Chapter Six Genitourinary System.

Chapter Six Genitourinary System

Chapter Six Part I: Urinary System 2

Functions of the Urinary System Maintains homeostasis Cleans the blood
Extracellular fluids Cleans the blood Removes urea, creatinine, and uric acid Release of urine Urination Voiding Micturition Word Parts extra- = outside cellul/o = cell -ar = pertaining to urin/o = urine -ation = process of Note the functions of the urinary system and the different terms for the process of releasing urine from the body.

Male Urinary System Take a look at the male urinary system. We're going to compare it to the female urinary system on the next slide.

Female Urinary System Obviously, the male and female urinary systems are very similar. But take a look at the length of the urethra in each. Because the female urethra is so much shorter, infections (such as bladder infections) are much more common in women because the pathogens have less distance to travel to the bladder.

Renal Tissue Parenchymal tissue Stromal tissue Word Parts Kidneys
Ureters Urinary bladder Trigone Urethra Urinary meatus Be Careful! Do not confuse ureters with the urethra. Word Parts nephr/o, ren/o = kidney ureter/o = ureter cyst/o, vesic/o = urinary bladder trigon/o = trigone urethr/o = urethra meat/o = urinary meatus Remember that stromal tissue is supportive tissue. It doesn’t do the work of the system, but it’s necessary to help the parenchymal tissue (the kidneys) carry out its work. The ureters are the tubes that carry urine from the kidneys to the bladder. Again, these are paired, so the standard issue is two ureters. The combining form is ureter/o. The urinary bladder is the sac that stores the urine until it is ready to be excreted. Note that the combining form that is commonly used for the urinary bladder is “cyst/o,” which also means a “sac.” The other combining form for the urinary bladder is vesic/o. You will see it used in some of the terms later in the lecture. This also has a secondary meaning of “sac,” and you may notice that in the integumentary chapter, we use the term “vesicle” to describe a blister. Makes sense! It’s literally a “little sac.” Within the urinary bladder is an area that has a special name: the trigone. See the “tri-” at the beginning? Tri- means three. It gets its name from the two areas where the ureters join the bladder and the urethra exits. The combining form is trigon/o. Last, but not least, is the urethra. It is the tube that conducts urine from the bladder out of the body. The combining form for the urethra is urethr/o. Be Careful! not to confuse ureter/o with urethr/o. Remember that there are two of the first and one of the second. The opening of the urethra is the urinary meatus. Pronunciation alert! That is mee ATE us. Obviously an opening to the urethra is important; we will discuss a term for abnormalities of this opening.

The Kidney Word Parts Location Size Gross structure
Retroperitoneal cavity Size Gross structure Renal capsule Cortex Medulla Renal pyramids Papilla Renal pelvis Calyx/calix Hilum Be Careful! Calic/o, calyc/o, and cali/o are the combining forms for calyx, but calc/o is the combining form for calcium. Word Parts retro- = behind peritone/o = peritoneum cortic/o = cortex medull/o = medulla pyel/o = renal pelvis calic/o, calyc/o, cali/o = calyx hil/o = hilum There are two kidneys, located in the retroperitoneal cavity. Each kidney is about the size of an individual’s fist. The renal capsule is the tough outer covering of the kidney. The cortex is the outer aspect of the kidney, while the medulla is the middle part of the kidney. The triangular sections that extend from the renal medulla toward the renal pelvis are the renal pyramids. The downward point of each pyramid is termed a papilla. Both of these terms, cortex and medulla, are general terms and are also used to describe structures in other organs. The calyces (s. calix/calyx) are part of the renal pelvis. Be Careful! Calic/o and cali/o are the combining forms for the calyx, but calc/o is the combining form for calcium.

The Nephron Nephron Renal corpuscle Proximal convoluted tubule
Glomerulus (glomerul/o) Bowman’s capsule Proximal convoluted tubule Nephronic loop (loop of Henle) Distal convoluted tubule The microscopic unit within the kidney that filters the blood is called the nephron. Unfiltered blood is transported to the nephrons of the kidney through the renal afferent arteries. Remember that afferent means “pertaining to carrying toward a structure.” After entering the kidneys, the arteries divide into smaller arteries called arterioles, which end in tiny balls of renal capillaries called glomeruli (s. glomerulus). Each glomerulus is surrounded by a structure called Bowman’s capsule, which is the initial site for transfer of waste products from the blood to the kidney. The glomerulus and Bowman’s capsule together are referred to as the renal corpuscle. The proximal (remember that this means “pertaining to near the origin”) convoluted tubule, the nephronic loop (also called the loop of Henle), and the distal convoluted tubule are collectively sites for the selective filtration and reabsorption of electrolytes, water, glucose, and nitrogenous waste products. The resulting fluid, urine, is then directed to the renal pelvis.

Urinary Symptoms and Signs (R30 to R39) Anuria Dysuria Hematuria
Nocturia Oliguria Pyuria Be Careful! -uria is a suffix that means urinary condition; urea is a chemical waste product. Py/o means pus and pyel/o means renal pelvis. Word Parts -uria = urinary condition an- = without dys- = painful, abnormal hemat/o = blood noct/i = night olig/o = scanty, few poly- = excessive, frequent Remember that a sign is an objective finding – it can be observed or measured. A symptom is a subjective impression and is experienced by the patient, while a sign is an objective (measurable) finding. Anuria is a condition of no urine. Dysuria is a condition of painful urination. Hematuria is a condition of blood in the urine. Hemat/o = blood + -uria = urinary condition. Nocturia is a condition of excessive urination at night. Oliguria is a condition of scanty urination. Pyuria is a condition of pus in the urine. Py/o = pus + -uria = urinary condition. Be Careful! Py/o means pus and pyel/o means renal pelvis. A dilation of the renal pelvis caused by an accumulation of pus would be pyopyelectasis.

Urinary Symptoms and Signs (R30 to R39) Enuresis Extrarenal uremia
Extravasation of urine Urinary incontinence Urinary retention Vesical tenesmus Word Parts en- = in ur/o = urine -esis = state of extra- = outside ren/o = kidney vesic/o = bladder Enuresis is commonly called “bed wetting.” It can be nocturnal (at night) or diurnal (during the day). Extrarenal uremia is excessive urea in the blood due to kidney failure that is caused by a disease outside of the kidney. Urinary incontinence is an inability to hold urine, while urinary retention is an inability to release urine. Vesical tenesmus is bladder spasms.

Glomerular Diseases (N00-N08) Nephrotic syndrome
Acute nephritic syndrome Word Parts nephr/o = kidney -tic = pertaining to Nephrotic syndrome is a group of signs and symptoms including proteinuria, hypoalbuminemia, and edema. It is also termed nephrosis (an abnormal condition of the kidney). Acute nephritic syndrome is characterized by hypertension, hematuria, and, like nephrotic syndrome, proteinuria.

Renal Tubulo-interstitial Disease (N10-N16)
Hydronephrosis Pyelonephritis Pyonephrosis Vesicoureteral reflux Word Parts hydr/o = water nephr/o = kidney -osis = abnormal condition pyel/o = renal pelvis -itis = inflammation py/o = pus vesic/o = urnary bladder ureter/o = ureter Hydronephrosis is an accumulation of fluid in the kidneys as a result of an obstruction of the flow of urine. Pyelonephritis is inflammation of the renal pelvis and kidney. Pyonephrosis is a pus-producing infection of the kidneys. Vesicoureteral reflux is a backflow of urine from the bladder (vesic/o) to the ureter instead of the normal downward flow.

Acute Kidney Failure and Chronic Kidney Failure (N17-N19)
Renal Failure Acute renal failure (ARF) Chronic kidney disease (CKD) Formerly called chronic renal failure (CRF) When kidneys can no longer perform their function of removing wastes from the blood, it is termed renal failure. If the renal failure is a sudden inability due to trauma, injury, or an obstruction, it is then termed acute renal failure (ARF). If it is ongoing, it is termed chronic kidney disease (formerly called chronic renal failure) and is measured in stages of increasing severity (1 being the lowest and 5 being complete kidney failure).

Urolithiasis (N20-N23) Urolithiasis Word Parts
Also called urinary calculi Word Parts ur/o = urine, urinary system lith/o = stone -iasis = condition, presence of Urolithiasis Urolithiasis is the presence of stones within the urinary tract. Ur/o (urinary system) + lith/o (stones) + -iasis (condition, presence of). These stones can be associated with a particular structure, for example, nephrolithiasis (kidney stones), or described generally to be within the urinary system. Nephrolithiasis is the presence of stones in the kidney. Nephr/o (kidney) + lith/o (stones) + -iasis (presence of). Renal colic is the severe pain that is often associated with kidney stones that become lodged in a ureter. The term colic is often associated with pain.

Other Disorders of Kidney and Ureter (N25-N29) Nephroptosis
Nephropathy Nephrogenic diabetes insipidus Word Parts nephr/o = kidney -ptosis = drooping, sagging -pathy = disease process -genic = pertaining to producing Nephroptosis is a prolapse or sagging of the kidneys. Nephropathy is a general term meaning disease of the kidney. Nephrogenic diabetes insipidus is diabetes insipidus caused by a defect in the renal tubules.

Other Diseases of the Urinary System (N30-N39) Cystitis
Interstitial cystitis (IC) Trigonitis Word Parts cyst/o = bladder -itis = inflammation inter- = between stiti/o = space -al = pertaining to trigon/o = trigone Cystitis is literally an inflammation of the bladder (cyst/o = bladder + -itis = inflammation). This is what you may have heard called a “bladder infection.” Interstitial cystitis is an inflammation of the bladder wall. Trigonitis is an inflammation of the bladder between the inlet of the ureters and outlet of the urethra (the area of the trigone). Acute cystitis

Other Diseases of the Urinary System (N30-N39) Urethritis
Urethral structure Urinary tract infection (UTI) Word Parts urethr/o = urethra -itis = inflammation Urethritis is an inflammation of the urethra. A urethral stricture is a narrowing of the urethra. A urinary tract infection is an infection anywhere in the urinary system that is usually, but not always, caused by bacteria.

Benign Neoplasms (D30 and D41) Renal adenoma Renal oncocytoma
Transitional cell papilloma Bladder papilloma Word Parts ren/o = kidney aden/o = gland -oma = tumor, mass onc/o = tumor cyt/o = cell papill/o = nipple A renal adenoma is a small, slow-growing tumor, whereas a renal oncocytoma is a more common, solid kidney tumor. A transitional cell papilloma is a benign tumor of the bladder that can become malignant if it reoccurs.

Malignant Neoplasms (C64-C68) Renal cell carcinoma Nephroblastoma
Transitional cell carcinoma (TCC) of the bladder Word Parts nephr/o = kidney blast/o = embryonic -oma = tumor, mass Renal cell carcinoma (also called hypernephroma or adenocarcinoma of the kidney) is the tenth most common cancer. The image shows that most of the kidney has been replaced by gray and yellow tumor tissue. A little remaining renal cortex and fat are visible at the bottom of this specimen. A nephroblastoma (also called a Wilms’ tumor) is a kidney cancer that occurs mainly in children. A transitional cell carcinoma of the bladder is the most commonly occurring bladder cancer. Renal cell carcinoma From the CDC.

Procedures Urinalysis Blood urea nitrogen (BUN)
Creatinine clearance test Glomerular filtration rate (GFR) The composition of our blood is dependent on what our kidneys keep. Urinalysis is the examination of the products of that filtration process. The examination is physical, chemical, and microscopic. A blood urea nitrogen (BUN) is a blood test that measures the amount of nitrogenous waste in the circulatory system, which is an indicator of the level of kidney function. A creatinine clearance test is another test of kidney function that measures the rate at which the nitrogenous waste is removed, comparing its concentration in the blood and urine over a 24-hour period. The glomerular filtration rate (GFR) measures the amount of blood filtered by the kidneys. It is low when the kidneys are dysfunctional.

Procedures Cystoscopy Word Parts Cystoscopy cyst/o = bladder
-scopy = viewing -scope = instrument to view The process of viewing the urinary bladder is termed a cystoscopy. Cyst/o (bladder) + -scopy (process of viewing). The instrument used is a cystoscope. Cystoscopy

Procedures Cystectomy Cystolithotomy Nephrectomy Nephrolithotomy
Nephropexy Nephrostomy Nephrotomy Pyeloplasty Word Parts cyst/o = bladder -ectomy = cutting out -lithotomy = cutting out a stone nephr/o = kidney -pexy = suspension -stomy = making a new opening -tomy = cutting pyel/o = renal pelvis -plasty = surgically forming A cystectomy is a removal of part or all of the bladder. A cystolithotomy is an incision to cut a stone out of the urinary bladder. A nephrectomy is the removal of a kidney. A nephrolithotomy is an incision to cut a stone out of a kidney. A nephropexy is a suspension or fixation of a kidney. A nephrostomy is a new opening of the kidney so that a catheter may be inserted. A nephrotomy is an incision of the kidney. Pyeloplasty is the repair of a blockage between the renal pelvis and the ureter.

Procedures Lithotripsy Word Parts lith/o = stone -tripsy = crushing
If stones cause pain or obstruct the flow of urine, they need to be removed. One method is to crush the stones and allow them to flow out of the body with the urine. The process of crushing stones is termed lithotripsy. Lith/o = stones + -tripsy = crushing is the process of crushing.

Procedures Renal dialysis Word Parts
Continuous ambulatory peritoneal dialysis (CAPD) Hemodialysis CAPD Word Parts ren/o = kidney hem/o = blood dia- = through, complete -lysis = breaking down Renal dialysis is the process of diffusing blood across a semipermeable membrane to remove toxins and wastes. CAPD is dialysis that uses an indwelling catheter to drain fluid in and out of the peritoneal cavity to cleanse the blood. Hemodialysis cleanses the blood by shunting it from the body through a machine and then back to the body.

Procedures Urethrolysis Renal transplant Meatotomy Vesicotomy
Word Parts urethr/o = urethra -lysis = breaking down meat/o = meatus -tomy = cutting vesic/o = bladder A urethrolysis is destruction of adhesions in the urethra. A renal transplant is the surgical transfer of a complete kidney from a donor to a recipient. Meatotomy is an incision of the urinary meatus. A vesicotomy is an incision of the bladder. Vesic/o (bladder) + -tomy (incision). Renal transplant

Pharmacology Acidifiers Alkalinizers Anticholinergics Antidiuretics
Anti-infectives Antispasmodics Diuretics Acidifiers: decrease the ph of the urine to help prevent kidney stones Alkalinizers: increase the ph of the urine to treat acidosis or to promote excretion of some drugs and toxins Anticholinergics: help control urinary incontinence by delaying the urge to void, increasing the bladder capacity, and relaxing the bladder muscles Antidiuretics: suppress urine formation Anti-infectives: fight infection in the urinary system, such as antibiotics, antiseptics, or antifungals Antispasmodics: anticholinergic drugs that relax the bladder for the treatment of incontinence Diuretics: increase the formation of urine by promoting excretion of water and sodium. These drugs are often used to treat high blood pressure, congestive heart failure, and peripheral edema.

Part II: Male Reproductive System
27

Functions Function Reproduction Provides half of genetic information
The function of the male reproductive system is to reproduce! The male provides half of the genetic information. Andr/o = male + -logy = study of. Andrology is the study of males, usually in regard to fertility issues. Ur/o = urinary system + -logy = study of. Urology is the study of the urinary system; many of men’s health issues are treated by a urologist.

Sagittal View of the Male Reproductive System
Here is an illustration of the entire male reproductive system. Let’s start with the sac that holds the testes, called the scrotum. Next is the testis (pl. testes), the organ that is referred to as the male gonad. Again, this is the organ that produces the male gametes, the spermatozoa. Notice that it is covered by a membrane called the tunica vaginalis. Vaginalis here refers to a “sheath”– NOT to a female reproductive structure, but the term does share the same word origin. You can see the epididymis and the vas deferens. Remember that these are paired organs. You are seeing only one here. The vas deferens conducts the sperm around the bladder to the area of the seminal vesicles, where it picks up fluid for nourishment, then on to the urethra. The urethra continues through the penis and is surrounded by columns of tissue called the corpus cavernosa and the corpus spongiosum. These columns fill with blood during sexual excitement and are responsible for an erection of the penis. The end of the penis is termed the glans penis (no d in glans) and the skin surrounding it is called the prepuce (commonly called the foreskin).

Male Gonad: The Testis Sagittal view of a testis
This is a sagittal view of a testicle/testis. Notice that the testicle is filled with seminiferous tubules. These are the sites of sperm production. At the top of the testicle is the epididymis. This is the area in which the sperm are stored until they are released through ejaculation. The vas deferens (also called the ductus deferens) is the vessel that conducts sperm out of each testicle. The spermatic cord is a sheath that includes the vas deferens along with nerves and blood vessels.

Route of Sperm Testes → Vas deferens → Seminal vesicle →
Ejaculatory duct → Urethra → Urinary meatus Notice that the sperm start in the testes, travel to the vas deferens, pass the seminal vesicle, and proceed to the ejaculatory duct. This duct opens during ejaculation, closing off the passage of urine into the urethra. The sperm then continues out through the urethra, exiting through the urinary meatus.

Review Question The structure that stores sperm is the:
A. vas deferens B. seminal vesicle C. seminiferous tubules D. epididymis D. Epididymis

Parenchymal Tissue Gonad Gamete Word Parts Testis Seminiferous tubules
Testosterone Gamete Spermatozoon Spermatogenesis Semen Word Parts testis = test/o, testicul/o, orchid/o, orchi/o sperm = spermat/o semen = semin/i To review: Gonad/o is the combining form for gonad, the general term for a sex organ. In the male it’s the testis or testicle; in the female it is the ovary. The combining forms for the testicles are test/o, testicul/o, orchid/o, orch/o, and orchi/o. Seminiferous in seminiferous tubules is built from the combining form for semen, semin/i, and the suffix –ferous, meaning to bear or to carry. The sex cells are the gametes. In the male, they are called spermatozoa (singular: spermatozoon). The production of sperm is spermatogenesis. Spermat/o = sperm + -genesis = production. Semen is the combination of sperm and the fluid in which it is bathed. As mentioned, semin/i is the combining form for semen.

Stromal Tissue Scrotum Epididymis Vas deferens Spermatic cord
Word Parts scrotum = scrot/o epididymis = epididym/o vas deferens = vas/o, duct/o The combining form for the sac that holds the testicles outside of the body is scrot/o. Epididym/o is the combining form for the vessels that store the sperm, and vas/o and duct/o are used to represent the vas (or ductus) deferens. The spermatic cord does not have a combining form, but we shall see that it can involve a specific, serious condition.

Stromal Tissue Seminal vesicles Prostate gland Bulbourethral glands
Ejaculatory duct Penis Glans penis Prepuce Word Parts seminal vesicles = vesicul/o prostate gland = prostat/o penis = pen/i, phall/o glans penis = balan/o prepuce = preputi/o The combining form for the seminal vesicles is vesicul/o. The seminal vesicles, bulbourethral glands (also called Cowper’s glands), and the prostate gland (combining form prostat/o) provide fluid for the nutrition and motility (movement) of the sperm. Pen/i and phall/o are combining forms for the penis. You will probably rarely see them used, except in their adjectival form as penile and phallic. The combining form for the glans penis (balan/o) is one of the word parts most commonly forgotten by the end of the term. Can you think of a way to remember this one? The final combining form for stromal tissue is preputi/o for the foreskin. Again, you will probably see this in its adjectival form as preputial. The ejaculatory duct does not have its own combining form.

Congenital Disorders (Q00-Q99) Anorchism Cryptorchidism Epispadias
Hypospadias Congenital chordee Word Parts an- = no, not, without orch/o = testis -ism = condition crypt- = hidden epi- = above -spadias = a rent or tear hypo- = below An- (no, not, without) + orchid/o (testicle) + -ism (condition). A condition of no testicle. It may be stated as unilateral (pertaining to one side) or bilateral (pertaining to two sides). The fertility of an individual is not compromised if one testicle remains. Crypt- (hidden) + orchid/o (testicle) + -ism (condition). A condition of a “hidden” or undescended testicle. Epidspadias is a urethral opening on the dorsum (top) of the penis rather than at its tip. A seldom used synonym is hyperspadias. Hypospadias is the opposite of epispadias – the urethral opening is on the ventral surface (underside) of the penis. In some cases this may be acquired as a result of a disease process and, in that case, would obviously not be coded as a congenital disorder. Chordee (chord/o = cord) is usually a congenital defect resulting in a downward curvature of the penis due to a fibrous band (cord) of tissue along the corpus spongiosum. In some cases it may be acquired. Cryptorchidism

Diseases of Male Genital Organs (N40-N51) Azoospermia Oligospermia
Spermatocele of epididymis Epididymitis Word Parts a- = no, not, without zo/o = animal sperm/o = sperm olig/o = scanty, few -cele = herniation epididym/o = epididymis Azoospermia is a condition of no living sperm in the semen. Oligospermia is a condition of temporary or permanent deficient (scanty) sperm. A spermatocele of the epididymis is a swelling of the epididymis that contains sperm. Epididymitis is an inflammation of the epididymis , usually as a result of an ascending infection through the genitourinary tract.

Diseases of Male Genital Organs (N40-N51) Balanitis Balanoposthitis
Phimosis Word Parts balan/o = glans penis -itis = inflammation posth/o = foreskin Balanitis is inflammation of the glans penis. Balanoposthitis is an inflammation of the glans penis and the foreskin. Phimosis is a condition of a tightening of the foreskin around the glans penis. It may be acquired or congenital. Balanitis Phimosis

Diseases of Male Genital Organs (N40-N51) Erectile dysfunction (ED)
Induration penis plastica Priapism Orchitis Testicular torsion Hydrocele Word Parts indur/o = to make hard -ation = process of orch/o = testis -itis = inflammation hydr/o = water, fluid -cele = hernation, protrusion Erectile dysfunction (abbreviation ED – pronounced EE DEE, not like the man’s name) is an inability to achieve or sustain an erection for sexual intercourse. Another name for erectile dysfunction is impotence. Induration penis plastica is a hardening (the students will later see dur/o meaning “hard” in the nervous system with the two dura maters) of the corpus cavernosa that can cause painful erections. The cause is idiopathic, that is, unknown. The eponym for the disease is Peyronie’s disease. Priapism is an abnormally prolonged erection. Orchitis is an inflammation of the testicles (easily decoded). It may or may not be associated with the mumps virus. Another name is testitis. Testicular torsion is a twisting of a testicle on its spermatic cord. The cause is normally trauma, and the complication is ischemia. The term torticollis refers to a “twisted neck,” with the two terms related through the twisting action. A hydrocele is an accumulation of fluid in the tunica vaginalis. The treatment is usually to remove the entire sac of fluid – a hydrocelectomy. Priapism

Diseases of Male Genital Organs (N40-N51)
Benign prostatic hyperplasia (BPH) Prostatitis Vesiculitis Word Parts prostat/o = prostate hyper- = excessive -plasia = formation vesicul/o = seminal vesicle -itis = inflammation BPH (benign prostatic hyperplasia) is an enlargement (excessive formation) of the prostate gland. Because it surrounds the urethra, an enlargement can lead to difficulty with urination. A PSA (prostatic specific antigen) is a blood test to detect prostatic hypertrophy. It is also called benign prostatic hypertrophy or an enlarged prostate. Prostatitis is simply an inflammation of the prostate. Vesiculitis is an inflammation of the seminal vesicles and is often associated with prostatitis.

Sexually Transmitted Diseases (STDs)
Gonorrhea Syphilis Herpes genitalis (HSV-2) Human papillomavirus (HPV) Nongonoccal urethritis (NGU) Gon/o = seed + -rrhea = flow, discharge. Gonorrhea is a term that has changed its meaning over time. A sexually transmitted disease, gonorrhea is marked by a mucopurulent (mucus and pus filled) discharge. Initially, it was thought that this discharge was of semen, containing sperm. Hence the use of gon/o meaning seed. Gonorrhea is caused by the gram-negative diplococcus Neisseria gonorrhoeae bacteria, which can infect the urethra, prostate, rectum, and pharynx. In women, it can involve the cervix and fallopian tubes and may be asymptomatic (a- = no, not, without), meaning that it has no symptoms. Syphilis is a multistage sexually transmitted disease caused by a spirochete, Treponema pallidum. The first sign of this disease may be a painless red pustule, called a chancre, that usually appears on the genitals. HSV-2 is a form of the herpesvirus that is spread through sexual contact. It causes painful vesicular (blister-like) eruptions. HPV is a virus that causes warts of the hands, feet, and mucous membranes. Genital warts are referred to as condyloma (pl. condylomata). NGU is an inflammation of the urethra (urethr/o = urethra + -itis = inflammation); it is named by what it is NOT caused by (gonorrhea). The pathogens that do cause it are Chlamydia trachomatis, Mycoplasma genitalium, and Ureaplasma urealyticum. Syphilis

Benign Neoplasms (D29) Leydig and Sertoli cell tumors
Benign prostatic hyperplasia (BPH) Leydig and Sertoli cell tumors are benign tumors that arise from the stromal tissue of the testes that produce hormones. BPH is benign prostatic hyperplasia (also called benign prostatic hypertrophy). Hyper- = excessive + -plasia = condition of formation, development. An overgrowth of prostatic tissue, although benign and characteristically not prone to spread, can cause the urethra to be narrowed or closed. It is a common disorder in men older than 50 years of age.

Malignant Neoplasms (C60-C63)
Germ cell tumors (GCT) Seminoma Nonseminoma Adenocarcinoma of the prostate Malignant teratoma Dermoid cyst Seminoma Germ cell tumors can be divided into seminoma and nonseminoma. Note that both are malignant, even though the ending is not –sarcoma or –carcinoma. The majority of testicular cancer cases are nonseminoma and occur in younger males (15-35 years of age). Teratocarcinoma is the malignant form of the teratoma/dermoid cyst. A seminoma is developed from the cells that form sperm. Adenocarcinoma of the prostate is the formal term for prostate cancer. Unfortunately, it is currently diagnosed in one of six men. Terat/o = monster + -oma = tumor. A teratoma is a type of tumor that is named for its unusual appearance. Because it is composed of germ cells, it has half of the genetic information to form an individual. Another name for a teratoma is a dermoid cyst. Adenocarcinoma

Epididymovesiculogram
Procedures Epididymovesiculography Vasography Word Parts epididym/o = epididymis vesicul/o = seminal vesicle -graphy = recording vas/o = vessel, vas deferens Epididymovesiculography is the imaging of the epididymis and seminal vesicle using contrast medium. A vasography is an imaging of the vas deferens to visualize possible blockages. Epididymovesiculogram

Procedures Orchidectomy Orchiopexy Vasoligation Vasovasostomy
Vasectomy Vesiculectomy Epididymotomy Word Parts orchid/o = testis -ectomy = cutting out vas/o = vas deferens, vessel -ligation = tying -stomy = making a new opening vesicul/o = seminal vesicle epididym/o = epididymis -tomy = cutting Orchid/o (testis) + -ectomy (removal). An orchidectomy is the removal of one or both testicles. Again, this would be stated as unilateral (for one side) or bilateral (for two sides). Orchid/o (testis) + -pexy (fixation). An orchidopexy is a fixation or suspension of a testicle. This is the standard procedure done for cryptorchidism, in which a testicle needs to be moved from the abdominopelvic cavity and fixed in place in the scrotum. Vasoligation is a tying of the vas deferens as a sterilization procedure. A vasovasostomy is an anastomosis (joining) of the ends of the vas deferens to reverse a sterilization procedure. A vasectomy is an incision, ligation, and cauterization of both of the vas deferens for the purpose of male sterilization. Vasectomy

Procedures Circumcision Phalloplasty Word Parts
Be Careful! Don’t confuse phall/o, which means penis, and phalang/o, which is a bone in the finger or toe. Word Parts circum- = around -cision = cutting phall/o = penis -plasty = surgically forming Circumcision is the surgical procedure in which the prepuce of the penis is excised. A phalloplasty is surgically correcting a penile defect.

Procedures Prostatectomy Word Parts TUIP TURP TURP
prostat/o = prostate gland -ectomy = cutting out TUIP stands for transurethral incision of the prostate gland. Trans- = through + urethr/ = urethra + -al = pertaining to. This procedure involves a series of incisions that are made through the urethra into the prostate gland in order to reduce its pressure on the urethra. It is NOT removed in this procedure. TURP stands for transurethral resection of the prostate. Again, transurethral means through the prostate, but here the prostate is removed. This is an extremely common procedure for benign prostatic hyperplasia (BPH). TURP

Pharmacology Alpha-adrenergic inhibitors Alternative medicine
Androgen hormone inhibitors Antibiotics Anti-impotence agents Antivirals Alpha-adrenergic inhibitors: block alpha-1 adrenergic receptors to relax smooth muscle in prostate to improve urinary flow Alternative medicine: saw palmetto (serenoa repens), which has been shown to be as effective as finasteride (propecia) for treatment of symptoms of BPH Androgen hormone inhibitors: block the conversion of testosterone to the more potent hormone 5-alpha-dihydrotestosterone (DHT) to suppress growth of and even shrink the enlarged prostate Antibiotics: treat bacterial infection, such as syphilis. Anti-impotence agents: used to alleviate erectile dysfunction Antivirals: treat viral infections

Part III: Female Reproductive System
49 Mastering Healthcare Terminology/Chapter8

Functions Provide genetic material for reproduction
Nurture fertilized ovum to delivery Females have an important role in reproduction – to nurture the fertilized ovum to delivery.

The Female Reproductive System
The role of the female reproductive system is to keep her genetic material in the world’s gene pool. The female gamete, the ovum, provides 23 pairs of chromosomes to be combined with the male gamete, the spermatozoon, and its 23 pairs of chromosomes to create a new life. Once the gamete is fertilized, the female reproductive system functions to nurture the fertilized ovum to delivery. What two planes are shown here? (frontal and sagittal) Female reproductive organs Mastering Healthcare Terminology/Chapter8

Internal Anatomy Ovum Ovaries Menstruation Word Parts Ovulation
Follicles Menstruation Menarche – menopause Word Parts o/o, ov/i, ov/o = ovum oophor/o, ovari/o = ovary men/o, menstru/o = menstruation The ovum is the female gamete (remember that the spermatozoon is the male gamete). The release of an ovum is termed ovulation. The ovaries are the female gonads, the small, almond-shaped, paired organs located on either side of the uterus in the pelvic cavity, that produce the ova. Approximately every 28 days, in response to hormonal stimulation, the ovaries alternate in releasing an ovum. The egg matures in a tiny secretory sac within the ovary called a follicle. If the egg is not fertilized, the lining of the uterus that has been formed to receive the fertilized egg is shed in a process termed menstruation. Menarche is the term for the first menstrual period, which signals the beginning of a woman’s fertility. Menopause refers to the ending of menstruation and the end of a woman’s fertile period. Mastering Healthcare Terminology/Chapter8

Internal Anatomy Hormones Pituitary secretion Corpus luteum
Follicle-stimulating hormone (FSH) Luteinizing hormone (LH) Ovulation Corpus luteum Estrogen Progesterone The female gonads, the ovaries, are influenced by the secretion of two hormones from the pituitary gland. Follicle-stimulating hormone (FSH) causes the ovarian follicles to begin to mature and secrete estrogen. The presence of estrogen causes the pituitary to secrete luteinizing hormone, which stimulates the follicle to mature and release its ovum in a process referred to as ovulation. Luteinizing hormone is also instrumental in the development of the corpus luteum, a structure that develops in the follicles after they rupture, and serves to secrete estrogen and progesterone. These hormones are responsible for female secondary sex characteristics (breast development) and the cyclical maintenance of the uterus for pregnancy. Ovulation Mastering Healthcare Terminology/Chapter8

Internal Anatomy

Internal Anatomy Fallopian tubes Rectouterine pouch Vagina Mesentery
Infundibulum Ampulla Isthmus Rectouterine pouch Vagina Mesentery Be Careful! Don’t confuse culd/o, which means the rectouterine pouch, with colp/o, which means vagina. Word Parts salping/o, -salpinx = fallopian tube culd/o = rectouterine pouch (Douglas’ cul-de- sac) colp/o, vagin/o = vagina Mes/o = mesentery The internal anatomy continues with the fallopian tubes, two thin tubes about cm long, that join the ovaries to the uterus. Other names for the fallopian tubes are the oviducts or uterine tubes. Note that the word parts for the fallopian tubes are salping/o and –salpinx and that the areas of the tubes are named by their shape (infundibulum = funnel shaped, ampulla = bottle shaped, and isthmus = narrowed area). The rectouterine pouch is the space in the pelvic cavity between the uterus and the rectum. It is also referred to as Douglas’ cul-de-sac. The vagina is a muscular, tube-like structure at the entrance/exit to the internal female genitalia. The mesenteries that hold the fallopian tubes, ovaries, and uterus in place are the mesosalpinx, mesovarium, and the mesometrium. Note that the combining forms for the vagina and the rectouterine pouch look somewhat similar (colp/o and culd/o). Mastering Healthcare Terminology/Chapter8

Internal Anatomy

Internal Anatomy Uterus Word Parts Layers Areas Endometrium Myometrium
Perimetrium Intramural Areas Corpus Fundus Cervix Internal os External os Cervical canal Word Parts hyster/o, metr/o, metri/o, uter/o = uterus endometri/o = endometrium myometri/o = myometrium perimetri/o = perimetrium corp/o = body fund/o = fundus ervic/o = cervic/o, trachel/o The uterus, or womb, is a pear-shaped organ that serves to nurture the developing embryo/fetus. It is composed of three layers, the inner lining called the endometrium, the muscle layer, called the myometrium, and the outer layer called the perimetrium. Note that each of their combining forms is built from a combining form for uterus (metri/o) plus a prefix (endo-, peri-) or another combining form (my/o). Be careful not to confuse -metry (which means the process of measuring) with metr/o (which is the combining form for the uterus). The cervix is the lowered narrow part of the uterus, often referred to as the neck of the uterus. Note the internal opening of the cervis (internal os) and the external opening (esternal os). The lateral fornices are on either side of the external os. Be Careful! to remember that cervic/o has two meanings—neck and cervix. Be Careful! The combining form cervic/o has two meanings: the neck and the cervix (the neck of the uterus). Mastering Healthcare Terminology/Chapter8

Review Question Which of the following is a combining form for the uterus? A. salping/o B. metri/o C. gynec/o D. oophor/o B. Metri/o

Female external genitalia
Vulva Vaginal orifice Hymen Labia Minora Majora Word Parts vulv/o = vulva hymen/o = hymen labi/o = labia The external genitalia of the female is called the vulva. It is composed of the vaginal opening (or orifice), the membrane that covers the opening (the hymen), and the two folds of skin that surround the opening: the labia minora (small “lips”) and labia majora (large “lips”). Female external genitalia Mastering Healthcare Terminology/Chapter8

Female external genitalia
Clitoris Perineum Mons pubis Vestibular glands Greater/Bartholin glands Lesser (Skene’s/paraurethral) Be Careful! perine/o vs. peritone/o vs. perone/o Word Parts clitorid/o = clitoris perine/o = perineum bartholin/o = Bartholin gland The clitoris is the sensitive erectile tissue that is anterior to the urethra. The vestibular glands are paired mucous glands that secrete a lubricant. Note that the greater and lesser glands have eponymic names, also. The mons pubis is the fatty cushion of tissue over the pubic bone. The perineum is the area between the opening of the vaginal orifice and the anus. Be careful! for perine/o , which means the space between external genitalia and the anus, vs. peritone/o , which means the abdominal lining, vs. perone/o, which means fibula. Female external genitalia Mastering Healthcare Terminology/Chapter8

Nipple/mammary papilla Areola
The Breast Function Milk Composition Lobules Alveolus Ducts Lactiferous sinuses/ampullae Nipple/mammary papilla Areola Word Parts mast/o, mamm/o = breast lact/o, galact/o = milk papill/o, thel/e = nipple The Breast The breasts (mammary glands) function to secrete milk. The breast tissue is composed of glandular milk-producing, fatty, and fibrous tissue. The segments that make up the breast are lobules, each of which ends in a bulblike cavity termed an alveolus (meaning small cavity, and also mentioned in the respiratory system). The passages that carry the milk to the nipple are ducts, while the small dilations of the ducts near the nipple are termed lactiferous sinuses or ampullae. The nipple of the breast is called the mammary papilla and the darker area around the nipple is called the areola. Note the significance of the breast quadrants in regard to breast cancer (a method of naming the location of the tumor). Mastering Healthcare Terminology/Chapter8

Review Question Which of the following is a combining form for the nipple? A. mast/o B. thel/e C. mamm/o D. papul/o B. Thel/e

Disorders of the Breast (N60 – N65) Mastodynia Mastoptosis
Gynecomastia Galactorrhea Benign mammary dysplasia Word Parts mast/o = breast -dynia = pain -ptosis = drooping, sagging gynec/o = female mamm/o = breast dys-= abnormal -plasia = formation Mastodynia is pain in the breasts. Mastoptosis is a downward displacement of the breasts. Gynecomastia is an enlargement (uni- or bilateral) of the breast tissue in males. Galactorrhea is an abnormal discharge of milk from the breasts. Benign mammary dysplasia is noncancerous breast tissue formation. Mastering Healthcare Terminology/Chapter8

Inflammatory Diseases of Female Pelvic Organs (N70-N77)
Bartholinitis Cervicitis Female pelvic inflammatory disease (PID) Oophoritis Salpingitis Vulvitis Word Parts bartholin/o = Bartholin’s gland -itis = inflammation cervic/o = cervix oophor/o = ovary salping/o = fallopian tube vulv/o = vulva All of the terms but PID are obviously inflammations of the named organ/body part. PID is a general term that refers to a bacterial infection of the uterus, fallopian tubes, and/or ovaries.

Review Question An inflammation of the external female genitalia is:
A. cervicitis B. salpingitis C. vaginitis D. vulvitis D. Vulvitis All of the other structures are internal. Mastering Healthcare Terminology/Chapter8

Noninflammatory Disorders of Female Genital Tract (N80-N98)
Amenorrhea Dysmenorrhea Oligomenorrhea Polymenorrhea Word Parts a- = without men/o = menses -rrhea = discharge, flow dys- = painful olig/o = scanty poly- = many Notice that each of these terms ends in -menorrhea, which means “menstrual discharge or flow.” The beginnings of the terms explain the specific abnormality named. Amenorrhea is the absence of menstruation. Dysmenorrhea is a painful menstrual flow. Oligomenorrhea is an abnormally light or infrequent menstrual flow. Polymenorrhea is an abnormally frequent menstrual flow. Mastering Healthcare Terminology/Chapter8

Menometrorrhagia Menorrhagia Metrorrhagia Dysfunctional uterine bleeding (DUB) Postmenopausal bleeding (PMB) Word Parts men/o = menses metr/o = uterus -rrhagia = bursting forth post- = after Menometrorrhagia is excessive menstrual flow and uterine bleeding other than that caused by menstruation. Menorrhagia is abnormally heavy or prolonged menstrual (men/o) bleeding. This may be indicative of fibroids. Metrorrhagia is uterine (metr/o) bleeding other than that caused by menstruation. Dysfunctional uterine bleeding is abnormal uterine bleeding not caused by a tumor, inflammation, or pregnancy. Postmenopausal bleeding is dysfunctional bleeding that occurs after the cessation of the menses. Mastering Healthcare Terminology/Chapter8

Premenstrual syndrome (PMS) Mittelschmerz Dyspareunia Word Parts dys- = painful, abnormal -pareunia = intercourse Premenstrual syndrome (PMS) is a poorly understood group of symptoms that occurs in some women on a cyclic basis. The symptoms of PMS are breast pain, irritability, fluid retention, headache, and a lack of coordination. Mittelschmerz is midcycle pain – pain on ovulation. Dyspareunia is the term for painful intercourse. Mastering Healthcare Terminology/Chapter8

Hysteroptosis Retroflexion of uterus Endometriosis Hematosalpinx Vulvodynia Word Parts hyster/o = uterus -ptosis = drooping, sagging endometr/o = endometrium -osis = abnormal condition hemat/o = blood -salpinx = fallopian tube vulv/o = vulva -dynia = pain Hysteroptsis Hysteroptosis is a falling or sliding of the uterus from its normal location in the body (-ptosis = falling, drooping). A synonym is uterine prolapse. Retroflexion of the uterus is a bending backward of the uterus forming an angle with the cervix (retro- = backward). Students may have heard this referred to as a “tipped uterus.” Endometriosis is an abnormal condition of the endometrium. The tissue is found growing outside of the uterus and the causes are unknown. Hematosalpinx is a condition of blood in the fallopian tubes (hemat/o = blood + - salpinx = fallopian tube). Vulvodynia is an idiopathic syndrome of complaints of pain (-dynia) of the vulva. Endometriosis Mastering Healthcare Terminology/Chapter8

Cystocele Rectocele Ovarian cyst Endometrial hyperplasia Cervical intraepithelial neoplasia (CIN) I and II Word Parts cyst/o = urinary bladder -cele = herniation rect/o = rectum ovari/o = ovary endometr/o = endometrium hyper- = excessive -plasia = condition of formation, development intra- = within neo- = new Cystocele A cystocele is a herniation of the urinary bladder into the vagina. A rectocele is a herniation of the rectum into the vagina. An ovarian cyst is a benign fluid-filled sac on the ovary. If it is a follicular cyst, it develops when a follicle does not rupture at ovulation. A cyst of the corpus luteum is caused when it does not continue its transformation. Endometrial hyperplasia is an excessive (hyper-) development (-plasia) of cells in the lining of the uterus. It is a benign condition but must be monitored as it can become malignant. Cervical intraepithelial neoplasia (CIN), also called cervical dysplasia, is abnormal cell growth that may or may not develop into cancer. It is reported in grades of I-III, with I being the mildest and III being the most severe. Ovarian cyst Mastering Healthcare Terminology/Chapter8

Review Question Which of the following is a scanty or infrequent menstrual period? A. amenorrhea B. dysmenorrhea C. polymenorrhea D. oligomenorrhea D. Oligomenorrhea

Benign Neoplasms (D06, D24, D25)
Cervical intraepithelial neoplasia (CIN) III Fibroadenoma of the breast Leiomyoma of the uterus Word Parts cervic/o = cervix neo- = new -plasia = condition of formation, development fibr/o = fiber aden/o = gland -oma = tumor, mass Cervical intraepithelial neoplasia (CIN), also called cervical dysplasia, is abnormal cell growth that may or may not develop into cancer. It is reported in grades of I-III, with I being the mildest and III being the most severe. Fibroadenoma of the breast is a noncancerous breast tumor composed of fibrous and glandular tissue. A leiomyoma of the uterus (commonly called a fibroid) is a smooth muscle tumor that is usually a nonpainful growth. Fibroadenoma Leiomyoma Mastering Healthcare Terminology/Chapter8

Malignant Neoplasms (C50 and C51-C58)
Infiltrating ductal carcinoma (IDC) Lobular carcinoma Paget’s disease of the breast Infiltrating ductal carcinoma is the most common type of breast cancer. It arises from the cells that line the milk ducts. Lobular carcinoma begins in the glandular tissue of the breast at the ends of the milk ducts. It occurs in about 15% of all diagnosed breast cancers. Paget‘s disease of the breast is a rare form of cancer, a malignancy of the nipple that can occur in either women or men. Lobular carcinoma Mastering Healthcare Terminology/Chapter8

Malignant Neoplasms (C50 and C51-C58)
Endometrial adenocarcinoma Leiomyosarcoma Epithelial ovarian cancer (EOC) Mature teratoma of the ovary Squamous cell carcinoma of the cervix Endometrial adenocarcinoma is the most common type of uterine cancer. It develops from cells that line the uterus. Leiomyosarcoma is a rare type of cancer that develops from the smooth muscle of the uterus. Epithelial ovarian cancer is the most common malignancy of the ovaries. It is associated with a mutation of the BRCA1 or BRCA2 gene that is also linked to an increased risk of breast cancer. A mature teratoma of the ovary (also called a dermoid cyst) is usually a noncancerous ovarian growth that arises from germ cells. A squamous cell carcinoma of the cervix is the most common cervical cancer. It is thought to be caused by the human papillomavirus (HPV). It is one of the most curable cancers if detected in its early stage. Many forms of HPV are also preventable through a vaccine. Mastering Healthcare Terminology/Chapter8

Hysterosalpingography
Procedures Colposcopy Culdoscopy Hysterosalpingography (HSG) Mammography Word Parts colp/o = vagina -scopy = viewing culd/o = cul-de-sac hyster/o = uterus salping/o = fallopian tube -graphy = recording mamm/o = breast A colposcopy is the process of viewing the vagina. A culdoscopy is the process of viewing the rectouterine pouch. A hysterosalpingography is an x-ray procedure in which a contrast medium is used to image the uterus and fallopian tubes. Mammography is the process of recording the breast for the early detection of breast cancer. The record or recording is called a mammogram. Hysterosalpingography Mastering Healthcare Terminology/Chapter8

Procedures Colpoplasty Colpopexy Vaginotomy Hysterectomy Hysteropexy
Hysterotracheloplasty Dilation and curettage (D&C) Uterine artery embolization Word Parts colp/o = vagina -plasty = surgically forming vagin/o = vagina hyster/o = uterus -ectomy = cutting out trachel/o = cervix A colpoplasty is the surgical repair of the vagina. Colpopexy is the fixation (-pexy) of the vagina to an adjacent structure to hold it in place. A vaginotomy is an incision of the vagina, which may be incidental (unintentional) during a cesarean section. Also call a colpotomy. A hysterectomy is the removal of the uterus. It can be partial, total (the prefix pan- is used), or may include other organs as well. A TAH-BSO is a total abdominal hysterectomy with a bilateral salpingo-oophorectomy. The approach for a hysterectomy may be abdominal, vaginal, or laparoscopic. A hysteropexy is the suspension and fixation of the uterus. Connect the pathologic condition of hysteroptosis and the corrective procedure of hysteropexy. A hysterotracheloplasty is plastic surgery of the uterine cervix, usually for repair of a laceration. A dilation and curettage is a procedure that widens (dilates) the cervix until a curette (a sharp scraping tool) can be inserted to remove the lining (curettage)of the uterus. A D&C is used to control conditions such as heavy menstrual bleeding or to empty the uterus of the products of conception. Uterine artery embolization is an injection of particles to block a uterine artery supplying blood to a fibroid with resultant death of fibroid tissue. Also termed uterine fibroid embolization. Mastering Healthcare Terminology/Chapter8

Procedures Cervicectomy Loop electrocautery excision procedure (LEEP)
Oophorectomy Salpingolysis Tubal ligation Word Parts cervic/o = cervix -ectomy = cutting out oophor/o = ovary salping/o = fallopian tube -lysis = breaking down A cervicectomy is a removal of the cervix of the uterus. A loop electrocautery excision procedure is done to remove abnormal cells from the cervix (cervical dysplasia). An oophorectomy is the removal of one or both ovaries (unilateral or bilateral). Salpingolysis is the removal of adhesions in the fallopian tubes to reestablish patency, with the goal of fertility. A tubal ligation is the cutting, tying (ligation), and cauterization (burning) of the fallopian tubes to prevent released ova from being fertilized by spermatozoa. Tubal ligation Mastering Healthcare Terminology/Chapter8

Procedures Pap smear Pap smear
A Pap smear is an exfoliative cytologic procedure used to detect vaginal and cervical cancer. Pap smear Mastering Healthcare Terminology/Chapter8

Procedures Mammoplasty Mastectomy Mastopexy Word Parts mamm/o = breast
-plasty = surgically forming -ectomy = cutting out -pexy = suspension A mammoplasty is the surgical or cosmetic repair of the breast. This can include augmentation (increasing) or reduction (reducing) of the size of the breasts. A mastectomy is the removal of the entire breast. It may be unilateral or bilateral. Mastopexy is a reconstructive procedure to lift and fixate (-pexy = fixation, suspension) the breasts. Mastering Healthcare Terminology/Chapter8

Pharmacology Hormone replacements
Hormone replacement therapy, estrogen replacement therapy Phytoestrogens Hormone replacement therapy (HRT), and estrogen replacement therapy (ERT): the healthcare replacement of estrogen alone (ERT) or with progesterone (HRT) perimenopausally in several forms (tablet, transdermal patch, injection, or vaginal suppository) to relieve symptoms of menopause and protect against osteoporosis Phytoestrogens: an alternative source of estrogen replacement that occurs through the ingestion of certain plants like soy beans. Phytoestrogens act similarly to human estrogens in the body.

Review Question Which procedure is a process of viewing the vagina?
A. colposcopy B. culdoscopy C. culdocentesis D. Apgar score A. Colposcopy Mastering Healthcare Terminology/Chapter8

Review Question Which is a term for the removal of an ovary?
A. oophorectomy B. salpingectomy C. mastopexy D. cervicectomy A. Oophorectomy

Review Question Which of the following terms is a removal of adhesions from the fallopian tubes? A. D&C B. salpingolysis C. theleplasty D. mastopexy B. Salpingolysis Salping/o means the fallopian tubes and -lysis stands for freeing from adhesions or destruction. Mastering Healthcare Terminology/Chapter8

Suffixes and Root Operations for the Female Reproductive System
-ectomy excision, resection -ligation occlusion -lysis release -pexy repair, reposition -plasty repair, supplement, alteration, replacement -scopy inspection -tomy drainage, division Note the suffixes used in this chapter and their respective root operations. Note that some suffixes have more than one root operation, meaning that the coder needs to examine the purpose of the procedure in order to determine the correct code.

Sort These Terms into Their Correct Categories
1. oligohydramnios 2. menarche 3. Pap smear 4. mastopexy 5. fimbriae Categories __ A+P __ Pathology __ Procedures A+P – menarche, fimbriae Pathology – oligohydramnios Procedures – Pap smear, mastopexy

Chapter Six Genitourinary System.

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Chapter Six Genitourinary System.

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