Note
Studied by 11 people
AAPC Med Term/Anatomy/PathoPhysio 3 #bf9eea
CHAPTER 8
Respiratory System
cellular respiration involves the breakdown glucose in the presence of oxygen to produce energy in the form of adenosine triphosphate (ATP), carbon dioxide, and water
respiration refers to the process of breathing
Roots, Suffixes and Prefixes
nas/o - nose
rhin/o - nose
pharyng/o - pharynx
laryng/o - larynx
trache/o - trachea
bronch/o - bronchus
broch/i - bronchus
bronchiol/o - bronchiole
phren/o - diaphragm
phrenic/o - phrenic nerve
pleur/o - pleura
pulm/o - lung
pulmon/o - lung
pneumon/o - lung
pneum/o - air, gas; respiration, lung
pneumat/o - air, gas; respiration, lung
spir/o - breathing
-pnea - breathing
-oxia - level of oxygen
-capnia - level of carbon dioxide
-phonia - voice
Vocabulary
bleb - small collection of air between the lung and the outer surface of the lung (visceral pleura) usually found in the upper lobe
commissure - a point or line of union or junction especially between two anatomical parts (oral cavity and nasal cavity in respiratory system)
cytology - diagnostic exam of a single cell type, often found in fluid specimens
decubitus - posture adopted by a person who is lying down
epiglottis - a leaf shaped cartilage that covers the larynx during swallowing to prevent food from entering trachea
glottis - below the epiglottis, opening between the vocal folds
infundibulum - a funnel shaped cavity or structure, seen between right ventricle that leads to pulmonary artery
innominate artery - an artery that supplies blood to the right arm, head and neck direct from the aorta
loculated - the process of being divided into compartments by septa
meatus - a passage or opening leading to the interior of the body
mediastinotomy - procedure in which a tube is inserted into the chest to view tissues and organs in the area between the lung and breastbone and heart
pleurodesis - procedure that sticks your lung to your chest wall, removing the space between your lung and pleural space so that fluid or air no longer builds up there
pneumothorax - when air leaks into the space between your lungs and chest wall, causing it collapse
polypectomy - surgical removal of a polyp
Reinke’s space - non-muscle part of the vocal cord, sometimes called the vocal fold, right under its surface
rhinosinusitis - inflammation of the nasal cavity and paranasal sinuses
sarcois - disease characterized by the growth of tine collections of inflammatory cells (granulomas)
VATS - video assisted thoracoscopic surgery, used to diagnose and treat problems in chest
Anatomy
upper respiratory
includes the nose, throat (pharynx), larynx
nose
air is taken in through nostrils, warmed, purified and dampened as it enters nasal cavity
dirt and foreign material are projected towards the pharynx for expulsion by the cilia (sputum)
mucous keeps nasal cavity moist, and blood flow underneath aid in warmth
paranasal sinuses
four sinuses that drain into each nasal cavity which produce mucus or the respiratory tract
frontal
maxillary
sphenoid
ethmoid
pharynx (throat)
inhaled air travels through mouth and pharynx
has 3 regions
nasopharynx
superior region
found behind nasal cavity
oropharynx
middle region
located behind mouth
laryngopharynx
inferior region
located behind larynx
houses the tonsils and lymphoid tissues
palatine tonsils on soft palate (oropharynx)
adenoids in nasopharynx
lingual tonsils at very back of tongue
larynx
voice box, houses vocal cords
located just below pharynx
made up of 9 pieces of cartilage
thyroid cartilage/Adam’s Apple is the largest
lower respiratory
includes trachea, bronchial tree and lungs
trachea
windpipe
allows the passage of air to travel from either the nose or mouth through the larynx to bronchi of lungs
c-shaped rings of cartilage reinforce trachea from collapse
bronchia tree
made up of trachea and two primary bronchi (resemble an upside down tree)
trachael bifurcation into left and right
the carina is located at bifurcation
right bronchus leading to right lung is shorter and wider
divides into 3 secondary bronchi
left bronchus leading to left lung
divides into 2 branches
bronchioles form as tubes decrease in size
alveolar ducts
miniscule pipes resembling a cluster of grapes that carry air into clusters or sacs where gas is traded between lungs and circulating blood
lungs
deep fissures or grooves partition each lung into lobes
right lung has 3 lobes
left lung has 2 lobes
each lobe is covered in double-layered membrane called pleura
parietal pleura layer
outermost, bound to the partition of thoracic cavity
visceral pleura layer
innermost, bound to the side of the lungs
pleural space
very slim space filled with fluid-like substance to allow for ease of expansion of the lungs during breathing
only organ that can float on water
contains about 300 million balloon-like structures called alveoli, which replace carbon dioxide waste in your blood with oxygen
Breathing
called pulmonary ventilation
inspiration = inhalation
expiration = exhalation
unconscious task that is regulated by the center of the brain stem
eupnea
normal RR
pt oblivious to their breathing pattern
meeting body needs
hyperventilation
rapid breathing patterns
hypoventilation
deep or slow and shallow respirations
technically doesn’t meet the body needs
carbon dioxide levels ride, causing a build up of acid
causes sleepiness
dyspnea
forced or difficult breathing, often connected to hypoventilation
inspiration
diaphragm contracts and moves in descending motion
at the same time, muscles between ribs contract and pull in ascending motion
expiration
(exhalation)
relaxation of diaphragm and elastic recoil of tissue lessening the thoracic volume
escalates pressure
Respiratory Diseases
Chronic Obstructive Pulmonary Disease (COPD)
chronic inflammatory lung disease that causes obstructed airflow from lungs
causes strain and labored breathing, especially when emptying lungs
irreversible
symptoms:
SOB
wheezing
chronic cough
Chronic Bronchitis
persistent inflammation of the lungs and bronchi
acute bronchitis occur temporarily and clears up
symptoms:
sputum
wheezing
chest pain
SOB
Emphysema
air sacs in lungs have become damaged, causing inner walls of air sacs to breakdown, erode and separate, reducing surface area of lungs
symptoms:
dyspnea
SOB
Influenza
viral respiratory infection causing fever, cough, headache, and malaise
mortality possible
vaccine available to everyone aged over 6 months who does not have a contraindication
lung cancer
symptoms do not appear until advanced stages
chest pain
SOB
bone pain
coughing up blood
headache
mostly caused by smoking or second hand smoke
believed that smoking causes lung cancer by mutilating the cells that actually line the lung
carcinogens in smoke cause immediate changes to the lung tissue
second hand smoke causes more than 7,300 lung cancer deaths among US nonsmokers each year
secondhand smoke increases the risk of breast cancer, nasal sinus cavity cancer, nasopharyngeal cancer in adults and leukemia, lymphoma and brain tumors in children
two types of lung cancer:
small cell lung cancer
commonly materializes exclusively in heavy smokers
less common
non-small cell lung cancer
umbrella term
(includes adenocarcinoma, large cell carcinoma, squamous cell carcinoma)
often metastasizes to other part of body such brain or bones
non curable when spread beyond lungs
pleural effusion
accumulation of fluid in the pleural space
classified as
transudates
require no treatment
exudates
require thoracentesis, chest tube drainage, pleurectomy or combination
pneumonia
infection affecting one or both lungs, causing air sacs to be inflamed and to fill with fluid or pus which will be coughed up as pus or phlegm
symptoms:
chest pain when breathing and/or coughing
fatigue
fever, sweats, chills
nausea, vomiting, diarrhea
cough with phlegm
mostly caused by bacteria and viruses in the air we breathe
arranged in 4 types of germ classifications that generate the infection
community-acquired pneumonia
most common type
may originate from bacteria, fungi or viruses
hospital-acquired pneumonia
may become resistant to antibiotics
healthcare-acquire pneumonia
occurs in pts in long-term care facilities
aspiration-acquired pneumonia
occurs when pt inhales food, drink, vomit or saliva into their lungs
more likely in something disturbs your gag reflex, such as brain injury, swallowing problem or excessive use of substances
respiratory failure
life threatening impairment of oxygenation, carbon dioxide elimination, or both
may occur because of
impaired gas exchange
decrease ventilation
both
common manifestations
dyspnea
use of accessory muscles of respiration
tachypnea
tachycardia
diaphoresis
cyanosis
altered consciousness
eventually, obtundation, respiratory arrest or death
treatment is in ICU and involves correction of underlying disorder, use of supplemental oxygen or ventilatory assistance
CHAPTER 8 (Respiratory System): Starts on page 1 and ends on page 6.
CHAPTER 9 (Digestive System): Starts on page 6 and ends on page 18.
CHAPTER 10 (Urinary System): Starts on page 18 and ends on page 25.
CHAPTER 10 (Male Reproductive System): Starts on page 25 and ends on page 28.
CHAPTER 11 (Female Reproductive System): Starts on page 28 and ends on page 29.
CHAPTER 9
Digestive System
consists of the alimentary tract (digestive tract) and it’s accesory organs
alimentary/digestive tract
long, hollow, muscular tube beginning at the mouth and ending at the anus
includes the mouth, pharynx, esophagus, stomach, small intestines and large intestines; and accessory organs like salivary glands, liver, pancreas and gallbladder
Roots, Suffixes and Prefixes
abdomin/o - abdomen, abdominal
an/o - anus
appendic/o - appendix
bil/i - bile
bilirubin/o - bilirubin, bile pigment
bucc/o - cheek
cec/o - cecum
celi/o - abdomen
cheil/o - lip
chole/o - gallbladder
choleangio/o - bile duct
cholecyst/o - gallbladder
choledoch/o - common bile duct
col/o - large intestine, colon
colon/o - large intestine, colon
dent/i - teeth
dent/o - teeth
odont/o - teeth
diverticul/o - diverticulum
duoden/o - duodenum
end/o - within, inner, containing
ent/o - with in, inner, containing
enter/o - small intestine
esophag/o - esophagus
gastr/o - stomach
gingiv/o - gingivae, gums of the mouth
gloss/o - tongue
hepat/o - liver
herni/o - hernia, rupture, protrusion of a part of a structure through containing tissue
ile/o - ileum
jujun/o - jejunum
labi/o - lips
lapar/o - abdominal wall
lingu/o - tongue
lith/o - stone
or/o - mouth
pancreat/o - pancreas
peritone/o - peritoneum
polyp/o - polyp
proct/o - rectum
pylor/o - pylorus
rect/o - rectum
sial/o - saliva, salivary gland, salivary duct
sialaden/o - salivary gland
sigmoid/o - sigmoid colon
splen/o - spleen
stomat/o - mouth
uvul/o - uvula
viscer/o - internal organs
-ase - enzyme
-cele - hernia
-chezia - defecation
dia- - through, throughout, completely
-ectasia - dilation, expansion, distension
-ectasis - dilation, expansion, distension
emesis - vomiting
-lysis - separation, loosening, dissolving, destructiono
-ostomy / -stomy - artificial surgical creation of an opening
-pepsia - digestion
-phagia - eating, swallowing
-plasty - plastic repair, plastic surgery, reconstruction
-rrhea - flow, discharge
-scope / -scopy - involving the use of an instrument for viewing
-tomy - incision into, cutting
Digestive Tract
primary function is to digest (break down) foods taken into the body using two methods
mechanic digestion (mastication / chewing)
stomach churns chewed food and small intestines aborbs the food
chemical digestion
stomach bile, acids and enzymes break up large carbohydrate, lipid, protein and nucleic acid molecules into subcomponents of nutrients
the long hollow organs have circular and longitudinal fibers running throughout which enable food to move from organ to organ when they contract; called peristalsis
Common Conditions
hernias
when the contents of a body cavity bulge out of the area where they usually are contained
can be congenital, acquired or recurrent
specified categories
inguinal hernia
occur in the groin and can be either direct or indirect
direct hernias arise because of the weakening of the abdominal wall, common in older adults
indirect hernias result from protrusion through the internal inguinal ring, often congenital
hiatal hernia
anatomical abnormalities of the stomach which protrude or herniate through the opening of the diaphragm into the chest
umbilical hernia
common
caused by an opening in the abdominal wall
ventral hernia
occur at the site of previous abdominal surgery and are called an incisional hernia
diaphragmatic hernia
occur when there is an abnormal opening in the diaphragm
can be acquired or congenital
parastomal hernia
happen when intestine press outward near a stoma
polyps
abnormal growth of tissue projecting from mucous membrane frequently occur in the lining of the large intestine, colon
shape can be flat, slightly raised or on a stalk (called pedunculated)
often benign but can become malignant over time if not removed
any PHx or FHx of neoplasm is clinically significant and should be noted in medical record
gastrointestinal (GI) bleeding
refers to every form of hemorrhage in the GI tract
can range from microscopic to massive bleeding
massive bleeding can result in hypovolemia, shock or even death
has many causes (not limited to)
esophageal varices
Mallory-Weiss tears
peptic ulcer disease
diverticular disease
hemorrhoids
fissures
gastroenteritis
infection or irritation of the digestive tract, particularly the stomach and intestines
most common symptoms
nausea
vomiting
diarrhea
abdominal cramps
weakness
fever
caused by either virus or bacteria
typically lasts about 3 days
children, elderly and vulnerable adults susceptible to dehydration
common conditions of small and large intestines:
Crohn’s disease
chronic inflammatory process of the bowel that often leads to fibrosis and obstructive symptoms
can affect any part of Gi tract
most involves small bowel, particularly terminal ileum
characteristic presentation is abdominal pain and diarrhea, possible complications including combinations of intestinal fistulization, obstruction, hemorrhage, abscess
congenital megacolon
abnormal dilation of the colon
often accompanied by paralysis of peristaltic movement
diverticulosis
pouches or projections (diverticula) causing muscle weakness in colon wall as it contracts and exerts pressure
most frequent in the sigmoid colon
can cause changes in bowel function, like discomfort, diarrhea or constipation
in advanced stages
lower colon may become very fixed, distorted or narrowed
thin or pellet-shaped stools may occur, or constipation, and occasional rush of diarrhea
diverticulitis
inflammation as bacteria in the colon cause infection of the diverticular pockets
can be mild with only slight discomfort in left lower abdomen or can be extreme with severe tenderness and fever, requiring treatment and dietary restrictions
can cause bleeding and perforation
inflammatory bowel disease
group of inflammatory conditions of colon and small intestines
includes Crohn’s disease and ulcerative colitis
irritable bowel syndrome
also known as
spastic colon
spastic colitis
nervous of function bowel
most often affects large intestine
colon does contract normally but in violent disorganized manner; may be exaggerated or sustained for prolonged periods; one area may contract with no regards to another
result in changing bowel patterns with constipation and pain being most common
Meckle’s diverticulum
congenital condition
remnant of the connection from yolk sac to small intestine present during embryonic development
sometimes contains gastric tissue, sometimes contains pancreatic tissue
asymptomatic
managed by surgical resection
redundant colon
congenital variation on the normal anatomy of a colon, longer than normal
asymptomatic
usually not found until x-ray or colonoscopy performed
ulcerative colitis
chronic inflammatory disorder
causes inflammation and sores in the lining of the rectum and colon
ulcers form where inflammation has killed the cells that usually line the colon
ulcers will bleed and produce pus
inflammation causes colon to empty frequently, resulting in diarrhea
common conditions of the rectum and anus
hemorrhoids
dilated or enlarged varicose veins in and around the anum and rectum
may be external (distal end of anal canal) or internal (in the rectum)
can slip out of anus (prolapsed)
can be complicated by
thrombosis
strangulation
prolapse
ulceration
rectal prolapse
can be
complete
when full thickness of bowel protrudes through the anus
partial
mucous membrane lining the anal canal protrudes through anus
abscess can occur in the perirectal and perianal areas
anal fissures
tears in the mucosa and skin of the anal canal due to passing a large stool, straining during childbirth, and laceration from passing a foreign body
anal fistulas
tiny channels or tracts that develop because of an infection, inflammation, or abscess
one opening in anal canal and one in perianal skin, rectum, bladder or vagina
Anatomy
mouth
associated structures
lips
soft and hard palates
teeth
gums
tongue
salivary glands
performs two main functions
speech
digestion
digestive process begins when food enters the mouth
teeth and tongue break up food into small particles
salivary glands secrete saliva and enzymes that aid in digestion
tongue mixes saliva with food and keeps food pressed against the teeth for chewing, pushing it backwards to swallow
categories of teeth
incisors
front of the mouth
shaped like chisels
use in biting off large pieces
8 total, 4 top and 4 bottom
cuspids
point teeth immediately behind incisors, “canines”
used for grasping or tearing
4 total, 2 top and 2 to bottom
molars
flattened teeth used for grinding food
farthest back in mouth'
number can vary
common conditions:
cleft lip and/or palate
congenital condition
resulting from abnormal facial development in gestation
causing fissure, gap or opening deformity
affecting lip, soft palate, hard palate, or nasal cavities
can be corrected with surgery
pharynx
5” tube immediately behind the mouth
serves as an airway and passageway for food
aids in the closure of the nasopharynx and larynx when swallowing to keep food out of respiratory tract
common condition:
dysphagia (swallowing disorder)
causes impairment of the movement of solids or fluids from the mouth, down the throat, and into the stomach
can have sever effect on caloric intake and nutritional status
may affect ability to swallow liquids, solids or both
may make individual susceptible to pneumonia when swallowed substances are inhaled into lungs
esophagus
long, straight tube about 10” long
descends from pharynx, passes through diaphragm, continues into stomach
diaphragm
muscular and membranous partition that separates the chest cavity from abdominal cavity
peristalsis moves food to stomach
common conditions:
Barrett’s esophagus
abnormal growth of stomach or intestinal cells at the distal end of the esophagus
leads to cancer of lower esophagus
may develop because of chronic gastroesophageal reflux disease, exposing esophagus to stomach acids
esophagitis
inflammation of the lining of the esophagus
untreated, becomes very uncomfortable causing problems with swallowing, ulcers, and scarring
caused by infection or irritation
candida
herpes
meds like aspirin or NSAIDs
can cause the esophagus to constrict, causing esophageal stricture
esophageal varices
extremely dilated submucosal veins in the lower end of esophagus
mostly caused by portal hypertension (portal vein to the liver)
strong tendency to develop bleeding
Mallory-Weiss tear
occur in the mucous membrane of esophagus, where it connects to stomach
usually caused by forceful or long-term vomiting or coughing, or by epileptic convulsion
may be followed by vomiting bright red blood or by-passing blood in stool
stomach
large chamber that receives solids, semisolids and liquids from the esophagus
has four main parts
cardia
fundus
body (corpus gastricum)
antrum (pylorus)
digests food and passes the chyme (partially digested food) into the duodenum (upper part of the small intestine)
common condition:
gastritis
acute or chronic inflammation of the stomach
commonly caused by bacterium (helicobacter pylori, H. pylori)
can lead to ulcers or cancer
long-term use of NSAIDs or alcohol also a cause
peptic ulcer disease
may be referred to as gastric or stomach ulcers
sore or opening in the inner lining of the stomach or duodenum
ulcers develop when protective layer is broken down and digestive juices can damage esophagus
most common causes
H. pylori infections
prolonged use of NSAIDs
small intestines
coiled muscular tube that occupies the central and lower abdomen
divided into three portions
duodenum
first portion
connected to stomach
about 10” long
small ducts from pancreas, liver and gallbladder open into via hepatopancreatic ampulla (ampulla of Vater)
jejunum
middle portion
about 7.5 feet long
ileum
last and longest portion
about 12 feet long
fluid contents moved to it by vigorous peristaltic waves
most of the absorption of food happens here
connected to large intestines
large intestines
the colon, plus rectum and anal canal
about 5 feet long and 2.5 inches in diameter
water is reabsorbed as the food material travels through the large intestine and eventually is eliminated from the body
stores unabsorbed food material
begins just after the ileocecal valve at the cecum, with appendix attached at the bottom
four portions to the colon:
ascending
proceeds from ileocecal valve upward to hepatic flexure on right side of abdomen
transverse
turns downward at the splenic flexure
descending
gives way to sigmoid colon
ends at rectum
sigmoid pelvic
internal and external anal sphincters at the terminus of rectum control flow of fecal material leaving body
common conditions of small and large intestines:
Crohn’s disease
chronic inflammatory process of the bowel that often leads to fibrosis and obstructive symptoms
can affect any part of Gi tract
most involves small bowel, particularly terminal ileum
characteristic presentation is abdominal pain and diarrhea, possible complications including combinations of intestinal fistulization, obstruction, hemorrhage, abscess
congenital megacolon
abnormal dilation of the colon
often accompanied by paralysis of peristaltic movement
diverticulosis
pouches or projections (diverticula) causing muscle weakness in colon wall as it contracts and exerts pressure
most frequent in the sigmoid colon
can cause changes in bowel function, like discomfort, diarrhea or constipation
in advanced stages
lower colon may become very fixed, distorted or narrowed
thin or pellet-shaped stools may occur, or constipation, and occasional rush of diarrhea
diverticulitis
inflammation as bacteria in the colon cause infection of the diverticular pockets
can be mild with only slight discomfort in left lower abdomen or can be extreme with severe tenderness and fever, requiring treatment and dietary restrictions
can cause bleeding and perforation
inflammatory bowel disease
group of inflammatory conditions of colon and small intestines
includes Crohn’s disease and ulcerative colitis
irritable bowel syndrome
also known as
spastic colon
spastic colitis
nervous of function bowel
most often affects large intestine
colon does contract normally but in violent disorganized manner; may be exaggerated or sustained for prolonged periods; one area may contract with no regards to another
result in changing bowel patterns with constipation and pain being most common
Meckle’s diverticulum
congenital condition
remnant of the connection from yolk sac to small intestine present during embryonic development
sometimes contains gastric tissue, sometimes contains pancreatic tissue
asymptomatic
managed by surgical resection
redundant colon
congenital variation on the normal anatomy of a colon, longer than normal
asymptomatic
usually not found until x-ray or colonoscopy performed
ulcerative colitis
chronic inflammatory disorder
causes inflammation and sores in the lining of the rectum and colon
ulcers form where inflammation has killed the cells that usually line the colon
ulcers will bleed and produce pus
inflammation causes colon to empty frequently, resulting in diarrhea
common conditions of the rectum and anus
hemorrhoids
dilated or enlarged varicose veins in and around the anum and rectum
may be external (distal end of anal canal) or internal (in the rectum)
can slip out of anus (prolapsed)
can be complicated by
thrombosis
strangulation
prolapse
ulceration
rectal prolapse
can be
complete
when full thickness of bowel protrudes through the anus
partial
mucous membrane lining the anal canal protrudes through anus
abscess can occur in the perirectal and perianal areas
anal fissures
tears in the mucosa and skin of the anal canal due to passing a large stool, straining during childbirth, and laceration from passing a foreign body
anal fistulas
tiny channels or tracts that develop because of an infection, inflammation, or abscess
one opening in anal canal and one in perianal skin, rectum, bladder or vagina
liver
second largest organ in the body (after skin)
weighs about 4 pounds
lies in upper abdomen, right side, under diaphragm and above duodenum
has 4 lobes
right lobe
left lobe
quadrate lobe
caudate lobe
cannot live without liver due to numerous functions
proteins digested become amino acids, with by-product ammonia which is toxic to cells; liver converts ammonia into urea which is excreted
converts glucose into glycogen or fat
produces bile salts, aiding the emulsification of fat for absorption into intestines
only organ able to regenerate itself, which is why an adult can donate a portion to a child (usually regrowing within six weeks)
pancreas
soft, oblong gland about 6” long and 1” thick
beneath the great curvature of the stomach
has 5 parts
head
neck
body
tail
uncinate process
empties digestive fluid (mixture of enzymes) into duodenum and insulin into bloodstream
insulin is produced inside pancreas
in islets of Langerhans
by beta cells
allows muscle, fat, and liver cells to absorb sugar in blood stream
common conditions:
pancreatitis
inflammation of pancreas
acute or chronic
digestive enzymes get into tissue of organ (rather than staying within the duct) causing severe damage to pancreas
commonly caused by
binge drinking alcohol
gallbladder disease
certain drugs like diuretics
extreme high blood fat level (triglycerides)
gallbladder
sac-like structure attached to the inferior surface of the liver
serves as a reservoir for bile
periodically empties into the duodenum by way of cystic ducts
Vocabulary
alimentary limb - created during different GI surgeries, accepts incoming food
Ampulla of Vater - opening in duodenum where pancreatic and bile ducts release into intestines
anoscopy - procedure to scope the anus
antimesenteric - part of the intestine that lies opposite the mesenteric attachment
appendiceal orifice - opening of appendix which leads to cecum
bariatric surgery - gastric restrictive procedures to treat morbid obesity
barium enema - radiographic contract medium enhanced examination of the colon
biliary - gallbladder, bile or bile duct
biliopancreatic - bile and pancreatic fluids
biliopancreatic limb - created during gastric surgeries, located at beginning of small intestine
buccal - pertaining to cheek
calculus - concreating of mineral salts, also called a stone
cholangiogram - radiographic imaging of bile ducts
cholangiopancreatography - radiographic recording of biliary system and pancreas
colectomy - excision of part of colon
cholecystectomy - surgical removal of the gallbladder
cholelithiasis - gallstones
cholecystoenterostomy - creation of a connection between the gallbladder and intestine
Crohn’s disease - regional enteritis
dentate line - line which divides upper two-thirds and lower third of anal canal
duodenography - radiographic recording of the duodenum
enteroenterostomy - anastomosis between one part of small bowel and another part of small bowel, used to restore bowel continuity after resection of bowel segment
enterolysis - releasing of adhesions of intestine
epigastrium - part of the abdomen between the bottom of the rib cage and belly button
epiglottidectomy - excision of covering of larynx
esophageal - pertaining to esophagus
esophagogastroduodenoscopy - scoping of the esophagus, stomach and duodenum
eventration of intestines - protrusion of intestines through abdominal wall
evisceration - pulling the viscera outside of the body through incision
exenteration - major operation during which an organ and its adjacent structures are removed
exstrophy - condition in which the bladder is turned inside out
exteriorization - expose an internal structure outside the body for observation, surgery or experimentation, such as creating passage from bladder to abdominal wall
femoral hernia - intestines protrudes along femoral canal
fundoplasty - repair of the bottom of an organ or muscle
gastrojejunal anastomosis - surgical procedure in which a connection is mad between the stomach and the proximal loop of the jejunum
gastrostomy - surgical opening made between stomach and abdominal wall
hematemesis - vomiting blood
hemicolectomy - surgical removal of half the colon
ileocolic arcade - loops of arteries around the jejunum and ileum
ileostomy - artificial opening between ileum and abdominal wall
incarcerated - constricted irreducible hernia that maybe obstruct organ it is contained within
intussusception - slipping of one part of intestine into another part
jejunostomy - artificial opening between jejunum and abdominal wall
lumbar hernia - posterior abdominal wall or retroperitoneal outpouching occurring between 12th rib and iliac crest
marsupialization - produce that creates an exterior pouch from an internal abscess
mesenteric - fold of membrane that attaches intestine to abdominal wall
monitored anesthesia care (MAC) - conscious sedation, where patient remains aware of their surroundings yest still remains calm, constantly monitored by anesthesiologist
mucosal incision - incision into mucosal layer of hollow organ wall
nasogastric tube - feeding/medication tube to the stomach through the nose
peritoneal cavity - space within the abdomen that contains the intestines, stomach, and liver
pneumoperitoneum - presence of air in peritoneal cavity
proctitis - inflammation of the lining of the rectum
prolapse - internal hemorrhoid that descends past anal sphincter
rectocele - herniation of the rectum into the vagina
seromyotomy - incision in the wall of a hollow organ that involves the serosa and muscularis but mucosa
small bowel - long tube that carries digested food between stomach and large intestine
sphincter - muscular ring around a lumen, or hollwo structure
stoma - hole created for colostomy or ileostomy appliance
stomatitis - inflammation of the mucous membrane of the mouth
strangulation (hemorrhoidal) - condition that can happen to hemorrhoids in which the blood supply has become occluded by constricting action of the anal sphincter
terminal ileum - most distal segment of the small bowel, just before the small bowel connects to the colon
ulceration - inflammation or necrotic changes of the tissue
umbilical hernia - protrusion of internal organs through the abdominal wall around the umbilicus
uvulopalatopharyngoplasty - surgery to open upper airways by taking out extra tissue in the throat
Warthin’s tumor - tumor found in the salivary gland
Abbreviations
EGD - esophagogastroduodenoscopy
ERCP - endoscopic retrograde cholangiopancreatography
GERD - gastroesophageal reflux disease
GI - gastrointestinal
HJR - hepatojugular reflux
IBD - inflammatory bowel disease
IBS - irritable bowel syndrome
LLQ - left lower quadrant
LUQ - left upper quadrant
NG - nasogastric
PEG - percutaneous endoscopic gastrostomy (tube)
PEH - paraoesophageal hernia
PUD - peptic ulcer disease
RLQ - right lower quadrant
RUQ - right upper quadrant
CHAPTER 10
Urinary System
produces urine for excretion of metabolic waste, and fluid balance
plays an important role in blood pressure control within the body
four basic parts for females and five basic parts for males
two kidneys
two ureters
one bladder
one urethra
prostate gland (males only)
Roots, Suffixes and Prefixes
calic/o - calyx
cali/o - calyx
cyst/o - filled sac or pouch, cyst, bladder, urinary bladder
dips/o - thirst
glomerul/o - glomerulus
hydr/o - water, fluid
ket/o - ketone bodies
lith/o - calculus, stone
nephr/o - kidney
pyel/o - renal pelvis
ren/o - kidney
trig/o - trigone region, kidney
ur/o - urine, urinary tract
ureter/o - ureter
urethr/o - urethra
urin/o - urine
vesic/o - urinary bladder
-lysis - separation, loosening, dissolving, destruction
-uria - urination or urinary
Anatomy
kidneys
bean shaped organs, approximately the size of a fist
located near the middle of the back, bilateral to the spine
filter urea (waste) and excess fluid from blood
using tiny filter units called nephrons
nephron
consists of glomerulus (ball of capillaries) and a renal tubule
urea
produced when foods are broken down
carried in bloodstream to kidneys
combined with water, and other waste substances forms urine after passing through nephron
works with lungs, skin and intestine to keep chemicals and water balanced
ureters
muscular tube carrying urine from the kidneys to bladder
originate in renal pelvis and ends in bladder
receives urine through major calyces
approx. 12” long and 3-4 mm in diamter
muscles in wall constantly tight and relax (peristalsis) to force urine down
urine allowed to stand still or reflux can cause a kidney infection
ureterovesical junction
anatomical area where ureters join the bladder
has 3 major components
lower ureter
trigone muscle
adjacent bladder wall
urinary bladder
hollow, muscular, expandable organ collecting urine
held in place by ligaments attached to other organs and by pelvic bones
stores urine until nerves from bladder signal brain that bladder is full
brain signals bladder to tighten and sphincter muscles to relax
urine exits through urethra
urethra
tube connecting urinary bladder to outside of body
in males
is the conduit for fluid waste and semen
shaped like an S to follow line of the penis
prostatic urethra
portion of urethra passing along neck of urinary bladder, and through prostate gland
designed to accept drainage from tiny ducts within prostate
equipped with two ejaculatory tubes
due to this portion, males who have prostate issues tend to exhibit urinary dysfunction
in females
straight
approx. 4 cm long
leads out of body via urethral orifice
has no reproductive function
bladder muscles will tighten and squeeze urine into urethra
bladder neck
proximal opening of urethra
in men, adjacent from prostate gland
if it does not open and close properly may become obstructed
in men, caused by enlarged prostate
in women, caused by pelvic prolapse
Common Conditions
chronic kidney disease (CKD)
progressive disorder in which kidneys are damaged and not functioning properly
causes excess fluid and toxin build up
urine production decreases
hypertension begins to rise, meaning less filtering happens
5 stages
CKD I - CKD V
CKD III has two substages
stages determined by glomerular filtration rate (GFR)
how much blood is being filtered by glomeruli, lower number signifies more severe disease development
irreversible
when kidneys stop functioning pt is in end stage renal disease (ESRD)
requires the start of dialysis
treatment:
diet
medication
control of disease processes (DM, HTN)
dialysis, when required
two types
hemodialysis
involves accessing pt’s blood stream through special surgical tunnel and passing blood into external machine to filter waste, toxins and excess fluid
typically done 3-4 times a week for a minimum of 4 hours
peritoneal dialysis
filling abdomen with fluid called dialysate
over 8 to 24 hours period, dialysate pulls toxins and waste from blood via osmosis before being drained from abdomen
acute renal failure and acute kidney injury
ARF and AKI
caused by injury, severe illness, heart attack and anaphylactic reactions
reversible
some meds can initially cause AKI that resolves after med adjustment
urinary incontinence
inability to control urine leakage form bladder
numerous causes, which vary depending on gender
5 different types
stress
occurs within in activity such as coughing or sneezing
urge
sudden need to urinate followed by involuntary release of urine
mixed
overflow
functional
can be diagnosed symptomatically or by urodynamic testing
urodynamic testing
done by urologist or gynecologist
completed with a mix of tests
hydronephrosis
dilation of kidney and renal pelvis due to an obstruction causing excess fluid and urine accumulation
causes of obstruction include urinary reflux, stones or cancers
polyuria
excessive production and passage of urine, often occurring with polydipsia
often a symptom of other conditions like DM
hematocele
blood silled sac found within the body area
Surgical Approach Procedures
surgical roots, suffixes and prefixes
-centesis - to puncture
-clasis - surgical break or fracture
-desis - fixation, binding
-ectomy - surgical removal
-graphy - imaging
-lysis - to free up
-orraphy - surgical suture
-opexy - surgical fixation of an organ
-otomy - incision, to cut open
-scopy - observation, related to endoscope
-plasty - remodel or repair
through a natural opening or orifice
minimally invasive
ex: transurethral resection of prostate (TURP) or cystoscopy
percutaneous
through the skin
includes puncturing skin to gain access to body cavity or organ with a catheter or probe
endoscopic or laparoscopic
minimally invasive
uses endoscope (flexible tube with light and camera) to examine or treat internal organs
performed through natural openings or percutaneously
open surgical approach
use of scalpel to open area under treatment
often used to treat cancers, pelvic adhesions or elarged organ
in urological surgery, the direct and depth of dissection is important to note
laparotomy (vertical)
Pfannenstiel (horizontal)
was peritoneum, bladder or prostate opened?
did they repair or remove any of the reproductive organs?
inguinal incision typically made in groin for procedure involving testicles or spermatic cord
Diagnostic Procedures
cystoscopy
scope inserted into bladder through urethra to examine the inside
prostate specific antigen (PSA) blood test
measure the level of a specific protein made by prostate
the higher the PSA result the higher the possibility of infection or cancerous condition
digital rectal examination (DRE)
physician places a finger into patient’s rectum and checks for enlargement or masses
prostate biopsy
removal of tissue samples following continuous high PSA blood test levels or suspected enlarged or hardened prostate to determine diagnosis
completed either transrectally or transperineally
transrectal
most common
placing a needle through the wall of the rectum into the prostate
typically done with ultrasound guidance
completed in physician’s office
transperineal
needle place into prostate through the perineum
done in a hospital
usually done with CT or MRI guidance
if cancer cells are detected, a Gleason score is assigned by a pathologist to indicate how fast-growing it is and how likely it is to spread (higher score means more aggressive)
blood urea nitrogen (BUN) test
blood test to detect levels of urea nitrogen
urea nitrogen and creatinine levels from food break down increase when kidneys are not fully functioning
urodynamic testing
assesses the function of the bladder
comprised of several tests for
bladder capacity
pressure
bladder muscle activity
urine flow rate
post-void ultrasound maybe be performed to check for residual urine
Therapeutic Procedures
transurethral resection of a bladder tumor (TURBT)
a cystoscope placed through urethra into bladder for examination, and resection or removal of tumors found within
ureterolithotomy
surgical removal of stones lodged in the ureter by making an incision into ureter
nephrolithotomy
incision for the removal of kidney stones
nephrotomy
surgical incision into kidney
extracorporeal shock wave lithotripsy (ESWL)
surgical procedure to crush or break down calculi in kidney or ureter either externally (extracorporeal) or internally using (cystourethroscopy)
Vocabulary
albuminuria - presence of serum protein (albumin) in the urine can be a sign of kidney disease
bacteriuria - bacteria in the urine
chronic kidney disease (CKD) - a chronic diase in which the kidney’s ability to filter waster from the blood declines slowly
cystectomy - excision of all or part of the bladder, removal of a cyst
cystitis - inflammation of bladder
cystocele - hernia of the bladder protruding into the vagina
cystolithectomy - excision of a calculus (stone) from the bladder
cystopexy - surgical fixation of the bladder to abdominal wall
cystoplasty - surgical repair of the bladder
cystorrhagia - blood bursting forth from the bladder
dialysis - separation of waste material from blood to maintain fluid, electrolyte and acid-base balance in impaired kidney function
dysuria - difficult or painful urination
glomerulonephritis - inflammation of the glomeruli, tiny filters of the kidney
hematuria - blood in urine
hydronephrosis - condition caused by excess fluid or urine accumulated kidney and renal pelvis due to obstruction
incontinence - inability to control urine leakage from bladder
interstitial cystitis - condition of sever, chronic pain, pressure, or discomfort in the pelvic region and bladder
nephrectomy - remove of one or both kidneys
nephritis - inflammation of the kidney
nephrolithiasis - condition of having stones or calculi in the kidney
nephrologist - specialist in disease of the kidney
nephropathy - disease of the kidney
nephrosclerosis - hearing of the kidney
polycystic kidney disease - hereditary disorder developing numerous fluid filled cysts in the kidneys, causing enlargement and failure
polyuria - excessive urination
pyelocystitis - inflammation of the bladder and renal pelvis
pyelonephritis - inflammation of the kidney and renal pelvis
pyelostomy - procedure to form an artificial opening in the renal pelvis
pyuria - pus in the urine
renal calculi - kidney stone
renal agenesis - condition where one or both kidneys fail to form at birth
uremia - excess urea and other nitrogenous waste in blood
ureteroplasty - surgical repair of ureter
urethralgia - pain in the urethra (urethrodynia)
urinalysis - examination of the urine to detect abnormalities by various diagnostic methods
urologist - physician treating disease of the urinary system
vesicoureteral reflux (VUR) - vesicoureteral reflux is urine flow from the bladder back into the ureter and kidneys, which can lead to bacterial infection and an increase in hydrostatic pressure, causing kidney damage
Abbreviations
ARF - acute renal failure
BUN - blood urea nitrogen
CKD - chronic kidney disease
CMG - cystometrogram
CPP - chronic pelvic pain
CRF - chronic renal failure
ESRD - end stage renal disease
ESWL - extracorporeal shock wave lithotripsy
GFR - glomerular filtration rate
IC - interstitial cystitis
IVP - intravenous pyelogram
KUB - kidney ureter bladder
LUTS - lower urinary tract symptoms
PVR - post void residual
RCC - renal cell carcinoma
SUI - stress urinary incontinence
TURBT - transurethral resection of bladder tumor
UA - urinanlysis
UDS - urodynamics
UTI - urinary tract infection
VCUG - voiding cystourethrogram
VUR - vesicoureteral reflux
Male Reproductive System
Roots, Suffixes and Prefixes
andr/o - male
baln/o - head of penis
crpyt/o - hidden
epididym/o - epididymis
meat/o - meatus or opening
orchi/o - testes
orchid/o - testes
peni/o - penis
phallo/o - penis
osche/o - scrotum
prostat/o - prostate
semin/o - semen
sperm/o - sperm, spermatozoon
spermato/o - sperm, spermatozoon
test/o - testis, testicle
vas/o - vessel, duct, vas deferens
vasicul/o - seminal vesicle
Anatomy
testes
produce and store sperm cells
surround on front and sides by serous membrane (tunica vaginalis)
oval shaped
about 5 cm (2 in) in length, and 3 cm (1 in) in diameter in adult males
scrotum
holds testicles outside the body
shrinks to hold closer to body to conserve heat when cold, becomes larger to get rid of excess heat
need to be kept colder than body temperature to create sperm
spermatic cord
bundle of nerves and blood vessels that connect testicles to abdominal cavity
considered part of the endocrine system since they secrete hormones
during development, pituitary gland signals testicles to produce testosterone
causes cells to transform into sperm cells
seminiferous tubule
system of tiny tubes where sperm is developed
epididymis and vas deferens
epididymis
coiled tube within scrotum that connects testicles to vas deferens
where sperm cells complete their development
sperm cells uses their tails to push themselves from the seminiferous tubules into the epididymis
after maturing, sperm moves to vas deferens
vas deferens
muscular tube that transports semen from epididymis into pelvis, then connects to prostatic urethra
seminal vesicles
pair of tubular sac-like glands
located behind bladder and above prostate gland
about 5 cm (2 in) in length
secrete much of the fluid that creates semen
together with prostate gland (accessory sex glands) provide fluids that lubricate the duct system and nutrients to sustain sperm
ejaculatory duct
short tube formed by joining of vas deferens and excretory duct or seminal vesicles
passes through prostate gland and opens into prostatic urethra
as semen pass through, it receives fluids from both prostate gland and seminal vesicles
prostate gland
surrounds the neck of the bladder and urethra in males
approx. the size of a walnut
partly muscular, partly glandular
secretes the liquid portion of seminal fluid which carries sperm
during orgasm
muscles of the prostate propel prostate fluid and sperm into urethra
semen leaves through the tip of the penis
can be palpated by a physician during digital rectal examination
bulbourethral glands (Cowper’s glands)
two accessory glands located below the prostate
secrete pre-ejaculatory fluid which lubricates the urethra and neutralizes the acidity of remaining urine
penis
made up of two parts
shaft
made up of 3 columns of erectile tissue
two called corpus cavernose
one called corpus spongiosum
surrounds urethra
expand with increased blood flow causing erection
glans (head)
at the end is a small slit called meatus (where semen and urine exit the body)
foreskin or prepuce
loose skin covering the end of the penis
Common Conditions
spermatocele
noncancerous cyst-like, fluid and semen filled sac found within the testicle and/or epididymis
can be smalll and found incidentally on exam or large and causing pain or discomfort requiring treatment
orchitis
inflammation of the testicle
epididymitis
inflammation of epididymis
prostatitis
inflammation of the prostate gland causing painful or difficult urination and occasionally flu-like symptoms
usually due to an infection
can be acute or chronic
Procedures
orchiectomy
removal of a testicle
“radical” means removal of additional tissue and lymph nodes around testicle that could be cancerous
orchiopexy
surgical procedure that moves and secures testes to scrotum
may be performed to correct undescended testicle or to correct testicular torsion
circumcision
removal of the prepuce (foreskin) and glans (tip) of penis
may treat conditions like phumosis, too tight, or paraphimosis (becomes trapped behind the glans)
vasectomy
relatively permanent surgical form of male sterilization
cut, puncture or removal of part of vas deferens, thereby severing the tub that delivers sperm
vas deferens
2 muscular tubes that moves sperm from the epididymis and testicles
may be performed unilaterally or bilaterally
reversal success not guaranteed but can be attempted using vasovasostomy or vasovasorrhaphy
Vocabulary
benign prostatic hyperplasia - prostate enlargement cause by an overgrowth or prostatic cells or tissue, tends to cause urinary symptoms
chordee - congenital condition of the penis which the head of the penis bends abnormally
circumcision - removal of foreskin
cryptorchidism - condition of one or both testes not descending into scrotum
epispadias - congenital deformity of the penis where the urethral opening (meatus) in found on the top or upper portion of penis rather than the usual through the tip
erectile dysfunction - inability to get or maintain an erection
gleason score - grade assigned by pathologists to indicate growth rate and aggressiveness of prostate cancer and how likely it is to spread (lower number, slower growing)
hypospadias - congenital deformity of the penis where the urethral opening (meatus) is on underside of penis or perineum rather that usual through the tip
orchiectomy - excision of a testicle
phimosis - condition of foreskin too tight to retract over glans, circumcision made be necessary
priapism - prolonged erection lasting more than 4 hours
prostatalgia - pain in the prostate
prostatectomy - surgical removal of part or all of prostate gland
prostatic hypertrophy - prostate enlargement due to increase in size of prostate cells rather than the growth of new prostate tissue
testicular torsion - twisting of the testicle inside of the scrotum, which may interfere with blood flow to the testicle causing the tissue to eb deprived of oxygen
vasectomy - form of male sterilization by which the vas deferens is cut or puncture to prevent sperm from being ejaculated
Abbreviations
BPH - benign prostatic hyperplasia
ED - erectile dysfunction
GG - Gleason grade
LUTS - lower urinary tract symptoms
PCa - prostate cancer
PIN - prostatic intraepithelial neoplasia
PSA - prostate specific antingen
TUMT - transurethral microwave thermotherapy
TUNA - transurethral needle ablation
TURP - transurethral resection of the prostate
CHAPTER 11
Female Reproductive System
Roots, Suffixes Prefixes
abort/i - abortion, miscarriage
amin/o - amniotic sac
cervic/o - cervic
chori/o - membrane or sac, sac enclosing a fetus
chroiod/o - membrane or sac, sac enclosing a fetus
colp/o - vagina
epis/o - vulva
fet/o - fetus
gamet/o - egg or sperm
gest/o - pregnancy
gonad/o - sex glands (ovaries, testes)
gyn/o - woman
gynec/o - woman
hyster/o - uterus, womb
labi/o - lips
lact/i - milk
lact/o - milk
mamm/o - breast
mast/o - breast, mammary gland
men/o - menstruation
mens/o - menstruation
metra/o - uterus
metr/o - uterus
metri/o - uterus
nat/o - birth
omphal/o - navel
o/o - ovum, egg cell
oophor/o - ovary
ov/o - ovum, egg cell
ov/i - ovum, egg cell
ovul/o - ovum, egg cell
ovari/o - ovary
pelv/i - pelvic
pelv/o - pelvic
pelvi/o - plevic
pub/o - pubis
salping/o - oviduct, fallopian tube
toc/o - childbirth
uter/o - uterus
vagin/o - vagina
vulv/o - vulva
Anatomy
Uterus and Cervix
comprised of 3 layers
endometrium
inner layer
thickens and slough each month during menstrual cycle
if pregnancy occurs, thickened lining provides home and nutrients for embryo
myometrium
middle layer
muscle fibers running horizontally, vertically and diagonally to provide strong contractions during labor and delivery
perimetrium
serous outer layer
secretes lubrication fluid to reduce friction
3 distinct regions
uterine fundus
uppermost portion, closest to tube
corpus
body of uterus
middle portion
uterine isthmus
lower portion
narrows down and communicated with the uterine end of the cervix (cervix uteri)
cervix uteri
lower portion of the cervix that protrudes into vaginal canal
fornix (fornices)
anterior and posterior recess in upper vagina surrounding vaginal attachment to cervix
external os
opening in the cervix, near the vagina
communicates with the vagina
internal os
opening in the cervix, near the uterus
communicates with the corpus of the uterus
Uterine Adnexa
fallopian tubes
also called ovidcuts, uterine tubes, tubes, and salpinges (singular: salpinx)
one on either side of the uterus, arching over ovaries
infundibulum
distal end of fallopian tubes
fimbriae
(“fingers”)
help capture the ovum (egg, or oocyte) at ovulation as it travels into the tubes and uterus
ampulla
section of the tube at its widest and longest (7-8 cm in length)
fertilization often takes place at this section of the tube
narrows as it approaches the uterine horns
ovaries
actual egg producing reproductive organs
produce hormones related to female reproductive cycles
part of both endocrine and reproductive systems
broad ligament
thin sheet of peritoneum that drapes over uterus and fallopian tubes to connect them to later wall of pelvis
divided into 3 parts
mesosalpinx
over the fallopian tubes
mesovarium
over the ovaries
mesometrium
largest subsection
surrounds uterus
cardinal ligament
ligamentum transversum cervicis
supports the connection between the cervix and pelvic wall
round ligament
ligamentum teres
thickening of the broad ligament as it comes off the anterior surface of uterus, connecting the anterior uterine horns to the anterior abdominal wall
utero-ovarian (UO) ligament
“ovarian ligament”
connects the uterus to the ovary
uterosacral ligament
connects the back of uterus at the cervix level to the sacrum
integral to structural support of the uterus, preventing uterine prolapse into vagina
Vagina
tubular, muscular canal leading from the uterus to outside the body
top of vagina surrounds cervix
distal vagina opens to vulva and perineum
vaginal septum
congenital partition or septum of vaginal canal
longitudinal
creating a double vagina
transverse
may block menstrual flow
if incomplete, may cause dyspareunia (pain during intercourse) or obstruct vaginal delivery
Vulva (External Female Genitalia)
vulva
external structures that comprise the genitalia for females, collectively
mons pubis
pad of fat that is located on the anterior over pubic bone
becomes covered with hair in puberty
labia majora
folds of hair-covered skin that begin just posterior the mons pubis
labia minora
thinner and more pigmented
located on the inside of labia majora
clitoris
“glans clitoris”
encircled by the apex of the labia minora
originates from the same cells as the glans penis
has abundant nerves that make it important in sexual sensation, stimulation and orgasm
hymen
thin membrane located in the bottom portion of vagina
Bartholin’s glands
located on slightly inferior on either side of the vaginal introitus (opening)
secrete a fluid to lubricate the vagina
Skene’s glands
“lesser vestibular glands” or “paraurethral glands”
located on the anterior wall of vagina, near lower end of urethra
important in both urinary and sexual health
release fluids into the urethra to lubricate it
secrete mucous containing fluid when stimulated which helps lubricate vagina for intercourse
contain antimicrobial substances, which may help prevent UTI
sometimes referred to as female prostate
when aroused, there is increased blood flow resulting in swelling of Skene’s glands and clitoris
perineum
area between the legs, between the pubis symphysis and the anus
can be used for surgical access to vagina or rectum
Pregnancy
egg → zygote → blastocyst → gastrula → embryo → fetus →
zygote
travels to uterus and implants in uterine wall
divides by cleavage, to make more cells
does not grow in size
lasts 4 days
blastocyst
implants into endometrium and burrows into walls of uterus
embryo
lasts until week 8
fetus
organogenesis and formation of other germ layers takes place
placenta connects mother and fetus via umbilical cord
temporary organ
provides food and oxygen to the fetus and protects it, acting as barrier for infections experienced by mother
grows alongside fetus and is expelled after fetus is delivered
“after birth”
pregnancy is divided into 3periods
antepartum
conception → labor beginning
intrapartum
beginning of true labor → delivery of fetus
postpartum
delivery → 6 weeks
pregnancy is measured in weeks and has 3 trimesters
1st trimester
upto 14 weeks
2nd trimester
14-28 weeks
3rd trimester
28-delivery
37 weeks is considered full term, less than is pre-term
40 weeks is considered normal gestation
42+ weeks is considered post term
Gravidity and Parity
G_P_ or GTPAL
gravidity, term, preterm, abortion/miscarriage, live birth
gravidity
the number of pregnancies a woman has had
“G”
nulligravida
a woman who has never been pregnant
primigravida
a woman who is pregnant for the first time or who has been pregnant once
mutligravida or secundigravida
a woman who has been pregnant more than once
parity
the number of times a woman has given birth to a fetus more than 24 weeks gestation
can be live birth or not for parity count
“P”
Labor and Delivery
braxton hicks
practice contractions which feel very painful and real in the weeks leading up to the actual event
lightening
the sensation of feeling the fetus drop and head settle into pelvis
fetus not pressing on diaphragm anymore causes mothers to feel “lighter”
mucous plug
forms in cervix in early pregnancy to protect uterine opening
pushed into vagina when dilation begins in days leading to delivery
bloody show
increase in vaginal discharge that is clear, pink or slightly bloody
rupture of the membranes
when amniotic sac breaks
“water breaking”
a ferning test can determine if leaked fluid is amniotic
delivery should ideally occur within 24 hours to avoid amnionitis
serious in-womb infection
6 stages of vaginal birth
prelabor
engagement (head in canal)
internal rotation
crowing (head showing)
extension of head (head out)
restitution (shoulders passing)
Abortion, Miscarriage
abortion
medically is the early loss of pregnancy
“spontaneous abortion”
miscarriage
causes bleeding, cramping, and expulsion of tissue
“missed abortion”
likely didn’t know they were pregnant
fetus stops developing and expires, retained inside uterus
surgical procedure used to remove fetus
“induced abortion”
intentional or deliberate termination of pregnancy for many reasons
Placental Problems
placenta previa
when the placenta forms partially or completely toward the lower end of the uterus
sometimes will grow and move out of way
other cases require cesarean due to complete covering of the cervical os
placenta accreta
placenta digs too deep into uterine wall (without penetrating myometrium (uterine muscle) causing the placenta to not be expelled propely
leads to hemorrhage and shock
surgery needed to remove uterus is most cases
placenta increta
placenta develops in the uterine wall and penetrates myometrium (uterine muscle)
rare occurrence
usually requires cesarean section and subsequent hysterectomy
placenta pancreta
placenta latches all the way through uterine wall, maybe even growing on surrounding organs
extremely rare
requires cesarean section and subsequent hysterectomy
placental insufficiency
placenta unable to provide enough nourishment for fetus
has a variety of causes
treatments include better diet to medication
abruptio placenta
premature separation of placenta from uterine wall
obstetrical emergency
mother and fetus will hemorrhage to death
cesarean to deliver fetus and surgical intervention to stop in utero bleeding required
Ectopic and Pregnancy Loss
ectopic pregnancy
pregnancy occurring outside uterus
surgery may be necessary if body doesn’t naturally expel the tissue
blighted ovum
gestational sac that formed without an embryo within
molar pregnancy
hydatidiform mole
abnormal pregnancy with overgrowth of placenta and no viable fetus
surgery may be necessary if body doesn’t naturally expel the tissue
potentially becomes malignant, especially in cases where patient didn’t know they were pregnant
Common Conditions
gestational diabetes
diabetic symptoms caused by pregnancy
insulin receptors on cell membranes won’t let insulin in
usually resolves a few weeks after delivery
gestational hypertension
typically occurs during first pregnancy from 20 week mark to 6 weeks postpartum
can progress to preeclampsia or HELLP syndrome
hemolysis, elevated liver enzymes and low platelets syndrome
preeclampsia
formerly called toxemia
pregnancy-induced high blood pressure, accompanied by protein in the urine and swelling due to fluid retention
defined as new onset HTN of 140/90 after 20 weeks gestation
eclampsia
complication of preeclampsia
includes new onset of tonic-clonic (grand mal) seizure
toxoplasmosis
infection caused by single celled parasite (T. gondii) causing flu like symptoms including swollen lymph glands, muscle aches and pains (lasting days to weeks)
many people have had a toxoplasma infection but the immune system keeps parasite from causing illness
babies infected with toxoplasmosis before birth can be born with serious mental or physical problems
testing for antibodies or fetal testing including ultrasound and testing amniotic fluid or cord blood can be done
common ways to contract
food consumption
in many cases, while changing cat litter
chlamydia
most frequently reported bacterial infectious disease in the US
highest prevalence in 24 years and under
women experience multiple sequalae, including:
pelvic inflammatory disease (PID)
ectopic pregnancy
infertility
premature labor
rupture of the membranes
can be passed to fetus during birth causing eye inflammation or pneumonia in newborn
hepatitis
inflammation of the liver, which can cause cell damage and liver failur
most common cause of jaundice in pregnancy
most common forms are:
hepatitis A
single stranded RNA virus
most contracted through contact with contaminated feces or those with oral infections, also contracted through sexual contact
rarely transmitted intrauterine or perinatally
hepatitis B (HBV)
partially double stranded DNA virus
transmitted through intercourse, bodily fluid, blood transfusions
may be transmitted during childbirth
causing cirrhosis and hepatocellular carcinoma
hepatitis C (HCV)
partially doubled stranded plus-sense RNA virs
transmitted through parental transmission; IV drug users sharing needles, sexual contact and mother-to-child transmission
perinatal transmission is mostly during last month of pregnancy or delivery
risk for HCV increases with performing of invasive procedures (amniocentesis, chorionic villus sampling)
hepatitis D
caused by hepatitis delta virus (HDV)
single stranded, circular RNA virus
transmitted through the same routes as hep B
HIV/AIDS
human immunodeficiency virus (HIV)
kills or impairs the immune system and reduce the body’s ability to fight infections and certain cancers
mothers have a 1 in 4 chance of infecting their fetus if not on medication
advanced stage is acquired immunodeficiency syndrome (AIDS)
transmission:
sexual contact with infected partner or contact with infected blood
sharing needles, syringes and drug use equipement
maternal-fetal transmission during pregnancy, childbirth and breastfeeding (most cases reported is US)
genital herpes
caused by herpes simplex virus (HSV)
chronic infection with outbreaks
common signs and symptoms:
blisters and ulcers on the mouth
blisters and ulcers on the genital area
cesarean delivery for pregnant women with active infections as passage of the virus as fetus travels vaginal canal can cause blindness
Gynecological Conditions
endometriosis
when menstruation takes place, endometrium is not completely shed, and some tissue moves outside the uterus and reimplants (in places like the fallopian tube, ovaries, peritoneum, intestines or bladder)
this tissue follows the monthly cycle but as it as no exit route it is not expelled from body
untreated it usually causes infertility and the inability to sustain a pregnancy
symptoms:
extremely painful menstruation
bleeding between menstrual cycles
pelvic pain
adenomyosis
comparable to endometriosis except the endometrial tissue embeds itself deeper into the uterine muscle rather than escaping into the abdominal cavity
causes the uterus to enlarge with all the new tissue
responds to monthly cycle
symptoms:
severe pelvic pain
excessive bleeding
may respond to treatment but only cure is hysterectomy
genital prolapse
cystocele
happens when bladder falls into the vagina due to a weakness in the anterior vaginal wall
rectocele
happens when the rectum falls into vagina due to a weakness in the posterior vaginal wall
enterocele
happens when small intestine falls into the vagina due to weakness in the top apical portion of the vagina (the vaginal vault)
categorized by grade or degree of severity
treatments include insertion of pessary
pessary - prosthetic device that can be placed non-surgically in the vagina to support or lift prolapsed organs
if insufficient, surgical intervention may be needed
amenorrhea
loss of period
almost always related to another condition, including:
low body weight
excessive exercise
mental stress
eating problems
drugs and medications
pregnancy
hormonal imbalance
Bartholin’s gland cyst
exit from a gland gets backed up, forming these cysts
when cyst infected even walking can hurt
must be lanced, or opened and drained
cervical dysplasia
abnormal cells on a pap smear
dysmenorrhea
pain menstruation
dyspareunia
painful intercourse
leucorrhea
excessive white vaginal discharge
menopause
when menstrual cycle begins to cease
diagnosed 12 months after cycle stops
can occur anytime in 40s and 50s
ovaries making lower levels of estrogen, progesterone and testosterone
causes mood swings, hot flashes and difficulty sleeping
menorrhagia
abnormal uterine bleeding
heavier than normal
periods sometimes lasting more than 7 days
menometrorrhagia
excessive uterine bleeding, both during and between normal periods
longer lasting periods common
polycystic ovarian syndrome (PCOS)
hormonal disorder common among women of reproductive age
cause unknown
may cause irregular, prolonged periods
pt’s may have a higher level of male hormones called androgens
ovaries may develop several small follicles which may not mature properly to release eggs regularly
vaginitis
inflammation of the vagina the can result in discharge, itching and pain
etiology attributed to change in balance of vagina bacteria or infection
can be caused by reduced estrogen level in menopause or some skin conditions
most common types:
bacterial vaginosis
the result of an overgrowth of bacteria naturally found in vagina, which upsets balance
yeast infection
usually caused by naturally occurring fungus called candid albicans
trichomoniasis
caused by a parasite and is often sexually transmitted
fibroid tumors (myomas)
usually benign
tumors of the uterus
types:
intramural
within the walls of uterus
transmural
through the wall of the uterus
submucosal
reside just below the mucous lining and protrude into uterine cavity
subserosal
reside just below the serosal lining of uterus, (outer surface of uterus)
may cause excessive bleeding during mestruation and excessive pelvic pain, or affect fertility or ability to maintain pregnancy, pain during intercourse or chronic pressure felt in lower abdomen
can be treated symptomatically or with surgery
UAE
cutting into blood supply of fibroid to reduce size
Diagnostic Procedures
culdocentesis
procedure in which peritoneal fluid is obtained from the cul-de-sac of mother, using a spinal needle through the vaginal wall into the pouch of Douglas
finding blood during aspiration can indicate a ruptured ectopic pregnancy
dilatation and curettage (D&C)
cervix is dilated and the contents of the uterus is suctioned or scraped out using a a vacuum extractor or a sharp curette
common gynecological procedure
treats incomplete abortion or dysfunctional uterine bleeding
colposcopy
non-surgical procedure done to examine cervix, vagina and vulva more closely, usually following an abnormal pap smear
biopsy sample can be taken if anything concerning is found on the colposcope
hysteroscopy
procedure done to diagnose or treat uterine problems by using hysteroscope inserted through vagina to take pictures of uterus
sends pictures for further examination
might be used for:
removal of adhesions
locating an intrauterine device
determining cause of repeated miscarriage
hysterosalpingogram (HSG) or sonohysterography (saline sono)
done to evaluate the inside of the uterine cavity
HSG can also provide information regarding fallopian tubes
loop electrosurgical excision procedure (LEEP)
electrically charged, thin wire loop is inserted and used to cut away any abnormal tissue found on a pap smear
performed under local anesthesia
uterine biopsy
testing of endometrial tissue
method of evaluating:
uterine abnormalities
abnormal postmenopausal bleeding
presence of endometrial cancers or its precursors
done in an office with endometrial suction catheter
papanicolaou (Pap) test
collected cell specimens scraped from the cervix are examined under a microscope to check for abnormal, cancerous or pre-cancerous cells
can diagnose cervical intraepithelial neoplasia (CIN)
abnormal growth or premalignant cells
CIN grade I
mild dyslasia
“low-grade squamous intraepithelial lesion” (LGSIL)
CIN II
moderate dysplasia
CIN III
severe dysplasia
considered carcinoma in situ of cervix
“high-grade squamous intraepithelial lesion” (HGSIL)
human papillomavirus (HPV) test
sample from cervix is tested to determine whether HPV is present
HPV can lead to cervical cancer
cold knife conization (cone biopsy)removal of a cone or wedge of tissue from the cervix where abnormal cells were identified using pap smear
typically done in hospital
three hour GTT
follow up test for gestational diabetes performed after the mother has failed the initial glucose challenge test
done by drawing a sample of her initial fasting glucose level, then having her drink a special glucose-laden drink to draw the blood every hour for three hours to determine how her body is responding over time to the large surge of glucose
Hysterectomy Techniques
abdominal hysterectomy
uterus (or uterus and its adnexa) are removed through a 6-8 inch incision
reasons for procedure:
removal of ovaries and fallopian tubes
enlarged uterus
large fibroids
endometriosis, cancer or other diseases of the pelvic cavity
can either be vertical (laparotomy incision) or horizontal (Pfannenstiel incision) bikini cut (surgeon determines based on conditions)
vaginal hysterectomy
uterus is removed through vaginal opening
most often used when there is a vaginal prolapse or other vaginal repairs needed
not always possible due to size of removal contents
minimally invasive laparoscopic hysterectomy
the abdominal cavity is inflated with gas, and a laparoscope is used to remove the uterus through a tube or through the vagina
minimally invasive robotic hysterectomy
3-d imaging is used to visualize the uterus as a surgeon uses a robotic device with miniature instruments to excise the uterus
colporrhaphy
surgical repair of a defect in the vaginal wall (like cystocele or rectocele)
performed through the vagina from anterior or posterior
anterior
used to treat a cystocele or urethrocele
posterior
used to fix a rectocele
accomplished by making incisions into the vaginal wall, and repairs are made in the fascia with sutures, removing any excess vaginal skin
Additional Vocab
cytogenetics - study of chromosome
erythematous - redness
external os - opening from cervix to vagina
fibroma - fibrous tumor
follicle - sac in ovary that contains an immature egg or oocyte
hydatidiform mole - a clump or mass of tissue that does not develop into a fetus
hypertrophic - increase in organ size due to enlargement of cells, not number of cells
inguinal adenopathy - swelling of lymph nodes in groin
introitus - vaginal opening
menarche - start of first period
missed abortion - loss of pregnancy before 20 weeks with retained tissue
oophorectomy - removal of one or both ovaries
perineum - area between the genitals and anus
salpingectomy - removal of fallopian tubes
spontaneous abortion - miscarriage
suprapubic - above pubic bone
Abbreviations
BC - birth control
BV - bacterial vaginosis
CIN - cervical intraepithelial neoplasia
CIS - carcinoma in situ
C/S - cesarean section
DNC - dilatation and curettage (D&C)
DUB - dysfunctional uterine bleeding
ECC - endocervical curettage
FLM - fetal lung maturity
HGSIL - high grade squamous intraepithelial lesion
HSG - hysterosalpingogram
hCG - human chorionic gonadotropin
IND - incision and drainage (I&D)
IVF - in vitro fertilization
LEEP - loop electrosurgical excision procedure
LGSIL - low grade squamous intraepithelial lesion
MLP - last menstrual period
NST - nonstress testPCOS - polycystic ovarian syndrome
PID - pelvic inflammatory disease
SROM - spontaneous rupture of membranes
TAH-BSO - total abdominal hysterectomy and bilateral salpingo-oophorectomy
TOLAC - trial of labor after cesarean section
VBAC - vaginal birth after cesarean
VIN - vulvar intraepithelial neoplasia