Tabers Cyclopedic Medical Dictionary, 20th Edition

Tự diển Y khoa Anh Anh khá đầy đủ và có nhiều mục từ giải nghĩa rõ ràng. Sách cung cấp kiến thức y khoa và giúp trau giồi kỹ năng đọc tiếng Anh chuyên ngành y khoa. Illustrations: This edition ofTaber’sincludes 700 illustrations, 119 of which are new to this edition. More than three fourths of the images are fourcolor photographs and line drawings. The images were carefully chosen to complement the text of the entries with which they are associated. Each illustration is crossreferenced from its associated entry. A complete list of illustrations begins on page xix.

Copyright © 2005 by F A Davis.

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Proofreaders

James Eidam Joy Matkowski Christopher Muldor

Pronunciation Editor Rima Elkins McKinzey (Deceased)

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Copyright 娀 2005 by F A Davis Company

Copyright 1940, 1942, 1945, 1946, 1948, 1949, 1950, 1951, 1952, 1953,

1954, 1955, 1956, 1957, 1958, 1959, 1960, 1961, 1962, 1963, 1965, 1968,

1969, 1970, 1973, 1977, 1981, 1985, 1989, 1993, 1997, and 2001 by F A.

Davis.

All rights reserved This publication is protected by copyright No part of

it may be reproduced, stored in a retrieval system, or transmitted in any

form or by any means, electronic, mechanical, photocopying, recording,

or otherwise, without written permission from the publisher.

PRINTED IN THE UNITED STATES OF AMERICA

NOTE: As new scientific information becomes available through basic

and clinical research, recommended treatments and drug therapies

un-dergo changes The author and publisher have done everything possible

to make Taber’s accurate, up to date, and in accord with accepted

stan-dards at thetimeof publication Theauthor, editors, and publisher are

not responsible for errors or omissions or for consequences from

appli-cation of the book, and make no warranty, expressed or implied, in regard

to the contents of the book The practices described in this book may or

may not meet professional standards of care in the reader’s community;

they may or may not apply to specific clinical situations and should not

be relied upon for their direct applicability; they may have been overtaken

by newer or more recent recommendations or scientific evidence The

reader is always advised to research particular clinical questions further

and to check product information (package inserts) for changes and new

information regarding dose and contraindications before administering

any drug Caution is especially urged when using new or infrequently

ordered drugs.

Library of Congress Cataloging in Publication Data

Taber’s cyclopedic medical dictionary.— Ed 20, illustrated in full color /

editor, Donald Venes

p ; cm.

Includes bibliographical references and index.

ISBN 0-8036-1207-9 (index)— ISBN 0-8036-1208-7 (non index)— ISBN

0-8036-1209-5 (deluxe)

1 Medicine— Dictionaries I Title: Cyclopedic medical dictionary.

II Venes, Donald, 1952- III Taber, Clarence Wilbur, 1870-1968

[DNLM: 1 Medicine— Dictionary— English W 13 T113d 2001]

R121.T18 2001

610⬘.3—dc21

00-064688 ISSN 1065-1357

ISBN 0-8036-1208-7

ISBN 0-8036-1207-9 (indexed)

ISBN 0-8036-1209-5 (deluxe)

ISBN 0-8036-1303-2 (CD-ROM)

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vii

CONTENTS

INTRODUCTION TO EDITION 20 ix

CONSULTING EDITORS AND CONSULTANTS xi

TABER’S FEATURE FINDER xiii

FEATURES AND THEIR USE xv

LIST OF ILLUSTRATIONS xix

Illustration Sources xxviii

LIST OF TABLES xxxi

ABBREVIATIONS USED IN TEXT xxxv

VOCABULARY 1

APPENDICES 2373

Table of Contents 2373

Index to Appendices 2376

Nutrition 2378

Integrative Therapies: Complementary and Alternative Medicine 2394

Normal Reference Laboratory Values 2431

Prefixes, Suffixes, and Combining Forms 2449

Latin and Greek Nomenclature 2454

Medical Abbreviations 2463

Symbols 2470

Units of Measurement (Including SI Units) 2471

Phobias 2477

Manual Alphabet 2480

The Interpreter in Three Languages 2481

Medical Emergencies 2496

Health Professions 2530

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viii

Health Care Resource Organizations 2556

Professional Designations and Titles in the Health Sciences 2564

Documentation System Definitions 2567

Standard and Universal Precautions 2568

Recommended Immunization Schedules 2579

Nursing Appendix 2584

Shortly after the terrorist attacks of September 11, 2001, spores of

anthrax were weaponized and distributed through the U.S postal system,

and several Americans died Bioterrorism and biological warfare, which

for years had been considered only a theoretical threat to public health,

became an actual menace Diseases such as anthrax, smallpox, and

tu-laremia leapt onto news headlines and into the forefront of social

aware-ness The potential threat of exposure to chemical warfare agents, such

as ricin, sarin, tabun, and to radioactive debris (‘dirty bombs’) suddenly

became much more real both to society at large, and to health care

pro-viders in the U.S and around the globe.

It is safe to say that many professionals in the health and life sciences

communities have both increased their preparedness and become more

anxious about incident management In late 2003, a newly identified,

deadly respiratory contagion spread rapidly through Asia and the Far

East I was attending a national medical conference when this agent was

first identified; speakers at the conference worried out loud that 40 or

even 80 million might die of the emerging infection, SARS, within a year,

far eclipsing the mortality rate of the deadly influenza pandemic of 1918.

SARS did prove both contagious and deadly, but as a result of strict travel

restrictions and quarantines that were put into place, the actual number

of affected persons has, as I write this introduction, been limited to less

than 9,000, and the number of deaths, less than 800 These numbers are

significant, but the devastation could have been much worse.

Remarkably we learned in the same year that West Nile Virus had

in just a few short years spread across the entire continental U.S by the

summer migration of infected crows and jays, and that soldiers, at war

in Afghanistan and Iraq, had been infected by tegumentary leishmaniasis

and Crimean-Congo Hemorrhagic Fever.

This new edition of Taber’s— the 20th— reflects much of what is

known about all these modern scourges, and many others Our editorial

staff, consultants, and correspondents have combed the medical

litera-ture for new and updated information about previously unknown health

threats, developing cures, the miraculous discoveries of the Human

Ge-nome Project, and many other new approaches to health care, its delivery,

and its management We have expanded and updated our coverage of

alternative, complementary, and integrative medicine; bioethics; drugs

and their use; evidenced-based care; informatics; nutrition; and patient

safety This edition of Taber’s has nearly 100 new entries devoted to new

developments in radiological technology; and hundreds of columns of new

x

material explaining contemporary cancer care, child care, neurology,

pal-liation, psychiatry, and women’s health care.

In all we have added 2400 new terms to this edition of Taber’s; we

have revised about 6000 others; added dozens of new tables and new

images; reviewed each and every appendix, revising most of them, some

quite extensively; and written about a hundred new patient care sections

to accompany our cyclopedic entries.

The writing, editing, and production of each edition of Taber’s is a

task that can only be performed by a skilled, dedicated, and permanent

team of professionals, working together and in parallel I have had the

privilege and honor of working with the F.A Davis staff and want to

mention in particular the members of the Taber’s Editorial Department

for this edition: Arthur Biderman, Evelyn Adler, Brigitte Fenton, and

Alison Enright.

This edition is the first in the last thirty years without input from

Clayton L Thomas, M.D Doctor Thomas served as Editor for Editions

12– 18 and as Coeditor for Edition 19 His contributions to Taber’s have

been enormous and continue to be carried forward in Edition 20.

All of us who worked on Taber’s hope that you will use it as a resource

on which to build your careers and your knowledge We also hope it will

help you to care for yourselves and others in these uncertain times.

Donald Venes, M.D.

xi

CONSULTING EDITORS AND CONSULTANTS

CONSULTING EDITORS

Carroll Conner Bouman, RN, PhD Charles Christiansen, EdD, OTR, OTC, FAOTA Judith E.Meissner, RN, BSN, MSN Valerie C.Scanlon, PhD Chad Starkey, PhD, ATC

CONSULTANTS Tonia Dandry Aiken, RN, BSN, JD Cindi Brassington, MS, CMA Richard R.Carlton, MS, RT(R), FAERS Marilynn E.Doenges, RN, BSN, MA, CS

Ellen Drake, BA, CMT Robert Elling, MPA, REMT-P Jacqueline Fawcett, PhD, FAAN Rose S.Fife, MD Maxine Goldman, BSHC, RN Bruce E.Hirsch, MD, FACP Donna Ignatavicius, MS, RN, Cm Jeanette G.Kernicki, RN, PhD, ANP

Ruth Lipman, PhD Mary Frances Moorhouse, RN, CRRN, CLNC Robert F.Moran, MS, PhD, FCCM, FAIC Betty J.Reynard, EdD, RDH Victor S.Sierpina, MD Susan M.Weiner, MSN, RN,C, CNS Mary Ann Wharton, PT, MS Robert L.Wilkins, PhD, RRT Kathleen Young, MA, RN, C

(Material supplied by the consulting editors and consultants has been

reviewed and edited by Donald Venes, MD, MSJ, editor, with whom final

responsibility rests for the accuracy of the content.)

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xiii

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xv

FEATURES AND THEIR USE

This section describes the major features found in Taber’s and provides

information that may help you use the dictionary more efficiently The

Feature Finder on page xiii is a graphic representation of many of the

features described below.

1 Vocabulary: The extensive vocabulary defined in Taber’s has been

updated to meet the ongoing needs of health care students, educators, and clinicians, as well as interested consumers The medical editor and the nursing and allied health consulting editors and consultants have researched and written new entries, revised existing entries, and deleted obsolete ones, reflecting the many changes in health care technology, clinical practice, and patient care American, rather than British, spellings are preferred.

2 Entry format: Taber’s combines two systems for the placement and

organization of entries: (a) main entries in strict alphabetical order;

and (b) a main entry– subentry format All single-word terms (e.g.,

cell) are main entries, as are some compound, or multiple word, terms (e.g., Alzheimer’s disease; acid-reflux disorder; nucleic acid test) However, many compound terms, especially those in

anatomy and physiology, are placed using the main entry– subentry format (e.g., arteries, veins, ligaments, and types of respiration) En- tries having 30 or more subentries are tinted in a yellow background for ease in finding them This melding of two systems combines the best features of both: compound terms that share an important com- mon element or classification, e.g., arteries, are subentries under the main entry (or headword) Terms that tend to be sought under the first word, e.g., diseases, disorders, tests, and syndromes, appear as main entries Also names of individuals and organizations are listed

as main entries An especially important compound term may be listed as both a main entry and a subentry, with one of the terms serving as a cross-reference to the other All main entries are printed

in bold type; subentries are indented under the main entry and are printed in bold italic type All entries are listed and defined in the singular whenever possible.

3 Alphabetization:

Main entries are alphabetized letter by letter, regardless of

spaces or hyphens that occur between the words; a comma marks the

end of a main entry for alphabetical purposes (e.g., skin, tenting of precedes skin cancer) In eponyms the ’s is ignored in alphabetizing (e.g., Albini’s nodules precedes albinism).

Subentries are listed in straight-ahead order following the same

letter-by-letter alphabetization used for main entries; a comma marks the end of a subentry for alphabetical purposes The headword

xvi

is often abbreviated in subentries (such as premature l under labor

or pulmonary i under infarction).

4 Eponyms: Included as main entries are the names of individuals

who were the first to discover, describe, or popularize a concept, a

microorganism, a disease, a syndrome, or an anatomical structure.

A brief biography appears in brackets after the pronunciation

Bio-graphical information includes the person’s professional designation,

the country in which the person was born or worked, and the date of

birth and death if known.

5 Definitions: The text that occurs before the first period in an entry

constitutes the definition for that entry Many entries are written in

encyclopedic style, offering a comprehensive understanding of the

disease, condition, or concept defined See “Encyclopedic entries” for

further information.

6 Pronunciations: Most main entries are spelled phonetically

Pho-netic pronunciations, which appear in parentheses after the boldface

main entry, are given as simply as possible with most long and short

vowels marked diacritically and secondary accents indicated

Dia-critics are marks over or under vowels Only two diaDia-critics are used

in Taber’s: the macron ¯ showing the long sound of vowels, as the a

in rate, e in rebirth, i in isle, o in over, and u in unite; and the breve

˘ showing the short sound of vowels, as the a in apple, e in ever, i in

it, o in not, and u in cut Accents are marks used to indicate stress

upon certain syllables A single accent⬘ is called a primary accent A

double accent ⬙ is called a secondary accent; it indicates less stress

upon a syllable than that given by a primary accent This difference

in stress can be seen in the word an⬙es-the⬘si-a Syllables are

sepa-rated by either an accent mark or a hyphen An unstressed vowel

sounds like the final a in anesthesia, a sound known as schwa.

7 Singular/Plural forms: When the spelling of an entry’s singular or

plural form is a nonstandard formation (e.g., villus pl villi, or

viscera sing viscus), the spelling of the singular or plural form

ap-pears in boldface after the pronunciation for the main entry

Non-standard singular and plural forms appear as entries themselves at

their normal alphabetical positions.

8 Etymologies: An etymology indicates the origin and historical

de-velopment of a term For most health care terms the origin is Latin

or Greek An etymology is given for most main entries and appears

in brackets following the pronunciation.

9 Abbreviations: Standard abbreviations for entries are included

with the definition and also are listed alphabetically throughout the

text Additional abbreviations used for charting and prescription

writing are listed in the Appendices A list of nonmedical

abbrevia-tions used in text appears on page xxxv.

10 Encyclopedic entries: Detailed, comprehensive information is

in-cluded with entries that require additional coverage because of their

importance or complexity Often this information is organized into

several subsections, each with its own subheading The most

xvii

quently used subheadings are Patient Care, Symptoms, Etiology, Treatment, and Diagnosis.

11 Illustrations: This edition of Taber’s includes 700 illustrations, 119

of which are new to this edition More than three fourths of the ages are four-color photographs and line drawings The images were carefully chosen to complement the text of the entries with which they are associated Each illustration is cross-referenced from its as- sociated entry A complete list of illustrations begins on page xix.

im-12 Tables: This edition contains 106 color-screened tables located

ap-propriately throughout the Vocabulary section A complete list of bles begins on page xxxi.

ta-13 Adjectives: The adjectival forms of many noun main entries appear

at the end of the definition of the noun form or, if the entry is long,

at the end of the first paragraph Pronunciations for most of the jectival forms are included Many common adjectives appear as main entries themselves.

ad-14 Caution statements: This notation is used to draw particular

at-tention to information that may affect the health and/or safety of patients or the professionals who treat them The information is of more than routine interest and should be considered when delivering health care These statements are further emphasized by colored rules above and below the text.

15 Synonyms: Synonyms are listed at the end of the entry or, in

en-cyclopedic entries, at the end of the first paragraph The abbreviation SYN: precedes the synonymous term(s) Terms listed as synonyms have their own entries in the Vocabulary, which generally carry a cross-reference to the entry at which the definition appears.

16 Cross-references: Illustrations, tables, appendices, or other

rele-vant vocabulary entries may be given as cross-references These are indicated by SEE: followed by the name(s) of the appropriate ele- ment(s) in italics Cross-references to the Nursing Diagnoses Appen-

dix are highlighted in color at the end of the entry as SEE: Nursing Diagnoses Appendix Entries at which an illustration appears carry

the color-highlighted SEE:illus.

17 Appendices: The Appendices contain detailed information that

could be organized or presented more easily in one section rather than interspersed throughout the Vocabulary This edition features several new appendices: Health Professions; Recommended Immu- nization Schedules; and Latin and Greek with English Equivalent.

Among the revised appendices are Nursing Diagnoses; Standard and Universal Precautions; Medical Abbreviations; Prefixes, Suffixes, and Combining Forms; Conceptual Models and Theories of Nursing;

Medical Emergencies; Integrative Therapies: Complementary and Alternative Medicine; Normal Reference and Laboratory Values;

Phobias; Nutrition; Nursing Interventions Classification System;

and Nursing Outcomes Classification System A substantial omy Appendix can be found at www.tabers20.com.

Anat-18 Nursing Diagnoses Appendix: This appendix has been updated

through the 2003– 2004 Conference of NANDA (North American

Nursing Diagnosis Association) It is divided into several sections,

including two lists of NANDA’s nursing diagnoses organized into

Doenges and Moorhouse’s Diagnostic Divisions and Gordon’s

Func-tional Health Patterns; an at-a-glance look at the most recent

diag-noses approved by NANDA; nursing diagdiag-noses commonly associated

with almost 300 diseases/disorders (cross-referenced from the body

of the dictionary); and a complete description of all NANDA-approved

diagnoses through the 2003– 2004 conference in alphabetical order.

Included are the diagnostic division, definition, related factors, and

defining characteristics for each nursing diagnosis See the Quick

View of Contents on page 2656 for further explanation.

xviii

xix

LIST OF ILLUSTRATIONS

Illustrations are listed according to the main entry or subentry they

ac-company Information in parentheses indicates the source of the

illustra-tion; a list of sources appears at the end of the list.

Ribonucleic acid (Scanlon), 26

Cystic acne (Goldsmith), 30

Acne papulosa (Reeves), 30

Adenovirus (Sacher), 45

Nasopharyngeal/oropharyngeal

airway, 64

Alopecia areata (Goldsmith), 78

Alopecia capitis totalis

Muscles of the arm (Scanlon), 164 Bones of the arm and shoulder girdle (Scanlon), 165 Ventricular arrhythmia (Brown), 166 Systemic arteries (Scanlon), 169 Structure of an artery

(Scanlon), 170 Brachial artery, 171 Coronary arteries, 172 Rheumatoid arthritis, 175 Arthrocentesis, 177

Ascaris lumbricoides

(Leventhal), 181 Aspergillosis of lung (Kern), 182

Aspergillus niger in culture

(Kern), 183 Audiogram, 199 Auer body (Sacher), 200 Autonomic nervous system (Scanlon), 205

Bacillus (Bartelt), 212 How to stay on your feet without tiring your back, 212

Bacteria (shapes and structures) (Sacher), 215

Bacteria (Scanlon), 216 Bag-valve-mask resuscitator, 217

Balantidium coli (Leventhal), 218

Male pattern baldness (Goldsmith), 219 Types of bandages, 222 Triangular bandages, 225 Biconcave lens/biconvex lens, 242

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Bile ducts, 244

Bilirubin crystals

(Strasinger), 244

Punch biopsy (Goldsmith), 249

Urinary bladder (Scanlon), 255

Blastomyces dermatitidis in

culture (Kern), 257

Blood composition (Scanlon), 264

Types of blood cells (Harmening),

(Sacher), 265

ABO blood types (Scanlon), 267

Systemic blood pressure

(Scanlon), 268

Blood transfusion (Scanlon), 271

Bone tissue (Scanlon), 275

Bony structures of the thorax,

abdomen, and pelvis, 276

Hyoid bone, 277

Boutonnie`re deformity (Donald

Venes, M.D.), 281

Brain (Scanlon), 284

Vascular anatomy of brain, 285

Brainstem (Manter and

Trachea and bronchi, 300

Buffy coat (Sacher), 303

Bullae of impetigo

(Goldsmith), 305

Burns (Scanlon), 307

Coronary artery bypass, 311

Cabot’s ring (Harmening), 313

(Epithelial cast/fatty cast/

hyaline cast/red blood cell cast/

waxy cast/white blood cell cast) Cataract, 356

Types of catheters, 357 Central venous catheter, 358 Catheterization of urinary bladder, 361

Cavities of the body (Scanlon), 363 Generalized human cell and organelles (Scanlon), 366 Burr cells (Sacher), 367 Clue cell (Sacher), 368 L.E cell (Strasinger), 369 Target cells (Sacher), 372 Cellulitis (Kozol), 373 Cerebellum (Gilman), 379 Cerebrum (left hemisphere) (Scanlon), 381

Typical chancre of primary syphilis (Reeves), 385 Chancroid (Goldsmith), 386 Basal body temperature chart, 388

Graph of respiratory movements

in Cheyne-Stokes breathing, 396

Chilomastix mesnili

(Leventhal), 397 Chloasma gravidarum (Reeves), 399 Cholesterol crystals (Strasinger), 406 Action of cilia, 419 Circulation of blood through heart and major vessels, 421

Fetal circulation (Scanlon), 422 Hepatic portal circulation (Scanlon), 423

Portal circulation of hypothalamus-pituitary (Scanlon), 424

Cladosporium in culture

(Kern), 427

Clonorchis sinensis

(Leventhal), 433 Clubbing, 434 Cmax, 435 Coagulation cascade (Harmening), 437

Coccidioides immitis spherules

(Kern), 439 Cochlea, 440

xxi

Collimator below x-ray tube

(Wallace), 448

Colon and rectum, 450

Color blindness (Scanlon), 451

Flow cytometry (Harmening), 530

Darier’s sign (Goldsmith), 534

Do¨hle bodies (Sacher), 625

Uniform donor card, 627

Dracunculus medinensis

(Leventhal), 633

Universal dressing, 635 Drownproofing technique, 637 Dupuytren’s contracture (Kozol), 646

Structure of the ear (Scanlon), 657 Ecchymosis of the leg (Harmening), 659

Echinacea purpurea (Leonard

Perry, Ph.D.), 659

Echinococcus granulosus

(Leventhal), 659 Nummular eczema (Goldsmith), 664 Pitting edema (Kloth), 666 Pericardial effusion (Donald Venes, M.D.), 668 Elbow joint, 672 QRST complex of electrocardiogram/ECG leads, 674

Normal and abnormal electroencephalogram wave patterns (Merck), 677 Electrolyte concentrations in body fluids (Scanlon), 678

Embolism, 683 Pulmonary embolism (Kozol), 684 Stages of development of human embryo including mature fetus, 686

Embryonic development (Scanlon), 687 Embryoscopy, 688 Emmetropia, myopia, hyperopia, 692 Possible sites of occurrence of endometriosis, 704 Cuffed endotracheal tube (Williams), 709 Barium enema (Harvey Hatch, M.D.), 710

Entamoeba histolytica

(Leventhal), 712

Enterobius vermicularis

(Leventhal), 714 Epididymis, 723 Epiglottis, 724 Epithelial tissues (Scanlon), 730 Erysipelas (Goldsmith), 735 Erythema multiforme (Goldsmith), 736 Normal erythrocytes (Strasinger), 738

Foreign body (esophagus), 744

Isometric exercise (Kisner), 755

Range-of-motion exercises, 756

Extraocular eye muscles

(movements produced and

cranial nerve supply), 764

Extraocular eye muscles (lateral

Cerebrospinal fluid (formation,

circulation, and reabsorption)

(Scanlon), 811

Cerebrospinal fluid (specimens)

(Strasinger), 812

Pleural fluid (Strasinger), 813

Fontanels of infant skull

(Scanlon), 819

Food Guide Pyramid, 820

Bones of foot and ankle

(Scanlon), 821

Athlete’s foot (Reeves), 821

Types of fractures and

Gaucher’s cell (Harmening), 862

Inheritance of eye color

(Scanlon), 865

Female genital organs (Scanlon), 868 Male genital organs (Scanlon), 869 Genu recurvatum (Starkey), 870

Giardia duodenalis

(Leventhal), 874 Adrenal glands, 877 Endocrine system, 879 Eccrine and apocrine sweat glands, 882

Glaucoma, 885 Glottis and vocal cords (Scanlon), 890 Massive goiter (Williams), 896 Goniometer (Starkey), 898 Gout (Strasinger), 900 Gram stain (Sacher), 904 Granulocytopoiesis†(Harmening), 906 Growth chart girls, 913 Growth chart boys, 914 Cerebral gyri, 919 Hair and adjacent structures of cross-section of skin, 923 Bones of the right hand and wrist, 926

Muscles of the head and neck (Scanlon), 932

Arteries and veins of the head (Scanlon), 933

Wound healing, 935 The heart (Scanlon), 939 Projection of heart and great vessels/valves on chest wall, 941

Conduction system of the heart (Scanlon), 943

Complete heart block (Brown), 944 Heart-lung machine, 946 Heimlich maneuver, 951 Helmet cell (Harmening), 952 Representative helminths (Scanlon), 952

Hemangiomas in a neonate (Morton), 954

Hemochromatosis (Harmening), 961 Hemocytoblast (stem cell) and blood cells (Scanlon), 963 Hemoglobin C disease (Harmening), 966

Genital herpes (Goldsmith), 988

Herpes labialis (Reeves), 989

Herpes simplex (Goldsmith), 989

Herpes zoster (Goldsmith), 990

Herpes zoster ophthalmicus

Bullous impetigo (Reeves), 1080

Impetigo contagiosa in axilla

(Reeves), 1080

Endosseous dental implant, 1081

Body mass index (Shape Up

IUD (Lippincott, Williams &

Wilkins), 1150

Ixodes tick (Scanlon), 1151

Jaw, 1154 Synovial joint (Scanlon), 1158 Myoneural junction

(Scanlon), 1161 Kaposi’s sarcoma (Kozol), 1163 Karyotype of pairs of human chromosomes of male and female, 1165

Keloids (Kozol), 1167 Keratoacanthoma, 1169 Kerion (Goldsmith), 1172 Kidney (Scanlon), 1173 Nephron and blood vessels (Scanlon), 1174

Formation of urine (Scanlon), 1175 Kidney tubules (Homero Sepulveda, Ph.D.), 1176 Anatomy of the supporting structures of the knee, 1180 Knots, 1181

Koilonychia (Harmening), 1182 Krebs cycle, 1184

Sequence of labor and childbirth, 1188 Labyrinths of inner ear (Scanlon), 1193 Lacrimal apparatus (Scanlon), 1194 Slit lamp examination (Donald Venes, M.D.), 1200

Langer’s lines, 1202 Larynx (Scanlon), 1207 Muscles of the leg (Scanlon), 1218 Bones of the leg and foot

(Scanlon), 1219 Mucocutaneous leishmaniasis (Leventhal), 1221

Lentigo of sun-exposed skin (Goldsmith), 1223 Leopold’s maneuvers (Mosby), 1223 Acute lymphocytic leukemia (Harmening), 1228 Chronic lymphocytic leukemia (Harmening), (Sacher), 1229

Lichen planus (Goldsmith), 1236

Lichen simplex chronicus

(Goldsmith), 1236

Deltoid ligaments (Starkey), 1241

The limbic system of the

Lyme disease (Stevens), 1275

Lymph node (Scanlon), 1277

Mandible— left lateral view, 1301

Normal red bone marrow

(Sacher), 1305

Mast cells (Harmening), 1308

Medic Alert symbol, 1319

Menstrual cycle (Scanlon), 1341

Metastases (Harvey Hatch,

M.D.), 1351

Metatarsus varus, 1352 Miliaria (Goldsmith), 1365 Mitosis, 1371

Moles (Goldsmith), 1376 Molluscum contagiosum (Goldsmith), 1377 Monocytes (Harmening), 1380 Mononucleosis (Sacher), 1381 Montgomery straps, 1384 Morton’s toe (Starkey), 1388 Mouth, tongue, and pharynx, 1390 Muscles of the trunk

(Scanlon), 1402 Muscle tissues (Scanlon), 1403 Skeletal muscle (Scanlon), 1404 Morphological forms of

muscle, 1405

Mycobacterium tuberculosis

(Sacher), 1411 Systemic mycosis (Kern), 1412 Myelofibrosis (Hillman), 1414 Multiple myeloma (Sacher), 1414 Myocardial infarction (Donald Venes, M.D.), 1417

Nail (Scanlon), 1425 Two views of nasal cavity, 1429 Nasogastric tube (Colyar), 1430 Nebulizer (Colyar), 1434

Glossopharyngeal nerve, 1446 Spinal nerves (Scanlon), 1448 Neurodermatitis on neck (Reeves), 1454 Neurofibromatosis, 1455 Acoustic neuroma (Kozol), 1457 Neuron structure (Scanlon), 1458 Neutrophils (Strasinger), 1465 Junction nevi (Goldsmith), 1466 Spider nevus (Reeves), 1467

Nocardia asteroides in culture

(Kern), 1473 Nocardiosis (Kern), 1473 Technique for control of hemorrhage from posterior nasal cavity, 1481

xxv

Nucleic acid (Scanlon), 1484

Nursing assessment tool

Peritoneal and pleural fluid, 1638

Peritoneum (Donald Venes,

Plasmodium falciparum

(Leventhal), 1684 Platelet plug formation and clotting (Scanlon), 1686

Pneumocystis carinii

(Leventhal), 1693 Lobar pneumonia (Harvey Hatch, M.D.), 1697

Pneumocystis carinii pneumonia

(Leventhal), 1697 Open pneumothorax, 1699 Poikilocytes (Sacher), 1701 Poison ivy/poison oak/poison sumac, 1704

Poison ivy dermatitis (Goldsmith), 1705 Digitalis poisoning, 1713 Polycythemia vera (Harmening), 1724 Nasal polyps, 1729 Nasal polyps (photograph) (Morton), 1729

Pompholyx (Goldsmith), 1732 Positions, 1736

Postural drainage of lungs, 1743 Hyperlordotic posture

(Starkey), 1745 Ectopic pregnancy, 1757 Presentations of fetus, 1767 Pressure sore (Goldsmith), 1771 Promyelocyte (Harmening), 1785 Prostate cancer (AFIP), 1788 Protozoa, 1798

Pseudofolliculitis barbae (Goldsmith), 1802 Psoriasis (Goldsmith), 1806 Guttate psoriasis (Reeves), 1806 Ptosis (Morton), 1813

Pulmonary function test (Scanlon), 1817 Purpura (Harmening), 1823 Idiopathic thrombocytopenic purpura (Harmening), 1824 Universal radiation symbol, 1841 Diaper rash (Reeves), 1851 Raynaud’s phenomenon (Goldsmith), 1855 Reed-Sternberg cell (Harmening), 1863 Respiratory system, 1888 Cardiopulmonary

resuscitation, 1893– 1895

Rheumatic fever (Goldsmith), 1909

Rhinophyma and rosacea

Steroid rosacea (Reeves), 1925

Rosette of red blood cells

Sacrum and coccyx, 1934

Saint John’s wort (Leonard Perry,

Shoulder dislocation (Colyar), 1993

Simian and normal palmar

creases, 2000

Paranasal sinuses (Scanlon), 2002

Skeleton, 2007

Skin section (Scanlon), 2009

Skull, right lateral and anterior

Renal artery stenosis (Arnold Klein, M.D.), 2069– 2070 Sternum, 2074

Steroid hormone nucleus, 2074 Stevens-Johnson syndrome (Reeves), 2075

Stomach (Scanlon), 2080 Stomatitis (Kozol), 2081 Hemorrhagic stroke (Harvey Hatch, M.D.), 2089

Stryker frame, 2093 Relationship of dental surfaces, 2112 Synapse (Scanlon), 2125 Syphilis (Goldsmith), 2131 The digestive system (Goldsmith), 2134 Ventricular tachycardia (Williams), 2138

Taenia saginata (Leventhal), 2139 Taenia solium (Leventhal), 2139

Skin tags (Goldsmith), 2140 Pericardial tamponade, 2143 Deciduous/permanent teeth, 2151 Telangiectasia (Goldsmith), 2152 Temperature regulation

(Scanlon), 2155 Testis (Scanlon), 2162 Tourniquet test (Harmening), 2208 Thymus (Scanlon), 2185

Thyroid gland and related structures, 2187 Wood tick (Scanlon), 2189 Tinea capitis (Goldsmith), 2191 Tinea corporis (Reeves), 2192 Tinea cruris on inner thigh (Reeves), 2192

Tinea versicolor on back§(Kern), 2192

Connective tissues (Scanlon), 2194

Inflamed tonsils (Morton), 2202

Tooth structure (Scanlon), 2203

Torsade de pointes (Brown), 2206

Tracheostomy tube

(Williams), 2213

Biliary tract in relation to liver,

pancreas, and duodenum, 2215

Brain tumor (Kozol), 2247

Tuberculosis (reported cases), 2248

Possible relations of fetal

(Goldsmith), 2295 Varicose veins (Reeves), 2297 Varus (Starkey), 2298 Vas deferens and other male organs, 2299

Vasculitis (Goldsmith), 2300 Vasectomy and its reversal, 2300 Systemic veins (Scanlon), 2305 Structure of a vein and venule (Scanlon), 2306

Venous cutdown, 2308 Ventricles of the brain (Scanlon), 2311 Vermiform appendix, 2313 Verruca vulgaris (Kozol), 2314 Vesicles (Goldsmith), 2317 Villi of the small intestine (Scanlon), 2321

Viruses (Scanlon), 2324 West Nile Virus, 2326 Visual field abnormalities (Williams), 2329 Vitiligo (Goldsmith), 2332 Vocal cords, 2334

Vulva (Scanlon), 2338 Common warts (Goldsmith), 2341 Genital warts on penis

(Reeves), 2341 Plantar wart (Reeves), 2342 Components of waves, 2344 Circle of Willis (Scanlon), 2352 Open wound (Kloth), 2358 Compression wrap (Starkey), 2358

Wuchereria bancrofti

(Leventhal), 2359 Xanthelasma (Morton), 2360 Xerocytes (Harmening), 2362 Xerosis (Goldsmith), 2362 Budding yeast (Strasinger), 2364 Yin-yang, 2365

Z-plasty method of correcting a deforming scar, 2371

* WB Saunders Company, Philadelphia,PA; with permission.

†Reproduction of Morphology of Human Blood Cells has been granted

with approval of Abbott Laboratories Inc., all rights reserved.

‡From Hyun, BK: Morphology of Blood and Bone Marrow, American

So-ciety of Clinical Pathologists, Workshop 5121, September 1983, with

permission.

§From Beneke: Human Mycoses, Pharmacia & Upjohn, 1979, with

per-mission.

Brown, KR and Jacobson, S: Mastering Dysrhythmias: A Problem Solving

Guide FA Davis, Philadelphia, 1988.

Colyar, MR and Ehrhardt, CR: Ambulatory Care Procedures for the

Nurse Practitioner, ed 2 FA Davis, Philadelphia, 2004.

Doenges, ME, Moorhouse, MF and Geissler, AC: Nursing Care Plans:

Guidelines for Individualizing Patient Care, ed 6 FA Davis,

Phila-delphia, 2002.

Eickhoff, L, Portland, OR, photograph.

Gilman, S and Newman, SW: Manter & Gatz’s Essentials of Clinical

Neu-roanatomy and Neurophysiology, ed 9 FA Davis, Philadelphia, 1996.

Goldsmith, LA, Lazarus, GS and Tharp, MD: Adult and Pediatric

Der-matology: A Color Guide to Diagnosis and Treatment, FA Davis,

Phil-adelphia, 1997.

Hatch, H, Gold Beach, OR, photograph.

Harmening, DM: Clinical Hematology and Fundamentals of Hemostasis,

Klein, A, Portland, OR, photograph.

Kloth, LC: Wound Healing Alternatives in Management, ed 3 FA Davis,

Philadelphia, 2002.

Kozol, RA, Fromm, D and Konen, JC: When to Call the Surgeon: Decision

Making for Primary Care Providers FA Davis, Philadelphia, 1999.

Lentner, C (ed): Geigy Scientific Tables, ed 8 Ciba Geigy, Basle,

Swit-zerland, 1981.

Leventhal, R and Cheadle, RF: Medical Parasitology: A Self-Instructional

Text, ed 5 FA Davis, Philadelphia, 2002.

Lowdermilk, DL: Maternity & Women’s Health Care, ed 7 Mosby, Inc,

Philadelphia, 2000.

Mazziotta, JC, and Gilman, S: Clinical Brain Imaging: Principles and

Applications Oxford University Press, New York, 1992 Used by

Per-mission of Oxford University Press, Inc.

xxix

Morton, PG: Health Assessment in Nursing, ed 2 FA Davis, Philadelphia,

1993 McKinnis, L: Fundamentals of Orthopedic Radiology, FA Davis, Phila-

delphia, 1997.

Perry, LP: “Perry’s Perennials.” http://www.uvm.edu/pass/perry (August

2000).

Reeves, JRT and Maibach, HI: Clinical Dermatology Illustrated: A

Re-gional Approach, ed 3 Elsevier Australia, Marrickville, Australia, 1998.

Sacher, RA, McPherson, RA with Campos, JM: Widmann’s Clinical

In-terpretation of Laboratory Tests, ed 11 FA Davis, Philadelphia, 2000.

Scanlon, VC and Sanders, T: Essentials of Anatomy and Physiology, ed

4 FA Davis, Philadelphia, 2003.

Sepulveda, H, San Diego, CA, photograph.

“Shapeup”: http://www.shapeup.org

Speroff, L: A Clinical Guide for Contraception, ed 3 Lippincott, Williams

& Wilkins, Philadelphia, 2000 Starkey, C and Ryan, JL: Evaluation of Orthopedicand AthleticInjuries,

ed 2 FA Davis, Philadelphia, 2002.

Stevens, CD: Clinical Immunology and Serology: A Laboratory

Perspec-tive FA Davis, Philadelphia, 1996.

Strasinger, SK: Urinalysis and Body Fluids, ed 4 FA Davis, Philadelphia,

2001.

Venes, D, Portland, OR, photograph.

Wallace, JE: Radiographic Exposure: Principles and Practice FA Davis,

Philadelphia, 1995.

Williams, LS and Hopper, PD (eds): Understanding Medical-Surgical

Nursing, ed 2 FA Davis, Philadelphia, 2003.

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xxxi

LIST OF TABLES

Activities of daily living and factors affecting them, 37

Clinical conditions and opportunistic infections indicating AIDS, 60

Common Allergies and Allergens, 75

Stages of Alzheimer’s disease, 82

Stages of angina pectoris, 116

Apgar score, 148

Some severe illnesses that may mimic appendicitis, 153

Common bacterial infections, 214

Control of arterial bleeding, 258

Selected Risk factors for breast cancer, 289

Features of bronchodilator drugs, 298

Estimated New Cancer Cases and Deaths by Sex, U.S., 2003, 324

Controversies in cancer screening in the general population, 325

Classification of important carbohydrates, 336

Digestion of carbohydrates, 336

Effects of Carboxyhemoglobin, 338

Important Considerations in the Administration of Chemotherapy, 395

Lipid level management for cholesterol level reduction, 407

Contraceptive use by women, 15 to 44 years old: 1995, 476

Contraindications to the Topical Application of Cold to Musculoskeletal

Injuries, 509 Ten leading causes of death in the U.S (2001), 537

Signs and symptoms and recommended emergency management of

odontogenic problems, 557 Preventing Oral Diseases/Maintaining Oral Health, 559

Comparison of diabetic ketoacidosis and hypoglycemia, 581

Comparison of type 1 insulin-dependent diabetes mellitus and type 2

non– insulin-dependent diabetes mellitus, 583 Top Diagnosis-Related Groups (DRGs) in the U.S., 585

Diseases in which diet plays an important role, 594

The DASH Diet (Eating Plan), 595

Dietary guidelines for Americans, 598

Action of digestive enzymes on food, 601

Method of transmission of some communicable diseases, 611

Inherited Diseases and Conditions: A Brief List, 613

Fungal Diseases, 616

Ultraviolet Treatment Dosages, 630

Comparison of toxic and allergic drug reactions, 641

Electromagnetic spectrum, 679

Exercise: energy required, 754

Comparison of heatstroke and heat exhaustion, 758

xxxii

Fahrenheit and Celsius scales, 774

Food sources of saturated fats, 781

Development of fetal tissue, 790

The American College of Rheumatology 1990 criteria for classification

of fibromyalgia, 798

Principal endocrine glands, 880

Gram conversion into ounces (avoirdupois), 904

Elimination of body heat, 947

Routine precautions for the care of all hemodialysis patients, 964

Hemodynamic Parameters Frequently Measured in Critical Care, 965

Comparison of hemoptysis and hematemesis, 971

Common sites of bleeding, 971

Classification of BPfor adults age 18 and older, 1040

Oral agents that lower blood glucose, 1051

Blood type compatibility, 1086

Incubation and isolation periods in common infections, 1089

Colors of indicators of pH, 1092

Fungal infections, 1099

Mediating factors in inflammation, 1102

Information Technologies Used in Health Care, 1103

Some classes of drugs that inhibit libido, 1235

Expectation of life in years, by race, sex, and age: 1996, 1238

Expectation of life at birth, 1970 to 1997, and projections, 1995 to

2010, 1238

Physical signs of malnutrition, 1298

Monoclonal antibodies and their uses, 1379

Comparison of properties of three types of muscle, 1403

Common Neuropathies, 1460

Typical noise levels in decibels and their effect, 1476

Diagnostic Tests for Occult Bleeding, 1509

Representative occupational illness, 1510

Criteria for Diabetes Mellitus in Pregnancy Using the 3-hr

OGTT, 1528

Size, weight, and capacity of various organs and parts of the adult

body, 1531

Risk factors for osteoporosis, 1547

Usual adult doses and intervals of drugs for relief of pain, 1567

Important Considerations in Palliative Care, 1573

A Patient’s Perception of Quality Health Care, 1608

Symptoms and Signs of Periodontitis, 1634

pH of some fluids, 1648

Toxicity of Carbon Monoxide, 1710

Positions of fetus in utero, 1735

Pregnancy table for expected date of delivery, 1759

The Norton scale, 1771

Tests for Premature Rupture of Membranes, 1785

Table of pathogenic protozoa, 1799

Psychomotor and physical development: birth to 1 year, 1810

Prominent Issues in Hospital Risk Management, 1920

Causative agents of sexually transmitted diseases, 1983

International System of Units (SI units), 2005

Prefixes and their symbols used to designate decimal multiples and

submultiples in SI units, 2005 Bones of the human skeleton, 2008

U.S FDA categories for drugs by teratogenic or fetotoxic

potential, 2161 Comparative thermometric scale, 2173

Thermometric equivalents (Celsius and Fahrenheit), 2174

Some Culturally Specific (Folk) Illnesses, 2219

Revised trauma score, 2229

Significance of changes in urine, 2276

Common disorders of urination, 2277

Common viral characteristics, 2324

Causes of vomiting, 2336

1983 Metropolitan height and weight tables for men and women

according to frame, ages 25 to 59, 2347

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at wt atomic weight

Med L Medieval Latin

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A

␣ Alpha, the first letter of the Greek

al-phabet

A˚ angstrom unit.

A 2 aortic second sound.

a¯ [L.] ante, before.

a accommodation; ampere; anode;

ante-rior; aqua; area; artery.

a-, an- [Gr., not] Prefix meaning without,

away from, not (a- is usually used before

a consonant; an- is usually used before

a vowel)

AA, aa achievement age; Alcoholics

Anon-ymous; amino acid; arteriae.

[Gr ana, of each] Prescription

nota-aa

tion meaning the stated amount of each

of the substances is to be used in

com-pounding the prescription.

AAA American Ambulance Association.

A.A.A American Academy of Allergists;

American Association of Anatomists.

A.A.A.S. American Association for the

A.A.C.N American Association of

Criti-cal-Care Nurses; American Association

AAL anterior axillary line.

A.A.M.A American Association of

A.A.N American Academy of Nursing.

A.A.N.A American Association of Nurse

Anesthetists.

A.A.N.N American Association of

Neu-roscience Nurses.

A.A.O.H.N American Association of

Oc-cupational Health Nurses.

A.A.O.S American Academy of

Orthope-dic Surgeons.

A.A.P American Academy of Pediatrics;

American Association of Pathologists.

A.A.P.A American Academy of Physician

Assistants.

AAPMR American Academy of Physical

Medicine and Rehabilitation.

A.A.R.C American Association for

Respi-ratory Care.

AARP American Association of Retired

Persons.

AAS atomic absorption spectroscopy.

AASECT American Association of Sex

Ed-ucators, Counselors, and Therapists.

Ab antibody.

ab- [L ab, from] Prefix meaning from,

away from, negative, absent.

abacavir (a˘-ba˘k⬘a˘-ve¯r) A nucleoside alogue reverse transcriptase inhibitorused in the treatment of HIV-1

an-Abadie’s sign (a˘-ba˘-de¯z⬘) [Charles A

Abadie, Fr ophthalmologist, 1842–

1932] In exophthalmicgoiter, spasm ofthe levator palpebrae superioris

Abadie’s sign (a˘-ba˘-de¯z⬘) [Jean Abadie,

Fr neurologist, 1873– 1946] In tabesdorsalis, insensibility to pressure overthe Achilles tendon

abandonment A premature termination

of the professional treatment ship by the health care provider withoutadequate notice or the patient’s consent

relation-abarognosis (a˘b⬙a˘r-o˘g-no¯⬘sı˘s) [Gr a-,

not, ⫹ baros, weight, ⫹ gnosis,

knowledge] A rare disorder marked byloss of the ability to gauge the weight of

objects held in the hand SEE: nosis.

barag-abarticulation (a˘b⬙a˘r-tı˘k-u¯-la¯⬘shu˘n)

1.Ambiguous term meaning dislocation

of a joint 2 Diarthrosis.

abasia (a˘-ba¯⬘ze¯-a˘) [Gr a-, not, ⫹ basis,

step] 1 Motor incoordination in ing 2 Inability to walk due to impair-

walk-ment of coordination abasic, abatic,

adj.

a.-astasia Lack of motor coordination

with inability to stand or walk SYN:

astasia-abasia.

paralytic a Abasia in which the leg

muscles are paralyzed

paroxysmal trepidant a. Abasiacaused by trembling and sudden stiff-ening of legs on standing, making walk-ing impossible It may be related to hys-teria

abate (a˘-ba¯t⬘) [L ab, from, ⫹ battere,

to beat] 1 To lessen or decrease 2 To

cease or cause to cease

abatement (a˘-ba¯t⬘me˘nt) Decrease in verity of pain or symptoms

se-abaxial, abaxile (a˘b-a˘k⬘se¯-al,−sı˘l) [L ab,

from, ⫹ axis, axis] 1 Not within the

axis of a body or part 2 At the opposite

end of the axis of a part

Abbe-Wharton-McIndoe operation, Indoe operation (a˘⬘be¯-wha˘r⬘to˘n-ma¯k⬘-ı˘n-do¯) A surgical procedure performed

Mc-to create a vagina in patients who do nothave one This is achieved by creatingadequate space between the rectum andbladder; the inlaying of a split-thicknessgraft; and most importantly, continuousand prolonged dilatation during the

Abbott’s method 2 abdomen

shortstandard

top of rhbase of rhhealing stage when tissues are most

likely to contract

PATIENT CARE: The health care

team supports the patient medically

and psychologically by helping the

pa-tient learn about her condition and the

procedure, by answering questions, and

by alleviating anxiety

Abbott’s method (a˘b⬘u˘tz) [Edville G

Abbott, U.S orthopedicsurgeon, 1871–

1938] A treatment for scoliosis that is

no longer used, in which a series of

plas-ter jackets were applied to straighten

the spine

ABC antigen-binding capacity; airway,

breathing, circulation (mnemonicfor

as-sessing status of emergency patients)

ABCD A mnemonicto aid health care

pro-viders in the recognition of malignant

melanoma The letters represent

“asym-metry,” “border,” “color,” and

“diame-ter.” Pigmented lesions on the skin with

irregularities of growth and color and

diameters greater than 0.7 mm have a

considerable likelihood of being

mela-nomas and should be professionally

ex-amined Additional characteristics of

melanomas include the sudden change

of an existing mole or sudden

appear-ance of pigmented moles In some cases

an existing mole that was flat elevates

above the skin SEE: melanoma.

abciximab (a˘b-sı˘x⬘ı˘-ma˘b) A monoclonal

antibody that inhibits platelet

aggre-gation and prevents blood clots from

forming It is used esp to treat and

pre-vent clots in the coronary arteries, for

example, in acute myocardial

infarc-tion, and after stent placements

abdiction (a˘b-dı˘k⬘shı˘n) The intolerance

or avoidance of drugs or chemicals

abdomen (a˘b-do¯⬘me˘n, a˘b⬘do¯-me˘n) [L.,

belly] The portion of the trunk lying

be-tween the thorax and the pelvis It

con-tains the stomach, lower part of the

esophagus, small and large intestines,

liver, gallbladder, and spleen The

pa-rietal peritoneum lines the abdominal

cavity The organs within this cavity are

enveloped by the visceral peritoneum

The kidneys, adrenal glands, ureters,

prostate, seminal vesicles, and greater

vascular structures are located behind

the peritoneum (retroperitoneal or

ex-traperitoneal) SEE: abdominal

quad-rants for illus.

INSPECTION: Visual examination of

the abdomen is best done while the

pa-tient is supine with the knees slightly

bent In a healthy person the abdomen

is oval shaped, with elevations and

de-pressions corresponding to abdominal

muscles, umbilicus, and to some degree

the forms of underlying viscera

Rela-tive to chest size, it is larger in children

than in adults; it is more rotund and

broader inferiorly in males than in

fe-males

Disease can alter the shape of the

ab-domen A general, symmetrical ment may result from ascites; a partialand irregular enlargement may resultfrom tumors, hypertrophy of organssuch as the liver or spleen, or intestinaldistention caused by gas Retraction ofthe abdomen may occur in extremeemaciation and in several forms of ce-rebral disease, esp tubercular menin-gitis of children

enlarge-The respiratory movements of the dominal walls are related to movements

ab-of the thorax and are ab-often increasedwhen the latter are arrested and viceversa; thus, abdominal movements areincreased in pleurisy, pneumonia, andpericarditis, but are decreased or whollysuspended in peritonitis and disease-caused abdominal pain

The superficial abdominal veins aresometimes visibly enlarged, indicating

an obstruction of blood flow in either theportal system (as in cirrhosis) or the in-ferior vena cava

AUSCULTATION: Listening to soundsproduced in abdominal organs providesuseful diagnosticinformation Absent ordiminished bowel sounds may indicateparalyticileus or peritonitis High-pitched tinkling sounds are associatedwith intestinal obstruction Bruits mayindicate atherosclerosis or an abdomi-nal aorticaneurysm During pregnancy,auscultation enables identification andevaluation of the fetal heart rate andvascular sounds from the placenta

PERCUSSION: For the practitioner toobtain the greatest amount of informa-tion, the patient should be supine withthe head slightly raised and kneesslightly flexed Percussion should becarried out in a systematic fashion overthe anterior surface of the abdomen Acombination of audible or tactile sensa-tion will be perceived by the examineraccording to underlying structures (e.g.,gaseous distended organs versus solidorgans) A large abdominal aneurysmgives dullness or flatness over it unless

a distended intestine lies above it

PALPATION: The abdomen may bepalpated with fingertips, the wholehand, or both hands; pressure may beslight or forceful, continuous or inter-mittent The head is supported to relaxthe abdominal wall On occasion, the pa-tient may be examined in a standing po-sition (e.g., palpation of groin herniasthat might not be palpable in the supineposition)

Palpation is helpful in detecting thesize, consistency, and position of vis-cera, the existence of tumors and swell-ings, and whether the tumors changeposition with respiration or are mov-able It is necessary to ascertainwhether tenderness exists in any por-tion of the abdominal cavity, whetherpain is increased or relieved by firm

abdomen 3 abdominocentesis

shortstandard

top of rhbase of rh

RIGHT UPPER QUADRANT

LEFT UPPER QUADRANT

RIGHT LOWER QUADRANT

LEFT LOWER QUADRANT

RIGHT UPPER QUADRANT

RIGHT LOWER QUADRANT

LEFT UPPER QUADRANT

LEFT LOWER QUADRANT

ABDOMINAL QUADRANTS

pressure, and whether pain is

accentu-ated by sudden release of firm pressure

(i.e., rebound tenderness)

An arterial impulse, if one exists, issystolic and expansive A thrill accom-

panying a bruit may occasionally be

pal-pated A tumor’s surface is usually firm

and smooth but may be nodular

Inflam-matory masses are typically firm and

reproducibly tender Effusion of blood

into tissues (e.g., hematoma) may

pro-duce a palpable mass

acute a An abnormal condition of

the abdomen in which there is a sudden,

abrupt onset of severe pain It requires

urgent evaluation and diagnosis, as it

may indicate a need for immediate

sur-gical intervention SYN: sursur-gical

abdo-men.

pendulous a A condition in which

the excessively relaxed anterior

abdom-inal wall hangs down over the pubis

scaphoid a A condition in which the

anterior wall is hollowed, presenting a

sunken appearance as in emaciation

surgical a Acute abdomen.

abdomin- SEE: abdomino-.

abdominal (a˘b-do˘m⬘ı˘-na˘l) Pert to the

abdomen

abdominal muscles SEE: under muscle.

abdominal quadrants Four parts or

di-visions of the abdomen determined by

drawing imaginary vertical and

hori-zontal lines through the umbilicus The

quadrants and their contents are:

Right upper quadrant (RUQ): right

lobe of liver, gallbladder, part of

trans-verse colon, part of pylorus, hepatic

flex-ure, right kidney, and duodenum; Right

lower q (RLQ): cecum, ascending colon,

small intestine, appendix, bladder if

dis-tended, right ureter, right spermatic

duct in the male; right ovary and right

tube, and uterus if enlarged, in the

fe-male; Left upper q (LUQ): left lobe of

liver, stomach, small intestine, verse colon, splenic flexure, pancreas,

trans-left kidney, and spleen; Left lower q.

(LLQ): small intestine, left ureter,

sig-moid flexure, descending colon, bladder

if distended, left spermaticduct in themale; left ovary and left tube, and uterus

if enlarged, in the female.SEE: illus

abdominal reflexes Contraction of the

muscles of the abdominal wall on ulation of the overlying skin Absence ofthese reflexes indicates damage to thepyramidal tract

stim-abdominal regions The abdomen and its

external surface, divided into nineregions by four imaginary planes: twohorizontal, one at the level of the ninthcostal cartilage (or the lowest point ofthe costal arch) and the other at thelevel of the highest point of the iliaccrest; two vertical, through the centers

of the inguinal ligaments (or throughthe nipples or through the centers of theclavicles) or curved and coinciding withthe lateral borders of the two abdominalrectus muscles.SEE: illus

abdominal rescue SEE: under rescue.

abdominal rings The apertures in the

ab-dominal wall External inguinal or perficial: An interval in the aponeurosis

su-of the external oblique muscle, justabove and to the outer side of the crest

of the pubicbone

abdomino-, abdomin- (a˘b-do˘m⬘ı˘-no¯)

Combining forms meaning abdomen.

abdominocentesis (a˘b-do˘mte¯⬘sı˘s) [L abdomen, belly, ⫹ Gr ken- tesis, puncture] Puncture of the abdo-

⬙ı˘-no¯-se˘n-men with an instru⬙ı˘-no¯-se˘n-ment for withdrawal

of fluid from the abdominal cavity SYN:

abdominal paracentesis.