Resilience Medical Coding Academy

CPC Certification
Study Material- 2024

Prepared by N. Srinivas (CCS

 Anatomy & Physiology
&
Pathology

The Digestive System

Organs of the Digestive System
 D
igestive Metabolism
 Digestion - Breakdown of ingested food
 Absorption - Passage of nutrients into the blood
 Metabolism - Production of cellular energy
Digestive Tract or Alimentary Canal
Mouth
Pharynx

Esophagus
Stomach
Small Intestine
Large Intestine
Resctum
Anus
 Mouth (Oral Cavity)
 Lips (labia) - protect the anterior opening
 Cheeks – form the lateral walls
 Hard palate – forms the anterior roof
 Soft palate – forms the posterior roof
 Uvula – fleshy projection of the soft
palate

Tonsils (Adenoids)
 Palatine tonsils
 Lingual tonsil

Salivary Glands: (contains amylase,

which helps to break down starch)
 Parotid salivary gland
 Sublingual salivary gland
 Submandibular salivary gland

Epiglottis (Vula) - is a flap-like structure at the back of the throat that closes over the trachea
preventing food from entering it. It is located in the Pharynx
  Teeth - are used for chewing the food…mastication. The food is broken apart and mixed
with saliva to form a bolus, ready to be swallowed
 Pharynx - Muscular constrictions move the bolus through the pharynx and into the
esophagus.
Esophagus
 Runs from pharynx to stomach through the diaphragm
 Food moves from the throat to the stomach using muscle movement called peristalsis

Stomach
 Located on the left side of the
abdominal cavity.
 Food enters at the cardioesophageal sphincter.
 Fundus - upper portion.
 Body
 Antrum - lower portion
 Hydrochloric acid and other gastric juices
convert the food to a semiliquid state
called chyme
 digesting enzyme – pepsinogen
 Food empties into the small intestine at the
pyloric sphincter.
 Acts as a storage tank for food
 Site of food breakdown
 Chemical breakdown of protein
 Delivers chyme (processed food) to the
small intestine

Small Intestine
 Extending from the Pyloric sphincter valve to the ileocecal valve
 Nutrients from the food pass into the bloodstream through the walls of the small intestine.
 The liver’s primary contribution to digestion is the production of Bile- helps to digest fats.
 The pancreas secretes pancreatic juice contain digestive enzymes into the duodenum.
 The jejunum and ilium are lined with hair-like protrusions called villi.
 The blood inside the villi can absorb the nutrients in the food.
 Pancreatic enzymes - Responsible for fat digestion (lipase), Digest nucleic acids
(nucleases), Alkaline content neutralizes acidic chym
 Large Intestine (Colon)
 Cecum, Appendix, Ascending Colon, Transverse colon, Descending colon, S-Sigmoid
colon, Rectum, Anus.
 Absorb the remaining water and nutrients K and B from indigestible food matter.
 Goblet cells produce mucus to act as a lubricant
 Produce some vitamin K and B and release gases
 Bowel movements
 Remaining materials are eliminated via feces
Accessory Digestive Organs
 Salivary glands
 Teeth
 Pancreas
 Liver
 Gall bladder

Process of Digestive system

 Ingestion - getting food into the mouth
 Propulsion – moving foods
 Peristalsis
 Mechanical digestion
 Chemical Digestion
 Absorption
 Defecation - Elimination

Rectum & Anus

 As the rectal walls expand with waste material, receptors from the nervous system
stimulate the desire to defecate.
 For defecation or egestion, we consciously relax the external anal sphincter muscle to
expel the waste through the anus.
 Pathology of Digestive System
1.Gallstones (Cholelithiasis)
Def: Gallstones are hard, pebble-like pieces
of material, usually made of cholesterol or
bilirubin, that form in your gallbladder.
Causes: cholesterol, excess bile secretions
Symptoms: Pain, indigestion
Test: US
Treat: Low fat diet, cholecystectomy, med

2. Hepatitis (A, B, C, D and E

Alcoholic, autoimmune)
Def: Hepatitis means inflammation of the
liver.
Causes: virus, infection, toxic substances
Symptoms: pain, jaundice, loss of appetite, dark urine
Test: blood test
Treat: antiviral

3. Peptic ulcer
Def: Peptic ulcers are open sores that develop on
the inside lining of your stomach and the upper
portion
of your small intestine.
Causes: alcohol drinking, tobacco bacteria,
viral,
Symptoms: Pain, indigestion, vomiting, loss of
appetite
Test: endoscopy- A long, thin tube with a small
camera inside.
Treat: antibiotics, antacid drugs.

4. Cirrhosis
Def: a chronic condition that makes it hard for the liver to remove toxins (poisonous
substances) from the body.
Causes: Alcohol, medications, and other
substances may build up in the
bloodstream and cause problems.
Symptoms: skin itching, poor appetite,
weakness, pain
Test: Blood, scanning, Biopsy
Treat: low sodium diet, medications-
anti biotics, ligation,
1. Crohn’s disease
Def: Crohn’s disease is a chronic (long-
lasting) disease that causes inflammation
in your digestive tract.
Causes: Food, med, toxic
Symptoms: pain, diarrhoea, weight loss,
anaemia
Test: colonoscopy, biopsy.
Treat: dietary supplements, vitamin
supplements.

Other Terms & diseases:

Haemorrhoids – Haemorrhoids are swollen veins in your lower rectum.
Diverticulitis - Marble-sized pouches to protrude through the colon wall. Diverticulitis occurs
when diverticula tear, resulting in inflammation, and in some cases, infection.
Achalasia - Increase in LES muscle tone; loss of peristalsis in esophagus. The esophagus
muscles do not contract properly and do not help propel food down toward the
stomach.
Appendectomy- An operation to remove the appendix.
Appendicitis - Irritation, inflammation, and pain in the appendix, caused by
infection, scarring, or obstruction
Ascites - Fluid that fills the abdomen when the liver is not functioning properly.
Bile ducts - Tubes that take bile from the liver to the gallbladder and small
intestine to aid in digestion
Bilirubin - A normal substance produced when red blood cells break down and are
excreted by the liver. Bilirubin gives bile its yellow-green color.
Too much bilirubin in the blood causes jaundice.
Bowel movement – Passage of stool (body wastes) from the large intestine through the
rectum and anus.
Cholecystectomy – An operation to remove the gallbladder.
Colostomy - Surgical opening of colon
Constipation - Hard, dry stools that are difficult to pass in a bowel movement, or
having fewer than three bowel movements per week.
Dysphagia - Dysphagia is difficulty swallowing.
Diarrhea - Increased frequency of bowel movements
Increased volume, fluidity, weight of the feces
Ulcerative Colitis – Chronic inflammatory disease that causes ulceration of the colonic mucosa
Colon Cancer – Abnormal growth of cells (Tumours) in colon
 GERD - Gastroesophageal reflux disease Gastroesophageal reflux disease develops when the
reflux of stomach contents in the esophagus causes chronic symptoms (such as
heartburn, regurgitation, occasionally sore throat and cough) and mucosal damage
Irritable Bowel Syndrome (IBS) – An intestinal disorder causing pain in the stomach,
diarrhea, constipation, and change in the appearance of stool.
Anal Fistula – It’s an abnormal, tube-like passageway from the anal canal to a hole in the skin
near the opening of your anus.

.
 Respiratory system
Respiration: The primary function of this system is process of gas exchange between
atmosphere and body cells.
Respiration is 2 Types
1. External respiration:
 It is the process of inhaling oxygen into the lungs, and exhaling carbon dioxide.
 That process includes the ventilation of the lungs and the exchange air in the lungs and
blood within the capillaries of the alveoli of the lungs.
2. Internal respiration:
 It is the metabolic process by which living cells use blood flowing through the
capillaries, absorbing the oxygen (O2) they need and releasing the carbon dioxide (CO2)
they
create.
Nose
 The external opening of the nose is the nostrils or
anterior nares
 The dividing partition between the nostrils is the
nasal septum, which forms two nasal cavities.
Each cavity is divided into 3 air passages:
 The superior, middle, and inferior conchae.
 Sinuses are Air filled spaces in skull.
Pharynx
 The pharynx is the correct term for the throat
 Nasopharynx is behind the nose;
 Oropharynx is behind the mouth;
 Laryngopharynx is behind the larynx
Larynx
 The larynx, commonly called the voice box, is
located at the upper end of the trachea.
 The larynx contains vocal cords, which produce
sound.
 The epiglottis covers the entrance of the larynx
while swallowing, to avoid choking.
Trachea
 The trachea or windpipe is a smooth, muscular
tube leading from the larynx to the main
bronchi.
 Cartilage rings prevent crushing of the trachea
 The trachea is the passageway for air to and
from the lungs.
 It is lined with cilia (hairs), which sweep
foreign matter out of the pathway.
Bronchi
 The bronchi are the two main branches at the bottom of the trachea, providing passageway
for air to the lungs.
 The trachea divides into the right bronchus and the left bronchus, and then divides further
into the bronchial tree
 As the branches of the bronchial tree get smaller, the 2 primary bronchi become
bronchioles, and then very small alveolar ducts.
 The left bronchi is smaller than the right bronchi, because room is needed to accommodate
the heart.
Lungs & Alveoli
 The lungs are 2 spongy organs located in the thorax.
 They consist of elastic tissue, filled with an interlacing network of tubes and sacs that carry
air and blood vessels that carry blood.
 Each lung is divided into lobes, the right lung into 3 lobes and the left lung into 2.
 The left lung has an indentation called the cardiac depression or notch… for placement of
the heart.
 At the end of each bronchiole are the alveoli (Functional unit of Respiratory)
 The lungs contain about 300 million alveoli sacs, which are the air cells where the exchange
of oxygen and carbon dioxide takes place with the capillaries.
Diaphragm
 The base of the lungs rest on the diaphragm, a muscular wall separating the thorax from the
abdominal cavity.
 It is involved in respiration, drawing downward in the chest during inhalation, and pushing
upward during exhalation.

Pathology of Respiratory System

1. Chronic Obstructive Pulmonary Disease
Def: A group of lung diseases (emphysema, asthma, bronchitis, bronchiectasis) that block
airflow and make it difficult to breathe
Causes: smoking, air pollution
Symptoms: SOB, Wheezing (high-pitched whistling sound made while breathing), chronic
cough
Tests: Spirometry. The most common lung function test is called spirometry.
Chest x-ray, CT scan, AAT test (This is a type of blood test. It helps find out if you
have a genetic disorder called alpha-1 antitrypsin deficiency)
Treat: bronchodilators (Salbutamol), oxygen therapy, pulmonary rehabilitation.
2. Asthma
Def: airways become inflamed, narrow (constrict) and swell and produce extra mucus,
which makes it difficult to breathe.
Cause: Exposure to chemical irritants and allergens, dust.
Symptoms: difficult breath, cough, wheezing, chest pain.
Test: spirometry- (a machine that measures how fast you can breathe out and how much air
you can hold in your lungs.)
Treat: Bronchodilators, steroids, quit smoking.
3. Pulmonary Tuberculosis
Def: TB is a bacterial (Mycobacterium tuberculosis) infection that mainly affects the lungs
and can also affect any part of the body.
Cause: M Bacteria.
Symptoms cough, blood tingled, weight loss,
chest pain, fever.
Test: TB skin test, TB blood test, sputum
microscopy.
Treat: Antibiotics, antituberculosis therapy.
4. Emphysema
Def: The air sacs in the lungs (alveoli) are
damaged.
Cause: smoking, air pollution
Symptoms: SOB, Difficult breath, cough
 Tests: spirometry
Treat: Medications
5. Interstitial lung disease (ILD)
Def: a large group of diseases that cause scarring (fibrosis) of the lungs. The scarring causes
stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream
Symptoms: Dry cough, SOB
Causes: smoking, medicines, drugs, family history
Tests: CT, X-ray
Treat: steroids, meds

Atelectasis (collapse) - Incomplete expansion of the lungs or collapse of previously

inflated lung substance
Centrilobular emphysema - The central or proximal parts of the acini are affected, while
distal alveoli are spared
Bronchiectasis - Chronic necrotizing infection of the bronchi and bronchioles
leading to or associated with abnormal dilatation of these
airways.
Pneumonia - Pneumonia is an infection in your lungs caused by bacteria,
viruses or fungi. Pneumonia causes your lung tissue to swell
(inflammation) and can cause fluid or pus in your lungs
 Circulatory System
Circulatory systems generally have three main features:
 Fluid (blood) that transports materials.
 System of blood vessels.
 A heart to pump the fluid through the vessels.

Heart - Pumping blood to all body parts

 Cone-shaped organ
 In the mediastinum
 Slightly left of the midline
 Posteriorly by the vertebral column
 Anteriorly by the sternum

Pericardium - Covers the heart and large blood vessels attached to the heart.

Visceral pericardium - Innermost layer

- Directly on the heart
Parietal pericardium - Layer on top of the visceral pericardium

Heart walls:
 Epicardium
 Outermost layer
 Fat to cushion heart
 Myocardium
 Middle layer
 Primarily cardiac muscle
 Endocardium
 Innermost layer
 Thin and smooth
 Stretches as the heart pumps
The Heart: Structure: Four chambers
 Two atria
 Upper chambers
 Left and right
 Separated by interatrial septum
 Two ventricles
 Lower chambers
 Left and right
 Separated by interventricular septum
Atrioventricular septum separates the atria
from the ventricles
  Tricuspid valve – prevents blood from
flowing back into the right atrium when
the right ventricle contracts
 Bicuspid valve – prevents blood from
flowing back into the left atrium when
the left ventricle contracts
 Pulmonary valve – prevents blood from
flowing back into the right ventricle
 Aortic valve – prevents blood from
flowing back into the left ventricle

Cardiac Conduction System

1.Sinoatrial node (SA node)
 Wall of right atrium
 Generates impulse
 Natural pacemaker
 Sends impulse to AV node
2.Atrioventricular node (AV node)
 Between atria just above ventricles.
 Atria contract.
 Sends impulse to the bundle of His.
3.Bundle of His
 Between ventricles
 Two branches
 Sends impulse to Purkinje fibers
4.Purkinje fibers
 Lateral walls of ventricles
 Ventricles contract

Blood Vessels:
Arteries and Arterioles
 Strongest of the blood vessels.
 Carry blood away from the heart.
 Under high pressure.
Vasoconstriction
Vasodilation
 Arterioles - Small branches of arteries.
 Aorta - Takes blood from the heart to the body. Largest blood vessel in the heart
 Coronary arteries - Supply blood to heart muscle.
Veins and Venules
 Blood under no pressure in veins.
 Does not move very easily.
 Skeletal muscle contractions help move blood.
 Sympathetic nervous system also influences pressure.
 Venules
 Small vessels formed when capillaries merge.
 Superior and inferior vena cava
 Largest veins.
 Carry blood into right atrium.

Blood Pressure
 Systolic pressure
 Ventricles contract
 Blood pressure is at its greatest in the arteries
 Diastolic pressure
 Ventricles relax
 Blood pressure in arteries is at its lowest.
Baroreceptors
 Also help regulate blood pressure.
 Located in the aorta and carotid arteries.

Pulmonary circuit
right atrium  right ventricle  pulmonary artery trunk  pulmonary arteries  lungs 
pulmonary veins  heart (left atrium).
Systemic circuit
left atrium  left ventricle  aorta  arteries  arterioles  capillaries  venules  veins
 vena cava  heart (right atrium)
Blood
 Red blood cells (erythrocytes) 45%
 White blood cells (leukocytes) 1%
 Platelets – cell fragments
 Plasma – fluid part of blood 55%
Red Blood Cells (Erythrocytes) - Made in bone marrow; carries oxygen, food, and rids body
of CO2 and waste
 Transport oxygen throughout the body
 Small biconcave-shaped cells
 Hemoglobin is a pigment in RBCs
 Oxyhemoglobin carries oxygen; bright red
 Deoxyhemoglobin does not carry oxygen; darker red
 Erythropoietin – regulates production of RBCs
White Blood Cells - Help fight disease and infection by destroying bacteria and
germs that enter the body. Made in the lymph nodes
 Granulocytes
 Neutrophils –destroy bacteria, viruses, and toxins in the bloodstream (phagocytes)
 Eosinophils – get rid of parasitic infections such as worm infections.
 Basophils – control inflammation and allergic reactions.
 Agranulocytes
 Monocytes (8%) – destroy bacteria,
viruses, and toxins in blood
 Lymphocytes (33%) – provide
immunity for the body
 WBC count normally 5000 to 10,000 cells
per cubic millimeter of blood
 Leukocytosis
 Elevated WBC count
 Usually due to
infection
 Leukopenia
 Low WBC count
 Some viral infections
and other conditions
Platelets - Help blood to clot, to prevent
excess bleeding.
 Fragments of cells found in the
bloodstream
 Also called thrombocytes
 Important in the clotting process of blood
 Normal count 130,000 to 360,000 platelets per cubic millimeter of blood
Plasma
 Liquid portion of blood composed mostly of water
 Proteins - Albumins
 Smallest plasma proteins
 Pull water in to help maintain blood pressure
Globulins – transport lipids and fat-soluble vitamins
Fibrinogen – needed for blood clotting
 Nutrients - Amino acids
Glucose
Nucleotides
Lipids from the digestive tract
 Gases – oxygen, carbon dioxide, and nitrogen
 Electrolytes
 Waste products.
Hemostasis – the control of bleeding
Three processes of hemostasis
 Blood vessel spasm
 Platelet plug formation
 Blood coagulation

Blood Types

Blood Type Antigen Antibody Blood That Can

Present Present Be Received

A A B A and O

B B A B and O

AB AB None A, B, AB, and O

O None A and B O

Pathology of Circulatory system

1. Atherosclerosis
Def: Narrowing of coronary arteries caused by hardening of the fatty plaque deposits within
the arteries
Causes: smoking, alcohol, obesity.
Symptoms: angina, SOB, Fatigue, poor wound healing
Tests: physical exam, angiography, ECG.
Treat: CABG, stenting, Meds.

2. Myocardial Infarction
Def: A myocardial infarction is a condition in which an artery that supplies blood to the
heart is blocked, cutting off the supply of oxygen and nutrients to that area of the heart.
As a result, the affected heart tissue dies or is permanently damaged.
Causes: Blood clots, fatty plaques that build up inside the coronary arteries, Sudden severe
stress
 Symptoms: Chest pain, SOB, Rapid or irregular heartbeat.
Tests: Electrocardiogram, Coronary angiography, MRI, Nuclear scans
Treat: anticoagulants or thrombolytics, Oxygen therapy, CABG, stenting.

3. Atrial fibrillation
Def: Atrial fibrillation is an arrhythmia (an abnormal rhythm of the heart) in which the two
small upper chambers of the heart, called the atria, “fibrillate” (contract very fast and
irregularly) and quiver instead of beating effectively
Causes: BP, Congenital heart defects, Abnormal heart valves
Symptoms: Palpitations (sensations of a racing, irregular heartbeat or a pounding or
flopping in the chest)
Decreased blood pressure
Weakness or fatigue
Tests: Electrocardiogram, Holter monitor, Echocardiogram
Treat: Blood thinning medications to prevent clots.
Medications to control the heart rate and rhythm
Pacemaker implantation.

4. Cardiomyopathy
Def: Cardiomyopathy is a disease of the heart muscle that impairs the function of the heart.
Primary cardiomyopathy
Secondary cardiomyopathy
Ischemic cardiomyopathy
Nonischemic cardiomyopathy- Dilated cardiomyopathy, Hypertrophic
cardiomyopathy, Restrictive cardiomyopathy
Causes: Long-term high blood pressure, Heart valve problems, long-term use of alcohol
Symptoms: Swelling or edema of the lower extremities, Chest pain, Heart murmurs
Tests: Electrocardiogram, Holter monitor, Echocardiogram
Treat: Pacemaker or cardioverter, defibrillator, Surgery or ablation procedures.

5. Peripheral vascular disease

Def: “Peripheral vascular disease” is a broad term that refers to diseases of the blood vessels
outside the heart and brain. These diseases, over time, cause occlusion of the
peripheral blood vessels
Causes:
Symptoms: Arterial bruits (a whooshing sound heard with a stethoscope over the artery), s
intermittent claudication, Diminished pulse in the legs or feet
Tests: Ankle-brachial index (ABI) test, blood testing, US, Angiography
Treat: Smoking cessation, Diet management, exercise and weight control, Surgery (e.g.,
angioplasty)
6. Heart failure
Def: Heart failure is a condition in which the heart muscle is unable to pump enough blood
through the heart to meet the body’s needs for blood and oxygen
Causes: Smoking, Obesity, Coronary artery disease, DM.`
Symptoms: Edema or swelling, SOB, Fatigue.
Tests: BNP (B-type natriuretic peptide), electrocardiogram, Echocardiogram
Treat: Medications, Pacemaker or implantable cardioverter defibrillator, Heart pumps.
Other Diseases
1. Anemia: The blood does not have enough red blood cells or hemoglobin to carry an
adequate amount of oxygen to the body’s cells
2. Aneurysm: A ballooned, weakened arterial wall
3. Arrhythmias: Abnormal heart rhythms
4. Endocarditis: Inflammation of the innermost lining of the heart, including valves
5. Myocarditis: Inflammation of the muscular layer of the heart
6. Pericarditis: Inflammation of the membranes that surround the heart (pericardium)
7. Leukemia: Bone marrow produces a large number of abnormal WBCs
8. Thalassemia: Inherited form of anemia; defective hemoglobin chain causes, small, pale, and
short-lived RBCs
9. Thrombophlebitis: Blood clots and inflammation develops in a vein
10. Varicose Veins: Twisted, dilated veins
11. Stroke: Happens when a cluster of blood cells blocks blood vessels in the brain.
12. Hemophilia: Blood does not clot properly.
 Urinary System

(Excretory System)

Parts:
 Two kidneys: bean shaped organs located in superior dorsal abdominal cavity that filter
blood & make urine, & accessory structures.
 Ureter: a tube that carries urine from each kidney to a single urinary bladder, located in
inferior ventral pelvic cavity.
 Bladder: expandable sac that holds urine.
 Urethra: a tube that transports urine from bladder to the Meatus.
Functions: Functional unit - Nephron
 It extracts wastes from the bloodstream, converts them to urine, then transports and
eliminates it.
 Control electrolyte (Na, K, Cl,
Co2) & fluid balances for body.
 A major part of homeostasis is
maintaining the composition, pH,
and volume of body fluids within
normal limits
 Red blood cell production- by
producing hormone
erythropoietin to stimulate RBC
production in bone marrow
 Blood pressure (vessel size)- by producing renin which causes vasoconstriction
 Blood volume (water balance)- ADH released from Anterior Pituitary targets the kidney to
limit water loss when blood pressure decreases or changes in blood composition
 Blood composition (electrolyte balance)- water follows salt; aldosterone reclaims sodium to
the blood
 Blood pH- regulates.

Kidneys

 The kidneys are bean-shaped organs located at the back of the abdominal cavity, lying on
each side of the spinal column just above the waistline.
 Three layers surround each kidney:
 The true capsule is a smooth, fibrous membrane adhering to the kidney surface;
 The perirenal fat is adipose tissue surrounding each kidney;
 The renal fascia is fibrous tissue that anchors the kidney to surrounding structures.
 The notch in the concave area of the kidney is called the hilum.
 The renal artery, renal vein, nerves, and lymphatic vessels enter and leave through the
hilum.
 Kidney divided into 3 layers:
 Renal cortex: outer layer, grainy in appearance, has little obvious structure to naked
eye; where blood filtration occurs.
 Renal medulla: middle layer: Transports urine to the renal pelvis via “pyramids.”
  Renal pelvis: inner layer. Collects urine

 Each nephron contains a Bowman’s capsule and a Gomerulus

 The Nephron - 3 processes must occur in Nephron
1. Glomerular Filtration: fluid & molecules pass from glomerular capillaries into
glomerular (Bowman’s) capsule. Filtrate
flows into renal tubule.
2. Tubular Reabsorption: substances
reabsorbed pass from renal tubule into
peritubular capillaries & return to blood
stream.
3. Tubular Secretion: substances that are
secreted pass-through peritubular capillaries
into renal tubule & eventually leave body as
urine, no longer filtrate

Ureters
 Ureter walls have 3 layers: the inner mucous membrane, the middle smooth
muscle, and the outer fibrous tissue

Bladder
 The urinary bladder is a muscular, membranous sac that serves as a reservoir for urine
 The bladder has an upper portion called an apex, a neck that extends downward into the
urethra, and the triangular trigone near the base.
 As the bladder fills with urine, the muscular walls thin and expand

Urethra
 The urethra extends from the
bladder to the outside opening of
the body called the urinary
meatus
 The urethra is about 7.8” long in
the male, and transports both urine
and semen.
  It is only about 1.2” long in the female and transports only urine.

Pathology of Urinary System

1. Kidney Stones (Renal calculi)
Def: stones that are formed in kidney.
Causes: Calcium, phosphorus, & uric acid crystals, & nephritis.
Symptoms: Hematuria, flank/abd/pelvic pain. Urgency, fever. Mild to extreme pain
Tests: Ultrasound or CT, KUB, IVP
Treat: Increasing fluids to flush out and medications, lithotripsy –by using US to broken into

small particles of kidney stones. Ureteroscopy, ureterolithotomy.

2. Urinary Tract (Bladder) Infection (UTI)

Def: Bacteria can infect the Urinary tract.
Causes: bacteria or viral
Symptoms: dysuria, hematuria, urine with unusual odor, fever
Tests: urin test, blood test, US.
Treat: Antibiotics, increase fluids

3. Polycystic Kidney Disease

Def: An inherited disorder in which clusters of cysts develop in the kidneys

Causes: Genetic
Symptoms: enlarged, cystic kidneys, hypertension, UTI, dilute urine, pain, hematuria.
Tests: CT, MRI, Genetic tests
Treat: No cure without transplant

4. Chronic kidney disease

Def: Chronic kidney disease (CKD), also known as chronic kidney failure, means a gradual
loss of kidney function over time.
Causes: diabetes, High BP, abnormal structure of kidney.
Symptoms: swelling, usually in your legs, feet, or ankles, fever.
Tests: Blood test, urine test
Treat: Life style, control your blood sugar if you have diabetes, Follow a low-salt, low-fat diet
Avoid smoking, drinking
5. Glomerulonephritis
Def: Inflammation & scarring of glomerulus
Causes: toxins & medications, viral infections.
Symptoms: uremia, hypertension
Tests: BUN, Creatinine, UA
Treat: treating underlying cause may decrease progression, diet, bp control.

Other Diseases
6. Ischemic Nephropathy - decrease blood flow to kidneys.
7. Uremia - buildup of organic waste products in blood due to renal insufficiency.
8. Diabetes Insipidus - ADH deficiency.
9. Incontinence - Loss of bladder control.
10. Gout - Metabolism of purine, uric acid crystalizes.
11. Acute renal failure – occurs when your kidney suddenly unable to filter waste from blood.

Musculoskeletal System
Muscular system
 The muscular system consists of all the muscles of the body. These make up approximately
42% of total body weight, and are composed of long, slender cells known as fibers.
 The fibers are different lengths and vary in color from white to deep red.
 Each muscle consists of a group of fibers held together by connective tissue, and enclosed in
a fibrous sheath or fascia.
 Muscles cause movement, help to maintain posture, and produce heat.

Types of Muscles
There are 3 types, classified according to function and appearance.
Skeletal muscles
 Skeletal muscles are elastic and work in pairs - one flexing while the other is extending.
 They are striated, with horizontal markings, and are stimulated to contract by electrical
impulses from the nervous system.
 Fast, white muscle fibers contract rapidly, have poor blood supply, operate without oxygen,
and tire quickly.
 Slow, red muscle fibers contract more slowly, have better blood supplies, operate with
oxygen, and do not tire as easily.
 They are used in ongoing movements, such as maintaining posture

Smooth muscles

 Smooth muscle lines most hollow organs of the body, such as the intestines, stomach, and
uterus.
 They help move substances through tubular areas such as blood vessels and the small
intestines, contracting automatically and rhythmically.
 Smooth muscles contract slower than skeletal muscles, but can remain contracted longer, and
are not as dependent on oxygen.
 They are stimulated by electrical impulses or hormones, and use carbohydrates for energy.

Cardiac muscles
 The cardiac muscle or myocardium are striated like skeletal muscles, but are smaller and
shorter.
 They are stimulated to contract by electrical impulses sent out from small clumps of
specialized tissue in the heart… the sinoatrial and atrioventricular node.
 Found only in the heart

Tendons
 A tendon is a means of attachment, connecting the muscle to the bone.
 They vary in length, from less than an inch to more than a foot.

Ligaments
 Connect bone to bone
Voluntary muscle
 Contracts (moves) only when you want it to
 Moves bones of the skeleton
 Examples: biceps, triceps, abdominals
Involuntary muscle
  Contracts (moves) on its own
 Involuntary movements
 Examples: cardiac, stomach, intestinal

Skeleton system
Functions:
 Provides structure and movement for
 Consists of bones, skeletal muscles,
 Allows the body to stand erect and
 Protects organs Produces red blood
 Hematopoiesis
 Bones store minerals, such as calcium and phosphorus, for use by the body
JOINTS:
 This is the place where the bones comes together.
 There are several types of joints in the body.
 They provide flexibility for the movement.
 Endocrine system
The endocrine system is made
up of glands and the hormones
they secrete.

The three major components of the endocrine system are:

Glands—specialized cell clusters or organs
Hormones
A hormone is a chemical transmitter. It is released in small amounts from glands, and is
transported in the bloodstream to target organs or other cells.
Hormones are chemical messengers, transferring information and instructions from one set of
cells to another.
Hormones regulate growth, development, mood, tissue function, metabolism, and sexual
function.
Hyposecretion or hypersecretion of any hormone can be harmful to the body
Receptors—protein molecules that bind specifically with other molecules, such as hormones, to
trigger specific physiologic changes in a target cell.

Endocrine glands
 Pituitary, thyroid, parathyroid, adrenal and pineal glands
 Hypothalamus, thymus, pancreas, ovaries, testes, kidneys, stomach, liver, small intestine,
skin, heart, adipose tissue, and placenta also have endocrine function.
 The endocrine system and nervous system work together to help maintain homeostasis
balance.
Exocrine glands
Exocrine glands send chemical substances (tears, sweat, milk, saliva) via ducts to the outside of
the body. Examples of exocrine glands are sweat, mammary, mucous, salivary, and lacrimal
(tear) glands.

The pituitary gland

The pituitary gland (also called the
hypophysis or master gland) rests in
the Sella turcica.
The pituitary gland has two main
regions: the anterior pituitary and the
posterior pituitary.

Anterior pituitary
The anterior pituitary (adenohypophysis) is the larger region of the pituitary gland.
It produces at least six hormones:
1.Growth hormone (GH), or somatotropin
2.Thyroid-stimulating hormone (TSH), or thyrotropin
3. Follicle-stimulating hormone (FSH) & Luteinizing hormone (LH)
4.Prolactin.
5. Adrenocorticotropic hormone

Posterior pituitary
The posterior pituitary makes up about 25% of the gland. It serves as a storage area for
antidiuretic hormone (ADH), also known as vasopressin, and oxytocin, which are produced by
the hypothalamus.

Anterior pituitary gland hormones:

1. Growth hormone (GH), or somatotropin (STH): Promotes protein synthesis that results in
the growth of bones, muscles, and other tissues. GH also stimulates the liver to make insulin-like
growth factor, which stimulates the growth of bones. It increases blood glucose levels and is
secreted during exercise, sleep, and hypoglycemia.
2. Thyroid-stimulating hormone (TSH), or thyrotropin—Stimulates the growth of the thyroid
gland and secretion of thyroxine (T4) and triiodothyronine (T3).
3. Gonadotropic hormones—Several gonadotropic hormones influence the growth and
hormone secretion of the ovaries in females and the testes in males. In the female, follicle-
stimulating hormone (FSH) and luteinizing hormone (LH) stimulate the growth of eggs in the
ovaries, the production of hormones, and ovulation. In the male, FSH influences the production
of sperm, and LH (an interstitial cell stimulating hormone) stimulates the testes to produce
testosterone.
4. Prolactin (PRL)—Stimulates breast development during pregnancy and sustains milk
production after birth
5.

Adrenocorticotropic hormone (ACTH), or adrenocorticotropin—Stimulates the growth of

the adrenal cortex and increases its secretion of steroid hormones (primarily cortisol).
Posterior pituitary gland hormones :
1. Antidiuretic hormone (ADH), also called vasopressin—Stimulates the reabsorption of water
by the kidney tubules. In addition, ADH also increases blood pressure by constricting arterioles.
2. Oxytocin (OT)—Stimulates the uterus to contract during childbirth and maintains labor
during childbirth. Oxytocin is also secreted during suckling and causes the production of milk
from the mammary glands.
Thyroid gland & Parathyroid glands
The thyroid lies directly below the larynx, partially in front of the trachea. Its two lateral lobes—
one on either side of the trachea— join with a narrow tissue bridge, called the isthmus, to give
the gland its butterfly shape.

Two lobes that function:

The two lobes of the thyroid function as one unit to produce the hormones triiodothyronine (T3),
thyroxine (T4), and calcitonin.

T3 and T4 equal thyroid hormone

The body’s major metabolic hormone, thyroid hormone regulates metabolism by speeding
cellular respiration.
T3 and T4 are essential for normal growth and development, especially of the skeleton and
nervous system.
Calcitonin- This hormone is
secreted by the parafollicular or C-
cells in the thyroid gland.
Calcitonin lowers raised blood
calcium (Ca2+) levels.
Parathyroid glands:
The parathyroid glands are the body’s
smallest known endocrine glands.
These glands are embedded on the
posterior surface of the thyroid,
one in each corner.
Working together as a single gland, the parathyroid glands produce parathyroid hormone (PTH).
The main function of PTH is to help regulate the blood’s calci um balance. This hormone adjusts
the rate at which calcium and magnesium ions are lost in the urine. PTH also increases the
movement of phosphate ions from the blood to urine for excretion

Adrenal Glands:
The two adrenal glands each lie on top of a kidney. These almond shaped glands contain two
distinct structures—the adrenal cortex and the adrenal medulla—that function as separate
endocrine glands.
The adrenal cortex secretes three types of corticosteroids.
1. Glucocorticoids—These steroid hormones have an important influence on the metabolism of
sugars, fats, and proteins within all body cells and have a powerful anti inflammatory effect.
Cortisol helps regulate glucose, fat, and protein metabolism. It raises blood glucose as part of a
response to stress. Cortisone is a hormone very similar to cortisol and can be prepared
synthetically. Cortisone is useful in treating inflammatory conditions such as rheumatoid
arthritis.
2. Mineralocorticoids—The major mineralocorticoid is aldosterone. It regulates the
concentration of mineral salts (electrolytes) in the body. Aldosterone acts on the kidney to
reabsorb sodium (an important electrolyte) and water and to excrete potassium (another major
electrolyte). Thus, it regulates blood volume and blood pressure and electrolyte concentration.
3. Sex hormones—Androgens (testosterone) and estrogens are secreted in small amounts and
influence secondary sex characteristics, such as pubic and axillary hair in boys and girls. In
females, the masculinizing effects of adrenal androgens (increased body hair), may appear when
levels of ovarian estrogen decrease after menopause.

The adrenal medulla secretes two types of catecholamine hormones:

1.

Epinephrine (adrenaline)—Increases heart rate and blood pressure, dilates bronchial tubes, and
releases glucose (sugars) from glycogen (storage substance) when the body needs it for more
energy.
2. Norepinephrine (noradrenaline)—Constricts blood vessels to raise blood pressure. Both
epinephrine and norepinephrine are sympathomimetic agents because they mimic, or copy, the
actions of the sympathetic nervous system. They are released to help the body meet the
challenges of stress in response to stimulation by the sympathetic nervous system.

Pancreas
The pancreas, a triangular organ, is nestled in the curve of the duodenum, stretching horizontally
behind the stomach and ex tending to the spleen.
Endo and Exo
The pancreas performs both endocrine and exocrine functions.

The endocrine tissue of the pancreas consists of specialized hormone-producing cells called the
islets of Langerhans [3] or islet cells.
The endocrine cells of the pancreas are called the islet cells, or islets of Langerhans. These cells
exist in clusters and are found scattered among the acinar cells. The islets contain alpha, beta,
and delta cells that produce important hormones:
• Alpha cells produce glucagon, a hormone that raises the blood glucose level by triggering the
breakdown of glycogen to glucose. I’m an alpha cell, the glucagon producer.
• Beta cells produce insulin. Insulin lowers the blood glucose level by stimulating the conversion
of glucose to glycogen.
• Delta cells produce somatostatin. Somatostatin inhibits the release of GH, corticotropin, and
certain other hormones

Pineal Gland
The pineal gland is a small body attached to the roof of the third ventricle and is connected to it
by a short stalk containing nerves, many of which terminate in the hypothalamus.
• The gland tends to atrophy after puberty and may become calcified in later life.
Function: The physiological role of the pineal gland remains unclear. The pineal gland secretes
melatonin, which is thought to promote sleepiness and help regulate the body's biological clock.

The Ovaries and Testes

The ovaries and testes are paired oval organs referred to as gonads

Ovaries:
The ovaries are two small glands located in the lower abdominal region of the female. The
ovaries produce the female gamete, the ovum, as well as hormones that are responsible for
female sex characteristics and regulation of the menstrual cycle.
Function: The ovarian hormones are estrogens (estradiol and estrone) and progesterone.
Estrogens stimulate development of ova (eggs) and development of female secondary sex
characteristics.
Progesterone is responsible for the preparation and maintenance of the uterus in pregnancy.
Testes:
The testes are two small ovoid glands suspended from the inguinal region of the male by the
spermatic cord and surrounded by the scrotal sac. The testes produce the male gametes,
spermatozoa, as well as the male hormone called testosterone.
Function: Testosterone is an androgen (male steroid hormone) that stimulates development of
sperm and secondary sex characteristics in the male (development of beard and pubic hair,
deepening of voice, and distribution
of fat).

Thymus Gland
• Hormones produced by the thymus gland are thymus gland thymosin.
• These hormones promote the proliferation and maturation of T cells (white blood cells which
destroy microbes and foreign substances).
• Thymic hormones may also help to retard the aging process

PATHOLOGY
1.Hyperthyroidism: Overactivity of the thyroid gland; thyrotoxicosis
The most common form of this condition is Graves disease (resulting from autoimmune
processes).
Because metabolism is faster, the condition is marked by an increase in heart rate (with irregular
beats), higher body temperature, hyperactivity, weight loss, and increased peristalsis (diarrhea
occurs).
2.Hypothyroidism: Underactivity of the thyroid gland.
These include fatigue, muscular and mental sluggishness, weight gain, fluid retention, slow heart
rate, low body temperature, and constipation.
3. Thyroid carcinoma:
4. Hyperparathyroidism:.
Hypercalcemia occurs as calcium leaves the bones and enters the bloodstream, where it can
produce damage to the kidneys and heart. Bones become decalcified with generalized loss of
bone density (osteoporosis) and susceptibility to fractures and formation of cysts.
5. Hypoparathyroidism:
Hypocalcemia results as calcium remains in bones and is unable to enter the bloodstream. This
leads to muscle and nerve weakness with spasms of muscles, a condition called tetany (constant
muscle contraction).
 Integumentary system
The integumentary system is the largest body system and includes the skin, or integument, and
its appendages (the hair, nails, and certain glands).

The integumentary system performs many vital functions, includ ing:

 Protection from external environment, injuries, pathogens etc.
 Acts as barrier to permeability, UV radiation, microorganisms and other toxins.
 Sensory perception to touch, pain, pressure, pleasure etc
 Thermoregulation by maintaining constant body temperature
 Secretion of sweat and sebum
 Maintenance of fluid balance (Excretion/absorption)
 Vitamin D
synthesis
from sunlight UV
rays

Human skin is composed of three layers of tissue:

1.Epidermis 2. Dermis 3. Hypodermis or Subcutaneous tissue
Epidermis is the outer most nonvascular visible portion made up several layers of squamous
epithelium arranged as strata.

Stratum corneum:
The outermost horny layer of skin made up of keratinized cells that constantly replaced by
new cells.
Stratum lucidum:
Thin, lighter appearing layer only present on the palms and soles
Stratum granulosum:
Thin layer of cells with granules, Keratinocyes from stratum spinosum migrates to form
granules. nucleus disappears
Stratum spinosum:
Skin cells that are connected by desmosomes which gives a spiny appearance under a
microscope.
Stratum basale:
the deepest layer
of epidermis,
made up of single
layer cuboidal or
columnar
epithelial
cells attached to
basement
membrane.
• Basal layer constantly growing and multiplying. (mitosis)
• Melanocytes and merker cells also found here. Melanocytes transfer to upper layers of
epidermis which gives specific skin color.
Functions of epidermis:
• Protects body from pathogens,
• dead cells filled with keratin acts physical barrier,
• melanin pigment protects form harmful sunrays,
skin hydration ability prevents water loss from inside

Dermis
Dermis is a thick layer of living tissue below the epidermis which forms the true skin,
containing blood capillaries, nerve endings, sweat glands, hair follicles, lymph vessels, mast
cells etc It is made up of elastic & collagen fibers. Thus it provides strength and flexibility to
the skin.

Two types of Dermis:

The papillary layer is a thin outer layer of areolar connective tissue with fingerlike projections
called dermal papillae , which forms finger prints.
The reticular layer is a thick layer of dense connective tissue. It lies deep to the papillary layer
and makes up most of the dermis.
Functions of Dermis:
• It is a connective
tissue which
supports & nourishes
epidermis with its blood
capillaries,
• lymph cells protect from
pathogens, mast cells
protect from toxins.
• Nerve endings are
sensitive to touch
receptors,
• Sweat glands & helps in thermoregulation,
• Sebaceous glands protect and nourishes hair & skin.
The hypodermis (subcutaneous
layer) lies between the dermis and
underlying tissues and organs. It
consists of mostly adipose tissue and is
the storage site of most body fat.
• Functions as a mode of fat
storage.
• Provides insulation from cold
temp.
• Cushioning for the integument
and acts as shock absorber
Accessory structures - HAIR
Hair Shaft:
Portion of the hair that projects out from skin surface
Hair follicle
Sac like structure within which hair fiber grows
Hair bulb matrix
Has layer of mitotically active basal cells called hair
matrix which involves in hair growth
Hair Papilla:
connective tissue cells which has blood capillaries and
nerve endings from the dermis.
Smooth muscle
• Erector pili which extend from the dermis to the
side of the hair follicle. Contraction cause goose
bumps
Functions: Melanin protects from sunrays,
Decreases heat loss, protect from foreign particles.

Accessory structures- Glands

Sweat Glands:
Eccrine gland:
• Tiny coiled sweat glands found most part of human body, more on hands and feet.
• Produce a clear, odorless substance, consisting primarily of water and NaCl.
Apocrine sweat gland:
• A special variety of sweat gland, active only from puberty onwards, present underarms, groins
etc
• These glands secrete an odorless sweat, containing substances easily broken down by bacteria
on the skin
Sebaceous Glands:
These are located in the dermal layer of the skin over the entire body, with the exception of the
palms (hands), soles (feet), and lips.
Functions:
Sebaceous glands protects and nourishes hair & skin.
Sweat glands helps in thermoregulation.

Accessory structures – Nails

Packed keratinized epidermal cells
• Nail body: The visible attached portion
• Nail root: embedded in the skin.
• Nail folds: nail borders overlapped by skin folds
• Cuticle: the thick proximal nail fold
• Nail bed: the epidermis beneath the nail
• Lunula: the white crescent
Function: grasp, protect digits, scratching etc

Pathology
• Infectious: Chicken pox(varicella), Rubella,
Herpes, ring worm, impetigo, cellulitis
• Infestations: ex Pediculosis, scabies
• Inflammatory: Dermatitis, folliculitis,
• Autoimmune: Lupus, Psoriasis, pemphigus
(bullous disorder)
• Sunburns- first degree, second degree, third
degree, NOS
• Neoplasm: BC ca, Sq ca, Melanoma
• Skin Ulcers: Pressure ulcers, non-pressure ulcers
• Other: Acne vulgaris, corns, leukoderma
• Onychomycosis, also known as tinea unguium, is a fungal infection of the nail
• Tinea corporis or Ringworm infection of body.
• Psoriasis : Psoriasis is a chronic autoimmune condition that causes the rapid buildup of skin
cells. Common signs chronic, recurrent dermatosis marked by itchy, scaly, red plaques
covered by silvery gray scales. Psoriasis increase risk of skin Ca.
• Systemic Lupus Erythematosus (SLE) is a chronic autoimmune condition marked by
“butterfly” pattern rash of face
• Eczema or Atopic dermatitis : Eczema, also called atopic dermatitis, is a common allergic
skin inflammatory disease that usually starts in early childhood. Severity can be acute of
chronic, patient develops pruritic erythematous and papalosquamous lesions. Treatment
includes the use of corticosteroids and moisturizers
• Pressure Ulcer stages
Pressure ulcers are a type of injury that breaks down the skin and underlying tissue when an
area of skin is placed under constant pressure for certain period causing tissue ischemia,
cessation of nutrition and oxygen supply to the tissues and eventually tissue necrosis.
Commonly seen in bedridden patients, or wheel chair bond patients.

SKIN
BURN –
Three
degrees

Skin

cancers:
Basal and Squamous Cell Skin Cancer: These cancers are most often found in areas exposed
to the sun, such as the head, neck, and arms, but they also can occur elsewhere. They are very
common but are also usually very treatable
Melanoma:
Melanoma is more likely to grow and spread that other types of skin cancer. Learn about
melanoma skin cancer risk factors, causes, symptoms, and treatment

Squamous cells: These are flat cells in the upper (outer) part of the epidermis, which are
constantly shed as new ones form. When these cells grow out of control, they can develop into
squamous cell skin cancer (also called squamous cell carcinoma).

Actinic keratosis (solar keratosis)

Actinic keratosis (AK), also known as solar keratosis, is a pre-cancerous skin condition caused
by too much exposure to the sun. AKs are usually small (less than 1/4 inch across), rough or
scaly spots that may be pink-red or flesh-colored. Usually they start on the face, ears, backs of
the hands, and arms of middle-aged or older people with fair skin, although they can occur on
other sun-exposed areas. People who have them usually develop more than one.
 Nervous system
Main function: The nervous system controls and coordinates functions throughout the body and
responds to internal and external Organs
Messages carried by nervous system are electrical signals called Impulses
Cells that transmit these impulses are called Neurons (Basic units of nervous system)
Two types Neurons
Neurons are structurally classified
Multipolar, bipolar, or unipolar.

Neurons are Functionally classified

1.Sensory- neurons bring information about the world and around the body from sense organs
to the brain and spinal cord
2. Motor- neurons carry messages from the brain and spinal cord out to the muscles and glands.
3. Interneurons - transmit impulses from one part of the brain or spinal cord to another.
Parts of a Neuron
Cell Body
contains nucleus and most of
cytoplasm
Most metabolic activities occur here
Dendrites
Short, branched extensions
Carry impulses from environment or
other neuron toward cell body
Neurons can have several dendrites
Axon
Long fiber which carries impulses
away from cell body
Ends in axon terminals, located a
distance away from cell body
Neurons only have one axon
Myelin Sheath
Insulating membrane surrounding axon
Nerve Impulse
An impulse begins when a neuron is stimulated by another neuron or the environment.
Location where a neuron can transfer an impulse to another cell -Synapse.
Space between neurons
Structure

Together, the central nervous system (CNS) and the peripheral nervous systems (PNS) transmit
and process sensory information and coordinate bodily functions.

Brain
The brain controls body activities.
The largest part of the brain is the “thinking” area, or cerebrum.
On the surface of the cerebrum, nerve cells lie in sheets, which make up the cerebral cortex. These sheets,
arranged in folds called gyri, are separated from each other by grooves known as sulci.
The cerebrum has many functions. Thought, judgment, memory, association, and discrimination take place
within it.

In the middle of the cerebrum are spaces, or canals, called ventricles (pictured in Figure 10-8). They contain a
watery fluid that flows throughout the brain and around the spinal cord. This fluid is cerebrospinal fluid (CSF),
and it protects the brain and spinal cord from shock by acting like a cushion.