Med Term unit 2

1.4 -pepsia and -phagia

-pepsia means digestion; someone suffering from dyspepsia has "bad" (dys-) digestion. In general, this could mean anything from a stomachache to indigestion to acid reflux. -phagia means eating or swallowing. In Module 5, we discussed dysphagia, or the inability to swallow normally. Polyphagia is a condition in which a person overeats. Poly- means many, much, or increased.

.5 Parenteral and Enteral Drug Routes

.5 Parenteral and Enteral Drug Routes

Peptic Ulcers

A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, the duodenum. A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer. The direct cause of peptic ulcers is the destruction of the gastric or intestinal mucosal lining by hydrochloric acid, an acid normally present in the digestive juices of the stomach. Infection with the bacterium Helicobacter pylori is thought to play an important role in causing both gastric and duodenal ulcers. H. pylori may be transmitted from person to person through contaminated food and water. Treatment involves a combination of medications to kill the H. pylori bacteria (if present) and to reduce acid levels in the stomach.

1.5 Threaded Case Study: Urinary Tract Infections (UTIs)

A urinary tract infection (UTI) is usually classified as either an upper UTI or a lower UTI. Upper UTIs are in the kidneys and ureters, and lower UTIs affect the bladder and urethra. In Owen's case, not only is an infection present, but Dr. Pandit is also beginning to suspect Owen's bigger problem is acute renal failure—possibly caused by an obstruction. Renal failure is what its name indicates. The kidneys (ren/o) fail to excrete urine because of impaired filtration function. A large number of conditions, including high blood pressure, infection, and diabetes can lead to renal failure, which may be acute or chronic. The severity of renal failure can vary. The final phase of the chronic version is end-stage renal disease or chronic kidney disease (CKD), which can be fatal if not treated.

Achalasia

Achalasia is a constriction, or closing off, of the lower esophagus attributable to the failure of the lower esophageal sphincter (LES) to relax (a- = without; -chalasia = relaxation). This condition results from a loss of peristalsis that usually occurs when the patient has been unable to take in food by mouth for an extended period. As a result, food cannot easily pass through the esophagus into the stomach, which can cause a dilation or dilatation (widening) of the esophagus just above this constriction.

1.2 Threaded Case Study: pH Test, Blood Protein, and Glycosuria

After color analysis, the next test Vicky's urine undergoes is a pH test, which is used to determine to what degree the urine is acidic or alkaline (basic). The abbreviation pH stands for potential hydrogen. Urine pH may become alkaline with a bladder infection because the bacterial breakdown of urea releases ammonia, which is very alkaline. In addition, one of the earliest signs of renal involvement in diabetes mellitus is the presence of an abnormal amount of albumin, a major blood protein in urine, a condition called albuminuria (albumin/o = albumin; -uria = urine condition). A special, sensitive urinalysis test can aid in detecting albumin. The presence of too much glucose (glyc/o), or sugar, in the urine is called glycosuria and is an indication of diabetes mellitus.

6.3 Hepatitis A

Although hepatitis may be attributable to alcohol or drug misuse, other toxins may be responsible and can produce one of three fairly widely varied forms of the disease. For instance, hepatitis A results from a specific hepatitis A virus found in contaminated food or water. Although an acute, self-limiting disorder, hepatitis A is not always mild and can even become life threatening.

4.3 Bladder Malignancy

Although most disorders of the urinary system involve the kidney, the bladder is a more common site for malignancy, particularly in men, smokers, and individuals over the age of 50 years. Chemicals used by some kinds of industrial workers can also contribute to the risk. Early symptoms usually include blood in the urine, increased urinary frequency, and dysuria, which is difficult or painful (dys-) urination. Cancer is discussed in greater detail in a later module.

1.6 Intravenous Pyelogram with Nephrotomography

An intravenous pyelogram (IVP) is a special x-ray examination of the kidneys, bladder, and ureters. An iodine-based contrast material is injected into the patient's arm. A series of x-ray images is then taken at different intervals to determine how the kidneys remove the dye and how it collects in the urine. An IVP may be performed to evaluate bladder and kidney infections, blood in the urine, flank pain (possibly attributable to kidney stones), and tumors.

6.6 Cirrhosis

Another common disorder of the liver is cirrhosis, which is a degeneration of liver tissue. The severity of this disease becomes apparent when you stop to realize that the liver is known for its regenerative capabilities. Cirrhosis occurs when toxicity levels are so high that regeneration cannot keep up and damaged portions are replaced with scar tissue. These dangerous levels of toxicity can be caused by hepatitis, malnutrition, infection, or chronic alcohol abuse. Cirrhosis can cause the symptom of ascites, an abnormal accumulation of fluid in the abdomen.

4.1 Threaded Case Study: Renal Cell Carcinoma

At one point, Dr. Pandit thought that the pain and a feeling of a lump in Vicky's side might mean a nephroptosis—that is, a dropping or displacing (-ptosis) of the kidney (nephr/o) because of weak support. Her other symptoms, however, do not support that diagnosis. Blood in the urine, pain, and/or a lump in the back (or side), along with leg and ankle edema, can all signal a number of disorders, of course; however, one of the more serious is renal cell carcinoma, or a cancerous tumor of the kidney (also called hypernephroma). In Vicky's case, diagnostic sonography revealed renal cell carcinoma.

1.7 KUB Imaging Series and MRI

At the time of his hospitalization with kidney stones, Owen's BUN suddenly increased, along with his serum potassium level. His serum creatinine increased by 2 mg/dL at his last visit, and his creatinine clearance was decreased. Dr. Pandit requested two imaging procedures to help confirm the diagnosis of renal failure. Both the kidney, ureters, and bladder (KUB) examination—also called urography—and magnetic resonance imaging (MRI), can demonstrate the kidneys in relation to other organs in the abdominopelvic region. However, often kidney or abdominal ultrasound is the best diagnostic imaging procedure.

Process of Digestion: Small and Large Intestines

Because the duodenum is significantly smaller than the stomach, the stomach contents are ejected into the duodenum approximately every 20 seconds. The rate of ejection is controlled by hormonal and nervous signals that prevent overloading the duodenum. Once food enters the intestines, mechanical digestion will alternate between two types of motility: peristalsis, or forward movement, and segmentation, which is primarily a mixing movement. In addition, the liver secretes bile, which is concentrated and stored in the gallbladder until it is needed. Bile works to emulsify fats, increase blood pH, and aid in the excretion of cholesterol and bile pigments. Finally, the intestines secrete mucus and water for mixing and lubrication and sodium bicarbonate for optimal enzyme function. A final function of the large intestine is elimination—the removal of materials from the body. In the digestive system, this elimination is called defecation and specifically refers to the elimination of feces (solid waste) from the digestive tract through the rectum and anus.

3.3 Gingivectomy

Before we close our discussion of procedural word parts, let's have a look at uses for the suffix -ectomy, which means surgical removal. This illustration shows a line marking the site of a gingivectomy. You may recall that gingiv/o is a combining word form representing the gums. Thus gingivectomy is the removal of a portion of the gums. Similarly, then, sialoadenectomy is surgical removal of the salivary gland (sialoaden/o)

2.3 Threaded Case Study: Owen Seagraves

Being physically fit helps Owen make a quick recovery from the lithotripsy procedure. However, treatment is still far from over. Now that the primary cause—nephrolithiasis—has been treated, Owen, "happy and stone free," can now be treated for secondary acute renal failure, a complication of his kidney stones. This treatment consists of the administration of the hormone erythropoietin to stimulate the production of red (erythr/o) blood cells (-poietin = substance that forms).

2.5 Reabsorption

Being trapped in the glomerular capsule is not the last chance for these materials, however. Some useful substances such as water, salt, and sugar have one more chance to be returned to the bloodstream, and this second chance happens during the process of reabsorption. As these wastes exit the glomerular capsule by a proximal renal tubule, most of the water, all of the sugar, and almost all of the salts are returned to the bloodstream through tiny capillaries around each tubule. The other wastes remain in the proximal tubule where they are carried through the loop of Henle. The loop of Henle reabsorbs salts from this tubular fluid before the fluid moves through the distal convoluted tubule where water and salts are reabsorbed. The fluid is then carried out of the nephron via the collecting tubule.

2.7 CAPD and Renal Transplant

Continuous ambulatory peritoneal dialysis (CAPD) is a type of dialysis that does not require a machine; therefore the patient is free to walk around (ambulate). CAPD works by using the patient's own peritoneal membrane as a filtering unit for waste products. Automated peritoneal dialysis, shown here, can be used while the patient is sleeping. The catherization required for peritoneal dialysis should not be confused with urinary catheterization, which is used for short-term urine drainage. A related procedure, cystostomy, is the creation of an artificial opening (-stomy) into the urinary bladder (cyst/o) for insertion of a catheter. Patients with renal failure can become candidates for renal transplant (receiving a kidney from a donor), particularly in cases in which dialysis is no longer effective.

5.4 Fistulae, Fissures, and Polyps

Crohn disease can lead to the formation of anal fistulae, anal fissures, and polyps. An anal fistula is an abnormal tubelike passageway near the anus, which often results from an infection. An anal fissure is a painful narrow slit in the mucous membrane of the anus that may cause or lead to a fistula. An abscess (infected area) can also cause a fistula. A polyp (polyp/o) is a benign growth that protrudes from a mucous membrane. Polyps that occur in the colon are called colonic polyps. The presence of polyps may not always produce symptoms, but sometimes they are accompanied by hematochezia—defecation (-chezia), in which feces contain bright red blood (hemat/o). Polyps are usually premalignant and are often removed for biopsy in a procedure called a polypectomy. Colorectal cancer (adenocarcinoma) can arise from polyps in the colon (col/o) or rectal (rect/o) region.

5.3 Crohn Disease

Crohn disease is another type of IBD. This immune-related disease usually affects the intestines but may occur anywhere from the mouth to the anus. People with Crohn disease have chronic inflammation of the GI tract, which causes the intestinal wall to thicken. Signs and symptoms include cramp-like abdominal pain, fever, fatigue, loss of appetite, persistent diarrhea, and weight loss. Treatment is aimed at easing the symptoms. If medications do not work, then bowel resection may be necessary to remove part of the intestine. Bowel resection does not cure the condition.

1.8 Diagnostic Sonography

Diagnostic sonography (ultrasonography) records the echoes of sound waves as they bounce off tissues, thus creating detailed images of internal structures. This procedure is especially helpful for viewing fluid-filled structures such as the gallbladder. Endoscopic ultrasound (EUS) combines the use of sound waves with the advantages of direct visualization that endoscopy provides. During this procedure, an endoscope is inserted through the mouth or rectum, and ultrasound images are obtained. This test is often used in assessing pancreatic cancer.

1.3 Abbreviation Examples

Did you predict that the E in GERD stands for the combining form esophag/o? If so, you were correct. This illustration shows the mechanism involved in gastroesophageal reflux disease (GERD). Recall the discussion of heartburn in Section II. A ring of muscle called the lower esophageal sphincter (LES) surrounds the opening between the esophagus and the stomach. It normally allows food to pass into the stomach, but if the sphincter weakens and no longer tightly closes, then stomach acid flows back up into the esophagus. This gastroesophageal reflux causes heartburn. If heartburn becomes chronic, then it is diagnosed as GERD. The abbreviation for inflammatory bowel disease is IBD. The two major types of IBD are Crohn disease and ulcerative colitis. The abbreviation BRBPR stands for bright red blood per rectum, a condition also referred to as hematochezia. HBV means hepatitis B virus.

Process of Digestion: The Mouth

Digestion begins in the mouth where saliva mixes with the food to break it down in preparation for swallowing, primarily through the presence of the enzyme amylase, which is secreted by the salivary glands and by the pancreas. Enzymes are chemicals that speed up a reaction between substances. In the digestive system, enzymes break down complex foods into simpler substances. Enzymes usually have names that end in -ase.

5.7 Diverticulitis vs. Diverticulosis

Diverticulosis is an abnormal outpouching (diverticulum) in the wall of the colon. Diverticulitis is a complication of diverticulosis. When fecal matter becomes trapped in diverticula (sing., diverticulum), diverticulitis can occur. Pain and rectal bleeding are symptoms.

Gastric Carcinoma and Barrett Esophagus

Do you remember Mrs. Kreider's complaint of "stomach cramping?" On inspection, this pain is actually coming from her intestines, not her stomach. Had her condition been true chronic gastritis, it may have indicated a possible gastric carcinoma, which is a malignant tumor of the stomach. Esophageal cancer is a malignancy of the esophagus and is often preceded by Barrett esophagus, which is long-term irritation of the esophagus attributable to repeated gastric reflux. Cancer will be discussed in greater detail in a later module.

Internal Structure of the Tooth

Each tooth has a crown, a neck, and a root. The crown is covered with enamel to help it withstand the pressures of mastication, or chewing. Just beneath the enamel are two more layers, the dentin and cementum, a bonelike connective tissue that covers the roots of the teeth for support. This cementum is surrounded by a periodontal membrane to hold the tooth in place in its socket. As you can see, dentin makes up most of the tooth's shell. It contains a pulp cavity full of connective tissue, blood vessels, lymphatic vessels, and nerves.

1.5 CT and MRI

Earlier we learned that computed tomography (CT) produces computerized images of cross-sectional slices of tissue structure. Magnetic resonance imaging (MRI) exposes the body to magnetic and radio waves. The device in this photograph is an MRI machine.

-emesis and -ectasia

Emesis, as a term by itself, refers to an act or instance of vomiting; however, -emesis used as a suffix also means vomiting. Hematemesis is the vomiting (-emesis) of blood (hemat/o). The suffixes -ectasis and ectasia mean dilation, or widening. Cholangiectasis is the dilation or widening (-ectasis) of the bile duct vessel (cholangi/o).

Eructation, Flatus, and Anorexia

Eructation is the expulsion of gas from the stomach through the mouth, commonly called a burp. Eructation may not be the symptom of any disease. Similar to this, flatus is gas expelled through the anus. This, too, may not be the symptom of any disease. Flatulence is the presence of excessive stomach or bowel gas. Anorexia, or lack of appetite, can result from several very different factors. For example, in a natural response to intense emotion, sometimes the body cannot focus its energy on both the emotion and digestion; thus eating may be temporarily delayed. An- means no or without and -orexia means appetite. Anorexia can also be abnormal, signaling the presence of a condition such as malignancy or liver disease. Anorexia nervosa is an eating disorder that will be discussed in greater detail in Module 22.

1.5 -spasm, -stasis, and -stenosis

Esophageal stenosis is a narrowing, or stricture, of the esophagus caused by the build-up of scar tissue. A ring of muscle called the lower esophageal sphincter (LES) surrounds the opening between the esophagus and the stomach. -stenosis is a stricture (narrowing). A stricture can occur in any tubal structure, such as an artery (arterial stenosis), the spine (spinal stenosis), or the trachea (tracheal stenosis). Pylorostenosis, also known as pyloric stenosis is a narrowing of the pylorus, the opening from the stomach into the small intestine. Pyloric stenosis is a congenital defect in newborns that blocks the flow of food into the small intestine. The condition can be corrected with surgery. -Stasis and -stasis mean stopping, controlling, or standing still. Cholestasis occurs when the flow of bile (chol/e) from the liver to the duodenum is interrupted (-stasis). -spasm describes an involuntary contraction. A person who experiences pylorospasm is having involuntary contractions (-spasm) of the pylorus (pylor/o) of the stomach. Colon spasms are painful spontaneous contractions of the muscle tissue in the colon. Irritable bowel syndrome (IBS) is a common cause.

6.5 Hepatitis C

Finally, hepatitis C can be acquired through blood or blood products, through sexual contact, and, very rarely, through mother-infant transmission. Although hepatitis C is slightly more likely to lead to hepatic fibrosis, cirrhosis, or hepatocellular carcinoma, these cases are not all that common, occurring approximately 10% of the time.

Heartburn, Reflux, and Esophagitis

Finally, one of Mrs. Kreider's ongoing symptoms has been what she calls "stomach cramping." "Maybe I have heartburn," she says. Heartburn is a burning sensation caused by regurgitation or reflux; that is, the backward flow of hydrochloric acid from the stomach into the esophagus.

Malabsorption Syndrome, Steatorrhea, and Melena

Finally, we should examine the malabsorption syndrome as an example of a group of symptoms often found together in response to the small intestine's failure to absorb nutrients. As these nutrients are passed without absorption, the symptoms that occur include anorexia, abdominal bloating, cramps, anemia, and fatigue. Related to malabsorption is steatorrhea, which is the improper absorption of fats. Neither of these conditions should be confused with melena, which is blood in the feces. This symptom can be attributable to a number of different conditions of both the liver and the intestines. Now that we have reviewed the most common symptoms, let's look at several specific disorders of the GI tract proper.

3.1 Urine Flow: Renal Pelvis

From the nephron units, the urine flows into the larger collecting tubules in the renal pelvis (pyel/o), which is the central collecting region in the kidney. This small basin in the central part of the kidney is made up of more cup-shaped regions called calices or calyces. Each calyx (cali/o, calic/o) helps collect the urine and aids its passage through the renal pelvis, which narrows into the ureter.

2.2 Filtration

From the renal artery and the arterioles, the blood enters the microscopic nephrons. The nephron (nephr/o) is the functional part of the kidney, doing the bulk of its work, and processing blood plasma and urine formation. Each nephron includes a glomerulus and a renal tubule. Let's take a closer look at how the nephron functions in filtration. The blood enters each nephron through a ball of even tinier blood vessels called capillaries. This small ball is called a glomerulus (glomerul/o). Blood pressure forces materials through hundreds of thousands of these glomeruli, which open into the functional nephrons. Once these substances enter the glomerulus and its glomerular capsule, it is then filtered through the renal tubules, which include the proximal and distal tubules and the loop of Henle. The distal tubules of several nephrons then connect to form a common collecting duct

1.2 Esophageal Reflux

Heartburn is actually a condition of esophageal reflux (esophag/o + -eal = pertaining to the esophagus). The esophagus becomes irritated when acid from the stomach flows back (reflux) into the esophagus, causing a burning sensation. Usually the lower esophageal sphincter (LES) keeps stomach acid in the stomach, but if the LES opens too often or does not tightly close, then heartburn, or acid indigestion, can occur. Too much food in the stomach or too much pressure on the stomach from obesity or pregnancy can also contribute to heartburn.

3.4 Polycystic Kidney Disease

Heredity can also play a part in kidney disease. One hereditary disorder, called polycystic kidney disease (PKD), is a condition in which multiple, fluid-filled sacs, or cysts, form both inside and outside the kidney. This condition is progressive but usually asymptomatic (without symptoms) until middle age, when the patient may develop nephrolithiasis, hematuria (blood in the urine), urinary tract infection, hypertension, and renal failure. Hematuria - smoky red color to the urine When the kidneys (ren/o) fail to excrete urine, uremia may occur. Uremia is a toxic state in which a large amount of nitrogenous wastes accumulate in the blood because they are not being excreted in the urine. Azotemia (azot/o = nitrogen) is another term that refers to high levels of urea. This term is primarily used when the abnormal levels can be chemically measured but have not yet produced symptoms. Fortunately, Vicky does not have uremia or azotemia; however, she has exhibited hematuria and hypertension.

3.8 Untreated Ulcers

If left untreated, ulcers will continue to erode the stomach or intestinal wall. Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency. If a perforation does not occur, then an untreated ulcer may eventually lead to anemia from small but persistent bleeding.

1.5 Upper GI Series

Imaging can also be performed for the upper GI tract. After a patient drinks a contrast agent, called a barium swallow, x-ray images are taken. This procedure is called an upper gastrointestinal (GI) series and is performed to diagnose esophageal strictures and disorders of the stomach and duodenum.

1.4 Cholangiography

Imaging procedures, such as the lower gastrointestinal (GI) series with barium enema (BE), are important tools to determine causative factors of symptoms. Jesse's physician considers using cholangiography (chol/e = bile or gall; angi/o = vessel; -graphy = process of recording), in which contrast material is injected into either the liver or biliary system to allow x-ray diagnostic imaging, cytologic sampling, dilation of narrowed areas, or the removal of stones. In percutaneous transhepatic cholangiography (PTHC), a contrast medium enters via a needle through the abdominal wall into the liver. In endoscopic retrograde cholangiopancreatography (ERCP), the contrast medium is injected via a catheter tube through the mouth, esophagus, stomach, duodenum, and then into the bile ducts.

1.3 Laparoscopy

In Jesse's case, the physician might use a laparoscope (in a laparoscopy) (see photograph) to look at the liver inside the body, filling the abdomen with gas to lift it away from the organs for easier viewing. The laparoscope is inserted through the abdomen to relay pictures back to a computer screen.

5.1 Dysentery

In addition to being an infectious disorder on its own, diarrhea can also be a symptom of dysentery. Dysentery is a painful (dys-) inflammatory disorder of the intestine (enter/o), especially of the colon (col/o), that results in severe diarrhea containing mucus and blood and accompanied by fever and abdominal pain. This disorder may be caused by the ingestion of bacteria, viruses, parasites, or protozoa. Colitis means inflammation of the colon (large intestine), and enterocolitis describes inflammation of both the large and the small intestines.

1.7 Components of the Urinary System

In addition to filtering the blood and eliminating waste materials, the urinary system also contributes to the body's homeostasis by maintaining the proper balance of water, salts, acids, and electrolytes in the body fluids. Electrolytes such as sodium (nat/o) (Na+) and potassium (kal/o) (K+) are chemical elements that, when dissolved in water, transmit electrical charges needed for proper muscle and nerve functioning. The kidney (ren/o) also secretes the hormones renin and erythropoietin (EPO). Renin raises blood pressure to keep blood moving through the kidney. EPO stimulates the production of red (erythr/o) blood cells in the bone marrow (-poietin = substance that forms). The kidneys also release calciferal, an active form of vitamin D necessary for the absorption of calcium from the intestine.

2.2 Liver Function Tests

In addition to imaging, Jesse's physician orders liver function tests (LFTs), which test for the presence of enzymes and bilirubin in the blood. Alanine transaminase (ALT) and aspartate transaminase (AST) are enzymes that are present in many tissues. Levels are elevated in patients with liver disease. Alkaline phosphatase (alk phos) is another enzyme that may be elevated in patients with liver, bone, or other diseases.

The Liver

In addition to producing bile, the liver can store excess simple sugar, called glucose (gluc/o, glyc/o), as a starch (amyl/o), called glycogen (glycogen/o), converting it back into glucose when the blood sugar level drops. This process is called glycogenolysis. The liver can also convert proteins and fats (steat/o, lip/o) into glucose when the body needs sugar. This process is called gluconeogenesis. The liver also manufactures blood proteins for clotting, releases bilirubin, and detoxifies the blood.

Adult Teeth

In adulthood, we gain four bicuspids (or premolars) and two third molars, commonly referred to as wisdom teeth. Thus in the adult, the upper and lower gums (gingiv/o) each form a dental arch of 16 permanent teeth, for a total of 32 permanent teeth in the entire mouth.

Deciduous Teeth

In childhood we receive 20 deciduous teeth (dent/i, odont/o), commonly referred to as our baby teeth. Children have two central incisors, two lateral incisors, two canines (or cuspids), two tricuspids (or first molars), and two second molars.

1.7 Computed Tomography and Magnetic Resonance Imaging

In computed tomography (CT or CT scan), a circular array of x-ray beams produce cross-sectional images of internal organs, using contrast material to allow visualization of specific structures in these "slices." Another imaging technique that Jesse's physician considers is a noninvasive examination called magnetic resonance imaging, more commonly referred to as an MRI. An MRI uses magnetic waves to produce images of organs and tissues in all three planes of the body. This technique does not use x-ray beams and shows subtle differences in tissue composition.

GERD and Hiatal Hernia

In the previous lesson, one of the symptoms Mrs. Kreider wondered about was heartburn. Heartburn is associated with gastroesophageal reflux disease (GERD), a disorder in which solids and fluids return through the esophagus (esophag/o) to the mouth from the stomach (gastr/o). When heartburn becomes chronic, the constant exposure of the esophagus to harsh gastric acid and pepsin results in reflux esophagitis. Sometimes GERD can be caused by the upper part of the stomach protruding through the diaphragm as seen in the illustration. This condition is a hiatal hernia.

4.1 Inguinal Hernia

In the previous lesson, we discussed a hiatal, or diaphragmatic, hernia. Hernias can also occur in the intestines. A hernia is any protrusion of an organ or part of an organ through the muscle that normally contains it. An inguinal hernia is the protrusion of a small loop of bowel through the abdominal muscle that usually holds it in place.

Threaded Case Study: Sigmoidoscopy

In the previous section, we learned that Dr. Maldonado wanted to examine the walls of Mrs. Kreider's sigmoid colon, so she undergoes a sigmoidoscopy. In this procedure, a tubular instrument with a light in it, called a sigmoidoscope, allows direct visual examination (-scopy) of the mucous membrane lining the sigmoid colon (sigmoid/o). As a result of this examination, a few benign polyps are discovered, but Mrs. Kreider is fortunate that no cancer was found. If a possible cancer had been found during Mrs. Kreider's sigmoidoscopy, a full colonoscopy (examination of the entire colon [colon/o] using a more elongated endoscope) may have been the next step. Depending on the extent of the cancer, colon cancer may be treated with wide surgical resection, chemotherapy, and/or radiotherapy. Mrs. Kreider's sigmoidoscopy did reveal the presence of diverticula.

Process of Digestion: The Stomach and Pancreas

In the stomach, gastric juices are secreted and mixed with the partially digested food to form a creamy semifluid called chyme. These secretions contain pepsin and intrinsic factor, both of which aid digestion and absorption of specific nutrients. Hydrochloric acid decreases the pH of stomach chyme. As chyme moves into the intestines, the pancreas releases enzymes: proteases for digesting proteins and polypeptides; lipases for digesting emulsified fats; nucleases for digesting nucleic acids; amylase for digesting starches; and sodium bicarbonate to increase the pH for optimum enzyme function.

2.5 Nocturia, Anuria, and Diuresis

Is coffee or alcohol becoming increasingly important in your daily routine? If so, you should know that caffeine or alcohol intake could cause diuresis—increased urine formation and secretion. Other urinary dysfunctions can include nocturia (frequent, excessive urination at night; noct/o = night; -uria = urine condition) and anuria, diminished or absent (an-) urination usually caused by either renal dysfunction or a urinary tract obstruction.

6.2 Jaundice and Hepatitis

Jaundice is best recognized on the sclera. Jaundice is a yellowing of the skin, tissues, and whites of the eyes (the sclerae) and is caused by hyperbilirubinemia. Hyperbilirubinemia is a condition in which too much (hyper-) bilirubin is in the blood (-emia = blood condition). Jaundice can be caused by inadequate liver (hepat/o) function attributable to infection or other factors. Fortunately, Mrs. Kreider does not have yellow skin or sclera, nor does she have any other symptoms of viral hepatitis—one of the two most notable diseases of the liver. Viral hepatitis is inflammation (-itis) of the liver (hepat/o) that is usually exhibited with anorexia, malaise, joint pain, abdominal discomfort, pale feces, and dark urine.

3.2 Threaded Case Study: Gastric Bypass

Jesse asks his physician about the possibility of help with weight reduction using gastric bypass surgery, also called bariatric surgery (bar/o = weight; iatr/o = treatment). This procedure involves reducing the size of the stomach to a volume of 2 tablespoons, either by banding or stapling. However, since Jesse is not morbidly obese, his physician explains that Jesse is not a good candidate for gastric bypass. He also explains that lifestyle changes are always the healthier and less risky option.

3.2 Threaded Case Study: Cirrhosis

Jesse is surprised to hear the physician suggest that he may have cirrhosis, a chronic degenerative disease of the liver. Jesse has a common misconception of cirrhosis. Many people associate this disease with alcoholism, but cirrhosis can be caused by a number of things other than alcohol disease. Hepatitis, certain inherited diseases, blocked bile ducts, drugs, toxins, and infections can be causative factors for cirrhosis. A buildup of fat in the liver, which eventually creates scar tissue, can also cause cirrhosis.

2.4 Threaded Case Study: Jesse's Diagnosis

Jesse's physician has reached a diagnosis of cirrhosis (degenerative liver disease), brought on by nonalcoholic steatohepatitis. Now, however, the diagnosis must be confirmed with a liver biopsy, a procedure during which a sample of liver tissue is removed for further analysis.

1.9 Scintigraphy

Jesse's physician settles on an imaging procedure called scintigraphy, in which a radioisotope is injected into the patient's vein. The resultant scintiscans reveal where the radioactive material has gone in the body. The images are displayed on a computer.

3.2 Kidney Stones

Kidney stones are thought to be formed by high levels (hyper-) of calcium (calc/i) in the urine (-uria), a condition known as hypercalciuria. Chronic dehydration, gout, and urinary tract infections can also lead to kidney stones, and some dietary choices may also increase the risk. These stones tend to block passageways in the ureter, bladder, or renal pelvis. Dr. Pandit will find the location of the obstruction and determine how best to remove it.

Tests such as the measurement of ALT, AST, and serum bilirubin are known collectively as:

LFTs - liver function tests

Leukoplakia

Less common are white patches, or plaques, on the oral mucosa. This precancerous condition, called oral leukoplakia, can be caused by chronic smoking or alcohol intake.

3.3 Threaded Case Study: Vicky James

Let's return to our patient, Vicky. Blood in the urine, along with symptoms such as pain in her back, swelling, high blood pressure, and fatigue, all suggest some sort of nephropathy, that is, a kidney disorder. Yet Vicky does not have a urinary tract infection, nor does she show evidence of having a kidney stone.

1.2 Endoscopy

Let's start with direct visual examinations. Endoscopy makes use of a viewing device that is passed inside the body. The word part endo- means inside. Word parts can precisely indicate what body parts are being examined. For example, a patient undergoing esophagogastroduodenoscopy (EGD) would expect an examination of the esophagus, stomach, and duodenum. This is an example of an upper gastrointestinal (GI) endoscopy, in which the endoscope is inserted into the mouth and threaded down through the esophagus, into the stomach, and then into the duodenum. Sometimes, endoscopy focuses on the large intestine, or colon. A colonoscopy is the use of a scope with a light and camera to examine the lining of the colon. A recent advance, called virtual colonoscopy (or CT colonography), uses computer technology to examine the entire colon in minutes.

2.4 Glomerular Capsule and Glomerulus

Let's take a closer look at these structures of filtration. Because the walls of each glomerulus are so thin, water, salts, sugar, urea, and other wastes can pass through from the bloodstream. The waste materials collect in a small cup at the mouth of a nephron, called a glomerular (or Bowman) capsule, which is wrapped around the glomerulus to catch them. The glomerulus and its capsule, together, make up the renal corpuscle, which is the beginning of the nephron unit. Larger substances such as proteins and blood cells cannot filter through the walls of the glomerulus and, consequently, remain in the bloodstream to be used.

1.1 BUN and Creatinine Clearance Test

Many laboratory tests are used to diagnose kidney function. The blood urea nitrogen (BUN) test is used to determine how much urea and nitrogen have accumulated in the blood (uremia). Of particular interest is the fact that chronic kidney disease (the final phase of chronic renal failure [CRF] is now classified according to the level of creatinine clearance. The creatinine clearance test (CrCl) measures the rate at which creatinine concentration in a blood sample is excreted in the urine over a 24-hour period. Creatinine clearance is also useful in assessing the glomerular filtration rate (GFR).

Diarrhea and Constipation

Mrs. Kreider has intermittent bouts of both diarrhea and constipation. Diarrhea is the frequent passage of loose, watery feces, usually occurring in response to a toxin or infection and sometimes accompanied by abdominal cramping. Diarrhea can be accompanied by a rumbling or gurgling noise in the GI tract called borborygmus. By contrast, constipation is a decreased motility of the colon; defecation becomes difficult because the feces are dry and hard. Slow peristalsis or inadequate diet can be a cause of constipation. Chronic constipation can put pressure on anal veins, causing swollen, twisted varicose veins in the rectal region called hemorrhoids. Hemorrhoids can occur either internally (within the rectum) or externally (outside the anal sphincter)

Threaded Case Study: Cholecystectomy (Animation)

Mrs. Kreider's physician explains to her that treatment for gallstones sometimes involves traditional surgery to remove the gallbladder in a procedure called a cholecystectomy (cholecyst/o = gallbladder; -ectomy = removal) or to remove the stone by choledochotomy (choledoch/o = common bile duct; -tomy = process of cutting). However, more often, a laparoscope is used to remove the damaged gallbladder through a significantly smaller incision and the use of endoscopes. "The good news is that this procedure is the one we'll use for you," the physician says. Your recovery time should be minimal."

Nausea and the Vomiting Reflex

Nausea is an unpleasant sensation in the throat or stomach in response to irritation of specific nerve endings in the stomach that sends a message to the vomiting reflex center in the brain. Nausea often, but not always, precedes vomiting, or (emesis). Nausea and vomiting may be symptoms of a disease, organ perforation, or obstruction, or it may be a natural reaction to toxins in the stomach. Extraordinary stress can also produce these symptoms. Some symptoms are related to swallowing. For example, dysphagia (dys- = difficulty; -phagia = swallowing) is difficulty in swallowing.

4.5 Nephrotic Syndrome

Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Nephrotic syndrome can be a primary disease of the kidneys or it may be a consequence to the kidneys of a systemic general illness. In either case, improperly functioning glomeruli play a part, and the kidneys leak large amounts of protein from the blood into the urine (proteinuria). Glomerulonephritis is inflammation of the glomeruli within the kidney that results in leaky glomeruli.

2.5 Threaded Case Study: Owen Seagraves

Now that his kidney stones have been treated, Owen's treatment can focus on preventing the buildup of toxins by restricting his fluid intake, along with other dietary modifications. Owen is also given antibiotics and diuretics. The next focus is on bringing a potentially dangerous hyperkalemia (increased blood potassium) under control (Kal/i = potassium). Owen is intravenously (IV) administered calcium, glucose insulin, and oral potassium exchange resin. Finally, his blood pressure is brought back under control. Soon Owen is back at work. Along with his regular exercise routine, he watches his sodium intake and has regained all of his former energy.

2.2 Acute Pyelonephritis

Other inflammations include interstitial cystitis (IC), which is a chronic inflammation of the bladder wall, and pyelonephritis. With acute pyelonephritis, a bacterial infection in the renal pelvis (pyel/o) of the urinary tract causes collections of pus (abscesses) to form in the kidney (nephr/o). Pus may also be in the urine (pyuria). A renal abscess can be visualized on radiographic images similar to this computed tomographic (CT) scan (arrow points to an abscess). Inflammation of the urethra is called urethritis. Inflammation of a ureter is called ureteritis.

2.6 Hemodialysis and Peritoneal Dialysis

Owen has made an excellent recovery. His renal failure did not become chronic or, worse, turn into end-stage renal disease. When the kidneys can no longer separate nitrogenous waste materials from the bloodstream, dialysis can save a patient's life. There are two methods of dialysis. Hemodialysis (HD) uses an artificial kidney machine that receives waste-filled blood from the patient's bloodstream, filters it through an artificial porous membrane called a dialyzer, and then returns the dialyzed blood to the patient's body. The other method is peritoneal dialysis (PD). PD uses a peritoneal catheter to introduce fluid into the abdominal (peritoneal) cavity. Waste materials in the capillaries of the peritoneum pass out of the bloodstream and into the fluid. This fluid is then drained from the body through the catheter. PD may be continuously performed.

3.1 Threaded Case Study: Owen Seagraves

Owen's next test is scheduled, but before the day arrives, the pain in his side returns and is worse than ever. The pain is also now occurring in his back. Owen calls Dr. Pandit's office to tell him that the pain is so bad he is sweating profusely and vomiting. Dr. Pandit tells Owen to get to the emergency department right away. From these symptoms, Dr. Pandit quickly moves to confirm his earlier suspicion and takes action. Owen, indeed, has nephrolithiasis—that is, the condition (-iasis) of having kidney (nephr/o) stones (lith/o), or renal calculi.

2.1 Threaded Case Study: Interstitial Nephritis

Owen's particular inflammation occurs in the connective tissue that lies between the renal tubules, or the renal interstitium; this condition is called interstitial nephritis. In Owen's case, this condition is a response to his recent administration of a penicillin medication for tonsillitis. The condition can also develop from the excessive use of aspirin and aspirin-type drugs. Signs and symptoms may include poor renal function, a fever and skin rash similar to the one shown in the illustration, and eosinophils in the blood and urine. Dr. Pandit takes his patient off the offending drug to clear up the nephritis.

2.2 Treatment of Kidney Stones

Owen's tests pinpoint the location of the kidney stones, which are treated by lithotripsy, the process of crushing (-tripsy) calculi or stones (lith/o) so that they can pass from the body through the urethra. In extracorporeal shock wave lithotripsy (ESWL), a shock wave is administered from outside (extra-) the body (corpor/o) to crush the stones. Unlike Owen, some patients will need surgery to remove the stone through an incision in the kidney, called a nephrolithotomy (nephr/o = kidney; lith/o = stone or calculus; -tomy = process of cutting into). Removing the stone through an incision in the renal pelvis is a pyelolithotomy (pyel/o = renal pelvis).

7.2 Necrosis of the Pancreas

Pancreatic cancer is a malignant tumor of the pancreas, usually in the head of the pancreas. Pancreatic cancer can spread to the liver and has a 5-year survival rate of 5%.

1.10 Threaded Case Study: Ultrasound

Polycystic kidney disease can also be diagnosed using diagnostic sonography, which is also called ultrasonography or diagnostic ultrasound. This imaging procedure uses sounds waves to record images of internal organs and tissues. The image produced is called a sonogram.

2.1 Treatment of Pyelonephritis

Pyelonephritis can be treated with antibiotics. If this condition becomes chronic, then renal tissue necrosis and scar formation can result. The treatment for urethral stricture or narrowing is usually surgery (urethroplasty) and typically involves urethral dilation urethrotomy.

1.8 Renal Angiogram

Renal angiography is a diagnostic procedure during which radiographic images of the blood vessels (angi/o) of the kidney (ren/o) are made. This examination is performed using a contrast material. Renal angiography helps diagnose obstruction or constriction of blood vessels leading to the kidney. These changes may also be visualized on CT and MRI urography.

Salivary Glands

Saliva (sial/o) is a digestive juice produced by the salivary glands (sialaden/o). The extrinsic salivary glands lie outside (ex-) the oral cavity. They all occur bilaterally and are named for their location: the parotid (near the ear), the submandibular, and the sublingual. The intrinsic salivary glands are located inside (in-) the mucous membranes of the oral cavity. Saliva contains the enzyme amylase, which begins the digestion of carbohydrates. (The suffix -ase denotes an enzyme.) Saliva also contains cytokines and proteins (prote/o), which are substances that contribute to healing and growth.

2.3 Serum Bilirubin Test

Serum bilirubin levels are elevated in patients with liver disease and jaundice. The direct bilirubin test measures conjugated bilirubin in the blood. High levels indicate liver disease or biliary obstruction. An indirect bilirubin test measures unconjugated bilirubin in the blood. Increased levels indicate excessive hemolysis, as may occur in a newborn. Icterus is another term for jaundice. The icterus index is a calculation representing the amount of bilirubin in the blood as determined by comparing the color of a sample of test serum with a set of color standards. The #3 specimen shown in the photograph appears deep yellow to orange and is due to an elevation of bilirubin. Amylase and lipase tests are used to determine the levels of amylase and lipase enzymes in the blood. Increased levels are associated with pancreatitis

1.2 Threaded Case Study: CT Scan

Several different imaging techniques can be used to visualize cysts and polycystic kidneys. Let's start with a familiar method: the computed tomography (CT) scan. The CT scan can present multiple transverse x-ray views with or without the use of a contrast material. This CT scan clearly identifies multiple cysts in the kidney.

2.1 Stool Test for Occult Blood

Several laboratory tests also provide key data about the digestive system, including the stool culture. The stool guaiac test detects occult blood (occult means hidden) in a stool sample and is an excellent screen for colon cancer. Guaiac is a wood chemical that reacts with any blood present in the feces. The abbreviation FOBT means fecal occult blood test.

Production of Bile

Several other organs also play an important role in digestion, although they are not directly part of the digestive tract. The liver is most commonly known for its production of bile (bil/i, chol/e), a yellowish or green substance that contains cholesterol, acids, and several pigments, the chief of which is bilirubin (bilirubin/o). Bilirubin is carried through the bloodstream to the liver, which combines it with other substances before it is added to bile. This bile then travels through the hepatic duct to the cystic duct, then into the gallbladder for storage. After a meal, the bile is forced into the common bile duct (choledoch/o).

2.9 Threaded Case Studies: Vicky James and Owen Seagraves

Six months later, life is looking much better for both Vicky and Owen. Both appear to be in good health after potentially life-threatening disorders. Vicky, of course, will continue to receive blood tests to check for kidney function at 3- or 4-month intervals for several years. Chest x-ray images, CT scans of the abdomen and chest, and other imaging tests will help monitor for any recurrence of the cancer. When they both left Dr. Pandit's office after follow-up visits, the nurse remarks, "Those two amaze me. Just think, not so many decades ago, recovery would have been a lot more difficult for both of them." Dr. Pandit nods, "And maybe out of reach."

1.9 MRI Detection of Tumors

Small renal tumors are now found earlier than ever because of the increased use of the CT scan and MRI. In MRI (magnetic resonance imaging), a cylinder-shaped machine produces an image using a changing magnetic wave to capture the movement of protons within the body, producing images of the kidney and surrounding structures in three planes of the body. With MRI urography, images are made of the pelvic and retroperitoneal regions. This test is useful in visualizing tumor invasion of blood vessels, lymph nodes, and adjacent tissue.

1.1 Abbreviations for Different GI Processes

Some of these abbreviations should be already familiar to you. GB means gallbladder, and GI is short for gastrointestinal. BE stands for barium enema, which is an imaging study of the large intestine and rectum. To make the intestine visible on a radiographic image, the colon is filled with a contrast material containing barium. The contrast material is administered via an enema. BM stands for bowel movement. Finally, a G tube is another word for a gastrostomy tube or stomach tube; that is, a tube that is inserted through the abdominal wall to introduce nutrients into the stomach.

3.4 Paracentesis

Sometimes fluid builds up in the abdomen (ascites) and must be drained. This procedure is called paracentesis or abdominocentesis. The fluid is also commonly tested for cancer cells or other substances.

2.8 Renal Angioplasty

Sometimes in the course of renal angiography, arterial constriction may be identified as the cause of changes in renal blood flow. When these changes occur, blood flow to the kidney can be greatly improved by a procedure called renal angioplasty. In this procedure, a balloon catheter is inserted through an artery and into the narrowed artery in the kidney. Inflating the balloon not only widens the stenosis (narrowing), but it also redistributes lipid deposits within the artery. Both widening and redistribution improves blood flow to the kidney, improving renal hypertension and preserving renal function. Stents (metal tubes) can be inserted to keep the vessel open.

Structures of the Stomach

Sphincters are rings of muscle fibers that constrict a passage or close a natural opening. Sphincters can be found at the top and bottom openings of the stomach. The lower esophageal sphincter (LES), sometimes called the cardiac sphincter because of its proximity to the heart, controls the entry of food from the esophagus into the stomach. Once food enters the stomach, it passes through all three of the stomach's sections: the fundus, the body, and the pylorus. Small glands found in the stomach folds, or rugae, secrete hydrochloric acid and the enzyme pepsin to help break down food so that it can enter the small intestine for digestion and absorption into the bloodstream. The rugae increase the surface area available for digestion. The lower pyloric sphincter (pylor/o) ensures that food does not leave the stomach and enter the small intestine until it is both chemically ready and physically small enough. The pyloric sphincter is normally closed, but a wave of peristalsis can open it.

3.5 Male vs. Female Urethral Structures and Function

Structural and functional differences between the male and female urethras exists. The female urethra (Fig. A) is approximately 1.5 inches long, with a small meatus (meat/o), that is, the opening to the outside of the body, between the clitoris and the opening of the vagina. The male urethra (Fig. B) is approximately 8 inches long, and the urinary meatus is at the tip of the penis. Notice that part of the male urethra is embedded in the prostate gland. The main functional difference is that the female urethra carries only urine out of the body, whereas the male urethra serves as an exit passageway for both urine and semen, although never at the same time.

3.4 Gallbladder Word Parts

Take a careful look at the following combining forms that are sometimes confusing. The combining form chol/e can mean either bile or gall. Cholecyst/o means gallbladder, and this combining form is used to build terms such as cholecystitis and cholecystectomy. The combining form cholangi/o describes a vessel (angi/o) that carries bile (chol/e). Cholangitis is an inflammation of a bile vessel. Choledoch/o means bile duct. Choledocholithotripsy is the crushing of gallstones in the common bile duct using a lithotrite.

1.2 Abbreviations of Condition, Symptom, and Infection

The abbreviations in this set all represent a condition, a symptom, or an infectious agent. The second abbreviation, GERD, is represented in this illustration. Knowing that, can you predict what combining form the E stands for in the abbreviation GERD?

Esophageal Varices

The close proximity of the esophagus and stomach to the liver can present special complications. For example, some liver diseases can lead to an increased pressure in the veins near and around the liver, which in turn leads to swollen varicose veins in the distal, or lower, portion of the esophagus or upper part of the stomach—a condition called esophageal varices.

7.3 Threaded Case Study: Cholelithiasis

The emergency department physician correctly identifies Mrs. Kreider's attacks of severe pain as biliary, colic (bil/i = bile). Mrs. Kreider experienced similar pain once after a fried chicken potluck dinner at church when her husband was out of town. Biliary colic is caused by cholelithiasis (chol/e = bile or gall; lith/o = stone; -iasis = abnormal condition), commonly referred to as gallstones. Gallstones are made up of cholesterol, bilirubin (pigment in bile), and calcium salts. Gallstones may not cause any symptoms. When an attack of severe pain (biliary colic) occurs, the stones become a medical problem. Cholecystitis—inflammation and infection of the gallbladder—is another symptom of cholelithiasis. When stones, or calculi (sing., calculus), block both the gallbladder and bile ducts, the condition is called choledocholithiasis (choledoch/o = common bile duct). Choledocholithiasis prevents the passage of bile to the duodenum.

The Peritoneum

The first layer of the peritoneum, the parietal peritoneum, lines the walls of the abdominal cavity; the second layer, the visceral peritoneum, coats the organs themselves. (Remember that viscer/o means internal organs.) Note the fan-shaped projection of the parietal peritoneum, called the mesentery. This covering allows free movement of the intestines and prevents them from being strangled.

1.6 More GI Abbreviations

The first two abbreviations in this figure, TPN and NPO, are patient nutrition directives. Total parenteral nutrition (TPN) means that all of the nutrients must be administered through an intravenous (IV) tube. NPO means nil per os, which is Latin for nothing by mouth. A nasogastric (NG) tube is used in nasogastric intubation. The tube is inserted through the nose (nas/o) and into the stomach (gastr/o) to obtain fluid for analysis. In percutaneous endoscopic gastrostomy (PEG), a PEG tube is inserted through (per-) the skin (cutane/o) of the abdominal wall and into the stomach, whereas in percutaneous endoscopic jejunostomy (PEJ), the feeding tube extends to the jejunum. A T tube is a small tube used for drainage. It can be placed in the bile duct for drainage into a small pouch (bile bag) on the outside of the body. Finally, PUD stands for peptic ulcer disease.

1.8 Structures of the Kidney

The kidney is divided into two regions. The cortex (cortic/o), or outer region, cradles approximately 1 million nephrons (nephr/o). These nephrons are considered the parenchyma, the functional part of the kidney where urine is actually formed. The medulla, or inner region, holds most of the collecting tubules. Waste products enter the kidney from the bloodstream through the renal artery, which enters the kidney through an outer concave, hollow notch called the hilum. Blood vessels and nerves enter and leave the kidney through this hilum.

1.11 Cystoscopy

The most common diagnostic procedure is cystoscopy (cysto). Cystoscopy is the direct visualization of the urethra and urinary bladder using a cystoscope. Flexible cystoscopy uses a thin fiberoptic cystoscope for diagnosis and checkups of the urinary bladder. Rigid cystoscopy passes a hollow metal tube through the urethra into the bladder and is used to take biopsy samples, remove polyps, or perform laser treatments.

7.1 Pancreatitis

The pancreas is most commonly involved in endocrine disorders, but damage from digestive enzymes, viral infection, drug toxicity, alcohol, bile stones, or a blockage of the pancreatic duct can cause inflammation of the pancreas, or pancreatitis. Acute pancreatitis is more common than chronic pancreatitis and can involve massive swelling and bleeding. If left untreated, pancreatitis can result in shock, renal failure, and respiratory collapse.

The Pancreas

The pancreas secretes its enzymes (-ase) into the pancreatic duct to enter the duodenum with bile to help with emulsification—the breakdown of fat or lipid (lip/o) globules into small enough parts for the enzymes to digest. The pancreas also secretes insulin, a hormone that acts as a carrier to bring glucose into the cells to be used for energy.

1.5 Urine Production

The primary components of the urinary system are the kidney, ureter, urinary bladder, and urethra. These components work together in filtration—a process for removing waste products such as urea, potassium, uric acid, and creatinine from the blood. Many of these products are nitrogenous, meaning they are high in nitrogen. Eventually, these wastes exit the body as urine. Urea is a nitrogenous waste formed in the liver and carried in the bloodstream to the kidneys. The urea then passes out of the bloodstream as the kidneys produce urine (ur/o, urin/o), which is also composed of water, salts, and acids. The urine then travels down the ureters (ureter/o) into the urinary bladder (cyst/o) and out of the body through the urethra (urethr/o). This process of urination is also called voiding or micturition.

1.3 Retrograde Pyelogram and Radioisotope Scan

The retrograde pyelogram (RP) involves the administration of a contrast medium through a catheter into the ureters from the bladder before x-ray images of the renal pelvis and ureters are taken. The radioisotope scan is an image of the kidney enhanced by the injection of a radioactive substance into the bloodstream. Both procedures reveal the presence of a renal embolus, urinary stones, and other obstructions.

Gastroenterology Symptoms

The study of the diseases that affect the GI tract is, as you may have already figured out, gastroenterology. Gastr/o means stomach and enter/o means intestines. Although every disease is unique, some symptoms are frequently encountered in numerous disorders of the GI tract. These are eructation, anorexia, nausea and vomiting, heartburn, diarrhea (dia- = through; -rrhea = abnormal discharge), and constipation. We will examine these symptoms first.

1.6 -rrhaphy and -plasty

The suffixes -rrhaphy and -plasty mean similar things; -rrhaphy means suture, and -plasty means surgical repair. Be careful, though; these suffixes are NOT interchangeable. For example, a herniorrhaphy is a term that means suturing of a hernia. A hernia is a bulging of internal organs or tissues through a defect in the wall of the body cavity containing it. Gastroplasty is the surgical repair of the stomach. (Gastroplasty is also a term used to describe surgery on the stomach to initiate weight loss.)

3.3 Steatohepatitis

The term for this last form of hepatitis—a buildup of fat in the liver—can be easily constructed using word parts you know. First, you know that -itis means inflammation and hepat/o means liver. Steat/o means fat. Inflammation of the liver caused by fat buildup is called steatohepatitis.

Pathologic Conditions of the Mouth

The term pathology refers to the study of disease. The root path/o means disease and -logy means study of. When we discuss a disease's etiology, we are talking about its origins—eti/o means cause. If we do not know or understand its cause, then we say the disease is idiopathic—idi/o means unknown. The most common pathologic conditions of the mouth are dental caries, or tooth decay. Debris in the mouth can build up and form a plaque on the teeth, which dissolves tooth enamel, creating a pit of decay called a cavity. Periodontal disease is inflammation and deterioration of the gums, teeth (odont/o), and even the surrounding (peri-) bone. Gingivitis is an inflammation (-itis) of the gums (gingiv/o), specifically.

2.3 Lingu/o, Gloss/o, and Sialaden/o

The tongue has two combining forms—lingu/o and gloss/o. Lingu/o comes from the Latin word lingua, which means tongue. The lingual tonsil is at the back of the tongue. Gloss/o comes from the Greek word glossa, which also means tongue. A hemiglossectomy is the removal (-ectomy) of one half (hemi-) of the tongue (gloss/o). The combining form sialaden/o means saliva gland. Several saliva glands are in the mouth. The term sialadenitis means inflammation of a saliva gland.

The Tongue

The tongue lies loose along the floor of the oral cavity, revealing the glossy mucosal floor beneath it, but it is attached at the inside of the lower jaw bone. The tongue aids in chewing, or mastication, by grouping and repositioning the food between the teeth. These movements mix food with saliva to form a compact mass (called a bolus) to initiate swallowing. As the food shifts around on the tongue's surface, it slips across the papillae; these small raised areas contain receptor organs (taste buds) that detect specific types of flavors.

3.2 Urine Flow: Ureter, Bladder, and Urethra

The ureter (ureter/o, vesic/o) is the urine's route out of the kidney and down to the urinary bladder (cyst/o). Both ureters enter through a triangular area in the bladder called the trigone (trigon/o), where the urine is then transferred into the urethra (urethr/o) to exit the body. Here is how this process works: The urinary bladder is a collapsible, flexible bag. As urine accumulates in it, the bladder expands and puts pressure on the base of the urethra, which creates the urge to urinate. The bladder releases urine into the urethra through a series of small muscles shaped similar to rings. These sphincters control urine flow.

1.1 Urinalysis

The urinary system is unique in the sense that a great number of common disorders can be detected through the same simple multipurpose test: the urinalysis (UA). For that reason, this test is discussed in conjunction with these disorders, rather than in the diagnostic procedures section of this module. One of the first and easiest aspects to check is the color of the urine specimen. Although normal urine ranges fairly widely in color, other substances can also affect its hue.

1.4 Voiding Cystourethrogram (VCUG)

The voiding cystourethrogram (VCUG) can also reveal abnormalities of the bladder. In this procedure, the bladder is filled with a contrast material, and real-time x-ray imaging (fluoroscopy) is performed as the patient expels urine. Reflux of the contrast material into the ureters is abnormal.

3.5 Renal Hypertension and Diabetes

Three disorders that are closely linked to the urinary system's functioning are renal hypertension, diabetes insipidus (DI), and diabetes mellitus (DM). In diabetes insipidus, antidiuretic hormone (ADH) is either not secreted or the kidneys are resistant to it. In diabetes mellitus, insulin is either not adequately secreted or tissues are resistant to its effects. Two common symptoms of diabetes are polyuria, excessive (poly-) excretion of urine, and polydipsia, excessive thirst (dips/o).

The Tonsils

Tonsils are masses of lymphatic tissue that serve as filters to protect the body from invading microorganisms. The tonsils produce lymphocytes, which are disease-fighting white blood cells. Three kinds of tonsils are located in the mouth. The lingual tonsils are located on the tongue (lingu/o). The palatine tonsils are located on each side of the oropharynx, the part of the throat (pharynx) located at the back of the mouth (or/o). The pharyngeal tonsils, also called the adenoids, are located behind the nasal cavity, on the roof of the nasopharynx, where the roof of the mouth blends into the throat.

2.2 Dent/i and Odont/o

Two combining forms mean tooth—dent/i and odont/o. Have you heard the term dentifrice? Many toothpaste products have that term on the box. A dentifrice is any pharmaceutic compound used with a toothbrush for cleaning and polishing the teeth. (The suffix -frice means friction.) A dentist is, of course, a specialist (-ist) of teeth (dent/i). Everyone has heard of an orthodontist. This health care professional straightens (orth/o) teeth (odont/o). Odontalgia is tooth pain.

Inflammatory Conditions of the Mouth

Two other common conditions involve inflammation of the mouth. These two mouth sores are frequently confused, but their etiologies and appearances differ. Aphthous stomatitis, more commonly known as a canker sore, is idiopathic. A cold sore, or fever blister, is caused by an infection with the herpes simplex I virus—thus its alternative name herpetic stomatitis.

Irritable Bowel Syndrome and Bowel Obstructions

When constipation, diarrhea, bloating, and abdominal pain all occur together over a period and are associated with stress and tension, they are usually an indication of irritable bowel syndrome (IBS). Constipation and pain may be caused by an ileus—a failure of peristalsis with obstruction of the intestines caused by adhesions, a tumor, or stones. Another cause of intestinal obstruction is intussusception, a telescoping of the intestines, shown in the illustration on the left. In this condition, one bowel segment collapses into the opening of another segment. This condition is significantly more common in young children than in adults. A volvulus is a twisting of the intestine upon itself.

1.2 Resection and Ileostomy

With conditions such as ulcerative colitis, inflammatory bowel disease, and Crohn disease, if inflammation spreads from the rectum to the entire colon, then the patient may need surgical resection of the entire colon and an ileostomy—the creation of an opening (-stomy) from the ileum (ile/o) to the surface of the abdomen for emptying feces out of the body. A colostomy is performed when part of the colon is removed. A colostomy can sometimes be reversed if the inflammation is brought under control. An enteroenterostomy involves creating a connection between two segments of the small intestine (enter/o + enter/o), usually when a section of the intestine must be removed. Finally, pancreatic cancer is usually treated with a pancreatoduodenectomy, which is the removal of all or part of the pancreas and duodenum to relieve obstructions in pancreatic cancer. This procedure is also known as a Whipple procedure.

2.1 Renal Artery, Arterioles, and the Role of Renin

You may recall earlier that we talked about the role of the urinary system in the important process of filtration. Now we will see just how that happens. When blood flows into the kidney through the renal artery, it passes through smaller and smaller arteries in the cortex of the kidney. These small arteries, called arterioles, are so small that blood slows as it flows through them. If this slowed rate of flow drops low enough, then the kidneys secrete the hormone renin into the blood to stimulate contraction of the arterioles so that blood pressure is increased and the flow in the kidneys becomes normal again.

2.4 Threaded Case Study: Owen Seagraves

You may remember that Dr. Pandit suspects—among other possibilities—that Owen may have a urinary blockage. A blockage can be caused by long-term medication use or long-term use of an indwelling urinary catheter, which can produce scarring and thus cause a fibrotic narrowing of the urethra, called urethral stricture. The patient experiences diminished force, dysuria (painful urination), polyuria (urinary frequency), and hesitation.

The blood levels of ALT, which is the abbreviation for ___________, and AST, which is the abbreviation for ___________, are elevated when liver cells are damaged.

alanine transaminase, aspartate transaminase

Peristalsis: The Passage of Food

bolus of food will first pass through the pharynx, or throat (pharyng/o). The pharynx is a muscular, mucus-filled tube approximately 5 inches long. It serves as a passageway not only for food but also for air traveling to the trachea (trache/o) from the nose. Despite the sharing of this passageway, food does not fall into the trachea during swallowing, or (deglutition), thanks to the epiglottis, a cartilaginous flap of tissue that moves to cover the trachea with each swallow. Once the bolus of food enters the esophagus (esophag/o), it is moved along this 10 inch-long tube by rhythmic contractions called peristalsis (peri- = surrounding; -stalsis = contraction) all the way into the stomach (gastr/o).

Structures of the Digestive System

can also be referred to as either the gastrointestinal tract or the GI tract for short. The system extends from the mouth to the anus, and its principal function is to take in food (ingestion); process it (digestion); absorb nutrients for distribution throughout the body (absorption); and discard solid waste byproducts (elimination).

6.4 Hepatitis B

hepatitis B, on the other hand, is almost always more severe and can be called serum hepatitis because it can be parenterally acquired through blood and body fluids.

1.3 Additional Urinalysis Results

ketonuria: elevated levels of ketone bodies (ket/o, keton/o), also known as acetones, in the urine ketoacidosis (or ketosis): excessive blood acidity attributable to dangerous levels of blood ketones pyuria: presence of pus (py/o) in the urine, which will usually appear turbid or cloudy phenylketonuria (PKU): elevated levels of phenylketones hyperbilirubinemia: excess levels of hemoglobin pigment bilirubin in the blood, which leads to bilirubinuria, or excess bilirubin (bilirubin/o) in the urine specific gravity (sp gr): comparison of density between the urine and water

Structures of the Large Intestine

large intestine, also called the colon (col/o, colon/o) or large bowel, is only 5 or 6 feet long A bolus of food enters the large intestine through the cecum (cec/o), a small pouch connected to the ileum at the ileocecal sphincter. The most notable thing about the cecum is that the sometimes troublesome appendix (append/o, appendic/o) hangs from it! The food bolus then travels along the ascending colon as it curves to become the transverse colon. At the point where the colon vertically extends again, it becomes the descending colon. As it forms its final "S" shape, it becomes the sigmoid colon (sigmoid/o), after the Greek letter sigma, which curves like an "S." From there, the feces enter the final segment of the intestine, the rectum (rect/o), to await expulsion through the anus (an/o). illeum, cecum, ascending colon, transverse colon, descending colon, sigmoid, rectum, anus

The Mouth

mouth (or/o, stomat/o), the cheeks (bucc/o) and lips form an enclosure called the oral cavity. The underside of the tongue (lingu/o, gloss/o) forms the floor, and the hard and soft palates (palat/o) form the roof ridges or rugae. This uvula (uvul/o) helps form vocal sounds.

2.1 Bucc/o, Cheil/o, Labi/o, and Stomat/o

the combining form for the cheek is bucc/o? The mucous membranes lining the inside of the cheek are called the buccal mucosa. Buccopharyngeal means pertaining to the cheek and the pharynx. Cheil/o and labi/o are combining forms that mean lips. Cheilosis is an abnormal condition of fissures and scales around the lips. Cheilitis is an inflammation and cracking of the skin around the lips. The term labiolingual means pertaining to the lips and the tongue. stomat/o means mouth. It does not mean stomach! Stomat/o comes from the Greek word stoma, which means opening. Stomatitis is a general term that means any inflammatory condition of the mouth.

Structures of the Small Intestine

the small intestine (enter/o) is the primary site of digestion and absorption. As soon as a bolus of food enters the small intestine from the stomach, it is moved along this 20-foot passageway's coiled loops by millions of tiny villi. These villi absorb digested nutrients into the bloodstream and lymphatic vessels. This is the first point in the digestive system at which nutrients begin to be absorbed for distribution to the rest of the body. The bolus first enters the upper section of the small intestine, the duodenum (duoden/o), where it is mixed with bile from the liver (hepat/o) and gallbladder (cholecyst/o) and with pancreatic enzymes from the pancreas (pancreat/o). These enzyme-rich secretions further break down the food for its passage into the 8 foot-long jejunum (jejun/o) and then into the 11 foot-long ileum (ile/o), which attaches to the large intestine. doudenum, villi?, jejunum, illeum

5.2 Ulcerative Colitis

ulcerative colitis is a disease characterized by chronic inflammation (-itis) of the colon (col/o) with the presence of ulcers. Ulcerative colitis is a type of inflammatory bowel disease (IBD). IBD is treated with drugs to control inflammation and, if necessary, by the surgical removal of the diseased portions of the intestine.

Digestive Process in Review

water is the main element absorbed from the material moving through the digestive system before it reaches the large intestine. As the waste material enters the large intestine, it moves through the colon toward the rectum. Waste material is stored in solid form until it can be expelled from the body through elimination, the removal of waste material from the body. In the digestive system, this solid waste leaves through the anus as feces through the process of defecation (de- = removal of; fec/o = feces; -ation = process of). When referring to the anus and rectum together, many terms use the combining form proct/o. An/o means anus.