanje, konzumacija (npr. hrane)
integument opna, koža, prirodni ovoj, pokrov
integumentary ovojni, pokrovni
intensive care intenzivna njega
inter- među, između

338
interact međusobno djelovati
interaction međusobno djelovanje, interakcija
interbrain međumozak, diencefalon
intercellular međustanični
intercostal međurebreni
intercourse snošaj
interdigital između prstiju
interferon interferon
interior unutrašnjost
intermediate koji se nalazi između; srednji; prijelazni
internal unutrašnji, interni
internal medicine interna medicina
interpretation tumačenje, objašnjenje
interseptal međupregradni, interseptalni
interstitial fluid intersticijska tekućina
interstitial nephritis nespecifična upala bubrega, pijelonefritis
interstitium međustanično vezivno tkivo
intestinal crijevni, utrobni
intestine crijevo
intima unutarnja ovojnica krvne žile
intoxication trovanje, intoksikacija
intra- unutar, unutra
intracellular unutarstanični
intracranial unutar lubanje, intrakranijalni
intracutaneous unutar kože, intrakutani
intraocular pressure tlak u očima
intrauterine unutar maternice, intrauterini
intravenous unutar vene, intravenski
intrinsic factor unutarnji, esencijalni čimbenik, intrinzični
faktor
introduce uvesti, uvoditi
intussusception invaginacija, intususcepcija

339
invade napadati; zahvaćati (bolest)
invasive nasilan, koji napada, invazivan
involuntary nehotičan, koji nije pod kontrolom volje
involvement uključenost, zahvaćenost
iodine jod
ion ion, čestica s električnim nabojem
iridectomy izrezivanje dijela šarenice, iridektomija
iridodialysis odvajanje baze šarenice od hvatišta,
iridodijaliza
iris, pl. irides šarenica
iron željezo
irradiation obasjavanje, ozračivanje
irrational neracionalan
irritant koji izaziva upalu, koji draži, nadražuje
irritate iritirati, nadraživati
irritation nadraženost; upala
isch(a)emia nedostatna opskrbljenost krvlju, ishemija
isch(a)emic bez krvi, ishemičan
ischiatic, ischial· koji se odnosi na kuk
ischium, pl. ischia kost kuka, sjedna kost
isolate izolirati, odvojiti
isolation izolacija; karantena
isomer izomer
isomerism odnos između dva izomera
isoniazid tuberkulostatski lijek, izonijazid
isotope izotop
issue izlaženje, emitiranje; predmet
(npr. rasprave)
isthmic koji se odnosi na prevlaku, suženje
isthmus prevlaka, suženje, tjesnac
itch mite grinja svraba, svrabac

340
itch n., vb. svrbež (npr. od svraba); svrbjeti
itching svrbjeti, svrbež, pruritus

J
jaundice žutica, ikterus
jaw čeljust
jawbone donja čeljust, mandibula
jejunum tašto crijevo, jejunum
jelly žele, gel, želatina
jerk trzaj; trzanje
joint capsule zglobna čahura
joint n., adj. zglob; združen, udružen
judge ocjena; mišljenje; sud
jugular vratni, jugularni
juice sok
junction spoj; šav; veza
juncture line šavni spoj; spojna crta
juvenile mlad, mladenački, malodoban

K
kapok tropsko stablo iz porodice bambusa
Kaposi sarcoma Kaposijev sarkom, idiopatski hemoragični
sarkom
karyoplasm karioplazma, nukleoplazma
karyotype kariotip
keloid keloid, fibrozna hiperplazija, zadebljano
ožiljno tkivo
keratin keratin, rožnato tkivo
keratinized keratiniziran
keratitis upala rožnice
keratosis keratoza

341
kernicterus kernikterus, hiperbilirubinemija, žutica
moždanih jezgri
ketoacidosis ketoacidoza, nakupljanje velikog broja
ketonskih tijela
ketosis ketoza, prevelika količina ketona u tijelu
kick udarac; snaga; pokušaj
kidney bubreg
killer cells stanice ubojice
kin srodan, blizak
kinesi(o)therapy kineziterapija
kinesiology kineziologija
kinetic koji se odnosi na pokret, kinetički
knee koljeno
knee cap iver, patela
knock otkucaj (npr. srca); udarac
knot čvor; vezanje čvora; uzao
knuckle zglob prsta, članak
kophemia gluhoća, kofemija
kyphosis, pl. kyphoses grbavost, kifoza

L
labium majus, pl. labia velika usna
majora
labium minus, pl. labia mala usna
minora
labo(u)r trudovi (porođajni)
labo(u)r pains porođajne boli
labyrinth labirint (npr. uha)
lacrimal suzni
lactation dojenje, laktacija
lactiferous duct mliječni vod
laden opterećen, pun
lamina, pl. -ae tanka ploča ili sloj

342
laminectomy laminektomija
langerhans, the islands of, langerhansovi otoci, otočići
the islets of
laparoscope laparoskop, enoskopski instrument
za prelged unutrašnosti trbušne šupljine
laryngitis upala grkljana (grla) laringitis
laryngopharynx grkljan i ždrijelo
laryngoscopy pregled unutarnjeg dijela grkljana,
laringoskopija
larynx, pl. larynges larinks, grkljan
lateral bočni, lateralni
laxative sredstvo za pospješivanje stolice, laksativ
layer sloj
lead olovo
leak out istjecati, propuštati, curiti
leaky koji curi, propušta, istjeće
leg noga
leiomyoma leiomiom, vrsta benignog tumora
lens leća
lesion ozljeda, oštećenje, lezija
lethal smrtan, smrtonosan
leuk(a)emia leukemija
leuk(c)ocyte bijela krvna stanica, leukocit
leuk(c)ocytic leukocitni
leuk(c)ocytosis leukocitoza, broj leukocita iznad normalne
granice
leuk(c)openia broj leukocita ispod normalne granice,
leukopenija
leuk(c)oplakia leukoplakija
leuk(c)orhea leukoreja
leuk(c)otaxis svojstvo leukocita da se nakupljaju na
mjesta ozljede ili upale
libidinal koji se odnosi na libido

343
libido libido, spolna želja
lid poklopac, zatvarač
life-threatening opasan po život, ugrožavajući
ligament veza, spona, ligament
ligation vezanje, podvezivanje
light rays svjetlosne zrake
limb ud, ekstremitet
lime stone kamen vapnenac
line obavijati, obložiti, presvući
linger oklijevati, zaostajati
lingual tonsil jezični krajnik
lining ovojnica, prevlaka
lipid mast, lipid
lipocyte masna stanica, lipocit
lipoid lipoidan
lipoma, pl. -s, -ata lipom
liposarcoma liposarkom
lithoid poput kamena
lithotomy kirurško odstranjenje kamenca, litotomija
live živ
liver jetra
load of life teret (teskoće) života
lobby potajno se zalagati
lobe režanj, resa
lobotomy uklanjanje moždanog tkiva, lobotomija
lobster jastog
locomotion pokretnost, micanje, kretanje
loin slabine, kriza
loop of henle henleova petlja
loose slobodan, pušten, oslobođen, labav
loosening oslobađanje; omekšavanje, olabavljenje
lordosis lordoza

344
louse, pl. lice uš
lubricate mazati, podmazivati
lubricating fluid tekućina za podmazivanje
lues lues, sifilis
lumbar slabinski, lumbalni
lumen, pl. lumina šupljina, lumen
lump kvržica, gruda, izbočina, lokalno oticanje
ili tumor
lumpectomy uklanjanje kvržice
lung pluća
lung cancer rak pluća
lunula, pl. -ae mali mjesec, lunula (nokta)
lupus niz kroničnih degenerativnih kožnih lezija
luteinizing hormone, lh luteinizirajući harmon, lh
lymph limfa
lymph(o)edema začepljenje limfne žile, limfedem
lymphadenitis limfadenitis, upala limfnog čvora
lymphatic, adj., n. limfni, limfatički; limfna žila
lymphocyte limfocit
lymphocytosis limfocitoza, povećan broj limfocita
lymphoid cancer limfni ili limfoidni karcinom
lymphokine limfokin
lymphoma limfom, maligni tumor limfnog tkiva
lymphotoxin limfotoksin
lyse razgradivati, otapati, osloboditi
(npr. od priraslica)
lysin lizin
lysis, pl. -es razgradnja; otapanje stanice, liza
lytic koji se odnosi na lizu, lizni

M
macrocytic an(a)emia makrocitna anemija

345
macrophage makrofag, velika fagocitna stanica
macrotia abnormalno veliko vanjsko uho, makrotija
macula lutea žuta pjega
macule mrlja, pjega, makula
major veći; punoljetan; glavni
maladaptation loša, slaba prilagodba
malaise slabost, mlitavost
maldevelopment nedostatan iii nepravilan rast iii razvoj
male, adj., n. muško, muškarac
malformation nakaznost, malformacija
malfunction nepravilan rad
malignant zloćudni, maligni
malleolus, pl. malleoli gležanj; dio kosti koji ima oblik glave čekića
malleus, pl. mallei čekić (srednjeg uha)
mamma, pl -ae dojka
mammary gland mliječna zlijezda
mammectomy amputacija dojke, mamektomija
mammillary koji se odnosi na bradavicu dojke
mammography radiografsko snimanje dojke, mamografija
mammoth mamut
mandible donja čeljust
margin rub, kraj, margina
marrow koštana srž, moždina
masculine muški
mass mnoštvo, masa
massive sveobuhvatni, veliki, masivni
mast cell mastocit
mastectomy amputacija dojke, mastektomija
mastication žvakanje
mastitis upala dojke, mastitis
mastoid process mastoidni nastavak
mastoiditis upala mastoidnog procesa

346
matter tvar, materija
mattress strunjača, madrac
maturation dozrijevanje, sazrijevanje
maturity zrelost
maxilla, pl. -ae gornja čeljust
maxillary maksilaran
measles ospice, morbilli
meatus otvor, prolaz, hodnik
meconium mekonij, stolica novorođenčeta
(zelenkaste boje)
medial srednji, medijalni
median srednja crta (tijela, šake, stopala)
mediastinum, pl. mediastina sredoprsje
medical liječnički, medicinski, medikameotozni
medication lijek; liječenje
medicine liječništvo, medicina; lijek; čarolija
medium, pl. media sredstvo; oruđe; medij, hranilište
medulla oblongata, pl. -ai produžena moždina
medulla, pl. -ae moždina, srž
medullary medularan
medulloblastoma meduloblastom, zloćudni tumor malog
mozga
melanin melanin
melanocyte melanocit
melanoderma melanoderma
melanoma melanom
melatonin hormone harmon melatonin
melena crna stolica, melena
membrane opna, membrana
membraneous opneni, membranski
memory cells stanice memorije (u imunosnim reakcijama)
menarche prva menstruacija, menarha

347
Meniere syndrome Menierov sindrom (bolest slušnog aparata)
meningeal sarcoma meningealni sarkom
meninges, sg. meninx opne, ovojnice (moždane)
meningioma lokalni tumor szs-a, meningiom
meningitis upala opni, meningitis
meningoc(o)ele meningokela, hernija opni kroz koštano
oštećenje
meningococcus meningokok (neisseria meningitidis)
meningomyeloc(o)ele meningomijelokela, hernija opni
i kralješnične moždine
menopause meonopauza, klimakterij
menorrh(o)ea mjesečnica, menstruacija
menorrhagia preobilna mjesečnica, menoragija
menstrual menstruacijski, menstrualni
menstruation mjesečnica, menstruacija
mental umni, duševni
mesencephalon srednji mozak
mesenchyme mezenhim, embrijsko vezivno tkivo
mesentery trbušna opna, mezenterij
mesoderm mezoderma, srednji zametni listić
metabolism mijena tvari, metabolizam
metabolite metabolit
metacarpal koji se odnosi na kosti zapešća,
metakarpalni
metastasis, pl. -ses metastaza – prijenos bolesti s jednog organa
na drugi (osobito svojstvo zloćudnih stanica)
metastasize metastazirati
metastatic metastatski
metatarsal koji se odnosi na kosti donožja, metatarzalni
metronidazol metronidazol (vrsta antibiotika za liječenje
infekcija anaerobnim mikroorganizmima)
metroptosis prolaps maternice, metroptoza
metrorrhagia krvarenje iz maternice, metroragija

348
microbe mikrob, mikroskopski mali (osobito
patogeni) orgnaizam
microbiology mikrobiologija
microglia mikroglija, fagocitne stanice glijalnog tkiva
živčanog sustava
microorganism mikroorganizam
microscope mikroskop
microstaging method metoda određivanja mikrostadija
microtia neprirodno mala vanjska uska, mikrotija
micturition mokrenje
midbrain srednji mozak, mezencefalon
middle ear srednje uho
midline središnja crta (tijela)
midstagittal plane središnja (medijalna) sagitalna ravnina tijela
midwife primalja, babica
mildness blagost
milk teeth mliječni zubi
mind um, svijest
mineral ruda, mineral
mineralocorticoid steroidni harmon kore nadbubrežne žlijezde
minor, adj., n. manji, niži, donji; malodobnik, maloljetnik
minute malen, sićušan
miscarriage pobačaj (spontani)
mite grinja; svrabac
mitochondrion, pl. -a mitohondrij
mitral mitralan, dvokuspidni (npr. zalistak)
mo(u)ld kalup, odljev; plijesan
mo(u)ld spore spora (gljivice) plijesni
modifier modifikator, izmjenjivač
moist vlažan, mokar
molar kutnjak (zub)
mole madež; zakržljali zametak; krtica

349
molecule molekula
mongolism (obsolete) Downov sindrom, trisomija 21
monitoring praćenje
monocyte monocit
mononucleosis, infective mononukleoza, infektivna
(uzročnik – Epstein-Barr virus)
monoxide monoksid; popularni naziv za ugljični
monoksid
mood raspoloženje
moral, n., adj. moral; moralan, ćudoredan
morbid izopaćen, bolestan, morbidan
morbidity pobol, morbiditet
morbilli ospice, morbilli
mortality smrtnost
morula morula, kupinasta nakupina blastomera
u početnoj diobi zigote
motile gibljiv, pokretan
motility gibljivost, pokretnost
motivation motivacija
motivational motivacijski
motor motorički, koji pokreće
mounting koji povećava, raste
mouth usta
mucolytic mukolitik, koji razgrađuje sluz
(u dišnim organima)
mucorrh(o)ea mukoreja, prekomjerno stvaranje sluzi
mucosa sluznica
mucous, adj. sluzav, mukozan
mucus, n. sluz
multicentric koji ima mnoga središta, multicentričan
multifaceted koji ima mnogo ravnih površina
(npr. neki žućni kamenci)
multiform raznolik, s mnogo oblika, polimorfan

350
multiple sclerosis multipla skleroza
multiple, adj., n. višestruk; višekratnik
multipotent koji ima višestruku moć, djelovanje, učinak
mumps zaušnjaci
murine mišji
murmur šum (srčani)
muscle mišić
muscular mišićni, mišićav
musculoskeletal mišićnokoštani
mushroom gljiva
myalgia bol u mišiću, mialgija
myasthenia gravis mijastenija gravis
myasthenic koji boluje od mišićne slabosti, mijasteničan
mycosis bolest izazvana gljivičnom infekcijom
myelin mijelin
myelocytic leukemia granulocitna leukemija
myeloma, multiple mnogostruki mijelom, zloćudni plazmacitom
myocardial koji se odnosi na srčani mišić
myocarditis upala srčanog mišića, miokarditis
myocardium srčani mišić, miokard
myomectomy kirurško odstranjenje mioma, miomektomija
myometrium mišićni sloj maternice, miometrij
myoneural koji pripada mišiću i živcu (odnosi se na
živčane završetke u mišićnom tkivu)
myoneural junction mioneuralni spoj
myopia kratkovidnost, miopija
myringotomy rez na bubnjiću, miringotomija
myx(o)edema hipofunkcija štitne žlijezde, miksedem

N
nail nokat
narcotic opojno sredstvo, narkotik

351
narcotism narkotiično stanje, odavanje narkoticima
naris, pl. nares nosnica
narrowing suženje, konstrikcija
nasal nosni
nasopharynx nosni dio ždrijela
natural defense mechanism prirodni obrambeni mehanizam
nausea mučnina
navel, col. belly button pupak
nearsightedness kratkovidnost, miopija
neck vrat, šija, grlić (npr. maternice)
necrosis, pl. -ses odumiranje tkiva, nekroza
necrotic koji odumire, nekrotičan
need potreba
negligible beznačajan, nevažan, zanemariv
neonatal novorođenački, neonatalan
neonate novorođenče
neonatology neonatologija (izutavanje stanja djece
do 2 mjeseca starosti)
neoplasm tumor, neoplazma
neoplastic neoplastičan, tumorski
neostigmine neostigmin, vrsta neuroprijenosnika
nephritis, pl. nephritides upala bubrega, nefritis
nephrolithiasis bubrežni kamenac, nefrolitijaza
nephrologist nefrolog, specijalist za bubrežne bolesti
nephrology nefrologija
nephron nefron, osnovna funkcionalna i anatomska
bubrežna jedinica
nephropathy bubrežna bolest, nefropatija
nephrosclerosis nefroskleroza
nephrosis degenerativna bolest bubrega, nefroza
nephrotic syndrome nefrotički (nefropatski) sindrom
nephrotomy nefrotomija

352
nerve živac
nervous živčani, koji se odnosi na živce, nervozan
nest, n., vb. gnijezdo; ugnijezditi se
neural neuralan, koji se odnosi na živce
neuralgija neuralgija, jaka bol u području inervacije
nekog živca
neurilemma, neurolemma neurolema, Schwannova ovojnica
neurilemmoma neurilemom, tumor Schwannove ovojnice
neuritis upala živca
neuroblastoma neuroblastom
neurocytoma neurocitom
neuroectoderm neuroektoderma
neuroglia neuroglija, vezivno žičano tkivo
neurohypophysis neurohipofiza
neurologist neurolog
neurology neurologija
neuroma neurom, tumor građen od živčanih stanica
i živčanih vlakana (neurogangliom)
neuron živčana stanica, neuron
neurosis neuroza
neurosurgeon neurokirurg
neurotoxin živčani otrov, neurotoksin
neurotransmitter neuroprijenosnik
neurotripsy drobljenje živaca, neurotripsija
neutrophil neutrofil
nevus, pl. nevi madež, znamenka, nevus
nickel nikal (kem. el. ni)
nicotine nikotin
nipple bradavica, mamilla
nit jajašca ili larva (uši), gnjida
nitrogen dušik
nitrogenous dušični, koji sadrži dušik

353
nitroglycerine nitroglicerin
node čvor
nodular goitre/goiter adenomska gušavost (struma)
nodule čvorić
nonmalignant koji nije zloćudan
nonsmoker nepušač
nonsuppurative koji se ne gnoji; kirurški čist
noradrenaline noradrenalin
norepinephrine nos
nourish hraniti, prehranjivati, jacati, uzgajati
nourishment hrana, prehrana, hranjivi sastojak
nuclear koji se odnosi na jezgru
nucleoplasm nukleoplazma, karioplazma
nucleus, pl. nuclei jezgra
numbness ukočenost, omamljenost, obamrlost, tupost
nurse medicinska sestra
nursemaid dadilja, njegovateljica
nursery dječja soba; dječji vrtić
nursing njega (bolesnika); dojenje
nutrient, n., adj. hranjiva tvar, hrana; hranjiv
nutrition prehrana; hranjenje
nyctalopia noćno sljepilo
nystagmus nistagmus, nehoticne titrajuće kretnje
očiju u jednom smjeru i natrag

O
oat cell carcinoma oblik karcinoma (pluća) kojeg su stanice
nalik zrnu zobi
oath zakletva, prisega
obese gojazan, debeo, pretio
obesity gojaznost, debljina, pretilnost
objective, n., adj. cilj, predmet; objektivan

354
oblique muscles kosi mišići
obstetrician porodničar, opstetričar
obstetrics porodništvo, opstetricija
obtrusive nametljiv
occipital zatiljni, koji pripada zatiljku
occiput zatiljak
occlusion zatvorenost, začepljenost, okluzija
occur javiti se, nastati, dogoditi se
ocular tendon očna tetiva
odo(u)r miris, zadah
offending agent štetna tvar, sredstvo
oil glands žlijezde lojnice
ointment mast (za mazanje)
olecranon vrh lakta
olfactory koji se tiče osjetila mirisa, njušni, olfaktorni
oligodendroglia Oligodendroglija, vrsta neuroglijalnih
stanica
oligodendroglioma oligodendrogliom
oligospermia manjak spermija, oligospermija
oncogenic koji se odnosi na stvaranje tumora, onkogeni
oncologist onkolog, spicijalist za tumore
oncology onkologija
onset početak, izbijanje (simptoma)
onychia upala ležišta nokta, onihija
oophoritis upala jajnika
opacity neprozirnost, zamućenje
opaque neproziran, zamućen
operable koji se može operirati, operabilan
operating theatre/room operacijska dvorana (sala)
ophthalmologic očni, oftalmološki
ophthalmologist specijalist za očne bolesti, oftalmolog
ophthalmology oftalmologija

355
ophthalmoscopy oftalmoskopija
optic disc/disk vidna ploča (disk)
optic nerve vidni živac
option slobodan izbor, pravo izbora
oral usni, usmen, oralan
oral cavity usna šupljina
orbit očna šupljina, orbita
orchi(d)opexy Orhidopeksija, kirurško fiksiranje
nespuštenih testisa u skrotum
orchitis upala sjemenika (testisa)
ordinary redovit, pravilan; uobičajen
organ organ
organic organski
organism organizam
orifice otvor, ušće
origin podrijetlo, ishodište
originate uzrokovati, nastati, vući podrijetlo
oropharynx usni dio ždrijela
orthop(a)edic ortopedski
orthop(a)edics ortopedija
orthopnea ortopneja, otežano disanje osim u sjedećem
ili stojećem položaju
orthoptic training ortoptičke vježbe (očnog mišića)
orthosis, brace, splint ortopedsko omagalo ili aparat
osmolarity osmolarnost, propusnost (npr. opne)
osseous koštan; košćat
ossicle mala kost, košćica
ossification okoštavanje, osifikacija
osteitis upala kosti, osteitis
osteitis fibrosa cystica fibrozna cistična upala kosti
(von Recklinghausenova bolest)
osteoarthritis osteoartritis, upala kosti i zglobova

356
osteoblast osteoblast, početna (nezrela) koštana
stanica
osteochondroma osteokondrom, benigna koštano-hrskavične
izraslina
osteoclasis osteoklazija, kirurški prijelom kosti
osteoclast osteoklast, koštani fagocit
osteolytic koji se odnosi na degeneraciju kosti,
osteolitičan
osteoma osteom, benigni sporo rastući koštani tumor
osteomalacia osteomalacija, rahitis odraslih
osteomyelitis osteomijelitis, upala kosti i koštane srži
osteoporosis osteoporoza, smanjenje koštane gustoće
osteosarcoma osteosarkom, zloćudni primarni tumor kosti
otalgia, otodynia uhobolja
otitis media upala srednjeg uha
otoencephalitis otoencefalitis
Otopyorrh(o)ea gnojni iscjedak iz uha, otopioreja
otosclerosis otoskleroza
outbreak početak, nastup (bolesti)
oval window ovalni otvor (prozor), fenestra vestibuli
ovarian koji se odnosi na jajnike
ovary jajnik
overcome prevladati, nadjačati
overgrowth prekomjeran rast
overpowering pretežan, kojemu se ne može oduprijeti;
tegoban
overwhelming silan, nadmoćan, neodoljiv
oviduct jajovod
ovulation ovulacija, sazrijevanje jajašca
ovum, pl. -ova jaje, jajašce
oxide oksid
oxidization oksidacija; izgaranje
oxidize oksidirati

357
oxigenate obogatiti (spojiti sa) kisikom, oksigenirati
oxygen kisik
oxygenation obogaćivanje (spajanje sa) kisikom,
oksigenacija
oxytocin oksitocin
oyster oštriga (kamenica)
ozone ozon

P
p(a)ediatric pedijatrijski
p(a)ediatrician pedijatar
p(a)ediatrics pedijatrija
pace korak; hod; brzina hoda; tempo
pacemaker, SA node predvodnik; električni stimulator srca;
SA čvor
pad jastučić (koji umanjuje trenje)
pain bol
palate nepce
palatine nepčani
pale blijed
paleness bljedilo, bljedoća
palliative palijativan, koji ublažuje, olakšava
pallor bljedilo, bljedoća, blijedost
palm dlan
palpation pipanje, pregled pipanjem, palpacija
palpitation pojačano, prekomjerno udaranje bila,
treperenje, lupanje (srca)
palsy kljenut, uzetost, paraliza
panacea lijek protiv svih bolesti, panaceja
pancreas gušteraća
pancreatitis upala gušteraće, pankreatitis
papanicolau test, pap.test citološki postupak (za otkrivanje raka
grlića maternice; papa-test)

358
papilla, pl. -ae sitna izraslina, bradavica
papillary dermis papilarni dermis
papilloma, pl. -s, -ata Papilom, benigni epitelni tumor
papule čvorić (na koži)
paracentesis of the cornea paracenteza (punkcija) rožnice
paralysis kljenut, uzetost, paraliza
paranasal paranazalni
paraplegia kljenut (uzetost) donjih udova
parasite nametnik, parazit
parasitic nametnički
parasympathetic parasimpatički
parathyroid gland paratiroidna (nusštitna) žlijezda
parenchymal parenhimni
parenchyme funkcionalni elementi tkiva, parenhim
parietal zidni, parijetalni
parietal bone tjemena kost
parietal pleura porebrica, parijetalna pleura
Parkinson disease Parkinsonova bolest
paronychial koji se odnosi na rub nokta
parotid zaušna (parotidna) žlijezda
parotitis upala zaušne žlijezde, mumps
paroxysm nenadano pojačanje boli,
nastup grča i sl., paroksizam
particle čestica
particulate matter tvar u obliku čestice
partition dijeljenje, pregrada
parturition porođaj, rađanje
partus porođaj
partus agrippinus porođaj djeteta zatkom
atch komadić; zakrpa; mrlja
patella, knee cap iver, patela
pathogen sve ono što izaziva bolest, patogen

359
pathologic bolestan, patološki
pathologist patolog
patient bolesnik
pattern uzorak; model; način; obrazac
peak vrh, gornja granica (npr. krivulje)
pectoral prsni
peculiar svojstven, osobit, osebujan
peer ravan nekomu po časti, položaju, podrijetlu,
i sl.
pellucid proziran, bistar, kristalan
pelvis, pl. pelvises, pelves zdjelica
pemphigus čir, pemfigus
penicillin penicilin
penis muško udo, penis
peptic ulcer peptički vrijed, ulkusna bolest
perceive opažati, shvatiti, percipirati
perception opažanje, percepcija
percussion pregled kucanjem, perkusija, perkutiranje
percutaneous koji se obavlja preko kože, perkutani
perianal koji se nalazi ili nastaje u predjelu anusa,
perianalni
pericarditis upala osrčja, perikarditis
pericardium osrčje, perikard
peril opasnost, pogibelj
perimetrium serozni sloj maternice, perimetrij
perimisium vanjska mišićna ovojnica, perimizij
perinatal perinatalni
perineal koji pripada međici, perinealni
perineum, pl. -a međica
periosteum, pl. -a pokosnica
perish nestati, išćeznuti, slabiti, propasti
peristalsis peristaltika

360
peristaltic peristaltički
peritoneum potrbušnica
peritonitis upala potrbušnice, peritonitis
peritubular peritubularni
perk up dizati nos, razmetati se; razveseliti se,
živnuti
pernicious an(a)emia perniciozna anemija; nepostojanje
intrinzičnog faktora za resorpciju
vitamina B12
perpetuation neprekidno trajanje, produživanje
persistent ustrajan, tvrdokoran
perspiration znoj, znojenje
pertussis hripavac
pessary pesar; podupirajući prsten
petechia, pl. -ae petehija
petit mal napadaj gubitka svijesti, napadaj padavice
phagocyte stanica žderač, fagocit
phagocytic fagocitni
phagocytosis fagocitoza
phalanx, pl. phalanges članak (prsta)
pharyngeal tonsils ždrijelni krajnici
pharynx, pl. pharynges ždrijelo
phenol fenol, otrovan bezbojni kristalinični spoj
phenomenon, pl. -a pojava, fenomen
phenotype fenotip
phenylketonuria prisustvo fenilketona u mokraći
pheochromocytoma tumor srži nadbubrežne žlijezde
phimosis suženost udne navlake, fimoza
phlebitis upala vene, flebitis
phlebotomy otvaranje vene, flebotomija, venesekcija
phlegm gusti sekret iz dišnih putova
phobia bolesni strah, fobija

361
phonation stvaranje glasa, fonacija
phosphorus fosfor
physical tjelesni, fizički; fizikalni
physician liječnik
physiologic/al fiziološki
physiology fiziologija
pia mater meka moždana ovojnica, mozgovnica
pigmentation pigmentacija
pigmented pigmentiran
piles šuljevi, hemoroidi
pillow jastuk; podloga, ležaj
pilonidal cyst pilonidna cista
pimple bubuljica
pineal gland cerebralna epifiza
pinkeye akutni zarazni konjunktivitis; upala očiju
pinna, pl. pinnea ušna školjka, uška
pituitary cachexia hipopituitarizam, pituitarna kaheksija
pituitary gland žlijezda hipofiza
placenta posteljica
placenta praevia placenta previja
placental koji se odnosi na posteljicu, placentaran
plant biljka; postrojenje
plantar flexion plantarna fleksija, fleksija tabana
plaque ploča; naslaga
plasma plazma (krvna)
platelet krvna pločica, trombocit
pleasurable koji pruža zadovoljstvo, ugodu
plegia uzetost, kljenut, paraliza
pleomorphic pleomorfan, koji se javlja u mnogo različitih
oblika
pleura, pl. pleurae plućna maramica, porebrica, pleura
pleural effusion pleuralni izljev (eksudat)

362
pleurisy, pleuritis upala porebrice
pneumoconiosis pneumokonioza, taloženje raznih vrsta
prašine u plućnom tkivu
pneumonia upala pluća, pneumonija
pneumothorax zrak u prsištu, pneumotoraks
podagra ulozi, podagra (bol u nozi), giht
poison otrov
polio dječja paraliza, poliomijelitis
pollen pelud, cvjetni prah
polycentric policentričan, koji ima vise središta
ili jezgara
polycythemia povećan broj eritrocita, policitemija
polydipsia prekomjerna žeđ
polyp peteljkasta izraslina, polip
polyphagia prekomjerna glad, polifagija
polyuria prekomjerno mokrenje, poliurija
pons, pl. pontes most
poppy mak; opijum koji se dobiva iz maka
pore pora
portal vein vena vratarnica
positioning namještanje
posterior stražnji
posture položaj, držanje (tijela)
potassium kalij
potential mogućnost, potencijal, latentna sila
pouch vrećica
pound funta, oko 1/2 kg
practice obavljanje posla, praksa
predisposition sklonost, predispozicija
preeminence nadmoć, superiornost, isticanje
pregnancy trudnoća
premature birth prijevremeni porođaj

363
prepuce udna navlaka, prepucij
presby(a)cusis staračka nagluhost, smanjenje sluha,
prezbiakuzija
presbyopia staračka dalekovidnost, smanjenje vida,
prezbiopija
prescribe propisati
prescription recept (liječnički); propis
primary health care primarna zdravstvena zaštita
primipara žena koja prvi puta rađa, prvorotkinja
probe, cryoprobe štapić za širenje kanala, sonda; pipaljka;
sonda koja se primjenjuje u liječenju ledom
probing pretraživati sondom
process nastavak, izdanak
productive cough produktivni kašalj
profuse obilan
progesterone progesteron; glavni gestacijski hormon
prognosis predviđanje, prognoza
progressive koji napreduje, širi se, dalje se razvija (npr.
bolest)
prolapse spuštanje, pad (npr. organa)
proliferate rasti, množiti se
proliferation nagli rast, bujanje
prominence isticanje, izbočina
pronation ležanje ničice, potrbuške
prone licem prema zemlji, potrbuške; sklon,
naklonjen
propel potiskivati, tjerati naprijed
propelling pressure potisni (propulzivni) tlak
prophylactic zaštitan, profilaktičan
propulsion potisak, propulzija, pogon
prostate gland predstojna žlijezda, prostata
prostatectomy prostatektomija, kirurško uklanjanje
prostate

364
prostatic hypertrophy hipertrofija prostate
protect zaštititi
protection zaštita
protein bjelančevina
proteinuria bjelančevine u mokraći
prothrombin protrombin, faktor zgrušavanja, faktor II
protoplasm protoplazma
protrusion izbočenje, stršenje
prowess odvažnost, junaštvo, smjelost
proximal bliži, proksimalan
pruritus svrbež
psoriasis psorijaza
psyche duša, psiha
psychiatrist psihijatar
psychiatry psihijatrija
psychologist psiholog
psychology psihologija
psychosis psihoza
ptosis spuštanje, ptoza, prolaps
puberty doraslost, pubertet
pubic koji se odnosi na stidnu (preponsku) kost
pubis, pl. pubes stidna (preponska) kost
puerperal babinji, puerperalni
puerperium babinje, puerperij
pulmonary plućni
pulmonary emphysema plućni emfizem
pulp srž, pulpa (zuba)
pulse bilo, puls
puncture punkcija, ubod
pupil zjenica

365
purification pročišćavanje, čišćenje
purity čistoća, jasnoća
purpura purpura, sitna potkožna periferna krvarenja
purulent gnojan
pus gnoj
pustular gnojan
pustule gnojni mjehurić, pustula, prištić
putrefaction truljenje, gnjiljenje
pyelonephritis pijelonefritis
pyeloplasty pijeloplastika, plastična operacija bubrežne
zdjelice
pyloric valve pilorički zalistak, pilorus, vratarnik
pylorospasm pilorospazam
pylorus vratarnik, pilorus
pyogenic gnojan, piogen
pyothorax empijem, piotoraks, gnoj u grudnom košu
pyrosis, heartburn žgaravica
pyuria pijurija (bakterijska infekcija),
gnoj u mokraći
Q
quadrant kvadrant
quadruplets četvorke
quality kakvoća, kvaliteta
quantity količina, kvantitet
quarter četvrtina, kvartal; cca 1l
questionable koji je pod znakom pitanja; sumnjiv
quinsy gnojna upala krajnika; peritonzilarni apsces
quit napustiti; prestati; ostaviti
quotient količnik, kvocijent

R
race rasa, rod, vrsta

366
rachitis, rickets rahitis
radial zrakast, radijalan
radiate zračiti, sjajiti se, širiti se (zrakasto)
radiation zračenje, isijavanje
radical temeljit, korjenit, radikalan, koji se odnosi
na korijen
radiologist radiolog
radiology radiologija
radiotherapy radioterapija
radius, pl. radii palčana kost; polumjer
raised izbočen, uzdignut, ispupčen
rale hroptanje
random slučajan
range kretati se, varirati, javljati se; raspon
rarely rijetko, neobično
rash osip
rate odnos, omjer, stupanj, brzina
rather zapravo, stoviše, prije (nego), radije
raw ranjav, otvoren, bolan, upaljen, sirov
Raynaud’s phenomenon Raynaudova pojava, fenomen
re-establish opet uspostaviti, opet utvrditi
reach doprijeti, dosezati, prodrijeti
rear stražnji dio, straznja strana, pozadina
receive primati, prihvatiti, dobiti
recent nedavni, skorašnji, recentan
receptor prihvatač, receptor
recipient primatelj
Recklinghausen disease von Recklinghausenova bolest (osteitis
fibrosa cystica)
recognition prepoznavanje, raspoznavanje, identifikacija
record, n. bilješka, zapis, evidencija
record, vb. bilježiti, zapisivati

367
recourse rješenje, izlaz
recovery oporavak, rekonvalescencija
rectal rektalan
rectum, pl. recta ravno crijevo
rectus ravan mišić
recumbent ležeći, počivajući, naslonjen
recurrent povratan, recidivan
reduce smanjiti; kir. reducirati, uzglobiti, učašiti
reduction smanjenje, redukcija, uzglobljenje, ulaganje
refer to odnositi se, ticati se (čega), upućivati (na)
refine usavršiti, poboljsati, dotjerati
reflux tok unatrag, vraćanje, povrat
refractive refrakcijski
refracturing kirurško lomljenje kosti
regard smatrati, gledati, paziti, motriti
regarding s obzirom na, u vezi sa
regenerate obnavljati, regenerirati
region područje, mjesto, dio, regija
regress vraćati se, povratiti se (bolest, ponašanje)
regression vraćanje, povratak, regresija
regurgitation povraćanje, vraćanje hrane iz želuca u usta,
bljuvanje
rehabilitation oporavak, osposobljavanje za rad,
rehabilitacija
reinforce pojačati
relapse vratiti se, opetovati se, recidivirati
relapsing koji vraća, opetuje, recidivan
relax opustiti se, omlohaviti se, odmoriti se
relay prenositi (impulse)
release osloboditi, ispustiti, pustiti
relevance značajnost, važnost
relief olakšanje, smirenje

368
relieve olakšati, smiriti, ublažiti
reluctance protivljenje, opiranje, nesklonost, odvratnost
remain preostati, ostati
remainder ostatak, preostali dio
remarkable znatan, značajan, jedinstven, zamjetan
remedy lijek
remission stadij mirovanja bolesti, privremeno
jenjavanje bolesti, remisija
remote udaljen, dalek
removal uklanjanje, odstranjenje
remove ukloniti, odstraniti
renal bubrežni, renalan
renal calculus, pl. calculi bubrežni kamenac
renal pelvis bubrežna zdjelica
renal vein bubrežna vena
renew obnavljati se
renewed izliječen, nanovo oživljen, obnovljen
renin renin
repair obnavljanje, regeneracija
repetitive koji se opetuje, ponavlja
replacement nadomjestak, nadopuna, zamjena
repolarization repolarizacija
reproduction umnažanje, razmnažanje, rasplodnja,
reprodukcija
reproductive rasplodni, reprodukcijski
require tražiti, zahtijevati, iziskivati, trebati, biti
potreban
resection isijecanje, resekcija, kirurško uklanjanje
resemblance sličnost
resemble sličiti, biti sličan, naličiti
reserpine lijek protiv hipertenzije, reserpin
reservoir spremište, spremnik

369
residual preostali
residue ostatak
resilient savitljiv, podatan, otporan
resin smola
resistance otpornost, čvrstoća, otpor
resolve otopiti, rastvarati (se), riješiti (problem)
respectively odnosno, dotično
respiration disanje
respiratory dišni
respond odgovoriti, reagirati
response odgovor, reakcija
responsible odgovoran
restful miran, spokojan, tih
restoration obnavljanje, vraćanje u prijašnje stanje
restore obnoviti (se), uspostaviti, vratiti u prijašnje
stanje
restrictive ograničen, koji ograničuje
retain zadržavati
retardation zaostajanje, retardacija
retention zadržavanje, retencija (mokraće)
reticuloendothelial retikuloendotelni
reticulum, pl. reticula retikulum, mrežica
retina, pl. retinae mrežnica
retinitis upala mrežnice
retinitis pigmentosa upala mrežnice s pigmentacijom na očnoj
pozadini
retinoblastoma retinoblastom, maligni tumor embrionalnih
stanica mrežnice
retraction uvlačenje, povlačenje, prevlačenje
retrograde koji se povlači, koji se pogoršava, koji
nazaduje
reveal otkriti, pokazati
revenue prihod, dohodak

370
reverse adj. obratan, protivan, naopak, suprotan
reverse, vb. okrenuti, promijeniti
rhabdomyoma rabdomiom, tumor poprečnoprugastog
mišića
rhabdomyosarcoma rabdosarkom
rhesus factor rezus (rh) čimbenik
rheumatic fever reumatska groznica
rheumatoid arthritis reumatoidni artritis
rhinitis hunjavica, upala nosne sluznice
rhinology rinologija
rib rebro
rib cage prsni koš
ribonucleic acid ribonukleinska kiselina
ribosome ribosom
rickets rahitis
ridge greben, hrbat, krijesta
rigidity krutost, ukočenost, rigidnost
ring prsten, kolut, obruč
ringworm lišaj (kožna bolest)
ripening sazrijevanje
risk pogibelj, opasnost, rizik
rod štapić
rod-shaped štapičast
rodent ulcer nagrizajući čir, ulkus rodens
roentgen rendgen
roentgenology rendgenologija
role funkcija, uloga
roof of the mouth svod usne šupljine
root korijen, žila, srž
root canal work liječenje kanala zubnog korijena
rosacea rozaceja (kožni osip)
rotation obrtanje, okretanje, vrtnja

371
rough hrapav, grub, neravan, promukao (glas),
trpak
rubella crvenka, rubeola
rubeola trodnevne ospice
ruga, pl. rugae nabor, bora
ruggedness hrapavost
rumbling kruljenje
rupture prsnuće, ruptura

S
sac vreća
saclike vrećast
sacral križni, koji pripada križima
(križnim kralješcima)
sacroiliac sakroilijakalni
sacrum, pl. sacra križna kost
safe siguran, bezopasan, neškodljiv
sagittal usporedan s uzdužnom središnjom
ravninom, sagitalan
saliva slina
salivary glands žlijezde slinovnice
salpingectomy salpingektomija, kirurško uklanjanje
jajovoda
salpingitis upala jajovoda
salpinx jajovod, tuba uterina
salt sol
sample uzorak
sane razuman, pametan, normalan
saphenous vein površinska vena (safena)nogu
sarcolemma ovojnica mišićnog vlakna, sarkolema
sarcoma,pl. sarkom
sarcomas,sarcomata
saturated zasićen, ispunjen

372
scab krasta
scabies svrab
scale ljuska, ljuskica
scalelike ljuskav
scaling ljuska, ljuskica, stvaranje ljuskica
scalp vlasište, kosom poikrivena koža lubanje
scan, vb. podrobno ispitati, pregledati, radarski
pretražiti
scapula, pl. scapulae lopatica; lopatična kost
scar ožiljak
scar tissue ožiljno tkivo
scarcity oskudnost, nestašica, rijetkost
scarlatina, scarlet fever šarlah, skarlatina
scarring stvaranje ožiljaka odn. ožiljka
scheme shema, nacrt, plan
Schwann sheath Schwannova ovojnica, neurilema
sciatica išijas, bol duž živca ischiadicusa
sclera, pl. sclerae bjeloočnica
scleroderma sklerodermija
sclerosis, pl. scleroses skleroza
scoliosis, pl. scolioses skolioza, postranično (lateralno)
iskrivljenje kralješnice
scotoma točkasti ispadi u vidnom polju, skotom
scrape strugati, ostrugati
scraping away abrazija
screen zakloniti, zaštititi; proučavati
scrotum, pt. scrota mošnje
seal off začepiti, zatvoriti (hermetički)
search tražiti, istraživati
sebacious glands žlijezde lojnice
sebum loj (ljudski)
secrete izlučivati

373
secretion izlučivanje
section rez, presjek, dio, odsjek, sekcija
securely sigurno, čvrsto
sedation liječenje sedativima, stanje prouzrokovano
liječenjem sedativima
seek tražiti, potražiti
seemingly prividno
seep out iscuriti, cijediti se
seizure napadaj bolesti
self-limiting disease bolest ograničenog trajanja
sella turcica tursko sedlo
semen, pl. semina sjeme
semicircular polukružan
semilunar valve polumjesečasti zalistak
seminal sjemenski
seminal vesicle sjemenski mjehurić
seminiferous tubules sjemenski kanalćci (tubuli)
seminoma seminom, maligna neoplazma testisa
senescent starački
senile starački, senilan
sensation osjet, osjećaj
sense organ osjetilo, osjetni organ
sensitivity osjetljivost, nježnost
sensitized osjetljiv, senzibiliziran
sensory osjetni, osjetilni
separate zaseban, odijeljen, razdvojen
separation odjeljivanje, rastavljanje, separacija
septum, pl. septa pregrada, pregradna stijenka
sequence of involvement redoslijed uključivanja
sequestrum, pl. sequestra mrtav dio tkiva ili organa, sekvestar
serosa serozna opna, seroza
serosal koji se odnosi na serozu

374
serous sukrvičast, koji proizvodi ili sadrži serum,
serumski
serous fluid serumska tekućina
serum, pl. sera krvni serum
serve poslužiti, pomagati, koristiti, služiti
serviette ubrus
sesame sezam
sesamoid bone sezamska kost
set off istaknuti, dati se (na posao)
several nekoliko, nekolicina
sever presjeći, prekinuti, odrezati
severity žestina, težina, ozbiljnost (bolesti)
sew šivati, sašiti
sex cord spolni snop u ranom fetal nom razvoju
sex glands spolne žlijezde, gonade
sex linked spolno vezan
sexual climax spolni vrhunac, orgazam
sexual intercourse odnošaj
shaft trup (kosti), dijafiza
shallow plitak
shape oblik
sharp oštar
sheath ovojnica, omotac
shedding ljuštenje (kože)
sheet plahta, ploha
shell-fish školjka, rak, ljuskar
shepherd pastir, ovčar
shield, n. štitnik, zastita
shield, vb. štititi, braniti
shigella, pl. shigellae šigela
shin bone cjevasta kost
shingles herpes zoster

375
shock šok, udarac
shortsightedness kratkovidnost, miopija
shoulder rame
shoulder blade lopatica, skapula
shoulder bone lopatica, skapula
shrink skvrčiti se, smanjiti se, skupiti se
shrinkage skupljanje, smanjenje, stezanje
shuffling gate teturav hod
shunt spoj, skretaljka, premosnica
sickle-cell an(a)emia anemija srpastih stanica
siderosis, pl. sideroses pneumokonioza prouzročena udisanjem
željezne prašine, sideroza
sieve sito, rešeto
sigmoid colon sigmoidno debelo crijevo
sign znak
significant značajan, važan, istaknut
signify značiti, označiti, naznačiti
silica silicijski dioksid
silicon silicij
silicon dioxide silicijski dioksid
silicosis, pl. silicoses pneumokonioza prouzrocena udisanjem
pješćane prašine koja sadrzi silicijski
dioksid, silikoza
silvery srebrnast, srebrene boje
similarity sličnost, istovrsnost
Simmonds disease pituitarna kaheksija, Simmondsova bolest
simple fracture jednostavan lom kosti (fraktura)
simultaneous istodoban
single jednostruk, pojedinacan
sinister lijevi; zlokoban
sinistral lijevi, usmjeren na lijevo
sinotrial node sinuatrijski (SA) čvor

376
sinus zaton, sinus
sinusitis upala sinusa
sip, n. gutljaj, srkanje
sip, vb. gucnuti, srknuti
sister in charge dežurna medicinska sestra
site sijelo, lokalizacija (tumora)
size veličina
skeletal kosturni, skeletni
skeleton kostur, skelet
skin oštećenje kože
skin rash osip na koži
skull lubanja
slant kosa crta
slender tanak, slab, nježan, malen
slipped disk iskliznuće diska
slit pukotina, prorez, rascjep, usjeklina
slitlike poput pukotine (usjekline), uzak
slope-away nagnuti se, ukoso se spuštati,
biti nagnut, kos
slough ljuštiti se
slow-motion usporen, usporeno snimljen
small intestine tanko crijevo
smallpox, variola crne kozice, velike boginje, variola
smell osjet mirisa, njuh, miris
smooth muscle glatki mišić
snail -shaped u obliku puževe kućice
snare uhvatiti u omču (npr. polip)
soak namakati (se), promočiti, upijati, prožeti
(tekućinom)
socket udubljenje, supljina (zglobna, očna)
sodium natrij
soft palate meko nepce

377
softening omekšavanje, smekšavanje, ublažavanje
sole potplat, đon
sole of the foot taban
solely samo, jedino, isključivo
solid krut, čvrst
solidify skrutnuti, ukrutiti, zgusnuti se
soluble topiv
solution otopina; rješenje
somatic tjelesan, somatičan
somatotropin somatotropin
somewhat nešto
somnolent pospan, sanjiv, snen
sore rana, bolno mjesto, ranjeno mjesto
sore throat upala grla i krajnika, angina
sound zvuk, šum, glas
sound production stvaranje glasova, fonacija
sound wave zvučni val
source izvor, podrijetlo, početak
space prostor, svemir
span, n. vremenski razmak, raspon, trajanje, opseg
span, vb. premostiti
sparingly umjereno, štedljivo
spark iskra, varnica
spasm grč, napad kašlja, spazam
spastic grčevit, spastički
spastic colon spastički kolon
spasticity zgrčenost, spastičnost
specialized poseban, specijaliziran
speck mrlja, točkica
spell razdoblje, kratko vrijeme
spelling sricanje, pravopis
sperm sjeme, sperma

378
sperm viability životna sposobnost, životnost spermija
spermatic cord sjemeni snop
spermatozoon, pl. muška sjemenska stanica, spermij
spermatozoa
sphenoid bone klinasta (sfenoidna) kost
sphincter kružni mišić, sfinkter
sphygmomanometer tlakomjer, sfigmomanometar
spider-web paučinast, tanak; paukova mreža
spina bifida rascjep kralješnice, spina bifida
spinal kralješnični
spinal cord kralješnična moždina
spine kralješnica
spinous process šiljasti, trnasti nastavak
spirochete spiroheta
spit ispljunuti, pljuvati
spleen slezena
splenectomy kirursko odstranjenje slezene,
splenektomija
splenodynia bolovi u slezeni
splenomegaly povećanje slezene, splenomegalija
splenopexy splenopeksija
splenorrhaphy splenorafija
splint longeta, imobilizacija
splinter smrskati, razmrviti
split rascjep (usne)
spongy spužvast, spongiozan
spontaneous samonikao, sam od sebe, spontan
spot mrlja, točka, pjega
sprain iščašenje, uganuće, distorzija
spread rasprostirati se, širiti se, protezati se
sputum ispljuvak
squama, pl. squamae ljuska

379
squamous ljuskav, plosnat
squamous cell carcinoma rak pločastih stanica, planocelularni
karcinom
squint razrokost, škiljavost, strabizam
stabilization učvršćenje, stabilizacija
stable čvrst, stalan, stabilan
stage stupanj, faza, stadij, razdoblje razvoja
stain obojiti, bojati
stalk držak, stalak, stabljika
stapedectomy stapedektomija, kirurško uklanjanje
(ekscizija) stremena
stapes, pl. stapedes, stirrups stremen
staphyloccocus, pt. stafilokok
staphylococci
star-shaped zvjezdolik
starch škrob
steatorrh(o)ea velika količina masti u stolici
stem stablo, stabljika, peteljka, korijen (riječi)
stem cell hematoblast, osnovna (početna) stanica
stenosis, pl. stenoses suženje, stenoza
step korak
sterilization sterilizacija
sternum, pl. sterna prsna kost
steroid steroid
stethoscope stetoskop
stiffen ukrutiti se, ukočiti se, postati ukrućen
stiffening kočenje, ukočenost, ukrućenost
stiffness ukočenost
stimulus, pl. stimuli podražaj
stirrup stremen
stomach želudac
stones kamenci

380
stool stolica, feces
store pohraniti, spremiti, uskladištiti
strabismus razrokost, škiljavost, strabizam
strabotomy strabotomija, presjecanje tetive očnog
mišića
straighten out izravnati
strain napor, naprezanje; soj (bakterija);
istegnuće (mišića)
strand vlakno, pramen
strangulated ukliješten, udavljen
stratum, pl. strata sloj
stratum corneum rožnati sloj
straw slama, slamčica
strengthen pojačati, učvrstiti
streptococcal streptokokni
streptococcus, pl. streptokok(i)
streptococci
stress udarac, potres, stres
stretch rastezati, protezati, istezati
stretching rastezanje, istezanje
stria, pl. striae pruga, strija
striated muscle poprečno prugasti (kosturni) mišić
stricture suzenje
stridor disanje poput šištanja (zviždanje), stridor
strike udariti, pogoditi
stringy žilav, vlaknast, ljepljiv, viskozan
strip uska vrpca, pojas, pruga
stroke moždani udar, kap, apopleksija
stroma, pl. stromata potporno tkivo, stroma; tkivna matrica
structure anatomska tvorba, građa, struktura
stupor tupost, stupor
stye ječmenac, halazion

381
subarchnoid ispod paučinaste ovojnice (mozga),
subarahnoidan
subclavian vein potključna vena
subcutaneous potkožan, supkutan
subsequent sljedeći, kasniji, naredni
subside jenjavati, povući se (bolest)
substance tvar
suckling dojenče
sudor znoj
sudoriferous glands žlijezde znojnice
suffer from trpjeti, bolovati, patiti (od čega)
suffice dostajati, zadovoljavati
sufficient dostatan, dovoljan
suffocating gušeći, koji guši, zagušljiv
suitable prikladan, pogodan, zgodan
sulcus, pl. sulci brazda, žlijeb
superficial površinski
superior vena cava gornja šuplja vena
supination usporedan položaj kostiju
podlaktice,supinacija
supine ležeci licem prema gore, supinacijski
supply snabdijevati, opskrbiti
support potporanj, oslonac, podupirač, podloga
suppository siljast čepić, supozitorij
suppurative gnojan
suprapubic suprapubičan
suprarenal gland nadbubrežna žlijezda
supress suzbiti, spriječiti, potisnuti, zatomiti
surface površina
surge of blood navala krvi
surgeon kirurg
surgery kirurški zahvat, kirurgija

382
surgical kirurški
surrounded okružen, opasan, obavijen
surroundings okolina, okoliš
survival preživljavanje, opstanak
survival rate stopa preživljenja
susceptibility osjetljivost, prijemljivost, podložnost
susceptible osjetljiv, prijemljiv, podložan (bolesti)
suspect, v. sumnjati, posumnjati, nagađati
suspended lebdeci, suspendiran
suspension učvršćenje, fiksacija, suspenzija
sustain pretrpjeti (ozljedu); održati (život)
suture, n. šav rane; kirurški konac; šavni spoj kostiju;
sutura
suture, v. spojiti šavom, sašiti ranu, vezati
swallow gutati
swallowing gutanje
sweat glands žlijezde znojnice
sweat, s. znoj
sweat, vb. znojiti se
sweating znojenje
swelling oticanje, otok, edem
swollen otečen
sympathetic koji pripada simpatikusu, simpatički
sympodia sraštenost donjih ekstremiteta, simpodija
synapse sinapsa, spojište živčanih stanica
synarthrosis nepomičan zglob, sinartroza
syncope nesvjestica, sinkopa
synovial koji pripada sinoviji
synovial capsule zglobna čahura
synovial fluid sinovijalna tekućina
synovial membrane sinovijalna opna (membrana)
synthesis, pl. syntheses spajanje, sastavljanje, sinteza

383
synthesize sintetizirati; proizvesti
syphilis sifilis, lues
syphilitic sifilitičan
syringe štrcaljka
system sustav
systemic circulation veliki krvotok
systole/sistole stezanje (srčanog mišića), sistola
systolic sistolički

T
tachycardia ubrzano bilo, ubrzani rad srca, tahikardija
tachypn(o)ea ubrzano disanje, tahipneja
tag navika, privjesak, pramen, prirepak, etiketa
tail rep, kauda
tailbone trtična kost
take over preuzeti (funkciju)
take place dogoditi se
talipes urođeno zgrčeno (krivo) stopalo
tap lupkati, perkutirati
tapper off nestajati, prestajati, stanjivati (se)
tar katran, smola
target tissue ciljno tkivo
tarsal kost korijena stopala (tarzusa)
task zadatak, zadaća
taste okus
taste buds okusni pupoljci
tax državni porez, dažbina, pristojba, taksa
tear gland suzna žlijezda
tear, n. suza
tear, vb. kidati, cijepati
technique postupak, tehnika, način obavljanja
telescope teleskopirati

384
telescoping teleskopiranje
temporal sljepoočni
temporal bone sljepoočna kost
temporary privremen, prolazan
temporomandibular joint čeljusni zglob
tendency sklonost, naklonost, naginjanje, težnja
tender osjetljiv, mekan, bolan
tenderness osjetljivost, mekoća
tendon tetiva
tension napetost, napregnutost, tenzija
teratocarcinoma teratokarcinom
teratoma, pl. teratomata, urođena nakaznost, nakazna izraslina,
teratomas teratom
tertiary treći po redu, tercijaran
test tube epruveta
testicle sjemenik, mudo, testis
testicular koji se odnosi na testis
testicular carcinoma rak sjemenika
testis, pl. testes sjemenik, mudo
testosterone testosteron, muški spolni hormon
tetanus tetanus
tetany tetanija
thalamotomy talamotomija
thalamus vidni humak, ložnica, talamus
thalassemia nasljedna hemolitička anemija, talasemija,
hemoglobinopatija
thick gust (tekućina); debeo
thickened zgušnjavanje (tekućine); zadebljanje
thickness debljina; gustoća (tekućine)
thigh bedro
thin rijedak, proziran (tekućina); tanak
thin sore plitka ranica

385
thinness rijetkoća (tekućine), tankoća
thinning prorjedivanje, razrjedivanje, smanjenje,
opadanje (dlaka, kose)
thirst žeđ
thoracic koji se odnosi na prsni koš, torakalni
thorax, pl. thoraces prsni koš
thought misao, mišljenje, razmišljanje
thread vlakno, nit, konac
threat prijetnja, opasnost, ugroženost
thrive rasti, razvijati se
throat grlo, grkljan
thrombm:yte krvna pločica, trombocit
thrombophlebitis upala vena s trombozom, tromboflebitis
thrombosis, pl. thromboses začepljenje krvne žile ugruškom krvi,
tromboza
thrombus, pl. thrombi krvni ugrušak, tromb
thrush upala usne sluznice
thumb palac na ruci
thymectomy kirurško uklanjanje prsne žlijezde,
timektomija
thymitis upala prsne žlijezde, timitis
thymoma timom, dobroćudni i zloćudni tumor timusa
thymus prsna žlijezda, timus
thyroid gland štitnjača, štitna (tiroidna) žlijezda
thyroidectomy kirurško odstranjenje štitne žlijezde,
tiroidektomija
thyrotoxicosis tireotoksikoza, hipertireoza
thyroxine hormon štitne žlijezde, tiroksin
tibia, pl. tibiae goljenična kost, tibija
tick krpelj
tied off podvezan
timing vremensko usklađivanje
tinea pedis gljivična bolest stopala, športsko stopalo

386
tinge preljev, (nijansa) boje
tinnitus šum u uhu
tiny malen, sitan, sićušan
tip vrh, kraj, apeks
tiredness sustalost, malaksalost, umor
tissue tkivo
titre/er titar
tobacco duhan
toe prst stopala
toenail nokat na prstu stopala
toll porez, carina, taksa, namet, danak
tongue jezik
tonometar mjerač tlaka (krvnog), tonometar
tonsil krajnik, žabica, mandula
tonsillectomy tonsilektomija, kirurško odstranjenje
krajnika
tonsillitis upala krajnika, tonsilitis
tooth removal vađenje zuba
tooth, pl. teeth zub
toothpick čačkalica
tough žilav, čvrst, krut
tox(a)emia otrovanje krvi, toksemija
toxic otrovan, toksičan
toxin otrov
trabecula, pl. trabeculae gredica, tračak, trabekula
trachea dušnik
tract vod, sustav, trakt
trait značajka, osobina, karakteristika
tranquillizer sredstvo za umirenje, trankvilizator
transaminase transaminaza
transient prolazan, kratkotrajan
translucent proziran, providan

387
transmit prenositi, prenijeti, širiti podražaje
transparent proziran, providan
transplant, n. kalem, transplantat
transplant, vb. presaditi, transplantirati
transurethral resection transuretralna resekcija
transverse colon poprečno (transverzalno) debelo crijevo
transverse process poprečni nastavak, (kralješka)
trap uhvatiti, uloviti
trauma, pl. traumata, ozljeda, trauma
traumas
travel putovati, kretati se
treatment liječenje, postupak, tretman
treponema pallidum blijeda treponema (uzročnik sifilisa)
triangular trokutni, trouglast, trobridan
trichomonas vaginalis trihomonas vaginalis
trichomoniasis trihomonijaza
tricuspid valve trolisni (trikuspidalni) zalistak
trigger izazvati, prouzrociti
triglyceride triglicerid
trigone trokutasto područje, trigon
triiodothyronine trijodtironin, tironin (hormon štitnjače)
triple-looped trostruko zavijen
triplets trojke
trochanter kvrga
true ribs prava rebra
trunk trup, stablo
tube cijev
tubercle kvržica, tuberkulum
tuberculosis sušica, tuberkuloza
tuberosity hrapavost
tubes jajovodi
tubular cjevast

388
tubule cjevčica, kanalić, tubul
tuft of capillaries mreza kapilara
tumo(u)r novotvorevina, izraslina, tumor
turkey puran, purica
twin blizanac, dvojnik
twist zavijati
twisted uvojit, zavojit, spiralan
twitches grčevito trzanje (miića)
twitching stezanje, kontrakcija, trzanje (udova)
tympanic cavity bubnjište
tympanorrhexis prsnuće (razdor) bubnjića, timpanoreksija
tyrosine tirozin

U
ulcer vrijed, čir, ulkus
ulcerate gnojiti se, prouzročiti čireve
ulceration gnojenje, stvaranje vrijeda, ulceracija
ulcerative gnojan, ulcerozan
ulcerative colitis ulcerozna upala debelog crijeva
ulcerlike poput čira
ulcerous zahvaćen ulceracijom
ulna, pl. ulnae lakatna kost
ultrasound ultrazvuk
ultraviolet ultraljubičast
ultraviolet radiation ultraljubičasto zračenje
umbilical pupčan
umbilical cord pupkovina, pupčana vrpca
umbilical hernia pupčana kila (hernija)
umbilicus pupak
unable nesposoban
unblinking koji ne trepće
uncertainty nesigurnost, neizvjesnost, nepouzdanost

389
uncondensed nekondenziran
unconscious nesvjestan, onesviješten
unconsciousness nesvjestica
undergo pretrpjeti, prepatiti, podvrći se
(pregledu, pretragama)
underlying koji se nalazi ispod
underneath dolje, ispod
undescending koji se ne spušta
undesirable nepoželjan, neugodan
undifferentiated nediferenciran
unequal nejednak, nerazmjeran
unfortunately nažalost
unicellular jednostaničan
unilateral jednostran
union veza, spoj
unit jedinica, uređaj
unobtainable koji se ne može dobiti, nedokučiv,
nedostižan, nedohvatljiv
unobtrusively nenametljivo, čedno
unossified neokoštan
unpaired neparan, nesparen, jedan
unpleasant neugodan, odvratan
unpolluted čist, nezagađen
unresponsitivity odsutnost reagiranja, reakcije
unspecialized nespecijaliziran, koji nije pojedinacno
naveden
untwist otplesti, rasplesti, razmrsiti
unusual neobičan, izvanredan
upper viši, gornji
upper back gornji dio leđa
upper respiratory infection infekcija gornjih dišnih putova
uppermost najvisši, gornji

390
urban gradski
urea mokraćevina, urea
uremia otrovanje mokraćnim sastojcima u krvi,
uremija
ureter mokraćovod, ureter
urethra mokraćna cijev, mokraćnica
urethritis upala sluznice mokraćne cijevi
urge pospješivati, požurivati, natjerati
uric acid mokraćna kiselina
urinary mokraćni
urinary bladder mokraćni mjehur
urinary meatus mokraćni prolaz
urinary passages mokraćni putovi
urinary retention zastoj mokraće, zadržavanje, zaustavljanje
urination mokrenje, mikcija
urine mokraća, urin
urinogenital mokraćno-spolni, urogenitalni
urogenital urogenitalni
urologist urolog
urology urologija
urticaria koprivnjača, urtikarija
use, n. primjena, namjena, upotreba
use, vb. upotrebljavati, služiti, primijeniti
usual običan, uobičajen, redovan
usually obično, pravilno, redovito, u pravilu
uterine koji pripada maternici
uterus, pl. uteri maternica
utilization korištenje, potrošnja, uporaba
uvula, pl. uvulae resica, uvula

V
vaccinate cijepiti, vakcinirati

391
vaccination cijepljenje, vakcinacija
vaccine, n. cjepivo, vakcina
vagina, pl. vaginae rodnica
vaginal koji se odnosi na rodnicu, vaginalan
vaginismus bolan grč rodnice, vaginizam
vaginitis upala rodnice
valve zalistak
valvula, pl. valvulae malen zalistak
valvular koji ima zaliske, koji se odnosi na zalistak
vapour para, isparina, maglica
variable promjenljiv, nestalan, kolebljiv, varijabilan
varicella vodene kozice, varićele
varices čvorasta proširena vena, varikozitet
varicoc(o)ele oteklina od proširenih sjemenskih vena,
varikokela
varicose vein proširena vena (varikozna vena)
varix, pl. varices variks, proširena i iskrivljena vena,
arterija ili limfna žila
vary mijenjati se, promijeniti se, razlikovati se
vas deferens, pl. vasa sjemenovod, vas deferens
deferentia
vascular koji se odnosi na krvne žile, vaskularni
vascularity prokrvljenost
vascularize snabdjeti krvlju
vasectomy presijecanje sjemenovoda, vazektomija
vasoconstriction vazokonstrikcija, suženje krvnih žila
vasodilator sredstvo za širenje krvnih žila, vazodilatator
vasopressin vazopresin, antidiuretski hormon
(oslobađa ga neurohipofiza)
vast vrlo velik, golem, ogroman
vein vena
vena cava šuplja vena

392
veneral disease; STD = spolna ili splno prenosiva (venerična) bolest
sexually tranmitted disease
venous venozan
ventral trbušni
ventricle srčana klijetka; moždana komora
venule mala vena, venula
verruca bradavica, bradavičasta izraslina
vertebra, pl. vertebrae kralježak
vertebral koji se odnosi na kralješnicu
vertebral arch luk kralješka
vertebral body tijelo kralješka
vertebral column kralješnica
vertigo vrtoglavica
vesicle mjehurić, vezikula
vesicular mjehurast, mjehuricast
vessel (krvna) žila
vestibule predvorje, vestibulum
vestige rudiment, zakržljalo udo ili organ
vestigial rudimentaran, zakržljao
viability životnost, životna sposobnost
viable životan, koji ima životnu sposobnost
vibrate titrati, odzvanjati, vibrirati
vice porok, mana, zla navika, pogreška, zabuna
vicinity blizina, susjedstvo, bliži okoliš
victim žrtva, stradalnik
victory pobjeda
view pregledati, ispitati, gledati, istražiti
vigorous snažan, jak, energičan, žestok
villus, pl. villi crijevna resica
vinegar ocat, kvasina
violent žestok, nagao, nasilan
viral virusni

393
virgin djevica
virginal djevičanski, čist
virginity djevičanstvo
virilism muževnost, muškost, virilizam
virtue krijepost, vrlina
virus virus
viscera, sg. viscus utroba, unutarnji organi
visceral pleura poplućnica, visceralna pleura
visceropexy visceropeksija – fiksiranje spuštenog
unutarnjeg organa (npr. spuštenog bubrega
i dr.)
viscosity viskoznost
visible vidljiv, vidan, očevidan, jasan
vision vid
visual vidni, očni
vital životni, vitalan
vitality životna snaga, vitalnost
vitamin vitamin
vitiligo bjelkaste mrlje na koži, bolest
depigmentacije kože, vitiligo
vitreous staklast, staklen
vitreous humour tekućina staklastog tijela, humor vitreus,
stakličevina
vocal glasovni, usmen, govorni, vokalni, pjevni
vocal cords glasnice
voice box grkljan, larinks
void isprazniti, izbaciti, izlučiti
voiding pražnjenje (mjehura), mokrenje
volcanoconiosis vulkanokonioza, pneumokonioza izazvana
vulkanskom prašinom
voluntary voljan, namjeran
voluntary muscle prugasti mišić
volvulus zapletaj crijeva

394
vomer ralo, lemeš
vomit povraćati
vomiting povraćanje
voracious lakom, pohlepan, proždrljiv
vowel samoglasnik, vokal
vulva, pl. vulvae stidnica
vulvovaginitis upala stidnice i rodnice, vulvovaginitis

W
wall stijenka, zid
wall-eyed škiljav, razrok
wane slabiti, popuštati, smanjivati se, nestajati,
iščeznuti
ward bolnički odjel
ward off upozoriti, izbjeći opasnost
warm, adj. topao, zagrijan
warm, vb. utopliti, grijati, zagrijati
wart bradavica
waste-product otpadni proizvod
watch for pripaziti (na)
wave val
wavelike valovit
wax vosak
weakened oslabljen, neotporan, opušten
weakness slabost, boležljivost, slabunjavost
wealth izobilje, bogatstvo, imućnost
wedge klin, predmet klinasta oblika
wedged ukliješten
weed korov, trava, biljka, duhan, cigara,
marihuana
weigh težiti

395
weight težina
weight gain povćanje tjelesne težine, debljanje
weight loss mršavljenje, smanjenje tjelesne težine
welfare dobra, dobrobit, sreća; socijalna skrb
wet mokar, vlažan
wheal urtika
wheeze soptati, dahtati, teško disati
wheezing sipljiv, koji sopće, dahće
whiplike u obliku biča
whir zujanje, cvrčanje
whirl vrtnja, okretanje
white matter bijela tvar
whitish bjelkast
whooping cough, pertussis veliki kašalj, hripavac, pertusis
wide širok
Wilms tumour Wilmsov tumor
windpipe dušnik, traheja
wipe obrisati, izbrisati, osušiti
wishful pun želja, željan, požudan, koji čezne
withdraw povući natrag, dići, povući se
within u, unutra, u opsegu
womb maternica, utroba
word root korijen riječi
wormlike crvolik
worn-out istrošen, iscrpljen, iznošen, izmožden
wound rana, ozljeda
wrapping ovojnica, omotač
wrist ručni zglob, zglavak
wrong pogrešan, kriv, neprikladan

X
x-ray, v. rentgenski snimiti

396
x-rays, n. rentgenske zrake, x-zrake
xanthemia prisustvo žutog pigmenta (bilirubina) u krvi,
ksantemija
xenograft, heterofgraft tkivni presadak od ruge životinjske vrste
xiphoid u obliku mača, ksifoidan, mačolik
xiphoid appendage ksifoidni nastavak prsne kosti
Y
yawning zijevanje
yaws frambezija (endemska tropska kožna
bolest), malinaste tropske boginje
yeast kvas, kvasac, pjenica
yellow body žuto tijelo, corpus luteum
yellow fever žuta groznica; akutna virusna infekcija koju
penose komarci
yellow marrow žuta koštana moždina (srž)
yield proizvesti, ostvariti
yolk žumanjak, žumanjce
yolk sac žumanjčana vreća

Z
zone pojas, područje, predio, zona
zoster, herpes zoster pojas, pojasni zoster
zygoma, pl. zygomata/ sponična kost
zygomas
zygomatic sponični, zigomatični
zygote oplođeno jajašce; stanica koja je rezultat
spajanja muške i ženske spolne stanice

397
References
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New York 1979
2. Bujas Ž: Veliki hrvatsko-engleski i englesko hrvatski rječnik, 2. Izdanje,
Zagreb Globus 2001
3. Caroll, Ch. i Miller, D. Health, the Science of Human Adaptation, WBC, New
York, 1983
4. Chabner, D.E. The Language of Medicine, 5th and 7th eds., Saunders, Phila-
delphia 2001, 2004
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phia 2003
6. Ellis, J.W. Medical Symptoms and Treatments, Beekman House, New York
1986
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11. Merriam-Webster’s Collegiate Dictionary
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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
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