Chapter Ten Respiratory System

Chapter Ten Respiratory System
Mastering Healthcare Terminology/Chapter 11

Respiration Illustration of inspiration and expiration. The air enters the nose and travels down the pharynx, larynx, and trachea to the bronchi and the lungs. On inspiration the diaphragm contracts, pulling air into the lungs. On expiration the diaphragm relaxes, and air is expelled from the lungs.

Functions of the Respiratory System  Oxygen  Carbon dioxide
Filtering, warming, humidifying air Regulation of blood pH Role in producing sound (speech) and sense of smell Phonation Olfaction Word Parts re- = again spir/o = to breathe -atory = pertaining to oxy-, ox/i, ox/o = oxygen capn/o = carbon dioxide phon/o = sound -ation = process of Oxygen is taken in and carbon dioxide is breathed out during respiration. On the route to the lungs, the air is filtered, warmed, and humidified. The respiratory system also assists in the regulation of the acidity/alkalinity of blood. Have you noticed how your voice changes when you have a cold or laryngitis? And how a cold affects your sense of smell (olfaction)? Mastering Healthcare Terminology/Chapter 11

Functions of the Respiratory System Inspiration/inhalation
Breathing in Expiration/exhalation Breathing out Respiration External Internal Cellular Word Parts in- = in spir/o = to breathe -ation = process of ex- = out hal/o = to breathe These terms are easily decoded, but note the missing “s” in expiration because of the s sound of the letter x. Also note that when one expires (as in dies), he/she breathes out and does not breathe in again. Three types of respiration: External respiration is the exchange of oxygen and carbon dioxide between the lungs and the blood. Internal respiration is the exchange of gases between the blood and cells of the body. Cellular respiration is the use of oxygen to generate energy. Note that disease processes can affect each type of respiration to prevent the cells of the body from procuring oxygen to generate energy. Mastering Healthcare Terminology/Chapter 11

Detail of Upper Respiratory Tract and Proximal Trachea
Note the normal route of air (through the nostrils), down the back of the throat and through the trachea. Note also how some individuals breathe through their mouths, and how the air still passes into the trachea. Mastering Healthcare Terminology/Chapter 11

Path of air passage from upper to lower respiratory system
Upper Respiratory Tract Nose Paranasal sinuses Pharynx Larynx Word Parts nas/o, rhin/o = nose or/o = mouth, oral cavity pharyng/o = pharynx, throat laryng/o = larynx, voice box trache/o = trachea, windpipe Bronch/o, bronchi/o = bronchus Alveol/o = alveolus, small cavity Follow the route of the air to the lungs and note the combining forms for the structures. Note the common names of the pharnyx (throat) and larynx (voice box). Note the separation between the upper and lower respiratory tracts. Review singular/plural endings for pharynx/pharynges, larynx/larynges, and bronchus/bronchi. Be Careful! Don’t confuse bronchi/o, which means the bronchial tubes, with brachi/o, which means the arm. Note that the combining form for the alveoli will also be seen in the digestive system. In that case, it refers to the sockets in the jawbones that the teeth sit in. Path of air passage from upper to lower respiratory system Mastering Healthcare Terminology/Chapter 11

Upper Respiratory Tract Nose
Nares/nostrils Nasal septum Nasal turbinates/conchae Vibrissae Mucous membrane Cilia Word Parts rhin/o, nas/o = nose sept/o = wall -um = structure muc/o = mucus cili/o = tiny hairs A closer look at the nose shows the nares (nostrils), which are divided by a wall, the nasal septum. Students may have heard of patients with a deviated septum (one that is crooked) that prevents the efficient passage of air into the nasal cavity. The nasal turbinates, also referred to as the nasal conchae, are the scroll-shaped bones that increase the surface area in the nasal cavity. They are named by their location: inferior, middle, and superior (quick review of terms from Chapter 2!). The term turbinate is derived from the term turban that is a twisted strip of cloth used as a headdress. The conchae is derived from the Latin meaning a shell, so the appearance is shell-like. The vibrissae are the coarse hairs in the nose that help filter out dust and particulate matter. The sticky mucous membrane and small hairs of the respiratory tract, the cilia, also help to clean, warm, and moisturize the air as it moves toward the lungs. The cilia play an important role in their continual wavelike motion to sweep the sticky mucus and debris out of the respiratory system. Mastering Healthcare Terminology/Chapter 11

Upper Respiratory Tract Paranasal sinuses
Frontal Maxillary/antrum of Highmore Sphenoid Ethmoid Air cells Olfactory bulb Word Parts para- = near nas/o = nose sin/o, sinus/o = sinus antr/o = antrum ethmoid/o = ethmoid The cavities in the bone that surround the nasal cavity are the paranasal sinuses. Note that the paranasal sinuses are decoded to give you a clue as to where they are located. Note the names of each and how they are named after the bones that they reside in. The maxillary cavity is also referred to as the antrum of Highmore. Antrum (as you may remember from Chapter 2) is a synonym for sinus. The ethmoid bone holds its sinuses that are divided into anterior, middle, and posterior air cells and also holds the olfactory bulb in the cribriform plate, named for its sievelike appearance that allows the passage of the nerves involved in the sense of smell. Mastering Healthcare Terminology/Chapter 11

Upper Respiratory Tract Pharynx
Eustachian tube Tonsils Pharyngeal (adenoids) Lingual Palatine Nasopharynx Pharyngeal tonsil Oropharynx Lingual tonsil Palatine tonsil Laryngopharynx Be Careful! Salping/o means both eustachian tubes and fallopian tubes. Word Parts pharyng/o = pharynx, throat salping/o = eustachian tube tonsill/o = tonsil adenoid/o = adenoid lingu/o = tongue palat/o = palate nas/o = nose or/o = mouth, oral cavity laryng/o = larynx, voice box As the air passes through the throat, it travels past the eustachian tube (note the combining form salping/o) that connects the ears with the throat. It serves to equalize the pressure between the ears and the throat. The term eustachian, no longer capitalized, is named after an Italian person in the 1500s who named it, Bartolomeo Eustachio. Synonyms for the eustachian tube are the auditory tube and pharyngotympanic tube – see how decoding is so much easier than eponyms? The tonsils are lymphatic tissue that helps to protect the respiratory system from pathogens. The pharyngeal tonsils (called the adenoids) are located in the nasopharynx. The palatine tonsils are located in the oropharynx and are continuous with the roof of the mouth. The lingual tonsils are those that are located towards the back of the tongue. Note that each of the structures already mentioned is located in a part of the throat. Mastering Healthcare Terminology/Chapter 11

Upper Respiratory System Larynx
Location Laryngeal prominence/Adam’s apple Hyoid bone Cartilaginous tissue Vocal folds False vocal folds/vestibular folds True vocal folds/vocal cords Glottis Rima glottidis Epiglottis Word Parts laryng/o = larynx, voice box epiglott/o = epiglottis Inferior to the laryngopharynx is the main instrument of sound production (phonation), the larynx. It is located in the anterior aspect of the neck and is covered by two thin cartilaginous plates termed laminae (remember that term from the musculoskeletal system?). In males these are larger and more angular, and are referred to as the Adam’s apple (otherwise referred to as the laryngeal prominence). The hyoid (small U-shaped bone) provides the point of attachment for these plates. The larynx is composed of several sets of supportive, protective cartilaginous structures and two vocal folds, the glottis, the rima glottidis, and the epiglottis. The false vocal folds (also termed the vestibular folds) are located at the entrance to the larynx (the vestibule!). Although they are used in some cultures to produce a second “tone” in singing, they are not active in the production of speech. The true vocal folds (vocal cords) are those that do produce song and speech. They are composed of the glottis (two muscular folds) and the rima glottidis (the space between them). The epiglottis is the oval-shaped cartilage that covers the windpipe to prevent food from being pulled into the trachea instead of the esophagus while swallowing. Mastering Healthcare Terminology/Chapter 11

Review Question Laryng/o is a combining form for the: A. epiglottis
B. throat C. voice box D. lungs C. Voice box Mastering Healthcare Terminology/Chapter 11

Lower Respiratory Tract Trachea Bronchi Bronchioles Alveoli Lungs
Carina Bronchioles Alveoli Lungs Be Careful! Don’t confuse bronchi/o, which means bronchial tubes, with brachi/o, which means the arm. Word Parts trache/o = trachea bronch/o, bronchi/o = bronchial tree bronchiol/o = bronchiole alveol/o = alveolus pulmon/o, pneum/o, pneumon/o = lungs Note the route of the lower respiratory tract and again the combining forms. The carina is the cartilage that divides the right and left bronchi. Mastering Healthcare Terminology/Chapter 11

Lungs Lobes Segments Lingula Word Parts RUL, RML, RLL LUL, LLL
Anterior Posterior Apical Basal Medial Lateral Lingula Word Parts pulmon/o, pneum/o, pneumon/o = lung lob/o, lobul/o = lobe apic/o = apex, tip, point bas/o = base The lungs are divided into lobes, which are the upper and lower on the left and the upper, middle, and lower on the right. The secondary and tertiary bronchi are the branches from the bronchial tree as it divides into the lung. Note the segments that correspond to the segmental arteries that branch off of the pulmonary arteries. They are named for their location, again providing a review of basic positional and directional terminology. The lingula is the area where the superior and inferior segments appear on the left lung (possibly a remnant of a left medial lobe?). Mastering Healthcare Terminology/Chapter 11

Cells of the Respiratory Tract
Goblet cells Ciliated basal (stem) cells Tall simple columnar cells Simple cuboidal cells Simple squamous cells Type I and type II cells At the beginning of the respiratory system, its cells begin tall and wide; then they become shorter and thinner as they progress toward the alveoli. The goblet cells are those that produce mucus (a gruesome, but easy way to remember is to visualize what they produce – goblets of mucus). The ciliated basal cells (also called stem cells) help cleanse the bronchial lining. Tall simple columnar cells in the primary bronchi progress to squat simple cuboidal cells in the terminal bronchioles. Ciliated cells continue to appear in the terminal bronchioles, but the goblet cells do not. Simple squamous cells appear in the alveoli. The type I cells provide gas exchange, while the type II cells produce surfactant to keep the lungs from collapsing. Mastering Healthcare Terminology/Chapter 11

Hemoglobin -> oxyhemoglobin Mitochondria Carbonic acid Bicarbonate
Blood pH Regulation Hemoglobin -> oxyhemoglobin Mitochondria Carbon dioxide formation Carbonic acid Bicarbonate Hyperventilation Kussmaul’s respiration Role of kidneys in pH regulation Word Parts oxy- = oxygen hem/o = blood -globin = protein substance Once the air passes through the lungs to the alveoli, it continues on to the cells of the body through the blood. The red blood cells contain a protein called hemoglobin. The oxygen binds with the hemoglobin (now termed oxyhemoglobin) to be delivered to the cells. The mitochondria of the cells need the oxygen for cellular respiration. Once the mitochondria use the oxygen, carbon dioxide is formed that travels back to the lungs on red blood cells as carbonic acid. If the pH is excessive, carbonic acid splits into bicarbonate and a hydrogen ion to increase the concentration of hydrogen ions to cause the pH to fall. If the pH is too low, the bicarbonate ions bond to the unattached hydrogen ions, lowering the concentration of hydrogen ions and causing the pH to rise. At the capillaries, the bicarbonate and carbonic acid change back to carbon dioxide and water, where it is exhaled as warm, moist breath. Hyperventilation is faster and deeper breathing to move carbon dioxide out of the body. Kussmaul’s respiration is the result of a drop in pH caused by an excessive breakdown of fats in ketoacidosis, a complication of diabetes mellitus. The kidneys assist in the regulation of blood pH by monitoring and adjusting the level of bicarbonate ions by recycling them back to the bloodstream, or by excreting excessive hydrogen ions in the urine. Mastering Healthcare Terminology/Chapter 11

Pleura, Diaphragm, and Ribs Visceral pleura Parietal pleura
Muscles in respiration Diaphragm Intercostal muscles Word Parts pleur/o = pleura viscer/o = viscera, organ pariet/o = wall diaphragmat/o, diaphragm/o, phren/o = diaphragm inter- = between cost/o = rib -al = pertaining to Finally, the double-folded serous membrane that encloses the lungs is the pleura. The side that coats the lungs is the visceral pleura, while the side toward the inner surface of the rib cage is the parietal pleura. The serous nature of the membrane provides a means of frictionless expansion and contraction of the lungs as we breathe. The muscles involved in respiration are the dome-shaped diaphragm that pulls down, while the intercostal muscles expand to create negative pressure and pull air into the lungs. Relaxation of these muscles pushes the air back out on expiration. Mastering Healthcare Terminology/Chapter 11

Review Question The combining form for the pharyngeal tonsils is:
A. adenoid/o B. pharyng/o C. epiglott/o D. tonsill/o A. Adenoid/o The combining form for the palatine tonsils is tonsill/o. Mastering Healthcare Terminology/Chapter 11

Symptoms and Signs Involving the Respiratory System (R00-R99)
Aphonia Dysphonia Cheyne-Stokes respiration Clubbing Cyanosis Epistaxis Word Parts a- = no, not, without phon/o = sound -ia = condition dys- = difficult cyan/o = blue -osis = abnormal condition Aphonia (a- = without + phon/o = sound) is a loss of the ability to produce sounds. Dysphonia (dys- = difficult), a term used to discuss a condition of hoarseness, is difficulty making sound. Cheyne-Stokes respiration is deep, rapid breathing followed by a period of apnea (a temporary lack of breathing). Clubbing is the abnormal enlargement of the distal (far end) phalanges as a result of diminished oxygen in the blood. Cyanosis (cyan/o = blue) is a discoloration of the skin and mucous membranes caused by insufficient oxygenation of the blood. The color of the skin, nail beds, and/or mucous membranes may be blue (as the term describes) or gray, slate, or dark purple. Note that the “blueness” may appear as a gray shade in different shades of skin. Also note that it can be seen in the nail beds and gingivae. Epistaxis is the medical term for a nosebleed. Students might note the prefix “epi-” meaning above or upon. The suffix –staxis refers to tiny drops, as in the tiny drops of blood that fall upon whatever is below the nose of a person with epistaxis. The suffix does not appear in any other terms, so it is not worth remembering aside from this quick note. Clubbing Mastering Healthcare Terminology/Chapter 11

Hemoptysis Hypercapnia Hyperventilation Hypoxemia Abnormal sputum Shortness of breath (SOB) Word Parts hem/o = blood -ptysis = spitting hyper- = excessive capn/o = carbon dioxide -ia = condition hypo- = deficient ox/o = oxygen -emia = blood condition Hemoptysis (-ptysis = spitting) is the coughing up of blood or blood-stained sputum. Hypercapnia (hyper- = excessive + capn/o = carbon dioxide) is a condition of an excessive amount of carbon dioxide in the blood. Hyperventilation is abnormally increased breathing. Hypoxemia (hypo- = deficient + ox/o = oxygen + -emia = blood condition) is a condition of deficient oxygen in the blood. Hypoxia is a condition of deficient oxygen in the tissues. Sputum is the mucous that is coughed up from the lungs and expectorated through the mouth. If abnormal, it would be described in terms of its amount, color, and/or odor. Shortness of breath is a term for breathlessness, or air hunger. Mastering Healthcare Terminology/Chapter 11

Apnea Bradypnea Dyspnea Eupnea DOE Hyperpnea Hypopnea Orthopnea Tachypnea Word Parts a- = no, not, without -pnea = breathing brady- = slow dys- = difficult eu- = healthy, normal hyper- = excessive hypo- = deficient orth/o = straight tachy- = fast Each of these terms ends with the suffix -pnea, which means breathing. Apnea (a- = without) means a temporary lack of breathing. If it was permanent the patient would have died. Bradypnea (brady- = slow) is abnormally slow breathing. Dyspnea is abnormal, difficult, or uncomfortable breathing. Eupnea (eu- = good, normal) is good, normal breathing. DOE is dyspnea on exertion. Hyperpnea (hyper- = excessive) is excessively deep breathing. Hypopnea (hypo- = deficient) is extremely shallow breathing. Orthopnea (orth/o = straight) is a condition of difficult breathing unless the patient is in an upright position. Tachypnea is rapid, shallow breathing. Which term is normal? (eupnea) Mastering Healthcare Terminology/Chapter 11

Abnormal Breath Sounds (R06-R09)
Auscultation Vesicular vs. adventitious Friction sounds Hiccough/hiccup/singultus Rales Crackles/crepitations Rhonchi Stridor Wheezing Sibilant rhonchi Sonorous rhonchi The process of listening is termed auscultation. Normal breath sounds are described as “vesicular,” while abnormal ones are described as adventitious. You might want to note the relationship between the adventitia (an outer tunic) and the term adventitious. They both derive from a root that means coming from outside or foreign. Friction sounds are those that are made by dry surfaces rubbing together. A hiccup is a sound produced by the involuntary contraction of the diaphragm, followed by rapid closure of the glottis (the opening between the vocal cords). Rales (also called crackles) are discontinuous bubbling noises. Rhonchi are abnormal rumbling sounds caused by airways blocked by secretions or muscle contractions. Stridor is a high-pitched inspiratory sound from the larynx. It is a sign of an upper airway obstruction. Wheezing is a whistling sound made during breathing. Mastering Healthcare Terminology/Chapter 11

Review Question Coughing up blood or blood-stained sputum is:
A. hemoptysis B. epistaxis C. pyrexia D. rhinorrhea A. Hemoptysis Mastering Healthcare Terminology/Chapter 11

Congenital Disorders (Q00-Q99) Tracheoesophageal fistula
Tracheomalacia Tracheostenosis Word Parts trache/o = trachea, windpipe esophag/o = esophagus -malacia = softening -stensosis = narrowing Tracheoesophageal fistula is a congenital abnormal opening between the trachea and the esophagus. It can be acquired. Tracheomalacia (-malacia = softening) is a softening of the tissues of the trachea. Tracheostenosis (-stenosis = narrowing) is a narrowing of the trachea. Discuss how each of these conditions, the fistula, softening, and narrowing of the windpipe, are disease processes. Mastering Healthcare Terminology/Chapter 11

Acute Upper Respiratory Infections (J00-J06) Epiglottitis Laryngitis
Obstructive laryngitis Croup Nasopharyngitis Coryza Pharyngitis Sinusitis Tracheitis Word Parts epiglott/o = epiglottis -itis = inflammation laryng/o = laryngx, voice box nas/o = nose pharyng/o = pharynx, throat sinus/o = sinus trache/o = trachea, windpipe Epiglottitis is an inflammation of the epiglottis. Laryngitis is an inflammation of the larynx. Obstructive laryngitis is an acute viral infection of early childhood, marked by stridor caused by spasms of the larynx, trachea, and bronchi. Also called croup. Nasopharyngitis is the common cold. Also referred to as coryza. Pharyngitis is an inflammation of the throat. Sinusitis is an inflammation of one or more of the paranasal sinuses. Tracheitis is an inflammation of the windpipe. Mastering Healthcare Terminology/Chapter 11

Influenza and Pneumonia (J09-J18) Influenza Pneumonia
Avian (bird) flu Pneumonia Pneumonitis Types Lobar Double Severe acute respiratory syndrome (SARS) Word Parts pneumon/o = lung -ia = condition syn- = together, with -drome = to run Influenza is also known as the flu. It is an acute infectious disease of the respiratory tract caused by a virus. Avian (bird) flu is caused by type A influenza virus. Swine flu is caused by H1N1 virus. Pneumonia is an inflammation of the lungs caused by a variety of pathogens. If infectious, it is termed pneumonia; if noninfectious, it is termed pneumonitis. The name(s) of the lobes are used to describe the extent of the disease (e.g., RML pneumonia is pneumonia of the right middle lobe). If both lungs are affected, it is termed double pneumonia. Severe acute respiratory syndrome (SARS) is a viral respiratory disorder caused by a coronavirus. It usually results in pneumonia. Discuss the outbreaks of SARS and how air travel has made the world “closer” in disease communication. Mastering Healthcare Terminology/Chapter 11

CM Guideline Alert! 10.C INFLUENZA DUE TO CERTAIN IDENTIFIED INFLUENZA VIRUSES Code only confirmed cases of avian influenza (code J09.0-, Influenza due to identified avian influenza virus) or novel H1N1 or swine flue, code J This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis). In this context, “confirmation” does not require documentation of positive laboratory testing specific for avian or novel H1N1 (H1N1 or swine flu) influenza. However, coding should be based on the provider’s diagnostic statement that the patient has avian influenza. If the provider records “suspected or possible or probable avian influenza,” the appropriate influenza code from category J11, influenza due to unspecified influenza virus, should be assigned. A code from category J09, influenza due to certain identified influenza viruses, should not be assigned. Note how the rules for documentation have an impact on one’s coding for flu viruses. Mastering Healthcare Terminology/Chapter 11

Other Acute Lower Respiratory Infections (J20-J22)
Bronchiolitis Bronchitis Acute Chronic Word Parts bronchiol/o = bronchiols -itis = inflammation bronch/o = bronchus Bronchiolitis is a viral inflammation of the bronchioles, most common in children younger than 18 months. Bronchitis is an inflammation of the bronchi that may be acute or chronic. Discuss the differences between what would be acute and chronic bronchitis. Mastering Healthcare Terminology/Chapter 11

Other Diseases of the Upper Respiratory Tract (J30-J39)
Deviated septum Hypertrophy of nasal turbinates Laryngismus Ulcerative nasal mucositis Polyps, nasal and vocal cord Rhinorrhea Word Parts sept/o = wall, septum -um = structure hyper- = excessive -trophy = development laryng/o = larynx, voice box -ismus = spasm condition mucos/o = mucus -itis = inflammation rhin/o = nose -rrhea = discharge A deviated septum is a deflection of the nasal septum that may obstruct the nasal passages, resulting in infection, sinusitis, shortness of breath, headache, or recurring epistaxis. Hypertrophy of nasal turbinates is an excessive development (enlargement) of the scroll-like bones within the nasal cavity. Laryngismus is a spasm of the larynx. Also called stridulus. Ulcerative nasal mucositis is inflammation of the mucous membrane within the nose. Ulcerative indicates that there is erosion of the mucous membrane. Polyps, nasal and vocal cord: small, tumorlike growths that project from a mucous membrane surface, including the inside of the nose, the paranasal sinuses, and the vocal cords. Rhinorrhea is a discharge from the nose. Mastering Healthcare Terminology/Chapter 11

Specific Infections of the Respiratory System (A15-B97) Diphtheria
Pertussis Respiratory syncytial virus (RSV) Rhinomycosis Tuberculosis Multidrug-resistant tuberculosis (MDR) Word Parts rhin/o = nose myc/o = fungus -osis = abnormal condition Diphtheria is a bacterial respiratory infection characterized by a sore throat, fever, and headache. Pertussis is a bacterial infection of the respiratory tract with a characteristic high-pitched “whoop.” Also called whooping cough. Respiratory syncytial virus (RSV) is an acute respiratory disorder usually occurring in the lower respiratory tract in children and the upper respiratory tract in adults. Most common cause of bronchiolitis and pneumonia in infants and highly contagious in young children. Rhinomycosis is an abnormal condition of fungus in the nose. Tuberculosis (TB) is a chronic infectious disorder caused by an acid-fast bacillus, Mycobacterium tuberculosis. Transmission is normally by inhalation or ingestion of infected droplets. Multidrug-resistant tuberculosis (MDR TB) is fatal in 80% of cases. Mastering Healthcare Terminology/Chapter 11

Terms Related to Chronic Lower Respiratory Diseases (J40-J47)
Asthma Status asthmaticus Extrinsic vs. intrinsic Intermittent vs. persistent Asthma is a respiratory disorder that is characterized by recurring episodes of paroxysmal (sudden, episodic) dyspnea. Patients exhibit coughing, wheezing, and shortness of breath. If the attack is continuous, it is referred to as status asthmaticus, which may be fatal. If described as extrinsic, the cause is from an allergic reaction to an inhaled substance. If intrinsic, the cause is unknown (idiopathic). Intermittent asthma is less than 2 times a week, while persistent asthma is more than 2 times per week. Mastering Healthcare Terminology/Chapter 11

Chronic Lower Respiratory Diseases (J40-J47) Bronchiectasis
Chronic obstructive pulmonary disease (COPD) Dyspnea on exertion (DOE) Emphysema (including panlobular) Word Parts bronchi/o = bronchus -ectasis = dilation pan- = all lob/o = lobe -ar = pertaining to Bronchiectasis is a chronic dilation of the bronchi. Symptoms include dyspnea, expectoration of foul-smelling sputum, and coughing. Chronic obstructive pulmonary disease (COPD) is a respiratory disorder characterized by a progressive and irreversible diminishment in inspiratory and expiratory capacity of the lungs. Patient experiences dyspnea on exertion (DOE), difficulty inhaling or exhaling, and a chronic cough. Emphysema (including panlobular) is an abnormal condition of the pulmonary system characterized by distension and destructive changes of the alveoli. The most common cause is tobacco smoking, but exposure to environmental particulate matter may also cause the disease. Mastering Healthcare Terminology/Chapter 11

CM Guideline Alert! 10a. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND ASTHMA 1) Acute Exacerbation of Chronic Obstructive Bronchitis and Asthma The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, although an exacerbation may be triggered by an infection. COPD and asthma are prevalent in our population. An acute exacerbation is a reason for a visit as opposed to a long-standing diagnosis without change. Mastering Healthcare Terminology/Chapter 11

Lung Disease Due to External Agents (J60-J70) Pneumoconiosis
Asbestosis Silicosis Coal worker’s pneumoconiosis (CWP) Word Parts pneum/o = lung coni/o = dust -osis = abnormal condition Pneumoconiosis is a loss of lung capacity caused by an accumulation of dust in the lungs. Types may include asbestosis (abnormal condition of asbestos in the lungs), silicosis (abnormal accumulation of glass dust in the lungs), and coal workers’ pneumoconiosis (CWP). CWP Mastering Healthcare Terminology/Chapter 11

Acute respiratory distress syndrome (ARDS) Pulmonary edema
Other Respiratory Diseases Principally Affecting the Interstitium (J80-J84) Acute respiratory distress syndrome (ARDS) Pulmonary edema Pulmonary fibrosis Word Parts pulmon/o = lung -ary = pertaining to fibr/o = fiber -osis = abnormal condition Remind students that the “interstitium” refers to the space in between the cells of the lung tissue. Acute respiratory distress syndrome (ARDS) is a sudden, severe lung dysfunction due to a number of different disorders (e.g., pneumonia, trauma). Patients have extreme difficulty with breathing and may need mechanical ventilation. Pulmonary edema is an accumulation of fluid in the lung tissue. Often present in congestive heart failure, it is caused by the inability of the heart to pump blood. Pulmonary fibrosis is a stiffening of the lungs as a result of the formation of fibrous tissue. It is idiopathic in origin. Mastering Healthcare Terminology/Chapter 11

Suppurative and Necrotic Conditions of the Lower Respiratory Tract (J85-J86)
Abscess of lung Pyothorax Empyema Word Parts py/o = pus -thorax = chest (pleural cavity) Remind students of the meaning of the terms “suppurative” and “necrotic.” An abscess is a localized accumulation of pus in an area of the lung tissue itself, while a pyothorax is pus in the pleural cavity. Mastering Healthcare Terminology/Chapter 11

Other Diseases of the Pleura (J90-J94) Hemothorax Hydrothorax
Pleural effusion Pneumothorax Word Parts hydr/o = water -thorax = chest (pleural cavity) hem/o = blood pleur/o = pleura pneum/o = air Hemothorax is blood in the pleural cavity. Hydrothorax is an accumulation of serous fluid in the pleural cavity. Pleural effusion is an abnormal accumulation of fluid in the intrapleural space. Pneumothorax is air or gas in the pleural space causing the lung to collapse. Hemothorax Pneumothorax Mastering Healthcare Terminology/Chapter 11

Diseases of the Respiratory System (J96-J99)
Acute respiratory failure (ARF) Atelectasis Bronchospasm Word Parts a- = no tel/e = complete -ectasis = dilation bronch/o = bronchus -spasm = sudden, involuntary contraction Acute respiratory failure (ARF) is a sudden inability of the respiratory system to provide oxygen and/or remove CO2 from the blood. May be caused by cardiac or pulmonary dysfunction or drug intoxication. Atelectasis is the collapse of lung tissue or an entire lung. Bronchospasm is a sudden involuntary contraction of the bronchi, as in an asthma attack. Note that “spasm” is a suffix and a stand-alone term. Mastering Healthcare Terminology/Chapter 11

Terms Related to Injuries to the Thorax (S20-S29)
Flail chest Flail chest is a condition in which multiple rib fractures cause instability in part of the chest wall and in which the lung under the injured area contracts on inspiration and bulges out on expiration. A, Fractured rib sections are unattached to the rest of the chest wall. B, On inspiration, the flail segment of ribs is sucked inward, causing the lung to shift inward. C, On expiration, the flail segment of ribs bellows outward, causing the lung to shift outward. Air moves back and forth between the lungs instead of through the upper airway. Mastering Healthcare Terminology/Chapter 11

Review Question An abnormal condition of fungus in the nose is:
A. coryza B. croup C. rhinomycosis D. rhinosalpingitis C. Rhinomycosis Myc/o = fungus Mastering Healthcare Terminology/Chapter 11

Respiratory Neoplasms
Note the changes in the various types of lung cells that lead to the different types of lung cancers. Mastering Healthcare Terminology/Chapter 11

Benign Neoplasms Mucous gland adenoma Papilloma Word Parts
muc/o = mucus -ous = pertaining to aden/o = gland -oma = tumor, mass papill/o = nipple A mucous gland adenoma is a benign tumor of the mucous glands in the respiratory tract. A papilloma is a benign tumor of epithelial origin in the respiratory tract. It is named for its nipple-like appearance. Papill/o means nipple. Mastering Healthcare Terminology/Chapter 11

Non-small cell lung cancer (NSCLC)
Malignant Neoplasms Mesothelioma Non-small cell lung cancer (NSCLC) Adenocarcinoma Large cell carcinoma Squamous cell carcinoma Small cell lung cancer (SCLC) Oat cell carcinoma Word Parts -oma = tumor aden/o = gland -carcinoma = cancer of epithelial origin squam/o = scaly -ous = pertaining to Mesothelioma is a rare malignancy of the pleura in the respiratory system (and other protective tissues that cover the internal organs of the body). This is often caused by asbestos. Much more common is the group of non-small cell lung cancers. These are most often caused by smoking, secondhand smoke, radon, asbestos, and air pollution. Adenocarcinoma is derived from the mucous-secreting glands in the lungs. Large cell carcinoma originates in the lining of the small bronchi. Squamous cell carcinoma originates in the squamous epithelium of the larger bronchi. Small cell lung cancer (also called oat cell carcinoma) is the second most common type of lung cancer. This cancer originates in the neuroendocrine cells in the bronchi and is most often caused by smoking. Discuss the causes of NSCLC versus the causes of SCLC and mesothelioma. Mesothelioma Mastering Healthcare Terminology/Chapter 11

Review Question Another name for an oat cell carcinoma is a/an:
A. papilloma B. small cell lung cancer C. mesothelioma D. adenocarcinoma B. Small cell lung cancer Mastering Healthcare Terminology/Chapter 11

Arterial blood gases (ABGs) Adenoidectomy Antrotomy Ethmoidectomy
Procedures Arterial blood gases (ABGs) Adenoidectomy Antrotomy Ethmoidectomy Laryngoplasty Lung VQ scan Word Parts arteri/o = artery adenoid/o = adenoid -ectomy = cutting out antr/o = antrum -tomy = cutting ethmoid/o = ethmoid laryng/o = larynx, voice box -plasty = surgically forming Arterial blood gases (ABGs) is a blood test that measures the amount of oxygen and carbon dioxide in the blood. Adenoidectomy is the removal of the adenoids. Also called the pharyngeal tonsils. Antrotomy is cutting one of the sinuses for the purpose of drainage. Also called sinusotomy. Note that drainage is a root operation. Ethmoidectomy is cutting out part or all of the ethmoid bone. Usually done to treat a chronic sinus infection. Laryngoplasty is surgically forming the larynx for the purpose of improving the voice for patients with hoarseness. Lung VQ scan is an imaging technique used to assess the areas of the lungs that are receiving air but are not perfused with blood, possibly as a result of a blood clot. Discuss why the lack of blood is a serious issue. Lung VQ scan Mastering Healthcare Terminology/Chapter 11

Procedures Bronchography Bronchoscopy Word Parts Bronchoscopy
bronch/o = bronchus -graphy = recording -scopy = viewing Bronchography records the bronchi through imaging techniques using a contrast medium. Bronchoscopy is viewing a bronchus using an instrument. Bronchoscopy Mastering Healthcare Terminology/Chapter 11

Procedures Metered dose inhaler (MDI) Nebulizer Peak flow meter Spacer
Hand-held nebulizer (HHN) Peak flow meter A metered dose inhaler (MDI) is a portable device that delivers a measured dose of an aerosol medication for inhalation. An additional device, a spacer, is an add-on chamber that holds the dispensed dose of medication, allowing the user to inhale it more slowly. A nebulizer is a battery- or electric-powered device/machine used to turn a liquid medication into a fine mist for inhalation through a mouthpiece or face mask. A hand-held nebulizer (HHN) is the portable form. A peak flow meter is an instrument used in a pulmonary function test (PFT) to measure breathing capacity. Peak flow meter Mastering Healthcare Terminology/Chapter 11

Plain radiography, chest (CXR) Positive end expiratory pressure (PEEP)
Procedures Plain radiography, chest (CXR) Pulmonary angiography Positive end expiratory pressure (PEEP) Word Parts radi/o = rays -graphy = recording pulmon/o = lung angi/o = vessel The plain radiography, chest (CXR), is one of the most common imaging techniques; it is used to visualize abnormalities of the respiratory system. X-rays may also include the use of a contrast medium, as in a pulmonary angiography, which uses a dye injected into the blood vessels of the lung, followed by subsequent x-ray imaging to demonstrate the flow of blood through these vessels. Positive end expiratory pressure (PEEP) is a method of providing assistance in exhalation through the use of an endotracheal tube, a tracheostomy, a face mask, or nasal prongs. CXR Mastering Healthcare Terminology/Chapter 11

Procedures Pleurolysis Pleurocentesis Pleurodesis Word Parts
Pleurosclerosis Word Parts pleur/o = pleura -lysis = breaking down -centesis = surgical puncture -desis = fixation -sclerosis = hardening Pleurolysis is the surgical separation of pleural adhesions through the use of an endoscope and electrical cauterization. The adhesions are often caused by scarring from repeated pleural inflammation. Pleurocentesis is the surgical puncture to remove fluid or air from the pleural cavity. Pleurodesis is the mechanical fixation of the two pleural membranes in order to prevent pleural effusions. If the fixation is done chemically, it is called pleurosclerosis. Mastering Healthcare Terminology/Chapter 11

Pulmonary resections and excisions
Procedures Positive support ventilation (PSV) Pulmonary resections and excisions Lobectomy Pneumonectomy Positive support ventilation (PSV) is a method of breathing assistance to increase a patient’s ability to inhale through an endotracheal tube. Pulmonary resections and excisions describes the excision of a segment or a lobe of the lung or the entire lung. Called a lobectomy when an entire lobe is resected and a pneumonectomy when the entire lung is resected. Pulmonary resections and excisions Mastering Healthcare Terminology/Chapter 11

Pulmonary function tests
Procedures Pulse oximetry Spirometry Pulmonary function tests Word Parts ox/i = oxygen -metry = measuring spir/o = to breathe pulmon/o = lung -ary = pertaining to Pulse oximetry is measuring the oxygen level of the blood using a pulse oximeter. A noninvasive, cliplike device is attached to either the earlobe or fingertip. Spirometry is a test to measure the air capacity of the lungs. A spirometer is the instrument used. Pulmonary function tests are procedures for determining the capacity of the lungs to exchange oxygen and carbon dioxide efficiently. Pulse oximetry Mastering Healthcare Terminology/Chapter 11

Procedures Mantoux skin test Quantiferon-TB gold test (QFT)
Sputum culture and sensitivity C. Rhinomycosis Myc/o = fungus Mastering Healthcare Terminology/Chapter 11

PCS Guideline Alert! B3.8 PCS contains specific body parts for anatomical subdivisions of a body part, such as lobes of the lungs or liver and regions of the intestine. Resection of the specific body part is coded whenever all of the body part is cut out or off, rather than coding Excision of less specific body part. Example: Left upper lung lobectomy is coded to Resection of Upper Lung Lobe, Left, rather than Excision of Lung, Left. Note that a lobe is considered an entire body part, so its removal is a resection. Mastering Healthcare Terminology/Chapter 11

Procedures Rhinoplasty Septoplasty Turbinectomy Word Parts
rhin/o = nose -plasty = surgically forming sept/o = septum, wall turbin/o = turbinate bone -ectomy = cutting out Rhinoplasty is surgically forming by correcting, altering, supplementing, or replacing the nose. Septoplasty is surgically straightening of the wall between the nares to correct a deviation. Turbinectomy is cutting out part or all of a turbinate bone, usually the inferior turbinate, to allow for greater air flow. Mastering Healthcare Terminology/Chapter 11

Tracheoesophageal fistulization (TEF) Tracheostomy Tracheotomy
Procedures Tracheoesophageal fistulization (TEF) Tracheostomy Tracheotomy Endotracheal airway Word Parts trache/o = trachea esophag/o = esophagus -eal = pertaining to -stomy = new opening -tomy = cutting endo- = within Tracheoesophageal fistulization (TEF) is the creation of a new opening between the trachea and the esophagus after a laryngectomy to preserve the ability to speak. Tracheostomy is a new opening of the trachea. A tracheostomy device is an instrument used to facilitate the maintenance of an opening in the trachea. Tracheotomy is cutting the trachea to establish an airway. Endotracheal airway is a device that is positioned in the trachea for the purposes of establishing an airway. Tracheostomy Mastering Healthcare Terminology/Chapter 11

Procedures Ventilation Ventilator Cannula Venturi mask
Rebreathing mask Positive pressure breathing (PPB) Continuous positive airway pressure (CPAP) Routes of oxygen therapy. A, Simple face mask. B, Venturi mask. C, Nasal cannula. D, CPAP. Ventilators provide positive pressure breathing to assist patients. Positive pressure breathing is greater than atmospheric pressure to move air into the lungs. A nasal cannula is a tube that is used to deliver oxygen into the nostrils. A Venturi mask offers the option of detecting and adjusting the oxygen level. CPAP may be delivered through a ventilator and endotracheal tube, or a nasal cannula, face mask, or hood. Students may be familiar with these from family members with obstructive sleep apnea. Mastering Healthcare Terminology/Chapter 11

Review Question A new opening of the windpipe is a/an: A. septoplasty
B. thoracocentesis C. tracheostomy D. tracheotomy C. Tracheostomy Mastering Healthcare Terminology/Chapter 11

Pharmacology Antihistamines Antitussives Bronchodilators Decongestants
Expectorants Inhaled corticosteroids Mucolytics Antihistamines: block histamine receptors to manage allergies associated with allergic rhinitis or allergy-induced asthma. Antitussives: suppress the cough reflex. Bronchodilators: relax bronchi to improve ventilation to the lungs. Decongestants: reduce congestion or swelling of mucous membranes. Expectorants: promote the expulsion of mucus from the respiratory tract. Inhaled corticosteroids: reduce airway inflammation to improve ventilation or reduce nasal congestion. Mucolytics: break up thick mucus in the respiratory tract. Mastering Healthcare Terminology/Chapter 11

Suffixes and Root Operations for the Respiratory System
-centesis drainage -ectomy excision, resection -lysis release -plasty alteration, reposition, repair, replacement, supplement -rrhaphy repair -tomy drainage Note that -centesis and -tomy share a root operation (drainage) and -plasty and -rrhaphy share the repair root operation. While some suffixes for the chapter’s terms only have one root operation, note that a coder will need to determine the reason for the procedure to determine the correct root operation. Mastering Healthcare Terminology/Chapter 11

Sort These Terms into Their Correct Categories
1. alveolus 2. epiglottis 3. arterial blood gases 4. epistaxis 5. pulmonary resection Categories __ A+P __ Pathology __ Procedures A+P – alveolus, epiglottis Pathology – epistaxis Procedures – arterial blood gases, pulmonary resection

Chapter Ten Respiratory System

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Chapter Ten Respiratory System

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