IMCI UNIVERSE - IBMC PRO - BOOK-2.pdf

IMCI UNIVERSE (P) LTD MEDICAL CODING ACADEMY [OFFLINE & ONLINE] COURSE NAME – IBMC PRO – IMCI BASIC OF MEDICAL CODING 24/7 HELPLINE – 9080905611, 9344244305 WWW.IMCI.IN STUDENT NAME: CONTACT NUMBE...

IMCI UNIVERSE (P) LTD MEDICAL CODING ACADEMY [OFFLINE & ONLINE] COURSE NAME – IBMC PRO – IMCI BASIC OF MEDICAL CODING 24/7 HELPLINE – 9080905611, 9344244305 WWW.IMCI.IN STUDENT NAME: CONTACT NUMBER: QUALIFICATION: 1|Page  Medical Coding Training Material CONTENTS Page: No Introduction of Medical terms and Body parts 3 Medical terminology 9 Integumentary system 23 Musculoskeletal System 29 Respiratory System 43 Cardiovascular System 52 Blood and lymphatic system 61 Digestive / Gastrointestinal system 65 Urinary system 79 88 Male Reproductive System 92 Female Reproductive System 99 Endocrine system 108 Special senses ENT (Ear, Nose, Eye) 111 Eye / Ophthalmology System 122 Nervous System 2|Page  Introduction of Medical terms and Body parts Medical terms: Studies: Biology: Study of all forms of life and living things. Histology: Study of microscopic structures and their composition and function of cells,tissues and organs. Pathology: Study of Disease. Physiology: Study of normal activity and functions of the body. Embryology: Study of embryos and their development. Cell: - The smallest structural and functional unit of an organism, which is typically microscopic andconsists of cytoplasm and a nucleus enclosed in a membrane. Cells that join together or group together to form tissue. Groups of different types of tissues join together to form an organ. Groups of organs that work together to form a body system 3|Page TYPES OF CELLS: Epithelial or skin cell: May be square or flat Fat cell: Contain large vacant spaces for fat storage Muscle cell: Long and slender Nerve cell: May be long and have finger like extensions which carry impulses TISSUES: 4|Page Connective tissue: Supports and encases body structures. It holds organs in place andconnects body parts to each other. Epithelial tissue: Found in the skin and in the lining of blood vessels, this makes up the outer covering of external and internal body surfaces (such as skin and mucous membranes)and the lining of the digestive, respiratory and urinary tracts. Muscle tissue: Provides movement. The main function of muscle tissue is to contract Nerve tissue: Conducts impulses to and from the brain and is composed of nerve cells calledneurons. Nervous tissue needs more oxygen and more nutrients than any other body tissue. Directional Terms: Superior or Cranial – Above Inferior or Caudal – Below Anterior or Ventral - Front Posterior or Dorsal – Back Medial - Toward the midline of the body Lateral - Away from midline Proximal - Closest to the point of origin or trunk of the body Distal - farthest away from point of origin or trunk of the body Superficial - structures nearer the skin Deep - structures further away from the skin ANATOMICAL PLANES: - Anatomical planes provide further division of the body to identify a specific location orarea. Frontal plane (Coronal, Vertical, Door): A plane that divide body into front (anterioror ventral) and back (posterior or dorsal). Sagittal plane (Median, Wheel): A plane that divides the body into left and right sides. Transverse plane (Horizontal, Table): A plane is parallel to the ground and divides thebody into up (towards the head) and down (towards the feet) Oblique plane It is slanted plane (at an angle) that lies between the horizontal and verticalplane. 5|Page Body Cavities: Dorsal cavity: Cranial cavity Vertebral cavity Ventral cavity: Thoracic cavity: Contain Pleural cavity and Pericardial cavity Abdominopelvic cavity: Contain Abdominal cavity and Pelvic cavity Other cavities: Oral cavity Nasal cavity Orbital cavity Middle ear cavity. Synovial cavity 6|Page Body Quadrants: - 1. The right upper quadrant (RUQ) 2. The left upper quadrant (LUQ) 3. The right lower quadrant (RLQ) 4. The left lower quadrant (LLQ) 7|Page Body Regions: 1. Right and left hypochondriac region 2. Right and left lumbar region 3. Right and left iliac or inguinal region 4. Epigastric region 5. Umbilical region 6. Hypogastric or pubic region ANATOMICAL POSITIONS: Prone position - the prone position is a position of the body lying face down Supine position - the supine position is a position of the body lying face up. Fowler’s position - Fowler's position is a standard patient position in which the patient isseated in a semi-sitting position (45-60 degrees) Trendelenburg position - the body is laid supine, or flat on the back on a 15–30-degree incline with the feet elevated above the head. Right lateral recumbent position - the individual is lying on their right side Left lateral recumbent position - the individual is lying on their left side 8|Page  Medical terminology Medical terminology is composed of a prefix, root word, and suffix. Prefix: A prefix is placed at the beginning of a word to modify or change its meaning. Premeans "before." Prefixes may also indicate a location, number, or time. Root: central part of a word Suffix: The ending part of a word that modifies the meaning of the word. PREFIX WHAT ITS MEANS A-, an- Lack of, without, not Ante- Before, in front of, or forward Anti- Opposing or against Bi- Double, two, twice, both Co-, con-, com- Together or with De- Down, or from Di- Twice or two Extra-, Extro- Beyond, outside of, or outward 9|Page Hemi-, semi- Half, half of Hyper- Above, excessive, beyond Hypo- Below, beneath, deficient Infra- Below or beneath Inter- Between Intra- Within, inside Intro- Into, or within Macro- Large Micro-, micro- Tiny, small Post- After, or following, behind Pre-, pro- In front of, before, preceding Retro- Behind, backward Semi Half Trans- Through or across Tri- Three Ultra- Excessive, beyond Mamo / Masto Breast Hystero / metro Uterus Oopharo Ovary Salphingo Fallopian tube Colpo Vagina Osteo Bone Artho Joints Spondylo Spine Costo Ribs Acro Extremities Ano Anus Recto Rectum 10 | P a g e Procto Rectum Laparo Abdomen Hemato Blood Pelvo Pelvis Blepharo / palpebro Eyelid Myo Muscle Neuro Nervous Irido Iris of eye ball Oncycho Nail Lipo Fat Somato Body Estro Female Andro Male Gonad Sex organ Partum Delivery process Dipso Thirst Kalo Potassium Natro Sodium Calco Calcium Gluco / glyco Glucose Toxico poison Juxta Near Arche Beginning Lacto Milk Uro Urine Crino Secretion Adenoido Adenoids Alveolo Alveolus 11 | P a g e Bronchio / broncho Branchus Bronchiolo Branchioles Capno Carbon dioxide Conio Dust Cyno Blue Epiglotto Epiglottis Laryngo Larynx Lobo Lobe of the lung Mediastino Mediastinum Naso Nose Ortho Upright / straight Oxo Oxygen Pectro Chest Pharyngo Pharynx Phono Voice Phreno Diaphragm Pleuro Pleura Pneumo Air Pneumono Lung Suffix What It Means -ac, -ic, -al, -ous, -tic Related to, or pertaining to -ate Subject to -ent, -er, -ist Person, agent -genic Produced by -gram A written record -graph Instrument used to record 12 | P a g e -graphy Process of recording -ism Condition or theory -itis Inflammation -ologist One who studies, specialist -ology Study of, process of study -oma Tumor -pathy Disease, disease process -phobia Morbid fear of or intolerance -scope Instrument used to visually examine -scopy Process of visual examination Prefix or suffix Meaning Example(s) a-, an- Denotes an absence of Apathy, Analgia ab- away from Abduction abdomin(o)- Of or relating to the abdomen Abdomen cardiac, hydrophobiac, -ac, -acal pertaining to pharmacomania Cal acanthion, acanthocyte, acanth(o)- thorn or spine acanthoma, acanthulus acous(io)- Of or relating to hearing acoumeter, acoustician Acrocrany, acromegaly, acr(o)- extremity, topmost acroosteolysis, acroposthia -acusis hearing paracusis -ad toward, in the direction of Dorsad increase, adherence, motion toward, ad- Adduction very Adenocarcinoma, aden(o)-, aden(i)- Of or relating to a gland adenology, adenotome, adenotyphus adip(o)- Of or relating to fat or fatty tissue Adipocyte adren(o)- Of or relating to a adrenal glands adrenal artery 13 | P a g e -aemia (BrE) blood condition Anaemia aer(o)- air, gas Aerosinusitis aesthesio- (BrE) sensation Anesthesia -al pertaining to abdominal alb- Denoting a white or pale color Albino alge(si)- pain Analgesic -algia pain Myalgia alg(i)o- pain Myalgia Denoting something as different, or allo- Alloantigen, allopathy as an addition Denoting something as positioned on ambi- Ambidextrous both sides; Describing both of two Pertaining to the membranous fetal amnio- Amniocentesis sac (amnion) Amphicrania, amph-, Amphi- on both sides amphismela, amphomycin an- not, without Analgesia ana- back, again, up Anaplasia an(o) anus andr(o)- pertaining to a man Andrology, android angi(o)- blood vessel Angiogram Anisotropic, aniso- Describing something as unequal anisocytosis ankyl(o)-, Denoting something as crooked or Ankylosis ancyl(o)- bent Describing something as positioned ante- antepartum in front of another thing Describing something as 'against' or anti- Antibody, antipsychotic 'opposed to' another apo- separated from, derived from Apoptosis archinephron: first arch(i,e,o) first, primitive formed kidney 14 | P a g e arteri(o)- Of or pertaining to an artery Artery, Arteriole arthr(o)- Of or pertaining to the joints, limbs Arthritis articul(o)- joint Articulation -ary pertaining to bilary tract -ase enzyme Lactase -asthenia weakness Myasthenia gravis atelocardia: imperfect atel(o) imperfect or incomplete development development of the heart -ation process atri(o)- an atrium (esp. heart atrium) atrioventricular aur(i)- Of or pertaining to the ear Aural aut(o)- self Autoimmune auxocardia: aux(o)- increase; growth enlargement of the heart Of or pertaining to the armpit axill- Axilla [uncommon as a prefix] azothermia raised temperature due to azo(to) nitrogenous compound nitrogenous substances in blood SUFFIX – Ending Itis Inflammation Algia/ Dynia Pain Scope To view Scopy Method of visual exam Gram Graphical representation Oma Tumor Emia Blood condition Emesis Vomit 15 | P a g e Logy Study Tripsy Crush / break Phobia Fear Penia Deficiency Trophy Growth / nourishment Osis Abnormal Plasia New growth Pepsia Digestion Ac, al, ar, ic, ary Pertaining Esthenia Weakness Esthisia Feeling / nerve sensation Ectasis Expansion Cardia Heart beat Pnea Breathing Pathy Disease Optosis Downward displacement Otomy Incision/ opening Ectomy Excision Ostomy Creation of new opening Pexy Fixation Megaly Enlargement Scelerosis Hardening Malacia Softening Centesis Surgical puncture Blast Immature Phagia Eat Rrhea Fluid discharge Rrhaphy Suture 16 | P a g e Plasty Surgical repair Adeno Gland Tropin Stimulating function of Uria Urine condition Osmia Smell Prefixes (starting) Hyper Increase Hypo Decrease Dys Abnormal / painful A/ an Absence Oligo Reduced Exo Out Endo Inner Inter In between Intra Inside Ante Before Anti Against Bi/ di Two Onco Tumor Bio Living Brady Slow Tachy Fast Ortho Straight / upright Litho Stone Sub Under Tri Three 17 | P a g e Tetra Four Melano Melanin pigment Xantho Yellow Leuco White Erythro Red Cyano Blue Nocto Night Peri Surrounding / around Neo New Epi Above Pre Before Post After Eu Normal / good Nato Birth Genesis Formation / produce Lysis Breakdown Theraphy Treatment Poiesis Formation Histo Tissue Retro Back Pyo Pus Elio Cause of Tin Substance Stenosis Narrow Meatal Opening Tx Treatment Rx Procedure Hx History 18 | P a g e Fx Fraction Dx Diagnosis Combining form Cephalo Head Encephalo Brain Opthalmo / oculo Eyes Oto Ear Rhino Nose Oro / stomato Mouth Glosso / ungio Tongue Cheilo / labio Lips Dento / odonto Teeth Cervico Neck Dermato Skin Gingivo Gum in mouth Pilo / Tricho Hair Thoroco / stetho Thorax / chest Cardio / corono Heart Angio / vaso Vessel Phlebo Vein Pulmono / pneumo Lungs Gastro Stomach Entero Small intestine Colono Large intestine Nephro / Reno Kidney 19 | P a g e Hepato Liver Cysto Urinary bladder Cholecysto Gall bladder Pancreato Pancreas Mammo / masto Breast Hystero / metro Uterus Oopharo Ovary Salphingo Fallopain tube Colpo Vagina Osteo Bone Artho Joints Spondylo Spine Costo Ribs Acro Extremities Ano Anus Recto Rectum Procto Rectum Laparo Abdomen Hemato Blood Pelvo Pelvis Blepharo / palpebro Eyelid Myo Muscle Neuro Nervous Irido Iris of eye ball Oncycho Nail Lipo Fat Somato Body Estro Female 20 | P a g e Andro Male Gonad Sex organ Partum Delivery process Dipso Thirst Kalo Potassium Natro Sodium Calco Calcium Gluco / glyco Glucose Toxico poison Juxta Near Arche Begining Lacto Milk Uro Urine Crino Secretion Adenoido Adenoids Alveolo Alveolus Bronchio / broncho Branchus Bronchiolo Branchioles Capno Carbon dioxide Conio Dust Cyno Blue Epiglotto Epiglottis Laryngo Larynx Lobo Lobe of the lung Mediastino Mediastinum Naso Nose Ortho Upright / straight Oxo Oxygen 21 | P a g e Pectro Chest Pharyngo Pharynx Phono Voice Phreno Diaphragm Pleuro Pleuro Pneumo Air Pneumono Lung 22 | P a g e  INTEGUMENTARY SYSTEM Layers of Skin Skin has several layers. The skin is a system of specialized tissue, containing glands that secrete fluids, nerves that carry impulses and blood vessels that assist in the regulation of body temperature. Integument means "covering." This system is the body's covering made up mostly of skin,but with the help of the accessory organs. The functions of skin include the skin acts as a protective membrane that is a barrier against microorganisms, and it protects organs from injury Skin helps maintain and regulate body temperature. Acts as a receptor for sensation (hot, cold, touch, and pain). The skin helps rid the body of waste products. It also guards deeper tissues of the body against excessive loss of water, salts, and heat. 23 | P a g e LAYERS OF SKIN: Epidermis The epidermis is the outer, totally cellular layer of skin. It is composed of epithelium. Epithelium covers both internal and external surfaces of the body. The epidermis has no blood vessels,lymphatic vessels, connective tissue, cartilage, or fat. It depends on the deeper dermis, or corium, layer and its network of capillaries for nourishment. Oxygen and nutrients from the capillaries in the dermis pass through tissue fluid, supplying nourishment to the deeper levels of the epidermis. The deepest layer of the epidermis is called the basal layer. Parts of epidermis: 1. Stratum corneum: Barrier between the deep layer of skin and environment to prevent toxins, bacterial substances entering our body 2. Stratum lucidum: Reduces the friction between stratum corneum and granulosum 3. Stratum granulosum: To prevent fluid loss from body 4. Stratum spinosum: Helps to make skin flexible and strong 5. Basal layer: It produces skin pigment as melanin, helps to protect deep layer of skin from harmful sunlight Dermis: The dermis, the second layer. below the epidermis, is also called the corium. The dermis differs from theepidermis in that it is living tissue composed of blood, lymph vessels, and nerve fibers, as well as the accessory organs of the skin. These accessories glands include the hair follicles, sweat glands, and oil glands. To support this system of nerves, vessels, and glands, the dermis contains connective tissue cells and fibers. The dermis is composed of different types of connective tissue cells. fibroblasts, histiocytes, and mast cells. Fibroblast cells act to repair an injury to the skin. Histiocytes protect the body by surrounding foreign materials. Mast cells contain histamine, a substancereleased in allergies that causes itching. Tissue composed of blood, lymph vessels, and nerve 24 | P a g e Subcutaneous layer (Hypodermis) The subcutaneous layer of the skin is made up of connective tissue that specializes in the formation of fat (Lipocytes) manufacture and store large amounts of fat. This layer of skin is important in protecting deeper tissues of the body and also acts as a heat insulator. The subcutaneous layer connects the dermis to the muscles and organs below it. Its fat tissue insulates inner structures from temperature extremes. HAIR: The hair follicle is one of the characteristic features of mammals serves as a unique Mini organ in humans, hair has various functions such as protection against external factors, sebum, apocrine sweat and pheromones production and thermoregulation The follicle is the essential unit for the generation of hair. The hair shaft consists of a cortex and cuticle cells, and a medulla for some types of hairs. Hair follicle has a continuous growth and rest sequence named hair cycle. A hair fiber is composed of a network of horny cells (hold your giggles, please) filled with hard protein called keratin. Hair growth is similar to the growth of the epidermal layer of the skin. Deep-lying cells in hair roots move forward through the hair follicles. Melanocytes located at the root of hair follicles supply the melanin pigment for the hair fiber. Hair color depends on the amount of melanin present, as it does with the color of the skin. 25 | P a g e Because hormone production decreases as we get older, the hair loses color and becomes transparent (which see as gray). NAILS: Nails are hard keratin plates that cover the dorsal (top) surface of the last bone of each toe and finger. Nails are composed of horny cells that are cemented together and can extend indefinitely until cut or broken. A nail grows in thickness and length by division of the cells of the nerve root, at the base of the nail plate. Nails grow approximately 1millimeter a week, which means that fingernails may regrow completely in 3-5 months. Toenails grow more slowly than fingernails, but if you have lost a toenail due to nasty stubbing incident, it will come back eventually. Vocabulary: Cuticle: Band of epidermis at the base and sides of the nail plate. Hair follicle: The sac or tube within which each hair grows. Lunula: The half-moon-shaped White area at the base of a nail. Sebaceous gland: An oil-secreting gland in the dermis that is associated with hair follicles Collagen: Structural protein found in skin and connective tissue. 26 | P a g e PATHOLOGY: Disease Condition Description Removal or scraping away of the superficial layers of the Abrasion skin or mucous membrane. A cavity filled with purulent matter, usually caused by a Abscess localized infection. An inherited disorder in which the body is unable to Albinism produce melanin, causing the skin and hair to be white Alopecia Loss of hair. It can be either total or partial. A thickening of the skin that develops when pressure or friction is applied to it over a period of time. Calluses often Callus develop on the palms and soles and can protect the skin from damage. A dark blue or purplish coloration to the skin caused by lack Cyanosis of oxygen. A skin lesion caused by pressure being placed on the skin Decubitus ulcer over an extended period of time. Also referred as a bedsore. Diaphoresis Sweating. An inflammatory skin disease typically with the redness of Eczema the skin, vesicles, and crusting. An abnormal thickening of the skin caused by excessive Keratosis keratin. A chromic, recurrent, inflammatory skin disease resulting in Psoriasis dry scaly red patches covered by silvery-gravy scales. Ringworm A fungal infection, tinea. A transmissible skin infection caused by fever and a red Scabies rash. It can cause birth defects in pregnant women Also known as German measles. An area of fibrous tissue that has replaced normal skin after Scar some form of destruction of the dermis. 27 | P a g e Urticaria An allergic reaction that results in the eruption of small itchy patches called wheals. Also called hives. Seborrhea Over activity of the oil glands lending to excessive sebum. Abbreviations: Abbreviations Meaning Bx Biopsy Dermo Dermatology FS Frozen section HSV-1 Herps simplex virus type 1 HSV-2 Herps simplex virus type 2 I& D Incision & Drainage, Irrigation & Drainage SQ, sub cu Subcutaneous UV Ultraviolet. PROCEDURES: 1. Incision & drainage- The incision is made through the skin over the abscess & pus or purulent matter is drained out 2. Debridement- Removal of dead cells or necrotic tissues 3. Laceration- A deep cuts or tear in skin requires a closure (sutures) 4. Skin Biopsy (excision)- A tissue sample collected over an affected area for lab examination 5. Skin graft- A patch of a skin is removed from one area of body and transferred to damaged area to heal. 28 | P a g e  MUSCULOSKELETAL SYSTEM BONE Bone is a highly vascular living connective tissue in which the matrix is calcified by the deposition of calcium phosphate. The human skeleton consists of 206 bones. A basic primer on bones, muscles, tendons, ligaments, nerves, and cartilages. FUNCTIONS OF THE BONE. Bone provides supporting framework and shape for the body. Bone protects vital organs of the body (e.g., heart and brain). 29 | P a g e  They help in transmission of the body weight. They provide attachment to the muscles and act as levers of the joints helping in locomotion. Bone is the storehouse of calcium salts. Involved in erythropoiesis. (Formation of red blood cells). Nerves: Nerves control the contraction of skeletal muscles, interpret sensory information,and ccoordinatethe activities of the body's organ systems. Tendons: These attach muscle to bone Ligaments: These attach bone to bone Classification of the Bones According to their Position 1. Axial: Bones forming the axis of the body, (e.g., skull, ribs, vertebrae) 30 | P a g e  2. Appendicular: Bones of the limbs. According to the Shape TYPES OF BONES: 1. Long bones: They have three parts: Upper end, lower end and middle shaft. The ends of these bones take part in forming the joint (articulates with other bone), e.g., bones of limbs (humerus, ulna, radius, femur, 2. Short bones: These bones are small and generally cuboidal in shape, e.g., carpal and tarsal bones. 3. Flat bones: These bones are expanded and are flat, e-g. sternum, scapula, ribs, and parietal bone. 4. Irregular bone: The shape is irregular without any proper outline, e.g., vertebrae, sphenoid, temporal bones, etc. Gross Structure of bone 1. Compact (lamellar bone): Structurally it is made up of bony plates (lamellae) which are arranged compactly, e.g., outer cortical part of the long bone. 2. Spongy bone (cancellous): Structurally it is made up of bony plates, which are arranged irregularly leaving spaces in between them. It gives a spongy appearance, and e.g., flat bones, irregular bones and ends of the long bone. 31 | P a g e CARTILAGE Cartilage is a specialized dense connective tissue. It is hard but not rigid like bone. It can be bent and also brought back into its original form when bending force is withdrawn. This cartilage forms the 'skeletal' basis of some parts of the body (auricle of the ear, external nose). At the time of birth, many parts of the skeletal framework of the newborn is made up of cartilage. Later this cartilage will be converted into bones by process called 'ossification'. However, depending on the functional need, some of them remain as cartilages even in adults Hyaline cartilage: Is the most common type of cartilage. This type of cartilage provides stiff but somewhat flexible support. Examples in adults include the tips of ribs (where they meet the sternum) and part of the nasal septum. Another example is articular cartilage, which is cartilage that covers the endsof bones within a joint. The surfaces of articular cartilage are slick and smooth, which reduces friction during joint movement. Elastic cartilage: provides support but can tolerate distortion without damage and return to its original shape. The externalflap of the ear is one place where elastic cartilage can be found. Fibrocartilage: Fibrocartilage resists compression, prevents bone to bone contact, and limits relative movement. Fibrocartilage Can be found within the knee joint, between the pubic bones of the pelvic, and between thespinal vertebrae. Cartilage heals poorly, and damaged fibrocartilage in joints such as the knee can interfere with normal movements. The knee contains both hyaline cartilage and fibrocartilage. The hyaline cartilage covers bonysurfaces and fibrocartilage pads in the joint prevent contact between bones 32 | P a g e during movement. Injuries to the joints can produce tears in the fibrocartilage pads, and the tears do not heal. Eventually, joint mobility is severely reduced. AXIAL SKELETON SYSTEM: VERTEBRAL COLUMN It is a skeletal framework that supports the body. It transmits its weight to the pelvis and lower extremities. It protects the spinal cord and its membranes. The vertebral column extends from the base of the skull to the coccyx. It is made up of 33 vertebrae. Intervertebral discs further increase the length of the column. The length of the adult vertebral column is about 70 cm in male and 60 cm in female. The vertebral column is subdivided into the following parts: 1. Cervical part: Consists of 7 vertebrae 2. Thoracic part: Consists of 12 vertebrae 3. Lumbar part: Consists of 5 vertebrae 4. Sacrum (formed by the fusion of 5 sacral vertebrae) 5. Coccyx (formed by the fusion of 4 coccygeal pieces) RIBS: These are 24 elongated, curved bone form the bony wall of chest. True ribs are first 7pairs, false ribs are pairs 8-10. and floating ribs are pairs 1 and 12. There are the 12 pairs of Ribs. SKULL & FASCIAL BONES: The skeleton of the head is called skull. It consists of several bones that are joined together to form the which is a separate bone. Skull consists of 22 bones and 6 ear ossicles (28+ total hyoid bone =29). Twenty-one bones are connected the skull includes the mandible (lower jaw) to each other by sutures and are immobile. The only movable bone is the mandible. The bones are classified into paired and unpaired: PAIRD UNPAIRED Parietal Frontal Temporal Occipital Maxilla Sphenoid Zygomatic Sphenoid Nasal Ethmoid Lacrimal Mandible Palatine Vomer Inferior nasal concha 33 | P a g e The important features of the skull can be described by viewing the skull from different sides. 1. Norma verticals: Superior view 2. Norma occipitalis: Posterior view 3. Norma frontalities: Anterior view 4. Norma lateralis: Lateral view 5. Norma basalis: Inferior view The important parts skull is mentioned here the students are expected to identity these structures. APPENDICULAR SKELETON SYSTEM. UPPER LIMB: 34 | P a g e LOWER LIMB: Joints A joint formed where two or more bones meet. All joints are held together by ligaments. The main function of ligaments is to connect to bones together, improve the stability of the joint by allowing somemovement but reducing unwanted movement. Types of joints Immovable or fibrous joint – where two bones are joined by connective tissue, there is no joint cavity (space between the bones filled with synovial fluid), and there is little or no movement. For example, thebones of the pelvic girdle. Slightly moveable or cartilaginous joint- the bones are connected by a ligament and cartilage, there isno joint cavity, and there is only limited movement. For example, bones of the vertebrae. Freely moveable or synovial joints – there is a gap between the joints (joint cavity) containing synovialfluid. There is far greater movement bones connected by synovial joints. The extent of the movement varies due to the shape of the bones, and the ligaments and tendons that surround the joint. An example isthe knee joint. 35 | P a g e  Synovial joint Types of synovial joint. Plain or gliding joints-two flat surfaces in which some movement including slight rotationis possible. Examples include the vertebrae and bones in hand. Ball and socket joints- this is where one bone has a hall end, which fits into a socket ofadjacent bone. Ball and socket joints allow a wide amount of movement in almost everydirection (multiaxial). Examples include the shoulder and hip. Hinge joints- allow movement in one direction only (monoaxial). There will be a convex cylinder in one bone and a concavity in the opposing bone. Examples include the elbow knee. Pivot joints- movement is restricted to rotation around a single axis (monoaxial). An example is theradius and ulna. Condyloid joints- these are modified ball and socket joints. Their movement is biaxial because the movement is restricted to two axes with rotation restricted. Examples include thewrist where flexion and extension can occur. Saddle joints- these are biaxial joints. One bone surface is concave the other convex. An example is the joint at the base of the thumb. Acetabulum: Rounded depression or socket in pelvic bone where femur (thigh bone) joinsthe pelvis, forming the hip joint. Acromion: Outward extension of shoulder bone forming the point of shoulder. It overlies the shoulder joint and articulated with clavicle. 36 | P a g e BONE MARROW It is the vascular connective tissue present in the cavity (medullary cavity) of the bone. The bone marrow differs in composition in different bones and at different ages. It occurs in two forms, yellow marrow and red marrow. The red marrow is actively engaged in the production of blood cells. The yellow marrow derives its color from the large quantity of fat cells it contains. At birth the red marrow is present throughout the skeleton. After about fifth year of postnatal life, the red marrow is gradually replaced in the long bones by yellow marrow. BONE CELLS Osteoblasts These are bone forming cells. They are more numerous in periosteum. The cells are ovoid, triangular or cuboidal in shape with oval nucleus. Osteocytes These are mature bone cells. They are derived from osteoblasts after they have laid down the matrix. They are present in the lacunae' of the bone between the lamellae. Osteocytes show many cytoplasmic processes, which establish connections with other osteocytes. Osteocytes maintain the integrity of the lacunae and thus keep open the channels for diffusion of nutrients. Osteoclasts These are bone removing cells and found in relation to the surfaces of the bone. Osteoclasts are multinucleated large cells (diameter varies from 20 to 100 um). The lysosomes present in their cytoplasm contain 'Acid phosphatase. Osteoclasts are involved in demineralization and removal of bone matrix. Osteoclasts are stimulated by parathyroid hormone. 37 | P a g e TERMS DESCRIBING MOVEMENTS AT JOINTS: Flexion: Bending/making a decreasing angle between the bones or parts of the body. In this movement there i an approximation of flexor surfaces. Extension: Straightening of a bent part or making an increasing the angle between bones of the body. In this movement there is an approximation of extensor Surfaces. Abduction: Moving away from the median plane. Adduction: Moving toward the median plane. Rotation: Moving around the long axis. Medial rotation: Inward rotation. Lateral rotation: Outward rotation. Circumduction: Circular movement combining flexion, abduction, extension and adduction. Eversion: Raising the lateral border of the foot. Inversion: Raising the medial border of the sole of the foot. Pronation: Rotation of the forearm so that the palm is turned backwards. Supination: Rotation of the forearm so that the palm is turned forwards. Protrusion: Moving anteriorly (forward). Retraction: Moving posteriorly (backward). MUSCLES Muscle is a contractile tissue, which brings movement of the body. Types: There are three types Smooth muscles. Cardiac muscles. Skeletal muscles 38 | P a g e SMOOTH MUSCLES (NON-STRIATED/INVOLUNTARY) I. Each muscle fiber is an elongated spindle shaped cell with a single nucleus placed centrally. 2. The length of the smooth muscle is highly variable (15-500 um). 3. They often aggregate to form bundles and fascicles. 4. They are found in the walls of gastrointestinal tract, fatigue easily. respiratory tract, urogenital tract, blood vessels and a few muscles of the eye. They are arranged circularly inside and longitudinally outside in the walls of the gastrointestinal tract, urogenital tract, etc. 5. They do not exhibit cross striations and are smooth in form, supplied by autonomic nerves, hence involuntary. 6. They are made up of actin and myosin filaments. CARDIAC MUSCLE (STRIATED/INVOLUNTARY) 1. It forms the myocardium of the heart, shows striations but is involuntary. It is meant for automatic and rhythmic contractions. 2. Each muscle fiber has a single rounded nucleus placed centrally. 39 | P a g e 3. Each muscle fiber branches and anastomoses with the neighboring fibers at intercalated discs. 4. Myocytes are about 80 um long and 15 um broad. SKELETAL MUSCLES (STRIATED/VOLUNTARY) 1. These are most abundant, found attached to the skeletal system. 2. They exhibit cross striations under the microscope. 3. They are supplied by somatic (cerebrospinal) nerves, hence under voluntary control. 4. Each muscle fiber is a multinucleated cylindrical cell containing a group of muscle fibrils, e.g., muscles of the limb and body wall. PATHOLOGY: DISEASE CONDITION DESCRIPTION Chronic systemic arthritis involving inflammation and Ankylosing spondylitis stiffening of axial skeleton and the large peripheral joints. Ankylosis Stiffening of joints Compression of median nerve as it passes through the Carpal tunnel syndrome tunnel in the wrist containing median nerve and blood (CTS) vessels. It is frequently caused by repeated flexion and extension of wrist. Can lead to pain. Malignant bone tumor involving plasma- producing Multiple myeloma (hemopoietic) cells in bone marrow. Commonly occurs in multiple sites. Osteoarthritis Inflammation of bone and joint. Osteomyelitis Inflammation and destruction of bone and bone marrow caused by bacterial or fungal infection. Osteoporosis A generalized progressive loss of bone density. Leads to poor bone structure and skeletal weakness. A malignant tumor of bone. Found most commonly in Osteosarcoma the knee, but can occur in any bone. Also called osteogenic sarcoma. Rheumatoid arthritis (RA) 40 | P a g e  Chronic condition characterized by inflammation of the peripheral joints, leads to destruction of connective tissue. It is an autoimmune condition. Childhood disease caused by vitamin D deficiency and Rickets lack of exposure to sunlight. Results on softening and bending of bone. Spondylitis Inflammation of one or more vertebrae. Tendonitis Inflammation of tendon. Also called tendinitis. Abbreviations: Abbreviations Meaning AE Above the elbow(amputation) AK Above the knee(amputation) BE Below the elbow (amputation) BK Below the knee (amputation) C1 through C7 Abbreviation for 7 cervical vertebrae CDH Congenital dislocation of hip CK Creatine kinase CTS Carpal tunnel syndrome FX, fx Fracture HD Hip disarticulation KD Knee disarticulation L1 through L5 Abbreviation for 5 lumbar vertebrae NSAID Non-steroidal anti-inflammatory drug OA Osteoarthritis RA Rheumatoid arthritis S1 through S5 Abbreviation for 5 sacral vertebrae T1 through Abbreviation for 12 thoracic vertebrae T12 41 | P a g e PROCEDURES: 1. Open fracture- broken bone that requires an internal fixation 2. Amputation- Removal of complete or partial limb or fingers, toes 3. Arthrocentesis- Removal (Aspiration) of fluid from joints 4. Arthrodesis- fusion of spine joints by instrumentation or graft 5. Splinting- Placed for immobilize for (particular period of time) musculoskeletal injuries for healing 42 | P a g e  RESPIRATARY SYSTEM Respiratory system is mainly involved in providing oxygen and removing carbon dioxide from the blood. Some parts of this system are involved in smell (Nasal cavity) and speech (Larynx). The respiratory tract is divided into two parts. Conducting part (Upper respiratory parts): It includes, nasal cavity, pharynx, larynx, trachea, bronchus and terminal bronchiole Respiratory part (Lower respiratory parts): It includes Lungs, respiratory bronchiole, alveolar ducts, air saccules and pulmonary alveoli. The conduction part provides humidity and temperature to the inhaled air. The respiratory part involved in gaseous exchange. 43 | P a g e UPPER RESPIRATORY TRACT: Nasal Cavity. The nasal cavity extends from the nostrils and continues as the nasopharynx. The nasal cavity is divided into right and left halves by the nasal septum. The function of the nasal cavity is to ensure that air is warmed, moistened and filtered. Paranasal Air Sinuses: These are air filled spaces lined by mucous membrane and communicate with nasal cavity. 1. Maxillary air sinus: It is the largest paranasal sinus situated inside the body of maxilla 2. Ethmoid air sinus: they are placed between the lateral wall of the nasal cavity and medial wall of the orbit. 3. Sphenoid air sinus: It is present in the body of the sphenoid bone 4. Frontal air sinus: It is present in the frontal bone. 44 | P a g e Larynx: Larynx is an organ of respiration and phonation. It extends from epiglottis to lower border cricoid cartilage which is in neck region. The wall of the larynx is made up of cartilages, muscles, membranes and ligaments. The larynx performs the following functions: 1. Filtering and moistening of air 2. Voice production via vocal cords 3. Airway is closed during swallowing by epiglottis Trachea: Trachea is the part of respiratory tract. It extends from lower part of cricoid cartilage to the lower border of thoracic vertebrae 6 (T6) The length of trachea is about 10 to 11cm. The anterior part of the trachea is composed of C shaped cartilaginous rings (16-20 in numbers) The esophagus descends in posterior to the trachea LOWER RESPIRATORY TRACT: PLEURA: It is the fibro serous membrane covering the lungs. The pleural sac consists of visceral and parietal layers. 1. Visceral pleura: It is closely investing the lungs 2. Parietal pleura: It is divided into different parts, according to the structure it lines. 45 | P a g e  Pleural cavity: The space between the visceral and parietal pleura forms the pleural cavity. Normally it contains fluid called pleural fluid which allows the lungs to glide freely without friction over the thoracic wall during breathing movement. Lungs: Each lung presents an apex, a base, three surfaces (superior, medial, inferior/base) There are two lungs which lie in the thoracic cavity. The right lung has three lobes and the left lung has two. The lungs allow a free exchange of gases to take place between the alveoli and the capillary network around them. Bronchus & Bronchioles: The two bronchi (plural for bronchus) begin where the trachea branches. Within the lungs the bronchi further divide into smaller tubes called the bronchioles. These bronchioles further subdivide into microscopic tubes called alveolar ducts. Each alveolar duct ends in several alveolar sacs, each of which resembles bunch of grapes. External and Internal respiration External respiration occurs between the outside environment and the capillary bloodstream of the lungs whereas another method of respiration is happening between the body cells and capillary blood vessels that surround them. This process is called internal or cellular respiration Internal respiration is the exchange of gases not in the lungs, but in cells of all body organs. Oxygen passes out of the bloodstream and into the tissue cells. At the same time, carbon dioxide passes from thetissue cells into the bloodstream and is carried by the blood back to the lungs to be exhaled. Exchange of gases take place by process of simple diffusion. Gases movethe higher concentration to the lower until equilibrium is established. Air contains about 21 % of oxygen that is inhaled through the nose, finds its way to the lungs, into thelung's air spaces, and passes into tiny capillary blood vessels surrounding the air spaces. VOCABULARY: Ventilation -Inhaling and exhaling, the movement of air in and out of the lungs. Inspiration -Breathe in. Expiration -Breathe out. Internal Respiration - Occurs between the body cells and capillary blood vessels. External Respiration- Occurs between the outside environment and the capillary bloodstream of the lungs. 46 | P a g e Thoracic cavity -That divides into the pleural and mediastinum cavities. Pleural cavity -Surrounds the lungs. Mediastinal cavity- between the lungs holds the heart, trachea, and esophagus. The right lung consists ofthree lobes, and the left lung two lobes. Oxygen (02): Gas that passes into blood stream at the lungs and travels to all body cells Carbon dioxide (CO2): Gas produced by body cells when oxygen and food combines;exhaled through lungs. Pharynx (13cm): Throat. Composed of nasopharynx, oropharynx and laryngopharynx Glottis: The opening to the larynx. Epiglottis: Lid-like piece of cartilage that covers the larynx. Carina: Terminal ring of trachea and it forms the ridges between two bronchi Apex of lung: Uppermost portion of lung. Apical Means pertaining to apex. Base: The lower portion of the lung Hilus or hilum of lung: Midline region where the bronchi, blood vessels and nerves enter and exit thelungs. Hilar means pertaining to hilum. Diaphragm: Muscle separating the chest and abdomen I is the most important muscle for breathing. Lobes: Divisions of lung Cilia: Thin hairs attached to mucus membrane epithelium lining the respiratory tract Pulmonary parenchyma: The essential cells of Lung, those performing Its main function; the air sacs(alveoli) and small bronchioles. 47 | P a g e PATHOLOGY: DISEASE CONDITION DISCRIPTION Acute respiratory failure that appears following pulmonary Adult respiratory injury, such as direct chest trauma, sepsis or inhalation of distresssyndrome toxicgas. Hypoxemia, respiratory distress, and pulmonary (ARDS) edema aresome of the signs. Anoxia Complete or nearly complete absence of oxygen from the blood and tissue Anthracosis A type of lung disease caused by the long-term inhalation of coal dust during coal mining. A type of pneumoconiosis. Alsocalled coal workers pneumoconiosis to black lung disease. Asbestosis A type of lungs disease caused by the long-term inhalation ofasbestos dust. A type of pneumoconiosis. Asthma Inflammation and constriction of the airway over a relativelyshort period of time that can be caused by a reaction to a stimulus such as an allergen or exercise. Asthma is usually reversible. Bradypnea Breathing that is slower than normal Bronchitis Inflammation of the bronchi Pleural effusion Increased amount of fluid in the pleural cavity. An inflammation of the pleura that usually causes Pleurisy stabbingchest pain and pleura effusion. Also called as pleuritis. 48 | P a g e  An occupational lung disease causing inflammation of Pneumoconiosis thelungs due to the inhalation of dust particles. Pneumothorax The pressure of air or gas in the pleural cavity A sudden dislodging of a blood clot in the pulmonary Pulmonary embolism (PE) artery (the artery supplies blood to the lung), causing obstruction ofblood to the lung. Tachypnea Breathing that is more rapid and more shallowed than normal An infectious disease typically characterized by Tuberculosis (TB) coughing, weight loss, chest pain, and plitting up blood. It is caused byMycobacterium tuberculosis. Wheeze Abnormal breath sound that are longer than crackles and mayhave a whistling, puffing or hissing quality. Abbreviations Abbreviations Meaning A&P Auscultation and percussion ABG Arterial blood gas AP Anterior posterior ARDS Adult respiratory distress syndrome BAL Broncho alveolar lavage BOOP Bronchiolitis obliterans with organizing pneumonia CO Carbon monoxide CO2 carbon dioxide COLD Chronic obstructive lung disease COPD Chronic obstructive pulmonary disease CPR Cardio pulmonary resuscitation CXR Chest x-ray (chest radio graph) 49 | P a g e DNR Do not resuscitate HMD Hyaline membrane disease IPPB Intermitted positive distress breathing IRDS Infant respiratory distress syndrome PA Posterior anterior PCP Pneumocystis carinii pneumonia PE Pulmonary embolism PFT Pulmonary function test RD Respiratory disease RDS Respiratory distress syndrome SOB Shortness of breath TB Tuberculosis PROCEDURES: 1. Bronchoscope- To view bronchus to know about infections 2. Tube Thoracostomy-A chest tube is inserted in chest wall to remove excess fluid, air, pus 3. Pneumectomy- Removal of lungs 4. Lung transplantation- Surgical replacement of lung 5. Thoracocentesis- Removal fluid from thoracic cavity 50 | P a g e  CARDIOVASCULAR SYSTEM The Cardiovascular system can be thought of as the transport system of the body. This system has three main components: the heart the blood vessel and the blood itself. The heart is the system's pump and the blood vessels are like the delivery routes. Blood can be thought of as a fluid which contains the Oxygen and nutrients the body needs and carries the wastes which need to be removed. The following informationdescribes the structure and function of the heart and the cardiovascular system as a whole. HEART: Human heart is a hallow muscular organ, which pumps the blood to various parts of the body to meet the nutritive requirement. SITUATION: The heart is situated in thoracic cavity (middle mediastinum) between the two lungs and behind the sternum. It is a size of a fist, and is roughly cone-shaped. PERICARDIUM: The pericardium is a fibrous covering which wraps around the whole heart. It holds the heart in place but allows it to move as it beats. The wall of the heart itself is made up of a special type of muscle called Cardiac muscle. 51 | P a g e TYPES OF CIRCULATION: There are the three types of circulation: Pulmonary circulation: Blood flows Between heart and lungs. Systemic circulation: Blood flows from heart to rest of all body parts. Cardiac circulation: Blood flow with in heart. Chambers of the Heart: The heart has two sides, the right side and the left side.The heart has four chambers. The left and right side each have two chambers, a top chamber and a bottom chamber. The two top chambers are known as the left and right atria (singular: atrium). The atria receive blood from different sources. (Receiving chambers) The left atrium receives blood from the lungs and the right atrium receives blood from the rest of the body. The bottom two chambers are known as the left and right ventricles. The ventricles pump blood out todifferent parts of the body. The right ventricle pumps blood to the lungs while the left ventricle pumps out blood to the rest of the body. (Delivering chambers) 52 | P a g e Heart Wall: The heart is enclosed in a fluid-filled sac called the pericardium Layers of heart: Heart consists of three coats from outside to inside Endocardium: Endo- is the Greek prefix for "within." This is the inner layer of theheart, lining the chambers and covering the valves. Epicardium: Epi- is the Greek prefix for "on." This is the outer layer of the heart. Myocardium: Myo- is the Greek prefix meaning "muscle." This is the actual heartmuscle and makes up the thick middle layer. Blood Vessels: Blood Vessel is tubes which carry blood. Three types of blood vessels - Arteries, Veins, Capillaries Arteries are blood vessels which carry blood from the heart to the body. The arterial system is composed of arteries and arterioles (smaller arteries). All arteries carry oxygenated blood away from the heart, except pulmonary artery (are t two one in right side, one in left side) which carries De-oxygenated blood to the lungs Veins are blood vessels which carry blood from the body back to the heart. The venous system is made up of veins and venules (smaller veins). All veins carry De-oxygenated blood back to the heart from cells, except pulmonary vein The pulmonary veins (are four two in right side, two in left side) which carry oxygen- rich blood from the lungs back to the heart Capillaries are microscopic blood vessels which connects arteries and veins together. These super-tiny vessels bridge the gap between arterioles and venules to keep blood flowing in a continuous motion 53 | P a g e Valves: Valves are fibrous flaps of tissue found between the heart chambers and in the blood vessels. They are rather like gates which prevent blood from flowing in the wrong direction. They are found in a number of places. Valves between the atria and ventricles are known as the right and left atrioventricular valves, otherwise known as the Tricuspid and Mitral valves. (Bicuspid valve). Valves between the ventricles and the great arteries are known as the semilunar valves. The aortic valve is found at the base of the aorta, while the pulmonary valve is found the base of the pulmonary trunk. Heart Beat: The Sequence of events that occurs when the heart beats Two phases Systole- Contraction phase (Ventricles contract higher pressure) Diastole - Relaxation phase (ventricles are relaxed- lower pressure) An adult human's normal heart rate is 72-80 beats per minute. A child's is 100-120 beats per minute. 54 | P a g e CIRCULATON OF BLOOD: Right atrium receives deoxygenated blood from the whole body through the superior and inferior vena cava. When it contracts, the blood passes to the right ventricle through the right atrioventricular orifice(open). When the right ventricle contracts, blood passes to the lungs through pulmonary trunk and pulmonary arteries. In the lungs it gets purified, returns to the left atrium through the pulmonary veins and reaches the left ventricle through left atrioventricular orifice. When the left ventricle contracts, the blood passes to the aorta and through its branches, to the different parts of the body. The main arteries which branch off the aorta and take blood to specific parts of the body: ▪ Carotid arteries, take blood to the neck and head ▪ Coronary arteries, which provide blood supply to the heart itself ▪ Hepatic artery, which takes blood to the liver ▪ Mesenteric artery, which takes blood to the intestines ▪ Renal arteries, which takes blood to the kidneys ▪ Femoral arteries, which take blood to the legs 55 | P a g e CONDUCTION SYSTEM OF HEART: This pathway is made up of 5 elements: The sinoatrial (SA- node) Atrio ventricular node (AV-node) The bundle of his The left and right bundle branches The Purkinje fibers SINOATRIAL NODE: SA node is situated in right atrium and generates normal rhythmic cardiac impulse at the rate 72- 80 beats / minute. it acts as a pacemaker of the heart and the rhythm is called sinus rhythm. ATRIOVENTRICULAR NODE: Inter nodal pathway conduct the impulse from SA node to AV node. This receives the impulse from SA node and transmits into the ventricles through Bundle of His. 56 | P a g e BUNDLE OF HIS: Bundle of his conduct the impulse from the atria of the ventricles LEFT AND RIGHT BUNDLE BRANCHES: The left and right bundle branches conduct the cardiac impulse to the ventricles PURKINJIE FIBERS: The main function of these fibers is to conduct impulse quickly to every part of the ventricular fibers. PATHOLOGY: DISEASE CONDITION DESCRIPTION An abnormal dilation or bulging out of an artery wall due to Aneurysm a congenital or acquired weakness in the wall. An attack of severe and often constricting chest pain. It is Angina pectoris usually caused by blockage of the coronary arteries due to atherosclerosis. Other causes include coronary embolism. A genetic term for several conditions characterized by thickening of the walls of arteries. The arteries lose their Arteriosclerosis elasticity, making them less efficient in pumping blood. Commonly called hardened arteries. A congenital defect in which there is an abnormal opening in Atrial septal defect (ASD) the septum between the left and right atria. Failure of the systemic circulatory system due to absent or Cardiac arrest (CA) inadequate contraction of the ventricles. The inability of the heart to pumps adequate amount of Congestive heart failure (CHF) blood. It results in congestion and edema of tissues and is frequency a result of myocardial infarction. A broad term used to cover any condition that affects the Coronary artery disease (CAD) coronary arteries. Any blockage or occlusion of a vessel by a mass such as a Embolism thrombus or a foreign body. Rapid, irregular contractions of the atrial or ventricular Fibrillation muscles. Ventricular fibrillation leads to virtually no cardiac output and is extremely serious. 57 | P a g e  A temporary deficiency in blood supply within a localized Ischemia area. It is due to an obstruction in a blood vessel, most commonly the barrowing of an artery. A bulging into the left atrium during left ventricular systole Mitral valve prolapsed (MVP) of one or more the flaps (called leaflets) that make up the mitral valve. A sudden insufficiency of the blood supply to an area of the Myocardial infarction (MI) heart muscle. It is most commonly caused by an occlusion of a coronary artery. Usually forceful, rapid and/ or irregular heartbeats of which Palpitation the patient is aware. Blockage of the blood supply to an extremity caused by an Peripheral arterial occlusion embolism or plaque caused by atherosclerosis. Phlebitis Inflammation of a vein A sudden temporary loss of consciousness. Also called Syncope fainting. A clot formed from blood components and found in the Thrombus cardiovascular system. Backward flow of blood through an incompetent heart valve. Valvular regurgitation Also called valvular insufficiency or valvular incompetence. A congenital defect in which there is an abnormal opening in Ventricular septal defect (VSD) the septum between the left and right ventricles. Abbreviations Abbreviations Meaning ACG Angiocardiography AS Aortic stenosis ASD Atrial septal defect ASHD atherosclerotic heart disease. AV Node atrioventricular node BBB Bundle branch block BP Blood pressure CA Cardiac arrest CABG Coronary artery bypass graft 58 | P a g e CAD Coronary artery disease CC Cardiac catheterization CCU Coronary care unit, cardiac care unit CHF Congestive heart failure CK-MB Creatine kinase-myoglobin CPR Cardiopulmonary resuscitation CV Cardiac vascular CVP Central venous pressure DVT Deep venous thrombosis ECG (EKG) Electrocardiogram EDP End- diastolic pressure EDV End- diastolic volume JVP Jugular venous pressure MI Myocardial infarction MPA Main pulmonary artery MRA Magnetic resonance angiography MS Mitral stenosis MVP Mitral valve prolapsed PA Pulmonary artery PDA Posterior descending artery PTCA Percutaneous transluminal coronary angioplasty PVC Premature ventricular contraction RCA Right coronary artery RPA Right pulmonary artery SA node Sinoatrial node SFA Superficial femoral artery TIMI Thrombolysis in myocardial infarction VSD Ventricular septal defect MPA PROCEDURS: 1. Pacemaker- Implantation of electronic device that stimulates the artificial heart beat 2. Defibrillator- Send an electrical pulse to regulate a normal heart beat 59 | P a g e 3. Coronary artery bypass grafting (CABG)- Surgical replacement of one blood vessel to damaged blood vessel 4. Percutaneous transluminal coronary angioplasty (PTCA)- Dilatation of atherosclerotic blood vessels by balloon catheter stenting method 5. Central venous access procedure- Insertion of centrally placed multiple lumen catheters to draw blood samples and for injections 60 | P a g e  BLOOD AND LYMPHATIC SYSTEM LYMPHATIC SYSTEM: Lymphatic system is a drainage system, which removes waste larger particles from the tissue fluid. It includes Lymph vessels Lymphoid organs Circulating lymphocytes The nutrients to the tissue are given by artery, arteriole and finally capillaries at tissues. The fluid from the tissue is taken up by venous end of the capillaries and then circulates through venules and veins. However, lymphatic vessels absorb about 10-20% of the tissue fluid, which begins at the tissue spaces. The tissue fluid flowing through these vessels is called "lymph". Which is yellowish in color. This lymph fluid finally drains into larger veins through lymphatic vessels 61 | P a g e Lymphatic vessels: The lymphatic capillaries begin blindly in the tissue Spaces. Lymphatic vessels are connected to each other forming a network. The superficial lymphatic vessels accompany veins while deep lymphatic vessels accompany arteries. Larger lymphatic vessels are named, e.g., thoracic duct. Lymph nodes are present in relation to the lymphatic vessels. The caliber of lymphatic capillary is greater and less regular than blood capillaries. Lymph fluid is colorless but, in the intestine, it is milk- white due to absorption of fat. It is called chyle. Lymphatic capillaries are absent in brain, spinal cord, bone marrow and other avascular structures Lymphoid Organs: Lymphatic organs are classified into central and peripheral parts. a. Central lymphatic organs are bone marrow and thymus. The lymphoid stem cells are produced by bone marrow except during early fetal life (produced by spleen and liver). The stem cell undergoes differentiation in these central lymphatic organs and becomes competent. Bone marrow differentiates the B lymphocytes, which are capable of synthesizing antibodies. Thymus differentiates immunologically competent but uncommitted T lymphocytes. b. Peripheral lymphatic organs include lymph nodes, spleen, tonsil and lymphoid tissue present in the wall of the gastrointestinal and respiratory tracts. The B and T lymphocytes reach peripheral lymphatic organs where they proliferate and mature into immunocompetent cells. Adenoids are a patch of tissue that is high up in the throat, just behind the nose. They along with the tonsils, are part of the lymphatic system. The adenoids and tonsils work by trapping germs coming in through the mouth and nose. The spleen is a small organ inside your left rib cage, just above the stomach. It's part of the lymphatic system stores and filters blood and makes white blood cells that protect you from infection and destroys old blood cells. 62 | P a g e Lymph Nodes Lymph nodes are oval or bean-shaped structures present in the course of small lymphatic vessels. They filter the lymph and multiply lymphocytes. Lymph nodes are present in-groups, The superficial lymph nodes are arranged along the veins and the deep nodes along the arteries. There are between 600-700 lymph nodes present in the average human body Afferent lymphatic vessels carry unfiltered lymph into the node. Here waste products,and some of the fluid, are filtered out. Efferent lymphatic vessels carry the filtered lymph out of the node so that it can continue its return to the circulatory system. Functions of the Lymphoid System: 1. Lymphatic vessels drain large protein molecules from the tissue places. Thus, cellular debris and foreign particles (dust particles inhaled into the lungs, bacteria and other micro-organisms) are drained by this system. 2. Lymphatic vessels help in transportation of fat from the gut. 3. Lymph node serves the following functions: They filter the lymph and prevent the foreign particles entering into the bloodstream. The foreign particles are phagocytosed by macrophages. They lymphocytes multiply in the lymph nodes. These lymphocytes provide both humoral and cellular immunity against the antigens. 63 | P a g e LYMPHATIC CIRCULATION: PATHOLOGY: DISEASE CONDITIONS DISCRIPTION Hemorrhage Bleeding. it is a flow of blood bleeding, Atrial hemorrhage and venous hemorrhage Lymphadenopathy Chronic excessive enlargement of lymph nodes Lymphoma A malignant cancer of lymphocytes Autoimmune disorder A disorder that develops when the immune response mistakenly targets the normal body cells and tissues Lymphangitis Inflammation of lymphatic vessels Elephantiasis The filarial parasite in lymphatic vessel and results in edema in peripheral area. Splenomegaly Enlargement of the spleen 64 | P a g e  DIGESTIVE SYSTEM The gastrointestinal system, also called the alimentary canal or digestive tract, The human digestive system consists of the gastrointestinal tract and the accessory organs of digestion. Digestion is the process of breaking down food into substances that the body can use for energy, tissue growth, and repair. THE THREE MAIN FUNCTIONS OF DIGESTIVE SYSTEM: Carrying food for digestion. Preparing it for absorption Transporting waste products for elimination Gastrointestinal organs are in the abdominal cavity also known as peritoneal cavity, often referred to as the gut or belly. The accessory organs of this system are teeth, salivary glands, liver, gallbladder, and pancreas all do their special part to add in the process of digestion, absorption, and elimination. STRUCTURE OF DIGESTIVE SYSTEM: 65 | P a g e  The digestive system is made up of, Gastrointestinal (GI) tract-also called the digestive tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI tract are the mouth, esophagus, stomach,small intestine, large intestine-which includes the rectum-and anus. Food enters the mouth and passes to the anus through the hollow organs of the GItract. Gastrointestinal Tract- Upper part: Mouth and Pharynx: The mouth is the beginning of the digestive tract; and, in fact, digestion starts here when taking the first bite of food. Chewing breaks the food into pieces that are more easily digested, while saliva mixes withfood to begin the process of breaking it down into a form your body can absorb and use. The digestive tract begins with the oral cavity or the mouth. The lips provide the opening and the cheeks form the walls The pharynx is divided into three types, nasopharynx, oropharynx, laryngopharynx. The hard palate is the roof of the mouth, and the muscular soft palate lies behind it. Nasopharynx is situated behind the nasal cavity and above the soft palate The oropharynx is situated behind the oral cavity or the back of themouth/top of the throat. below it continues with laryngopharynx (Hypopharynx). Hanging from the soft palate is a tiny piece of soft tissue called the uvula, which means "Little grape." 66 | P a g e The tongue extends from the floor of the mouth and is attached by muscles to the lowerjawbone. It moves food around during chewing (mastication) and swallowing (deglutition). The tongue is covered with tiny projections called papillae, which contain taste buds that are sensitive to the chemical nature of foods Food passes from the mouth to the pharynx (throat), a muscular tube lined with mucous membrane. It acts as the passageway for air from the nasal cavity to the larynx (voice box) but also as a food passageway going from the mouth to the esophagus. A flap of tissue called the epiglottis covers the opening to the larynx and prevents foodfrom going into the trachea (windpipe) when swallowing occurs. Tooth The teeth are the hardest part of digestive system. besides being essential for chewing, the teeth play an important role in speech. They are the several parts of teeth are. Esophagus Located in your throat near your trachea (windpipe), the esophagus receives food from your mouth when you swallow. By means of a series of muscular contractions called peristalsis, the esophagus delivers food to your stomach. Stomach The stomach is a hollow organ, or "container," which is a pear-shaped enlargement of the alimentary canal linking the esophagus to the small intestine. Divided into Fundus, Body and 67 | P a g e Pylorus It holds food while it is being mixed with enzymes that continue the process of breaking down food into a usable form. Cells in the lining of the stomach secrete strong acid and powerful enzymes that areresponsible for the breakdown process. Bacteria in the GI tract, also called gut flora or microbiome, helps in digestion. Parts of the nervous and circulatory systems also play roles in the digestive process. Secretions of stomach: Mucus - Secreted by mucus cells (helps to lubricate and protectepithelial layer from acids) HCL - Secreted by parietal cells of stomach (helps in breakdown offood particles and inactivation of ingested microorganisms such as bacteria). Pepsin - Secreted by chief cells of stomach (helps in initiating proteindigestion in stomach) Rennin OR -Secreted by chief cells of stomach Gastrin - Secreted by gastric epithelium (helps to control acid secretionin stomach and for gastric motility) When the contents of the stomach are sufficiently processed, they are released into the small intestine. 68 | P a g e Gastrointestinal Tract- Lower part: Small intestine: The small intestine is a 22-foot-long muscular tube extends from stomach to large intestine that breaks down food using enzymes released by the Pancreatic juice frompancreas and bile from the liver. Peristalsis work in this organ, moving food through and mixing it withdigestive secretions from the pancreas and liver. The duodenum is largely responsible for the continuous breaking-down process, with the help of villi in jejunum and ileum. Villi is a finger like projection that helps in absorbing food from small intestine and it is surrounded by the blood vessels. The pyloric sphincter: Between stomach and duodenum regulates the emptying of stomach contents into intestine. The ileocecal valve: Between ileum of small intestine and cecum of large intestine, this allows small intestinal content into large intestine. 69 | P a g e Contents of the small intestine start out semi-solid, and end in a liquid form after passes through the organ. Water, bile, enzymes, and mucous contribute to the change in consistency. These enzymes break down protein, fats, and carbohydrates. The pancreas also makes insulin, secreting it directly into the bloodstream. ACCESSORY ORGANS AND ITS FUNCTIONS: 70 | P a g e Liver, Gallbladder, Pancreas: The liver, pancreas, and gallbladder are the solid organs of the digestive system. Liver. The liver is a large, meaty solid organ that is located on the right upper quadrant of abdomen weighsabout 1.30g. It is reddish brown in color and feels rubbery to the touch. The liver has two large Lobes, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. Functions of Liver Bile production and excretion Excretion of bilirubin, cholesterol, hormones, and drugs Metabolism of fats, proteins, and carbohydrates Enzyme activation Storage of glycogen, vitamins, and minerals Synthesis of plasma proteins, such as albumin, and clotting factors Blood detoxification and purification 71 | P a g e Gallbladder The gallbladder is a small storage organ air pouch located inferior and posterior to the liver.It stores bile produced by the liver. In response to signals, the gallbladder squeezes stored bile into the small intestine through series of tubes called ducts. Bile helps digest fats. Bile is produced by hepatocytes cells in the liver and passes through the bile ducts to the cystic duct. From the cystic duct, bile is pushed into the gallbladder by peristalsis. Large intestine: The large intestine also called Colon or Large bowel. It is the final section of the gastrointestinal tract that performs the vital task of absorbing water and vitamins while converting digested food into feces. It is made up of following structures: Cecum - Intraperitoneal pouch, which is the beginning of large intestine. It receiveschyme from ileum of small intestine. The ascending (right) colon - Part of colon between cecum and transverse colon. The transverse (across) colon - Longest and most movable part of colon crosses theabdomen horizontally. The descending (left) colon - Stores waste until it can be removed. The sigmoid colon which connects to the rectum Expels sloid and gaseous waste from GIT. 72 | P a g e The Vermiform appendix or cecal appendix - A small tube attached to the cecumhas minor immune function. Rectum The rectum is a hollow muscular tube about 8 inches (20 cm) in length and 22inches in diameter at its widest point. It connects colon to the anus While feces are stored in the rectum, the walls of the rectum absorb some water and return it to the bloodsupply. Bacteria continue the fermentation of organic fecal matter that began in the colon and liberate someremaining nutrients that are absorbed by the rectal walls. The distention of the rectum stimulates stretch receptors in the rectal walls to send nerve impulses to thebrain. These impulses are integrated in the brain and result in feelings of discomfort and mounting pressure to empty the rectum through defecation. Anus The anus is the opening where the gastrointestinal tract ends and exits the body. The anus starts at the bottom of the rectum, the last portion of the colon (large intestine). The anorectal line separates the anus from the rectum. The anus issurrounded by sphincter muscles that are important in allowing control of stool. Circular muscles called the external sphincter anal form the wall of the anus and hold it closed. Glands release fluid into the anus to keep its surface moist. 73 | P a g e Digestive Organs and it’s Functions: Organs Functions Teeth Physically breaks food by chewing Tongue Assists in chewing and helps in swallowing Salivary Glands Secrets salivary amylase to break down complex carbohydrates 1. Mixes salivary amylase, food and gastric juices, 2. Secretes HCL which begins protein digestion, Stomach 3. Initiates digestion of fat 1. Protein and fat break down continues, Small Intestine 2. Carbohydrates break down takes place 1. Makes bile and send that to gall bladder 2. Maintains normal blood glucose level 3. Metabolism of all the drugs, chemicals and toxic substance 4. Stores fat soluble vitamins like Vit - A, D, E & K Liver Stores vitamin B12 and the minerals like iron, copper etc… 1. Stores and concentrates bile which is produced from the liver Gall Bladder 2. Transports bile to the small intestine 1. Produces pancreatic enzyme and released into small intestine Pancreas 2. Secrets insulin and Glucagon hormones 1. Absorption of water 2. Produces feces via chemical breakdown Large intestine 3. Evacuates feces through rectum and anus 74 | P a g e Function of the digestive system: FOOD PATHWAY: Mouth Ingestion- mechanical digestion Large intestine -Excretion Rectum saml water Esophagus absorption Anus -Excretion Small intestine Stomach - Chemical digestion mechanical and chemical -Absorption in jejinum and digestion illeum 75 | P a g e PATHOLOGY: DISEASE CONDITION DISCRIPTION Anal fissure A tear, slit or ulcer in the mucous membrane of the anus. Anorectal cancer Malignancy in rectum and /or anus. Anorexia Loss of appetite. Aphagia Inability to eat A- absence, phagia- eat Appendicitis Acute inflammation of the appendix. It is- inflammation Bulimia A mental disorder characterization by secretive binge eating Cholelithiasis The presence of hard deposits called calculi or gallstones in thegallbladder. Cirrhosis A liver disease characterized by impairment to the normal structure and function of the liver cells. Colitis Inflammation of the colon. It is- inflammation Colorectal cancer Malignancy in the colon and/ or rectum. Constipation Difficult, delayed, or incomplete bowel movements. A condition in which the upper esophageal sphincter Cricopharyngeal (Cricopharyngeal muscle) does not open and/or close incoordination properly Dyspepsia Feeling of indigestion, gaseousness or a general burning sensationin the upper abdomen or chest. Diarrhea Abnormally frequent bowel movements, typically semisolid or liquid. Diarrhea is not a itself but rather a symptom of a wide variety of conditions. The forceful expulsion of gastric contents through the mouth. Emesis Alsocall vomiting. Esophageal cancer Malignancy in the esophagus. Esophagitis Inflammation of the esophagus. it is- inflammation 76 | P a g e  Inflammation of the mucosa of the stomach it is- Gastritis inflammation Gastro esophageal reflux A backward flow of gastric contents into the esophagus. It is disease (GERD) causedby the lower esophageal sphincter not functioning properly. A varicose condition of the hemorrhoidal veins near the anus leadingto itching, painful swelling and bleeding. Hemorrhoids Hemorrhoids can be either internal or external. Also called piles. Inflammation of the liver. It is most commonly viral, but can be caused by bacteria, fungi, parasitic organism, toxins or Hepatitis autoimmunedisorders. Types include hepatitis b and hepatitis c. hepato- liver, it is - inflammation Hepatomegaly Enlargement of the liver. hepato- liver, Megaly- enlargement A protrusion of a structure or a part of a structure through the Hernia tissuethat normally contains it. Spasm of the diaphragm that causes sudden inhalation and spasmodic closing of the glottis, producing the characteristics Hiccup "hiccup" sound. Inflammatory bowel disease Various diseases characterized by chronic inflammation of the (IBD) gastrointestinal tract. Dark-brown or black, tarry, feces indicating bleeding in the Melena uppergastrointestinal tract. Pancreatic cancer Malignancy in the pancreas. Peptic ulcer A lesion in the mucosa of the stomach or the first few inches of theduodenum. Inflammation is usually present. Splenomegaly Enlargement of the spleen. Pancreatic cancer Malignancy in the pancreas. Pancreatitis Inflammation of the pancreas. 77 | P a g e ABBREVIATIONS: - Abbreviations Meaning AAR Antigen-antibody reaction ALT Alanine transaminase AST Aspartate transaminase BE OR Bae Barium enema BM Bowel movement ERCP Endoscopic retrograde, Cholangiopancreatography GB Gallbladder GERD gastro esophageal reflux disease GI Gastrointestinal HCI Hydrochloric acid HPE History and physical examination IBD Inflammatory bowel disease, ischemic bowel disease IVC Intravenous cholangiography NG tube Nasogastric tube PTC or PTHC Percutaneous transhepatic cholangiography PUD Peptic ulcer disease UGI Upper gastrointestinal PROCEDURES: 1. Hemorrhoidectomy- Removal of hemorrhoids(piles) 2. Anastomosis- Surgically connecting two hallow muscular structures 3. Endoscopy- Scope to view upper GI tract 4. Colonoscopy- Scope to view lower GI tract 5. Herniorrhaphy- Surgical repair of hernia 78 | P a g e  URINARY SYSTEM The urinary system consists of those organs, which excrete urine and eliminate it from the body. They are kidneys (paired), ureters (paired), urinary bladder and urethra. The production of urine and its elimination from the body are vital functions since together they constitute one of the most important mechanisms for maintaining homeostasis. KIDNEY: Kidneys are a pair of excretory organs, which eliminate the waste products of metabolism in the form of urine and maintain the electrolyte and water balance of the body Every day, the kidneys filter many liters fluid from the blood, allowing toxins, metabolic excisions to leave the body in urine and substances from the filtrate to the blood. Situation: Kidneys are placed retroperitoneally on the poster abdominal wall on either side of the vertebral column the level of T - L, Vertebrae. Right kidney is slightly lower than left (due to the liver) and left kidney is narrower and longer. 79 | P a g e Measurements: Average measurements of each kidney are: Length-11 cm Breadth-6 cm Anteroposterior thickness-3cm Each kidney contains around a million units called nephrons, each of which is a microscopic filter forblood. Nephrons are the structural and functional unit of kidney. Renal physiology is the study of kidney functions and Nephrology is the medical specialty that dealswith kidney diseases. PARTS OF KIDNEY: Renal Capsule -outer membrane that surrounds the kidney; it is thin but tough and fibrous Renal Pelvis-basin-like area that collects urine from the nephrons, it narrows into the upper end of theureter Calyx extension of the renal pelvis; they channel urine from the pyramids to the renal pelvis Cortex-the outer region of the kidney; extensions of the cortical tissue, contains about one million bloodfiltering nephrons Nephron -these are the filtration units in the kidneys Medulla - inner region of the kidney contains 8-12 renal pyramids. The pyramids empty into the calyx Medullary pyramids - formed by the collecting ducts, inner part of the kidney Ureter-collects filtrate and urine from renal pelvis and takes it to the bladder for urination Renal Artery-branches off of the aorta bringing waste-filled blood into the kidney for filtering in the n