Chapter 2 Review of Medical Terminology and Anatomy

the interior walls of the organs and tubes opening to the outside of the body such as those of the digestive, respiratory, urinary, and reproductive systems

Lined with epithelium tissue –Involved in absorption and secretion
- Composed of epithelium overlaying a layer of connective tissue called lamina propria
- In some instances, the lamina propria rests on third layer of smooth muscle
- Not every mucous membrane secretes mucus
- Serous Membrane- these line cavities, including the thoracic cavity and internal organs (eg Heart).
  - Consist of a layer of simple squamous epithelium overlaying a layer of loose connective tissue.
  - Support internal organs and compartmentalize the large cavities to hinder the spread of infection
  - Named according to their organ association
  - Lungs- Covered by pleura
  - Heart- Covered by pericardium
- Synovial Membrane- Line joint cavities
  - Composed of connective tissue
  - Secrete synovial fluid into the joint cavity, lubricates the end of the bones so they move more freely
- Meninges- Composed of three connective tissue membranes found within the dorsal cavity
  - Serve as a protective covering for the brain and spinal cord
  - Outer layer to inside – Dura Mater, Arachnoid Mater, and Pia Mater
- Cutaneous Membrane- Membrane forms outer covering of the body
  - Consists of a thin outer layer of stratified squamous epithelium attached to a thicker underlying layer of connective tissue
    - Cutaneous membrane is skin

 Connective Tissues- Support and connect tissues of the body

 Divided into four general groups

 Connective tissue proper

 Cartilage

 Bone

 Blood

 Integumentary System- largest organ system in the human body

 Comprised of three structures

 Skin

 Hair

 Nails

• These structures work together to provide

• Protection from injury, fluid loss, and micro- organisms

• Temperature regulation

• Fluid balance (excretion)

• Sensation

 Skin- made up of two layers

 Epidermis- Composed of four or five layers (depending on location) called stratum

 Stratum lucidum layer normally found on the palms of hands and soles of feet

 Varies of strata are

• Stratum Corneum- Also called the horny layer, outermost layer

• Stratum Lucidium (Palms & Soles)- Clear layer

• Stratum Granulosum- Granular layer of cells

• Contains two types of granules

 Keratchyaline Granules

 Lamellated Granules

• Stratum Spinosum- Composed of prickle cells that are interwoven for protection

• Stratum Basale (Stratum Germinatrum)- Deepest of the five layers

• Made up of basal cells

 Dermis- located deeper, just under the epidermis

 Has two strata

• Stratum Papillare- Thin superficial layer interlocked with the epidermis

• Stratum Reticulare- Thick layer of dense, irregular connective tissue

 The dermis contains many important structures nourishing and innervating the skin:

• Vessels carrying blood and lymph

• Nerves and nerve endings

• Glands

• Hair follicles

 The dermis lies on the subcutaneous (beneath the skin) tissue

 Subcutaneous Tissue- Beneath the skin

 Known as the hypodermis

 Not considered to be layer of skin

 Mostly composed of fatty(adipose) tissue, plus some areolar tissue (loose connective tissue). Consisting of a meshwork of collagen, elastic tissue and reticular fibers

 Hypodermis serves to protect the underlying structures, prevent loss of body heat, and anchor the skin to the underlying musculature

 Fibrous connective tissue (superficial Fascia) is included in this layer

Medical Terms Relating to Skin

 Allograft – A graft transplanted from one person to another who is not genetically identical; also called allogenic skin graft

 Autologous- Obtained from the patient as both the donor and recipient

 Cutaneous- Pertaining to the skin

 Dermatology- Study of skin

 Dermatologist- physician specializing in diseases of the skin and subcutaneous tissue

 Decubitus- Pressure ulcer or bedsore

 Ecchymosis-Condition in which blood seeps into the skin, causing discoloration

 Hypodermic- Pertaining to under the skin

 Intradermal- Pertaining to within the skin

 Jaundice- yellowish of skin

 Melanin- Pigment giving color to the skin

 Melanoma- Pigmented malignant tumor of the skin, the most dangerous form of skin cancer

 Pediculosis- Infestation with lice

 Percutaneous- Through the skin either by absorption or by needle puncture

 Pruritus- Severe itching

 Subcutaneous- Pertaining to below the skin

 Tinea- Ringworm (a fungal infection of skin)

 Transcutaneous- Penetrating, entering, or passing through the skin

 Trichomycosis- Fungal infection of skin

 Urticaria- Raised wheals or hives on the skin with itching

 Hair

 By 22 weeks a fetus has its lifetime supply of hair follicles

 On average, the body has 5 million follicles with the greatest concentration (approximately one million) on the head.

 Follicles are never added during life

 As the size of the body increases, density of the hair follicles on skin decreases

 Hair on the scalp grows approximately .3 to .4 mm/day or approximately 6 inches per year

 Has 2 separate structures

 Follicle

• Contains several layers

• At the base is a bulb like projection called papilla

• Capillaries nourish the bulb

• Cells in the bulb divide every 23 to 72 hours

• In sheaths end at the opening of the sebaceous gland, which secretes sebum

• It may pocket causing benign lesions on the scalp

 Report removal of these benign cyst using CPT code book 11400- 1147

• Muscles called the arrector pili attach to the outer sheath and cause hair to stand up when muscles contract

 Shaft is composed of keratin in 3 layers

• Medulla

• Cortex

• Cuticle

• Pigment cells in the cortex and medulla give hair its characteristic color

 The fingernail is made up of keratin acting as a protective plate and as a counterforce to the fingertip to increase sensory input of touch

 Nails grow all the time, slows with age and poor circulation

 Fingernails grow approximately 3 millimeters per month

 Toenails grow more slowly, at approximately one millimeter a month

 The nail is divided into 6 parts

 Root/germinal matrix- lies beneath the skin behind the fingernail and extends sever millimeters into the fingers

• Produces most of the volume of the nail and nail bed

• Its edge is the white, crescent- shaped structure called lunula

 Nailbed/ Sterile matrix- extends from the edge of the lunula to the hyponychium

• Contains blood vessels, nerves and melanocytes (melanin producing cells)

 Nail plate- the actual fingernail, made of translucent keratin

• Blood vessels underneath give the nail its pink appearance

• The grooves along the inner length of the nail plate anchor the nail to the nail bed.

 Eponychium (cuticle)- lies between the skin of the finger to the nail plate

 Perionychium/paronychial edge- the skin is overlying the nail plate on its sides and is the site of hangnails, ingrown nails, and infection of the skin called paronychia

 Hyponychium- junction between the free edge of the nail and the skin

Medical Terms related to hair and nails

 CPT codes in the 10000 range address procedures and services relative to the integumentary system.

 Alopecia- Loss of hair

 Follicles- Specialized structures required for skin growth

 Hair follicles- Sacs holding the root of hair fibers

 Hair Papilla- knoblike indentation at the bottom of the hair follicle containing the blood supply to hair root

 Lunula- Little moon area of the nail

 Nail Body- Visible part of the nail

 Onychitis- inflammation of the nail matrix

 Musculoskeletal System-system of muscles, joints, tendons, and ligaments

 Provides movement, form, strength, and protection

 Various muscle and bone types work together in this body system

 Bones- Composed of ridged connective tissue and provide the following functions:

 Form the skeleton

 Provide the chief means of support for the body

 Provide the mechanism for motion

 Protect vital organs

 Serve as a production factory for blood cells (example: marrow)

 Store calcium, phosphorus, and magnesium salts

 Bones are classified according to shape

 Long- Bones longer than they are wide and found in the limbs (femur & humorous)

 these bones are named for their elongated shape, not their size

 Tubular- Long bones

 Short – Roughly cube shaped bones such as carpal bones of the wrist and tarsal bones of the ankle

 Sesamoid- A short bone (shaped like a sesame seed) formed within tendons, cartilaginous in early life and osseous (bony) in adults.

 Patella is the largest sesamoid bone in the body

 Cuboidal- Short bones

 Flat- Consists of a layer of spongy bone between two thin layers of compact bone; cross section is flat, not rounded

 Flat bones have marrow but lack of a bone marrow cavity

 Examples: skull and ribs

 Irregular- These are bones in the body not fitting into the above categories mentioned; several are found in the face, such as the zygoma and mandible

 Vertebrae are irregular bones

 Cartilage- Type of flexible connective tissue that is nonvascular (has no blood vessels)

 Matrix made of chondrocyte, collagen, and glycosylated protein proteoglycans

 Depending on the type of cartilage

 Joints/articulating surfaces-synonymous and provide a connection between two or more parts of the skeleton

 Joints are classified according to the type of connective tissue at the articulating surfaces

 There are 3 types of joints

 Fibrous

 Cartilaginous

 Synovial

 Most joints are synovial and have the following characteristics:

 Articular Cartilage that covers bone ends

 Joint cavity lined with a synovial membrane, which secretes a thick, viscid, slippery mucous that cushions the joint and allow smooth motion

 Joint capsule of fibrous connective tissue that surrounds and provides stability of the joint

 Accessory ligaments that give reinforcement

 The human skeleton is divided into 2 parts

 Axial skeleton

 Includes skull, hyoid, ribs, sternum, vertebrae, and sacrum

 Appendicular skeleton

 Includes shoulder girdle, pelvic girdle, extremities

 Common Bone Fractures

 Understanding the type of fracture is essential to proper diagnosis and procedure coding

 An example of this can be seen when coding a compound fracture

• Compound fracture is coded as an open fracture

 Closed fracture- Does not involve a break in the skin

 Compound fracture- Projects through the skin with a possibility of infection

 Comminuted fracture-More than 2 separate bone components (fragments)

 Transverse fracture-Breaks shaft of a bone along longitudinal axis

 Greenstick fracture- Only one side of shaft is broken and other is bent, common in children

 Spiral fracture- Spread along the length of bone and produced by twisting stress

 Colles’ fracture- Occurs in wrist and affects the distal radius bone

 Compression fracture- Vertebrae collapse due to trauma, tumor, or osteoporosis

 Epiphyseal fracture- Occurs when matrix is calcifying, and chondrocytes are dying; usually seen in children

 Muscles- Have property of contractability

 Provide form and produces heat for the body

 There are 3 types of muscles

 Skeletal muscle – Also called straited muscle and is attached to the skeleton by tendons, contraction of skeletal muscle is under voluntary control

 Cardiac muscle- Also called heart muscle, and contains interlocking involuntary straited muscle, which allows the electrical impulses to pass quickly across the muscle fibers.

 Smooth muscle- Found in the walls of all the hollow organs of the body (except the heart) its contraction reduces the size of these structures, movement generally is involuntary (not under voluntary control)

 Medical terms related to Musculoskeletal system

 In CPT, the section containing 20000 code series pertaining to the musculoskeletal system, and is arranged by anatomical regions and structures

 Ankylosis- Condition of stiffening joint

 Arthralgia- Pain in joint

 Arthritis- Inflammation of joint

 Arthrodesis- Surgical fixation of a joint

 Arthropathy- Joint disease

 Bursitis- inflammation of bursa

 Carpal- Pertaining to the wrist bones

 Chondral- Pertaining to cartilage

 Chondralgia- Pain around and in the cartilage

 Coccygeal- Pertaining to the coccyx

 Connective- Tissue connecting or binding tissue

 Dactylic- Pertaining to finger or toe

 Femoral- Pertaining to femur (thighbone)

 Illiac- Pertaining to the illum

 Kyphosis- Abnormal curvature of thoracic spine (humpback)

 Lordosis- Abnormal anterior curvature of spine, usually lumbar (swayback or hollow back)

 Metacarpal- Long bones of the hand that form the skeletal structure of the palm

 Osteoblast- Bone forming cell

 Osteocarcinoma- Cancerous tumor of bone

 Osteochondritis- Inflammation of bone and cartilage

 Osteopenia- Lower than average bone density, can be a precursor to osteoporosis

 Osteoporosis- Condition resulting in redirection of bone mass

 Osteorrhapy- Suture of bone

 Patellar- Pertaining to patella

 Phalanges- Bone of fingers and toes

 Scoliosis- Lateral curvature of spine

 Sternotomy- Surgical incision of sternum

 Tarsal- pertaining to the tarsal bones in the foot

 Tendonitis- Inflammation of tendons

 Cardiovascular System- System composed of the heart and the blood vessels, working together to move blood throughout the body

 Blood provides nutrients and oxygen to all organs and tissues within the body

 There are three types of blood vessels

 Arteries- Carry blood away from the heart

• All arteries leaving the heart carry oxygenated blood except pulmonary arteries

• Pulmonary arteries carry deoxygenated blood from the right side of the heart to the lungs

• Arteries get smaller as they go into the extremities, turning into arterioles, and eventually comprising the arterial side of capillary bed.

• The venous side of the circulation begins in the venous side of the capillary bed, enlarging to form venules and eventually forming veins.

 Veins- Take deoxygenated blood back to the heart, except for pulmonary veins

• Pulmonary veins carry oxygenated blood from the lungs through pulmonary veins to the left side of the heart

• Most veins bring deoxygenated blood, which is dark red in color, back to the heart

 Capillaries- Tiny vessels, usually a single cell layer thick

• Semi permeable and facilitate the exchange of fluids, oxygen, nutrients, and waste between local tissues and the blood stream

 The heart is approximately the size of the human fist, and usually weighs less than one pound

 The heart pumps blood to two distinct systems for circulation (pulmonary & systemic)

 Pulmonary circulation- Receiving deoxygenated blood into the right atrium from the superior and inferior vena cava.

• Blood then flows into the right ventricle and is pushed into pulmonary circulation via pulmonary trunk, which divides into the right and left pulmonary arteries

• Blood circulates through the pulmonary vascular tree in the lungs and into the left atrium of the heart through the right and left pulmonary veins

• The left side of the heart pumps oxygenated blood to the systemic circulation system via the left ventricle to the aorta

• The left side of the heart is responsible for pumping blood throughout the entire body, the muscles surrounding the left ventricle is stronger and larger than the muscle of the right ventricle

 Blood Flow List

 Right side of the heart

 Veins deliver deoxygenated blood into the superior and inferior vena cava

 This blood empties into the right atrium. As the right atrium contracts, blood flows from right atrium into the right ventricle through the open tricuspid valve

 When the right ventricle is full, the tricuspid valve closes, preventing blood from flowing backward into the right atrium

 As the right ventricle contracts, blood leaves the heart through the pulmonic (pulmonary) valve, and flows into the pulmonary artery, which bifurcates into the right and left pulmonary arteries and into the lungs where it is oxygenated. This oxygenated blood then returns to the heart through the pulmonary veins.

 Left side of the heart

 The pulmonary veins take oxygen-rich blood from the lungs into the left atrium

 As the left atrium contracts, blood flows into the left ventricle through the open mitral (bicuspid) valve.

 When the left ventricle is full, the mitral valve closes preventing blood from flowing backward into the left atrium

 As the left ventricle contracts, oxygenated blood leaves the heart through the aortic valve and flows into the aorta to supply the body, and into the coronary arteries to supply the heart.

 The heart is composed of three layers and enclosed in double wall lining called the pericardium sac.

 Epicardium- The outer layer of the heart

 Myocardium- Main muscle of the heart

 Myocardial tissue allows electrical impulses to pass quickly across muscle fibers as part of the heart’s unique electrical conduction system

 Endocardium – Inner lining of the heart

 Pericardium sac- Prevents the heart from rubbing against other organs or body structures as it beats.

 Medical Terms Related to the cardiovascular System

 Understanding standard medical abbreviations used in medical records documentation. In the cardiovascular section, physicians often dictate using medical abbreviations to indicate the artery or vein involved.

 CPT codes 33016-37799 address surgical procedures to the cardiovascular system

 CPT codes 92930-92979 address therapeutic services and procedures to the cardiovascular system

 Angina- Relating to spasmodic attacks of suffocating pain as related to an inflammatory condition of the throat or mouth or angina pectoris. This is marked by chest pain due to deficient oxygenation of the heart muscle

 Angiocarditis- Inflammation of heart and vessels

 Angioplasty- Surgical repair of vessels

 Arteriotomy- Incision into an artery

 Atherosclerosis- A type of arteriosclerosis characterized by lipid deposits causing fibrosis and calcification

 Bradycardia- Slow heartbeat

 Cardiocentesis- Surgical puncture of the heart

 Cardiologist- a physician specializing in diseases of the heart

 Cardiomegaly- Enlargement of the heart

 Cardiopulmonary- Pertaining to heart and lungs

 Carditis- Inflammation of the heart

 Cyanosis- Bluing of skin and mucous membranes caused by oxygen deficiency

 Diastole- Relaxation of the heart allowing blood to refill the heart chambers

 Electrocardiogram- Electrical tracing of the heart and heart muscle activity ‘

 Embolism- Blood clot traveling through a blood vessel to another part of the body

 Hemangioma- Benign tumor of a blood vessel

 Hypertension- Persistent excessive pressure in the arteries

 Pacemaker- A system that uses low – energy electronic pulses to control the heart rhythm

 Pericarditis- Inflammation of the pericardium

 Systole- Contraction of the heart

 Thrombus- Contraction of the heart

 Transluminal- Passing through a tubular organ or part such as the lumen of a blood vessel

 Lymphatic System- Comprised of lymph vessels and lymph nodes

 Collects excess fluid from the interstitial spaces (Potential spaces between tissues) and returns it to the heart

 The venous end of the lymph capillaries reabsorbs fluid pushed from arterial capillaries into the interstitial space; the lymph picks up excess fluid

 The system operates without a pump using a series of valves to ensure fluid travels in one direction, back to the heart

 Lymphatic organs scattered throughout the body house phagocytic cells and lymphocytes essential to the body’s defense system, and its resistance to disease

 Lymphatic organs include spleen, thymus, tonsils, Peyer’s patches of the intestine, and the appendix

 Lymphatic vessels are similar to the structure of blood vessels.

 Lymphatic capillaries are closed at one end.

 After lymph fluid is picked up it is circulated to increasingly larger lymph vessels called lymphatics.

 Lymphatic empty into either the right lymphatic duct or the thoracic duct

 Both of which are located in the thoracic cavity

 The right lymphatic duct collects lymph fluid from the right arm, right side of the head and right side of the thorax

 The thoracic duct collects lymph from the rest of the body

• For the body to maintain an appropriate volume of circulating blood, it is necessary to put fluid back into the main system of circulation

 Both lymphatic ducts empty their contents into the right subclavian vein and the thoracic duct empties into the left subclavian vein.

 Spleen- An organ of the lymphatic system in the left upper abdomen that filters and destroys red blood cells that are no long efficient

 Serves as a blood forming organ early in life, and later a storage unit for extra red blood cells (RBCs) and platelets.

 Thymus- Soft organ located behind the sternum and between the lungs

 has two identical lobes that lie almost on top of the heart and trace up along the trachea

 prominent in newborns and continues to increase in size during the first years of life

• after puberty the thymus atrophies gradually

 Thymus is responsible for T- lymphocyte maturation, enabling these cells to function against specific pathogens in the immune system

 Tonsils-partially encapsulated lymphoid tissue located in the throat.

 Simplest lymphoid organ

 Named according to location

• Palatine tonsils, lingual tonsils, and pharyngeal tonsils (referred to as adenoids), if enlarged

 Peyer’s Patches- Found in the lining of the intestine and help protect against invading microorganisms

 Appendix- Finger-like projection of tissue attached to the cecum

 First part of the large intestine

 Medical Terms Related to the Lymphatic System

 CPT codes 38100-38999 addresses the surgical procedures for the hemic and lymphatic systems

 Lymphadenitis- Inflammation and enlargement of lymph nodes, usually as a result of infection

 Lymphangitis- Inflammation of lymphatic vessels as a result of bacterial infection

 Lymphedema- Swelling of tissue with lymph caused by obstruction or excision of lymphatic vessels

 Sentinel node-The first few lymph nodes into which a tumor drains, and cancer cells can likely spread from a primary tumor

 Thymitis- Thymus gland inflammation

 Respiratory system (Pulmonary system)- System that includes the nose, nasal cavity, pharynx, larynx, trachea, bronchi, and their smaller branches, lungs, and alveoli

 Functions to exchange carbon dioxide for oxygen

 Air inspired through nose and mouth passes to the lungs through a series of branching airways known as bronchial tree

 This series of structures connects to the lungs outside air containing oxygen

 Nose- Provides an airway to breathe (moistening, warming, and filtering inspired air), serves as a resonating chamber for speech, and houses smell receptors

 Pharynx- Divided into 3 regions: nasopharynx (air passageway), oropharynx (air and food passageway), and laryngopharynx (air and food passageway)

 Larynx- Is the voice box. In addition to voice production, it helps to provide an open(patent) airway and acts as a switching mechanism to route air and food into proper channels

 Trachea-Mediastinal region and splits into two bronchi (at the carina) that enters the lungs. There are three lobes in the right lung and two lobes in the left lung. The epiglottis is a loose flap at the top of the trachea that flips over to close the trachea when a person swallow

 Bronchi- at the smallest branch of the bronchial tree airways are known as bronchioles. Each of these bronchioles narrow further until they end in a tiny pouch called an alveolar sac. Gases are exchanged across the single layer of tissue comprising the alveolar sac into the pulmonary circulation. Capillaries from the pulmonary circulation are also a single cell layer thick. They form a bed around each alveolus; and gas is exchanged between the alveolus and the capillaries via diffusion (molecules flow from levels of higher concentration to lower concentration)

 Medical Terms Related to Respiratory System

 ARDS (Acute respiratory distress syndrome)- Pulmonary edema that can rapidly lead to death

 Bronchiolitis- Inflammation of the bronchioles

 Bronchoscope- Instrument uses to examine the bronchi

 Carina- A projection of the lowest tracheal cartilage where the trachea separates into two bronchi. Used as a landmark for endoscopy(bronchoscopy). The carina is the most sensitive area of the trachea and larynx for triggering a cough reflex.

 COPD (chronic obstructive pulmonary disease)- Any group of chronic, progressive, and debilitative respiratory diseases (emphysema, bronchitis, etc.)

 Dyspnea- Difficulty breathing

 Endotracheal tube- A tube placed through the mouth into the trachea to help a patient breath

 Hemothorax- Presence of blood in plural space

 Hyperpnea- Abnormally rapid or deep breathing

 Lobectomy- Surgical excision of a lobe of the lung

 Orthopnea- Difficulty breathing unless upright or in a straight position

 Pneumothorax- Collection of air in the chest or pleural cavity

 Rales (crackles)- Abnormal chest sounds heard when air enters small airways or alveoli containing fluid typically during inspiration

 Rhonchus- Rale or rattling sound in throat or bronchial tube caused by obstructed or inflamed bronchi

 Tachypnea- Fast or rapid breathing

 Thoracoscopy- Examination of plural cavity through an endoscope

 Thoracotomy- Incision into the chest wall

 Thoracentesis- Removal of fluid from the pleural cavity via surgical puncture; pleural tap

 Tuberculosis- A highly contagious, chronic bacterial infection usually infecting the lungs

 Wheeze- Whistling sound usually caused by air passageway obstruction, common in asthmatics.

 Digestive System- The gastrointestinal tract, GI tract, and its ancillary organs make up the digestive system

 the GI tract begins in the mouth and ends in the anus

 this continuous structure winds through several body cavities and encompasses a multitude of structures and organs

 mechanically and chemically breaks down food minuscule or molecular size for absorption into the blood stream and use at cellular level

 food enters the digestive system via the mouth.

• Teeth and tongue mechanically break food into small particles to provide greater exposure/surface area for the chemical processes that follow

• Chewing is called mastication

• Salivary glands surround the mouth and secrete saliva, which comprised primarily of water, mucus, electrolytes, and salivary amylase

• Saliva aids in the early phases of chemical digestion and liquefaction of food

 Food is swallowed, and peristalsis in the esophagus moves food through the upper thoracic cavity into the stomach

 Stomach-

 Cardiac Orifice- Opening to the stomach

 Fundus- Rounded upper portion, above the body of the stomach

 Body of stomach- Main portion of stomach

 Pyloric antrum- Lower portion of stomach

 Pyloric sphincter- Leads to the duodenum

 Food moves through the stomach into the small intestine, which is divided into 3 sections

 Duodenum- First section of the small intestine

 Jejunum- Second section of the small intestine

 Ilium- Distal portion of the small intestine

• Not be confused with ilium the bone

 Large Intestine- Begins just after the ileocecal valve at the cecum, with the appendix attached at the bottom

 There are four portions of the colon

 Ascending- Proceeds from the ileocecal valve upward to the hepatic flexure on the right side of the abdomen becoming the transverse

 Transverse- turns to the descending

 Descending- Gives way to the sigmoid colon and ends at the rectum

 Sigmoid/ Pelvic colon

• The internal and external Anal sphincters at the terminus of the rectum control the flow of fecal material leaving the body

 Ancillary organs- They are the pancreas, liver, and gallbladder

 are also part of the digestive system because the chemicals they produce are necessary for chemical breakdown of food

 Digestive (or exocrine) pancreas make digestive enzymes that are secreted into the intestines to help break down food

 The liver filters blood and makes bile

 The gallbladder stores bile produced in the liver

 Bile secreted into the intestines from the gallbladder helps to break down fat

 Medical Terminology Related to the Digestive System

 CPT 40490-49999 codes series address surgical procedures of the digestive system

 Aphagia-Inability to swallow

 Bariatric- Pertaining to the prevention and control of obesity

 Biliary- Pertaining to bile

 Buccal- Pertaining to the cheek

 Cholecystectomy- Surgical excision of the gallbladder

 Cholecystitis- Inflammation of gallbladder

 Colectomy- Excision of part of the colon

 Colonoscopy- Examination of the colon and may include examination of the terminal ileum with an endoscope

 Diverticulosis- Inflammation of one or more diverticulum

 Diverticulum- Small pouches that protrude from the walls of a hollow organ or structure. Diverticula means more than one diverticulum. They are most common in the lower portion of the large intestine and increasingly common with age

 Dysphagia- Difficulty in swallowing

 Epigastric- Region above the stomach

 Esophageal- Pertaining to the esophagus

 Gastralgia- Pain in the stomach

 Gastroenterologist- Physician specializing in the gastrointestinal system

 Hematemesis- Vomiting blood

 Herniotomy- Incision into a hernia

 Ileostomy- Creating an opening through the abdominal wall into the ileum

 Laparotomy- Surgical incision into the abdomen

 Pancreatitis- Inflammation of pancreas

 Pharyngeal- Pertaining to pharynx

 Rectocele- Herniation of the rectum into the vagina

 Sigmoidoscope- Instrument used to view the sigmoid

 Sphincter- A muscular ring around a lumen, or hollow structure

 Splenomegaly-Enlarged spleen

 Splenorrhaphy-Repair of the spleen

 Stomatitis- Inflammation of the mucous membrane of the mouth

 Sublingual-Below or beneath the tongue

 Synonym-Hypoglossal

 Transoral-Through the mouth

 Warthin’s tumor- A tumor found in the salivary gland

 Urinary System-Produces urine for excretion of metabolic wastes and fluid and electrolyte balance and provides transportation and temporary storage of urine prior to the intermittent process of urination

 Key structure of the urinary system include:

 Kidneys-Located in the low back region and regulate waste and electrolyte balance

• Also secretes hormones giving it endocrine function as well

 Ureters- Tubes to propel urine form kidneys to urinary bladder

 Urinary bladder- Hollow elastic organ on pelvic floor that holds urine for disposal through urethra

 Urethra- Allows for urination evacuation/ejaculation in males

• Male and female urethras differ anatomically in position and length however they perform similar functions and are treated similarly for many surgical procedures

• Patients with End Stage Renal Disease (ESRD) may need dialysis for removal of waste and electrolyte balance assistance

 Medical Terms Related to the Urinary System

 CPT codes dealing with the urinary system are found primarily in the 50010-53899

 Albuminuria- Presence of serum protein in the urine

 Bacteriuria- Bacteria in urine

 Chronic Kidney Disease (CKD)- A chronic disease in which the kidneys’ ability to filter waste from the blood declines slowly

 Cystectomy-Excision of the bladder or part of the bladder; removal of cyst

 Cystitis- Inflammation of bladder

 Cystocele- Hernia of the bladder protruding into the vagina

 Cystolithectomy-Excision of a stone from the bladder

 Cystopexy- Surgical fixation of the bladder to the 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, electrolytes, and acid-base balance in impaired kidney function or in the absence of a kidney

 Dysuria- Difficult or painful urination

 Hematuria- Blood in urine

 Hydronephrosis- Condition in which urine collects in the renal pelvis due to obstructed outflow, results in dilation of the renal pelvis and calices

 Incontinence- Inability to hold urine

 Nephrectomy- Excision of a kidney

 Nephritis- Inflammation of a kidney

 Nephrologist- A physician treating disease of the kidney

 Nephropathy- Disease of the kidney

 Nephrosclerosis- Hardening or sclerosis of the kidney

 Polyuria- Excessive urination, profuse micturition

 Pyelocystitis- Inflammation of the kidney or renal pelvis

 Pyelonephritis- Inflammation of the kidney or renal pelvis

 Pyuria- Pus in urine

 Uremia- Excess urea and other nitrogenous waste in blood

 Ureteroplasty- Surgical repair of the ureter

 Urinalysis-Examination of the urine to detect abnormalities by various diagnostic methods

 Urologist-A physician treating diseases of the urinary system

 Reproductive System- The organs of the reproductive system differ greatly between male and female, however functions are similar

 Each produce a 23- chromosome gamete

 Males produce sperm

 Females produce eggs

 Reproduction is achieved when two gametes, one egg and one sperm, unite and form a zygote.

 The female also houses, feeds, and protects the growing fetus through the gestational period

 Both male and female reproductive organs include external and internal genitalia

 Male External genitalia include the testis, epididymis, scrotum, and penis

 Male internal genitalia include the prostate gland, seminal vesicles, and Cowper’s glands, a system of tubes and ducts that the sperm travel through to leave the body comprised of the vas deferens, ejaculatory duct, and urethra

 Female external genitalia include uvula, labia majora and minora, clitoris, external opening of the vagina (also called the intrioitus), opening to the urethra or urinary meatus , skene’s glands (found on either side of the urinary meatus), and Bartholin’s glands( found on either side of the introitus).

 Female Internal genitalia include vagina, uterus, two fallopian tubes, and two ovaries.

 Medical Terms Related to the Male/Female Reproductive System

 CPT codes for male and female reproductive genitourinary systems can be found in the 54000-58999 range. Maternity care and delivery can be found in the 59000-59899 range

 Amenorrhea- Absence of menstruation

 Amniocentesis- Surgical puncture of the amniotic sac to obtain a sample of amniotic fluid

 Antepartum-Time period during pregnancy before childbirth

 Colporrhaphy-Suture or repair of the vaginal wall

 Dysmenorrhea- Painful or difficult menstruation

 Endometriosis- Condition in which the endometrial tissue is found outside of the uterus, such as in the abdominal or pelvic cavity

 Epispadias- Congenital defect in which the urethra opens on the upper aspect (dorsum) of the penis

 External os- The opening from the cervix into the vagina

 Fibroma- Fibrous tumor, called a myoma, fibroid or leiomyoma

 Genitalia- Male or female reproductive organs, internal and external

 Gynecologist- a physician specializing in the study of the female reproductive system

 Hysterotomy- Surgical incision into the uterus

 Hypospadias- congenital defect in which the urethra opens on the underside of the penis or on the perineum

 Mammography- A graphic recording of the breast, using x-ray technology

 Mastectomy- Surgical excision of the breast

 Menorrhagia- Excessive blood flow during menstruation

 Menorrhea- Normal menstruation

 Myometritis- Inflammation of the muscular wall (myometrium) of the uterus

 Oophorectomy- Surgical excision of one or both ovaries

 Orchiectomy- Surgical excision of a testicle

 Postpartum- Period after childbirth

 Salpingectomy- Surgical excision of fallopian tube(s)

 Prostatalgia-Pain in the prostate

 Trimester- period of three months, in pregnancy, there are first, second, and third trimesters

 Vaginitis- Inflammation of the vagina

 Vasectomy- excision of the vas deferens surgically

 Nervous system- An enormous network of nerve fibers traversing the human body.

 Composed of central and peripheral portions

 Central Nervous System (CNS)- The brain and spinal cord

• the command center

 Peripheral Nervous System (PNS)- The cranial & spinal nerves

• Serves as the communication lines linking all parts of the body to the CNS

 The nervous system functions as both the central operator and central intelligence for the body

 Regulates body functions and provides an internal method of communication between the brain and other organs, and between the organism and the environment (for instance it sends signals from the finger to the brain when a hot, cold, or sharp object is encountered)

 The brain regulates the subconscious body functions such as respiratory rate, body temperature, and peristalsis of the intestines

 Medical terms related to the Nervous System

 Procedures of the nervous system are found primarily in the 60000 range of the CPT codes 61000-64999

 Amnesia- Loss of memory

 Ataxia- Loss of muscular coordination

 Bradykinesia- Abnormal or slowness of motion

 Cephalgia/Cephalalgia- Headache

 Cerebrospinal- Pertaining to the brain and spinal cord

 Craniotomy- Surgical opening in the skull

 Discectomy- Surgical excision of an intervertebral disc

 Dysphasia- Impairment of speech (syn. -aphasia)

 Encephalomalacia- Softening of the brain often due to ischemia or infraction

 Epidural- Pertaining to above or outside the dura mater

 Epilepsy- A brain disorder characterized by electrical- disturbances resulting in seizures

 Hemiparesis- Paralysis on one side of the body

 Intracranial- Within the skull

 Intrathecal administration- Injection into the spinal cord, or into the subarachnoid space

 Laminectomy- Excision of the vertebral posterior arch or spinal process

 Meningitis- Inflammation of the meninges or the membranes covering the spinal cord or brain

 Myelitis- Inflammation of the spinal cord

 Neuralgia- Serve or stabbing pain in the course of distribution

 Neuritis- Inflammation of a nerve

 Neurologist- Physician who specializes in diagnosis and treatment of disorders of the nervous system

 Neurolysis- Destruction of nerve tissue or lysis (breaking up) perineural adhesions

 Neurorrhaphy- Repair of several nerve by suture, graft or with synthetic conduit

 Neurosis- Emotional condition or disorder, anxiety is a primary cause

 Neurotransmitters- A chemical that transmits energy across a synapse

 Paranoia- A mental disorder, often includes delusions involving persecution

 Poliomyelitis- Inflammation of gray matter of the spinal cord

 Psychosis- An abnormal condition of the mind, gross disorganizations, or distortion of mental capacity

 Quadriplegia- Paralysis of all four extremities

 Radiculitis- Inflammation of the spinal nerve roots

 Sciatica- Severe pain along the sciatic nerve, usually unilateral based on the nerve root affected

 Subdural- Below the dura mater

 Vagotomy- Surgical incision of the vagus nerve

 Organs of sense

 Organs of sense are classified as subsection in the nervous system because they coalesce in nerve endings called sensory receptors

 Sensory organs receive and filter sensory input interpreted in the central nervous system

 The eye, the sense organ of sight, is a complex structure situated in the bony orbit or socket formed by seven bones: frontal, maxillary, sphenoid, lacrimal, malar, ethmoid, and palatine

 The eyeball has 3 layers

• Retina (innermost)

• Choroid (middle)

• Sclera (outermost)

 The eyeball is also separated into

• Crystalline lens separates the 2 segments

• Anterior segment- filled with aqueous humor

• Has 2 chambers (anterior and Posterior chamber)

• The aqueous humor is a watery substance filling the anterior and posterior chambers

 Responsible for intraocular pressure

• Posterior segment- filled with vitreous humor

• Vitreous- A clear gel- like substance filling the posterior segment of the eye

 Responsible for intraocular pressure and prevents the eyeball from collapsing

• The retina is part of the posterior segment serving as a light receptor.

• The optic nerve (sensory receptor for the eye) emerges in the posterior segment in the posterior – most region and is know as optic disk/ blind spot

• There are many adnexal and accessory structures in the eye – eyelids, eyelashes, and the lacrimal system

• Six ocular muscles – working in opposition to move the eye in multiple directions to facilitate a wide field of vision

 Common Medical Terms for the Eye Ophthalmology has its own vocabulary and is a very specialized field of medicine & coding. There are 2 types of services pertaining to eye vision services and surgical services. Vision services are found in the 92002-92499 range of CPT codes. Surgical services on the eye are found in 65091-68899 range of CPT codes.

 Amblyopia- Lazy eye causing dullness of vision

 Ametropia- Defect in the refractive power

 Aphakia- Absence of lens of the eye

 Astigmatism- Due to an abnormal curve of the cornea, rays of light do not focus on the retina, but are spread over area causing out of focus vision

 Blepharitis- An inflammation of the edges of the eyelids

 Cataract- Opacity of the lens of the eye

 Conjunctiva- A mucous membrane that covers the outer surface of the eye and lines the inside of the eyelids

 Corneal- Pertaining to the cornea

 Cycloplegia-Ciliary muscle paralysis

 Diplopia- Double vision

 Ectropion- Turning outward (eyelid)

 Entropion- Turning inward (eyelid)

 Glaucoma- Disease of the eye characterized by increased intraocular pressure

 Intraocular- Within the eye

 Keratitis- Inflammation of the cornea

 Lacrimal- Relating to tears or to the glands that secrete tears

 Ocular- pertaining to the eye

 Ophthalmologist- Physician specializing in diagnosis and treatment of disease of the eye

 Ophthalmoscope- An instrument used to examine the interior portion of the eye

 Presbyopia- Farsightedness associated with aging and progressive disease

 Retinopathy- non-inflammatory degenerative disease of the retina

 Tonometer- Instrument to measure intraocular pressure

 Trichiasis- Ingrown eyelashes; can rub against the cornea irritating the eye

 Organs of sense – Ear

 The ear works in tandem with the auditory nerves sending auditory nerves sending auditory impulses to the temporal lobes of the cerebrum

 These structures working together form the auditory apparatus

 The ear has 3 distinct anatomical divisions: the outer ear (external ear) middle ear (tympanic cavity) and inner ear (labyrinth)

 The auditory apparatus uses the ear to capture sound waves and transmits or conducts them into the thin hair cells in the organ of corti.

 Dendrites (nerve endings) of the sensory neurons for hearing are in the bottom of those tiny hair cells

 Ostology (study of the ear) is a specialized field of medicine and coding

 There are 2 types of services pertaining to the ear: auditory services (hearing testing) and surgical services

 surgical services on the ear are found in the 69000-69979 range of CPT codes.

 Special otorhinolaryngologic services are found in the 92502- 92700.

 The rage 92601-92604 is used to report diagnostic analysis of cochlear implants.

 Medical terms for the Ear

 Audiology- Study of hearing disorders

 Auricle-External Ear

 Labyrinthitis- Inflammation of the labyrinth

 Myringoplasty- Repair of tympanic membrane

 Ossicles- Three small bones in the middle ear known as the malleus, incus, and stapes

 Otolaryngologist- Physician specializing in diagnosis and treatment of diseases of ear and larynx

 Otologist- Physician specializing in diagnosis and treatment of diseases of ear

 Otopyorrhea- Pus draining from the ear

 Otoscope- Instrument used to examine the ear and ear drum

 Tinnitus-Ringing in the ear

 Vertigo- Feeling you and your environment is moving or spinning caused by a disturbance of equilibrium in the labyrinth

 Endocrine System- comprised of glands.

 Gland- A group of cells that secrete chemicals called hormones

 Found throughout the body, secretes hormones that affect tissues other than themselves

 The endocrine system and nervous system work together, they form a system of internal communication for the human bodya

 Each gland and its associated hormones have a unique cause and effect

 Endocrine glands- Ductless and secrete hormones directly into the blood stream

 Exocrine glands- Have ducts

 Gland found in the endocrine system are:

• Adrenal glands- These ductless, pyramid- shaped glands are situated on the top of the superior end of each kidney. There are two structural parts of the adrenal gland

• Each structure performs a separate function

 The inner portion is called the medulla

• Secretes epinephrine and norepinephrine

 The outer portion is called the cortex

 Secretes several steroids (glucocorticoids, mineral corticoids and adrenal estrogens, and androgens)

 Carotid body- This structure is made up of epithelial- like cells located on each side of the body at the bifurcation(division) of the common carotid artery. This vascular/sinusoidal bed and a large network of nerve fibers from the glossopharyngeal nerve. This configuration works together to measure concentration of oxygen, carbon dioxide, and free respiration and pH balance. Although not a true endocrine structure, it is made of both glandular and nongranular cells. Procedures on this structure are included in the endocrine family CPT codes.

 Pancreas- A structure that is also important in the function of the digestive system as a exocrine gland but is also an endocrine structure controlling blood sugar levels with the hormones insulin and glucagon

 Parathyroid gland- Small round bodies located on the posterior side of the thyroid gland and imbedded in the connective tissue surrounding it. The number of these bodies varies, but usually there are four. These glands regulate calcium and phosphorus and metabolism

 Pituitary gland- Also called the hypophysis cerebri, this single (unpaired)gland has two separate parts located in an area of the brain just under hypothalamus.

• Posterior pituitary/ neurohypophysis- Secretes oxytocin, a hormone responsible for uterine contractions and let down reflex of milk in response to a baby’s suckling, and vasopressin, and antidiuretic.

• Anterior pituitary- Manufactures adrenocorticotrophic hormone (ACTH), thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH), growth hormone(somatotropin or GH), melanocyte stimulating hormone(MSH), and prolactin(PRL)

 Thymus gland- This gland is composed of lymphoid tissue and located in the mediastinum of the chest. The precise functions of this gland are not entirely known.

• Helps regulate humoral (circulating defenses verus cellular defenses) immune functions.

• Does much of its work in early childhood and is largest shortly after childbirth. By puberty, its small and maybe replaced by fat

 Thyroid Gland-This gland regulates metabolism and serum calcium levels through the secretion of thyroid hormone and calcitonin, respectively. This bilobed, ductless gland is in the neck just below the thyroid cartilage in the trachea. The two lobes sit on either side of the trachea and are joined by a small band of tissue called isthmus.

 Common Terms in the Endocrine System

• the CPT 60000-60699 codes address surgical procedures of the endocrine system

 Adam’s apple- Thyroid cartilage that contains the vocal cords and can protrude out of the front of the neck

 Diabetes- Disorder of glucose metabolism; type 1 is caused by the pancreas’ failure to produce insulin and type 2 is caused by resistance to insulin

 Endocrinologist- Physician specializing in diagnosis and treatment of diseases of endocrine system

 Euthyroid- Normal thyroid gland activity

 Glandular- Pertaining to a gland

 Hyperkalemia- Excessive potassium in the blood

 Hyperthyroidism- Excessive secretion of the thyroid hormone

 Hypothyroidism-Deficient secretion of the thyroid hormone

 Insulin- Hormone secreted by the beta cells in the islets of Langerhans of the pancreas, which regulates energy and glucose metabolism. Also used in the management of diabetes.

 Parathyroid- Glands located behind the thyroid gland

 Thymitis- Inflammation of the thymus gland

 Thyroiditis- Inflammation of the thyroid gland

 Thyrotoxicosis- Condition caused by excess thyroid hormone, often due to hyperactivity of the thyroid gland

 Hematologic (Hemic) System- Involves the blood

 red cells, white cells, and platelets are produced in the marrow of bones, especially the vertebrae, ribs, hips, skull, and sternum.

 These essential blood cells fight infection, carry oxygen, and help control bleeding.

 Plasma is a pale-yellow mixture of water, protein, and salt, acts as a carrier for blood cells, nutrients, enzymes, and hormones

 Red blood cells (RBCs or Erythrocytes)- Disk shaped cells containing hemoglobin that enable cells to pick up and deliver oxygen to all parts of the body.

 Erythropoietin (EPO)- A glycoprotein hormone providing a direct stimulus for erythrocyte formation

• Some erythrocyte disorders include anemia and polycythemia

 White blood cells(WBCs or leukocytes)- Body’s primary defense against infection and account for less than 1 percent of total blood volume

 Types of leukocytes include Neutrophils, Lymphocytes, Monocytes, Eosinophils, basophils each of which has its own function in defense

 Leukocyte disorders include leukopenia, leukemias, and infectious mononucleosis

 Platelets(thrombocytes)- Form clusters to plug small holes in blood vessels and assist in the clotting process

 Bleeding disorders include thrombocytopenia, impaired liver function, and hemophilia

 Procedures on blood and its components are covered in the 80000 range of CPT codes.

 Immune system- Classified as a separate system from the hematologic system, however, must immune cells originate in the hematologic system.

 In medicine, the study of the immune system(immunology) and the study of allergies often go together because an allergic response is, in fact, an immune response

 The human immune system is the body’s final line of defense against invading microorganisms, harmful chemicals, and foreign bodies

 There are two kinds of immune cells: B-cells and T- cells.

 Several types of cells protect the body from infection (for example neutrophils, lymphocytes, monocytes, eosinophils, and basophils)

• Neutrophils- Body’s main defense against Infection and antigens

 high levels of neutrophils may indicate an active infection; a low count may indicate a compromised immune system or depressed bone marrow (low neutrophil production)

• Lymphocytes- Involved in protection of the body form viral infections such as measles, rubella, chicken pox, or infectious mononucleosis

 Elevated levels may indicate an active viral infection, while a depressed level may indicate exhausted immune system

• Monocytes- Fight severe infections and are the body’s second line of defense against infection

 Elevated levels are seen in tissue breakdown, chronic infections, carcinomas, leukemia(monocytic), or lymphomas

 Low levels of monocytes indicate a good state of health

• Eosinophils- used to protect against allergic reactions, allegens, and parasites,

 Elevated levels may indicate an allergic response

 Low level of eosinophils is normal

• Basophils- Activity is not understood fully, but is known to carry histamine, heparin, and serotonin

 Antigens- Elicit an immune response in the body

• Antigens entering the body from the environment can include

• Inhaled macromolecules (proteins on cat hairs triggering an asthma attack)

• Ingested macromolecules (shellfish proteins triggering an allergic response)

• Molecules introduced beneath the skin (on a splinter or in an injected vaccine)

 Antibodies- A immune system related protein called immunoglobulins

• Some antibodies destroy antigens directly; others fight antigens indirectly by making it easier for white blood cells to destroy antigens

 Clinical lab tests performed on the function and health of the immune system are performed in the clinical laboratory and reported using CPT code range 86000-86849

 Medical Terms Related to the Hematologic system and immune system

 Erythropathy- Disease of red blood cells

Hematocrit- Blood test that measures the red blood cell volume by centrifuge, a technique that separates the plasma and the blood cells

Hematologist- Physician specializing in the study of blood disorders

Hemoglobin- The red respiratory proteins of RBCs; transports oxygen to tissues

Hemolysis- Destruction of red blood cells

Hemostasis- Control of bleeding

Hypercalcemia- Excessive calcium in the blood

Hyperglycemia- Excessive sugar in the blood

Hyperlipemia- Excessive fat in the blood

Hypoglycemia- Deficient sugar in the blood

Leukemia- Overproduction of leukocytes resulting in a malignant, acute, or chronic disease

Mononucleosis- Disease of excessive mononuclear leukocytes in the blood due in infection with Epstein-Barr virus

Polycythemia- Abnormal increase in red blood cells

Septicemia- Pathogenic bacterial present in the blood