Introduction to Central Services 2023-2024 PDF

‫‪CSSD‬‬ ‫اعداد ‪:‬‬ ‫عبدهللا العنزي‬ ‫وال تنسوني من دعائكم‬ Table of Contents Module 1 INTRODUCTION TO CENTRAL SERVICS 1 Module 2 MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY 25 Module 3 MICROBILIOGY FOR CENTRAL SERVICE TECHNICIAN 67 Module 4 INF...

‫‪CSSD‬‬ ‫اعداد ‪:‬‬ ‫عبدهللا العنزي‬ ‫وال تنسوني من دعائكم‬ Table of Contents Module 1 INTRODUCTION TO CENTRAL SERVICS 1 Module 2 MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY 25 Module 3 MICROBILIOGY FOR CENTRAL SERVICE TECHNICIAN 67 Module 4 INFECTION PREVENTION 92 Module 5 REGULATION AND STANDARDS 95 Module 6 SURGICAL INSTRUMENTATION 99 Module 7 QUALITY ASSURANCE 123 Module 8 DECONTAMINATION POINT ZONE 134 Module 9 ASSEMBLY AND PACKAGING ZONE 147 Module 10 STERILIZATION ZONE 158 Module 11 STERILE STORAGE AND TRANSPORT 170 Module 12 SAFETY AND RISK MANAGEMENT 179 Module 13 PERSONAL AND PROFESSIONAL DEVELOPMENT 190  Introduction to Central Services 1 Introduction Decontamination is an entry-level program for new entrants to the field of decontamination and sterilization in a hospital, dental or ambulatory clinic setting. In this module, Introduction to Decontamination, we will talk about reusable medical device reprocessing, the facilities required to carry out this function, and how the life cycle of a reusable medical device fits in. Pre-Module Quiz What is CSSD? Keep these questions in mind as you go Central Sterile Service Department (CSSD) through the content and don’t worry if you is a place in hospitals or healthcare facilities don’t know the answers yet—that’s what that performs reprocessing of reusable you’re here to learn. medical devices used by health workers in the operating room for surgical and other patient procedures. This department is sometimes Q: Can you describe what called the sterile processing department manufacturing means? (SPD), central supply department (CSD) and Q: Can you list five items that you use central decontamination unit (CDU). Any of daily that are manufactured? these or other variations will be referred to as Q: Can you describe the CSSD in this program. decontamination life cycle? Manufacturing Q: Decontamination facilities are separated into key zones to maintain Manufacturing is the term most safety, how many do you think there commonly applied to industrial production, are? where raw materials are transformed into finished goods on a large scale. Cars, Q: Can you list five items used to electronics, appliances, and furniture are assist in cleaning reusable medical examples of items we buy that are devices? manufactured with standards to ensure Q: Do you know what the acronym PPE they are reliable and safe for use. Most means? consumables we purchase in supermarkets Q: What should the air pressure be are also manufactured, and need to be in the sterile storage room of a produced in a consistent safe process to decontamination unit? ensure no harm to consumers. With RMD, producing quality results is especially Q: What should the temperature be in a important as they will be used on patients decontamination unit? with compromised health. Medical Device Manufacturing Medical devices are defined by international regulatory bodies, such as the US Food and Drug Administration (FDA) and the European Medical Devices Directive, as any object or component used in the diagnosis, treatment, prevention, or cure of medical conditions or diseases, or affects body structure or function through means other than chemical or metabolic reaction to humans or animals. This includes all medical tools, excluding drugs, ranging from tongue depressors, to surgical instruments and radiology treatments. Most medical procedures require the use of medical supplies, surgical instruments and equipment. Some of these items are single use and used once then discarded, while many are designed for reuse. RMD must be thoroughly cleaned, disinfected, inspected, packaged and sterilized before they can be safely reused on another patient. In healthcare, CSSD is where the critical function of reprocessing reusable medical devices occurs. In a hospital setting, reusable medical devices and surgical instruments are more commonly used than disposable ones, as it is more cost effective and creates less environmental waste. This is especially true for surgical procedures in operating rooms where 50 or more surgical instruments are commonly used.  Some of these groups are: AAMI Association for the Advancement of Medical Instrumentation ST79 - Comprehensive guide to steam sterilization and sterility assurance WHO World Health Organization Decontamination and Reprocessing of Medical Devices for Health-care Facilities IAHCSMM International Association of Healthcare Central Service Material Management Technical Manual CBSPD Certification Board for Sterile Processing and Distribution The Basics of Sterile Processing AORN Association of perioperative Registered Nurses Recommended Practices for Cleaning and Care of Surgical Instruments UK DH Decontamination of Surgical Instruments (HTM 01-01) IE HSE Ireland Health Service Executive Standards and recommended practices for Central Decontamination Units Table M1– 1 Standard practices and procedures for reusable medical device reprocessing There is such a wide variety of equipment classified as reusable medical devices, that regulatory agencies have no single standard, but they do have an international standard, ISO 17664, that specifies what all manufacturers must do to create procedures or instructions for use (IFU) when processing their specific RMDs. Professional groups and associations use research and evidence-based practice to define minimum standards used to help set guidelines for standard practices and procedures for reusable medical device reprocessing. These and other similar professional bodies are used to ensure policies and procedures will produce safe, high quality and reliable RMD.  Maryam: Do all hospitals have the same setup for processing reusable medical devices? Khaled: All hospitals follow specific guidelines for optimum health and safety. Older hospitals may have special areas Decontamination Life Cycle The decontamination life cycle model shows the critical steps required for reprocessing reusable medical devices, and the pathway through the whole organization. This model will be referenced throughout this program, to detail how to safely meet standards and keep patients safe. ACQUISITION 1. Purchase 2. Loan CLEANING DISINFECTION TRANSPORT INSPECTION At all stages Location Facilities USE Equipment PACKAGING Management Policies/Procedures DISPOSAL 1. Scrap 2. Return to lender STORAGE STERILIZATION TRANSPORT Table M1–1 Decontamination life cycle Purchase Loan 1 TRANSPORT INSPECTION 2 USE DISPOSAL Scrap Return to lender PACKAGING 3 STORAGE TRANSPORT Table M1–2 Cleaning and disinfection life-cycle  Stage Frequency Cleaning involves removing all visible soil such as body fluids and tissues from reusable medical Cleaning devices. This may involve wiping or pre-cleaning, ultrasonication, manual or automated cleaning. At completion of this stage, 95% of microorganisms are removed from the device. Disinfection follows cleaning and kills the majority of remaining microbes, usually by chemical or heat treatment. Spores, some mycobacteria, and prions may not be inactivated by this. For flexible Disinfection endoscopes and other delicate reusable medical devices, this may be the final hygiene stage and must be as rigorous as possible. The reusable medical device is then inspected for functionality, visible soil, and damage. Remaining Inspection soil or damaged areas on reusable medical device may harbor clusters of microorganisms that are difficult to remove. Such reusable medical device are rejected or returned to the cleaning stage again. Reusable medical device which have been cleaned and disinfected are wrapped in special barrier Packaging packaging, ready for sterilization of the contents. This packaging will prevent microorganisms from entering the pack until time of use. Sterilization kills any remaining microorganisms in the reusable medical device pack. There is no such Sterilization thing as a device being more or less sterile—sterile means zero live microorganisms. Sterile reusable medical devices are transported to the storage zone or to the point of use in a careful Transport way to prevent damage or rupture to the packaging and prevent recontamination. Packed sterile reusable medical devices must be stored in a zone having cleanroom conditions in a Storage way that does not damage or rupture the packaging during handling or storage. Sterile reusable medical devices are used on patients in surgeries, theatres and wards. Once used, Use the reusable medical device is contaminated by microorganisms on or in the patient. Used reusable medical devices are contaminated by microorganisms and must carefully be Transport transported back to the decontamination facility. Loss, spillage or carelessness could result in the spread of infection. Standard Precautions are implemented. Table M1–3 Reprocessing life cycle Decontamination Design Before the CSSD, the critical role of design, construction and equipping of the zone areas were often neglected, but are now recognized as significant factors in ensuring safe practices in the reprocessing of RMD. Some building design resources are: HBN 13 Health Building Note: Sterile Services Department—Department of Health UK AAMI Building for the Future AIA Guidelines for Design and Construction in Health Care Facilities Ensuring a proper one-way flow is a key part of safe reprocessing of reusable medical devices. Separating dirty, clean, and sterile items avoids routes and workflows that could re-contaminate processed reusable medical devices. In CSSD this is achieved by using walls to separate the work areas into three primary functional zones. ZONE 1 ZONE 2 ZONE 3 DECONTAMINATION INSPECTION, ASSEMBLY STERILE STORAGE & PACKAGING (IAP) Dirty Items Receiving 1 Clean Items Inspection Sterile Items Storage Cleaning Assembly Dispatch Disinfection Packaging Sterilization Figure M1–1 Functional Zones in the CSSD  Zone 1 DECONTAMINATION ZONE Figure M1–2 Decontamination zone 1. Decontamination Zone Decontamination is the combination of processes (including cleaning, disinfection and sterilization) used to render reusable medical devices safe for 1 ‣ Gowning room—provides controlled entry and exit to the wash area, space for changing into PPE, a hand wash sink for hand hygiene, and an eye wash station in case of eye splash ‣ Wash room—space to carry out preparation, handling by staff and for use on patients. All reusable medical devices returned to cleaning and disinfection of contaminated the decontamination zone are considered reusable medical devices contaminated and potentially infected. You, ‣ Environmental cleaner room— dedicated as a decontamination specialist, must have an in-depth knowledge of microbiology, to cleaning only the decontamination room infection control and safe cleaning practices To ensure safety and prevent exposure to ensure safety for yourself and for to pathogens and other contaminants, patients. Ideally this zone is defined by decontamination specialists must wear personal specific rooms or at minimum segregated protective equipment such as: areas to ensure safety to staff and a Cover gown with sleeves unidirectional flow of reusable Face mask medical devices. Eye protection Gloves ‣ Contaminated returns room—provides Shoe covers or alternative shoes outside staff with secure and controlled or boots access into the zone, allowing delivery of Head covering contaminated containers and trolleys With the wide variety of surgical specialties and procedures, there is an extensive range of complex reusable medical devices being used. In order to clean these specialized reusable medical devices, processes and appropriate tools are required such as: Hand wash sink– with liquid soap and paper towels Instrument cleaning sink— with two or three basins Brushes Figure M1–3 Personal Protective equipment in CSSD Air guns Water guns Magnifiers Additional lighting Detergents Disinfectants Lubricants Ultrasonic washers Automated washer disinfectors Cart washer Figure M1–4 Hand wash sink and instrument cleaning sinks Automated endoscope re-processer Environmental monitors— temperature, humidity and pressure Spill kits Figure M1–5 Brushes Figure M1–6 Air/Water Gun Figure M1–7 Magnifying Lamp In the decontamination zone: PPE is worn to ensure specialist safety Reusable medical devices Figure M1–8 Enzymatic Detergents Figure M1–9 Disinfectants Figure M1–10 Environmental Monitoring received are checked for missing parts, manually pre-cleaned and prepared for automated washing Reusable medical devices not compatible with automated washers are manually cleaned and disinfected Figure M1–11 Automated washer disinfectors Figure M1–12 Ultrasonic washers Figure M1–13 Inspection, Assembly and Packaging (IAP) Zone 2. Inspection, Assembly and Packaging (IAP) Zone After cleaning and disinfection, reusable Gowning room—provides controlled medical devices are received in the entry and exit to the IAP zone, allows Inspection, Assembly and Packaging for changing into personal protective zone to prepare for sterilization. Reusable equipment, and a hand wash sink for hand medical devices are now safe for handling hygiene to protect clean instrumentation and extra care must be taken to ensure that from the risk of contamination they are not re-contaminated. Strict hand hygiene must be maintained and personal Materials transfer room—maintains an protective equipment must be used at air-lock to bring raw materials in and out of all times. Ideally this zone is defined by the IAP zone specific rooms or at minimum segregated areas to ensure safety to staff and ensure a Environmental cleaner room—dedicated unidirectional flow. to cleaning materials and equipment for use only in the IAP zone Inspection, assembly and packing (IAP) room—this room is restricted only Sterilization room—in newer CSSD to specialists who inspect, assemble designs sterilization equipment is located and package cleaned RMD to prepare in a room separate from IAP and Storage for sterilization. Sterilizers are frequently to further reduce contamination risks to located in this room. unwrapped RMD The extensive range of complex instrumentation requires specialized processes and appropriate tools for inspection and packing such as: Packing tables Chairs Figure M1–14 View Pack Pouches Figure M1–15 Tip Protectors Magnifiers Additional task lighting Wrappers and containers View pack pouches Heat sealers Surgical instrument tip protectors Tray liners Air guns Figure M1–16 Heat Sealers Figure M1–17 Packing tables Pass through hatchs Drying cabinets Sterilizers—high temperature Sterilizers—low temperature Biological incubators Environmental monitors temperature, humidity and pressure In the Inspection, Assembly Figure M1–18 Surgical Instrument Wrappers and Packaging zone, surgical instruments are unloaded from automated washers or pass through hatches (if manually cleaned) and: Visually checked to ensure cleanliness Manually inspected against a checklist to ensure items are correct and functional Packaged in appropriate materials and labelled Sterilized with the correct process or passed to a sterilization room if separate Figure M1–19 Pass-through hatch from IAP Figure M1–20 Steam Sterilizers Figure M1–21 Low Temp Sterilizers Figure M1–22 Low Temperature Formaldehyde sterilizers Figure M1–23 Drying Cabinets  Zone 3 STERILE STORAGE ZONE Figure M1–24 Inspection, Assembly and Packaging (IAP) Zone 3. Sterile Storage Zone CSSD requires a safe storage zone for sterile and clean supplies used in production. Sterile reusable medical devices are packaged, and stored safely in an 3 environmentally monitored (temperature, humidity and pressure) room using: Figure M1–25 Sterile Storage Shelving Washable, round-edged shelving Additional CSSD Support designed to avoid damage to packaging Transport carts Areas Workstations The CSSD is segregated into three primary zones and additional areas are required In the Sterile Storage zone processed to support the safety of specialists and reusable medical devices are: surgical instruments. Transferred from the sterilizer to this Staff Facilities—Changing, Toilets, room where they will either be kept until and Showers required or staged for end-user delivery Male and female toilets and areas to Removed from shipping boxes and change from outdoor to working clothing containers before being transferred here Lockers to accommodate storage of for storage or staged for end-user delivery specialist belongings  Showers located close to the decontamination area to ensure quick access in case of a workplace spill or contamination incident Hand hygiene station Mirrors to check PPE Staff Rest Room Facilities to prepare hot and cold drinks for staff breaks Area for eating and drinking (restricted to this area) Materials Storage Separate segregated area for bulk storing of production materials Sufficient stock levels of materials to ensure smooth operations Not used to store sterile processed items Education, Training and Meeting Rooms Separate from the work area and provides space for teaching materials and work samples Support for important regular Figure M1–26 Transport carts training and education for all grades of staff Central Detergent Dosing Room Adjacent room for detergent replacement without entering the contaminated area, reducing the opportunity for automated washer contamination General CSSD Requirements The unit is used exclusively for reprocessing reusable medical devices, must be physically separated Figure M1–27 Workstations from other work areas and never used as a thoroughfare to other units. Unit Access Air Pressure Due to the critical nature of this unit, access Air pressure is regulated to prevent cross is restricted to authorized personnel and contamination of airborne pathogens trained specialists. between each zone. A ventilation system is used to either exhaust air out of a room, Lighting creating negative air pressure, or vent air The light is kept at a brightness and into the room, creating positive air pressure. color balance for good working practices and visual examination of reusable Work Surfaces medical devices. Additional task lighting Walls are smooth, non-shedding, and magnification are available in water resistant and withstand frequent decontamination and IAP areas. cleaning. Floors are a washable non-slip material Temperature and have no exposed seams or Room temperature is controlled between openings. 18–25°C (64–77°F) and kept at a relative All tables, workstations and shelving humidity of 30–60% depending on the are made of easily cleanable materials activities carried out in the area. with non-glare surfaces. Adequate spacing allows for staff and equipment movement. Decontamination Figure M1–32 Sterile storage zone Positively Negatively Pressured Room Pressured Room Clean Dirty Figure M1–28 Air pressure regulation  ∞ ∞ General Changing Room General Domestic Contaminated (Male & Female Offices Waste Services Returns Lobby Disposal/ + WCs) Room § Laundry Returns One-way Contaminated transfer Staff Returns Holding Area § entrance * hatch Domestic Test Equip Gowning Trolley ervices and Data Room Wash Room Room WC Reception * * Materials Store Training Wash Room Chemic * Transferal Hatch Transfer Hatches * Staff * Mater ls Tran er Roo Room Washer- disinfectors IAP Washer- disinfectors * IAP * Gowning Packed Product Goods R oom Transfer Facility entrance Domestic Services Room Sterilizer loading area Despatch Cooling Area Processed Products Store Waste Interlocking doors Work flow * ∞ Controlled exterior access Raw materials Departmental personnel § Controlled interior access (within wash room) Note: this diagram does not provide for specialist plant Non-departmental personnel areas, ie ventilation plant, reverse osmosis, clean steam and compressors Figure M1–29 SSD layout (source: DH Estates and Facilities and HBN 13 https://www.gov.uk/government/publications/the-planning-and-design-of-sterile-services-departments) Exercises and Checklists You have been introduced to a central sterile service department and what an important function it provides to safe patient care. The following exercises will help you compare what you have learned to real-world examples in your current training environment. Assignment Compare what you have learned to real-world examples in your training environment. Explore your current department by completing the exercise in your log book. MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY Table of Contents Analyzing Medical Terms ____________________________________ 27 Common Prefixes and Suffixes Pre-Module Quiz __________________ 30 Organization of the Body Multicultural Workplace _________________ 39 The Integumentary System Introducing Khaled and Maryam - The Skeletal System Pre-Module Quiz __________________________ 50  2 MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY Introduction While learning medical terminology, you will also learn some basic anatomy (body struc- tures), physiology (body functions), and pathology (body diseases). Because medical termsdescribe the human body in health and in disease, attaining an elementary understanding of these topics will help you retain a working memory of medical language. Learning medical terms can be easy if you approach the subject from a proper perspective.Begin by telling yourself that medical terms do not make up a separate language. Medical terms are simply words that you can add to your vocabulary. As with all words, medical words are meant to convey information. As you enter a medical profession, you will be communicating with other medical profes-sionals and with patients. Therefore, your job will include choosing words and sentence structures that convey accurate information and reflect a professional attitude. That is to say, both your communication skills and your attitude toward patients are very important.As you are about to discover, learning medical terminology can be easy at times and challenging at others. Analyzing Medical Terms Introduction There are many ways and various books to help you learn medical terminology. This book is intended for a short course in medical terminology and focuses on medical terms, their definitions, and brief exercises to help you quickly gauge your understanding. That means this book can be worked through in as little as 8 weeks. Our goal is to give you all the basics you will need to be successful in your career, while allowing you to have a little fun learning. Latin and Greek word parts are found here. These word parts can be combined to make thousands of medical terms and understanding the basic word parts is the first step towardunderstanding complete words. While it is possible to memorize the definitions of individual medical words, understanding just the parts that make up the medical word is easier and faster than learning every word because there are fewer word parts than complete words.In fact, approached the right way, medical terminology may be the easiest subject in your program. Learning it takes a bit of thought and an open mind; but it need not involve sweat- ing or ripping out your hair in frustration. Why is medical terminology important? Can’t medical professionals just use simple wordslike “gut” and “cut”? Unfortunately, these aren’t always specific enough. Gut can refer to the stomach, small intestine, large intestine, or any part of your digestive system. If you have pain in one of these areas, you would want to be able to easily identify a single area and have all medical professionals recognize that specific area. The term “cut” could mean just an incision, or in other cases it could mean cutting off a body part. For example, “She cut herhand” indicates an incision, but “Cut the hand distal to the wrist” could mean an amputation. Luckily medical terminology allows us to specifically identify places in the body and even what type of cut it is with words. Figure 1-1 The foundation of medical terminology is rooted in learning the four basic word parts: prefixes, roots, suffixes, and combining forms. You’ll learn how to distinguish among theseword parts in order to combine them into meaningful medical terms. First, let’s examine some medical term characteristics. Most medical terms are derived from Latin and Greek languages. While this may make them seem “foreign,” 75% of all English words are derived from Latin and Greek. When you look up a term in the dictionary, its etymology, or word origin, is usually given along with its definition. For example, demen-tia is an impairment of cognitive function marked by memory loss. MEDICAL TERM PARTS Nearly every medical term contains one or more roots. It may also contain one or more prefixes and one or more suffixes. When you start combining parts into words, you will alsouse a combining form of a root. This means a single medical term may consist of one part or several parts, but every part of a term behaves in one of three ways: root, prefix, or suffix. The good— and maybe surprising—news is that these three parts also make up all other English words. The even better news is that as an English speaker, you already know a lot of these parts, especially prefixes and suffixes. Here is the order of word parts used in forming words: prefixes first, roots second, and suffixes last, assuming a word contains all three parts. If a prefix is present, it appears at the beginning of the term. A root is next. The root is found in the middle of the word, and they form words by adding prefixes or suffixes to them. Suffixes are always the endings ofwords. A combining form is used in combination with another word part that is distinct froma prefix or suffix that adjusts the sense or function of the word. Some words, such as nontraditional, contain all three-word parts. The prefix is non- (not), the root is tradition (established customs or norms), and the suffix -al (makes the word anadjective meaning “relating to”). This word is thus an adjective meaning “not relating to customs or norms. EXAMPLE: There are movements that encourage women to seek nontraditionaloccupations such as firefighting. Some words contain only two parts, such as traditionist. Tradition is the root and–ist is thesuffix that refers to “adhering to a system of beliefs or customs.” So, a traditionist is a person with established beliefs or customs. EXAMPLE: Mr. Brown, who asked that boys in his classroom removed their hats, was consid- ered a traditionist. Other words contain other combinations, such as nontradionalist (the prefix non- = not; theroot tradition = established customs or norm; the suffix-al = adjective form meaning relat- ing to; and another suffix –ist = refers to adhering to a system of beliefs or customs). So, a nontraditionalist is a person without established beliefs or customs. EXAMPLE: Mrs. Brown, who didn’t mind boys wearing hats in her classroom, was consid- ered a nontradionalist. Analyzing Medical Terms Learning to pick out prefixes, roots, and suffixes, as is done for you in Table 1-1, will permit you to define many, or even most, medical terms. Before going any further, we must deal with what has been traditionally referred to as a fourth word part: the combining form. A combining form is simply a root that includes one or more vowels tacked onto the end of itto make a root– suffix combination pronounceable, as in the word psychology. The main rootis psych (mind), and the suffix is -logy (study of). But “psychlogy” doesn’t flow as well as psychology, thus we insert the “o” to create a more English- sounding word. So, as the example shows, the combining form concept is all about vowels, consonants, and pronuncia-tion. A problem thus arises. That problem is that we remember a word (or a word part, for that matter) in two ways: by recalling the sound it makes when we hear it spoken and by thesound a visual combination of its letters makes when we see it written. Table 1-1 Analysis of example words Term Prefix Root Suffix Term Meaning fibromyalgia, pain in the heart; also, cardialgia cardi (heart) heartburn (a digestive neuralgia disorder) cardiology cardio (heart) -logy (study of) Study of the heart andits disorders card (heart) -itis Inflammation of the carditis heart (inflammation) diagnosis dia-(across; gnosis (Greek word meaning Discovery of the cause of through) “knowledge”) signs and symptoms iatrogenic iatro -ic (adjective Disease caused by health (physician); gen(origin, care (whether anindividual disease cause) suffix) worker, particular institution, o the system as a whole) d psycho (mind); path(disease) Person with a (serious) psychopath mental disease The root psycho comes from the Greek word psyche, which means soul or mind. The suffix-es -ist and -ician mean practitioner, and the suffixes -y and - ics mean practice. The final two items in the list introduce two new roots: ger/o and ped/o, the meanings of which you may deduce from the meanings of the terms geriatrics and pediatrician. The root ger/o (also sometimes ger/onto) comes from the Greekword geron, which means old man. The root ped/o is derived from the Greek word pais, which means child. See Tables 1-2, 1-3, and 1-4, which list a sampling of roots, suffixes, and prefixes. Studythese so you can start building and defining terms. TABLE 1-2 WORD ROOTS TO BEGIN TABLE 1-3 PREFIXES TO BEGIN BUILDING BUILDING TERMS TERMS Word Root Meaning Prefix Meaning arthr/o joint epi- upon, following, or subse- quent to card/i/o heart micro- small derm/o/ato skin peri- around gen/o origin, cause, formation post- after ger/o/onto old age pre- before hem/a/ato blood SUFFIXES TO BEGIN BUILDING TABLE 1-4 TERMS iatr/o physician Suffix Meaning muscul/o muscle -al adjective suffix natal birth; born -algia pain neur/o nerve -dynia pain os/teo bone -gen, -genesisa origin, cause, formation path/o disease -ic adjective suffix denoting of ped/ia child phren/o diaphragm, mind -itis inflammation psych/o mind -logy study of skelet/o skeleton -pathy disease tend/o, tendon -scope viewing, an instrument used for ten/o viewing Common Prefixes and Suffixes ORD ROOTS INTRODUCED IN THIS CHAPTER Table 2-1 lists common word roots with their meanings to get you started on your task of learning hundreds of medical terms. You may wish to memorize the roots given in the table now, because there are just a few. Or if you prefer, just give them a quick glance now and, asyou go through the chapter, refer back to this table whenever you run across a term with a root you do not recognize.  TABLE 2-1 COMMON WORD ROOTS AND MEANINGS Word Root Meaning arter/i/o artery arthr/o joint card/i/o heart derm/at/o skin gen/i/o origin, cause, formation ger/o/onto old age hem/a/t/o blood iatr/o physician muscul/o muscle neur/o nerve, nerve tissue oste/o bone path/o disease ped/i/o child phren/o diaphragm, mind psych/o mind skelet/o skeleton spin/o spine tend/i/n/o tendon CATEGORIES OF PREFIXES Not all medical terms include a prefix, but when one is present, it is critical to the term’s meaning. For example, hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) are conditions that are exact opposites. Confusing those two prefixes creates errors.Two other similar- sounding prefix pairs prone to creating errors are ante- and anti-. The prefix ante- means “before,” and the prefix anti- means “against.”  Term Part Meaning hypoglycemia prefix: hypo- = low root: glyc/o- = sugar suffix: -emia = condition antecubital prefix: ante- = before root: anterior to the elbow cubitum = elbow anticoagulant prefix: anti- = against preventing coagulation(clotting) root: coagulant = substance that causes blood to clot. Prefixes of Time or Speed Prefixes denoting time or speed are used in everyday English. Prehistoric and postgraduateare common words with a prefix relating to time. Prefixes denoting speed, such as tachy- (fast) and brady- (slow), are often used to describe heart rate. Table 2-2 lists prefixes relat- ed to time or speed. Table 2-2 PREFIXES OF TIME OR SPEED Prefix Refers to Example Meaning ante-, pre- before antepartum, premature before birth, before full development brady- abnormally slow rate of bradycardia abnormally slow heartbeat speed neo- new neonatal newborn (adjective) post- after postscript a written thought added after themain message tachy- rapid, abnormally highrate tachycardia abnormally fast heartbeat of speed Prefixes of Direction The word abnormal is an example of a word containing a prefix that signifies direction. Weuse such prefixes in everyday life without bothering to analyze them. For example, we normally would not take the time to think about the prefix contra- (against) in the word contradiction, yet we understand its meaning. Prefixes related to direction are listed in Table 2-3. Table 2-3 PREFIXES OF DIRECTION Prefix Refers to Example Meaning ab- away from, outside of, abnormal beyond not normal ad- toward, near to adjective toward a noun con-, sym-, with, within congenital,sympathetic, with (or at) birth, with feeling toward,with syn- synthetic the same idea or purpose contra- against contraband substance against the law dia- across, through diameter a line through the middle Prefixes of Position Infrastructure (infra-means inside or below), interstate (inter- means between), and paralegal (para- means alongside) are all words we frequently use that include prefixes of position. Having these prefix meanings already in our working vocabularies makes it easierto learn their medical uses. Prefixes of position are commonly used during diagnostic and treatment procedures. Table 2-4 lists prefixes relating to position. Table 2-3 PREFIXES OF POSITION Prefix Refers to Example Meaning ec-, ecto-, outside extraction removal to the outside ex-, exo- en- inside encephalopathy disease inside the head, brain disease endo- within endoscopy visual examination of the insideof some part of the body epi- upon, subsequent to epigastric adjective referring to something above the stomach extra- beyond extracellular adjective referring to something outside a cell or cells hyper- above, beyond normal hyperglycemia high blood sugar hypo- low, below, below hypogastric region beneath the stomach normal adjective referring to something infra- inside or below infrarenal below the kidneys inter- between interosseous between bones entra- inside, within intracerebral inside the cerebrum  meso- middle mesothelioma tumor arising from the mesothelium low, below, belownormal metacarpal the bone beyond the carpus; one of meta- five bones in either hand pan- inside or below pancarditis general inflammation of the heart para- between paraplegia paralysis of the lower half of the body peri- inside, within perivascular in the tissues surrounding a vessel retro- inside, within retrosternal adjective referring to something behind the sternum Prefixes of Size and Number A semiannual (semi- means “half,” annual means “yearly”) sale is one that occurs every 6months. The unicorn (uni- means “one”) is a fictitious creature that has one horn. Prefixes ofsize and number are very common. Table 2-5 lists prefixes related to size and number. Table 2-5 PREFIXES OF SIZE AND NUMBER Prefix Refers to Example Meaning bi- two biannual twice per year two, twice diplopia double vision di-, dipl- hemi- half hemiplegia paralysis of one body side macro- big macrocyte big call small microscope micro- instrument to view small objects mono- one monocyte cell with one nucleus a few, a little oliguria scant urine production olig-, oligo- pan- all or everywhere pancarditis whole heart inflammation poly- many polydactyly more than five hand or foot digits four quadriplegia quadri- paralysis of all four limbs half, partial semiannual occurring every half year semi- tetra- four tetradactyl having only four hand or foot digits tri- three triceps three-headed muscle uni- one unicellular one-celled Prefixes of Negation Negation means absence or opposite of something. These include words like antidepres- sant (anti- means “against”) and decriminalize (de- means “without”). Table 2-6 lists prefix-es related to negation. Table 2-6 PREFIXES OF NEGATIONR Prefix Refers to Example Meaning a-, an- not anuria not able to urinate anti- against, opposed antibiotic drug that inhibits microbes de- without dehumidifier device that removes water dis- remove disable put out of action Suffixes Signifying Medical Conditions The suffix -porosis, which means porous, is added to the root oste/o, to form the term osteo- porosis, which means “a porous condition of bone.” See Table 2-7 for more examples. Table 2-7 SUFFIXES THAT SIGNIFY MEDICAL CONDITIONS Suffix Refers to Example Meaning -algia, -dynia pain biannual twice per year protrusion, hernia Rectocele hernia of the rectum -cele -cyte Leukocyte white blood cell Cell -ectasis, expansion ordilation Angiectasis dilation of a vessel -ectasia -edema (also a excessive fluid Angioedema Fluid buildup that causes swelling standalone word) under the skin -emesis Vomiting Hematemesis Vomiting of blood Blood Uremia Urea in the blood -emia -iasis Cholelithiasis , Stones in the gallbladder Condition orstate or bileducts. sometimes alsospelled ‘’ chlololithiasis’’ -ism a condition of, a Hypothyroidism condition characterized by process, or a state of thyroid hormonedeficiency Inflammation Appendicitis Inflammation of the appendix -itis -lith Stone , calculus, Pneumolith a stone in the lung calcification -lysis Disintegration , Hemolysis Rupture of red blood cells breaking down -malacia Softening Osteomalacia softening of the bones  Enlargement Gastromegaly enlargement of the stomach -megaly -oid resembling orlike opioid substance that resembles opium -oma tumor gastroma tumor of the stomach -osis osteoporosis condition of porous bones abnormal condition -pathy disease myopathy disease of the muscle -penia reduction of size or leukopenia low number of white blood cells quantity -phobia fear carcinophobia fear of cancer abnormal formation neoplasia abnormal growth of cells -plasia -plegia hemiplegia paralysis on one side of the body paralysis -pnea breathing tachypnea rapid breathing producing erythropoiesis production of red blood cells -poiesis -porosis porous condition osteoporosis porous -ptosis downward nephroptosis downward displacement of a kidney displacement significant discharge of blood from -rrhage flowing forth hemorrhage blood vessels discharge rhinorrhea discharge from the nose (runny -rrhea nose) rupture hysterorrhexis rupture of the uterus -rrhexis -sclerosis hardness atherosclerosis hardening of the arteries -spasm muscular angiospasm muscular contraction of a vessel contraction level, unchanging a constant, consistent internal body -stasis thermostasis temperature a narrowing arteriostenosis narrowed arteries -stenosis Suffixes Signifying Diagnostic Terms, Test Information, or Surgical Procedures Suffixes that form terms related to test information, diagnoses, and procedures are often attached to a root that signifies a body part. The term appendectomy is an example. The suffix - ectomy means “removal of,” and append is the root for appendix. Thus, the term means “removal of the appendix.” Table 2-8 lists common suffixes that signify Table 2-8 SUFFIXES THAT SIGNIFY DIAGNOSTIC TERMS, TEST INFORMATION,OR SURGICAL PROCEDURES Suffix Refers to Example -centesis surgical puncture thoracentesis -desis surgical binding arthrodesis -ectomy surgical removal appendectomy -gen, -genic, origin, producing osteogenic - genesis a recording, usually by an instrument electrocardiogram -gram -graph instrument for making a recording electrocardiograph -meter instrument for measuring audiometer -metry audiometry act of measuring -opsy examination autopsy -pexy surgical fixation hysteropexy -plasty surgical repair rhinoplasty -rrhaphy suture herniorrhaphy -scope instrument for viewing arthroscope -scopy act of viewing arthroscopy -stomy artificial or surgical opening tracheostomy -tome instrument for cutting dermatome -tomy incision colotomy -tripsy crushing lithotripsy diagnostic terms, test information, or surgical procedures. Suffixes That Name a Medical Practice or Practitioner Some suffixes relating to a medical practice or practitioner are derived from the Greek word iatros, which means “physician” or “medical treatment.” This Greek word is the sourceof the root iatr/o. For practical purposes, you may consider the root iatr as an integral partof the suffixes - iatric and -iatr, as in the terms geriatrics, psychiatric, psychiatry, psychia- trist, pediatrics, and pediatrician. Although both -ician and -ist are used in referring to a specialist, the suffix -ist is perhaps the more common one. An example is gerontologist, a physician who diagnoses and treats disorders of aging. Terms denoting a field or medical specialty may also end with the suffix - logy. Table 2-9 lists the suffixes for medical practice and practitioners. Table 2-9 SUFFIXES THAT SIGNIFY MEDICAL PRACTICE AND PRACTITIONERS Suffix Refers to -ian specialist -iatrics medical specialty -iatry medical specialty -ics medical specialty -ist specialist in a field of study -logy study of Suffixes That Denote Adjectives As with suffixes that signify medical practice and practitioners, suffixes used to create adjective forms are not governed by a clear set of rules. Nevertheless, there are some rulesthat come into play, such as the rules of English pronunciation. For example, we replace the final letter, x, in the word appendix with a c to form the adjective appendicitis because “appendixitis” does not sound much like an English word. In creating adjectives, we also sometimes change noun terms that name specialties. For example, psychiatry and pediatrics are the names of specialties. Dropping the y from psychi-atry and adding the adjective suffix -ic converts the specialty name to an adjective: psychiatric medicine psychiatric hospital With pediatrics, on the other hand, all we need to do to form the adjective is drop the s: pediatric medicine pediatric hospital Examples of adjective suffixes are listed in Table 2-10. Table 2-10 SUFFIXES THAT DENOTE ADJECTIVES Suffix -ac, -al, -an, -aneous, -ar, -ary, -eal, -eous, - iac, -iatric, -ic, -ical, -oid, -otic, -ous, -tic, - ular Prefixes and suffixes presented in this chapter will become familiar as you progress through the next chapters on body systems. Review the following study tables and do theself-testing exercises.  ORGANIZATION OF THE BODY Learning Outcomes Upon completion of this chapter, you should be able to: 1 Discuss the levels of body organization. 2 Describe the anatomic position and cite the directional terms used in relation to the body. 3 Name the body planes. 4 Name the body cavities. 5 Name the divisions of the abdomen and back. Pronounce, define, and spell each term introduced in this 6 chapter. Introduction Learning about how the human body is constructed will help you retain new medical terms by creating a mental picture of where things are. To begin, it is also useful to know the difference between the terms anatomy and physiology. Anatomy comes to us from the Greek word anatome, which means “dissection.” You may have recognized the word part “tome,” which indicates that anatomy has something to do with cutting. Physiology, on the other hand, is one of the many “ology” words; in this case, it means study of how the body’s parts work together. In short, anatomy reveals the “what it is” and physiology the “how it works.” The “what it is” begins with chemicals that act together to form cells. The cells process the food we eat and the air we breathe. Cells also reproduce themselves, each cell according to the DNA code it contains. WORD PARTS RELATED TO BODY ORGANIZATION Table 3-1 lists many of the word parts that make up terms related to the body as a whole. Not surprisingly, many of them have to do with how the body is divided or where things are located. Table 3-1 WORD PARTS RELATED TO BODY ORGANIZATION Word Part Meaning anter/o front, anterior cerv/o neck chondr/o cartilage cyt/o, -cyte cell dors/o back gastr/o stomach, abdomen inguin/o groin my/o muscle myel/o spinal cord neur/o nerve, neuron poster/o posterior, back proxim/o near super/o superior thorac/o thorac/o chest (thorax) chest (thorax) trans- across trans- across LEVELS OF ORGANIZATION The body is divided into different levels of organization, starting with the smallest level: cells, tissues, organs, organ (body) systems, and finally organism, which is the body as a whole. Each level is further examined under its own heading (see Figure 3-1). FIGURE 3-1 The levels of organization in the body beginning with the cell and ending with the organism. Cells A human body is said to have 10 trillion to 100 trillion cells, depending on whom you ask. Of course, no one has ever actually counted the number of cells in a body, but as all the esti- mates are in the trillions, it’s easy to appreciate the body’s complexity as a functioning whole. Cells work both individually and together. Although cells differ from one another and consist of different components, they do have some common elements (see Figure 3- 2): A cell membrane that allows certain substances in and out A nucleus that directs activities within the cell Mitochondria that generate energy for the cell Cytoplasm that is a watery fluid that fills the spaces outside the nucleus  FIGURE 3-2 Basic structure of a cell. The basic structure of a cell includes the cell membrane, nucleus, mitochondria, and the cytoplasm. Tissues Cells make up tissues, which are composed of similar cells working together to perform similar tasks. The four types of body tissues are muscle, connective, nerve, and epithelial. Organs Tissues with common functions come together to form the body’s organs, which perform specialized functions. Examples of organs are the brain, stomach, and heart. Systems A group of organs forms an organ (body) system, and each system has its own special purpose. Therefore, the rest of this book discusses each system in a chapter of its own. NAVIGATING THE BODY Health care professionals need to be familiar with directional and positioning terms. These terms are frequently used during patient examinations, diagnostic procedures, and treat- ments. Anatomic Position Directional terms in the field of human anatomy differ from plain language in two ways: first, unlike terms of location, directional terms are language- specific; second, directional terms are specified relative to the anatomic position. In the anatomic position, the body is erect and facing forward, and the arms are at the sides with the palms of the hands facing forward). Left and right are from the subject’s perspective, not the observer’s perspective. FIGURE 3-3 Anatomic position. In the anatomic position, the person is standing erect, and palms and body are facing forward. Directional Terms Directional terms are adjectives that help describe a complaint, symptom, body part, or process. These terms often have anoth- er term that is its opposite, and it is helpful to memorize these terms with their oppo- site in order to differentiate and under- stand them. Superior means above or nearer to the head. Two other words, cranial and cephal- ic, also mean “toward the head.” For exam- ple, “The bruise is superior to the eyebrow.” Inferior and caudal mean below or toward the feet, as in “The mouth is inferior to the nose.” Anterior is a direction- al term that relates to the front of the body. An example of the use of anterior would be, “The rash covered the entire anterior of the left thigh.” Ventral, usually used in veterinary anatomy, pertains to the front (anterior) or undersurface of an animal. Posterior specifies the back or toward the back of the body. Dorsal, generally used in veterinary anatomy, pertains to the back (posterior) or upper surface of an animal. Medial means toward the midline of the body, and lateral means away from the body’s midline or toward the side. You may see the adjective lateral used for descriptive purposes as in, “The tumor is located on the lateral wall of the left lung.” The final two directional terms are proximal and distal. Proximal refers to something nearer to the body trunk or point of attachment to the body: The shoulder is proximal to the elbow. Distal means further from the body trunk or point of attachment: The wrist is distal to the shoulder and the elbow. See Figure 3-4 for an illustration showing directional terms. FIGURE 3-4 Directional terms describe the body part in relationship to another. Two terms are used for placing patients in a lying down position. Both are common English words that have been adopted by medical terminology. The two terms are supine and prone. Supine refers to a position in which the patient is lying face up. (It means the same thing in plain English, but it can also mean lazy or simply reluctant to act.) Noticing that the word “up” is included in the first syllable of the word “supine” will help you remember its mean- ing of “face up” in medical terms. Prone is the opposite of supine and means that the patient is lying face down. Prone, too, means the same thing in plain English with another meaning: “tending toward,” as in “Smith is prone to making poor choices.” Both supine and prone are frequently used in the operat- ing room and in X-ray reports. For example, “The patient was placed in the supine position.” This means that the patient was placed on the operating table on his or her back, lying face up. See Table 3-2 for body position and direction terms. Table 3-2 BODY POSITION AND DIRECTIONAL TERMS Term Direction Example Anterior toward the front The eyes are on the anterior surface of the face. Ventral toward the belly or The nipples were on the ventral body undersurface surface. Posterior toward the back The spine is on the posterior side of the body. dorsal toward the back or The vertebrae are on the dorsal surface. upper surface superior above; toward the The neck is superior to the chest. head cranial relating to the head The brain is in the cranial cavity. cephalic relating to the head The neck is cephalic to the hips. inferior below; toward the The knee is inferior to the hip; the stom- soles of the feet ach is inferior to the chest. caudal pertainting to the tail The coccyx is caudal to the sacrum. proximal near the point of attach- The elbow is proximal to the wrist. ment to the trunk distal farther from the point of The fingers are distal to the wrist. attachment to the trunk lateral pertaining to the side; The eyes are lateral to the nose. away from the middle medial toward the middle The nose is medial to the eyes. of the body prone lying flat and face The patient was placed on the operating downward table in a prone position. supine lying flat and face The patient was placed on the operating upward table in a supine position.  Body Planes Body planes are imaginary surfaces within the body (see Figure 3-5). The anatomic position is always their reference point. Three planes are frequently used to locate structural arrangements. Frontal (coronal): The frontal (coronal) plane separates the front (anterior) of the body from the back (posterior). Sagittal: The sagittal plane is any vertical plane that divides the body or organ into unequal left and right sides. Transverse (horizontal): This transverse (hori- zontal) plane separates the body into upper (superior) and lower (inferior) planes, cutting “across” the body. FIGURE 3-5 Body planes divide the body into halves in different ways for reference purposes. BODY CAVITIES AND DIVISIONS A body cavity is defined as a hollow space that contains body organs. The body has several major cavities, including the cranial, spinal, thoracic, and abdominopelvic. The cranial cavity houses the brain, and the spinal cavity houses the spinal cord. The thoracic cavity contains the lungs, whereas the abdominopelvic cavity contains digestive and repro- ductive organs. The abdominopelvic cavity is divided into a superior abdominal cavity and an inferior pelvic cavity. The diaphragm is the muscle of breathing known and it physically divides the thoracic and abdominopelvic cavities (see Figure 3-6). FIGURE 3-6 The major body cavities shown in lateral view.  Divisions of the Abdominopelvic Cavity A person documenting a physical exam- ination or a surgical procedure needs to describe incisions, procedures, and location of organs. In order to do this effectively, the abdominopelvic cavity is divided into two different ways: either nine regions or four quadrants (see Figure 3-7A, B; Tables 3-3 and 3- 4). FIGURE 3-7 Abdominopelvic cavity. A. The nine regions of the abdominopelvic cavity. Table 3-3 NINE REGIONS OF THE ABDOMEN Region Description left hypochondriac region left lateral region just below the ribs left lumbar region left lateral region in the middle row left inguinal region left lower region of the lower row by the groin epigastric region middle region in the upper row umbilicus middle region in the middle row hypogastric region middle section in the lower row right hypochondriac region right lateral region just below the ribs right lumbar region right lateral region in the middle row right inguinal region right lower region of the lower row by the groin Table 3-4 FOUR QUADRANTS OF THE ABDOMEN Term Organs in Quardrant right upper quadrant (RUQ) right lobe of liver, gallbladder, portions of the pancreas, small intestines, and colon Left upper quadrant (LUQ) left lobe of liver, spleen, stomach, portions of the pancreas, small intestines, and colon Right lower quadrant (RLQ) contains portions of small intestine and colon, right ovary and uterine tube, appendix, and right ureter Left lower quadrant (LLQ) contains portions of small intestine and colon, left ovary and uterine tube, and left ureter Nine Regions Regions are used to describe the location of underlying organs. Note that in the following list, the number in parentheses refers to two sides within the region, a left and a right, and counts as two regions (see Figure 3-7A and Table 3-3). The regions are named as follows: Hypochondriac (2): There are right and left hypochondriac regions. Chondr- means “carti- lage,” and you will recall that the prefix hypo- means “below.” Hence, these areas are below the cartilage of the ribs on the left and right sides. Epigastric: This area is just superior to the stomach. Epi- is a prefix that means “beside” or “upon.” This area is above the stomach and is situated between the left and right hypochon- driac regions. Lumbar (2): There are right and left lumbar regions. They are located at waist level on either side of the navel. Umbilical: If you look at the nine regions as a tic-tac-toe chart, the umbilical region is the middle section. It contains the umbilicus (navel). Hypogastric: This is the bottom square in the middle column of the tic- tac-toe chart, just inferior to the umbilical section. Inguinal (2): There are right and left inguinal regions. They lie on either side of the hypogas- tric section. Inguinal also refers to the “groin” area. Doesn’t the word hypochondriac have another definition? Yes, someone with imagi- nary pains is called a hypochondriac, and the reason for this usage came about because the left side hypochondriac region is roughly where a hypersensitive person might interpret any discomfort as a heart attack. Four Quadrants Four quadrants identify the abdomen (see Figure 3-7B and Table 3-4). The center point is the navel. The quadrants are abbreviated as follows: right upper quadrant (RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and left lower quadrant (LLQ). FIGURE 3-7 B. The four quadrants of the abdominopelvic cavity. (continued) Regions of the Spinal Column The spinal column is a series of vertebrae that extend from the head to the coccyx. The five regions include the cervical (C), thoracic (T), lumbar (L), sacral (S), and coccyx (Co). They are labeled with a capital letter that corresponds to the name of the region (see Figure 3-8; Table 3-5). Cervical C1-C7 + Thoracic T1-T12 FIGURE 3-8 The regions of the spinal column show the locations of the vertebrae. Table 3-5 REGIONS OF THE SPINAL COLUMN Region Location cervical Neck Thoracic Chest Lumbar Lower bacl below waist Sacral Lower back Coccyx tailbone The terms for each region describe a part of the back. The cervical section describes the cervix (meaning neck). The thoracic section describes the thorax (meaning chest), the lumbar section describes the lumbus (meaning loin, or part of the side and back between the ribs and the pelvis), the sacral region describes the sacrum (lower back), and the coccygeal region describes the coccyx (tailbone). It is important to recognize which word is the body part and which word is the adjective describing the region in which that body part is located. Notice that lumbar is used to describe abdominopelvic regions and is also used to describe a section of the back. The lumbar is “the part of the back and sides between the ribs and the pelvis,” so it makes sense that it could be used to describe both of these divisions.  THE SKELETAL SYSTEM Learning Outcomes Upon completion of this chapter, you should be able to: 1 Name the major structures and functions of the skeletal system. 2 Differentiate between the axial and appendicular skeleton. 3 State the medical terms that name the three types of joints. 4 Pronounce, spell, and define medical terms related to the skeletal system and its disorders. 5 Interpret abbreviations associated with the skeletal system. Introduction Our skeletons form the basic structures of our bodies, much like the framework of concrete and steel does in a tall building. Buildings constructed in earthquake zones are designed to move and sway so they won’t fall down when the earth moves beneath them. We look upon such buildings as marvels of modern engineering, perhaps without giving a thought to the human skeleton, which allows us to walk, run, talk, gesture, throw things, and even draw up plans for tall buildings. WORD PARTS RELATED TO THE SKELETAL SYSTEM Many terms having to do with the skeletal system are made up of the word parts listed in Table 5-1. Other word parts you have already learned are also used to make up some terms in this chapter. Prefixes you learned in Chapter 2, such as dia- (through), epi- (outside), endo- (inside), and peri- (around), for example, will be evident in terms introduced under the “Structure and Function” heading. Important word parts to know for this chapter are related to the Greek words, osteon for bone and mys for muscle. It is also important to know that not every term has a root. The reason is simple: we borrow freely from Greek and Latin, and if you stop to think about that practice, you will realize that every word or word fragment we use is—in a narrow sense at least—a potential root. In other words, prefixes and suffixes can sometimes form the central idea of a term. Table 5-1 WORD PARTS RELATED TO SKELETAL SYSTEM Word Part Meaning -algia pain amphi- both sides ankyl/o stiff, fused, closed arthr/o joint btachi/o arm calcane/o calcaneus, heel bone crap/o wrist cervic/o neck chondr/o cartilage cost/o rib crani/o cranium dactyl/o finger, toe -ectomy surgical removal electr/o electricity femur/o fermur, thighbone -gram written record of humer/o humerus, upper arm bone -itis inflammation kinesi/o movement -kinesia movement kyph/o hump -logy study of lord/o swayback, curve lumb/o lower back -malacia softening muscul/o muscle my/o muscle myel/o bone marrow -oma tumor orth/o correct, straight os/te/o bone ped/o foot, child pelv/o pelvis phalang/o bones of fingers and toes -physis growth -plasty surgical repair -porosis porous -scopy to visually examine spondyl/o vertebrae syn- joined together thorac/o thorax , chest vertebr/o vertebrae zygo- joined (yoked) together STRUCTURE AND FUNCTION The human skeleton begins to form about 6 weeks after fertilization and continues to grow and develop until the person is around 25 years old. Its approximately 206 D Axial bones have many functions. The skeleton serves as a rigid but articulat- ing (movable at joints) framework for mus- skeleton cles and other tissues. It also protects our vital organs by forming a shield against jarring and bumps. Its less obvious jobs are to store minerals and to make blood cells. The skeleton is divided into two parts: the axial skeleton and appendicular skeleton (see Figure 5-1). The words axial and appendicular are adjective forms of the words axis and appendix. Axis is the Latin word for “axle,” but has become a common English word meaning an imaginary straight line, such as the one between the north and south poles of the earth. The axial skeleton has an axis running from the FIGURE 5-1 Axial and appendicular skeletons. middle of the top of your head to the bottom The axial skeleton is shown in yellow, and the of your spine. The axial skeleton therefore appendicular skeleton is shown in gray. includes the bones on this axis: the skull, chest, and spinal column. The appendicular skeleton comprises the arms and legs, along with the shoulder and pelvic bones. Although the appendicular skeleton has nothing to do with the body’s “appendix,” those two body parts do have a common classic word origin: the Latin word appendix refers to something attached to something else. Thus, the appendicular skeleton is attached to the axial skeleton, and the appendix is attached to the large intestine. The skeletal system depends on ligaments, tendons, and joints to allow for movement. Ligament comes from the Latin word ligamentum, meaning “a band” or “banding.” Ligaments are bands of tissue that connect two bones together. Tendon comes from a different Latin word, the verb tendere, which means to stretch, which is what tendons do. Tendons attach muscles to bone. The difference between these two connective tissues is that ligaments connect two bones, whereas tendons connect a muscle to a bone. Strictly speaking, of course, these two terms belong to the muscular system, but they are mentioned here because their function is essential to the skeleton. Joints, also called articulations, are the places where bones come together. They are not separate structures or tissues. Ossification is bone formation and it begins early in fetal development when the skeleton is Proximal composed mostly of cartilage. During the epiphysis Epiphyseal plateL- second and third months of fetal development, -- Periosteum cartilage hardens and turns into bone. Bone is Compact bone made up of osseous tissue, a form of connec- Medullary cavity Endosteum tive tissue with mature bone cells called osteo- cytes. The bones of the skeleton are of different shapes, sizes, and makeup. They may be essen- tially flat, such as those found in the cranium and ribs. They may also be short, such as those Distal epiphysis in the wrist and ankles, or long, such as those found in the arms, legs, hands, and feet. Long bones have subparts that are named. The term diaphysis is the shaft of a long bone, and the term epiphysis is the name given to each end of a long bone. FIGURE 5-2 Parts of a long bone. The epiphyseal plate is the growth area of a long bone. The term for the inside of the diaphysis is medullary cavity. Because it is a cavity, it is hollow, and medullary means that the cavity contains marrow. Marrow is the tissue that produces blood cells. Compact bone is hard, dense bone and makes up the diaphysis. Spongy bone is mesh-like bone tissue and is found in the epiphyses. Most bone surfaces are covered with a membrane called the periosteum. The inner surface of the medullary cavity is lined with a thin layer of cells called the endosteum (see Figure 5-2). By now, you are probably familiar with the prefixes peri- and endo-. But if you didn’t auto- matically identify those prefixes, as meaning around and inside, you may benefit from a review of Chapter 2, Table 2-8. The Axial Skeleton The axial skeleton is composed of the bones of the cranium (head), thorax, and vertebral column (series of vertebrae from the cranium to the coccyx). Cranial bones enclose and protect the brain. The six main cranial bones include the frontal bone; two parietal bones, one on each side; two temporal bones, on the sides of the head; and the occipital bone (see Figure 5-3). The main facial bones are the nasal bone, zygomatic bones, the maxilla, and the mandible. FIGURE 5-3 The bones of the cranium, face, and the associated sutures. The nasal bone forms the bridge of the nose, and the two zygomatic bones form the cheeks. The maxilla is the immovable upper jawbone, and the mandible is the movable lower jawbone. The cranial bones are joined by cranial sutures, which are fibrous mem- branes that join them. These include the coronal suture, squamous suture, and lambdoid suture. Isn’t maxilla Latin for jawbone? Yes. So where does the word mandible come from if we already have a Latin word for jawbone? Mandible comes from the Latin word mandibu- la, which means “to chew,” and the mandible moves while chewing. The skeleton of the thorax (thorax, breastplate) is known as the thoracic cage. The thoracic cage includes the 12 thoracic vertebrae, 12 ribs, costal (rib) cartilages, and the sternum. Parts of the flat sternum are the manubrium, body, and xiphoid process. The major organs inside the thoracic cage are the heart and lungs (see Figure 5-4). Rib pairs are attached to their correspondingly num- bered vertebrae (back bones). Ribs 1 to 7 are called true ribs or vertebrosternal ribs because their carti- lages attach directly to the sternum. Ribs 8 to 12 are the five lower ribs that do not attach directly to the sternum. Ribs 8 to 10 are called false ribs or vertebro- chondral ribs. The last two rib pairs (11 and 12) “float,” which means that they are attached only to the vertebrae (see Figure 5-4). The spinal column includes five sections of vertebrae (vertebra, singular). The naming of a vertebra consists of a prefix letter (C for cervical, T for thorac- ic, and L for lumbar), followed by a number indicating the placement on the column. There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar verte- brae. At the base of the spinal column are the sacrum and coccyx. The sacrum is formed by five fused sacral vertebrae, and the coccyx contains three to five fused coccygeal vertebrae (see Figure 5-5). Isn’t the cervix part of the female reproductive system? The word cervix is Latin for “neck.” The words cervix and cervical refer not only to the “neck” of the uterus, part of the female reproduc- tive system (see Chapter 15), but also to the neck to which the head is attached. FIGURE 5-5 The vertebral column in sagittal (anteroposterior) and anterior views. The sacrum is joined to the hip bones and, therefore, is part of the pelvic girdle, which is part of the appendicular skeleton. Although the sacrum is not part of the axial skeleton, it is men- tioned here because of its association with the vertebral column. The Appendicular Skeleton As mentioned previously, the appendicular skeleton consists of the body’s appendages (upper limbs and lower limbs) and the areas to which these appendages are attached: the shoulder and pelvic girdles. An upper limb is also called an upper extremity, and a lower limb is also called a lower extremity. Shoulder bones, although associated with the chest, are part of the appendicular skeleton. The main bones of FIGURE 5-6 The bones of the shoul- the shoulder girdle are the clavicle (collar- der girdle show the articulation with bone) and the scapula (shoulder blade) (see the humerus. Figure 5-6). The long arm bone extending from the shoulder and ending at the elbow is called the humerus, not because it is the “funny bone” but because humerus Humeus is the Latin word for “shoulder.” Howev- er, there is a connection with the word “humorous.” The phrase “funny bone” was most probably coined as a joke because the ulnar nerve, which causes the pins-and-needles sensation when it is struck, is located where the humer- us joins the elbow (see Figures 5-6 and 5-7). FIGURE 5-7 Bones of the upper limb. The arm contains the humerus, and the forearm is made up of the radius and ulna. The forearm consists of the ulna and radius, which extend from the elbow to the wrist (see Figure 5-7). The wrist includes eight bones, arranged in two rows, called carpal bones (karpos, wrist). These bones are the scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate. The five metacarpals are the hand bones that lie “beyond” the carpal bones, connecting the wrist to the fingers. The 14 phalanges are the bones that make up the fingers. The term phalanges is the plural form of phalanx, which is Greek for “line of soldiers.” The bones of the wrist and hand are shown in FIGURE 5-8 Wrist and hand bones. Eight carpal Figure 5-8. bones form the wrist. Five metacarpals and 14 phalanges form the hand. The pisiform is not visible in this view. FIGURE 5-9 The bones of the pelvic FIGURE 5-10 Bones of the pelvic girdle girdle. and lower limb. The pelvic girdle, so named because it surrounds and protects the pelvic organs, consists of the two hip bones (right and left), joined anteriorly at the pubic symphysis and posteriorly at the sacrum. The hip bone, also called the os coxae, is a fusion of three bones: the ilium, the ischium, and the pubis. The femur, Latin for “thigh,” is a long bone that extends from the hip to the knee, and the tibia and fibula are long bones that extend from the knee to the ankle. The femur attaches to the hip bone at the acetabulum (see Figures 5-9 and 5-10). The tibia, Latin for “shin,” is the shin bone or heavy bone of the leg; the fibula, from the Latin word figibula, mean- ing “fastener,” does not bear the body’s weight, but together with the tibia, it is connected to the talus (ankle bone) (see Figure 5-11). The patella (kneecap) is a “floating” bone that is imbedded in the tendon of the thigh muscle. It offers protection to the knee joint (see Figure 5-10). FIGURE 5-11 Bones of the ankle and foot. Tarsus (from the Greek tarsos, meaning “a flat surface”) is sometimes used as a technical name for the ankle. The seven tarsal bones of the ankle and the five metatarsals of