Chapter Five DIGESTIVE SYSTEM Copyright 2012 by Mosby

Digestive System Word Parts Gastrointestinal (GI) system or tract Alimentary canal Gastr/o = stomach Intestin/o = intestine aliment/o = nutrition Be Careful! The combining form gastr/o refers only to the stomach. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 2

Did You Know? The alimentary canal acquires its name from the Latin term alimentum, which refers to food or nourishment. Its influence is currently seen in contemporary words, such as adult, meaning grown up or nourished, alimony, meaning an allowance for sustenance, and alma mater, meaning a nourishing mother. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 3

Functions Ingestion Digestion Absorption Elimination • Intake of food • Physical and chemical breakdown of food • Extraction of nutrients • Excretion of waste products Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 4

General Description of the GI System: The Route Through the Body Route Oral cavity

Word Parts sub- = under viscer/o = organ, viscera General Description of the Digestive System: Layers Tunics/Coats peri- = surrounding -stalsis = contraction Tunica mucosa Submucosa Tunica muscularis Serosa: Visceral peritoneum Adventitia Mesentery Peristalsis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 6

Wall of the Gastrointestinal Tract Copyright © 2012 by Mosby, an imprint of Elsevier

Review Question Which process of the GI system refers to the breakdown of food?

Word Parts or/o, stomat/o = mouth, oral cavity Oral Cavity Mastication, deglutition Lips labi/o, cheil/o = lip dent/i, odont/o = teeth cusp/o = point bi- = two Teeth in- = in cis/o = to cut mol/o = molar Vermilion borders Frenulum Philtrum Incisors and cuspids Bicuspids and molars Be Careful! Don’t confuse stom/o and stomat/o, meaning mouth or oral cavity with stomach. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 9

Word Parts amel/o = enamel alveol/o = small cavity, alveolus dent/i = tooth -in = substance The Tooth in Detail Enamel Dentin Cementum Pulp Crown Alveolar ridge Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 10

Word Parts bucc/o = cheek Oral Cavity Cheeks Mucous glands Muc/o = mucus Mol/o = molar, grinding Labi/o = lip gloss/o, lingu/o = tongue palat/o = palate uvul/o = uvula Buccal Molar Labial Palatine Tongue Papillae Taste buds Palate Hard and soft Uvula Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 11

Word Parts maxill/o = upper jaw mandibul/o = lower jaw Oral Cavity Maxilla Mandible Gums dent/i, odont/o = teeth gingiv/o = gums peri- = surrounding sialoaden/o = salivary gland sial/o, ptyal/o = saliva par- = near Sub- = under Salivary glands and saliva Parotid Sublingual Submandibular Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 12

Word Parts pharyng/o = pharynx, throat nas/o = nose Throat and Esophagus Pharynx Nasopharynx Oropharynx Hypopharynx or/o = mouth hypo- = below, under esophag/o = esophagus Esophagus Bolus Lower esophageal sphincter (LES)/ cardiac sphincter/ gastroesophageal sphincter Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 13

Did You Know? A sphincter is a ringlike muscle: sphincters appear in other parts of the body as well, for example, in the urinary system and the eye. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 14

Review Question The parotid gland is a salivary gland located: A. B. C. D.

Word Parts periotone/o = peritoneum Peritoneum Visceral Parietal retro- = behind Retroperitoneum oment/o, epiplo/o = omentum Mesentery Mesoappendix Mesocolon Ligaments Folds Greater and lesser sacs Epiploic foramen Omenta: greater and lesser Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 16

Word Parts gastr/o = stomach cardi/o = heart fund/o = fundus corpor/o = body pylor/o = pylorus The Stomach Cardia Fundus Body Pylorus Rugae Chyme The stomach Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 17

Word Parts enter/o = small intestines duoden/o = duodenum jejun/o = jejunum ile/o = ileum plic/o = fold, plica vill/o = villus -ase = enzyme Small Intestine Duodenum Jejunum Ileum Plicae Villi Lacteals Enzymes Small intestines From Mosby’s dictionary, ed 8, Mosby Be Careful! Don’t confuse ileum with ilium (part of the hip). Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 18

Review Question The cardiac sphincter is the same as the: A. B. C. D. E. lower esophageal sphincter gastroesophageal sphincter pyloric sphincter A&B all of the above Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 19

Word Parts Large Intestine Cecum col/o, colon/o = large intestine, colon Ileocecal sphincter Vermiform appendix Ascending colon cec/o = cecum Transverse colon append/o, appendic/o = appendix Descending colon fec/a = feces Rectum sigmoid/o = sigmoid colon rect/o = rectum an/o = anus proct/o = rectum and anus Sigmoid colon Anus Internal and external sphincters Proct/o is for anus and rectum Defecation Feces, bowel movement: BM Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 20

Be Careful! gastr/o vs. abdomin/o, lapar/o, and celi/o Gastr/o refers only to the stomach, while abdomen/o, lapar/o, and celi/o refer to the abdomen. -cele vs. celi/o Don’t confuse –cele, the suffix meaning herniation with celi/o, a combining form for abdomen. an/o vs. ana- vs. an. An/o is the combining form for anus; ana-, the prefix meaning up or apart; and an -, the prefix meaning no, not, or without. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 21

Word Parts adnex/o = accessory hepat/o = liver Accessory Organs: Adnexa Liver Gallbladder Pancreas cholecyst/o = gallbladder pancreat/o = pancreas Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 22

Word Parts lob/o = lobe chol/e, bil/i = bile choledoch/o = common bile duct/ The Liver Location/lobes Right, left, quadrate, caudate The liver functions to produce bile Bile serves to emulsify fats Bile is composed of bilirubin and cholesterol Bile in liver bile ducts hepatic duct joins with cystic duct from the gallbladder to form the common bile duct empties bile into the duodenum Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 23

Anterior and Posterior View of Liver Copyright © 2012 by Mosby, an imprint of

Word Parts chol/e, bil/i = bile cholesterol/o = cholesterol = choledoch/o = common bile duct cholangi/o = bile vessel Gallbladder Location/description Stores bile from the liver Role of cholecystokinin in bile secretion Cystic duct Common bile duct cholecyst/o = gallbladder -kinin = movement substance Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 25

Word Parts pancreat/o = pancreas Pancreas Location Exocrine function of the pancreas is key in the digestion of: Carbohydrates, proteins, lipids Pancreatic enzymes enter the duodenum through the pancreatic duct that empties into the common bile duct Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 26

Review Question A combining form for the gallbladder is: A. B. C. D. choledoch/o

Symptoms and Signs Involving the Digestive System and Abdomen (R 10 -R 19) Halitosis

Word Parts dys- = difficult, bad -phagia = condition of swallowing, eating hepat/o = liver Symptoms and Signs Involving the Digestive System and Abdomen (R 10 -R 19) Dysphagia Hepatomegaly Jaundice -megaly = enlargement pyr/o = fire -osis = abnormal condition Pyrosis Gastralgia dia- = difficult, bad -rrhea = discharge, flow Diarrhea Jaundice Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 29

Did You Know? Nausea derives its name from the Greek word for seasickness. Notice the similarity between the words nausea and nautical. Heartburn is a misnomer. This burning sensation is experienced in the chest near the heart, not the heart itself. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 30

Word Parts ankyl/o = stiffening gloss/o = tongue Congenital Conditions (Q 00 Q 99) Anklyoglossia Esophageal atresia -ia = condition esophag/o = esophagus -eal = pertaining to a- = no, not, without -tresia = condition of an opening Esophageal atresia Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 31

Word Parts gastr/o = stomach -schisis = split omphal/o = umbilicus Congenital Conditions (Q 00 Q 99) Gastroschisis Omphalocele Pyloric stenosis -cele = herniation, protrusion pylor/o = pylorus -ic = pertaining to stenosis = narrowing Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 32

Congenital Conditions (Q 00 -Q 99) Cleft palate Hirschsprung’s disease Cleft palate and lip

Review Question The medical term/word part for “no opening” is: A. B. C. D.

Word Parts amel/o = enamel -genesis = production, origin an- = no, without Diseases of Oral Cavity and Salivary Glands (K 00 -K 14) Amelogenesis imperfecta Anodontia Edentulous odont/o = teeth -ia = condition Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 35

Word Parts aphth/o = ulceration -ous = pertaining to Diseases of Oral Cavity and Salivary Glands (K 00 -K 14) Aphthous stomatitis Cheilitis stomat/o = mouth -itis = inflammation cheil/o = lip Aphthous stomatitis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 36

Word Parts gingiv/o = gums -itis = inflammation gloss/o = tongue Diseases of Oral Cavity and Salivary Glands (K 00 -K 14) Dental caries Gingivitis Periodontal disease Glossitis Gingivitis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 37

Word Parts mucos/o = mucus -itis = inflammation leuk/o = white -plakia = condition of patches ptyal/o = saliva -ism = condition sialoaden/o = salivary gland Diseases of Oral Cavity and Salivary Glands (K 00 -K 14) Oral mucositis Oral leukoplakia Ptyalism Sialoadenitis Sialolithiasis sial/o = saliva lith/o = stone -iasis = presence of, condition Oral leukoplakia Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 38

Review Question Ptyalism is a condition of: A. B. C. D. the saliva the

Word Parts a- = without -chalasia = condition of relaxation dys- = abnormal, bad -pepsia = digestion condition gastr/o = stomach esophag/o = esphagus Diseases of Esophagus, Stomach, and Duodenum (K 20 -K 31) Achalasia Dyspepsia Esophagitis Gastroesophageal reflux disease (GERD) Barrett’s esophagus GERD -eal = pertaining to re- = back -flux = flow Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 40

Diseases of Esophagus, Stomach, and Duodenum (K 20 -K 31) Gastritis Peptic ulcer disease

Diseases of the Appendix (K 35 -K 38) Appendicitis Peritonitis Acute vs. chronic Be Careful! Don’t confuse peritone/o, which means the membrane that lines the abdominal cavity, with perone/o, which is a combining form for the fibula; and perine/o, which means the space between the anus and external reproductive organs. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 42

Hernias (K 40 -K 46) Complications Incarcerated hernia Irreducible Strangulated hernia Gangrene Copyright ©

Hernias (K 40 -K 46) Umbilical hernia (omphalocele) Femoral (crural) hernia Hiatal hernia (diaphragmatocele) Inguinal hernia Ventral hernia Umbilical hernia Hiatal hernia From Zitelli: Atlas of pediatric physical diagnosis, ed 4, Mosby Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 44

Noninfective Enteritis and Colitis (K 50 -K 52) Colitis Inflammatory bowel disease (IBD) Crohn’s disease (regional or granulomatous enteritis) Ulcerative colitis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 45

Other Diseases of the Intestines (K 55 -K 63) Anal fissure Anorectal abscess Anorectal

Other Diseases of the Intestines (K 55 -K 63) Ileus Intussusception Volvulus Irritable bowel syndrome (IBS) A. Intussusception, B. Volvulus Intussusception From Damjanov: Pathology for the health professions, ed 3, Saunders Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 47

Word Parts diverticul/o = diverticulum Other Diseases of the Intestines (K 55 -K 63) Diverticulitis Diverticulosis -itis = inflammation -osis = abnormal condition Diverticulosis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 48

Word Parts proct/o = rectum and anus -itis = inflammation -ptosis = drooping, prolapse Other Diseases of the Intestines (K 55 -K 63) Polyp of colon Proctitis Proctoptosis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 49

Review Question A twisting of the intestines: A. B. C. D. anastomosis paralytic ileus

Review Question A hiatal hernia is the same as a/n: A. B. C. D.

Word Parts cirrh/o = orange-yellow -osis = abnormal condition peritone/o = peritoneum Diseases of Peritoneum and Retroperitoneum (K 65 K 68) and Diseases of Liver (K 70 -K 77) Cirrhosis Peritonitis -itis = inflammation Normal liver Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Cirrhosis of the liver 52

Special Note Liver disease often requires additional codes like alcoholic liver diseases that need codes to describe alcohol abuse and dependence. Toxic liver disease requires a code to identify what type of drug or toxic agent caused the disease. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 53

cholang/o = bile vessel Diseases of Gallbladder, Biliary Tract, and Pancreas (K 80 -K 87) -itis = inflammation Cholangitis Word Parts cholecyst/o = gallbladder choledoch/o = common bile duct -lith/o = stone -iasis = presence of Cholecystitis Choledocholithiasis Cholelithiasis Pancreatitis chol/e = bile pancreat/o = pancreas Cholelithiasis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 54

Review Question Which of the following disorders involves the presence of stones? A. B. C. D. cholangitis cholecystitis choledocholithiasis cirrhosis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 55

Word Parts celi/o = abdomen hemat/o = blood -emesis = vomiting Other Diseases of Digestive System (K 90 -K 94) Celiac disease (celiac sprue) Hematemesis Melena melan/o = black, dark Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 56

Word Parts stomat/o = mouth -itis = inflammation hepat/o = liver Viral Infections Characterized by Skin and Mucous Membranes (B 00 B 09) and Viral Hepatitis (B 15 -B 19) Herpetic stomatitis (cold sore, fever blister) Hepatitis A (HAV) Hepatitis B (HBV) Hepatitis C (HCV) Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 57

Word Parts cyst/o = cyst Benign Neoplasms (D 10 -D 36) Cystadenoma Odontogenic tumor aden/o = gland -oma = tumor, mass odont/o = teeth -genic = pertaining to produced by Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 58

Benign Neoplasms (D 10 -D 36) Polyps, adenomatous or hyperplastic Sessile versus pedunculated Adenomatous

Word Parts aden/o = gland -carcinoma = cancerous tumor of epithelial origin hepat/o = liver Malignant Neoplasms (C 00 C 96) Adenocarcinoma Hepatocellular carcinoma/hepatoma Squamous cell carcinoma cellul/o = cell -ar = pertaining to squam/o = scaly -ous = pertaining to Adenocarcinoma of the esophagus Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 60

Review Question Which of the following tumors begins in the teeth? A. B. C.

Laboratory Tests Gamma-glutamyl transferase (GGT) Stool culture Stool guaiac/hemoccult test Total bilirubin Copyright ©

Laboratory Tests Albumin Alkaline phosphatase (ALP) Alanine transaminase (ALT) Aspartate transaminase (AST) Gastric analysis

Laboratory Tests Hepatitis-associated antigen (HAA) Liver function tests (LFTs) Prothrombin time (PT) Rapid urease

Review Question Which diagnostic procedure would be used to determine if blood was present in the stool? A. B. C. D. total bilirubin stool guaiac manometry fluoroscopy Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 65

Word Parts fren/o , frenul/o = frenulum -tomy = cutting esophag/o = esophagus -stomy = making a new opening Upper GI Procedures Barium swallow Frentomy, frenulotomy Esophagoesophagostomy Fundoplication, gastroesophageal fund/o = fundus -plication = folding Gingivectomy gingiv/o = gums -ectomy = cutting out Barium swallow Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 66

Word Parts gastr/o = stomach duoden/o = duodenum -stomy = making a new opening -plasty = surgically forming hyper- = excessive aliment/o = nutrition Upper GI Procedures Gastroduodenostomy Gastroplasty Gastrostomy Percutaneous endoscopic gastrostomy (PEG) Hyperalimentation Pyloromyotomy -ation = process of pylor/o = pylorus my/o = myscle -tomy = cutting Gastroduodenostomy Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 67

Procedures anastomoses vs. -stomy Definition of anastomosis Rules for building terms for anastomoses Terms using a single structure with “-stomy” Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 68

Word Parts gloss/o = tongue -rrhaphy = suturing odont/o = teeth -ectomy = cutting out palat/o = palate -plasty = surgically forming Upper GI Procedures Glossorrhaphy Odontectomy Palatoplasty Sialodochoplasty Stomatoplasty Uvulectomy sialodoch/o = salivary duct stomat/o = mouth uvul/o = uvula Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 69

Guideline Alert Bypass procedures are coded by identifying the body part bypassed “from” and the body part bypassed “to”. The fourth character body part specifies the body part bypassed from, and the qualifier specifies the body part bypassed to. Example: Bypass from stomach to jejunum, stomach is the body part and jejunum is the qualifier. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 70

PCS Guideline Alert PCS contains specific body parts for anatomical subdivisions of a body part, such as lobes of the lungs or liver and regions of the intestines. Resection of the specific body part is coded whenever all of the body part is cut or off, rather than coding Excision of a less specific body part. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 71

Review Question A sialoadenectomy is a cutting out of: A. B. C. D. a

Word Parts append/o = appendix -ectomy = cutting out cec/o = cecum -pexy = suspension colon/o = colon -scopy = viewing Lower GI Procedures Appendectomy Barium enema Cecopexy Colonoscopy Colostomy Stoma col/o = colon -stomy = making a new opening Colostomy and stoma Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 73

Word Parts diverticul/o = diverticulum Lower GI Procedures Diverticulectomy Enteral nutrition Herniorrhaphy -ectomy = cutting out enter/o = small intestine -al = pertaining to herni/o = hernia -rrhaphy = suturing Enteral nutrition Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 74

Word Parts ile/o = ileum ureter/o = ureter -stomy = making a new opening jejun/o = jejunum Lower GI Procedures Ileoureterostomy Jejunostomy Omentectomy, omentumectomy Peritoneocentesis Polypectomy, GI oment/o = omentum -tomy = cutting -ectomy = cutting out peritone/o = peritoneum -centesis = surgical puncture Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 75

Word Parts proct/o = rectum and anus -clysis = washing -scopy = viewing Lower GI Procedures Proctoclysis Proctoscopy Sigmoidoscopy Total parenteral nutrition (TPN) sigmoid/o = sigmoid colon par- = near, beside enter/o = small intestine -al = pertaining to Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 76

Review Question Surgical puncture of fluid from the abdominal cavity is: A. B. C.

Procedures of the Adnexa Cholangiography Cholecystectomy Choledocholithotomy Laparoscopic cholecystectomy Copyright © 2012 by Mosby,

Word Parts cholangi/o = bile vessel pancreat/o = pancreas -graphy = recording Procedures of the Adnexa Endoscopic retrograde cholangiopancreatography (ERCP) Hepatectomy hepat/o = liver -ectomy = cutting out ERCP Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 79

Review Question What does the suffix –lithotomy indicate in a choledocholithotomy? A. B. C. D. folding Cutting out a stone washing making a new opening Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 80

Suffixes and Root Operations for the Digestive System -centesis -ectomy -lithotomy -pexy -plasty -plication -rrhaphy -scopy -stomy -tomy drainage excision, resection extirpation repair, reposition repair, supplement, replacement restriction repair, supplement inspection bypass, drainage, release, division Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 81

Sort these terms into their correct categories Terms 1. esophagostomy 2. peristalsis 3. stool guaiac 4. diverticulitis 5. hepatitis Categories __ A + P __ Pathology __ Procedures Copyright © 2012 by Mosby, an imprint of Elsevier Inc. 82