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Editor
Donald Venes, M.D., M.S.J., F.A.C.P.

Managing Editor
Brigitte G. Fenton

Associate Editor
Joseph Patwell

Copy Editors
Evelyn Adler
Victoria C.S. Fenton
Kathleen McCullough
Linda van Pelt

Proofreaders
Progressive Publishing Services
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Copyright 娀 2017 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, 2001, 2005, 2009,
and 2013 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 CHINA

Last digit indicates print number 10 9 8 7 6 5 4 3 2 1

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 the time of publication. The author, 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. Any practice described in this book should be
applied by the reader in accordance with professional standards of care
used in regard to the unique circumstances that may apply in each sit-
uation. The reader is advised always to check product information (pack-
age inserts) for changes and new information regarding dose and contra-
indications before administering any drug. Caution is especially urged
when using new or infrequently ordered drugs.

Library of Congress Cataloging in Publication Data

ISBN 978-0-8036-5904-9 (indexed : alk. paper) — ISBN 978-0-8036-5905-


6 (deluxe : alk. paper)
ISSN 1065-1357
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CONTENTS
INTRODUCTION TO EDITION 23 ...................................... vi

CONSULTANTS ............................................................... viii

REVIEWERS .................................................................... ix

TABER’S FEATURE FINDER ............................................. x

FEATURES AND THEIR USE ............................................ xi

LIST OF ILLUSTRATIONS ................................................ xv

ILLUSTRATION SOURCES ............................................... xxiii

LIST OF TABLES ............................................................. xxv

ABBREVIATIONS USED IN TEXT ..................................... xxix

VOCABULARY ................................................................. 1

APPENDICES .................................................................. 2557

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INTRODUCTION TO
EDITION 23

The last several years have been heady, and at times bewildering, for
health care professionals. We have witnessed revolutions in our ability
to provide care for previously unmanageable diseases, like chronic hep-
atitis C, only to uncover new arthropod-borne infections, like Chikun-
gunya and Zika virus-associated illnesses. We have disseminated care
standards to combat iatrogenesis (not just within hospitals, but nation-
ally and internationally), and then realized that some recent shibboleths
(like providing opioids for chronic pain relief) have produced tragically
increased death rates. Prediabetes, diabetes mellitus, and obesity have
reached epidemic proportions even as our understanding of healthful nu-
trition and physical fitness has reached new heights. We repeatedly cre-
ate new solutions to health care delivery shortcomings, only to discover
that the costs of providing diagnostic studies, medicines, and invasive
procedures puts many medical services out of economic reach for individ-
uals, communities, and nations. We strive to improve public health, only
to find that lead contaminates the water supply of many cities. More than
ever we’ve grown to recognize that health care must become more effi-
cient, more effective, more rational, and, at the same time, more caring
and personal.
The 23rd edition of Taber’s Cyclopedic Medical Dictionary has been
edited and written to help students of health care, as well as seasoned
professionals, master the ever-evolving art and science of caring, and
communicate to each other and our patients with clarity and precision.
Our editorial staff has made thousands of revisions to our previous edi-
tion, and added thousands of the most important new terms that have
entered our understanding in the last few years; always, of course, to
bring meanings to life.
It gives me pleasure to acknowledge the many individuals who have
contributed directly or indirectly to this new edition of Taber’s: Robert
Craven, Jr., Brigitte Fenton, Joseph Patwell, and Alison Enright; Taber’s
content and consulting editors; the many readers who have written us
with suggestions; and the following students and educators to whom I
owe personal debts of gratitude: Dustin Jones-Phillips, Kennedy Sund-
berg, Clark Embleton, Eve Cunningham Sepulveda, Homero Sepulveda,
Brandyn Webb, Jeremy Ota, Stephen Snyder, Jenifer Marshall Lippin-
cott, Robert Lippincott, John Roberts, Jennifer Roberts, Thomas Kinane,
Ruth Kinane, Julian Parrino, Phillip Weinstein, George Beller, Tayeb Al-
Hafez, Lara Bovilsky, Louise Bishop, Habib Khan, Douglas Wickman,
Katherine Buddenberg, Bill Ehrhart, Mindy Amarante, Jamie Buth, Vic-
tor Marans, Anne Hayton, Hugh Osborn, Laura Goldfarb, Eikeem Bar-
ron, John Rudoff, Donna Jacobsen, Jorge Ponte-Fissgus, Thomas Marti-
nelli, Terry Morrow, Richard and Charlotte Barnhart, Eldon Gossett,
Neal Rendleman, Jon Stout, Kelly Chin, Janet Reed, and Robert Ashley.

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But my greatest thanks are due my wife, April D. Venes, who is both
a health care educator, and a loving spouse and formidable friend. With-
out April’s support, this edition of Taber’s would never have been possible.

Donald Venes, M.D., M.S.J., F.A.C.P.


Brookings, Oregon

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CONSULTANTS

Renee E. Amori, MD, FACE


Douglas J. Gould, PhD
Angela K. Keir, PTA, MHA
Marjorie Simon, RN (Canada)

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REVIEWERS

Deborah S. Adelman, PhD, RN, NE-BC


Kathleen G. Bailey, CPA, MBA, CPC, CPC-I, CCS-P
Jo Ann Baker, DNP, MSN, RN, FNP-C
Cynthia A. Bloss
Nancy E. Brauhn, PhD, RN
Logan D. Hansen, CMA
Riedetta M. McCreary, EdD, RMA, RRT-NPS
Brenda Orazietti, BScN, CNCC(C), MEd
Susan L. Moore Russell, BSN, MSN, EdD
Mindy Wray, CMA

(Material supplied by the consultants and reviewers has been reviewed


and edited by Donald Venes, MD, MSJ, editor, with whom final respon-
sibility rests for the accuracy of the content.)

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DavisPlus
MULTI-MEDIA
CONTENT

adrenocortical hormone.

VOCABULARY
CROSS
adrenal crisis. REFERENCE
bolded headword
for easy locating

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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 x is a graphic representation of many of the fea-
tures described below.
1. DavisPlus Premium Resources online at www.DavisPlus.com
feature a wealth of interactive, multimedia resources for nursing,
allied health, and medical students and professionals. Use the pro-
motional code on the first page of the book to access the DavisPlus
resources.
Explore through Sight & Sound features over 1,200 images
(465 unique to DavisPlus) with short definitions and audio pronun-
ciations that enhance the learning experience. The corresponding im-
ages, animations, or videos are indicated by the icon.
Taber’s Audio provides pronunciations for almost 32,000 terms
found in Taber’s.
Bonus Appendices include valuable educational and clinical
health care resources, tools, and reference materials.
Taber’s Online, powered by Unbound Medicine offers
FREE, one-year access to all of the Taber’s content online. Use the
promotional code on the inside front cover to activate your subscrip-
tion.
2. 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,
nursing 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.
3. Entry Placement: 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., acid-reflux disorder; nucleic acid test. However,
many compound terms, especially those in anatomy and physiology,
are treated as subentries and are placed using the main entry– sub-
entry format, e.g., arteries, veins, ligaments, and types of respiration.
Entries having a considerable number of subentries are tinted in a
yellow background for ease in finding them. This melding of two sys-
tems combines the best features of both: compound terms that share
an important common element or classification, e.g., arteries, are
subentries under the main entry (or headword). Terms that tend to

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be sought under the first word, e.g., diseases, disorders, tests, and
syndromes, appear as main entries under the first word. Also names
of individuals and organizations are listed as main entries. 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.
4. 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.
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
is often abbreviated in subentries (such as preterm l. under labor
or pulmonary i. under infarction).
5. 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.
6. Pronunciations: Most main entries are spelled phonetically. Such
spellings appear within parentheses after the boldface main entry
and are given as simply as possible. The vowel a stands for the sounds
in at, ant, or care; the vowel e for the sound in bed or set; i as in it or
hid; o as in got, god, or lawn; u as in foot or put. Taber’s also uses two
diacritics, or marks over vowels. The macron ¯ shows the long sound
of vowels, as the a in mate, the e in meet, the i in might, the o in
mote, and the u in mute. The breve ˘ shows the short, obscure vowel,
called schwa, which is pronounced like the a in sofa, the e in butter,
the i in maudlin the o in senator, and the u in up. The letter combi-
nations oo are pronounced as in food, ow as in now, ch as in chin, sh
as in shin, th as in thin or then, and zh as in vision. Accents are marks
used to indicate stress upon certain syllables. A single accent ⬘ marks
the primary accent. A double accent ⬙ marks a secondary accent. Both
kinds of stress can be seen in an⬙ĕs-thē⬘zhă. Syllables are separated
by either an accent mark or a hyphen.
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 vis-
cera sing. viscus, the spelling of the singular or plural form appears
in boldface after the pronunciation for the main entry. Nonstandard
singular and plural forms appear as entries themselves at their nor-
mal 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 many are also listed alphabetically as sepa-

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rate entries throughout the text. Additional abbreviations used for


charting and prescription writing are listed in the Appendices. A list
of nonmedical abbreviations used in text appears on page xxix.
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 sections, each with its own subheading. The most frequently
used subheadings are Causes, Symptoms and Signs, Diagnosis,
Treatment, and Patient Care.
11. Patient Care: Patient Care sections provide information for the
health care worker in clinical situations. These sections have proven
invaluable to health care professionals by providing patient teaching
and wellness information. There are now more than 800 Patient Care
sections in Taber’s.
12. Illustrations: This edition of Taber’s includes 800 illustrations in
the print. In addition, there are over 400 additional, ancillary illus-
trations in the electronic versions of this edition. The existence of
each of these ancillary illustrations in DavisPlus is indicated by
placement of the icon ( ) next to the entry with which the illustra-
tion is associated. The images were carefully chosen to complement
the text of the entries with which they are associated. Each illustra-
tion is cross-referenced from its associated entry. A complete list of
illustrations begins on page xv.
13. Tables: This edition contains over 150 color-screened tables located
appropriately throughout the Vocabulary section. A complete list of
tables begins on page xxv.
14. 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 ad-
jectival forms are included. Many common adjectives appear as main
entries themselves.
15. Caution/Safety statements: This notation is used to draw
particular attention to information that may affect the health
and/or safety of patients or the professionals who treat them. The infor-
mation is of more than routine interest and should be considered when
delivering health care. These statements are further emphasized by col-
ored rules above and below the text.
16. 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.
17. Cross-references: Illustrations, tables, appendices, or other rele-
vant vocabulary entries may be given as cross-references. These are
indicated by SEE: or SEE: under followed by the name(s) of the ap-
propriate element(s) in italics. Cross-references to the Nursing Di-
agnoses Appendix 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. When a SEE: refers

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to subentry, the main entry will appear in boldface, for easy refer-
ence, e.g., SEE: temporal line, where “line” is the main entry.
18. Bonus Appendices: The Appendices contain detailed information
that can be organized or presented more easily in one section rather
than interspersed throughout the Vocabulary. There are over 20 bo-
nus appendices available on the DavisPlus site.
19. Nursing Diagnoses Appendix: This appendix has been updated
through the 2015– 2017 Conference of NANDA-I (North American
Nursing Diagnosis Association-International). It is divided into sev-
eral sections, including two lists of NANDA-I’s nursing diagnoses or-
ganized into Doenges, Murr and Moorhouse’s Diagnostic Divisions;
an at-a-glance look at the most recent diagnoses approved by
NANDA-I; nursing diagnoses commonly associated with almost 300
diseases/disorders (cross-referenced from the body of the dictionary);
and a complete description of all NANDA-I approved diagnoses
through the 2015– 2017 conference in alphabetical order. Included
are the diagnostic division, definition, related factors, and defining
characteristics for each nursing diagnosis.

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LIST OF ILLUSTRATIONS
Illustrations are listed according to the main entry or subentry that they
accompany. Information in parentheses indicates the source of the illus-
tration; a list of sources appears at the end of this list. Bonus multimedia
content (illustrations and videos) can be found in DavisPlus.

ABCD’s of melanoma, 2 Major branches of aorta and vena


Abrasion (Venes), 6 cavae (Lippert), 156
Abruptio placentae (Holloway), 7 Reflex arc for patellar tendon reflex
Antecubital abscess (Venes), 8 (Hurst), 169
Visual accommodation (Scanlon), 18 Arcus senilis (Venes), 170
Acetabulum of right hip bone Muscles of the arm, 173
(female) (Scanlon), 20 Systemic arteries, 177
Nucleic acid DNA and RNA Aortic arteries (Thompson), 178
(Scanlon), 26 Structure of an artery
Clump of uric acid crystals (⫻400) (Thompson), 178
(Strasinger), 28 Brachial artery, 180
Cystic acne (Barankin), 32 Coronary arteries, 181
Acne papulosa, 33 Rheumatoid arthritis (Gylys), 189
Acrochordon (Venes), 34 Arthrocentesis, 192
Acromioclavicular traction test Arthroscopy of knee, 193
(Starkey), 35 Abdominal girth caused by massive
Nasopharyngeal airway ascites (Venes), 196
(Wilkinson), 71 Astrocytes (Scanlon), 206
Oropharyngeal airway Autonomic nervous system, 224
(Wilkinson), 72 Avulsed fingertip (Venes), 228
Allen test (Starkey), 81 Bacteria shapes and structures
Alopecia areata of scalp (Eagle), 235
(Barankin), 86 Balantidium coli cyst (⫻400)
Alopecia capitis totalis (Leventhal), 238
(Barankin), 87 Male pattern baldness
Alveolus of lungs (Gylys), 89 (Barankin), 238
Amniocentesis (Gylys), 101 Applying bandages (Wilkinson), 241
Anatomic snuffbox (Venes), 113 Baroreceptor (Thompson), 245
Aplastic anemia (⫻200) Basal temperature chart, 248
(Harmening), 116 Bell palsy (Venes), 256
Epidural anesthesia Biceps brachii (Lippert), 261
(Wilkinson), 120 Fine needle breast biopsy
Injection of spinal anesthesia (Williams), 267
(Williams), 121 Blanch test (Venes), 276
Aortic aneurysms (Gylys), 123 Test for color blindness (Eagle), 281
Angina pectoris, 124 Blood blister (Venes), 282
Coronary angiography (Venes), 127 Blood composition (Gylys), 285
Intravenous fluorescein angiogram Types of blood cells
(Chung), 128 (Harmening), 285
Arterial balloon angioplasty ABO blood types (Eagle), 288
(Gylys), 130 Blood pressure (Wilkinson), 289
Anthrax (CDC), 138 Transfer board (Wilkinson), 292
Antibody (Scanlon), 141 Boil (Venes), 295
Anticoagulation (Venes), 144 Parts of a long bone (Hurst), 296
Main parts of aorta (Lippert), 156 Hyoid bone, 297

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Brachialis (Lippert), 303 Cerebrum (Gylys), 432


Major arteries of the brain Typical chancre of primary syphilis
(Scanlon), 306 (Barankin), 439
Brain structures (Gylys), 306 Chancroid (CDC), 440
Brainstem, 307 Chloasma gravidarum (Ward), 456
Breast (Gylys), 307 Chloracne (Venes), 456
Breast cancer, 309 Laparoscopic cholecystectomy scars
Breast self-examination (Venes), 459
(Holloway), 313 Circulation of blood through heart
Bridging (Kisner), 314 and major vessels (Eagle), 480
Broncheal tree (Thompson), 322 Fetal circulation (Gylys), 481
Buffy coat (Eagle), 326 Pulmonary circulation (Eagle), 482
Bullae of impetigo (Barankin), 327 Systemic circulation
Second degree burn (Venes), 330 (Thompson), 482
Burns (Gylys), 330 Ascites caused by cirrhosis
Blistered partial thickness thermal (Venes), 484
burn (Williams), 332 Cladosporium (CDC), 487
Prepatellar bursitis (Venes), 333 Fingernail clubbing (Eagle), 495
Coronary artery bypass Structures of the cochlea
(Williams), 335 (Hurst), 502
Classic dihydrate calcium oxalate Philadelphia collar (Venes), 511
crystals (⫻400) (Strasinger), 341 Colon and rectum, 514
Callus (Venes), 344 Colon (Venes), 514
Anal canal, 347 Colostomy sites, 516
Cancer (Strasinger), 351 Vertebral column (Wilkinson), 519
Lung cancer (Kintz), 357 Comedones (Barankin), 522
Candidiasis (Barankin), 362 Condom use and HIV risk
Needleless cannulae (CDC), 536
(Wilkinson), 363 Female condom (Hawkins), 536
Lymphatic capillary (Gylys), 366 Conduction system of the heart
Caput medusae (Venes), 369 (Gylys), 537
Basal cell carcinoma Contracture of the right hand
(Barankin), 375 (Venes), 553
Squamous cell carcinoma Umbilical cord, 559
(Venes), 376 Normal and diseased coronary
Cardiomyopathies (Williams), 378 arteries, 561
Cardioversion (Venes), 381 Renal corpuscle (Thompson), 564
Carina of the trachea (Owens), 388 Organ of corti (Scanlon), 566
Decorated cast (Venes), 393 Cotton test (Starkey), 569
Cataract (Chung), 396 Craniometric points, 577
Types of catheters (Wilkinson), 399 Craniotomy (Venes), 578
Central venous catheter Simian crease (Ward), 579
(Wilkinson), 399 Crown-rump (Venes), 586
Suprapubic catheter (Venes), 401 Cryogenic applications equipment
Catheterization of urinary bladder (Venes), 588
(Wilkinson), 403 Cryotherapy (Venes), 589
Cavities of the body (Gylys), 406 Phases of the menstrual cycle
Nasal cavity, 407 (Eagle), 602
Thoracic cavity (Chambers), 408 Follicular cyst (Venes), 605
Common components and organelles Dehydration resulting from sweating
of human cells (Hurst), 411 (Thompson), 632
Helmet cells (Harmening), 415 Dendrites, 639
Mast cell (Harmening), 416 Dentition, 646
Cellulitis (Venes), 421 Actinic dermatitis (Venes), 652
Micturition center (Thompson), 424 Atopic dermatitis (Barankin), 652

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Contact dermatitis (Barankin), 652 Endocrine (hormonal)


Stasis dermatitis (Barankin), 653 communication (Thompson), 803
Dermatofibroma (Barankin), 653 Sites of occurrence of endometriosis
Dermatome, 654 (Eagle), 805
Dermatomyositis (Barankin), 654 Cuffed endotracheal tube, 810
Dermographism (Barankin), 655 Ependyma (Scanlon), 823
Desquamation of the skin Epididymis, 826
(Venes), 657 Epiglottis (Scanlon), 827
Abduction device (Williams), 660 Glandular epithelium (⫻430)
Well-controlled diabetes mellitus (Thompson), 833
(Venes), 666 Drug eruption (Venes), 840
Diapedesis (Thompson), 671 Erysipelas (Barankin), 841
Contraceptive diaphragm, 672 Erythema annulare (Venes), 841
Movement of rib cage and Erythema multiforme
diaphragm during respiration (Barankin), 842
(Gylys), 672 Erythrocytes (Harmening), 843
Diffusion of respiratory gases, 682 Erythroderma (Barankin), 844
The digestive system (Gylys), 684 Eschar (Venes), 846
Diphyllobothrium latum, 689 Esophagus, 850
Intercalated disk (Scanlon), 701 Foreign body in esophagus
Diverticulosis, seen endoscopically (Venes), 850
(Venes), 710 Pelvic exam with speculum
Diverticula of the colon (Gylys), 710 (Williams), 860
Uniform donor card, 714 Wide and deep excision of skin and
Postural drainage of lungs subcutaneous tissues (Venes), 861
(White), 721 Isometric exercise (Kisner), 863
Drop arm test (Starkey), 724 Range-of-motion exercises, 865
Bile ducts, 730 External fixation of fractures of the
Drainage areas for lymphatic ducts tibia and fibula, 872
(Thompson), 731 Extraocular eye muscles
Dupuytren contracture (Kozol), 734 (Dillon), 874
Structure of the ear (Gylys), 749 Extravasation (Venes), 875
Structure of the inner ear Anatomy of the eye (Gylys), 877
(Scanlon), 749 Muscles of face and scalp, 881
Traumatic ecchymosis (Venes), 751 Fasciola hepatica egg
Echinococcus granulosus cysts (Leventhal), 899
(Leventhal), 752 Fasciolopsis buski egg
Transesophageal (Leventhal), 899
echocardiography, 752 Right femur (Gylys), 907
Nummular eczema (Barankin), 758 Fertilization (Hurst), 909
Edema (Venes), 758 Fibromyalgia (Eagle), 926
Pitting edema (Venes), 759 Visual field, 930
Elbow joint (Thompson), 773 Fingerprint, 933
Table of elements in the body Flatfoot (Venes), 938
(Thompson), 777 Flow of cerebrospinal fluid through
Pulmonary embolism the brain and spinal column
(Williams), 782 (Strassinger), 943
Stages of development of human Fontanels of infant skull
embryo including mature fetus (Ward), 952
(Eagle), 784 Bones of foot and ankle
Embryoscopy, 785 (Thompson), 955
Emmetropia, myopia, hyperopia Athlete’s foot (Venes), 955
(Scanlon), 790 High Fowler position
Osler nodes as seen in ineffective (Williams), 964
endocarditis (Williams), 801 Foxglove (Venes), 965

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Types of fractures (Gylys), 967 Representative helminths


Traction applied to a fracture of the (Scanlon), 1089
lower extremity (Wilkinson), 968 Hemangioma beneath the right eye
Fracture of the humerus (Venes), 1089
(Strauss), 970 Hemochromatosis
Fundus of the uterus (Harmening), 1096
(Chapman), 981 Hemocytoblast (stem cell) and blood
Fungi (Scanlon), 982 cells (Scanlon), 1097
Gallstones (Eickhoff), 986 Hemoglobin A molecule
Ganglion cyst (Venes), 988 (Harmening), 1100
Gangrene (Venes), 990 Hemorrhoid, 1110
Gastrostomy button (Venes), 998 Henoch-Schönlein purpura
Autosomal dominant inheritance (Venes), 1112
(Thompson), 1001 Common locations of hernias
Autosomal recessive inheritance (Gylys), 1120
(Thompson), 1001 Abdominal wall hernia
Female genital organs (Gylys), 1005 (Venes), 1120
Male genital organs (Gylys), 1005 Reducible hernia (Venes), 1121
Genu recurvatum (Starkey), 1006 Herniated disk (Gylys), 1122
Adrenal glands, 1013 Genital herpes (Eagle), 1124
Endocrine system (Scanlon), 1015 Herpes labialis (Venes), 1125
Pituitary gland (Gylys), 1017 Herpes zoster (Barankin), 1125
Salivary glands (Thompson), 1018 Hesselbach triangle
Eccrine and apocrine sweat (Chambers), 1127
glands, 1019 Old world hookworm
(Leventhal), 1144
Thyroid gland (Prajer), 1020
Humerus (Hurst), 1152
Glaucoma (Gylys), 1022
Hormones affecting hunger
Filtration in glomerulus
(Thompson), 1150
(Thompson), 1027
Hydatid cyst (Leventhal), 1155
Goiter, 1033
Hydronephrosis (Gylys), 1160
Goniometer (Eagle), 1035
Hysterectomy (Gylys), 1195
Gout (Strasinger), 1037 Magnetic resonance imaging
Acute gout (Venes), 1037 (Hopkins), 1208
Gram stain (Sacher), 1041 Cell-mediated immunity
Granuloma annulare (Venes), 1042 (Scanlon), 1212
Growth chart girls (CDC), 1049 Humoral immunity (Scanlon), 1213
Growth chart boys (CDC), 1050 Impetigo (Barankin), 1221
Guidewire (Chambers), 1051 Dental implant, 1222
Gynecomastia (Venes), 1054 Body mass index (Shape Up
Cerebral gyri, 1055 America), 1232
Hair and adjacent structures of Myocardial infarction
cross-section of skin (Gylys), 1059 (Williams), 1240
Bones of hand (Hurst), 1062 Ulcer due to diabetic foot infection
Haustration, seen endoscopically (Venes), 1245
(Venes), 1067 Intravenous infusion
Hawkins test (Starkey), 1067 technique, 1256
Muscles of the face and neck, 1068 Metered-dose inhaler
Arteries and veins of the head, 1069 (Wilkinson), 1258
Wound healing, 1072 Subcutaneous injection
How hearing occurs (Thompson), 1263
(Thompson), 1077 Z-track injection (Eagle), 1264
Structures of the heart (Gylys), 1079 Injection drug use (Venes), 1264
Heart-lung machine, 1083 Insulin and glucagon functions
Heimlich maneuver, 1087 (Scanlon), 1276

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International symbol of access, 1285 The limbic system of the brain, 1403
Intertrigo occurring in armpit Massive lipoma on the back
(Venes), 1287 (Venes), 1408
Small intestine (Thompson), 1288 Extracorporeal shock wave
Intrauterine contraceptive devices lithotripsy (Williams), 1413
(Hawkins), 1293 Liver and gallbladder (Gylys), 1413
Orotracheal intubation Liver lobule (Thompson), 1416
(Venes), 1294 Louse (CDC), 1421
Jaundice (Venes), 1313 Lungs (Eagle), 1423
Jaw, 1314 Systemic lupus erythematosus
Types of joints (Hurst), 1317 (Williams), 1427
Myoneural junction (Scanlon), 1321 Cervical lymphadenopathy
Squamocolumnar junction (Venes), 1431
(Venes), 1321 The lymphatic system (Gylys), 1433
Kaposi sarcoma (CDC), 1323 Circulation of lymphatic fluid
Keloid (Venes), 1327 (Thompson), 1434
Keratoacanthoma (Barankin), 1329 Lymphatics of the breast
Actinic keratosis (Venes), 1331 (Thompson), 1434
Seborrheic keratoses on back Lymphedema of the leg
(Venes), 1331 (Venes), 1435
Stucco keratosis (Venes), 1332 Cutaneous T-cell lymphoma
Kidney (Gylys), 1334 (Venes), 1438
Nephron with its associated blood Non-Hodgkin lymphoma
vessels (Gylys), 1335 (Strasinger), 1438
Knee (Thompson), 1339 Macrophage, 1443
Knee injuries (Thompson), 1339 Left lateral view of mandible
Kyphosis (Venes), 1343 (Gylys), 1454
Sequence of labor and Medical marijuana card
childbirth, 1345 (Venes), 1460
Laceration of the thumb Red bone marrow (Thompson), 1461
(Venes), 1351 Medic alert symbol, 1477
Lachman test (Starkey), 1351 Adrenal medulla (Thompson), 1486
Lacrimal apparatus (Hurst), 1351 Megakaryocyte (Harmening), 1487
Laminectomy (Eagle), 1356 Meiosis (Hurst), 1488
Slit lamp examination (Gylys), 1357 Melanoma (Barankin), 1489
Langer lines, 1359 Alveolocapillary membrane
Laparoscope, 1360 (Scanlon), 1492
Larynx (Thompson), 1365 Cell membrane (Thompson), 1493
Muscles of the leg, 1376 Interosseous membrane
Bones of the leg and foot, 1377 (Lippert), 1493
Lentigo maligna (CDC), 1382 Meninges (Thompson), 1497
Leopold maneuvers Meningococcemia (Venes), 1500
(Chapman), 1382 Qi merdidans (Williams), 1506
Acute lymphocytic leukemia Metastases (Harvey), 1512
(Harmening), 1388 Microglia (Scanlon), 1520
Chronic lymphocytic leukemia Mitosis (Hurst), 1536
(Harmening), 1389 Moles (Barankin), 1540
Hairy cell leukemia Molluscum contagiosum
(Harmening), 1390 (Barankin), 1542
Leukoplakia (Wilkinson), 1392 Peak flow monitoring
Lichen planus (Barankin), 1396 (Williams), 1543
Lichen sclerosus et atrophicus Monocytes (Harmening), 1544
(Barankin), 1396 Morton toe (Starkey), 1553
Advanced cardiac life support Selected muscles of the body
(Venes), 1399 (Gylys), 1566

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Muscle fiber (Thompson), 1566 Pancreas (Thompson), 1744


Morphological forms of muscle Tools for Pap test (Hawkins), 1748
(Strasinger), 1567 Papules on heel (Barankin), 1751
Fingernail (Gylys), 1590 Paronychia (Barankin), 1763
Nasogastric tube (Wilkinson), 1594 Applying patch test
Navicular drop test (Starkey), 1599 (Barankin), 1767
Nebulizer (Gylys), 1599 Peau d’orange (Venes), 1774
Necator americanus Pectus excavatum (Venes), 1775
(Leventhal), 1600 Pelvis (Thompson), 1781
Lateral aspect of the neck, 1600 Penis and other male organs
Necrosis (Venes), 1601 (Thompson), 1786
Nerve structure (Thompson), 1610 Perineum (Hurst), 1794
Acoustic nerve (8th cranial), 1611 Peritoneum, 1799
Cranial nerves and their Pes anserinus (Lippert), 1805
distributions (Gylys), 1613 Petechiae (Williams), 1806
Superficial branches of facial nerve pH scale (Thompson), 1808
(7th cranial), 1614 Phagocytosis (Thompson), 1809
Glossopharyngeal nerve, 1615 Blood drawing from the antecubital
Spinal nerves (Gylys), 1618 vein (Venes), 1817
Neurodermatitis (Venes), 1625 Gastric pit (Thompson), 1830
Neuron structure (Eagle), 1628 Delivery of the placenta
Neuropathic foot due to diabetes (Chapman), 1832
(Venes), 1632 Body planes (Hurst), 1835
Neutrophils (Harmening), 1637 Epiphyseal plate (Thompson), 1839
Nevus flammeus (Barankin), 1638 Pleurae (Thompson), 1841
Junctional nevi (Barankin), 1638 Pneumocystis jiroveci (⫻1000)
Melanocytic nevus (Barankin), 1638 (Leventhal), 1846
Liquid nitrogen (Venes), 1643 Pneumothorax (Gylys), 1851
Lymph node, 1646 Poison oak (Venes), 1871
Subcutaneous nodules (Venes), 1647 Polycythemia vera
Nondisjunction (Thompson), 1650 (Harmening), 1876
Ober test (Starkey), 1670 Polyps (Venes), 1880
Coronary occlusion (Venes), 1676 Nasal polyps, 1880
Oligodendrocyte (Scanlon), 1684 Popeye sign (Venes), 1883
Omentum (Thompson), 1685 Positions (Wilkinson), 1886
Onychomycosis (Barankin), 1688 Sites for ectopic pregnancy
Oogenesis (Scanlon), 1689 (Chapman), 1905
Ophthalmoplegia (Venes), 1692 Presentations of fetus
Opisthotonos, 1693 (Chapman), 1914
Orchiectomy (Venes), 1696 Odontoid process (Thompson), 1923
Ankle-foot orthosis (Venes), 1704 Promyelocyte (Harmening), 1930
Osmosis (Hurst), 1707 Protozoa (Scanlon), 1943
Osteoarthritis of the knee Pseudomonas aeruginosa
(Venes), 1708 (Venes), 1948
Osteoporosis (Thompson), 1713 Psoriasis (Venes), 1950
Ostomy appliance (Venes), 1716 Guttate psoriasis (Venes), 1951
Human ovum (Ward), 1725 Ptosis (Venes), 1958
Transtracheal oxygen therapy Pulses (Thompson), 1960
(Williams), 1729 Insulin pump (Williams), 1963
Oxyhemoglobin dissociation curve Lumbar puncture (Eagle), 1965
(Scanlon), 1729 Pupil dilation and constriction
Pacemaker (Venes), 1731 (Thompson), 1966
Fat pad (Venes), 1734 Purpura (Venes), 1968
Sites of referred pain Idiopathic thrombocytopenic
(Williams), 1740 purpura, 1968

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Pyoderma gangrenosum of the lower Sphygmomanometer


leg (Venes), 1973 (Wilkinson), 2202
Abdominal quadrants Spinal cord (Scanlon), 2204
(Wilkinson), 1976 Incentive spirometer
Universal radiation symbol, 1984 (Williams), 2206
Causes of maternal death Splint (Venes), 2209
(WHO), 1998 Contraceptive sponge
Rectum (Venes), 2010 (Hawkins), 2212
Reed-Sternberg cell (center) Mongolian spots (Ward), 2214
(Harmening), 2013 Staphylococcus aureus (Venes), 2224
Abdominal regions (Scanlon), 2022 Stapled incision (Williams), 2225
Transurethral resection of the Stapling devices (Chambers), 2225
prostate, 2033 Renal artery stenosis (Klein), 2231
Muscles of respiration Stenotrophomonas infection of the
(Thompson), 2037 leg (Venes), 2231
Respiratory system, 2040 Insertion of a coronary artery stent
Cardiopulmonary resuscitation (Williams), 2232
(Meyers), 2046 Sternotomy (Venes), 2235
Retina of the right eye Sternum, 2235
(Chung), 2050 Stevens-Johnson syndrome
Retina, 2051 (Barankin), 2236
Rib cage (Hurst), 2066 Transcutaneous electrical nerve
Rosacea (Barankin), 2076 stimulation (Venes), 2238
Rugae (Gylys), 2082 Compression stocking (Venes), 2240
Rule of nines, 2083 Regions of the stomach
Sacrum and coccyx, 2087 (Thompson), 2241
Salter-Harris fracture Muscles of the stomach wall
(Starkey), 2092 (Thompson), 2242
Sarcoidosis (Barankin), 2096 Stomatitis (Barankin), 2243
Sarcoptes scabiei (Barankin), 2097 Stria atrophica (Venes), 2250
Scabies (Barankin), 2098 Stump of a foot (Venes), 2257
Scale, 2101 Swallowing (Thompson), 2284
Scalpels (Eagle), 2102 Sway-back (Levangie), 2285
Scapula (Hurst), 2103 Sycosis barbae (Venes), 2287
Schistocyte (Harmening), 2105 Synapse (Gylys), 2291
Scoliosis (Gylys), 2111 Syphilis (Barankin), 2297
Scurvy (Goldsmith), 2116 Syringes (Wilkinson), 2299
Seroma (Venes), 2133 Taenia saginata (Leventhal), 2305
Myelin sheath (Thompson), 2141 Taenia solium (Leventhal), 2305
Shingles (Barankin), 2144 Skin tags (Gylys), 2306
Shoulder (Thompson), 2150 Cardiac tamponade, 2308
Dialysis shunt (Venes), 2150 Temperature regulation
Paranasal sinus (Thompson), 2161 (Wilkinson), 2319
Skeleton (Gylys), 2167 Tenodesis (Lippert), 2322
Structure of the skin and Testis (Thompson), 2325
subcutaneous tissue (Gylys), 2168 Thoracentesis, 2338
Bones of skull (Gylys), 2170 Thoracotomy scar (Venes), 2339
Smallpox, 2176 Thymus (Hurst), 2348
Sense of smell (Thompson), 2178 Tinea capitis (Barankin), 2354
Nasal speculum (Wilkinson), 2197 Tinea corporis (Barankin), 2354
Vaginal speculum (Hawkins), 2197 Tinea cruris (Barankin), 2354
Normal and abnormal sperm, 2198 Tinea versicolor (Barankin), 2355
Spermatogenesis (Hurst), 2199 Positron emission tomography, 2361
Spermatozoon (Hurst), 2199 Surface of tongue (Prajer), 2361

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Geographic tongue Types of mechanical heart valves


(Wilkinson), 2362 (Williams), 2467
Tonometry (Gylys), 2363 Varicella (Barankin), 2469
Inflamed tonsils (CDC), 2363 Esophageal varix in a patient with
Structure of a tooth cirrhosis of the liver
(Thompson), 2365 (Roberts), 2471
Deciduous teeth (left side), 2365 Bowleg (Starkey), 2471
Tophi (Venes), 2367 Vas deferens and other male organs
Total hip replacement (Gylys), 2369 (Eagle), 2472
Tracheostomy tube in place Vasculitis (Barankin), 2473
(Gylys), 2376 Vasectomy and its reversal
Patient with tracheostomy tube (Gylys), 2474
(Williams), 2377 Systemic veins, 2478
Ultrasonic transducer (Venes), 2386 Structure of a vein and venule, 2479
Trichomonas vaginalis Varicose veins in leg (Gylys), 2481
(Leventhal), 2408 Venipuncture (Eagle), 2482
Trichuris trichiura Implantable venous access
(Leventhal), 2410 port, 2483
Trypanosoma cruzi Noninvasive positive pressure
(Leventhal), 2416 ventilation (Williams), 2485
Tuberculosis (Tamparo), 2419 Ventricles of the brain, 2487
Tuberculosis (CDC), 2419 Villi of small intestine (Eagle), 2495
Carpal tunnel (Thompson), 2425 Viral shapes (Eagle), 2498
Twins (Ward), 2427 Effect of HIV on immune system
Aphthous ulcer (Barankin), 2431 (Williams), 2501
Pressure ulcer (Barankin), 2434 Vector of West Nile virus, 2504
Rodent ulcer (Venes), 2434 Vitiligo (Barankin), 2509
Venous stasis ulcer (Venes), 2435
Vocal cords (Owens), 2511
Doppler ultrasonography
Vocal cords and glottis
(Chapman), 2436
(Thompson), 2511
Fetal ultrasound image
Vulva (Eagle), 2516
(Enright), 2437
Common warts (Barankin), 2521
Unna boot, 2443
Genital warts (Wilkinson), 2521
Female urethra (Thompson), 2446
Male urethra (Thompson), 2446 Plantar wart (Barankin), 2522
Urinary retention, 2448 Medicine wheel, 2533
Urine (Strasinger), 2451 Circle of Willis, 2535
Urine testing kit (Wilkinson), 2451 Open wound (Kloth), 2542
Urticaria (Venes), 2452 Compression wrap (Starkey), 2542
Uterus, 2453 Xanthelasma (Venes), 2544
Vacuum-assisted wound closure Xerocytes (Harmening), 2545
(Venes), 2461 Conjunctival xerosis (CDC), 2545
Vagina and other female organs Budding yeast (Strasinger), 2548
(Thompson), 2461 Yin-yang, 2548
Knock-knee (Starkey), 2465 Z-plasty method of correcting a
Cardiac valves (Thompson), 2466 deforming scar, 2554

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ILLUSTRATION SOURCES

Barankin and Frieman: Derm Notes: Clinical Dermatology Pocket Guide.


FA Davis, Philadelphia, 2006.
Centers for Disease Control and Prevention; Dr. Lucille K. Georg; Frank
Collins, PhD; James Gathany (2006); Carl Washington, MD; Emory
University, School of Medicine; Mona Saraiya, MD, MPH.
Chambers, K and Roche, V: Surgical Technology Review certification and
professionalism. FA Davis, Philadelphia, 2010.
Chapman, L and Durham, R: Maternal-Newborn Nursing : The Critical
Components of Nursing Care. FA Davis, Philadelphia, 2009.
Chung, Christine A, MD, Philadelphia, PA.
Dillon, PM: Nursing Health Assessment: A Critical Thinking, Case Stud-
ies Approach. FA Davis, Philadelphia, 2003.
Eagle, Sharon: The Professional Medical Assistant. FA Davis, Philadel-
phia, 2009.
Eickhoff, L, Portland, OR.
Enright, AD, Havertown, PA.
Goldsmith, LA, Lazarus, GS and Tharp, MD: Adult and Pediatric Der-
matology: A Color Guide to Diagnosis and Treatment, FA Davis, Phil-
adelphia, 1997.
Gylys, B and Masters, R: Medical Terminology Simplified: A Programmed
Learning Approach by Body Systems, ed 4. FA Davis, Philadelphia,
2010.
Gylys, B and Wedding, M: Medical Terminology Systems: A Body Sys-
tems Approach, ed 6. FA Davis, Philadelphia, 2009.
Harmening, D: Clincal Hematology & Fundamentals of Hemostasis. Ed
5. FA Davis, Philadelphia, 2009.
Hatch, H, Gold Beach, OR.
Hawkins, J, Chestnut Hill, MA.
Holloway, B et al: OB/GYN & Peds Notes: Nurse’s Clinical Pocket Guide,
ed 2. FA Davis, Philadelphia, 2011.
Hopkins, T: Lab Notes: Guide to Lab and Diagnostic Tests, ed 2. FA Da-
vis, Philadelphia, 2009.
Hurst, J: Anatomy & Physiology in a Flash. FA Davis, Philadelphia, 2010.
Kintz, J, Eugene, OR.
Kisner, C and Colby, L: Therapeutic Exercise, ed 5. FA Davis, Philadel-
phia, 2007.
Klein, A, Portland, OR.
Kloth, LC: Wound Healing: Alternatives in Management, ed 3. FA Davis,
Philadelphia, 2002.
Levangie, P and Norkin, C: Joint Structure and Function: A Comprehen-
sive Analysis, ed 5. FA Davis, Philadelphia, 2011.
Lentner, C (ed): Geigy Scientific Tables, ed 8. Ciba Geigy, Basle, Swit-
zerland, 1981.
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Leventhal, R and Cheadle, RF: Medical Parasitology: A Self-Instructional


Text, ed 5. FA Davis, Philadelphia, 2002.
Lippert, L: Clinical Kinesiology and Anatomy, ed 5. FA Davis, Philadel-
phia, 2011.
Myers, E: EMS Notes: EMT and Paramedic Field Guide. FA Davis, Phil-
adelphia, 2009.
Owens, April, Eugene, OR.
Prajer, R and Gross, G: DH Notes: Dental Hygienist’s Chairside Pocket
Guide. FA Davis, Philadelphia, 2011.
Roberts, John, MD.
Scanlon, VC and Sanders, T: Essentials of Anatomy and Physiology, ed
5 & 6. FA Davis, Philadelphia, 2007 & 2010.
http://www.shapeup.org.
Speroff, L: A Clinical Guide for Contraception, ed 3. Lippincott, Williams
& Wilkins.
Starkey, C: Examination of Orthopedic & Athletic Injuries, ed. 3. FA Da-
vis, Philadelphia, 2010.
Stevens, CD: Clinical Immunology and Serology: A Laboratory Perspec-
tive. FA Davis, Philadelphia, 1996.
Strasinger, S and Di Lorenzo M: Urinalysis & Body Fluids, ed 5. FA Da-
vis, Philadelphia, 2008.
Strauss, W. Robert, Jr., Cherry Hill, NJ.
Tamparo, C. and Lewis, M: Diseases of the Human Body, ed 5. FA Davis,
Philadelphia, 2011.
Thompson, G: Understanding Anatomy & Physiology: A Visual, Auditory,
Interactive Approach. FA Davis, Philadelphia, 2012.
Venes, D, MD. Brookings, OR.
Ward, S and Hisley, S: Maternal-Child Nursing Care, FA Davis, Phila-
delphia, 2009.
White, G: Respiratory Notes: Respiratory Therapist’s Pocket Guide, FA
Davis, Philadelphia, 2008.
Wilkinson, JM and Van Leuven, K: Fundamentals of Nursing, ed 1 & 2.
FA Davis, Philadelphia, 2007 & 2011.
Williams, LS and Hopper, PD (eds): Understanding Medical-Surgical
Nursing, ed 4. FA Davis, Philadelphia, 2011.
World Health Organization (WHO): http://www.who.int.

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LIST OF TABLES

Activities of Daily Living and Factors Affecting Them, 40


Factors That May Decrease Patient Adherence to Therapy in the
U.S., 50
Strategies that Improve Patient Adherence to Medical Regimens, 50
Oral Agents That Lower Blood Glucose, 61
Clinical Conditions and Opportunistic Infections Indicating AIDS, 68
Levels of Alcohol Consumption: A Guide to Contemporary Usages, 75
Common Allergies and Allergens, 83
Stages of Alzheimer disease, 90
Patient-Controlled Analgesia: Risk Factors for Adverse Outcomes*, 109
Stages of Angina Pectoris, 125
Cancer Antigens Used as Tumor Markers, 147
Apgar Score, 158
Some Severe Illnesses That May Mimic Appendicitis, 163
Routes of Drug Administration During Cardiac Arrest*, 174
Techniques for Assessing Fetal Health*, 202
Effects of Sympathetic and Parasympathetic Autonomic Stimulation on
Specific Tissues*, 225
Common Bacterial Infections, 234
Control of Arterial Bleeding, 279
Blood Components Used in Transfusion Therapy, 287
Selected Risk Factors for Breast Cancer, 308
Common and Experimental Techniques Used in Breast Imaging, 309
Features of Bronchodilator Drugs, 320
Estimated Number of New Cancer Cases and Deaths by Sex, U.S.,
2013*, 350
Controversies in Cancer Screening in the General Population, 352
Classification of Important Carbohydrates, 370
Digestion of Carbohydrates, 371
Effects of Carboxyhemoglobin, 372
Carcinogens, 374
Common Tests Performed Prenatally, 385
Important Considerations in the Administration of Chemotherapy, 450
Serious Complications of Childbirth*, 453
Criteria for Diagnosing CFS, 473
Hospital Emergency Codes, 503
Current Contraceptive Use Among Women Aged 15 to 44 Years of Age:
U.S., 2011– 2013, 550
Contraindications to the Topical Application of Cold to Musculoskeletal
Injuries, 590
The Leading Causes of Death in the U.S. (2010)*, 617
Common Birth Defects, 625
Birth Defects by Categories, with Examples*, 625
Prevalence of Dementia, by Patient Age, 638

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Signs and Symptoms and Recommended Emergency Management of


Odontogenic (Dental) Problems, 643
Preventing Oral Diseases/Maintaining Oral Health, 645
Comparison of Diabetic Ketoacidosis and Hypoglycemia, 665
Comparison of Type 1 (Insulin-Dependent) Diabetes Mellitus and Type
2 (Non– Insulin-Dependent) Diabetes Mellitus, 668
Diseases in Which Diet Plays an Important Role, 676
The DASH Diet (Eating Plan), 678
Dietary Guidelines for Americans, 680
Action of Digestive Enzymes on Food, 683
Fungal Diseases, 694
Method of Transmission of Some Communicable Diseases, 696
Inherited Diseases and Conditions: A Brief List, 698
Ultraviolet Treatment Dosages, 717
Comparison of Toxic and Allergic Drug Reactions, 729
Risk Factors for Erectile Dysfunction, 737
Major Electrolytes, 773
Electromagnetic Spectrum, 774
Derivatives of Embryonic Tissues, 783
Common Causes of Seizures, 830
Common Medication Errors, 839
Exercise: Energy Required, 863
Comparison of Heatstroke and Heat Exhaustion, 867
Fahrenheit and Celsius scales, 887
Causes of Acute Renal Failure, 888
Food sources of Saturated and Trans Fats, 901
The American College of Rheumatology 1990 Criteria for Classification
of Fibromyalgia, 926
Some Important Issues in Geriatric Health Care, 1008
Principal Endocrine Glands, 1016
Gram Conversion into Ounces (Avoirdupois), 1040
Top Diagnosis-Related Groups (DRGs) in the U.S., 1047
Major Public Health Achievements of the 20th Century, 1073
Some Public Health Indicators, 1075
Misconceptions About Health Care, 1076
Elimination of Body Heat, 1084
Routine Precautions for the Care of All Hemodialysis Patients, 1098
Hemodynamic Parameters Frequently Measured in Critical Care, 1100
Comparison of Hemoptysis and Hematemesis, 1107
Common Sites of Bleeding, 1107
Classification of Blood Pressure for Adults Age 18 and Older, 1176
Methods to Reduce Blood Pressure without Medication, 1177
Representative Occupational Illnesses, 1204
Examination Findings of Heat Illnesses, 1206
Blood Type Compatibility, 1226
Incubation and Isolation Periods in Common Infections, 1230
Colors of Indicators of pH, 1236
Fungal Infections, 1246
Basic Guidelines for Infection Control, 1248
Mediating Factors in Inflammation, 1251
Unsafe Injection Practices*, 1262
Traumatic Injuries, 1265
Mechanisms of Brain Injury, 1268
Natural and Artificial Stimulants That May Contribute to
Insomnia, 1271
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Duration of Effect of Various Insulins When Given by Subcutaneous


Injection, 1277
Desirable Levels of Anticoagulation in Terms of INR, 1284
Radioactive Isotopes Having Important Long-Term Health
Effects, 1309
Karnofsky Index, 1324
Some Classes of Drugs That Inhibit Libido, 1395
Life Expectancy by Sex, Age, and Race: 2008, 1397
Expectation of Life at Birth, 1970 to 2008, and Projections, 2010 to
2020, 1398
Causes of Swollen Glands, 1432
Physical Signs of Malnutrition, 1452
Grading Systems for Manual Muscle Tests, 1457
Seminal Medicolegal Court Decisions in the U.S., 1484
Micronutrients, Sources, and Deficiency Diseases, 1522
Some Monoclonal Antibodies and Their Uses, 1544
Ten Leading Causes of Death by Age Group, United States –
2013, 1551
Comparison of Properties of Three Types of Muscle, 1568
Common Neuropathies, 1630
Typical Noise Levels in Decibels and Their Effect, 1648
The Norton Scale, 1654
Adverse Events That Occur in More than 3% of Hospitalized
Patients, 1654
Diagnostic Tests for Occult Bleeding, 1677
Size, Weight, and Capacity of Various Organs and Parts of the Adult
Body, 1698
Organ Systems, 1702
Risk Factors for Osteoporosis, 1714
Usual Adult Doses and Intervals of Drugs for Relief of Pain, 1735
Sites of Referred Pain, 1738
Important Considerations in Palliative Care, 1771
A Patient’s Perception of Quality Health Care, 1771
Symptoms and Signs of Periodontitis, 1796
pH of Some Fluids, 1809
The Pneumoconioses, 1846
Toxicity of Carbon Monoxide, 1861
Positions of Fetus in Utero, 1885
Pregnancy Table for Expected Date of Delivery, 1900
Recommended Screening for Pregnant Women, 1904
Tests for Premature Rupture of Membranes, 1908
Table of Pathogenic Protozoa, 1944
Psychomotor and Physical Development: Birth to 1 Year, 1955
Purines in Food, 1967
Radiosensitive Tumors, 1989
Rate of Respiration, 2038
Common Findings on Funduscopic Examination in Retinopathy, 2053
Prominent Issues in Hospital Risk Management, 2072
Glasgow Coma Scale, 2100
Causative Agents of Sexually Transmitted Diseases, 2139
International System of Units (SI Units), 2164
Prefixes and Their Symbols Used to Designate Decimal Multiples and
Submultiples in SI Units, 2165
Bones of the Human Skeleton, 2167

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Grading System for Sprains, 2215


Stroke and its Causes, 2251
Information Technologies Used in Health Care, 2316
U.S. FDA Categories for Drugs by Teratogenic or Fetotoxic
Potential, 2323
Comparative Thermometric Scale, 2335
Thermometric Equivalents (Celsius and Fahrenheit), 2336
Some Culturally Specific (Folk) Illnesses, 2384
Revised Trauma Score, 2399
Significance of Changes in Urine, 2449
Common Disorders of Urination, 2450
Some Contraindications to Live Vaccines, 2456
Methods of Accessing the Vasculature, 2472
Common Viral Characteristics, 2499
Causes of Vomiting, 2514
Metropolitan Height and Weight Tables for Men and Women According
to Frame, Ages 25 to 59, 2529
Ethical Requirements for Expert Witnesses, 2538

* New table

xxviii
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ABBREVIATIONS USED
IN TEXT*

ABBR abbreviation Ger. German


Amerind American Indian Gr. Greek
approx. approximately i.e. id est (that is)
at. no. atomic number L. Latin
at. wt. atomic weight pert. pertaining
Brit. British pl. plural
e.g. exempli gratia (for ex- sing. singular
ample) Sp. Spanish
esp. especially SYMB symbol
Fr. French SYN synonym
fr. from

*Additionalabbreviations are listed in the Units of Measurement (Including SI Units)


Appendix and the Medical Abbreviations Appendix (SEE: Bonus Appendices).

xxix
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A
␣ Alpha, the first letter of the Greek al- tions, 90% or more of the partial
phabet. pressure of oxygen in the lungs will dif-
Å angstrom unit. fuse into the blood yielding an a/A ratio
a accommodation; ampere; anode; ante- greater than 0.9. This value can be used
rior; area; artery. to determine whether there is a problem
ā [L.] ante, before. with gas diffusion.
A2 aortic second sound. AARC American Association for Respira-
a- SEE: 1an-. tory Care.
AA Achievement age; Alcoholics Anony- AARP American Association of Retired
mous; amino acid; arteriae; arteries. Persons.
AAA abdominal aortic aneurysm; acne- AAS atomic absorption spectroscopy.
associated arthritis; American Acad- AASECT American Association of Sex Ed-
emy of Allergists; American Ambulance ucators, Counselors, and Therapists.
Association; American Association of AATS American Association for Thoracic
Anatomists; Area Agency on Aging. Surgery.
AAb Autoantibody. AAV adeno-associated virus.
AABB American Association of Blood Ab Antibody.
Banks. ab-, abs- [L. ab, from] Prefixes meaning
AACC American Association for Clinical from, away from, negative, absent. The
Chemistry. variant abs- is used before t, e.g., ab-
AACN American Association of Critical- stract.
1 Abadie sign (ă-bad⬘ē) [Jean Abadie, Fr.
Care Nurses; American Association of
Colleges of Nursing. neurologist, 1873– 1946] In tabes dor-
AACVPR American Association of Car- salis, insensibility to pressure over the
diovascular and Pulmonary Rehabili- Achilles tendon.
2 Abadie sign (ă-bad⬘ē) [Charles A. Aba-
tation.
AAFP American Academy of Family Phy- die, Fr. ophthalmologist, 1842– 1932]
sicians. In exophthalmic goiter, spasm of the le-
AAg Autoantigen. vator palpebrae superioris.
AAHN American Association for the His- abandonment (ă-ban⬘dŏn-mĕnt) [Fr.
tory of Nursing. abandoner, to surrender] Premature
AAMA American Association of Medical termination of the professional treat-
Assistants. ment relationship by the health care
AAMI Association for the Advancement of provider without adequate notice or the
Medical Instrumentation; age-associ- patient’s consent.
ated memory impairment. abasia (ă-bā⬘zh(ē-)ă) [1an- ⫹ Gr. basis,
AAMS Association of Air Medical Ser- step] 1. Motor incoordination in walk-
vices. ing. 2. Inability to walk due to impair-
AAMT American Association for Medical ment of coordination. abasic, abatic,
Transcription. adj.
AAN American Academy of Nursing. a.-astasia Lack of motor coordination
AANA American Association of Nurse with inability to stand or walk. SYN:
Anesthetists. astasia-abasia.
AANN American Association of Neurosci- paralytic a. Abasia in which the leg
ence Nurses. muscles are paralyzed.
AANP American Academy of Nurse Prac- paroxysmal trepidant a. Abasia
titioners. caused by trembling and sudden stiff-
AAOHN American Association of Occu- ening of the legs on standing, making
pational Health Nurses. walking impossible. It may be related to
AAOMS American Association of Oral hysteria.
and Maxillofacial Surgeons. abate (ă-bāt⬘) [Fr. abattre, to beat down]
AAOS American Academy of Orthopedic 1. To lessen or decrease. 2. To cease or
Surgeons. cause to cease. abatement (mĕnt), n.
AAP American Academy of Pediatrics; abaxial, abaxile (a-bak⬘sē-ăl, a-bak⬘sı̆l)
American Association of Pathologists. [ab- ⫹ axial] 1. Not within the axis of
AAPA American Academy of Physician a body or part. 2. At the opposite end of
Assistants. the axis of a part.
AAPMR American Academy of Physical Abbe-Wharton-McIndoe operation, Mc-
Medicine and Rehabilitation. Indoe operation (a⬘bē-whar⬘tŏn-mak⬘-
a/A ratio The ratio of arterial oxygen par- in-dō) A surgical procedure performed
tial pressure (a) to alveolar oxygen par- to create a vagina in patients who do not
tial pressure (A). Under normal condi- have one. This is achieved by creating
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Abbott method 2 abdomen

adequate space between the rectum and nal wall is formed by the flat abdominal
bladder; the inlaying of a split-thickness musculature. The abdomen contains the
graft; and most importantly, continuous stomach, the inferiormost part of the
and prolonged dilatation during the esophagus, the small and large intes-
healing stage when tissues are most tines, liver, gallbladder, and spleen. The
likely to contract. parietal peritoneum lines the abdomi-
PATIENT CARE: The health care nal cavity. The visceral peritoneum en-
team supports the patient medically velop the organs within the abdominal
and psychologically by helping the pa- cavity. The kidneys, adrenal glands,
tient learn about her condition and the ureters, prostate, seminal vesicles, and
procedure by answering questions, pro- greater vascular structures (such as the
viding comfort, and alleviating anxiety. abdominal aorta and inferior vena cava)
Abbott method (ab⬘ŏts) [Edville G. Ab- are located external to the peritoneum
bott, U.S. orthopedic surgeon, 1871– (extraperitoneal); those lying posteri-
1938] A treatment for scoliosis that is orly are retroperitoneal. abdominal (ab-
no longer used, in which a series of plas- dom⬘ı̆-năl), adj. SEE: abdominal quad-
ter jackets were applied to straighten rants for illus.
the spine. INSPECTION: Visual examination of
ABC American Botanical Council; anti- the abdomen is best done while the pa-
gen-binding capacity; airway, tient is supine with the knees slightly
breathing, circulation (the former mne- bent. In a healthy person the abdomen
monic for assessing the status of emer- is oval, with elevations and depressions
gency patients) corresponding to the abdominal mus-
ABCD asymmetry, border, color, diameter cles, umbilicus, and, to some degree, the
(a mnemonic to aid health care pro- forms of underlying viscera. Relative to
viders in the recognition of malignant chest size, the abdomen is larger in chil-
melanoma). Pigmented lesions on the dren than in adults; it is more rotund
skin with irregularities of growth and and broader inferiorly in males than in
color and diameters greater than 6 mm females.
have a considerable likelihood of being Disease can alter the shape of the ab-
melanomas and should be profession- domen. A general, symmetrical enlarge-
ally examined. Additional characteris- ment may result from ascites; a partial
tics of melanomas include the sudden and irregular enlargement may result
change of an existing mole or sudden ap- from tumors, from hypertrophy of or-
pearance of pigmented moles. In some gans such as the liver or spleen, or from
cases an existing mole that was flat el- intestinal distention caused by gas. Re-
evates above the skin. The letter E is traction of the abdomen may occur in
used as a mnemonic for this expansion extreme emaciation and in several
or evolution of skin lesions (thus the forms of cerebral disease.
mnemonic is sometimes referred to as The respiratory movements of the ab-
ABCDE). SEE: illus.; melanoma. dominal walls and the movements of the
ABCDE SEE: ABCD. thorax are inversely proportional: when
ABCD rule ABCD score. the movements of the one increase, the
ABCD 2 score, ABCD score ABCD rule. movements of the other decrease. Thus,
ABCDs of palliative care attitude, behav- abdominal movements increase in pleu-
ior, compassion, and dialogue. risy, pneumonia, and pericarditis but
abdiction (ab-dik⬘shŏn) [ab- ⫹ decrease in peritonitis and abdominal
(ad)diction] The intolerance or avoid- pain.
ance of drugs or chemicals. The superficial abdominal veins are
abdomen (ab-dō⬘mĕn, ab⬘dŏ-mĕn) [L. sometimes visibly enlarged, indicating
abdomen, belly] The portion of the an obstruction of blood flow in either the
trunk between the thorax and the pel- portal system (as in cirrhosis) or the in-
vis. The abdomen and the pelvis form ferior vena cava.
the abdominopelvic cavity. The abdo- AUSCULTATION: Listening to sounds
men is bounded superiorly by the tho- produced in abdominal organs provides
racic diaphragm and inferiorly by the useful diagnostic information. Absent or
pelvic brim. The anterolateral abdomi- diminished bowel sounds may indicate

6 MM

Asymmetry Border irregularity Color Diameter


ABCD’S OF MELANOMA
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abdomen 3 aberration

paralytic ileus or peritonitis. High- abdomin-, belly] Prefixes meaning ab-


pitched tinkling sounds are associated domen.
with intestinal obstruction. Bruits may abdominocentesis (ab-dom⬙i-nō-sen-tē⬘
indicate atherosclerosis or an abdomi- sis) [abdomino- ⫹ -centesis] Punc-
nal aortic aneurysm. During pregnancy, ture of the abdomen with an instrument
auscultation enables identification and for withdrawal of fluid from the abdom-
evaluation of the fetal heart rate and inal cavity.
vascular sounds from the placenta. abdominocyesis (ab-dom⬙in-ō-sı̄-ēs⬘is)
PERCUSSION: For the practitioner to [abdomino- ⫹ Gr. kuēsis, pregnancy]
obtain the greatest amount of informa- Abdominal pregnancy.
tion, the patient should be supine with abdominohysterectomy (ab-dom⬙i-nō-
the head slightly raised and knees his-tĕr-ek⬘tŏ-mē) [abdomino- ⫹ hys-
slightly flexed. Percussion should be terectomy] Abdominal hysterectomy.
carried out systematically over the an- abdominohysterotomy (ab-dom⬙i-nō-
terior surface of the abdomen. A com- his-tĕr-ot⬘ŏ-mē) [abdomino- ⫹ hyster-
bination of audible or tactile sensation otomy] Abdominal hysterotomy.
will be perceived by the examiner ac- abdominoperineal (ab-dom⬙i-nō-per⬙ı̆-
cording to underlying structures (such nē⬘ăl) [abdomino- ⫹ perineal] Pert.
as gaseous distended organs versus to the abdomen and the perineum.
solid organs). abdominoplasty (ab-dom⬘i-nō-plas⬙tē)
PALPATION: The abdomen may be [abdomino- ⫹ -plasty] Plastic surgery
palpated with fingertips, the whole on the abdomen, e.g., to remove un-
hand, or both hands; pressure may be wanted fat and skin from the abdomen
slight or heavy, continuous or intermit- and to tighten the rectus muscles.
tent. The head is supported to relax the abdominothoracic (ab-dom⬙i-nō-thŏ-ras⬘
abdominal wall. On occasion, the pa- ik) [abdomino- ⫹ thoracic] Pert. to
tient may be examined in a standing po- the abdomen and thorax.
sition, e.g., palpation of groin hernias abdominovaginal (ab-dom⬙i-nō-vaj⬘i-năl)
may not be feasible in the supine posi- [abdomino- ⫹ vaginal] Pert. to the
tion. abdomen and vagina.
Palpation is helpful in detecting the abdominovesical (ab-dom⬙i-nō-ves⬘i-kăl)
size, consistency, and position of vis- [abdomino- ⫹ vesical] Pert. to the ab-
cera; the existence of tumors and swell- domen and urinary bladder.
ings; and whether the tumors change abducens (ab-doo⬘senz⬙) [L. abducens
position with respiration or are mov- (participle), drawing away] Drawing
able. It is necessary to ascertain away from the midline of the body.
whether there is tenderness in any por- abducens nerve SEE: under nerve.
tion of the abdominal cavity, whether abducent (ab-dū⬘sĕnt) [L. abducens,
pain is increased or relieved by firm participial stem abducent-, fr abducere,
pressure, and whether pain is accentu- to draw away] Abducting; leading
ated by sudden release of firm pressure, away. SEE: abducens.
i.e., rebound tenderness. abduct (ab-dŭkt⬘) [L. abductus, perfect
An arterial impulse, if one exists, is participle fr. abducere, to lead away] To
systolic and expansive. A thrill accom- draw away from the median plane of the
panying a bruit may occasionally be pal- body or one of its parts.
pated. The surface of a tumor is usually abduction (ab-dŭk⬘shŏn) [L. abducere,
firm and smooth but may be nodular. In- to lead away] 1. Movement of a limb
flammatory masses are typically firm away from the median plane of the body.
and reproducibly tender. Effusion of 2. Movement of a digit away from the
blood into tissues, e.g., hematoma, may median plane of the limb. 3. Movement
produce a palpable mass. of an eye away from the nose.
acute a. An abnormal condition of abduction stress test SEE: under stress
the abdomen in which there is a sudden, test.
abrupt onset of severe pain. It requires abductor (ab-dŭk⬘tor) SEE: under mus-
urgent evaluation and diagnosis be- cle.
cause it may indicate a need for imme- aberrant (a-ber⬘ănt) [L. aberrare, to
diate surgical intervention. SYN: sur- wander] Deviating from normal. SYN:
gical a. abnormal.
pendulous a. An abdomen with folds aberration (ab⬙ĕ-rā⬘shŏn) [L. aberrare,
of fatty tissue that drape over the pubis. to wander] 1. Deviation from the nor-
scaphoid a. An abdomen that on ex- mal. 2. Imperfect refraction of light
amination appears hollowed, sunken, or rays.
emaciated. chromatic a. Unequal refraction of
surgical a. Acute a. different wavelengths of light through a
abdominal muscles SEE: under muscle. lens, producing a colored image.
abdominal quadrant SEE: under quad- chromosomal a. An abnormality in
rant. chromosomes regarding number (aneu-
abdomino-, abdomin- [L. abdomen, stem ploidy, polyploidy) or chromosomal ma-
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aberration 4 ABMLI

terial (translocation, deletion, duplica- ability depends on the integration of


tion). several higher brain functions, includ-
higher order a. In ophthalmology, a ing perception, planning, and motor co-
refractive error that cannot be corrected ordination. It is lost in organic brain
by bending light into the eye with eye- syndromes.
glasses or contact lenses. crystallized a. A learned skill, e.g.,
lateral a. Deviation of a ray from the the ability to read or write or use a piece
focus measured on a line perpendicular of equipment, such as a keyboard.
to the axis. fluid a. The ability to reason or draw
longitudinal a. Deviation of a ray inferences, to understand new informa-
from the direction parallel to the optic tion, or to cope with new problems, en-
axis. vironments, or experiences.
spherical a. Aberration or distortion functional a. The ability to perform
of an image due to rays entering the pe- activities of daily living, including bath-
ripheral portion of a spherical mirror or ing, dressing, and other independent
lens being refracted differently from living skills, such as shopping and
those closer to the center. Thus the pe- housework. Many functional assess-
ripheral rays are focused on the optical ment tools are available to quantify
axis at a different point from the central functional ability. SEE: activities of
rays. daily living.
aberrometry (a⬙bĕr-om⬘ĕ-trē) [L. aber- transfer a., impaired Limitation of
rare, to wander ⫹ -metry] The mea- independent movement between two
surement of refractive errors of the eye. nearby surfaces. SEE: Nursing Diagno-
Abeta, A␤ amyloid beta peptide ses Appendix.
Abeta42 amyloid-beta1-42 (a biomarker verbal a. The ability to use words,
in the cerebrospinal fluid for Alzheimer spoken or written, to communicate.
disease). ability bias The tendency to assume that
abetalipoproteinemia (ā⬙bāt⬙ă-lip⬙ŏ-prō⬙ success is linked to prolonged education
tēn-ē⬘mē-ă) [2an- ⫹ beta ⫹ lipopro- rather than to a person’s underlying
tein ⫹ -emia] An inherited disorder abilities, which make him or her a suc-
marked by an absence of beta lipopro- cess in education and other pursuits.
teins in the blood and low levels of cho- abiogenesis (ā⬙bı̄⬙ō-jen⬘ĕ-sis) [1an- ⫹
lesterol, fatty acids, and chylomicrons. biogenesis] Spontaneous generation.
The patient’s red blood cells have a abiogenetic, abiogenous (ā⬙bı̄⬙ō-jĕ-
thorny or spiked appearance (acantho- net⬘ik, ā⬙bē-oj⬘ĕ-nŭs), adj.
cytosis). The condition is most often abiosis (ā⬙bı̄-ō⬘sis) [a- ⫹ bio- ⫹ -osis]
seen in Ashkenazi Jews. Symptoms in- Absence of life. abiotic, adj.
clude retinal macular degeneration and abiotrophy (ā⬙bı̄-o⬘trŏ-fē) [1an- ⫹ bio-
chronic progressive neurological defi- ⫹ -trophy] Premature loss of vitality
cits, which usually begin in childhood. or degeneration of tissues and cells with
Affected infants develop steatorrhea consequent loss of endurance and resis-
and growth retardation. Later clinical tance. abiotrophic (ā⬙bı̄-o⬘trō-fik), adj.
manifestations include ataxia; by ado- ablactation (ab-lak-tā⬘shŏn) [ab- ⫹
lescence, many patients are unable to lactation] 1. The cessation of milk se-
walk. Vitamin E may be helpful in ar- cretion. SEE: wean.
resting the progression of neurological ablate (a-blāt⬘) [L. ablatus, taken away]
aspects. SYN: Bassen-Kornzweig syn- To destroy, excise, or remove.
drome. SEE: acanthocyte. ablation (a-blā⬘shŏn) [ablatio] Removal
abeyance (ă-bā⬘ăns) [Fr. abeance, expec- of a body part, a pathway, or a function,
tation] A temporary suspension of ac- as by chemical or physical destruction
tivity, sensation, or pain. or by surgery. Particular ablations are
abfraction (ab⬙frak⬘shŏn) [ab- ⫹ frac- listed under the first word. SEE: e.g., en-
tion] A wedge-shaped area in the re- dometrial ablation; radiofrequency ab-
gion of the cementoenamel junction of lation; tissue ablation.
the tooth resulting from biomechanical ablative (a-blā⬘tiv) [L. ablativus, taken
forces. away] Pert. to ablation, esp. by sur-
ABG arterial blood gas. gery.
ability (ă-bi⬘li-tē) [Fr. habileté, fr L. ha- ABLEDATA (ā⬘bı̆l-dā⬘tă) A searchable
bilitas, skill] The capacity to perform a Internet database of assistive technol-
task. ogy information maintained by the Na-
cognitive a. The ability of the brain tional Institute on Disability and Re-
to process, retrieve, and store informa- habilitation Research of the U.S.
tion. Impairment of these brain func- Department of Education. The website
tions is common in patients with de- address is www.abledata.com
mentia, drug intoxication, or head ablution (ă-bloo⬘shŏn) [L. abluere, to
injury. wash away] The washing of one’s body,
constructional a. The ability to copy or of a part of it.
or draw shapes, figures, or lines, e.g., ABMLI American Board of Medical Lab-
with a pen and paper. This nonverbal oratory Immunology.
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ABMM 5 abortion

ABMM American Board of Medical Mi- sue (embryonic or fetal) is preserved for
crobiology. laboratory examination. The patient is
ABMS American Board of Medical Spe- evaluated for shock, sepsis, and dissem-
cialties. inated intravascular coagulation.
abnormal (ab⬙nor⬘măl) [ab- ⫹ normal] A health care professional remains
ABBR: abnl. 1. Diverging from a with the patient as much as possible to
known standard or mean. SYN: aber- help allay anxiety, is aware of the pa-
rant. 2. Exceptional. 3. Unexpected. ab- tient’s coping mechanisms, and is alert
normally (ab⬙nor⬘mă-lē), adv. for responses such as grief, anger, guilt,
Abnormal Involuntary Movement Scale sadness, depression, relief, or happi-
test ABBR: AIMS test. A system for ness.
assessing abnormal involuntary move- If an elective abortion or surgical com-
ments, such as hand tremors or rhyth- pletion of the abortion is needed, the
mic movements of the tongue and jaw, procedure and expected sensations are
that may result from the long-term ad- explained, and general perioperative
ministration of psychotropic drugs. The care is provided. If the patient is Rh
test is often given before patients are negative and Coombs test negative (not
started on antipsychotic drugs and then isoimmune), and if the pregnancy ex-
readministered periodically to monitor ceeded 8 weeks’ gestation, Rho(D) is ad-
side effects. ministered as prescribed within 72 hr of
abnormality (ab⬙nŏr-mal⬘ı̆t-ē) [ab- ⫹ the abortion. Prescribed fluids, oxyto-
normality] Deviation from the normal. cics, antibiotics, and transfusions are
SYN: aberration. administered as required.
aborad (a-bōr⬘ad⬙) [ab- ⫹ oro- ⫹ -ad] After abortion, the patient is in-
Away from the mouth. structed to report excessive bleeding
aboral (a-bōr⬘ăl) [ab- ⫹ oral] Opposite (clots greater than dime-size), pain, in-
to, or away from, the mouth. aborally flammation, or fever and to avoid inter-
(-ă-lē), adv. course, tampon use, douching, or plac-
abort (ă-bort⬘) [L. aboriri, to miscarry] ing anything else in the vagina until
1. To expel an embryo or fetus prior to after a follow-up examination.
viability. 2. To arrest the progress of dis- complete a. Abortion in which the
ease. 3. To arrest growth or develop- total products of conception have been
ment. 4. To discontinue an effort or proj- expelled.
ect before its completion. elective a. Abortion for other than
abortifacient (ă-bort-ı̆-fā⬘shĕnt) [abort medical reasons. The procedure may be
⫹ -facient] Anything used to cause or recommended when the woman’s men-
induce an abortion. Examples of abor- tal or physical state would be endan-
tifacients include prostaglandins, gered by continuation of the pregnancy
among other agents. or when the fetus has a condition incom-
abortion (ă-bor⬘shŏn) [L. abortio, pre- patible with life. It may also be per-
mature delivery, miscarriage] The formed as a result of rape, incest, or at
spontaneous or induced termination of the woman’s request. SYN: voluntary
pregnancy before the fetus reaches a vi- termination of pregnancy.
able age. The legal definition of viability habitual a. Recurrent miscarriage.
(usually 20 to 24 weeks’ gestation) dif- incomplete a. An abortion in which
fers from state to state. Some prema- part of the products of conception has
ture neonates of less than 24 weeks’ ges- been retained in the uterus.
tation or 500 g are viable. Symptoms of induced a. Intentional abortion by
spontaneous abortion include abdomi- dilating the cervix and evacuating the
nal cramps and vaginal bleeding, some- uterus. Methods used during the first
times with the passage of clots or bits of trimester include cervical dilation with
tissue. a laminaria tent or a cannula, vacuum
ETIOLOGY: The most common spon- aspiration, or dilation and curettage (D
taneous causes are faulty development & C). In the second trimester, abortion
of the embryo resulting from chromo- may be induced with methotrexate, RU
somal anomalies, abnormalities of the 486, prostaglandins, or the instillation
placenta, endocrine disturbances, acute of hypertonic saline into the uterus.
infectious diseases, severe trauma, and SEE: uterine curettage; mifepristone.
shock. Other causes include problems inevitable a. An abortion that cannot
related to the uterus, immunologic fac- be halted.
tors, and use of certain drugs. medical a. Abortion induced with a
PATIENT CARE: Assessment in- drug or drugs, e.g., the combination of
cludes monitoring vital signs, fluid bal- mifepristone and a prostaglandin.
ance, and abortion status and progress. missed a. Abortion in which the fe-
Historical data must include duration of tus has died before completion of the
pregnancy; Rh status; and time of onset, 20th week of gestation but the products
type, and intensity of abortion symp- of conception are retained in the uterus
toms. Character and amount of vaginal for 8 weeks or longer.
bleeding are noted, and any passed tis- partial-birth a. An abortion per-
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abortion 6 abruptio

formed in the second or third-trimester,


in which the products of conception are
removed by suction curettage and for-
ceps and the cranial contents of the fe-
tus are evacuated before the removal of
the fetus from the uterus. SYN: dilation
and evacuation.
recurrent a. Recurrent miscarriage.
septic a. Abortion in which there is
an infection of the products of concep-
tion and the endometrial lining of the
uterus.
spontaneous a. Miscarriage.
therapeutic a. Abortion performed
when the pregnancy endangers the
mother’s mental or physical health or
when the fetus has a known condition
incompatible with life.
threatened a. The appearance of
signs and symptoms of possible loss of
the fetus. Vaginal bleeding with or with-
out intermittent pain is usually the first
sign. If the fetus is still alive and at-
tachment to the uterus has not been in-
terrupted, the pregnancy may continue.
Absolute bedrest is recommended, with ABRASION
avoidance of coitus, douches, stress, or
cathartics.
tubal a. 1. A spontaneous abortion in acting out a painful experience that had
which the fetus has been expelled been forgotten or repressed. The painful
through the distal end of the uterine or consciously intolerable experience
tube. 2. The escape of the products of may become bearable as a result of the
conception into the peritoneal cavity by insight gained during this process. SEE:
way of the uterine tube. catharsis (2). abreact (ab⬙rē-akt⬘), v.
abortionist (ă-bor⬘shŏn-ist) One who abrin (ā⬘brin) [L. fr. Gr. habros, graceful,
performs an abortion. delicate ⫹ -in] A powerful cellular
abortive (ă-bor⬘tı̆v) [L. abortivus] toxin derived from the seeds of the je-
1. Preventing the completion of some- quirty pea (Abrus precatorius), also
thing. 2. Abortifacient; that which pre- called the Rosary Pea. Abrin prevents
vents the normal continuation of preg- cells from making necessary proteins
nancy. and may cause death or poisoning after
abortus (ă-bor⬘tŭs) [L. miscarriage] A it is inhaled, consumed, or applied to the
fetus born before 20 weeks’ gestation or skin.
weighing less than 500 g. abruptio (ă-brŭp⬘shē-ō) [L. abruptio, a
ABR annual bleed rate. breaking away] A tearing away from.
abrachia (ā-bra⬘kē-ă, -brāk⬘) [a- ⫹ bra- PATHOLOGY: Three types of placen-
chium] Congenital absence of arms. tal abruption occur: a. centralis: a par-
abrachiocephalia (ā-bra⬘kē-ō-sĕ-fāl⬘ē-ă) tial central detachment with hidden
[a- ⫹ brachium ⫹ Gr. kephalē, head] bleeding between the placenta and the
Congenital absence of arms and head. uterine wall; occasionally, blood will in-
abrade (ă-brād⬘) [L. abradere, to scrape] vade the myometrium (Couvelaire
1. To chafe. 2. To roughen or remove by uterus); a. complete: total placental de-
friction. tachment, marked by profuse vaginal
abrasion (ă-brā⬘zhŏn) [L. abradere, to bleeding, profound fetal distress, and
scrape] 1. Wearing away of the sub- rapid fetal demise; a. marginalis: par-
stance of a tooth. It usually results from tial separation of an edge of the pla-
mastication but may be produced by me- centa, as evidenced by vaginal bleeding.
chanical or chemical means. 2. Scraping The large amount of circulating throm-
away of skin or mucous membrane as a boplastin may cause a coagulation de-
result of injury or by mechanical means, fect to occur, resulting in hypofibrino-
as in dermabrasion for cosmetic pur- genemia. SEE: Couvelaire uterus;
poses. SEE: illus.; avulsion; bruise. disseminated intravascular coagula-
pleural a. Mechanical pleurodesis. tion.
abrasive (ă-brā⬘siv) [L. abradere, to a. placentae The sudden, premature,
scrape] 1. Producing abrasion. 2. That partial, or complete detachment of the
which abrades. placenta from a normal uterine site of
abreaction (ab⬙rē-ak⬘shŏn) [ab- ⫹ re- implantation. The incidence of abruptio
action] In psychoanalysis, the release placentae is 1:120 births, and the risk of
of emotion by consciously recalling or recurrence in later pregnancies is much
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abruptio 7 abruptio

higher than that for cohorts. SYN: abla- women who have moderate to severe
tio placentae. SEE: illus.; placenta. abruptions. Complete detachment calls
ETIOLOGY: The cause is unknown; for immediate cesarean delivery, con-
however, the condition is most com- comitant treatment of shock and, some-
monly associated with pregnancy-in- times, management of a coagulation de-
duced hypertension (PIH). It may occa- fect. The massive loss of blood
sionally be related to abdominal jeopardizes the mother’s survival; fetal
trauma, substance abuse (cigarette, al- mortality is 100%. If the uterus fails to
cohol, or cocaine), or sudden premature contract after the surgical delivery, im-
rupture of membranes. mediate hysterectomy may be neces-
SYMPTOMS: Abruptio placentae is sary. SEE: Couvelaire uterus.
classified according to type and severity. PROGNOSIS: Although maternal
Grade 1: vaginal bleeding with possible mortality is unusual, other than as
uterine tenderness and mild tetany; nei- noted, the perinatal mortality is be-
ther mother nor baby is in distress; ap- tween 20% and 30%.
proximately 10% to 20% of placental PATIENT CARE: Early recognition
surface is detached. Grade 2: uterine and prompt management of the event
tenderness; tetany, with or without and any associated complications are vi-
uterine bleeding; fetal distress; mother tal. The woman’s vital signs, fundal
is not in shock. Approximately 20% to height, uterine contractions, labor pro-
50% of the total surface area of the pla- gress, and fetal status data are moni-
centa is detached. Grade 3: Uterine tet- tored, including heart rate and rhythm.
any is severe; the mother is in shock, al- Any changes are noted, such as pro-
though bleeding may be covert; and the longed decelerations in fetal heart rate
fetus is dead. Often the patient develops or alterations in baseline variability;
coagulopathy. More than 50% of the pla- uterine tetany; complaints of sudden,
cental surface is detached. severe abdominal pain; and the advent
PATHOLOGY: Extravasation of blood of or increase in vaginal bleeding. Vagi-
occurs between the placenta and the nal blood loss is estimated by weighing
uterine wall, occasionally between mus- perineal pads and subtracting the
cle fibers of the uterus. Hemorrhage can known weight of dry pads. The interval
be concealed or covert, causing con- between pad changes, the character and
sumptive coagulopathy (disseminated amount of the bleeding, and the degree
intravascular coagulopathy). of pad saturation are noted. Prescribed
TREATMENT: This varies with the IV fluids and medications are adminis-
type and extent of abruption. Women tered through a large-bore catheter. A
experiencing only a small marginal sep- central venous pressure line may be
aration of the placenta from the uterine placed to provide access to the venous
wall may be confined to bed and moni- circulation, and an indwelling catheter
tored closely for signs of further threat is inserted to monitor urinary output
to maternal or fetal status. If prematu- and fluid balance. A calm atmosphere is
rity also is a factor, the woman may be maintained, and the patient’s verbaliza-
given betamethasone to expedite devel- tion is encouraged. The patient is as-
opment of fetal pulmonary surfactant. If sisted in coping with her fears and an-
the woman is at or near term, induction xiety. Questions are answered
of labor and vaginal delivery may be an truthfully, comfort measures are imple-
option. SEE: betamethasone. mented, and reassurance is provided as
Supportive treatment and prompt possible and consistent with the current
surgical intervention are indicated for situation and prognosis. All procedures

Partial separation Partial separation Complete separation


(concealed hemorrhage) (apparent hemorrhage) (concealed hemorrhage)
ABRUPTIO PLACENTAE
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abs 8 abscess

are explained, and the woman and her alveolar a. An abscess around the
family are prepared for induction of la- root of a tooth in the alveolar cavity. It
bor, vaginal delivery, or cesarean birth, is usually the result of necrosis and in-
as appropriate. The woman must be as- fection of dental pulp following the oc-
sured that everything is being done for currence of dental caries. SEE: periapi-
the neonate’s survival, which depends cal a.
primarily on gestational age, blood loss, amebic a. An abscess, typically in
and associated hypertensive disorders. the liver, caused by Entamoeba histolyt-
abs A colloquial term for the rectus ab- ica. SYN: endamebic abscess.
dominis muscles. anorectal a. An abscess in the ischio-
abscess (ab⬘ses) [L. abscessus, a going rectal fossa. It occurs in patients with
away, departure] A localized collection Crohn disease, diabetes mellitus, or
of pus in any body part, resulting from anal fissures more often than in others.
invasion of a pyogenic bacterium or Incision, drainage, and antibiotics usu-
other pathogen. Staphylococcus aureus, ally provide effective treatment. SYN:
e.g., methicillin-resistant S. aureus rectal abscess.; SYN: ischiorectal ab-
(MRSA), is a common cause. The ab- scess.
scess is surrounded by a membrane of apical a. 1. An abscess at the apex of
variable strength created by macro- a lung. 2. Periapical a.
phages, fibrin, and granulation tissue. appendicular a. An abscess around
Abscesses can disrupt function in adja- an inflamed or ruptured vermiform ap-
cent tissues and can be life threatening pendix.
in some circumstances, e.g., in the lung axillary a. An abscess or multiple ab-
or within the peritoneal cavity. SEE: il- scesses in the axilla, e.g., in patients
lus.; inflammation; pus; suppuration. with hidradenitis suppurativa.
Bartholin a. SEE: under Bartholin,
Caspar (the younger).
Bezold a. SEE: under Bezold, Fried-
rich.
bicameral a. An abscess with two
pockets.
bile duct a. An abscess of the bile
duct. SYN: cholangitic abscess.
biliary a. An abscess of the gallblad-
der. It is an infrequent complication of
cholangitis or obstruction of the bile
duct.
bone a. Brodie abscess.
brain a. An intracranial abscess in-
volving the brain or its membranes. It
is seldom primary but usually occurs
secondary to infections of the middle
ear, nasal sinuses, face, or skull or from
contamination from penetrating
wounds or skull fractures. It may also
have a metastatic origin arising from
septic foci in the lungs (as in bronchi-
ectasis, empyema, lung abscess), in
bone (as in osteomyelitis), or in the
heart (as in endocarditis). Infection of
ANTECUBITAL ABSCESS nerve tissue by the invading organism
results in necrosis and liquefaction of
Antecubital abscess opened to allow the tissue, with edema of surrounding
drainage of infection tissues. Brain abscesses may be acute,
acute a. An abscess associated with subacute, or chronic. Their clinical man-
significant inflammation, producing in- ifestations depend on the part of the
tense heat, redness, swelling, and brain involved, the size of the abscess,
throbbing pain. The tissue over the ab- the virulence of the infecting organism,
scess becomes elevated, soft, and even- and other factors. SYN: cerebral ab-
tually unstable (fluctuant) and discol- scess; intracranial abscess.
ored as the abscess comes to a head. An SYMPTOMS AND SIGNS: Symptoms
abscess can rupture spontaneously or be may include headache, fever, vomiting,
drained via an incision. If it is left un- malaise, irritability, seizures, or paral-
treated, the invading pathogens may ysis.
spread to adjacent tissues or to other TREATMENT: The usual treatment is
parts of the body through the blood- chemotherapy. Surgical drainage may
stream. Appearance of or increase in fe- be required.
ver may indicate sepsis. breast a. Mammary a.
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abscess 9 abscess

Brodie a. SEE: under Brodie, Sir iliopsoas a. An abscess in the psoas


Benjamin Collins. and iliacus muscles. It typically results
bursal a. An abscess in a bursa. from a local or regional spread of an in-
canalicular a. A breast abscess that testinal or renal abscess or from a blood-
discharges into the milk ducts. borne infection, e.g., after a drug injec-
caseous a. An abscess in which the tion. SYN: psoas a.
pus has a cheesy appearance. intracranial a. Brain a.
cerebral a. Brain a. intradural a. An abscess within the
cholangitic a. Biliary a. layers of the dura mater.
chronic a. An abscess containing pus intraperitoneal a. Peritoneal a.
but without signs of inflammation. It ischiorectal a. Anorectal a.
usually develops slowly as a result of kidney a. An abscess in the kidney,
liquefaction of tuberculous tissue. It typically following pyelonephritis or a
may occur anywhere in or on the body blood-borne infection. The most com-
but more frequently is found in the mon causative organisms are gram-neg-
spine, hips, genitourinary tract, and ative bacteria from the lower urinary
lymph glands. Symptoms may be very tract that spread to the kidneys and
mild. Pain, when present, is caused by Staphylococcus aureus from a blood-
pressure on surrounding parts; tender- borne infection. Immunocompromised
ness is often absent. Chronic septic patients may develop abscesses caused
changes accompanied by afternoon fe- by Nocardia, Candida, or Aspergillus.
ver may occur. Amyloid disease may de- Occasionally, Mycobacterium tubercu-
velop if the abscess persists for a pro- losis and Echinococcus are responsible
longed period. SYN: cold abscess. agents. SYN: renal.
circumtonsillar a. Peritonsillar a. TREATMENT: Antimicrobial agents
cold a. Chronic a. are used in combination with surgical
collar-button a. Two pus-containing drainage. Occasionally, nephrectomy or
cavities, one larger than the other, con- retroperitoneal exploration is required.
nected by a narrow channel. lacrimal a. An abscess in a lacrimal
dental a. An acute inflammatory in- gland or in a lacrimal duct.
fection within the maxilla or mandible. lateral alveolar a. An abscess occur-
SEE: periapical a.; periodontal a. ring in periodontal tissue.
dentoalveolar a. Periapical a. liver a. An abscess in the liver caused
diffuse a. An abscess not circum- by pathogenic organisms such as those
scribed by a well-defined capsule. of species of Bacteroides, Streptococcus,
dry a. An abscess that disappears Staphylococcus, or Entamoeba histolyt-
without pointing or breaking. ica.
embolic a. Metastatic a. SYMPTOMS AND SIGNS: The patient
emphysematous a. An abscess con- generally has high fevers; sweats and
taining air or gas, produced by orga-
chills; and an enlarged, painful, tender
nisms such as Clostridium perfringens.
liver. Pus may be obtained by aspira-
SYN: gas abscess; tympanitic abscess.
tion.
endamebic a. Amebic a.
IMPACT ON HEALTH: Embolic (mul-
epidural a. Extradural a.
extradural a. An abscess on the dura tiple) abscesses are generally fatal.
mater that is an occasional cause of Liver abscesses may heal after they
back pain in febrile patients, usually in have been removed and treated with an-
those who inject drugs. SYN: epidural tibiotics. SEE: hepatic a.
abscess. lumbar a. An abscess in the lumbar
fecal a. An abscess containing both region.
pus and stool. SYN: stercoraceous ab- lung a. An abscess in lung tissue,
scess; stercoral abscess. caused by anaerobic bacteria such as
filarial a. An abscess caused by para- Staphylococcus aureus or Nocardia spe-
sitic infection with microfilariae. cies.
follicular a. An abscess in a follicle. lymphatic a. An abscess of a lymph
fungal a. An abscess caused by a fun- node.
gus, as in the syndrome mycetoma. mammary a. An abscess in the fe-
SYN: mycotic abscess. male breast, esp. one involving the glan-
gas a. Emphysematous a. dular tissue. It usually occurs during
gingival a. An abscess of the gum. lactation or weaning. SYN: breast ab-
helminthic a. Worm a. scess.
hemorrhagic a. An abscess contain- mastoid a. An abscess of the mastoid
ing blood. portion of the temporal bone.
hepatic a. Liver a. metastatic a. A secondary abscess at
hot a. Acute a. a distance from the focus of infection.
hypostatic a. Metastatic a. SYN: embolic abscess; hypostatic ab-
idiopathic a. An abscess of unknown scess; wandering abscess.
cause. miliary a. Multiple small embolic ab-
iliac a. An abscess in the iliac region. scesses.
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abscess 10 abscess

milk a. A mammary abscess during infection with pneumococci (Streptococ-


lactation. cus pneumoniae).
mycotic a. Fungal a. premammary a. A subcutaneous or
orbital a. An abscess in the orbit of subareolar abscess of the mammary
the eye. gland.
palatal a. An abscess in a maxillary pulp a. 1. An abscess in the pulp
tooth, erupting toward the palate. chamber of a tooth. 2. An abscess of the
palmar a. An abscess in the tissues tissues of the pulp of a finger.
of the palm of the hand. rectal a. Anorectal a.
pancreatic a. An abscess of pancre- renal a. Kidney a.
atic tissue, usually as a complication of retrocecal a. An abscess located be-
acute pancreatitis or abdominal sur- hind the cecum. It is an occasional, se-
gery. vere complication of a ruptured appen-
parametric a. An abscess between dix or Crohn disease.
the folds of the broad ligaments of the retromammary a. An abscess be-
uterus. tween the mammary gland and the
paranephric a. An abscess in the tis- chest wall.
sues around the kidney. SYN: perineph- retroperitoneal a. An abscess located
ric abscess. between the peritoneum and the poste-
parapancreatic a. An abscess in the rior abdominal wall. It may arise from
tissues adjacent to the pancreas. SYN: an abscess in the kidney or from the
peripancreatic abscess. spread of an intraperitoneal infection
parietal a. A periodontal abscess posteriorly.
arising in the periodontal tissue other retropharyngeal a. An abscess of the
than the orifice through which the vas- lymph nodes in the walls of the phar-
cular supply enters the dental pulp. ynx. It sometimes simulates diphthe-
pelvic a. An abscess of the pelvic ritic pharyngitis.
peritoneum, esp. in the pouch of Doug- CAUSES: Staphylococcus aureus and
las. It may arise as a complication of a group A beta-hemolytic streptococcus
sexually transmitted disease or diver- are the most common pathogens.
ticulitis. SYMPTOMS AND SIGNS: Typically, a
perianal a. An abscess of the skin history of pharyngitis is elicited. This is
around the anus. It usually results from followed by high fever, dysphagia, and
obstruction of intestinal crypts and sub- refusal to eat. The condition progresses
sequent fistula formation in the skin. to respiratory distress with hyperexten-
SYN: periproctic abscess. sion of the head (“sniffing position”),
periapical a. An abscess at the apex tachypnea, labored breathing, and
of a tooth, usually resulting from dental drooling. An exquisitely tender bulge in
the pharyngeal wall is usually evident.
caries or tooth trauma. It may be clas-
TREATMENT: A retropharyngeal ab-
sified further as an acute periapical ab-
scess, if fluctuant, should be treated
scess, a chronic periapical abscess, a
with incision and drainage. If it is rec-
periapical granuloma, or a radicular
ognized before becoming fluctuant, the
cyst. SYN: apical abscess (2); dentoal-
abscess should be treated with antibi-
veolar abscess. otics, intravenously administered if the
pericemental a. An alveolar abscess patient is unable to swallow.
not involving the apex of a tooth. retrovesical a. An abscess behind the
pericoronal a. Pericoronitis. bladder.
peridental a. An abscess of periodon- runaround a. A colloquial term for a
tal tissue. bacterial infection that surrounds a fin-
perinephric a. Paranephric a. gernail; a paronychia.
periodontal a. An acute or chronic sacrococcygeal a. An abscess over
abscess found in the gingiva, periodon- the sacrum and coccyx.
tal pockets, or periodontal ligament. septicemic a. An abscess resulting
peripancreatic a. Parapancreatic a. from septicemia.
periproctic a. Perianal a. spermatic a. An abscess of the semi-
peritoneal a. An abscess within the niferous tubules.
peritoneal cavity usually following peri- spinal a. An abscess resulting from
tonitis. It is usually caused by enteric necrosis of a vertebra.
bacteria, e.g., Escherichia coli, entero- splenic a. An abscess of the spleen.
cocci, or Klebsiella. SYN: intraperitoneal It may arise either from the spread of
abscess. infection from a neighboring organ
peritonsillar a. An abscess of the tis- (such as a diverticular abscess or a rup-
sue around the tonsillar capsule. Needle tured gastric ulcer) or from hematoge-
aspiration of the abscess, with subse- nous spread in patients with infective
quent antibiotic therapy, is an effective endocarditis.
treatment in 90% of cases. SYN: circum- stercoral a. Fecal a.
tonsillar abscess. sterile a. An abscess from which mi-
pneumococcic a. An abscess due to croorganisms cannot be cultivated, such
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abscess 11 absorptiometry

as an occasional complication of an in- tance from the actual radiation site or


tramuscular injection. target.
streptococcal a. An abscess caused absence (ab⬘sĕns) [Fr. fr. L. absentia]
by streptococci. 1. Brief temporary loss of consciousness,
subaponeurotic a. An abscess be- as may occur in petit mal epilepsy.
neath an aponeurosis or fascia. 2. Lack of development of a structure.
subarachnoid a. An abscess of the absenteeism (ab⬙sĕn-tē⬘izm) [absentee
midlayer of the covering of the brain ⫹ -ism] Prolonged or repeated absence
and spinal cord. from work, school, or assigned duties.
subareolar a. An abscess underneath Absidia (ab-sid⬘ē-ă) A genus of patho-
the areola of the mammary gland, some- genic fungi of the order Phycomycetes
times draining through the nipple. and the family Mucoraceae.
subdiaphragmatic a. An abscess be- absinthe, absinth (ab⬘sinth) [L. fr. Grap-
neath the diaphragm, e.g., a hepatic, sinthion, wormwood] A bitter, green,
splenic, or interperitoneal abscess. distilled, highly alcoholic, anise-fla-
SYN: subphrenic abscess. vored spirit derived from botanicals, in-
subdural a. An abscess beneath the cluding the flowers and leaves worm-
dura of the brain or spinal cord. wood, green anise, sweet fennel, and
subgaleal a. An abscess beneath the other herbs. By 1915, absinthe had been
galea aponeurotica (the epicranial apo- banned in the U.S. and in much of Eu-
neurosis). rope because of its alleged toxicity. A re-
subphrenic a. Subdiaphragmatic a. vival of absinthe began in the 1990s,
subungual a. An abscess beneath the and, by the early 21st century, nearly
fingernail. It may follow injury from a 200 brands of absinthe were being pro-
pin, needle, or splinter. duced in a dozen countries, including
sudoriparous a. An abscess of a the U.S. SEE: wormwood.
sweat gland. absinthium (ab-sin⬘thē-ŭm) [absinthe
syphilitic a. An abscess occurring in ⫹ -ium (2)] Wormwood.
the tertiary stage of syphilis, esp. in absolute (ab⬙sŏ-loot⬘) [L. absolvere, to
bone. set free] 1. Unrestricted, complete, to-
thecal a. A spinal epidural abscess. tal. 2. Pureor highly concentrated.
tonsillar a. Acute suppurative tonsil- absolute benefit increase ABBR: ABI.
litis. The beneficial effect of an intervention
tooth a. Alveolar a. or treatment in a clinical trial. It con-
tropical a. An amebic abscess of the sists of the number of events observed
liver. in the experimental cohort minus the
tuberculous a. Chronic a. number of events in the control group.
tubo-ovarian a. An abscess involving The term is the opposite of the “absolute
both the fallopian tubes and the ovaries. risk increase.”
It is typically transmitted sexually. absolute risk increase ABBR: ARI. A
tympanitic a. Emphysematous a. measure of the negative effect of an in-
tympanocervical a. An abscess aris- tervention or treatment in a clinical
ing in the tympanum and extending to trial. It consists of the number of ad-
the neck. verse events found in the experimental
tympanomastoid a. An abscess of group minus the number of adverse
both the tympanum and the mastoid. events in the control group. It is the op-
urethral a. An abscess in the urethra. posite of the “absolute benefit increase.”
urinary a. An abscess caused by es- absorb (ăb-sorb⬘) [Fr. fr. L. absorbere, to
cape of urine into surrounding tissues. suck in] To take in, suck up, or imbibe.
urinous a. An abscess that contains SEE: absorption; adsorb; adsorption.
pus and urine. absorbance (ăb-sor⬘băns) 1. In health
verminous a. Worm a. care, the ability of a material or a tissue
wandering a. Metastatic a. to absorb electromagnetic radiation,
worm a. An abscess caused by or esp. ionizing radiation. 2. In chemistry,
containing insect larvae, worms, or the negative logarithm of the transmit-
other animal parasites. SYN: helmin- tance of radiation through a substance
thic; verminous abscess. or solution.
abscissa (ab-sis⬘ă) [L. abscindere, to cut absorbent (ăb-sor⬘bĕnt) [absorb] 1. A
off] The horizontal line, or x-axis, in a substance that absorbs. 2. Having the
graph of a two-dimensional coordinate power to absorb.
system in which perpendicular horizon- absorptiometry (ăb-sorp⬙shē-ŏm⬘ĕ-trē)
tal and vertical lines are used in order [absorptiometer] The measurement of
to provide a frame of reference. The or- the dissipation of x-rays as they pass
dinate is the vertical line, or y-axis. through substances, e.g., body tissues.
abscission (ab-si⬘zhŏn) [L. abscindere, dual-energy x-ray a. ABBR: DEXA;
to cut off] Removal by cutting off; ex- DXA. A radiographic technique used to
cision. measure the average density of the min-
abscopal (ab-skō⬘păl) Concerning the ef- eral concentration of bone, as at the fe-
fect of radiation on tissues at some dis- mur, the heel, or the forearm. It is used
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absorption 12 abuse

primarily in the diagnosis of osteopenia erages, or sexual intercourse. 2. Accord-


and osteoporosis. ing to some ethical systems, renuncia-
absorption (ăb-sorp⬘shŏn) [L. absorptio] tion of all sexual activity, e.g., by
1. The taking up of liquids by solids or Buddhists monks and nuns and some
of gases by solids or liquids. 2. The tak- Christian clergy. SEE: continence. ab-
ing up of light or its energy by black or stinent (ăb⬘sti-nĕnt), adj.
colored rays. 3. The taking up by the abstract (ăb⬘străkt, ab⬘strakt, ab-strakt⬘)
body of radiant energy, causing a rise in [L. abstrahere, to draw away] 1. A sum-
body temperature. 4. The reduction in mary or abridgment of an article, book,
intensity of an x-ray photon as it passes or address. 2. Intangible.
through a substance or a beam of light discharge a. Discharge summary.
as it passes through a solution (used in abstraction (ăb-strak⬘shŏn) [L. abstrac-
clinical photometry as well as nuclear tio, separation] 1. Removal or separa-
methods). 5. The passage of a substance tion of a constituent from a mixture or
through some surface of the body into compound. 2. Distraction of the mind;
body fluids and tissues, such as the dif- inattention or absent-mindedness.
fusion of oxygen from the alveolar air 3. The process whereby thoughts and
into the blood, or the active transport of ideas are generalized and dissociated
amino acids from food through the epi- from particular concrete instances or
thelium of the small intestine. material objects.
carbohydrate a. The taking up of the abulia, aboulia (ă-bū⬘lē-ă) [a- ⫹ Gr.
monosaccharides by the brush border of boulē, will ⫹ -ia] 1. Absence of or de-
the small intestine. creased ability to exercise willpower or
colonic a. The uptake of water, elec- initiative or to make decisions. 2. A syn-
trolytes such as sodium, amino acids, drome marked by slow reaction, lack of
and some drugs by the mucosa of the spontaneity, and brief spoken re-
large bowel. sponses. It may be part of the clinical
cutaneous a. Absorption through the picture that accompanies injuries to or
skin. SYN: percutaneous a. diseases of the internal capsules, basal
external a. Absorption of material by ganglia, or frontal lobes of the brain.
the skin and mucous membrane. abuse (ă-būs⬘) [ L. abusus, wasting, mis-
fat a. The taking up of glycerols and use] 1. Excessive or improper use, e.g.,
fatty acids, suspended in bile salts, into of alcohol; misuse. 2. Injurious, patho-
the villi of the small intestine. logical, or malignant treatment of an-
gastric a. Absorption of water, alco- other person or living thing, e.g., verbal,
hol, and some salts through the gastric physical, or sexual assault.
mucosa. child a. Emotional, physical, or sex-
mouth a. Oral or buccal absorption ual injury to a child. It may be due ei-
of materials or medicines such as nico- ther to an action or to an omission by
tine or nitroglycerin. Alkaloids are bet- those responsible for the child. In do-
ter absorbed through the oral mucosa mestic situations in which a child is
than acidic chemicals. abused, it is important to examine other
parenteral a. Absorption of fluids, children and infants living in that
electrolytes, and nutrients from a site home; about 20% will have signs of
other than the gastrointestinal tract. physical abuse. The examination should
pathological a. Absorption of a sub- be done without delay. An infant or
stance normally excreted, e.g., urine, or child must never be allowed to remain
of a product of disease processes, e.g., in an environment where abuse has oc-
pus, into the blood or lymph. curred. SEE: battered child syndrome;
percutaneous a. Cutaneous a. shaken baby syndrome.
protein a. The taking up of amino ac- PATIENT CARE: All health care pro-
ids— singly, or linked as dipeptides or viders, teachers, and others who work
tripeptides— by the brush border of the with children are responsible for iden-
small intestine. tifying and reporting abusive situations
small intestinal a. The uptake of wa- as early as possible. Risks for abuse may
ter, fatty acids, monosaccharides, amino be assessed by identifying predisposing
acids, vitamins, and minerals from the parental, child, and environmental
lumen of the gut into the capillary net- characteristics, but these are not by
works and lacteals of the villi. The small themselves predictors of actual abuse. A
intestine is the major site of nutrient ab- detailed history and thorough physical
sorption in the body. examination should be carried out.
absorption lines In spectroscopy, dark Findings should be assessed not only in
lines of the solar spectrum. comparison to known indicators of mal-
absorptive (ăb-sorp⬘tiv) Absorbent. ab- treatment but also in light of diseases
sorptively, adv. absorptiveness, n. or cultural practices that can simulate
abstinence (ăb⬘sti-nĕns) [Fr. fr L. abs- abuse. Nurses play an important role in
tinere, to abstain] 1. Going without identifying child abuse because they of-
something voluntarily, esp. refraining ten are the first health care contacts for
from indulgence in food, alcoholic bev- child and family, e.g., in the emergency
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abuse 13 abuse

department, physician’s office, clinic, or gerated response); refusal of parents to


school. sign for needed tests or treatments; ex-
Physical neglect may be evidenced by cessive delay in seeking treatment; ab-
failure to thrive, signs of malnutrition, sence of parents for questioning; inap-
poor personal hygiene, dental neglect, propriate response of the child (little or
unclean or inappropriate dress, fre- no response to pain, fear of being
quent injuries from lack of supervision, touched, excessive or deficient separa-
enuresis, and sleep disorders. tion anxiety); previous reports of abuse
Emotional abuse (belittling, rejection) in the family; and/or repeated visits to
and neglect may be suspected but are emergency facilities with injuries (this
difficult to substantiate. Physical abuse may require checking with other facili-
is not always obvious and may be diffi- ties). Suspicions may be aroused by a
cult to diagnose. Overt evidence of feeling that behaviors are “not right.”
abuse includes bruises and welts, im- The first priority of care for the
print burns (forming the shape of a cig- abused child is prevention of further in-
arette tip or other item), immersion jury. This usually involves removing the
burns (socklike on feet and legs or do- child from the abusive situation by re-
nut-shaped on buttocks or genitalia), porting the situation to local authori-
spiral fractures and dislocations of ties. All U.S. states and Canadian prov-
limbs, facial and rib fractures, abra- inces have laws for mandatory
sions and lacerations in various stages reporting of such mistreatment. If evi-
of healing, human bite marks (with tis- dence of abuse is supported, further ac-
sue compression and contusion), and tion is taken. Care consistent with that
chemical poisonings. Behavioral indi- for a rape victim is provided when sex-
cators include self-stimulating behav- ual abuse is present. All needs of the
iors; lack of social smile and stranger abused child are considered as they
anxiety during infancy; withdrawal; un- would be for any other child. Caregivers
usual wariness; antisocial behavior (de- act as role models for parents, helping
structiveness, cruelty, stealing); being them to relate positively to their child
indiscriminately friendly or displaying and fostering a therapeutic environ-
unexpected affection; developing only ment: there is no accusation or punish-
superficial relationships; acting out to ment, only concern and treatment to
seek attention; being overly compliant, help parents recognize and change abu-
passive, aggressive, or demanding; de- sive behavior. Referral to self-help
lays in emotional, language, and intel- groups, resources for financial aid, im-
lectual developmental; and suicide at- proved housing, and child care are im-
tempts. portant to help families deal with over-
Symptoms in the older child include whelming stress.
begging or stealing food, frequent school Educational programs in the prenatal
absences, vandalism, shoplifting, or period, infancy home visits, and outpa-
substance abuse. tient parent groups provide opportuni-
When sexual abuse is suspected, a ties for health care providers to inform
thorough but gentle physical examina- families about normal growth and de-
tion must be conducted. Physical indi- velopment and routine health care.
cators may include any injury to the ex- Families can also share their concerns,
ternal genitalia, anus, mouth, and gain support from others, and obtain re-
throat; torn, stained, or bloody under- ferrals to appropriate services when
garments; pain on urination or recur- needs are identified. Prevention of sex-
rent urinary tract infections; pain, ual abuse focuses on teaching children
swelling, unusual odor, and itching of about their bodies, their right to pri-
the genitalia; vaginal or penile dis- vacy, and their right to say no. Parents
charge, vaginitis, venereal warts, or and school nurses can discuss such top-
sexually transmitted diseases; difficulty ics with children, using “what if” ques-
with walking or sitting; or pregnancy in tions to explore potentially dangerous
the young adolescent. In most cases, the situations. Everyone ought to know that
child knows the sexual abuser; in about “nice” people can be sexual abusers and
half the cases the abuser is a caregiver that a change in a child’s behavior
or parent. toward a person requires investigation.
Abuse should be suspected in the The child must always be reassured
presence of physical evidence, including that whatever happened was not his or
old injuries; conflicting stories about an her fault. Prevention of false accusa-
accident or injury from parents or oth- tions is also important. Caregivers play
ers; injury blamed on siblings or an- an important role by carefully docu-
other party; injury inconsistent with the menting all evidence of abuse and re-
history given; a history inconsistent cording exactly what they observed on
with the child’s developmental age; a examination and what behaviors oc-
chief complaint not associated with curred without interpreting their mean-
physical evidence; inappropriate level of ing.
parental concern (absence or an exag- For further information on abuse or
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abuse 14 abuse

reporting abuse, contact: U.S. Depart- deaths from opioid overdose as one of its
ment of Health and Human Services top five patient safety goals.
Children’s Bureau: Childhelp USA’s elder a. Abuse of someone over 65. It
National Child Abuse Hotline at 1-800- includes physical violence, financial ex-
4 A CHILD (https://www.childhelp.org/ ploitation, intimidation, humiliation,
hotline); Prevent Child Abuse America isolation, and neglect. Elders may be ex-
at 1-800-CHILDREN or 312-663-3520 ploited by individuals and organiza-
(http://www.preventchildabuse.org); or tions. SYN: elder mistreatment.
National Clearinghouse on Child Abuse PATIENT CARE: The assessment of
and Neglect Information at 1-800-394- older people thought to have been
3366 or 703-385-7565 (http:// abused includes looking for evidence of
www.childwelfare.gov). impairment in caregiver relationships
domestic a. Abuse of people in a do- to the aged and in finding unusual pat-
mestic setting. Such abuse includes terns of injuries or illnesses unlikely to
physical violence (such as striking or occur from disease. When abuse is sus-
raping a family member), passive abuse pected, questions such as “Do you feel
(such as withholding access to health safe and well cared for at home?” or
care), psychological or emotional abuse “Has someone hurt you?” or “Did some-
(such as intimidation, or threatening one do this to you?” may elicit a history
physical harm or abandonment), and of abuse if the patient is mentally com-
economic abuse by imposing financial petent. Careful documentation of his-
dependency. Domestic abuse is com- torical and physical findings (including
mon: more than two million Americans discrepancies between patient and care-
are abused or assaulted each year. giver reports) and notification of legal au-
PATIENT CARE: Domestic violence thorities (such as a local adult protective
should be considered in any patient who services agency, long-term-care ombuds-
presents with unexplained bruises, lac- man, or the police) are mandated in most
erations, burns, fractures, or multiple jurisdictions. Resources for health care
injuries in various stages of healing, providers include the National Center on
esp. in areas normally covered by cloth- Elder Abuse Phone (202-898-2586; http://
ing; delays seeking treatment for an in- www.ncea.aoa.gov); National Adult Pro-
jury; has a partner who is reluctant to tective Services Association (http://
leave the patient alone or is uncooper- napsa-now.org); the National Long Long-
ative or domineering; indicates that he Term Care Ombudsman Resource Cen-
or she has a psychiatric history or drug ter (202-332-2275; www.ltcombudsman
or alcohol problems; presents with in- .org); and the U.S. Administration on Ag-
juries inconsistent with the “accident” ing Elder Care Locator (1-800-677-1116;
reported; expresses fear about return- www.eldercare.gov/Eldercare.net/Public/
ing home or for the safety of children in HomeIndex.asp).
the home; or talks about harming him- Health care providers can also help
self or herself. Professional health care older adults by educating them about
providers should screen such patients the potential for abuse (such as in com-
privately to ensure confidentiality and munity education and outreach pro-
patient safety. “Do you feel safe at grams), explaining that abuse can be
home?” may elicit a history of abuse. A physical, emotional, or financial, and
sympathetic and nonjudgmental man- that even people who appear to be kind
ner helps victims communicate. Scru- can be abusive. Talking points include
pulous documentation of evidence of recommendations that older adults re-
abuse is critical. Reporting is manda- main active and engaged with others in
tory in many states. the community and that they get help
drug a. The use or overuse, usually and representation from ombudsmen or
by self-administration, of any drug in a family lawyers who can be trusted to
manner that deviates from the pre- represent their interests.
scribed pattern. fiduciary a. Unlawful appropriation
Health care workers, many of whom and misuse of money held in custody on
have easy access to narcotics, are at behalf of a dependent.
high risk of abusing analgesics. In- inhalant a. The deliberate inhala-
creased awareness of this problem has tion of dusts, gases, gasolines, paints,
led hospitals to establish special pro- solvents or other chemicals in order to
grams for identifying these individuals, alter perception or consciousness.
esp. physicians, nurses, and pharma- Many inhalants used for this purpose
cists, in order to provide support and ed- may damage the upper or lower res-
ucation in an attempt to control the piratory tracts or cause brief or long-
problem and prevent loss of license. lasting injuries to the central nervous
In the U.S., the abuse or misuse of system.
prescription drugs has been identified laxative a. The ingestion of cathartic
by the Centers for Disease Control and drugs to relieve perceived constipation
Prevention (CDC) as a growing prob- when none is present or to prevent the
lem. In 2014, the CDC listed reducing absorption of nutrients, e.g., in bulimia.
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abuse 15 acanthoma

Patients who consume excessive quan- large genus of trees (Acacia) native to
tities of laxatives may complain of the warm regions of the world. 2. Gum
chronic diarrhea or may present with arabic.
illnesses caused by electrolyte deficien- gum a. Gum arabic.
cies. academic dishonesty Intentional partic-
psychoactive substance a. Sub- ipation in deceptive practices in one’s
stance a. academic work or the work of others.
sexual a. Fondling, rape, sexual as- Examples include cheating, fraud, pla-
sault, or sexual molestation. The abuser giarism, or falsification of research re-
may be a male or female, adult or child. sults.
The victim may be of the same sex or the Academy of Breastfeeding Medicine
opposite sex as the abuser. SEE: incest; ABBR: ABM. An international profes-
rape. sional association of physicians who
spouse a. Emotional, physical, or promote, study, and support breastfeed-
sexual mistreatment of one’s spouse. ing and maternal lactation.
substance a. A maladaptive pattern acalculia (ā⬙kal-kū⬘lē-ă) [a- ⫹ L. cal-
of behavior marked by the use of chem- culare, to reckon] A learning or speech
ically active agents, e.g., prescription or disorder characterized by the inability
illicit drugs, alcohol, and tobacco. Sub- to perform simple arithmetic opera-
stance abuse is pervasive and causes tions.
half of all annual deaths in the U.S. acampsia (ă-kamp⬘sē-ă) [a- ⫹ Gr.
About 18% of adult Americans smoke kamptein, to bend] Inflexibility of the
cigarettes, 6% use illicit drugs regu- joints of a limb; rigidity; ankylosis.
larly, and about 14% are alcoholics. The acantha (ă-kan⬘thă) [Gr. akantha,
consequences of substance abuse in- thorn] 1. The spine. 2. A vertebral spi-
clude heart disease, cancer, stroke, nous process.
chronic obstructive lung disease, cirrho- Acanthamoeba (ă-kan⬙thă-mē⬘bă)
sis, trauma, and familial, social, legal, [acanth- ⫹ amoeba] A genus of
and economic difficulties. SYN: chemi- amoeba, found in soil and fresh water.
cal dependence; psychoactive substance Some species are opportunists that
a. SEE: alcoholism; drug dependence; cause infections in humans and other
nicotine; tobacco. animals, e.g., granulomatous amebic
vocal a. Any activity that trauma- encephalitis. SEE: granulomatous ame-
tizes the vocal folds and alters speech bic encephalitis.
quality and production, e.g., yelling, acanthesthesia (ă-kan⬙thes-thē⬘zh(ē-)ă)
forceful coughing, or inducing vomiting. [acanth- ⫹ -esthesia] A sensation as
volatile substance a. The inhalation of a pinprick; a form of paresthesia.
of volatile chemicals (such as chloro- acantho-, acanth- [Gr. akantha, thorn]
form, petroleum gases, or toluene) for Combining forms meaning thorn, spine.
their intoxicating properties. Acanthocephala (ă-kan⬙thŏ-sef⬘ă-lă)
abutment (ă-bŭt⬘mĕnt) [Fr. abouter, to [acantho- ⫹ Gr. kephalē, head] A phy-
place end to end] 1. A structure that lum of parasitic worms. Their usual
provides support for fixed restorations hosts are fish and birds. SYN: proboscis
and prosthetic devices. 2. In dentistry, worms; spiny-headed worms; thorny-
natural teeth or implants serving to headed worms.
support fixed restorations (bridges or acanthocyte (ă-kan⬘thŏ-sı̄t⬙) [acantho-
prosthetic devices). ⫹ -cyte] An abnormal red blood cell
ABVD A(driamycin), b(leomycin), with spines or thorns sticking out from
v(inblastine), and d(acarbazine), a com- its cell membrane.
bination of chemotherapeutic agents for acanthocytosis (ă-kan⬙thŏ-sı̄-tō⬘sı̆s)
treating Hodgkin’s lymphoma. [acanthocyte ⫹ -osis] Acanthocytes in
abzyme (ab⬘zı̄m⬙) [ab, abbr. for antibody the blood.
⫹ (en)zyme] A monoclonal antibody acanthoid (ă-kan⬘thoyd⬙) [acanth- ⫹
that acts as a catalyst. SYN: catalytic -oid] Thorny; spiny.
antibody; catmab. acanthokeratodermia (ă-kan⬙thŏ-ker⬙ă-
AC acromioclavicular; adrenal cortex; air tō-dĕr⬘mē-ă) [acantho- ⫹ kerato-
conduction; alternating current; anodal derma] Hypertrophy of the horny por-
closure; axiocervical. tion of the skin of the palms of the hands
A4C apical four-chamber view. and soles of the feet and thickening of
-ac [L. -acus, Gr. -akos, adj. suffix] 1. A the nails.
variant of the suffix -ic, used with Greek acantholysis (ak⬙an⬙thol⬘i-sis) [acantho-
nouns whose stems end in -i, e,g., car- ⫹ -lysis] Any disease of the skin ac-
diac, from cardi- and maniac, from companied by degeneration of the co-
mani-. 2. In pharmacology, a suffix des- hesive elements of the cells of the outer
ignating an anti-inflammatory drug de- or horny layer of the skin.
rived from acetic acid. acanthoma (ak⬙an⬙thō⬘mă) [acanth- ⫹
a.c. L. ante cibum, before meals. -oma] A benign tumor of the skin. It
acacia (ă-kā⬘shă) [L. acacia fr. Gr. was previously used to denote skin can-
akakia, Egyptian thorn] 1. Any of a cer.
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acanthoma 16 accelerometer

a. adenoides cysticum (ad⬙ĕn-ō⬘ı̆-dēz acarology (ak⬙ă-rol⬘ō-jē) [acarus ⫹


sis⬘tı̆-kŭm) A cystic tumor, often famil- -logy] The study of mites and ticks.
ial, occurring on the chest and face and acarophobia (ak⬙ă-rō-fō⬘bē-ă) [acarus
in the axillary regions. The tumor con- ⫹ -phobia] A phobia of small objects
tains tissues resembling sweat glands such as pins, needles, worms, mites, and
and hair follicles. SYN: epithelioma ad- small insects.
enoides cysticum. Acarus (ak⬘ă-rŭs) [L., mite] A genus of
acanthopelvis (ă-kan⬙thŏ-pel⬘vis) [acan- mites.
tho- ⫹ pelvis] A prominent and sharp A. folliculorum Demodex folliculo-
pubic spine on a rachitic pelvis. SYN: rum.
acanthopelyx. A. scabiei Sarcoptes scabiei. SEE:
acanthopelyx (ă-kan⬙thŏ-pel⬘iks) [acan- Sarcoptes; scabies; Sarcoptidae.
tho- ⫹ Gr. pelyx, wooden bowl, pelvis] acarus Any mite or tick.
Acanthopelvis. acatalasemia (ā⬙kat⬙ă-lă-sē⬘mē-ă) [1an-
acanthosis (ak⬙an⬙-thō⬘sis) [acantho- ⫹ ⫹ catalase ⫹ -emia] Acatalasia.
-sis] Increased thickness of the prickle acatalasia (ā⬙kat-ă-lā⬘zh(ē-)ă) [1an- ⫹
cell layer of the skin. acanthotic catalase ⫹ -ia] A rare inherited dis-
(ak⬙an⬙thot⬘ik), adj. ease in which there is an absence of the
a. nigricans A skin disorder in which enzyme catalase. The gingival and oral
dark brown or gray velvety plaques ap- tissues are particularly susceptible to
pear on the skin, typically under the bacterial invasion with subsequent gan-
arms, in the groin or upper thighs, on grenous changes and alveolar bone de-
the neck, or near the genitalia. They struction. SYN: acatalasemia.
usually appear in patients with relative accelerated drug approval The bringing
insulin excess, such as adults with obe- of a drug to market more rapidly than
sity, type 2 diabetes mellitus, or poly- most other drugs, typically because the
cystic ovaries. The condition may rarely drug serves a compelling public health
be associated with internal malignancy. interest.
SYN: keratosis nigricans. accelerated living benefit Payments
a. palmaris Tripe palm. from a life insurance policy maker to the
acarbia (ă-kar⬘bē-ă, ā⬙) [a- ⫹ L. carbo, beneficiary before the insured person’s
charcoal ⫹ -ia] Decrease of bicarbon- death to help defray medical expenses
ate in the blood. that arise during a terminal illness.
acariasis (ak⬙ă-rı̄⬘ă-sis) [acarus ⫹ -ia- SYN: accelerated death benefit; living
sis] Any disease caused by a mite or ac- needs benefit.
arid. SYN: acarinosis; acaridiasis. acceleration (ak-sel⬙ĕ-rā⬘shŏn) [L. acce-
demodectic a. Infection of hair folli- lerare, to speed up] 1. An increase in
cles with Demodex folliculorum. the speed of an action or function, such
as pulse or respiration. 2. The rate of
sarcoptic a. Infestation with a bur-
change in velocity for a given unit of
rowing mite, Sarcoptes scabiei, which
time.
deposits its eggs in the burrows. SEE:
angular a. Rate of change in velocity
scabies.
per unit of time during circular move-
acaricide (ă-kar⬘ı̆-sı̄d⬙) [acarus ⫹ -cide] ment.
1. An agent that destroys acarids. 2. De- central a. Centripetal a.
stroying a member of the order Acarina. centripetal a. Rate of change in ve-
acaricidal (-sı̄d⬘ăl), adj. locity per unit of time while on a circular
acarid, acaridan (ak⬘ă-rı̆d, ă-kar⬘ı̆-dăn) or curved course. SYN: central a.
[acarus] A tick or mite of the order fetal heart rate a. 1. The increase in
Acarina. heart rate associated with fetal move-
Acaridae (ă-kar⬘ı̆-dē) [acarus] A family ment. 2. A reassuring sign during labor
of mites that irritate the skin. SEE: itch, that the fetus is not experiencing intra-
grain; itch, grocer’s. uterine hypoxemia.
acaridiasis (ak⬙ă-rı̆-dı̄⬘ă-sis) [acarus ⫹ linear a. Rate of change in velocity
1-id ⫹ -iasis] Acariasis.
per unit of time while on a straight
Acarina (ak⬙ă-rı̄⬘nă, rē⬘) [acarus] An or- course.
der of arachnids that includes many negative a. Decrease in the rate of
ticks and mites. Most are ectoparasites change in velocity per unit of time.
whose bites or burrowing cause local- positive a. Increase in the rate of
ized dermatitis and itching. Systemic change in velocity per unit of time.
reactions are rare. Some may be vectors accelerator (ak-sel⬘ĕ-rā⬙tŏr) [L. acceler-
of disease. SEE: Ixodidae; Lyme disease; are, to speed up] 1. Anything that in-
Sarcoptidae; scabies; tick. creases action or function. 2. In chem-
acarinosis (ă-kăr⬙ı̆-nō⬘sı̆s) Acariasis. istry, a catalyst. 3. A device that speeds
acarodermatitis (ak⬙ă-rō-dĕr⬙mă-tı̄⬘tis) up charged particles to high energy lev-
[acarus ⫹ dermatitis] Skin inflam- els to produce x-radiation and neutrons.
mation caused by a mite. accelerometer (ak-sel⬙ĕ-rom⬘ĕtĕr) [ac-
acaroid (ak⬘ă-royd⬙) [acarus ⫹ -oid] celer(ation) ⫹ -meter] An instrument
Resembling a mite. that detects a change in the velocity of
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acceptance 17 accident

the object to which it is attached. The ence, the record or log of specimens re-
device may be designed to record the ceived from clinicians for analysis.
changes and indicate the direction(s) of accessory (ak-ses⬘ŏ-rē) [accessorius]
the acceleration. In athletic training Auxiliary; assisting, said of a lesser
and physical assessment, it measures structure that resembles in structure
the duration, frequency, and intensity of and function a similar organ.
body movements and how active or how accessory muscle of respiration Any of
sedentary a person is during a specified the muscles that are recruited to in-
time. SEE: pedometer. accelerometry crease ventilation by patients with la-
(ak-sel⬙ĕ-rom⬘ĕ-trē), n. bored breathing. The sternocleidomas-
acceptance (ak-sep⬘tăns) 1. According toids, scalenes, and pectoralis minors
to Dr. Elisabeth Kübler-Ross, the fifth may be used for a more forceful inhala-
and final stage of dying. Those who tion; the abdominal muscles may be
reach this stage (not all do) come to used for a more forceful exhalation.
terms with impending death and await Their use represents an abnormal or la-
the end with quiet expectation. 2. In or- bored breathing pattern and is a sign of
gan transplantation, the harmonious respiratory distress.
integration of grafted tissue into the accident (ak⬘sı̆-dĕnt) [L. accidere, to
body of the transplant recipient. 3. Ap- happen] 1. An unforeseen, unfortunate
proval of or acquiescence in, e.g., a rec- occurrence. 2. An unexpected complica-
ommended treatment or a functional tion of a disease or treatment. acciden-
impairment produced by an illness. tal (ak⬙sı̆-den⬘tăl), adj.; accidentally,
acceptance and commitment therapy A adv.
treatment for depression, dysphoria, cerebrovascular a. ABBR: CVA.
and other psychological conditions that Stroke.
relies on a person’s accepting those con- motor vehicle a. ABBR: MVA. A col-
ditions that cannot be controlled and lision between a moving motor vehicle
working actively to change those feel- and a person, or between two or more
ings, ideas, and situations that can be motor vehicles or an object. MVAs are a
positively affected through effort. common cause of serious injury and
acceptor (ak-sep⬘tŏr) [L. accipere, to ac- death, esp. among younger drivers (be-
cept] A compound that unites with a tween 17 and 35 years old).
substance freed by another compound, CAUSES: MVAs are commonly
called a donor. caused by driving while intoxicated by
hydrogen a. A substance that com- alcohol or other drugs; driving after less
bines with hydrogen and is reduced than 7 hours of sleep; and driving while
when a substrate is oxidized by an en- distracted (as by passengers, cellular
zyme. phones, other electronic devices).
SYMPTOMS AND SIGNS: Trauma
oxygen a. A substance that combines
during MVAs often results from: 1) pen-
with oxygen and is oxidized when a sub-
etration of the cabin by other vehicles or
strate is reduced by an enzyme.
roadside objects; 2) contact by the driver
access (ak⬘ses) [Fr. fr. L. accedere, to ap- or passengers with the instrument
proach] 1. The ability or the technique
panel, steering wheel or windshield; 3)
of obtaining data from a specific source vehicular rollover; and 4) blunt collision
by a specific user. 2. The ability of pa- with pedestrians, buildings, or highway
tients to see their health care providers guard rails. Trauma may cause a vari-
in a timely fashion. 3. A device, such as ety of life-threatening organ injuries, in-
a catheter used in hemodialysis, that cluding fractures, hemorrhage, brain
penetrates the body and is used for a damage, pneumothorax, aortic shear-
therapeutic purpose. ing, and cardiac contusion.
accessible (ak-ses⬘ı̆-bĕl) [L. accedere, to DIAGNOSIS: The diagnosis is usually
approach] 1. Able to be used or entered. made by first responders or emergency
In the U.S., under the requirements of medical service providers in the field.
the Americans with Disabilities Act PREVENTION: MVAs can be pre-
(ADA), public places and places of em- vented by assigning a designated driver,
ployment must be accessible to individ- avoiding driving while under the influ-
uals with disabilities through architec- ence of alcohol, getting adequate sleep
tural design (such as ramps, before and during long trips, participat-
wheelchair-wide doorways) and/or the ing in driver education programs, lim-
use of assistive technologies. SEE: bar- iting driver distractions, and taking
rier-free design. precautions for adverse weather and
2. In surgery or clinical laboratory sci- road conditions.
ence, easy to obtain. It is said of blood TREATMENT: Victims of MVA are tri-
or some body fluids (such as saliva), or aged in the field. Injured patients are
tissue samples. 3. In clinical medicine, typically evaluated in emergency de-
easy to approach or to obtain an ap- partments equipped with hospital
pointment with. trauma centers.
accession (ak-sesh⬘ŏn) In laboratory sci- PATIENT CARE: Patients who sur-
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accident 18 accreditation

vive crashes should be managed accord- whereby it is able to focus the image of
ing to standard trauma protocols, i.e., an object on the retina by changing the
assessments of airway and breathing, curvature of the lens. In accommodation
circulatory status, and neurological dis- for near vision, the ciliary muscle con-
ability; and securing the integrity of the tracts, causing increased rounding of
spine, esp. the cervical spine. Clothing the lens, the pupil contracts, and the op-
should be removed so that any occult in- tic axes converge. These three actions
juries can be promptly recognized. In- constitute the accommodation reflex.
travenous fluids are provided to pa- The ability of the eye to accommodate
tients who are bleeding or hypotensive. decreases with age. SYN: ocular accom-
Blood should be sent to hospital labo- modation; visual accommodation. SEE:
ratories for typing and crossmatching. illus. 3. In the learning theory of Jean
Type O blood should be administered to Piaget, the process through which a per-
the acutely bleeding patient in whom a son’s schema of understanding incorpo-
delay in blood transfusion would not be rates new experiences that do not fit ex-
tolerated. isting ways of understanding the world.
Multiple professional disciplines are SEE: adaptation.
often engaged in the acute care of MVA ocular a. Accommodation (2).
victims, e.g., subspecialty surgeons reasonable a. An employer’s educa-
(neurosurgeons, orthopedists, ear, nose, tor’s responsibility to provide necessary
and throat specialists); trauma and ICU workplace changes in reassignment,
specialists; internists; and ICU nurses. equipment modification, devices, train-
During recovery, care may also include ing materials, interpreters, and other
occupational and physical therapists, adjustments for disabled employees or
alcohol or drug counselors, and therapy students. SEE: disability discrimina-
for post-traumatic stress. Legal ramifi- tion.
cations of MVAs may include criminal visual a. Accommodation (2).
prosecution or civil suits, or limitations account (ă-kownt⬘) [Fr. acompte, aconte,
on future driving privileges. acunte, a reckoning] 1. In business, fi-
radiation a. Undesired excessive ex- nance, and banking, a relationship be-
posure to ionizing radiation. tween a client and an institution for pro-
accident-prone Frequently injured or at vision of regular transactions and other
risk for traumatic injury. The validity of services to the client. 2. In business, fi-
this concept is questionable. nance, and banking, the money depos-
acclimation (ak⬙lı̆-mā⬘shŏn) [Fr. accli- ited by a client for provision of regular
mater, acclimate] The act of becoming transactions and other services. 3. In
adapted and adjusted to a new or unfa- business, finance, and banking, a de-
miliar environment. SYN: acclimatiza- tailed chronological listing of transac-
tion. acclimate (ak⬘lı̆-māt⬙), v. tions for the client.
acclimatization (ă-klı̄⬙măt-ı̆-zā⬘shŏn) health savings a. A savings account
Acclimation. in which deposits may accumulate tax-
a. to heat The adjustment of an or- free and be used as self-financed health
ganism to high environmental temper- insurance to pay present or future med-
ature. Exposure to high environmental ical expenses. SYN: medical savings ac-
temperature requires a period of adjust- count.
ment for the body to function efficiently. itemized a. In health care, an ac-
The amount of time required depends count for professional services in which
on the temperature, humidity, and du- all medicines, materials, and therapies
ration of daily exposure. Significant supplied are itemized. It is customary
physiological adjustments occur in 5 for an account managerto provide an
days and are completed within 2 weeks itemized account if the client asks for
to a month. acclimatize (ă-klı̄⬘mă-tı̄z⬙), one.
v. medical savings a. Health savings a.
ACCME Accreditation Council for Contin- accountability (ă-kownt⬙ă-bil⬘ı̆t-ē) Re-
uing Medical Education. sponsibility of health care professionals-
accommodation (ă-kom⬙ă-dā⬘shŏn) [L. for their decisions, judgments, and acts.
accommodare, to suit] ABBR: a; acc. ACCP American College of Chest Physi-
1. Adjustment or adaptation. 2. The ad- cians.
justment of the eye for various distances accreditation (ă-kre⬙ı̆-tā⬘shŏn) [L. ac-

Normal eye Nearsighted Farsighted

VISUAL ACCOMMODATION
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accretio 19 acetone

credere, to give credence to] Formal rec- added to foods to enhance their palat-
ognition by an impartial body that an ability without adding calories. Like
educational faculty or health care insti- many sweeteners, it has a bitter after-
tution has met established quality taste.
benchmarks. In the U.S. there are two acetabulectomy (as⬙ĕ-tab⬙yŭ-lek⬘tŏ-mē)
types of educational accreditation: in- [acetabul(um) ⫹ -ectomy] Surgical re-
stitutional and specialized. The former moval of the acetabulum.
recognizes the institution for having fa- acetabuloplasty (as⬙ĕ-tab⬘yŭ-lō-plas⬙tē)
cilities, policies, and procedures that [acetabul(um) ⫹ -plasty] Surgical re-
meet accepted standards. The latter rec- pair or reconstruction of the acetabu-
ognizes specific programs of study lum.
within institutions for having met es- acetabulum (as⬙ĕ-tab⬘yŭ-lŭm) [L. ace-
tablished standards. tabulum, a little saucer for vinegar (ace-
accretio (ă-krē⬘sh(ē-)ō) [L. growth] Ad- tum)] The cavity or depression on the
hesion of parts normally separate from lateral surface of the innominate bone
each other. (hip bone). It is composed of three bones:
accretion (ă-krē⬘shŏn) [accretio] 1. An the ilium, ischium, and pubis; it pro-
increase by external addition; accumu- vides the socket into which the head of
lation. 2. The growing together of parts the femur fits. SYN: cotyloid cavity. ac-
naturally separate. 3. Accumulation of etabular (as⬙ĕ-tab⬘yŭ-lăr), adj. SEE: il-
foreign matter in a cavity. accretionary lus.
(-shŏ-ner⬙ē), adj. acetal (as⬘ĕ-tăl⬙) [L. acetum, vinegar ⫹
acculturation (ă-kŭl⬙chŭ-rā⬘shŏn) The -al] Chemical combination of an alde-
process by which a member of one cul- hyde with alcohol.
ture assumes the values, attitudes, and acetaldehyde (as⬙ĕ-tal⬘dĕ-hı̄d⬙) [L. ace-
behavior of another. acculturate (ă- tum, vinegar ⫹ aldehyde] CH3CHO;
kŭl⬘chŭ-rāt⬙), v. acculturational (ă- an intermediate in yeast fermentation
kŭl⬙chŭ-rā⬘shŏ-năl), adj. acculturative and alcohol metabolism. SYN: acetic al-
(ă-kul⬘chŭ-rāt⬙iv), adj. dehyde.
accumulate (ă-kūm⬘yŭ-lāt⬙) [L. accu- acetamide (ă⬙set-ă-m⬘ı̄d⬙, as⬙ĕt-am⬘ı̄d⬙)
mulare, to pile up] 1. To grow in num- [L. acetum, vinegar ⫹ amide] Acetic
ber or mass. 2. To store or incorporate. acid amide, CH3CONH2, used in indus-
Accupril (ak⬘yŭ-pril⬙) Quinapril. try for synthesis of chemicals and as a
accuracy (a⬙kyŭ-ră-sē) [L. accurare, to solvent.
take care of] 1. The ratio of the error of acetaminophen (ă-sēt⬙ă-min⬘ŏ-fĕn, as⬙
measurement to the true value. 2. The ĕt-) [Abbr. of N-acetyl-p-aminophenol]
state of being free of error. 3. The sum ABBR: APAP. C8H9NO2, a crystalline
of the true-positive and true-negative substance with antipyretic and analge-
test results, divided by the total number sic effects like those of aspirin but with
of tests performed. limited anti-inflammatory or antirheu-
ACD sol Citric acid, trisodium citrate, matic effects. It is used to treat mild to
dextrose solution; an anticoagulant moderate pain. Unlike aspirin and re-
used in collecting blood. lated drugs, it does not irritate the
ACE Adriamycin (doxorubicin), cyclo- stomach.
phosphamide, etoposide (a regimen of
chemotherapeutic drugs used to treat
Overdose may cause necrosis of the
small cell lung cancer); angiotensin-
liver or fulminant hepatic failure.
converting enzyme.
An acetaminophen level should routinely
-aceae [Feminine pl. of L. adjectival suf-
be checked on all patients who come to an
fix-aceus] Suffix used in formation of
emergency department because of medi-
names of plant families, e.g., Solana-
cation overdose.
ceae.
acellular (ā-sel⬘yŭ-lăr) [1an- ⫹ cellular]
1. Not containing cells. 2. Having cellu- acetate (as⬘ĕ-tāt⬙) A salt of acetic acid.
lar antigens, but no whole cells. The acetic (ă-sēt⬘ik) [L. acetum, vinegar ⫹
term is used to describe some vaccines. -ic] Pert. to vinegar; sour.
acentric (ā⬙sen⬘trik) [2an- ⫹ L. fr. Gr. acetic aldehyde Acetaldehyde.
kentron, needle, pivot point, center] aceto-, acet- [L. acetum, vinegar] Pre-
1. Not central; peripheral. 2. In genetics, fixes meaning vinegar, acetic acid, ace-
lacking a centromere. tyl group.
ACEP American College of Emergency Acetobacter (ă-sēt⬙ō-bak⬘tĕr) [L. ace-
Physicians. tum, vinegar, ⫹ Gr. bakterion, little
acephalia, acephalism (ā⬙sĕ-fāl⬘yă, ā⬙sef⬘ rod] A genus of gram-negative bacilli
ă-lizm) [a- ⫹ cephalo-, head] Con- that produce vinegar from plant matter.
genital absence of the head. acetone (as⬘ĕ-tōn⬙) [aceto- ⫹ -one] Di-
acephalus (ā⬙sef⬙ă-lŭs) [a- ⫹ cephalo-] methyl ketone, C3H6O, a colorless, vol-
A fetus lacking a head. atile solvent produced by the body in ex-
acesulfame potassium, acesulfame-K cessive amounts in diabetic
(ā⬙sē⬘sŭl-fām⬙) An artificial sweetener ketoacidosis, alcoholic ketoacidosis, and
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acetone 20 acetyltransferase

Posterior superior iliac spine


Iliac crest
Ilium

Anterior superior
iliac spine

Sacrum

Coccyx
Pubis
Greater sciatic
notch

Acetabulum

Obturator foramen
Ischium
ACETABULUM OF RIGHT HIP BONE (FEMALE)

starvation. It has a sweet, fruity odor coated with 5% acetic acid. The epithe-
and is found in the blood and urine of lium is then examined for a change in
diabetics, in those with other metabolic color, e.g., from pink or red to white.
disorders, and after lengthy fasting. It This color change in the presence of ace-
is produced when fats are metabolized tic acid suggests a pathologically sig-
for their stored energy, in place of sug- nificant lesion that may require biopsy
ars, because of insufficient insulin. SEE: or other intervention.
ketone; ketonuria; ketosis; test, acetone. acetyl (as⬘ĕt-ı̆l, ă-sēt⬘ı̆l) [aceto- ⫹ -yl]
a. in urine, test for A simple urine CH3CO, a univalent radical.
screening test, used principally in mon- a. CoA Acetylcoenzyme A.
itoring patients with type 1 diabetes a. L-carnitine A dietary supplement
mellitus, to determine the presence of (a form of L-carnitine) promoted for its
ketoacidosis. To perform the test, the positive effects on fat (esp. triglyceride)
patient wets a specially treated paper or metabolism and Alzheimer’s disease.
dipstick with urine. If ketones are acetylation (ă-set⬙ı̆-lā⬘shŏn) [acetyl]
present, the paper will change color The introduction of one or more acetyl
within a specified time. groups into an organic compound.
acetone body SEE: under body. acetylcholine (ă-set⬙ı̆l-kō⬘lēn⬙) [acetyl
acetone test A test for the presence of ac- ⫹ choline] ABBR: ACh. An ester of
etone in the urine; made by dribbling choline that is the neurotransmitter at
urine on a dipstick. The presence of ac- somatic neuromuscular junctions, the
etone causes a color change on the dip- entire parasympathetic nervous sys-
stick, which can be compared to cali- tem, sympathetic preganglionic fibers
brated standards. (cholinergic fibers), and at some synap-
acetonitrile (as⬙ĕ-tō-nı̄⬘trı̆l, ă-sēt⬘ō) ses in the central nervous system. It is
[aceto- ⫹ nitrile] Methyl cyanide, inactivated by the enzyme cholinester-
CH3CN, an ingredient of some commer- ase. SEE: cholinergic fiber.
cially available nail care products. acetylcholinesterase (ă-set⬙ı̆l-kō⬙lı̆-nes⬘
When ingested, it produces a toxic re- tĕ-rās⬙) [acetyl ⫹ cholinesterase]
action similar to cyanide poisoning. The ABBR: AChE. An enzyme that stops
onset is delayed 9 to 12 hr or more. It is the action of acetylcholine. It is present
also found in the urine of cigarette in various body tissues, including mus-
smokers. Treatment for poisoning is the cles, nerve cells, and red blood cells.
same as for cyanide poisoning. SEE: co- acetylcoenzyme A (ă-sēt⬙ı̆l-kō⬙ĕn⬘zı̄m⬙)
tinine; cyanide poisoning. [acetyl ⫹ coenzyme] A condensation
acetowhite test (ă-sēt⬘-ŏ-hwı̄t⬙) A product of coenzyme A and acetic acid.
means of examining a genital or anal le- acetylene (ă-set⬘ı̆l-ēn⬙, ı̆l-ĕn) [acetyl ⫹
sion for the presence of human papillo- -ene] C2H2, a colorless explosive gas,
mavirus infection and atypical cells sug- with a garlic-like odor, used as a fuel in
gestive of cancer. The lesion, e.g., an welding. Its systematic name is ethyne.
irregularity on the surface of the uterine It is an asphixiant.
cervix or a wart found on the penis, is acetyltransferase (ă-sēt⬙ı̆l-trans⬘fĕr-ās⬙)
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ACGME 21 achlorhydria

[acetyl ⫹ transferase] An enzyme that cause dysphagia or aspiration of food or


is effective in the transfer of an acetyl gastric contents.
group from one compound to another. pelvirectal a. Congenital absence of
ACGME Accreditation Council for Grad- ganglion cells in the distal large bowel,
uate Medical Education. resulting in failure of the colon to relax.
ACH adrenocortical hormone; acetylcho- secondary a. Pseudoachalasia.
line; achondroplasia. sphincteral a. Failure of the intesti-
ACh acetylcholine. nal sphincters to relax.
achalasia (ā⬙kă-lā⬘zh(ē)-ă) [2an- ⫹ AChE acetylcholinesterase.
chalasia] Failure to relax; said of ache (āk) 1. Pain that is persistent
smooth muscles, such as those posi- rather than sudden or spasmodic. It
tioned between the lower esophagus may be dull or severe. 2. To suffer per-
and the stomach. It is a cause of dys- sistent pain.
phagia (difficulty swallowing). SYN: a. acheilia (ā⬙kı̄⬘lē-ă) [a- ⫹ chilo- ⫹ -ia]
of the cardia; cardiospasm. Congenital absence of one or both lips.
INCIDENCE: About 1.5 people out of acheiria, achiria (ā⬙kı̄⬘rē-ă) [a- ⫹ chiro-
every 100,000 are diagnosed with ach- ⫹ -ia] 1. Congenital absence of one or
alasia annually. both hands. 2. A loss of sensation in one
CAUSES: The cause of achalasia is or both hands. This may result from
unknown. temporary or permanent injury or mal-
SYMPTOMS AND SIGNS: People with function of the sensory mechanism, or it
achalasia report gradual onset of in- may occur in hysteria. 3. Inability to de-
creasing difficulty swallowing, both for termine to which side of the body a stim-
solids and liquids. ulus has been applied.
DIAGNOSIS: Achalasia is typically in- Achillea millefolium (ak⬙ı̆-lē⬘a mil⬙ĕ-fōl⬘
dicated by an abnormal barium swallow ē-ŭm, ă-kil⬘ē-ă) SEE: yarrow.
test, in which barium accumulates in a Achilles tendon The combined tendon of
dilated esophagus, which tapers to a the gastrocnemius, soleus, and plan-
narrow beak at the esophagogastric taris, which attaches them to the cal-
junction. The condition is confirmed by caneus. SYN: calcaneal tendon; tendo
esophageal manometry. calcaneus. SEE: rupture of the Achilles
TREATMENT: Medical treatments in- tendon.
clude oral nitrates and or nifedipine (a Achilles tendon reflex (ă-kil⬘ēz) [Achil-
calcium channel blocker). Many pa- les, hero of the Iliad, whose vulnerable
tients find that these medications to be spot was his heel] Plantar flexion re-
mildly effective but that the effective- sulting from contraction of the calf mus-
ness of treatment wanes over time. cles after a sharp blow to the Achilles
Pneumatic dilation of the esophagus tendon, activating the S1 spinal reflex.
provides short-term relief for some pa- The variations and their significance
tients. Surgical division of the esopha- correspond closely to those of the knee
geal musculature is the most effective jerk. It is exaggerated in upper motor
treatment, although also the most in- neuron disease and diminished or ab-
vasive. It can be performed via an en- sent in lower motor neuron disease.
doscope and has a successful outcome in SYN: Achilles jerk; ankle reflex; triceps
nearly 90% of patients. surae jerk; triceps surae reflex.
IMPACT ON HEALTH: Mild weight achillobursitis (ă-kil⬙ŏ-bŭr-sı̄t⬘ı̆s) [Achil-
loss sometimes occurs. After 10 or 15 les ⫹ bursitis] Inflammation of the
years, patients with achalasia have a bursae lying over the Achilles tendon.
statistically increased risk of developing SYN: Albert’s disease.
esophageal cancers. This risk is rela- achillodynia (ă-kil⬙ŏ-din⬘ē-ă) [Achilles
tively low, and gastroenterologists do ⫹ -odynia] Nondescript pain arising
not currently recommend regular sur- from the Achilles tendon.
veillance for cancer in achalasia pa- achillorrhaphy (ă-iı̆l-or⬘ă-fē) [Achilles ⫹
tients. -rrhaphy] Suture of the Achilles ten-
PATIENT CARE: Some patients with don.
achalasia benefit from eating slowly, achillotomy (ă-kil-ot⬘ŏ-mē) [Achilles ⫹
taking small bites, and avoiding swal- -tomy] Division of the Achilles tendon,
lowing large volumes of food or liquid. e.g., surgically or traumatically. SYN:
Patient education centers on adapta- achillotenotomy.
tions the patient may make to avoid achlorhydria (ā⬙klor-hı̄⬘drē-ă) [a- ⫹
esophageal pain, regurgitation, and chlor- ⫹ hydr- ⫹ -ia] Absence of free
weight loss. Some patients are referred hydrochloric acid in the stomach. It may
for surgical myotomy or esophageal di- be associated with gastric carcinoma,
lation, but these procedures vary in gastric ulcer, pernicious anemia, adre-
their effectiveness. nal insufficiency, or chronic gastritis.
cricopharyngeal a. Failure of the SEE: achylia.
lower pharyngeal muscles to relax dur- histamine-proved a. Absence of free
ing swallowing. The condition may acid in gastric secretion even after sub-
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achondrogenesis 22 acid

cutaneous injection of histamine hydro- nutritional a. Grayness of the hair


chloride. due to dietary deficiency.
achondrogenesis (ā⬙kon⬙drō-jen⬘ĕ-sis) achylia, achylosis (ā⬙kı̄⬘lē-ă, ā⬙kı̄-lō⬘sis)
[a- ⫹ chondro- ⫹ -genesis] Failure [1an- ⫹ chyle ⫹ -ia] Absence of chyle
of bones and cartilage to grow, esp. the or other digestive enzymes, as in
bones of the extremities. atrophic gastritis. achylous (ā⬙kı̄⬘lŭs),
achondroplasia (ā⬙kon⬙drō-plā⬘zh(ē-)ă) adj.
[a- ⫹ chondro- ⫹ -plasia] The most acicular (ă-sik⬘yŭ-lăr) [L. aciculus, little
common form of short-limbed dwarfism. needle] Needle-shaped.
It is caused by a point mutation in a fi- acid (as⬘id) [L. acidus, sour] 1. Any sub-
broblast growth receptor and character- stance that liberates hydrogen ions
ized by impairment in the formation of (protons) in solution; a hydrogen ion do-
cartilage at the epiphyses of long bones. nor. An acid reacts with a metal to form
SYN: chondrodystrophy. a salt, neutralizes bases, and turns lit-
ACHRN Advanced Certified Hyperbaric mus paper red. 2. A substance that can
Nurse. accept a pair of electrons; a Lewis acid.
achroma (ā⬙krō⬘mă) [1an- ⫹ Gr. SEE: alkali; base; indicator; Lewis acid;
chrōma, color] An absence of color or pH. 3. A sour substance. 4. Slang term
normal pigmentation as in leukoderma, for lysergic acid diethylamide (LSD).
albinism, and vitiligo. acetic a. C2H4O2, the acid that gives
achromatic (ăk⬙rŏ-mat⬘ik) [Gr. achrō- the sour taste to vinegar. It is also used
matikos, colorless] 1. Colorless. 2. Not as a reagent. Glacial (highly purified)
dispersing light into constituent com- acetic acid contains at least 99.5% acetic
ponents. 3. Not containing chromatin. acid by weight.
4. Difficult to stain, with reference to acetoacetic a. C4H6O3, a ketone body
cells and tissues. achromatically (-i- formed when fats are incompletely oxi-
k(ă-)lē), adj. dized. It was formerly called acetylacetic
achromatin (ā⬙krō⬘măt-ı̆n) [achro- acid. SYN: diacetic a.
mat(ic) ⫹ -in] The weakly staining acetylsalicylic a. ABBR: ASA. Aspi-
nucleoplasm of a cell nucleus. rin (1).
achromatism (ā⬙krō⬘mă-tı̆zm) [achro- acrylic a. C3H4O2, a colorless corrosive
mat(ic) ⫹ -ism] Colorlessness. acid used in making acrylic polymers and
achromatolysis (ā⬙krō⬙mă-tol⬘ı̆-sı̆s) resins.
[achromat(ic) ⫹ -lysis] Dissolution of adenylic a. Adenosine monophos-
cell achromatin. phate.
achromatophil, achromophil (ā⬙krō- alpha-hydroxy a. ABBR: AHA. Any
mat⬘ŏ-fil⬙, ā⬙krō⬘mŏ-fı̆l) [achromat(ic) of a class of water-soluble acids derived
⫹ -phil] A cell or tissue not stainable from fruit or milk, having a hydroxyl
in the usual manner. moiety in the first position in the mole-
achromatopsia (ā⬙krō⬙mă-top⬘sē-ă) cule. AHAs are used in chemical peels
[achromat(ic) ⫹ Gr. opsis, vision ⫹ and other skin care products to remove
-ia] Complete color blindness. the outer layer of the epidermis. This
achromatosis (ā⬙krō⬙mă-tō⬘sis) [achro- chemical exfoliation is promoted for its
mat(ic) ⫹ -osis] The condition of being cosmetic effects on wrinkled or sun-dam-
without natural pigmentation. SEE: aged skin.
achroma. alpha-linolenic a. C18H30O2, an
achromatous (ā⬙krō⬘mă-tŭs) [achro- omega-3 fatty acid derived from plants,
mat(ic) ⫹ -ous] 1. Without color. esp. seeds (canola oil, flaxseed, walnuts,
2. Deficient in color; lighter than nor- and pumpkins) and from some fish
mal. (salmon and mackerel).
achromia (ā⬙krō⬘mē-ă) [a- ⫹ chrom- alpha-lipoic a. C8H14O2S2, a natural
⫹ -ia] 1. Absence of color; pallor. coenzyme and antioxidant, used for
2. Achromatosis. 3. Condition in which short-term treatment of peripheral neu-
erythrocytes have large central pale ar- ropathies.
eas; hypochromia. achromic, adj. amino a. SEE: amino acid.
congenital a. Albinism. aminoacetic a. Glycine.
Achromobacter (ā⬙krō⬙mŏ-bak⬘tĕr) aminocaproic a. C6H13NO2, a hemo-
[ an- ⫹ chromo- ⫹ bacter(ium)] A
1 static drug. It is a specific antidote for an
genus of gram-negative bacilli that may overdose of a fibrinolytic agent.
inhabit the lower gastrointestinal tract; arachidonic a. C20H32O2, an omega-6
may cause nosocomial infections. fatty acid formed by the action of en-
A. xylosoxidans Alcaligenes xylo- zymes on phospholipids in cell mem-
soxidans. branes. The acid is found in many foods.
achromocyte, achromatocyte (ā⬙krō⬘ It is metabolized primarily by the cyclo-
mŏ-sı̄t⬙, krō-mat⬘ŏ-sı̄t⬙) [1an- ⫹ oxygenase or 5-lipoxygenase pathways to
chromo- ⫹ -cyte] Red cell ghost. produce prostaglandins and leukotri-
achromotrichia (ā⬙krō⬙mŏ-trik⬘ē-ă) [a- ⫹ enes, which are important mediators of
chromo- ⫹ trich- ⫹ -ia] Lack of color inflammation. Corticosteroids inhibit
or graying of the hair. SYN: canities. formation of arachidonic acid from phos-
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acid 23 acid

pholipids when cell membranes are dam- carboxylic a. Any acid containing the
aged. Nonsteroidal anti-inflammatory carboxyl group 9 COOH. The simplest
agents such as salicylates, indomethacin, examples are formic and acetic acids.
and ibuprofen inhibit the synthesis of cholic a. C24H40O5, a bile acid formed
prostaglandins and leukotrienes. in the liver by hydrolysis of other bile
argininosuccinic a. C10H18N4O6, a acids. It is formed from the breakdown
compound intermediate in the synthesis of cholesterol and helps digest con-
of arginine, formed from citrulline and sumed fats.
aspartic acid. cinnamic a. C9H8O2, an insoluble
aristolochic a. C17H11NO7, an acid white powder derived from cinnamon. It
derived from Aristolochia, a genus of is used as a flavoring agent in cooking
flowering plants, and used as an herbal and in the preparation of perfumes and
remedy. It is promoted as an aphrodis- medicines.
iac, a weight loss agent, and an anticon- citric a. C6H8O7, an acid found natu-
vulsant. rally in citrus fruits or prepared syn-
thetically. It acts as a sequestrant, help-
ing to preserve food quality.
The acid is a known carcinogen, and
conjugated linoleic a. ABBR: CLA.
its use has been associated with and
Any of the isomers of linoleic acid effec-
may cause end-stage renal disease and can-
tive against cancer, obesity, diabetes,
cers of the urinary tract that may occur
and atheromata in laboratory rodents.
many years after usage has stopped.
CLAs have not been shown to have sim-
ilar beneficial effects in humans.
ascorbic a. Vitamin C. cysteic a. C3H7NO5S, an acid pro-
aspartic a. C4H7NO4, a nonessential duced by the oxidation of cysteine. Fur-
amino acid. ther oxidation produces taurine.
barbituric a. C4H4N2O3, a crystalline deoxycholic a. C24H40O4, a crystal-
acid from which phenobarbital and line acid found in bile.
other barbiturates are derived. deoxyribonucleic a., desoxyribonu-
benzoic a. C7H6O2, a white crystal- cleic acid SEE: DNA.
line acid having a slight odor. It is used diacetic a. Acetoacetic a.
in keratolytic ointments and in food 2,4-dichlorophenoxyacetic a. 2,4-D.
preservation. Saccharin is a derivative docosahexaenoic a., docosahexan-
of this acid. oic ABBR: DHA. C22H32O2, an omega-
beta-hydroxybutyric a. C4H8O3, any 3 fatty acid found in the oils of cold-wa-
of the acids present in the urine, esp. in ter fish and in algae. DHA plays a role
diabetic ketoacidosis, when the conver- in the development of nerve cell mem-
sion of fatty acids to ketones increases. branes and is required for the normal
bile a. Any of the complex acids that growth and development of the infant
occur as salts in bile, e.g., cholic, gly- brain. Lack of DHA has been linked to
cocholic, and taurocholic acids. They growing numbers of people suffering
give bile its foamy character, are impor- from depression.
tant in the digestion of fats in the intes- domoic a. C15H20NO6, a toxin that re-
tine, and are reabsorbed from the intes- sembles glutamate, the main excitatory
tine to be used again by the liver. SEE: amino acid of the brain. When ingested,
enterohepatic circulation. it may cause continuous seizures.
boric a. H3BO3, a white crystalline eicosapentaenoic a. ABBR: EPA.
acid that in water forms a very weak C20H30O2, an omega-3 fatty acid found in
acid solution poisonous to plants and fish oils, containing 20 carbons and five
animals. It is soluble in water, alcohol, double bonds.
and glycerin. SEE: boric acid poison- essential fatty a. ABBR: EFA. A
ing. fatty acid (alpha-linoleic and linoleic)
that is essential for health and must be
present in the diet because it cannot be
Boric acid is toxic and should be
synthesized in the body. SEE: digestion.
used only rarely. It is particularly
ethylenediaminetetraacetic a.
dangerous because it can be accidentally
ABBR: EDTA. C10H16N2O8, a chelating
swallowed by children or used in food be-
agent that, in its calcium or sodium
cause of its resemblance to sugar.
salts, is used to remove metallic ions
such as lead and cadmium from the
butyric a. C4H8O2, a viscous fatty body, as a food preservative, and as an
acid with a rancid odor, derived from anticoagulant for phlebotomized blood
butter but rare in most fats. It is used samples. SEE: chelation.
in disinfectants, emulsifying agents, fatty a. Any of numerous monobasic
and pharmaceuticals. acids with the general formula CnH2n⫹1
carbolic a. Phenol (1). 9 COOH (an alkyl radical attached to a
carbonic a. H2CO3, an acid formed carboxyl group).
when carbon dioxide is dissolved in wa- Fatty acids are insoluble in water, but
ter. bile salts secreted into the small intes-
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acid 24 acid

tine allow them to be absorbed after netic resonance imaging to enhance the
they are eaten. Fatty acids include ace- appearance of blood vessels.
tic, butyric, capric, caproic, caprylic, for-
mic, lauric, myristic, palmitic, and ste-
Contrast agents containing gado-
aric acids. Unsaturated fatty acids have
linium should not be given to pa-
one or more double or triple bonds in the
tients with diminished renal function.
carbon chain. They include those of the
oleic series (oleic, tiglic, hypogeic, and
palmitoleic) and the linoleic or linolic se- gallic a. C6H2(OH)3COOH, a color-
ries (linoleic, linolenic, clupanodonic, less crystalline acid. It occurs naturally
arachidonic, hydrocarpic, and chaul- as an excrescence on the twigs of trees,
moogric). SEE: fat. esp. oaks, as a reaction to the deposition
folic a. C19H19N7O6, a water-soluble of gall wasp eggs. It is used as a skin
B complex vitamin needed for DNA astringent and in the manufacture of
synthesis and amino acid metabolism. writing inks and dyes.
It is present in green leafy vegetables, gamma-aminobutyric a. ABBR:
beans, and yeast. It is used to treat GABA. C4H9NO2, the principal inhibi-
megaloblastic and macrocytic ane- tory neurotransmitter of the brain.
mias and to prevent neural tube de- gamma-linolenic a. ABBR: GLA.
fects (NTDs) and cardiovascular dis- C18H30O2, an essential fatty acid pro-
ease in adults. The U.S. Public Health moted by alternative medicine practi-
Service recommends that all women of tioners as a treatment for skin and in-
childbearing age who may become or flammatory disorders, cystic breast
are pregnant should consume 0.8 mg disease, and hyperlipidemia.
of folic acid daily to reduce their risk glucuronic a. CHO(CHOH)4COOH,
of having a child affected with spina an oxidation product of glucose that is
bifida or other NTDs. SYN: pteroylglu- present in the urine. Toxic products
tamic acid. SEE: neural tube defect. (salicylic acid, menthol, phenol) that
SYN: folate; vitamin B9. have entered the body through the in-
testinal tract are detoxified in the liver
by conjugation with glucuronic acid.
Folic acid should not be used to
glutamic a. HOOC · (CH2)2 · CH(NH2)
treat pernicious anemia (a vita-
· COOH, an amino acid formed in pro-
min B12 deficiency) because it does not
tein hydrolysis and an excitatory neu-
protect patients against the develop-
rotransmitter in the central nervous
ment of changes in the central nervous
system.
system that accompany this type of ane-
glyceric a. CH2OH · CHOH · COOH,
mia.
an intermediate product of the oxida-
tion of fats.
folinic a. C20H23N7O7, the active form glycocholic a. C26H43NO6, a bile acid
of folic acid. It is used to counteract the that hydrolizes to glycine and cholic
effects of folic acid antagonists and to acid.
treat folic acid deficiency anemia. glycolic a. C2H4O3, an alpha-hydroxy
formic a. HCOOH, the first and acid derivative used to remove the outer
strongest member of the monobasic layer of skin to rejuvenate its appear-
fatty acid series. It occurs naturally in ance.
certain animal secretions, e.g., the sting glyoxylic a. C2H2O3, an acid pro-
of insects such as bees and ants, and in duced by the action of glycine oxidase on
muscle, but it is also prepared synthet- glycine or sarcosine.
ically. hippuric a. C6H5CONHCH2COOH,
formiminoglutamic a. C6N2O4H10, an acid formed and excreted by the kid-
an intermediate product in the metab- neys. It is formed from the combination
olism of histidine. of benzoic acid and glycine. The synthe-
free fatty a. ABBR: FFA. The form sis takes place in the liver and, to a lim-
in which a fatty acid leaves the cell to ited extent, in the kidneys.
be transported for use in another part of homogentisic a. C8H8O4, an inter-
the body. FFAs are not esterified and mediate product of tyrosine catabolism.
may be unbound (not bound to protein). It is found in the urine in alkaptonuria.
In the plasma, the nonesterified fatty SYN: alkapton.
acids released immediately combine hyaluronic a. ABBR: HA.
with albumin to form bound free fatty (C14H21NO11)n, an acid mucopolysaccha-
acids. ride found in the extracellular matrix of
fumaric a. C4H4O4, one of the organic connective tissue that acts as a binding
acids in the Krebs cycle. It is used as a and protective agent. It is found in sy-
substitute for tartaric acid in beverages novial fluid and in the vitreous and
and baking powders. aqueous humors of the eye. Patients
gadolinium-diethylenetriamine pen- with osteoarthritis have elevated serum
taacetic a. ABBR: Gd-DTPA. A radio- levels of HA. SYN: hyaluronan.
graphic contrast agent, used in mag- hydrochloric a. HCl, an inorganic
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acid 25 acid

acid normally present in gastric juice. It naturally occurring fatty acid present in
destroys fermenting bacteria that might certain foods, including peanuts. It is
cause intestinal tract disturbances. also found in wood tar, various cerebro-
hydrocyanic a. HCN, a colorless, ex- sides, and in small amounts in most nat-
tremely poisonous, highly volatile acid ural fats. The acid is also a by-product
that occurs naturally in plants but is of lignin production.
also produced synthetically. It acts by linoleic a. C18H32O2, an omega-6 fatty
preventing cellular respiration. Hydro- acid found in vegetables, nuts, grains,
cyanic acid is used in electroplating, fu- seeds, fruits and their oils. Oils rich in
migation, and in producing dyes, pig- linoleic acid include (in descending or-
ments, synthetic fibers, and plastic. der) safflower, sunflower, corn, soybean,
Exposure of humans to 200 to 500 parts and cottonseed.
of hydrocyanic acid per 1,000,000 parts linolenic a. C18H30O2, an omega-6
of air for 30 min is fatal. SYN: hydro- fatty acid, thought to be cardioprotec-
gen cyanide. tive. It reduces the production of cyto-
hydrofluoric a. HF, a corrosive solu- kines and down-regulates serum cell ad-
tion of hydrogen fluoride in water. It can hesion molecules thought to be
be used in dentistry to etch composites intermediates in atherosclerosis.
and porcelain surfaces and is used in- lysergic a. C16H16N2O2, a crystalline
dustrially to etch glass. SEE: hydrogen acid derived from ergot. Its derivative,
fluoride. lysergic acid diethylamide (LSD), is a
potent hallucinogen. SEE: LSD.
lysophosphatidic a. ABBR: LPA.
Exposure to the skin and aerodi-
C21H41O7P, an acid purified from the as-
gestive tract causes severe burns
citic fluid of patients with ovarian can-
with local necrosis and systemic manifes-
cer. LPA stimulates the growth of ovar-
tations resulting from disordered calcium
ian cancer and may be a useful
and potassium metabolism. Treatments
screening test for the disease.
with calcium gluconate can be beneficial.
malic a. C4H6O5, an acid found in
sour fruits such as apples and apricots
hydroxy a. Any of the acids contain- and active in the aerobic metabolism of
ing one or more hydroxyl (– OH) groups carbohydrates.
in addition to the carboxyl (– COOH) malonic a. C3H4O4, a dibasic acid
group, e.g., lactic acid, CH3COHCOOH). formed by the oxidation of malic acid
hydroxycitric a. C6H8O8, an herbal and active in the Krebs cycle in carbo-
extract promoted for the treatment of hydrate metabolism. Malonic acid is
weight loss. Placebo-controlled studies found in beets. Its inhibition of succinic
have not found any benefit to the treat- dehydrogenase is the classic example of
ment. competitive inhibition.
hypochlorous a. HClO, an acid used mandelic a. C8H8O3, a colorless hy-
as a disinfectant, deodorant, and droxy acid. Its salt is used to treat uri-
bleaching agent. It is usually used in the nary tract infections.
form of one of its salts. methacrylic a. C4H6O2, a colorless
imino a. An acid formed as a result acid used to make methyl methacrylate.
of oxidation of amino acids in the body. mineral a. Inorganic a.
inorganic a. An acid containing no monounsaturated fatty a. A fatty
carbon atoms. SYN: mineral acid. acid containing one double bond be-
iopanoic a. C11H12I3NO2, a radio- tween carbon atoms. It is found in olive
paque contrast medium used in radio- oil and is the predominant fat in the
graphic studies of the gallbladder. Mediterranean diet. It is thought to re-
keto a. Any organic acid containing duce low-density lipoprotein levels
the ketone CO (carbonyl radical). without affecting high-density lipopro-
kynurenic a. C10H7NO3, a metabolite tein levels. SEE: Mediterranean diet.
of tryptophan whose concentration in- n-3 fatty a. Omega-3 fatty a.
creases during physical and emotional n-6 fatty a. Omega-6 fatty a.
stress and blocks neurotransmission. nicotinic a. Niacin.
lactic a. C3H6O3, an organic acid nitric a. HNO3, a colorless, poison-
formed in muscles during anaerobic cell ous, fuming corrosive acid, widely used
respiration in strenuous exercise. It is in industry and in chemical laborato-
also formed during anaerobic muscle ac- ries.
tivity when glucose cannot be changed 3-nitropropionic a. C3H5NO4, an in-
to pyruvic acid in glycolysis. It contrib- hibitor of mitochondrial energy genera-
utes to muscle aches and fatigue. SYN: tion through electron transport. It has
lactacid. been implicated in neurodegenerative
levulinic a. CH3COCH2CH2COOH, movement disorders affecting the basal
an acid formed when certain simple sug- ganglia.
ars are acted on by dilute hydrochloric nitrous a. HNO2, a weak acid chem-
acid. ical reagent used in biological laborato-
lignoceric a. C24H48O2, a saturated, ries.
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acid 26 acid

nonvolatile a. An acid, such as lactic of the long-chain polyunsaturated fatty


acid or sulfuric acid, that accumulates acids found in the oils of some saltwater
in the body as a result of digestion, dis- fish, and in canola, flaxseed, walnuts,
ease, or metabolism. It cannot be ex- and some vegetables. These acids in-
creted from the body by ventilation but clude eicosapentaenoic acid (EPA) and
must be excreted by organs other than docosahexaenoic acid (DHA). Alpha-lin-
the lungs, e.g., by acidification of the olenic acid (found in flaxseed and chia)
urine. can be metabolically converted to
nucleic a. Any of the high-molecular- omega-3 fatty acids in the body. People
weight molecules that carry the genetic whose diets are rich in omega-3 fatty ac-
information crucial to the replication of ids have a reduced incidence of cardio-
cells and the manufacturing of cellular vascular disease. SYN: n-3 fatty acid.
proteins. They have a complex structure omega-6 fatty a., ␻-6 fatty acid Any
formed of sugars (pentoses), phosphoric of the long-chain polyunsaturated fatty
acid, and nitrogen bases (purines and acids, such as linoleic acid and arachi-
pyrimidines). Most important are ribo- donic acid, thought to influence cardio-
nucleic acid (RNA) and deoxyribonu- vascular and growth function when bal-
cleic acid (DNA). SEE: illus. anced with omega-3 fatty acids in
octadecanoic a. Stearic a. eicosanoid production. Linoleic acids
oleic a. C18H34O2, a monounsatu- are derived from vegetable oils; arachi-
rated fatty acid found in most organic donic acids, from animal fats. SYN: n-6
fats and oils. fatty acid.
omega-3 fatty a., ␻-3 fatty acid Any organic a. An acid containing the

DNA strands

Hydrogen
bonds

RNA strand

Double helix

Chromatin in
Deoxyribose (DNA)
the nucleus
Ribose (RNA)
Cell Phosphate
Adenine

Guanine

Thymine (DNA)
Uracil (RNA)
Cytosine

NUCLEIC ACID
DNA and RNA
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acid 27 acid

carboxyl radical, – COOH. Organic ac- preparation for bonding of resin dental
ids include acetic acid, formic acid, lactic restorations.
acid, and all fatty acids. phosphorous a. H3PO3, a crystalline
orotic a. C5H4N2O4 , a crystalline acid formed when phosphorus is oxi-
acid occurring in milk. It is a precursor dized in moist air.
in the formation of pyrimidine nucleo- phytic a. C6H18P6O24, a pale, water-
tides. soluble acid that is found in cereal
osmic a. Osmium tetroxide. grains and, if ingested, may interfere
oxalic a. C2H2O4, the simplest diba- with the absorption of calcium and mag-
sic organic acid. Its potassium or cal- nesium.
cium salts occur naturally in rhubarb, picric a. C6H2(NO2)3OH, a yellow
wood sorrel, and other plants. It is the crystalline powder that precipitates
strongest organic acid and is poisonous. proteins and explodes when heated or
When properly diluted, it removes ink charged. It is used as a dye and a re-
or rust stains from cloth. It is used also agent. Its salts are used in the Jaffé re-
as a reagent. action (used to measure serum creati-
oxaloacetic a., oxalacetic acid nine). SYN: trinitrophenol.
C4H4O5, a product of carbohydrate me- polyglycolic a. (C2H2O2)n, a polymer
tabolism resulting from oxidation of of glycolic acid anhydride units. It is
malic acid during the Krebs cycle. It used to manufacture surgical sutures,
may be derived from other sources. clips, and mesh.
palmitic a. C16H32O2, a saturated polylactic a. Polylactide.
fatty acid occurring as esters in most propionic a. C3H6O2, a carboxylic
natural fats and oils. acid present in sweat.
pantothenic a. C9H17NO5, an acid of pteroylglutamic a. ABBR: PGA.
the vitamin B complex, occurring natu- Folic a.
rally in yeast, liver, heart, salmon, eggs, 4-pyridoxic a. C8H9NO4, a crystalline
and various grains. It is part of coen- acid that is the principal end product of
zyme A, which is necessary for the pyridoxine metabolism, excreted in hu-
Krebs cycle and for conversion of amino man urine.
acids and lipids to carbohydrates. SYN: pyroglutamic a. C5H7NO3, an amino
vitamin B5. acid that is a rare cause of anion gap
para-aminohippuric a. ABBR: PAH, metabolic acidosis, usually identified in
PAHA. C9H10N2O3, a derivative of ami- children with endogenous glutathione
nobenzoic acid. The salt, para-amino- metabolic disorders or in people who
hippurate, is used to test the excretory take acetaminophen chronically. Acido-
capacity of the renal tubules. sis associated with pyroglutamic acid
pectic a. C17H24O16, an acid derived can be life-threatening. SYN: 5-oxopro-
line; pyroglutamate.
from pectin by hydrolyzing its methyl
ester group.
pyruvic a. C3H4O3, an organic acid
that plays an important role in the
pentanoic a. Valeric a.
Krebs cycle. It is an intermediate prod-
peptide nucleic a. ABBR: PNA. A uct in the metabolism of carbohydrates,
synthetic nucleic acid analog in which
fats, and amino acids. Its quantity in
natural nucleotide bases are linked to a the blood and tissues increases in thia-
peptide-like backbone instead of the mine deficiency because thiamine is es-
sugar-phosphate backbone found in sential for its oxidation.
DNA and RNA. PNA has numerous quinic a. C7H12O6, a crystalline acid
uses in gene regulation, splicing, and present in some plants, including cin-
therapy; in hybridization; and as a mo- chona bark, and berries.
lecular diagnostic assay. quinolinic a. C7H5NO4, a neurologi-
peracetic a. C2H4O3, a colorless, car- cal excitotoxin that is produced by mi-
cinogenic, corrosive acid with a pungent croglial cells and macrophages and is an
odor, used as a biocide and sterilant. agonist of N-methyl-d-aspartate
SYN: peroxyacetic acid. (NMDA). It is an inflammatory pro-oxi-
perchloric a. HClO4, a colorless un- dant (a substance causing oxidative
stable liquid compound. It is the highest stress), damaging to neurons and glial
oxygen-containing acid of chlorine, cells.
strong and dangerously corrosive. retinoic a. C20H28O2, a metabolite of
peroxyacetic a. Peracetic a. vitamin A used in the treatment of cys-
phosphoric a. An acid formed by ox- tic acne.
idation of phosphorus. The phosphoric ribonucleic a. SEE: RNA.
acids are orthophosphoric acid, H3PO4; ricinoleic a. C18H34O3, an unsatu-
pyrophosphoric acid, H4P2O7; meta- rated hydroxy acid making up about
phosphoric acid, HPO3; and hypophos- 80% of fatty acids in the glycerides of
phoric acid, H4P2O6. The salts of these castor oil. It has a strong laxative ac-
acids are phosphates. Orthophosphoric tion.
acid, a tribasic acid, is used as a 30% to rubeanic a. H2NCSCSNH2, a histo-
50% solution to etch enamel of teeth in logical stain for tissue copper. SYN: di-
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acid 28 acid

thiooxamide; ethanedithioamide; hydro- to saturated ones. The more trans-fatty


rubeanic acid. acids in the diet, the higher the serum
salicylic a. C7H6O3, a white crystal- cholesterol and low-density lipoprotein
line acid derived from phenol used to cholesterol.
make aspirin, as a preservative and fla- 2,4,5-trichlorophenoxyacetic a.
voring agent, and in the topical treat- 2,4,5-T.
ment of some skin conditions such as undecylenic a. (ŭn⬙dĕ⬙sı̆-lĕn⬘ı̆k) An
warts and wrinkles. SEE: chemical antifungal drug used topically to treat
peeling. tinea pedis (athlete’s foot).
saturated fatty a. A fatty acid in unsaturated fatty a. An organic acid
which the carbon atoms are linked to in which some of the carbon atoms are
other carbon atoms by single bonds. linked to other carbon atoms by double
SEE: fatty a.; unsaturated fatty a. bonds, thus containing less than the
silicic a. Any of a family of acids con- maximum possible number of hydrogen
taining silica, such as H2SiO3 (metasil- atoms, e.g., unsaturated oleic and lino-
icic acid), H2SiO4 (orthosilicic acid), or leic acids as compared with the satu-
H2SiO7 (pyrosilicic acid). When silicic rated stearic acid. Polyunsaturated
acid is precipitated, silica gel is ob- fatty acids include linoleic acid and al-
tained. pha-linoleic acid. SEE: fatty a.; satu-
stearic a. C18H36O2, a monobasic rated fatty a.
fatty acid occurring naturally in plants uric a. C5H4N4O3, a crystalline acid
and animals. It is used in the manufac- occurring as an end product of purine
ture of soap and pharmaceutical prod- metabolism. It is formed from purine
ucts such as glycerin suppositories. bases derived from nucleic acids (DNA
SYN: octadecanoic acid. and RNA). It is a common constituent of
succinic a. C4H6O4, an intermediate urinary stones and gouty tophi. SEE: il-
in carbohydrate metabolism. lus.
sulfonic a. Any of the organic com-
pounds having the general formula
SO2OH, derived from sulfuric acid by re-
placement of a hydrogen atom.
sulfosalicylic a. C7H6O6S3, a crystal-
line acid soluble in water or alcohol. It
is used as a reagent for precipitating
proteins, as in testing for albumin in
urine.
sulfuric a. H2SO4, a colorless, corro-
sive, oily, viscous acid prepared from
sulfur dioxide and used in many indus-
trial processes and in clinical laborato-
ries. Industrial accidents involving sul-
furic acid through contact with skin or CLUMP OF URIC ACID CRYSTALS (⫻400)
inhalation of aerosols are common. OUTPUT: Uric acid must be excreted
sulfurous a. H2SO3, an inorganic acid because it cannot be metabolized. Uric
and a powerful chemical reducing agent acid output should be between 0.8 and
used commercially, esp. for as a bleach. 1g/day if the patient is on an ordinary
tannic a. C76H52O46, a mixture of di- diet.
gallic acid esters of D(⫹) glucose pre- Increased elimination is observed af-
pared from oak galls and sumac. It ter ingestion of proteins and nitroge-
yields gallic acid and glucose on hydrol- nous foods, after exercise, after admin-
ysis. istration of cytotoxic agents, and in gout
tartaric a. C4H6O6, an acid obtained and leukemia. Decreased elimination is
from by-products of wine fermentation. observed in kidney failure, lead poison-
It is widely used in industry in the man- ing, and in those who eat a protein-free
ufacture of carbonated drinks, flavored diet.
gelatins, dyes, and metals. It is also valeric a. C5H10O2, an oily fatty acid
used as a reagent. It is thought to be an having a distinctly disagreeable odor,
allergen. existing in four isomeric. SYN: penta-
taurocholic a. C26H45NO7S, a bile noic acid.
acid that hydrolyzes to cholic acid and valproic a. ABBR: VPA. C8H16O2, an
taurine. acid used to treat seizure disorders.
teichoic a. Any of the polymers found vanillylmandelic a., vanilmandelic
in the cell walls of some gram-positive acid ABBR: VMA. C9H10O5, a princi-
bacteria, such as the staphylococci. pal metabolic product of catechol-
trans-fatty a. The solid fat produced amines. VMA makes up approx. 90% of
by heating liquid vegetable oils in the the metabolites of the catecholamines
presence of hydrogen and certain metal epinephrine and norepinephrine and is
catalysts. Partial hydrogenation secreted in the urine. People with pheo-
changes some of the unsaturated bonds chromocytoma produce excess amounts
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acid 29 acidosis

of catecholamines; therefore there are guished from basophils and chromopho-


increased amounts of VMA in their bes and therefore are simply called acid-
urine. ophils. SEE: prolactin; somatotroph.
volatile a. An acid produced from 3. A tissue, organism, or substance that
carbon dioxide (CO2). It can be excreted stains readily with acid stains.
by the body by ventilation (colloquially, acidophilic (ă-sı̆d⬙ō-fı̆l⬘ı̆k) 1. Having
“blowing off CO2”). affinity for acid or pert. to certain tis-
xanthurenic a. C10H7NO4, an acid ex- sues and cell granules. 2. Pert. to a cell
creted in the urine of pyridoxine-defi- capable of being stained by acid dyes.
cient animals after they have been fed SYN: acidophil (1).
tryptophan. acidoresistant (as⬙ı̆-dō-rĕ-zis⬘tănt) Acid-
acid-citrate-dextrose ABBR: ACD sol. resisting; said about bacteria.
An anticoagulant solution used in blood acidosis (as⬙ı̆-dō⬘sis) [acid ⫹ -osis] An
collection (and in plasmaphoresis, in actual or relative increase in the acidity
place of heparin). Its components are of blood due to an accumulation of acids
citric acid, sodium citrate, and dextrose. (as in diabetic acidosis or renal disease)
acidemia (as⬙ı̆-dē⬘mē-ă) [acid ⫹ -emia] or an excessive loss of bicarbonate (as in
A decrease in the arterial blood pH be- renal disease). The hydrogen ion con-
low 7.35. The hydrogen ion concentra- centration of the fluid is increased, low-
tion of the blood increases, as reflected ering the pH. SEE: acid-base balance;
by a lowering of serum pH values. SEE: acidemia; buffer; pH. acidotic (as⬙ı̆-
acid-base balance; acidity; acidosis. dot⬘ik), adj.
isovaleric a. A rare autosomal reces- carbon dioxide a. Respiratory aci-
sive metabolic disease affecting leucine dosis.
metabolism. Isovaleric acid accumu- compensated a. Acidosis in which
lates in the blood during periods of in- the pH of body fluids has returned to
creased amino acid metabolism. Coma normal. Compensatory mechanisms
and death may occur. maintain the normal ratio of bicarbon-
lactic a. Lactacidemia. ate to carbonic acid (approx. 20 : 1) in
methylmalonic a. An inherited blood plasma even though the bicarbon-
metabolic disease caused by inability to ate level is decreased or the carbon di-
convert methylmalonic acid to succinic oxide level is elevated.
acid. The clinical signs are failure to diabetic a. Diabetic ketoacidosis.
grow, mental retardation, and severe dialysis a. Metabolic acidosis due to
metabolic acidosis. One form of the dis- prolonged hemodialysis in which the pH
ease will respond to vitamin B12 given of the dialysis bath has been inadver-
either in utero or to the mother before tently reduced by the action of contam-
delivery. inating bacteria.
acid-fast (as⬘id-fast⬘) In bacterial stain- hypercapnic a. Respiratory acidosis.
ing, pert. to bacteria that do not decol- hyperchloremic a. Acidosis in which
orize after application of acid-alcohol there is an abnormally high level of
but keep a dark stain. Microorganisms chloride in the blood. Bicarbonate ions
that are acid-fast include Mycobacteria maintain electroneutrality of plasma in
and Nocardia species. this disorder. As a result this condition
acid hemolysin test Ham test. is not a cause of a significant anion gap.
acid hydrolase Any hydrolytic enzyme SYN: hyperchloremic metabolic acido-
found in a lysosome that performs op- sis.
timal catalysis at a pH of about 5. hyperchloremic metabolic a. Hy-
acidify (ă-sid⬘ı̆-fı̄⬙) [acid ⫹ -ify] 1. To perchloremic a.
make a substance acid. 2. To become lactic a. An accumulation of lactic
acid. acid in the blood, often due to inade-
acidifiable (ă-sid⬙ı̆-fı̄⬘ă-bl), adj. acidifica- quate perfusion and oxygenation of vital
tion (-fı̆-kā⬘shŏn), n. acidifier (-fı̄⬙ĕr), n. organs, e.g., in cardiogenic, ischemic, or
acidity (ă-sid⬘ı̆-tē) [acid] 1. The quality septic shock, drug overdoses (com-
of possessing hydrogen ions (protons). monly, salicylates or ethanol), skeletal
SEE: acid; hydrogen ion; pH. 2. Sour- muscle overuse, e.g., after heavy exer-
ness. cise or seizures, or other serious ill-
a. of the stomach The lowered pH of nesses (some cancers; diabetes melli-
the gastric contents, due to hydrogen tus). Lactic acid is produced more
ion release by parietal cells. quickly than normal when there is in-
acid lipase disease Acid lipase adequate oxygenation of skeletal mus-
deficiency. cle and other tissues. Thus any disease
acidophil, acidophile (ă-sid⬘ŏ-fil⬙, ă-sid⬘ŏ- that leads to tissue hypoxia, exercise,
fı̄l⬙) 1. Acidophilic (2). 2. Pert. to two hyperventilation, as well as some drugs,
different types of cells (somatotrophs e.g., oral hypoglycemic agents, may
and prolactin cells) in the anterior pi- cause this condition. In general, when
tuitary that cannot be distinguished blood pH is less than 7.35 and lactate is
from each other by standard staining greater than 5 to 6 mmol/L (5 to 6 mEq/
techniques although they can be distin- L), lactic acidosis is present.
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acidosis 30 acidosis

metabolic a. Any process that causes bicarbonate or with citrated salts (such
a decrease in the pH of the body as a as potassium citrate). The acidosis of
result of the retention of acids or the loss chronic renal failure may require ther-
of bicarbonate buffers. Metabolic acido- apy with sodium bicarbonate or may be
sis is usually categorized by the pres- treated by dialysis with a bicarbonate-
ence or absence of an abnormal anion rich dialysate. Diets are adjusted for pa-
gap. The anion gap metabolic acidoses tients with renal failure to limit the
include diabetic, alcoholic, and lactic metabolic production of acids (these
acidoses; the acidosis of renal failure; usually rely on limitations of daily di-
and acidoses that result from the con- etary protein). Foods rich in potassium
sumption of excess acids e.g., salicy- and phosphate are restricted. Patients
lates, methanol, or ethanol. Nonanion with renal failure should be monitored
gap metabolic acidoses occur in diar- for signs and symptoms of renal acido-
rhea, renal tubular acidosis, and mul- sis, including loss of appetite, changes
tiple myeloma. in levels of consciousness, or alterations
ETIOLOGY: Possible causes include in respiratory rate or effort. Laboratory
excessive ingestion of acids, salicylates, monitoring may include frequent as-
methanol, or ethylene glycol; failure of sessments of arterial blood gas values,
the kidneys to excrete acids, e.g., in re- serum electrolytes, carbon dioxide lev-
nal failure or renal tubular acidosis; ke- els, and blood urea nitrogen and creat-
toacidosis (diabetic, alcoholic, owing to inine. Prescribed intravenous fluids are
starvation); severe dehydration; diar- given to maintain hydration.
rhea; rhabdomyolysis; seizures; and renal tubular a. ABBR: RTA. Any of
shock. a group of nonanion gap metabolic aci-
PATIENT CARE: A history is ob- doses marked by either loss of bicarbon-
tained, focusing on the patient’s urine ate or failure to excrete hydrogen ions
output, fluid intake, dietary habits (in- in the urine. Type I (distal RTA) is
cluding recent fasting), associated dis- marked by low serum potassium, ele-
orders, e.g., diabetes mellitus and kid- vated serum chloride, a urinary pH
ney or liver dysfunction, and the use of greater than 5.5, nephrocalcinosis, and
medications (including aspirin) and al- nephrolithiasis. Alkalis such as sodium
cohol. Arterial blood gas values, serum bicarbonate or Shohl’s solution are ef-
potassium level, and fluid balance are fective treatments.
monitored. The patient is assessed for Type II (proximal RTA) is caused by
lethargy, drowsiness, and headache, di- impaired reabsorption of bicarbonate by
minished muscle tone, and deep tendon the proximal tubules. Its hallmarks in-
reflexes. The patient is also evaluated clude preserved glomerular filtration,
for hyperventilation, cardiac dysrhyth- hypokalemia, excessive bicarbonate ex-
mias, muscle weakness and flaccidity, cretion in the urine during bicarbonate
and gastrointestinal distress (such as loading, and a urinary pH less than 5.5.
nausea, vomiting, diarrhea, and abdom- Osteopenia and osteomalacia are com-
inal pain). Prescribed intravenous flu- mon. Treatments include volume re-
ids, medications, e.g., sodium bicarbon- striction and potassium and bicarbon-
ate or insulin, and other therapies, e.g., ate supplementation.
oxygen or mechanical ventilation, are Type IV (hyperkalemia RTA) is usu-
administered. The patient is positioned ally associated with hyporeninemic hy-
to promote chest expansion and reposi- poaldosteronism due to diabetic ne-
tioned frequently. Frequent oral hy- phropathy, nephrosclerosis associated
giene with sodium bicarbonate rinses with hypertension, or chronic nephrop-
will neutralize mouth acids, and a wa- athy. Patients have high serum potas-
ter-soluble lubricant will prevent lip sium levels and low urine ammonia ex-
dryness. A safe environment with min- cretion but no renal calculi. The
imal stimulation is provided, and prep- hyperkalemia may be managed by min-
arations should be available if seizures eralocorticoids with furosemide. Glo-
occur. Both patient and family are given merular filtration is reduced in this dis-
oral and written information about pre- order.
scribed medication and managing re- respiratory a. Acidosis caused by in-
lated diseases. adequate ventilation and the subse-
renal a. Acidosis caused either by quent retention of carbon dioxide. SYN:
kidney failure, in which phosphoric and carbon dioxide a.; hypercapnic a.
sulfuric acids and inorganic anions ac- PATIENT CARE: The patient sus-
cumulate in the body, or by renal tubu- pected of developing acute respiratory
lar diseases. The acidosis is induced by acidosis is monitored using arterial
urinary wasting of bicarbonate and in- blood gases, level of consciousness, and
ability to excrete phosphoric and sulfu- orientation to time, place, and person.
ric acids. The patient is also evaluated for dia-
PATIENT CARE: Renal acidosis due phoresis, a fine or flapping tremor (as-
to one of the renal tubular acidoses re- terixis), depressed reflexes, and cardiac
sponds to treatment either with sodium dysrhythmias. Vital signs and ventila-
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acid rain 31 acne

tory effort are monitored, and ventila- teria that are able to survive moderate
tory difficulties such as dyspnea are doc- acidity.
umented. Prescribed intravenous fluids acinar (as⬘ı̆-nar⬙) [L. acinus, grape]
are given to maintain hydration. The Pert. to an acinus.
patient is oriented as often as neces- acinar cell carcinoma of the pancreas
sary, and information and reassurance SEE: under carcinoma.
are given to allay the patient’s and fam- Acinetobacter (a⬙ı̆-nēt⬙ŏ-bak⬘tĕr) [Gr.
ily’s fears and concerns. Prescribed akinētos, immovable, ⫹ bacter(ium)]
therapies for associated hypoxemia and A genus of gram-negative, aerobic coc-
underlying conditions are provided, re- cobacilli that is an increasingly impor-
sponses are evaluated, and related pa- tant cause of serious infections, esp. in
tient education is given. hospitalized patients. It is commonly
The respiratory therapist (RT) works found in water, soil, and on the skin of
with the attending physician to deter- healthy humans.
mine when to intubate and mechani- acini (as⬘ı̆-nı̄⬙) Pl. of acinus.
cally ventilate the patient with acute acinitis (as⬙ı̆-nı̄t⬘is) [acinus ⫹ -itis] In-
respiratory acidosis. Once the patient is flammation of glandular acini.
intubated and is receiving mechanical acinous, acinose (as⬘ı̆-nŭs, as⬘ı̆-nōs⬙)
ventilation, the RT monitors and main- [acinus] Consisting of acini. SYN: aci-
tains the patient’s airway and tolerance niform.
of the positive pressure ventilation. acinus (as⬘ı̆-nŭs, as⬘ı̆-nı̄⬙) pl. acini [L. ac-
This requires the RT to perform fre- inus, berry, grape] 1. A group of secre-
quent q1-2m assessments of the patient tory cells surrounding a cavity; the
and the ventilator and report side ef- smallest division of a gland. 2. The ter-
fects to the attending physician. Some minal respiratory gas exchange unit of
patients with advanced chronic obstruc- the lung, composed of airways and al-
tive lung disease develop chronic respi- veoli distal to a terminal bronchiole.
ratory acidosis (as a result of CO2 reten- ACIP The Advisory Committee on Immu-
tion), usually with a compensatory nization Practices of the U.S. Public
metabolic (renal) alkalosis. Health Service.
AC joint Acromioclavicular joint.
ACL Anterior cruciate ligament.
Acute respiratory acidosis is a med- acladiosis (ă-klad⬙ē-ō⬘sis) [Acladium ⫹
ical emergency in which immediate -osis] An ulcerative skin disease be-
efforts to improve ventilation are re- lieved to be caused by fungi of the genus
quired. Acladium.
aclasis, aclasia (ak⬘lă-sis, ă-klā⬘zē-ă) [a-
⫹ Gr. klasis, a breaking ] Abnormal
acid rain Rain that, in passing through tissue arising from and continuous with
the atmosphere, is contaminated with a normal structure, as in achondropla-
acid substances, esp. sulfur dioxide and sia.
nitrogen oxide. These pollutants are ox- diaphyseal a. Imperfect formation of
idized in the atmosphere to sulfuric acid cancellous bone in cartilage between di-
and nitric acid. Rainwater is considered aphysis and epiphysis.
abnormally acidic if the pH is below 5.6. ACLS Advanced Cardiac Life Support.
It may damage ecosystems or individual acme (ak⬘mē) [Gr. akmē, point] 1. The
plants and animal species. highest point; peak. 2. Apogee. 3. The
aciduria (as-ı̆-door⬘ē-ă, -dūr⬘) [acid ⫹ segment of uterine labor contraction
-uria] The presence of any organic or during which muscle tension is greatest.
inorganic acid in the urine. ACMG American College of Medical Ge-
branched-chain alpha-keto a., netics and Genomics.
branched-chain ␣-keto a. Maple syrup acne (ak⬘nē) [Ult. fr. acme] An inflam-
urine disease. matory disease of the sebaceous follicles
glutaric a. An inherited disorder of the skin, marked by comedones, pap-
marked by multiple neurological defi- ules, and pustules. It is exceptionally
cits in childhood, including motor dys- common in puberty and adolescence.
function, developmental delay, and Acne usually affects the face, chest,
brain atrophy. It is caused by defective back, and shoulders. In severe cases,
manufacture of glutaryl-coenzyme A de- cysts, nodules, and scarring occur. SYN:
hydrogenase. common a.; a. vulgaris.
orotic a. A rare autosomal recessive ETIOLOGY: The cause is unknown,
disorder of pyrimidine metabolism in but predisposing factors include hered-
which orotic acid accumulates in the itary tendencies and disturbances in the
body. Clinically, children fail to grow androgen-estrogen balance. Acne begins
and develop megaloblastic anemia and at puberty when the increased secretion
leukopenia. The disease responds to the of androgen in both males and females
administration of uridine or cytidine. increases the size and activity of the pi-
aciduric (as⬙ı̆-doo⬘rik, -dūr⬘) [acid ⫹ L. losebaceous glands. Specific inciting fac-
durare, to endure ⫹ -ic] Pert. to bac- tors may include food allergies, endo-
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acne 32 acne

crine disorders, therapy with adrenal a. atrophica Acne with residual pit-
corticosteroid hormones, and psycho- ting and scarring.
genic factors. Vitamin deficiencies, in- bromide a. The characteristic acne
gestion of halogens, and contact with caused by bromide.
chemicals such as tar and chlorinated a. ciliaris Acne that affects the edges
hydrocarbons may be specific causative of the eyelids.
factors. The fact that bacteria are im- common a. Acne.
portant once the disease is present is in- a. conglobata Acne vulgaris with ab-
dicated by the successful results follow- scesses, cysts, and sinuses that leave
ing antibiotic therapy. The lesions may scars.
become worse in women and girls before cystic a. Acne with cysts containing
the menstrual period. keratin and sebum. SEE: illus.
SYMPTOMS: Acne vulgaris is marked
by either papules, comedones with black
centers (pustules), or hypertrophied
nodules caused by overgrowth of con-
nective tissue. In the indurative type,
the lesions are deep-seated and cause
scarring. The face, neck, and shoulders
are common sites. Acne may be obsti-
nate and recurrent.
TREATMENT: Treatments include
skin cleansing, topical agents, e.g., aze-
laic acid or benzoyl peroxide or vitamin
A derivatives, and oral or topical anti- CYSTIC ACNE
bacterial drugs.
PATIENT CARE: The patient is in- TREATMENT: Isotretinoin, a vitamin
structed to wash the skin thoroughly A derivative, has been effective in treat-
but gently, avoiding intense scrubbing ing this condition. For Caution concern-
and skin abrasion; to keep hands away ing its use, SEE: isotretinoin.
from the face and other sites of lesions; a. fulminans A rare type of acne in
to limit the use of cosmetics; and to ob- teenage boys, marked by inflamed, ten-
serve for, recognize, and avoid or modify der, ulcerative, and crusting lesions of
predisposing factors that may cause ex- the upper trunk and face. It has a sud-
acerbations. The need to reduce sun ex- den onset and is accompanied by fever,
posure is explained, and the patient is leukocytosis, and an elevated sedimen-
advised to use a sunscreen agent when tation rate. About half of the cases have
vitamin A acid or tetracycline is pre- inflammation of several joints.
scribed. Information is provided to fill
halogen a. Acne due to exposure to
halogens such as bromine, chlorine, or
knowledge gaps or correct misconcep-
iodine.
tions, and emotional support and un-
a. indurata Acne vulgaris with
derstanding are offered, particularly if
chronic, discolored, indurated surfaces.
the patient is an adolescent. Patients
keloid a. Acne keloidalis nuchae.
(and others) need to be aware that ex- a. keloidalis nuchae Chronic follicu-
tensive use of antibiotic treatment for lar infection of the skin at the occiput
acne increases the prevalence of anti- (base of the skull) and the neck. It oc-
biotic-resistant facial bacteria and can curs most often in men of African heri-
affect treatment response. Most im- tage and causes scars and thickening of
provement occurs during the first 6 the skin. SYN: keloid a.
weeks of therapy, whatever the regi- a. keratosa Acne in which suppurat-
men. More than half of all patients re- ing nodules crust over to form horny
spond to therapy. Colonization with tet- plugs. These occur at the corners of the
racycline-resistant propionibacteria mouth.
diminishes response to all oral antibi- a. neonatorum Acne occurring in
otic regimens. Skin irritation as an ad- newborns. It is common, appearing
verse effect to treatment occurs most about the second to fourth week of life.
commonly with topical benzoyl peroxide Comedones, inflamed papules, and pus-
alone, which is the most cost-effective tules may be seen (the latter yield
treatment. Adding topical erythromycin staphylococcal species when cultured).
may help reduce irritation and increase The rash typically resolves spontane-
efficacy. ously by the third or fourth month of
life. Lesions are typically seen on the
chin, cheeks, and forehead. Usually no
Because of the teratogenicity of treatment is required, but keratolytic
some acne medications (such as is- agents may be used for severe cases.
otretinoin), pregnancy must be avoided a. papulosa Acne characterized by
during their use. formation of papules with very little in-
flammation. SEE: illus.
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acne 33 acroagnosis

ACOTE Accreditation Council for Occu-


pational Therapy Education.
acousmatamnesia (ă-kooz⬙măt-ăm-nē⬘
zē-ă) [Gr. akousma, something heard
⫹ amnesiaamnesia, forgetfulness] In-
ability to recall and identify sounds.
acoustic (ă-koos⬘tı̆k) [Gr. akoustikos,
pert. to hearing] Pert. to sound or to the
sense of hearing.
acoustic apparatus Auditory apparatus;
the anatomical structures essential for
ACNE PAPULOSA
hearing.
acoustic area A part of the brain that lies
over the vestibular and cochlear nuclei.
petroleum a. Acne that may occur in acoustic reflectometry Diagnostic tech-
those who work with petroleum and nique for the detection of middle ear ef-
oils. fusion. It measures the level of sound
a. pustulosa Acne with pustule for- transmitted and reflected from the mid-
mation and subsequent deep scars. dle ear to a microphone located in a
a. rosacea Rosacea. probe tip placed against the ear canal
steroid a. Acne caused by systemic or and directed toward the tympanic mem-
topical use of corticosteroid drugs. brane.
summer a. Acne that appears only in acoustics (ă-koos⬘tiks) [acoustic] The
hot, humid weather or that is much science of sound, its production, trans-
worse in such weather. Although the ex- mission, and effects.
act cause is unknown, the condition is acousto-, acoust-, acous- [Gr. akousti-
not caused by increased exposure to the kos, pert. to hearing, fr. akouein, to
sun’s rays. hear] Prefixes meaning hearing.
tropical a. Severe acne caused by or ACP acid phosphatase; advance care
aggravated by living in a hot, humid cli- planning; American College of Patholo-
mate. The skin of the thorax, back, and gists; American College of Phlebology;
legs is most commonly affected. American College of Physicians; Ameri-
a. urticaria An acneiform eruption of can College of Prosthodontists.
itching wheals. ACPE Accreditation Council for Phar-
a. varioliformis Vesiculopustular fol- macy Education (a provider of continu-
liculitis that occurs mostly on the tem- ing education for pharmacists).
ples and frontal margins of the scalp but acquired (ă-kwı̄rd⬘) [Fr. fr. L. acquirere,
may be seen on the chest, back, or nose. to get] Not hereditary or innate.
a. vulgaris Acne. acquired immunodeficiency syndrome
acnegenic (ak⬙nē-jen⬘ik) [acne ⫹
SEE: AIDS; HIV/AIDS.
-genic] Causing acne.
acquisition (ak⬙wı̆-zı̆sh⬘ŏn) [L. acquir-
acneiform, acneform (ak-nē⬘ı̆-form⬙, ak-
ere, to get] The measurement of image
nē⬘form⬙) [acne ⫹ -form] Resembling
data during a radiological study and of
acne.
acnemia (ăk-nē⬘mē-ă) [a- ⫹ Gr. knēmē, its subsequent storage in memory.
lower leg ⫹ -ia] Wasting of the calves ACR American College of Radiology;
of the legs. American College of Rheumatology.
ACNM American College of Nurse Mid- acral (ak⬘răl) [acro- ⫹ -al] Pert. to the
wives. extremities.
ACOG American College of Obstetricians acrania (ā⬙krā⬘nē-ă) [1an- -crania] Par-
and Gynecologists. tial or complete congenital absence of
aconite (ak⬘ŏ-nı̄t⬙) [Gr. akoniton, wolfs- the cranium.
bane] The dried tuberous root of Acon- acrid (ak⬘rı̆d) [L. acer, sharp] Burning,
itum, esp. A. napellus (monkshood) and bitter, irritating.
A. lycoctonum (wolfsbane); a poisonous acridine (ak⬘rı̆-dēn⬙) [acrid ⫹ -ine] A
alkaloid that may cause life-threatening coal tar hydrocarbon from which certain
cardiac arrhythmias. Aconite is believed dyes are prepared.
to have been used as an arrow poison acrimony (ak⬘rı̆-mō⬙nē) [L. acer, sharp]
early in Chinese history and perhaps Harshness or bitterness of words, man-
also by the inhabitants of ancient Gaul. ner, or attitude.
It was also used as an herbal remedy in acritical (ā⬙krit⬘ı̆-kăl) [a- ⫹ critical]
traditional Chinese medicine. Not marked by a crisis.
aconitine (ă-kon⬘ı̆-tēn⬙, -tı̆n) [aconite ⫹ ACRM American Congress of Rehabilita-
-ine] C34H47NO11, a poisonous white tion Medicine.
crystalline alkaloid that is the active in- ACRN AIDS Certified Registered Nurse;
gredient in aconite. Asthma Clinical Research Network.
acorea (ā⬙kor⬘-ē-ă) [1an- ⫹ Gr. korē, acro- [Gr. akron, extremity] Prefix
maiden, pupil of the eye ⫹ -ia] Ab- meaning extremity, top, extreme point.
sence of the pupil of the eye. acroagnosis (ak⬙rō-ăg-nō⬘sis) [acro- ⫹
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acroanesthesia 34 acrognosis

a- ⫹ Gr. gnōsis, knowledge] Absence acrocyanosis (ak⬙rō-sı̄-ă-nō⬘sı̆s) [acro-


of feeling of one’s limb. ⫹ cyanosis] A blue or purple mottled
acroanesthesia (ak⬙rō-an⬙ĕs-thē⬘zh(ē-)ă) discoloration of the extremities, esp. of
[acro- ⫹ 1an- ⫹ -esthesia] Lack of the fingers, toes, and/or nose. This find-
sensation in one or more of the extrem- ing is associated with many diseases
ities. and conditions, e.g., anorexia nervosa,
acrobrachycephaly (ak⬙rō-brak⬙ı̆-saf⬘ă- autoimmune diseases, cold agglutinins,
lē) [acro ⫹ brachycephaly] The con- or Raynaud’s disease or phenomenon.
dition of having an abnormally short Acrocyanosis is commonly observed in
head in the anterior-posterior diameter newborns and in others after exposure
due to fusion of the coronal suture. to cold temperatures and in patients
acrocentric (ak⬙rō-sen⬘trik) [acro- ⫹ with reduced cardiac output. In patients
center ⫹ -ic] Pert. to a chromosome in with suspected hypoxemia, it is an un-
which the centromere is located near reliable sign of diminished oxygenation.
one end. At metaphase it has the ap- (Instead of relying on this sign, pulse ox-
pearance of a wishbone. acrocentric, n. imetry or arterial blood gases should be
acrocephalosyndactylia, acrocephalo- measured.) acrocyanotic (-not⬘ik), adj.
syndactyly (ak⬙rō-sef⬙ă-lō-sin-dak- acrodermatitis (ak⬙rō-dĕr-mă-tı̄t⬘ı̆s)
til⬘ē-ă, -sin-dak⬘til-ē) [acro- ⫹ ce- [acro- ⫹ dermatitis] Dermatitis of the
phalo- ⫹ syndactyly] A congenital extremities.
condition marked by a peaked head a. chronica atrophicans Dermatitis
and webbed fingers and toes. SYN: of the hands and feet that progresses
Apert syndrome. slowly upward on the affected limbs.
acrocephaly, acrocephalia (ak⬙rō-sef⬘ă- a. continua An obstinate eczematous
lē, ak⬙rō-sĕ-fāl⬘yă) [acro- ⫹ Gr. keph- eruption confined to the extremities.
alē, head] The condition of having a a. enteropathica A rare disease in
malformed cranial vault with a high or children aged 3 weeks to 18 months that
peaked appearance and a vertical index may be fatal if untreated. The geneti-
above 77. It is caused by premature clo- cally determined cause is malabsorp-
sure of the coronal, sagittal, and lamb- tion of zinc. Onset is insidious with fail-
doidal sutures. This defect may be seen ure to thrive, diarrhea, loss of hair, and
in Apert syndrome. SYN: acrocephalia. development of vesiculobullous lesions,
acrocephalic (-sĕ-faliı̆k), adj. particularly around body orifices. SYN:
acrochordon (ak⬙rŏ-kor⬘don⬙) [acro– ⫹ zinc deficiency syndrome.
Gr. chordē, cord] A small, benign, TREATMENT: Zinc sulfate is given
polyp-shaped growth composed of skin orally to the affected children.
and subcutaneous tissue; typically a. hiemalis Dermatitis that occurs in
found on the neck, in the axilla, or near winter and affects the extremities. It
the eyelids. SYN: fibroepithelial polyp; tends to disappear spontaneously.
skin tag. SEE: illus. a. perstans Acrodermatitis con-
tinua.
acrodermatosis (ak⬙rō-dĕr⬙mă-tō⬘sı̆s)
[acro- ⫹ dermatosis] Any skin disease
that affects the hands and feet.
acrodynia (ak⬙rō-din⬘ē-ă) [acro- ⫹ -dy-
nia] A disease of infants and young
children caused by chronic mercury poi-
soning. It may have a prolonged clinical
course with various grades of severity.
SYN: pink disease.
TREATMENT: Treatment consists of
removing the source of the mercury with
dimercaprol (BAL) antidote and sup-
portive therapy. acrodynic (-din⬘ik),
adj.
acrodysesthesia (ak⬙rō-dis⬙es-thē⬘
zh(ē-)ă) [acro- ⫹ dysesthesia] Dys-
esthesia in the arms and legs.
acroesthesia (ak⬙rō-es-thē⬘zh(ē-)ă)
[acro- ⫹ -esthesia] 1. Abnormal sen-
sitivity of the extremities. 2. Pain in the
extremities.
acrofacial (ak⬙rō-fā’shăl) [acro- ⫹ fa-
cial] Pert. to the hands, feet, and face.
acrogeria (ak⬙rō-jēr⬘ē-ă) [acro- ⫹ Gr.
gerōn, old man] A condition in which
the skin of the hands and feet shows
ACROCHORDON
signs of premature aging.
(in the axilla) acrognosis (ak⬙rog-nō⬘sis) [acro- ⫹ Gr.
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acrokeratosis verruciformis 35 acro-osteolysis

gnōsis, knowledge] Sensory perception


of limbs.
acrokeratosis verruciformis (ak⬙rō-ker⬙
ă-tō⬘sis vĕ-roo⬘sı̆-for⬙mis) [acro- ⫹
keratosis ⫹ L. verruca, wart, -form]
Hereditary disease of the skin charac-
terized by warty growths on the extrem-
ities, principally on the backs of the
hands and on the feet.
acrokinesia (ak⬙rō-kı̆-nē⬘sē-ă) [acro- ⫹
-kinesi ⫹ -ia] Excessive motion of the
extremities.
acromegaly (ak⬙rō-meg⬘ă-lē) [acro- ⫹
-megaly] A chronic syndrome of growth
hormone excess in adults, most often
caused by a pituitary macroadenoma. It
produces a bony enlargement, resulting
in significant changes in facial and oral
features. The diagnosis is confirmed by
elevated levels of serum insulin-like
growth factor 1 (IGF-1), or by a growth
hormone level that does not suppress af-
ter oral glucose tolerance testing. SYN:
Marie’s disease.
ETIOLOGY: Overproduction of
growth hormone by somatotroph cells of
the anterior pituitary is responsible in
most cases.
SYMPTOMS: The onset is often so
gradual that patients and their close as-
sociates may not notice a change in ap- ACROMIOCLAVICULAR TRACTION TEST
pearance or function. Increased sweat-
ing, decreased libido, somnolence, mood ōmion, (little) shoulder] The lateral tri-
disorders, muscular pain, weakness, angular projection of the spine of the
and loss of vision may eventually occur. scapula that forms the point of the
Signs include a coarsening of facial fea- shoulder and articulates with the clav-
tures, often with frontal bossing (pro- icle. acromial (ă-krō⬘mē-ăl), adj. SYN:
tuberance of the skull); enlargement of acromial process. SEE: acromioclavicu-
hands and feet; deepening of the voice; lar joint.
and increased separation of the teeth. A acromioplasty (ă-krō⬘mē-ō-plas⬙tē)
quarter of patients develop diabetes [acromion ⫹ -plasty] The surgical re-
mellitus. moval of the distal inferior acromion
TREATMENT: Transsphenoidal re- process of the scapula to relieve im-
section of a growth-hormone secreting pingement of soft tissues in the subacro-
adenoma is the primary therapy. mial space, esp. the supraspinatus ten-
acromelalgia (ak⬙rō-mĕ-lăl⬘j(ē-)ă) [acro- don. This is usually performed with
⫹ Gr. melos, limb ⫹ -algia] Eryth- release of the coracoacromial ligament,
romelalgia. arthroscopically or through open inci-
acrometagenesis (ak⬙rō-met⬙ă-jen⬘ĕ-sis) sion.
[acro- ⫹ meta- ⫹ -genesis] Abnor- acromyotonia (ăk⬙rō-mı̄-ō-tō⬘nē-ă)
mal growth of the extremities. [acro- ⫹ myotonia] Myotonia of the
acromicria (ak⬙rō-mik⬘rē-ă, -mı̄k⬘) [acro- extremities, causing spasmodic defor-
⫹ micr- ⫹ -ia] Congenital shortness mity. acromyotonus (-ot⬘ŏ-nŭs), adj.
or smallness of the extremities and face. acroneurosis (ăk⬙rō-nu-rō⬘sis) [acro- ⫹
acromioclavicular traction test (ă-krō⬙ Gr. neuron, sinew, tendon ⫹ -osis]
mē-ō-klă-vik⬘yŭ-lăr) [acromion ⫹ cla- Any peripheral neuropathy affecting
vicular] A maneuver used to identify the extremities.
acromioclavicular and costoclavicular acro-osteolysis (ăk⬙rō-ŏos⬙tē-ŏl⬘ı̆-sis)
ligament sprains. As the patient sits or [acro- ⫹ osteolysis] 1. A familial dis-
stands with the affected shoulder hang- ease causing dissolution of the tips of
ing in the neutral position, the clinician the bones in the extremities of young
pulls the humerus down. A positive test children. There is no history of trauma,
result is marked by a visible separation and spontaneous amputation does not
between the acromion and distal clavi- occur. Its cause is unknown. 2. An oc-
cle. SEE: illus. cupational disease seen in workers who
acromiohumeral (ă-krō⬙mē-ŏ-hū⬘mĕ-răl) come in contact with vinyl chloride po-
[acromion ⫹ humeral] Pert. to the lymerization processes. It is marked by
acromion and humerus. Raynaud’s phenomenon, scleroderma-
acromion (ă-krō⬘mē-ŏn⬙) [acro- ⫹ Gr. like skin changes, and radiological evi-
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acropachyderma 36 acting out

dence of bone destruction of the distal healthcare applications, e.g. as a struc-


phalanges of the hands. Recovery fol- tural material in syringes and vials.
lows removal from exposure. SEE: Ray- ACS American Cancer Society; American
naud’s disease. Chemical Society; American College of
acropachyderma (ăk⬙rō-pak⬙ē-dĕr⬘mă) Surgeons; acute confusional state.
[acro- ⫹ pachyderma] Clubbing of the ACSC ambulatory care sensitive condi-
fingers, deformation of the long bones, tion.
and thickening of the skin of the scalp, ACSM American College of Sports Medi-
face, and extremities. cine.
acroparalysis (ăk⬙rō-pă-ral⬘ı̆-sis) [acro- act (akt) [L. agere, to drive, do] 1. To
⫹ paralysis] Paralysis of one or more accomplish a function. 2. The accom-
extremities. plishment of a function. 3. Legislation
acroparesthesia (ăk⬙rō-par⬙es-thē⬘ that has been passed and made law; a
zh(ē-)ă) [acro- ⫹ paresthesia] A sen- statutory law.
sation of prickling, tingling, or numb- compulsive a. The repetitive, ritu-
ness in the extremities. alistic performance of an act. This may
acropathology (ak⬙rō-pă-thŏl⬘ŏ-jē) be done despite the individual’s at-
[acro- ⫹ pathologyn] Any disease of tempts to resist the act.
the extremities, e.g., the fingers or toes. ACTH adrenocorticotropic hormone; As-
acrophobia (ăk-rŏ-fō⬘bē-ă) [acro- ⫹ sociation of Canadian Teaching Hospi-
-phobia] A phobia of high places. acro- tals.
phobe (ăk-rŏ-fōb⬙), n.; acrophobic (ăk- ACTH stimulation test A test to deter-
rŏ-fō-bik), adj. SYN: hypsophobia. mine the presence of adrenal insuffi-
acroscleroderma (ăk⬙rō-skler⬙ŏ-dĕr⬘mă) ciency.
[acro- ⫹ scleroderma] Hard, thick- PATIENT CARE: Synthetic adreno-
ened skin of toes and fingers. SYN: corticotropic hormone (ACTH) is in-
sclerodactylia. jected intravenously, and the serum cor-
acrosclerosis (ăk⬙rō-skle-rō⬘sis) [acro- tisol level is measured at timed
⫹ sclerosis] A scleroderma of the up- intervals (30 or 60 min after the injec-
per extremities. It sometimes extends to tion). A patient with normal adrenal
the neck and face after Raynaud’s dis- function will respond to the test with in-
ease. creased serum cortisol levels above 18
acrosomal reaction (ak⬙rŏ-sō⬘măl) The ␮g/dl. Serum cortisol levels ⬍15 ␮g/dl
release of enzymes from the acrosome are diagnostic of adrenal insufficiency.
on the head of the sperm. This process The test has been traditionally per-
causes the sperm to penetrate the zona formed with an injection of 250 ␮g of
pellucida of the egg and begin fertiliza- ACTH, but studies have shown that 1
tion. ␮g is an equally effective test dose. SYN:
acrosome (ak⬘rŏ-sōm⬙) [acro- ⫹ -some] Cortrosyn stimulation test; cosyntropin
An organelle within the head of a sperm stimulation test.
cell that contains enzymes to digest the actigraphy (ak-tig⬘ră-fē) [acti(vity) ⫹
zona pellucida of an ovum. acrosomal -graphy] The monitoring of body move-
(ak⬙rŏ-sō⬘măl), adj. SEE: spermatozoon ments with a small device usually at-
for illus. tached to the wrist or foot, used in sleep
acrylamide (ak⬙rı̆-la⬘mı̄d⬙, ă-krı̆l⬘ă-mı̄d) medicine (and sometimes in anesthesia
[acrylic (acid) ⫹ amide] 1. The amide or critical care medicine) to determine
of acrylic acid, C3H5NO. Acrylamide is whether and how well a person is rest-
used in many types of gel electrophore- ing or sleeping. In sleep medicine, actig-
sis to separate and identify proteins. raphy can aid in the diagnosis of insom-
2. A chemical by-product formed in nia, obstructive sleep apnea, and
foods cooked at high temperatures. Ac- periodic limb movements. It is used in
rylamides cause cancer and have ad- anesthesia to determine depth of seda-
verse effects on reproduction. SEE: car- tion, e.g., during recovery from surgery.
cinogen. actin (ak⬘tı̆n) [act ⫹ -in] One of the
contractile proteins that make up the
sarcomeres of muscle tissue. During
Acrylamide, a suspected carcino-
contraction, the actin filaments are
gen, found in starchy foods pre-
pulled toward the center of the sarco-
pared at high temperatures, e.g., potato
mere by the action of myosin filaments,
chips, french fries, and bread.
and the sarcomere shortens. Actin is
also found in the cytoskeleton of many
acrylate (ak⬘rı̆-lāt⬙) [acrylic (acid) ⫹ kinds of cells, where it contributes to
-ate] A salt or ester of acrylic acid. cell shape and movement.
acrylonitrile (ak⬙rı̆-lō-nı̄⬘trı̆l, trēl⬙) filamentous a. The polymerized form
C3H3N; a toxic compound used in mak- of actin.
ing plastics. SYN: vinyl cyanide. globular a. The monomeric form of
acrylonitrile-butadiene-styrene (a⬙krı̆- actin.
lō-nı̄⬘trı̆l-bū⬙tă-dı̄⬘ēn⬙stı̄⬘rēn⬙) A plastic acting out Expressing oneself through
polymer used in many industrial and actions rather than speech.
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acting out 37 action

neurotic a.o. 1. A form of transfer- vicofacial (lumpy jaw), thoracic, and


ence in which tension is relieved when abdominal areas of humans.
one responds to a situation as if it were A. antibioticus A species from which
the same situation that originally gave the actinomycin antibiotics are ob-
rise to the tension. It is a displacement tained.
of behavioral response from one situa- A. bovis A species that causes acti-
tion to another. 2. In psychoanalysis, a nomycosis in cattle.
form of displacement in which the pa- A. israelii A species that causes ac-
tient relives memories rather than ex- tinomycosis in humans. It is a normal
pressing them verbally. inhabitant of the mouth, but can cause
actinic (ak-tin⬘ik) [Gr. aktis, ray] abscesses in the gingiva or the jaw, as
1. Pert. to radiant energy, such as x- well as in the abdominal or thoracic cav-
rays, ultraviolet light, and sunlight, esp. ities. Viewed microscopically material
the photochemical effects. 2. Pert. to the from these abscesses contain purulent
ability of radiant energy to produce material within which are found yellow-
chemical changes. actinically (-i-k(ă)lē), colored sulfur granules.
adv. Actinomycetales (ak⬙tı̆-nō-mı̄⬙sĕ-tā⬘lēz⬙)
actinide (ak⬘tı̆-nı̄d⬙) [actin- ⫹ -ide] [Actinomyces] An order of bacteria that
Any of the radioactive heavy metals des- includes the families Mycobacteriaceae,
ignated on the periodic table of ele- Actinomycetaceae, Actinoplanaceae,
ments with atomic numbers 89– 103. Dermatophilaceae, Micromonospora-
The actinides include naturally occur- ceae, Nocardiaceae, and Streptomyce-
ring elements, e.g., actinium and ura- taceae.
nium, and artificial elements, e.g., fer- actinomycete (ak⬙tı̆-nō-mı̄⬘sēt⬙) [Acti-
mium. nomyces] Any bacterium of the order
Actinidia (ak⬙tı̆-nid⬘ē-ă) SEE: kiwifruit. Actinomycetales.
actinism (ak⬘tı̆-nı̆zm) [actin- ⫹ -ism] actinomycetic (-mı̄-sēt⬘ı̆k), adj. actino-
The property of radiant energy that pro- mycetous (-mı̄-sēt⬘ŭs), adj.
duces chemical changes, as in photog- actinomycin (ak⬙tı̆-nō-mı̄s⬘ı̆n) [Actino-
raphy or heliotherapy. myc(es) ⫹ -in] Any of the frequently
actinium (ak-tin⬘ē-ŭm) [actin- ⫹ -ium] toxic drugs obtained from the species of
SYMB: Ac. A radioactive element, soil bacteria Streptomyces antibioticus
atomic mass (weight) (most stable iso- (Actinomyces antibioticus).
tope) 227, atomic number 89. a. D Dactinomycin.
actino-, actin- [Gr. aktis, stem aktin-, ray] actinomycoma (ak⬙tı̆-nō-mı̄-kō⬘ma) [ac-
1. Prefixes meaning ray or radiation. tinomycosis ⫹ -oma] A tumor pro-
2. Prefixes meaning having a radiating duced by actinomycosis.
structure, e.g., Actinomyces. actinomycosis (ak⬙tı̆-nō-mı̄-kō⬘sı̆s) [Ac-
Actinobacillus (ak⬙tı̆-nō⬙bă-sil⬘ŭs) [ac- tinomyces ⫹ -osis] An infectious bac-
tino- ⫹ bacillus] A genus of aerobic terial disease in animals and humans.
gram-negative coccobacilli that are par- Infection may be of the cervicofacial,
asites of hoofed mammals, and, rarely, thoracic, or abdominal regions, or it may
of humans. The now-preferred but less be generalized. Microscopic analysis of
common name is Aggregatibacter. SEE: actinomycotic pus reveals characteristic
Aggregatibacter. SEE: HACEK. sulfur granules. actinomycotic (ak⬙tı̆-
A. actinomycetemcomitans A spe- nō-mı̄-kot⬘ı̆k), adj.
cies that often colonizes the upper res- ETIOLOGY: Causative organisms are
piratory tract, is an important cause of Actinomyces bovis in cattle and Actino-
periodontal infection, and is sometimes myces israelii (which is normally
implicated in blood-culture negative en- present in the mouth) in humans. SEE:
docarditis, brain abscesses, meningitis, nocardiosis.
or osteomyelitis. A. actinomycetemcom- TREATMENT: Prolonged administra-
itans was formerly called Haemophilus tion of high-dose penicillin is usually ef-
aphrophilus; its now-preferred but less fective. Alternative antibiotics include
common name is Aggregatibacter aphro- erythromycins, tetracyclines, and clin-
philus. SEE: Aggregatibacter aphrophi- damycin. Surgical incision and drainage
lus. of accessible lesions are helpful when
actinodermatitis (ak⬙tı̆-nō-dĕr-mă-tı̄t⬘is) combined with chemotherapy.
[actino- ⫹ dermatitis] Dermatitis actinophytosis (ak⬙tı̆-nō-fı̄-tō⬘sis) [ac-
caused by exposure to radiation. tino- ⫹ phytosis] Infection due to Ac-
actinogenic (ak⬙tı̆-nō-jen⬘ı̆k) [actino- ⫹ tinomyces.
-genic] Radiogenic. actinotherapy (ak⬙tı̆-nō-ther⬘ă-pē) [ac-
Actinomyces (ak⬙tı̆-nō-mı̄⬘sēz⬙, ak-tin⬙ō) tino- ⫹ therapy] Treatment of disease
[actino- ⫹ Gr. mykēs, mushroom, fun- by rays of light, esp. actinic or photo-
gus] A genus of bacteria of the family chemically active rays, or by x-rays or
Actinomycetaceae that contains gram- radium.
positive staining filaments. These bac- action (ak⬘shŏn) [L. actio, fr. agere, to
teria usually cause disease in the cer- drive, do] 1. Performance of a function
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action 38 activated protein C

or process. 2. In pathology, a morbid only certain tissues or organs; (7) syn-


process. ergistic, when one drug increases the ac-
adipokinetic a. The action of sub- tion of another; (8) antagonistic, when
stances to promote formation of free one drug counteracts another; (9) phys-
fatty acids from body fat stores. iological, when the drug exerts a poten-
bacteriocidal a. Action that kills bac- tially beneficial effect similar to that
teria. which the body normally produces; (10)
ball-valve a. Intermittent obstruc- therapeutic, when the effect is to treat
tion of a passageway or opening so that or repair diseased organs or tissues; (11)
the flow of fluid or air is prevented from side active, creating an undesired effect;
moving in and out in equal amounts. A (12) empirical, producing results not
common example is a mucus plug in a proved by clinical or laboratory tests to
distal airway. During inspiration the be effective; or (13) toxicological, having
airway widens allowing gas to flow past a toxic or undesired effect, generally the
the plug. During expiration the airway result of overdose or long-term usage.
narrows and gas is trapped. This mech- Cumulative: Some drugs are slowly
anism can be responsible for a pneu- excreted or absorbed so that with re-
mothorax in ventilated patients. peated doses an accumulation in the
calorigenic a. Heat produced by the body produces a toxic effect. Such drugs
metabolism of food. should not be administered continu-
capillary a. A surface tension effect ously.
shown by the elevation or depression of Incompatible: Undesired side effects
a liquid at the region of contact with a occur when some drugs are adminis-
solid, as in capillary tubes. SYN: capil- tered together. This may be due to the
larity. antagonistic action of one drug on oth-
cumulative a. Sudden increased ac- ers or to a physical interaction of the
tion of a drug after several doses have drugs that inactivates one of them, e.g.,
been given. precipitation of some drugs mixed in in-
cumulative drug a. The action of re- travenous fluids.
peated doses of drugs that are not im- reflex a. Involuntary movement pro-
mediately eliminated from the body. For duced by sensory nerve stimulation.
example, preparations containing lead, sparing a. The effect of a nonessen-
silver, and mercury tend to accumulate tial nutrient in the diet such that it de-
in the body and gradually produce creases the requirement for an essential
symptoms of poisoning. nutrient. For example, protein is esp.
drug a. The function of a drug in var- important for tissue growth and devel-
ious body systems. opment in children. If protein intake is
Local: When the drug is applied lo- sufficient but caloric intake is inade-
cally or directly to a tissue or organ, it quate, a protein deficiency will develop.
may combine with the cell’s membrane In this situation, the addition of suffi-
or penetrate the cell. Its action may be cient carbohydrates to the diet is said to
(1) astringent when the drug causes the spare the protein.
cell or tissue to contract, (2) corrosive specific a. The particular action of a
when the drug is strong enough to de- drug on another substance or on an or-
stroy cells, or (3) irritating when too ganism or part of that organism.
much of the drug combines with cells specific dynamic a. Stimulation of
and impairs them. the metabolic rate by ingestion of cer-
General, or systemic: This type of ac- tain foods, esp. proteins.
tion occurs when the drug enters the synergistic a. The ability of a drug or
bloodstream by absorption or direct in- muscle to aid or enhance the action or
jection, affecting tissues and organs not effect of another drug or muscle; oppo-
near the site of entry. Systemic action site of antagonistic action.
may be (1) specific, when it cures a cer- tendon a. Passive movement of a
tain disease; (2) substitutive or replen- joint when a two-joint or multijoint
ishing, when it supplies substances de- muscle is stretched across it.
ficient in the body; (3) physical, when thermogenic a. Action of a food,
some cell constituents are dissolved by drug, or physical agent to cause a rise
the action of the drug in the blood- in output of body heat.
stream; (4) chemical, when the drug or actionable (ak⬘shŏn-ă-bĕl) 1. Providing
some of its principles combine with the a valid reason for legal action or a law-
constituents of cells or organs to form a suit. 2. Providing justification for a med-
new chemical combination; (5) active by ical intervention, as from a laboratory
osmosis, caused by dilution of salt (also result.
acids, sugars, and alkalis) in the stom- activate (ak⬘tı̆-vāt⬙) [active] To make a
ach or intestines by fluid withdrawn process begin; to turn on or set in mo-
from the blood and tissues; or by diffu- tion.
sion, when water is absorbed by cells activated carrier A term sometimes used
from the lymph; (6) selective, when ac- as a synonym for coenzyme.
tion is produced by drugs that affect activated protein C ABBR: APC. An in-
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activation 39 activity

hibitor of thrombin, and a fibrinolytic activin (ak⬘tı̆-vin) [active ⫹ -in] Any of


and anti-inflammatory agent produced a family of polypeptide growth factors
in the bloodstream during sepsis. that help regulate various biological
activation (ak⬙tı̆-vā⬘shŏn) [activate] functions, esp. fertility. SEE: inhibin.
1. In immunology, the process that stim- activities of daily living ABBR: ADL.
ulates resting (nonfunctional) white Tasks performed by people in a typical
blood cells to assume their role in the day that allow independent living. Basic
immune response. The process involves activities of daily living (BADL) include
recognition of an antigen or a response feeding, dressing, hygiene, and mobil-
to cytokines. 2. In neuropsychology, ity. Instrumental activities of daily liv-
arousal. 3. In physiology, the triggering ing (IADL) include more advanced skills
of a cell response, as when a neurotrans- such as managing personal finances, us-
mitter causes ionic channels to open in ing transportation, telephoning, cook-
an excitable cell membrane, setting off ing, performing household chores, doing
an action potential. SEE: antigen pro- laundry, and shopping.
cessing; cytokine; immune response. The ability to perform activities of
activator (ak⬘tı̆-vāt⬙ŏr) [activate] 1. A daily living may be hampered by illness
substance in the body that converts an or accident resulting in physical or men-
inactive molecule into an active agent, tal disability. Health care rehabilitation
such as the conversion of pepsinogen workers play a significant role in teach-
into pepsin by hydrogen ions. 2. A sub- ing people to maintain or relearn these
stance that specifically induces an activ- skills so that they can achieve the high-
ity, such as an inductor or organizer in est possible degree of independence.
embryonic development or in a trophic PATIENT CARE: The nurse and other
hormone. 3. A removable orthodontic members of the rehabilitation team, in-
appliance that transmits force passively cluding occupational and physical ther-
from muscles to the teeth and alveolar apists, assess the patient’s ability to
process in contact with it. Also called perform ADLs. The rehabilitation team
myofunctional appliance. instructs and trains the patient in tech-
tissue plasminogen a ABBR: tPA, niques to relearn the skill, or to accom-
TPA. SEE: tissue plasminogen activa- modate for inability to perform the task.
tor. Where appropriate, family members are
urokinase-type plasminogen a. involved in the rehabilitation program.
ABBR: uPA. A protein that degrades Referrals to community agencies are ar-
extracellular tissues. It has been linked ranged when specific tasks cannot be
to the spread of some cancers by inva- performed independently. SEE: table.
sion and metastasis. electronic aids to a.d.l. ABBR:
active assistive range of motion ABBR: EADLs. Computerized or electronic de-
AAROM. An exercise in which a man- vices that help people with functional
ual or mechanical external force assists limitations gain entry to and exit from
specific muscles and joints to move buildings, use telephones and other
through their available excursion. The household items, and enjoy leisure ac-
force is graded according to the patient’s tivities.
strength. AAROM exercises are used extended a.d.l. Instrumental activi-
when the patient has difficulty moving ties of daily living.
or when tissue forces need to be re- instrumental a.d.l. ABBR: IADL.
duced. Those activities and tasks beyond basic
active compression decompression car- self-care that are necessary for living in-
diopulmonary resuscitation ABBR: dependently. These activities include
ACD CPR. The use of a handheld suc- communication, mobility, cooking, us-
tion device applied to the chest wall dur- ing the telephone, cleaning the house,
ing CPR to depress and then decom- doing laundry, shopping, going to the
press the chest. bank, and managing medications. SYN:
active electrode In electrosurgery, the extended a.d.l. SEE: activities of daily
electrode used for cutting or coagulating living; self-care.
tissue; the lead where the electrical cur- activity (ak-tiv⬘ı̆t-ē) [Fr. activité, fr L. ac-
rent concentrates. tivitas] 1. The production of energy or
active heat and moisture exchanger An motion; the state of being active. In the
addition to a ventilator circuit that uses medical sciences, activity applies to var-
a passive heat and moisture exchanger ious conditions: from enzyme activity to
and a heated component to filter, heat, the rate of influence of an enzyme on a
and humidify the gases supplied to the particular system; radiation activity to
ventilated patient. the energy produced by a source of ra-
active range of motion ABBR: AROM. diation. 2. A person’s use of time.
The amount of joint motion produced by graded a. In occupational therapy, a
voluntary muscle contraction. principle of therapeutic intervention in
active treatment Treatment directed which tasks are classified and gradually
specifically toward cure of a disease or presented according to the patient’s
the resolution of injury. level of function and the challenge or de-
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activity 40 activity intolerance

Activities of Daily Living and Factors Affecting Them


Category Activities Affecting Factors
Personal care Climbing stairs, moving Altered mobility, physical,
into and out of chair or mental, or emotional ill-
bed, feeding oneself, ness, elimination prob-
opening containers, lems
dressing, using toilet,
maintaining hygiene,
taking medication
Family responsibilities Shopping, cooking, doing Altered mobility, heavy
laundry, cleaning, car- work schedule, insom-
ing for yard, caring for nia, physical, mental, or
family and pets, manag- emotional illness
ing money
Work or school Fulfilling work responsi- Altered mobility, stress,
bilities or school assign- heavy family demands,
ments, getting to and job dissatisfaction, diffi-
from work or school culties in school, physi-
cal, mental, or emo-
tional illness
Recreation Pursuing hobbies and in- Altered mobility, physical,
terests, exercising, mental, or emotional ill-
reading, watching tele- ness
vision
Socialization Using the telephone, trav- Altered mobility, physical,
eling, visiting family mental, or emotional ill-
and friends, joining ness, relocation
group activities, ex-
pressing sexuality

gree of skill (physical, social, or cogni- diac tamponade is suspected, pericar-


tive) required by the task. diocentesis is performed; for tension
leisure a. An activity chosen for plea- pneumothorax, needle decompression
sure, relaxation, or other emotional sat- of the chest is performed. Epinephrine
isfaction, typically after work and other is the only drug proven to resuscitate
responsibilities are done. patients from PEA. Nasmyth mem-
optical a. In chemistry, the rotation brane.
of the plane of polarized light when the purposeful a. The goal-directed use
light passes through a chemical solu- of time, energy, or attention that in-
tion. Measurement of this property is volves a person’s active participation.
useful in determining optically active Purposeful activity often involves a so-
substances such as dextrose (sugars are cial environment (others), a physical en-
classified by this method). Optical activ- vironment (objects, tools, and materi-
ity of a substance in solution can be de- als), and a process.
tected by placing it between polarizing structured physical a. Physical ex-
and analyzing prisms. ercise organized for a specific goal, ap-
pulseless electrical a. ABBR: PEA. propriate for a patient’s age and health,
Cardiac arrest in which the continua- and defined in duration, frequency, and
tion of organized electrical activity in intensity.
the heart is not accompanied by a pal- activity analysis The process used by oc-
pable pulse or effective circulation of cupational therapists to determine the
blood. SEE: cardiopulmonary resusci- social, symbolic, physical, cognitive, and
tation. developmental characteristics of a task
ETIOLOGY: PEA may be caused by or activity. Typical characteristics of in-
severe acidosis, cardiac ischemia or in- terest include safety, cost, gradability,
farction, hyperkalemia, hypothermia, required space, tools or supplies, com-
hypoxia, hypovolemia (such as bleeding plexity, and social or cultural signifi-
or dehydration), massive pulmonary cance or meaning.
embolism, cardiac tamponade, or ten- activity intolerance Inadequate mental
sion pneumothorax. or physical energy to accomplish daily
SYMPTOMS: The patient is unrespon- activities. Risk factors include condi-
sive, pulseless, and apneic. tions such as anemia, obesity, muscu-
TREATMENT: Chest compressions loskeletal disorders, neurological defi-
are started. Intravenous fluids are cits (such as those following stroke),
given, and potentially correctable con- severe heart disease, chronic pulmo-
ditions are addressed, e.g., when car- nary disease, metabolic disorders, and
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activity intolerance, risk for 41 acupuncture

prolonged sedentary lifestyle. SEE: distance may still see “hand motion”
Nursing Diagnoses Appendix. (HM), or they may have light perception
activity intolerance, risk for Vulnerable (LP). People who are completely blind
to experiencing insufficient physiologi- are said to have “no light perception”
cal or psychological energy to endure or (NLP).
complete required or desired daily activ- Young children or people who do not
ities, which may compromise health. know the Roman alphabet may be able
SEE: Nursing Diagnoses Appendix. to demonstrate their visual acuity with
activity therapist An allied health profes- eye charts on which symbols, e.g., of an-
sional who assists patients or residents imals or other commonly recognized
of care facilities with activities for lei- shapes, are drawn to similar sizes and
sure, recreation, habilitation, or reha- specifications.
bilitation purposes. PATIENT CARE: A health care profes-
actomyosin (ak⬙tŏ-mı̄⬘ŏ-sı̆n) [act(in)- ⫹ sional should conduct an initial visual
myosin] The combination of actin and acuity test on all patients who come to
myosin in a muscle. the Emergency Department, clinic, or
Actos Pioglitazone. health care provider’s office with a vi-
ACTs arteminisin-based combination sual complaint or disorder. Visual acu-
therapies (drug combinations used to ity should be tested with an illuminated
treat proven cases of malaria). Snellen eye chart. The visual acuity of
actual (ak⬘choo-ăl) [Fr. fr. L. actualis, ac- each eye is checked independently with
tive, practical] Real, existent. and without the patient’s distance
actuator (ak⬘choo-āt⬙ŏr) A component of glasses or contact lenses; then the acu-
a mechanical or electronic device that ity of both eyes is checked.
initiates a given action. acuminate (ă-kū⬘mı̆-nit , ă-kū⬘mı̆-nāt⬙)
acu- [L. acus, needle] Prefix meaning [L. acuminatus, sharpened] Conical;
clarity, sharpness, or needle. pointed.
acuity (ă-kū⬘ı̆t-ē) [Fr. fr. L. acuere, to acupoint (ak⬘yŭ-point⬙) [acu- ⫹ point]
sharpen] 1. Clearness, sharpness of a A specific location on the body where an
sensory function, e.g., visual acuity. acupuncture needle is inserted or pres-
2. In emergency and critical care medi- sure is applied for therapeutic purposes,
cine, the severity of a hospitalized pa- e.g., the control of postoperative nausea
tient’s illness and the level of attention and vomiting.
or service he or she will need from pro- acupuncture (ak⬘yŭ-pŭngk⬙chŭr)
fessional staff. [acu- ⫹ puncture] A technique for
distance a. The ability to register op- treating pain, producing regional an-
tical details of objects that are far from esthesia, treating acute or chronic ill-
the eye, e.g., on a chart positioned 20 ft ness (such as hormonal, immune, or
away from the viewer in a test of visual
orthopedic), or preventing disease by
acuity.
passing thin needles through the skin
near a. The ability to register optical
into specific points on the body. The
details when objects are only 12– 14 in
free ends of the needles are manually
from the eye.
twirled, heated by moxa or moxibus-
visual a. A measure of the resolving
power of the eye. It is usually deter- tion, or connected to a weak electrical
mined by one’s ability to read letters of current. They are then typically left in
various sizes at a standard distance place for about 20 min. Although ac-
from the test chart. The result is ex- upuncture has a variety of uses in
pressed as a comparison: 20/20 is nor- Asia and Europe, in the U.S., it is
mal vision, meaning the subject has the principally considered a treatment for
ability to see from a distance of 20 ft (6.1 local pain. It is often used in combi-
m) what a person with normal vision nation with other therapies, including
should see at that distance. Visual acu- massage, meditation, and herbal rem-
ity of 20/40 means that a person sees at edies. Research suggests that acu-
20 ft (6.1 m) what a person with normal puncture relieves pain by stimulating
vision sees from a distance of 40 ft (12.2 the release of endogenous opioids,
m). other neurotransmitters (such as se-
DIAGNOSIS: The Snellen chart used rotonin), and by directly affecting af-
for most purposes ranges from 20/10 to ferent nerve fibers. Acupuncture has
20/200. People who can see no better also been found to be effective in vet-
than 20/200 are said to be legally blind. erinary applications. In the U.S. pro-
People with worse vision, e.g., 20/400 or fessional proficiency in acupuncture is
worse, are said to have “count fingers” attained by passing an examination
(CF) vision: they may not be able to read administered by the National Com-
any of the letters or figures on an eye mission for the Certification of Acu-
chart, but they can often see (and count) puncture and Oriental Medicine of the
how many fingers are held in front of American Academy of Medical Acu-
them from a specified distance. Those puncture. acupuncturist (-chŭ-rist),
who cannot identify fingers from any n.
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acute respiratory distress


acute 42 syndrome

of plasma proteins as well as other


It is important that the acupunc- metabolic, hematological, and neuro-
turist use sterile or disposable nee- endocrine events. Cytokines, produced
dles and that care be taken to prevent by white blood cells, esp. macrophages,
puncturing adjacent organs. stimulate the liver’s production of
acute phase proteins: interleukin-6, in-
acute (ă-kūt⬘) [L. acutus, sharp, sharp- terleukin-1␤, tumor necrosis factor ␣,
ened] 1. Of pain, sharp, severe. 2. Of interferon-␥, and transforming growth
disease, having rapid onset, severe factor ␤. These proteins, which in-
symptoms, and a short course. SEE: crease or decrease in the blood by at
chronic (2). 3. Of the senses, perceiving least 25%, include C-reactive protein,
keenly and accurately. complement, and coagulation factors;
acute chest syndrome A complication of they enhance the immune response
sickle cell disease resulting from vas- and tissue repair. Cytokines also stim-
cular occlusion or infection in the lungs ulate systemic changes, producing di-
and marked by chest pain, tachypnea, verse beneficial effects including fever,
fever, rales and rhonchi, leukocytosis, which enhances the immune response
and lobar consolidation. and stabilizes cell membranes;
acute cocaine hydrochloride poisoning increased adrenal cortisol and cate-
SEE: under poisoning. cholamine production, which helps
acute confusional state Acute confu- maintain hemodynamic stability;
sion thrombocytosis and leukocytosis; and
acute coronary syndrome ABBR: ACS. increased gluconeogenesis and lipoly-
Any circumstance that suddenly im- sis, which provide nutrients for cells.
pairs blood flow through the coronary There are also negative effects, how-
arteries. Acute coronary syndrome in- ever, including decreased production of
cludes all forms of acute myocardial in- erythropoietin, causing anemia; im-
farction, i.e., those that cause Q waves paired growth; anorexia; lethargy; and,
on the electrocardiogram and those that if prolonged, the loss of skeletal muscle
do not, as well as those that cause S-T and fat (cachexia). SYN: acute phase re-
segment elevation and those that do sponse. SEE: cytokine; inflammation;
not, and unstable angina pectoris. interleukin-6; protein, acute phase.
PATIENT CARE: On admission the fo- acute respiratory distress syndrome
cus of immediate care is stabilizing the ABBR: ARDS. Respiratory insuffi-
patient’s condition, relieving pain ciency marked by progressive hypox-
caused by ischemia, and administering emia due to severe inflammatory dam-
all medications as prescribed, including age causing abnormal permeability of
thrombolytic therapy when indicated. the alveolocapillary membrane. The al-
In the first 48 hours monitoring and veoli fill with fluid, which interferes
treating arrhythmias, and identifying with gas exchange. SEE: disseminated
and correcting exacerbating factors intravascular coagulation; sepsis; sys-
such as electrolyte imbalances, hypox- temic inflammatory response syndrome.
emia, acidosis or drugs are priorities in ETIOLOGY: ARDS may result from
care. direct trauma to the lungs, e.g., near
acute effect Any adverse effect of a tran- drowning, aspiration of gastric acids, se-
sient exposure to a noxious agent, such vere lung infection or systemic disor-
as an infectious microorganism, ioniz- ders, e.g., shock, septicemia, dissemi-
ing radiation, or a toxin. nated intravascular coagulation (DIC)
acute kidney injury ABBR: AKI. Acute cardiopulmonary bypass, or reaction to
renal failure blood transfusions. Widespread damage
acute nephritic syndrome Acute glomer- to the alveolocapillary membranes is
ulonephritis. SEE: glomerulonephritis. initiated through the aggregation and
acute panmyelosis with myelofibrosis activity of neutrophils and macrophages
ABBR: APMF. A form of acute leuke- and the activation of complement. Cy-
mia in which multiple cell lines develop tokines, oxygen-free radicals, and other
aberrantly, infiltrate internal organs, inflammatory mediators damage the
e.g., the spleen, and cause extensive walls of capillaries and alveoli, produc-
bone marrow fibrosis. ing diffuse inflammatory interstitial
acute phase reaction The release of and alveolar edema, fibrin exudates,
physiologically active proteins by the and hyaline membranes that block oxy-
liver into the blood in response to inter- gen delivery to the blood.
leukin-6 or other cytokines that partic- DIAGNOSIS: Diagnosis is based on a
ipate in the destruction of pathogens history of a recent event associated with
and promote healing during inflamma- the onset of ARDS, the presence of non-
tion. This results in fever, an increase cardiogenic pulmonary edema on the
in circulating neutrophils, and activa- chest radiograph, and persistent hypox-
tion of the hypothalamus, pituitary emia and a PaO2/FIO2 ratio of ⬍200.
gland, and adrenal glands. The acute SYMPTOMS: Dyspnea and tachypnea
phase response involves the production are followed by a progressive hypoxemia
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acute respiratory distress acute respiratory distress


syndrome 43 syndrome

that, despite oxygen therapy, is the hall- tory therapist as prescribed by the at-
mark of ARDS. Diffuse, fluffy infiltrates tending physician. Routine manage-
can be seen on chest radiographs as in- ment of a mechanically ventilated
flammation increases alveolar perme- patient includes 1) monitoring breath
ability, causing visible alveolar flooding sounds, chest wall movement, vital
and collapse. signs and comfort, and ventilator set-
TREATMENT: Endotracheal intuba- tings and function; 2) suctioning the en-
tion, mechanical ventilation with posi- dotracheal tube and oropharynx; and 3)
tive end-expiratory pressure (PEEP), assessing changes in pulse oximetry
supplemental oxygen, and tidal vol- and ABG values.
umes of 4 to 8 ml/kg optimize respira- Cardiac output may be decreased be-
tory outcomes. PEEP increases intra- cause PEEP increases intrathoracic
thoracic pressure, keeping alveoli open pressure and reduces venous return.
during exhalation. This reduces the For this reason, health care profession-
pressure required to open alveoli during als must monitor blood pressure, urine
inhalation, improves gas exchange, and output, mental status, peripheral
reduces oxygen need. The patient pulses, and pulmonary capillary wedge
should be monitored and treated for ac- pressure to determine the effects of pos-
idosis, cardiac arrhythmias, DIC, oxy- itive-pressure ventilation on hemodyn-
gen toxicity, renal failure, and sepsis. amics. Inotropic drugs must be admin-
PROGNOSIS: Mortality is high, ap- istered as prescribed if cardiac output
prox. 50% to 60%, depending on the falls. Hemoglobin levels and oxygen sat-
amount of lung tissue affected and the uration values must also be monitored
ability to maintain adequate oxygen closely because packed red blood cell
flow to vital organs. After resolution of transfusion may be required if hemoglo-
the inflammation, the damaged lung tis- bin is inadequate for oxygen delivery.
sue becomes fibrotic and can cause The nurse and respiratory therapist
chronic restrictive lung disease. Pro- (RT) must observe for signs and symp-
longed use of more than 50% oxygen in- toms of barotrauma, e.g., subcutaneous
creases the risk of residual lung dam- emphysema, pneumothorax, and pneu-
age. momediastinum. If mechanical ventila-
PATIENT CARE: To avert ARDS, res- tion is used, sedation may help calm the
piratory status must be monitored in at- patient and reduce the incidence of poor
risk patients. Recognizing and treating synchronization between the patient
early signs and symptoms can be crucial and the ventilator. Nutritional support
to a patient’s survival. Ventilation rate, should begin early to promote pulmo-
depth, and rhythm must be monitored nary cell regeneration and to provide
and subtle changes noted. The onset of proteins needed for successful weaning
ARDS is marked by the onset of a rapid, from a ventilator. Enteral nutrition is
shallow breathing pattern, and pulse preferred over parenteral because it re-
oximetry must be monitored continu- duces the risk of infection. A formula
ously for subtle changes. If shock ensues that is lower in carbohydrates helps de-
and blood is shunted away from body crease CO2 formation during metabo-
surfaces, resulting in cool skin, O2 read- lism in ARDS patients retaining CO2.
ings may become inaccurate, necessitat- Fluid replacement should maintain suf-
ing use of arterial blood gas monitoring ficient circulating volume without caus-
for respiratory alkalosis (early) and ing overhydration as determined by cen-
mixed metabolic and respiratory acido- tral venous pressure readings. Nursing
sis (later). Serial chest x-rays should be measures must be used to prevent prob-
obtained to assess for bilateral consoli- lems of immobility. Prone positioning
dation progressing to lung “whiteout.” may be prescribed to improve oxygena-
The patient must also be observed for tion while lessening the risk of baro-
chest wall retractions on inspiration, trauma, but it complicates some ele-
use of accessory breathing muscles, and ments of nursing care. Prone
level of dyspnea. The patient’s con- positioning, if prescribed (usually for 4
sciousness level, cardiac rate and to 6 hours daily), is often labor-intensive
rhythm, blood pressure, arterial blood and requires several staff members to
gas (ABG) values, serum electrolyte lev- position the patient and therefore is
els, and chest radiograph results must best accomplished on day shift when
be monitored. Fluid balance must be more staff are available in an emer-
closely watched by 1) measuring intra- gency. To limit the patient’s fear and
venous (IV) fluid intake, urinary output, isolation, the procedure should be ex-
and central venous pressure; 2) weigh- plained to the patient, assuring him or
ing the patient daily; and 3) assessing her of its safety. Sedation or analgesia
for peripheral edema. A patent airway are prescribed 30 to 60 minutes before
must be maintained, and oxygen ther- turning the patient on his or her abdo-
apy with continuous positive airway men. To reduce compression of the
pressure or mechanical ventilation with lungs by the heart and mediastinum, a
PEEP must be provided by the respira- specialty bed may be used, or a pronator
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acute retroviral syndrome 44 adactylia

device (a padded metal frame that is safety. They include intense anxiety,
placed against the patient’s chest and fear or helplessness, or dissociative
abdomen, with belt buckles that secure symptoms.
and protect the head, chest, and abdo- acute urethral syndrome Syndrome ex-
men during the procedure) is strapped perienced by women, marked by acute
to the patient. To use this device, the dysuria, urinary frequency, and lack of
side rails on the patient’s bed are low- significant bacteriuria; pyuria may or
ered, and the patient is pulled close to may not be present. The cause is un-
the edge of the bed farthest from the known, but it is important to determine
ventilator. The patient’s face is turned whether a specific bacterial infection of
away from the ventilator, his or her arm the bladder or vagina is present to en-
tucked under the body, and the leg far- sure that appropriate drugs are given as
thest from the ventilator crossed over needed. The syndrome is referred to col-
the other leg at the ankle to aid in turn- loquially as “honeymoon cystitis” be-
ing the patient. The patient can then be cause it may occur during periods of in-
turned by one staff member on each side creased sexual activity.
of the bed and one (usually an RT) at the PATIENT CARE: A history of the ill-
head, who protects the endotracheal ness, including events that increase or
tube, IV lines, and other attachments. decrease symptoms, is obtained. The de-
The prone patient’s blood pressure and gree and nature of the patient’s pain, its
heart and respiratory rates must be location and possible radiation, and its
closely monitored for evidence of posi- frequency and duration are ascertained.
tion tolerance, and the RT may confirm The patient is instructed in the proce-
correct endotracheal tube position by dure for collecting a clean-catch, mid-
capnography. Vital signs should return stream urine specimen and is prepared
to baseline within 5 min after prone po- for vaginal examination. If a bladder or
sitioning, repositioning the patient in vaginal bacterial, fungal, or protozoal
the supine position if there is any drop infection is diagnosed, prescribed treat-
in O2 saturation, deterioration in ABG ment measures are explained and dem-
results, or uncontrollable patient anxi- onstrated.
ety. Once in the prone position, the pa- acyclic (ā⬙sı̄⬘klı̆k, sik⬘lik) [a- ⫹ cyclic]
tient’s feet and elbows should be padded 1. Without a cycle. 2. In chemistry, ali-
to prevent pressure injuries. The pa- phatic.
tient’s head should be repositioned acyl (as⬘ı̆l, ēl⬙, ā⬘sı̆l) [ac(id) ⫹ -yl] Gen-
every hour to prevent necrosis of facial eral formula RC⫽O; in organic chemis-
skin and to provide oral care and airway try, the radical derived from an organic
suctioning. Range of motion exercises acid when the hydroxyl group (OH) is
should be performed at least every 2 hr. removed.
The patient should be repositioned to acylate (as⬘ı̆-lāt⬙) [acyl] To incorporate
the supine position after 4 or 6 hr, as an acyl (alkanoyl) group into a chemical
prescribed. Strict asepsis must be ob- compound. acylation (as⬙ı̆-lā⬘shŏn), n.
served in dressing changes, suctioning, acystia (ā⬙sis⬘tē-ă) [a- ⫹ cyst- ⫹ -ia]
hand hygiene, and oral care. The pa- Congenital absence of the bladder.
tient must be routinely assessed for fe- acystinervia (ā⬙sis⬙tı̆-nĕr⬘vē-ă) [a- ⫹
ver, changes in sputum color, and ele- cysti- ⫹ L. nervus, nerve ⫹ -ia] De-
vated white blood cell count. Response fective nerve supply to or paralysis of
to therapy must be evaluated and ad- the bladder. SYN: acystineuria.
verse reactions noted. The family must acystineuria (ā⬙sis⬙tı̆-noor⬘ē-ă) Acysti-
be encouraged to talk to the patient nervia.
even though he or she may not be able ad- [L. ad, to] Prefix indicating adher-
to respond verbally. ence, increase, toward, e.g., adduct.
Respiratory therapists play a key role -ad [L. ad, to] Suffix meaning toward or
in the care of patients with ARDS. They in the direction of, e.g., cephalad.
initiate mechanical ventilation as pre- a.d. [L.] auris dextra, right ear.
scribed by the attending physician and ADA American Dental Association; Amer-
monitor arterial blood gases and pulse ican Diabetes Association; American Di-
oximetry to ensure adequate oxygena- etetic Association; Americans with Dis-
tion. They adjust the tidal volume, res- abilities Act.
piratory rate, and PEEP levels to opti- ADAA American Dental Assistants Asso-
mize tissue oxygenation. They also help ciation.
determine when the patient may be ADAAG Americans with Disabilities Act
ready for weaning from mechanical ven- Accessibility Guidelines.
tilation by periodic assessment of the Adacel (ad⬘ă-sel⬙) Tetanus toxoid, diph-
patient’s cardiopulmonary status. theria, and acellular pertussis, ad-
acute retroviral syndrome ABBR: ARS. sorbed vaccine.
Acute HIV infection. adactylia, adactylism, adactyly (ā⬙dak⬙tı̆l⬘
acute stress disorder ABBR: ASD. The ē-ă, ā-dak⬘tı̆-lı̆zm, -lē) [a- ⫹ dactyl-]
emotional and behavioral consequences Congenital absence of digits of the hand
of a sudden alteration in one’s sense of or foot.
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adalimumab 45 addict

adalimumab (ad⬙al-im⬘ŭ-mab⬙) A mono- performance and for facilitating mas-


clonal antibody used to treat psoriatic tery for the patient over performance
and rheumatoid arthritis, Crohn dis- challenges. SEE: conceptual model; oc-
ease, ulcerative colitis, and ankylosing cupational therapy.
spondylitis. Its trade name is Humira. postural a. The ability to maintain
adamantine (ad⬙ă-man⬘tēn⬙ , ad⬙ă-man⬘ balance and remain upright during
tı̄n⬙, ad⬙ă-mant⬘ı̆n) [Gr. adamantinos, changes in position and challenges to
pert. to the hardest metal or to a dia- stability. SEE: postural control.
mond] 1. Extremely hard or lustrous. retinal a. Adjustment of the rods and
2. In dentistry, pert. to dental enamel. cones of the retina to ambient light.
adamantinoma (ad⬙ă-mant⬙ı̆n-ō⬘mă) Adaptation Model A conceptual model of
[adamantine ⫹ -oma] Ameloblas- nursing developed by nursing theorist
toma. Sister Callista Roy that is based on the
Adam’s apple (ad⬘ămz) A prominence in individual’s adaptation to environmen-
the midline of the throat, formed by the tal stimuli. In this model, the goal of
junction of two lateral wings of the thy- nursing is to promote adaptive physical,
roid cartilage. SYN: laryngeal promi- physiological, self-concept, and group
nence; pomum adami; prominentia lar- identities, role function, and interde-
yngea. pendence responses.
ADAMHA Alcohol, Drug Abuse, and Men- adapter, adaptor (ă-dap⬘tĕr) 1. A device
tal Health Administration. for joining one part of an apparatus to
Adams-Stokes syndrome (ad⬘ămz- another. 2. A device to facilitate con-
stōks⬘) SEE: Stokes-Adams syndrome. necting electrical supply cords to differ-
adapalene (ă-dap⬘ă-lēn⬙) A topical reti- ent receptacles. 3. A device for adapting
noid (vitamin A analogue) used to treat one type of electrical supply source to
acne. It is marketed as a gel in combi- the specific requirements of an instru-
nation with benzoyl peroxide. Redness, ment.
itching, discoloration of the skin, and adaptive capacity, decreased intracranial
photosensitivity may occur with use. Intracranial fluid dynamic mechanisms
SEE: benzoyl peroxide. that normally compensate for increases
adaptation (ad⬙ap⬙tā⬘shŏn) [L. adap- in intracranial volumes are compro-
tare, to adjust] 1. Adjustment of an or- mised, resulting in repeated dispropor-
ganism to a change in internal or exter- tionate increases in intracranial pres-
nal conditions or circumstances. sure (ICP) in response to a variety of
2. Adjustment of the eye to various in- noxious and non-noxious stimuli. SEE:
tensities of light, accomplished by Nursing Diagnoses Appendix.
changing the size of the pupil and ac- adaptive equipment (ă-dap⬘tiv) A de-
companied by chemical changes occur- vice to assist in the completion of activ-
ring in the rods. 3. In psychology, a ities of daily living (ADLs). SEE: activ-
change in quality, intensity, or distinct- ities of daily living.
ness of a sensation that occurs after con- adaptive functioning The ability to live
tinuous stimulation of constant inten- independently in a community, manag-
sity. 4. In dentistry, the proper fitting of ing one’s own affairs and maintaining
dentures or bands to the teeth or close- healthy and responsible social relation-
ness of a filling to the walls of a cavity. ships.
adaptational (-shŏ-năl), adj. adapta- adaptive therapy (ă-dap⬘tiv) Any of the
tionally (-lē), adv. services, techniques, and technologies
chromatic a. A change in hue or sat- used in occupational and physical ther-
uration, or both, resulting from pre-ex- apy to help patients with functional dis-
posure to light of other wavelengths. abilities overcome environmental bar-
color a. The fading of intensity of riers.
color perception after prolonged visual adaptogen (ă-dap⬘tŏ-jen⬙) [adapt ⫹
stimulation. -gen] Any agent, such as an herb or a
dark a. Adjustment of the eyes for vi- nutrient, that stimulates immunity or
sion in dim light. SYN: scotopia. provides resistance to disease.
light a. Changes that occur in a dark- adaptometer (ad⬙ap⬙tom⬘ĕt-ĕr) [adapt
adapted eye in order for vision to occur ⫹ -meter] A device to determine the
in moderate or bright light. Principal time required for visual adaptation to
changes are contraction of the pupil and darkness.
breakdown of rhodopsin. Bright sun- adaxial (ad⬙ak⬘sē-ăl) [ad- ⫹ axial]
light has 30,000 times the intensity of Toward the main axis.
bright moonlight, but the eye adapts so ADCC antibody-dependent cell-mediated
that visual function is possible under cytotoxicity; antibody-dependent cellu-
both conditions. SEE: night vision; vi- lar cytotoxicity.
sion. add (ad) In optometry, a treatment for
occupational a. ABBR: OA. A prac- presbyopia in which a plus lens is added
tice model used by the occupational to the lower segment of eyeglasses to
therapist to provide strategies for inter- improve near vision, as for reading.
preting and enhancing observed patient addict (ad⬘ikt) [L. addictus, given over]
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addict 46 Addison disease

1. One who cannot control the need or dizziness. Physical findings may include
craving for a substance or a behavior, postural hypotension and increased
esp. when the craving results in adverse skin pigmentation.
consequences or a decline in one’s abil- DIAGNOSIS: Serum chemistries usu-
ity to function effectively. 2. To make ally reveal hyponatremia and hyperka-
someone dependent or to become depen- lemia (a low concentration of serum so-
dent on a substance or behavior. dium and a high concentration of
active a. An addict who is neither potassium). If these findings are
currently abstinent nor undergoing present, a cosyntropin stimulation test
treatment. may be performed to establish the di-
addiction (ă-dik⬘shŏn) [addict] A com- agnosis. Fasting plasma cortisol levels
pulsive, abnormal dependence on a sub- less than 10 ␮g/dL suggest adrenal in-
stance (such as alcohol, cocaine, opiates, sufficiency. Cortisol levels remain re-
or tobacco) or on a behavior (such as duced even after the injection of syn-
gambling). The dependence typically thetic adrenocorticotropic hormone
has adverse psychological, physical, eco- (ACTH).
nomic, social, or legal ramifications. TREATMENT: Chronic adrenal insuf-
drug a. A compulsive and maladapt- ficiency is managed with corticoste-
ive dependence on a drug that produces roids, e.g., hydrocortisone or predni-
adverse psychological, physical, eco- sone, usually taken twice a day, at the
nomic, social, or legal ramifications. lowest effective dose to replace cortisol.
SEE: substance abuse; substance de- If the patient requires mineralocorticoid
pendence. replacement, fludrocortisone is pre-
exercise a. A pattern of obsessive scribed. Because of the vital role of cor-
physical training that impairs health, tisol in the body’s response to stress, the
produces excessive weight loss, results maintenance dose of these medications
in injury, or has adverse economic, fa- during episodic illnesses or stresses,
milial, psychological or social conse- e.g., surgeries, is increased and then ta-
quences. pered over several days back to baseline
addictionologist (ă-dik⬙shŏn-ol⬘ŏ-jı̆st) levels. SEE: adrenal crisis.
[addiction ⫹ -logy] A specialist in the IMPACT ON HEALTH: Untreated pa-
diagnosis, study, and treatment of psy- tients may develop progressive prob-
chological dependence. lems with abdominal pain, nausea,
Addison disease (ad⬘ı̆-sŏn) [Thomas Ad- vomiting, low blood pressure, electro-
dison, Brit. physician, 1793– 1860] A lyte disturbances, or shock during major
rare illness marked by gradual, progres- illnesses. Patients treated with cortico-
sive failure of the adrenal glands and by steroids have an excellent prognosis.
insufficient production of steroid hor- PATIENT CARE: Patients with pri-
mones. Patients with Addison disease mary adrenal insufficiency who are suf-
are deficient both in glucocorticoids, fering from other acute conditions are
e.g., cortisol, and in mineralocorticoids, assessed frequently for hypotension,
e.g., aldosterone. Cortisol is important tachycardia, fluid balance, and electro-
to glucose metabolism; it affects the me- lyte and glucose levels. Prescribed ad-
tabolism of proteins, carbohydrates and renocortical steroids, with sodium and
fats, and helps maintain blood pressure fluid replacement, are administered.
and cardiovascular function. Hypovole- The patient is protected from stressors,
mia and hypotension may result from e.g., infection, noise, and light and tem-
aldosterone deficiency. SEE: primary perature changes. Extra time for rest
adrenal insufficiency. and relaxation is planned.
CAUSES: Primary adrenal failure For chronic maintenance therapy:
typically results from autoimmune de- Both patient and family are taught
struction of the adrenal glands (80% of about the need for lifelong replacement
cases), chronic infections; e.g., tubercu- therapy and medical supervision. Pa-
losis, cytomegalovirus, and other viral tients are taught about self-administra-
diseases such as Lyme disease or his- tion of steroid therapy (typically two
toplasmosis; or cancers that metasta- thirds of the dose is given in the A.M.
size to the adrenal glands from other or- and one third in the P.M. to mimic di-
gans, such as cancers of the lungs or urnal adrenal activity). Symptoms of
breast. Secondary adrenal insufficiency overdose and underdose and the course
is related to suppression of hypotha- of action, if either occurs, are explained.
lamic-pituitary-adrenal axis function. The patient and family also are taught
SYMPTOMS AND SIGNS: The patient how to monitor blood pressure, heart
may be symptom-free until the majority rate, and blood glucose level. A medical
of adrenal tissue is destroyed. Early alert tag should be worn (or a card car-
complaints are usually nonspecific, e.g., ried) indicating that the person has Ad-
a feeling of weakness or fatigue. Sub- dison disease and requires a 100 mg cor-
sequently patients may notice a lack of tisol injection if found severely injured
appetite, weight loss, nausea, vomiting, or incapacitated. Patient and family
abdominal pain, a craving for salt, and should learn how to administer hydro-
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Addison plane 47 adenoepithelioma

cortisone by injection and should have a bolster or enhance the effectiveness of a


prepackaged syringe and needle with previous one, esp. when the first treat-
the drug readily available at all times. ment proved not to be fully effective.
The patient also should be taught to rec- adduct (ă-dŭkt⬘) [L. adductus, perfect
ognize physical or mental stressors and participle fr. adducere, to bring toward]
how to adjust the usual dosage to pre- 1. In physiology, to draw toward the
vent a crisis. He or she is instructed to long axis of the body or a limb. 2. In
increase fluid and salt replacement if chemistry, to form a compound by add-
perspiring and to follow a diet high in ing one chemical structure to another.
sodium, carbohydrates, and protein, adduction (ă-dŭk⬘shŏn) [adduct]
with small, frequent meals if hypogly- 1. Movement of a limb toward the me-
cemia or anorexia occurs. Measures to dian plane of the body. SEE: abduction
help prevent infection include getting for illus. 2. Movement of a digit toward
adequate rest, avoiding fatigue, eating the median plane of the limb. 3. Inward
a balanced diet, and avoiding people rotation of an eyeball.
with infections. Verbalization of feel- ADEM acute disseminated encephalo-
ings and concerns is encouraged. The myelitis.
patient is assisted in developing coping adenase (ad⬘ĕ-nās) [aden- ⫹ -ase] An
strategies and is referred for further enzyme secreted by the pancreas,
mental health or stress management spleen, and liver that converts adenine
counseling if warranted. Educational into hypoxanthine.
materials and support are available adenectomy (ad⬙ĕn-ek⬘tŏ-mē) [aden- ⫹
from the National Adrenal Diseases -ectomy] Excision of a gland.
Foundation http://www.nadf.us/ or the Adenia digitata (ă-dēn⬘ē-ă dı̆j⬙ı̆-tā⬘tă)
National Institutes of Health at http:// [L] A broad-leafed plant native to SE
endocrine.niddk.nih.gov/pubs/addison/ Africa. The tubers contain concentrated
addison.aspx. modeccin, a protein toxic to mammalian
Addison plane (ad⬘ı̆-sŏn) [Christopher ribosomes.
Addison, Brit. anatomist, 1869– 1951] adenine (ad⬘ĕ-nēn⬙) [aden- ⫹ -ine] A
Any of the planes that divide the abdo- purine base, C5H5N5, that is part of the
men into nine regions to aid in the lo- genetic code of DNA and RNA. In DNA
cation of internal structures. SEE: ab- it is paired with thymine; in RNA, with
dominal regions. uracil.
addition (ă-di⬘shŏn) [L. addere, to add] adenitis (ad⬙ĕ-nı̄t⬘is) [aden- ⫹ -itis]
In chemistry, a reaction in which two Inflammation of lymph nodes or a
substances unite without loss of atoms gland.
or valence. adeno-, aden- [Gr. adēn, gland] Prefixes
additive (ad⬘ı̆-tiv) [L. additivus] 1. In meaning gland.
pharmacology, the effect that one drug adenoacanthoma (ad⬙ĕ-nō-ak⬙an⬙thō⬘
or substance contributes to the action of mă) [adeno- ⫹ acanthoma] Adeno-
another drug or substance. 2. Any sub- carcinoma in which some cells have un-
stance that changes the composition or dergone squamous metaplasia.
action of another when it is added or adenocarcinoma (ad⬙ĕ-nō-kar⬙sı̆n-ō⬘mă)
combined with the first; an adulterant. [adeno- ⫹ carcinoma] A malignant
color a. Any dye, pigment, or sub- tumor that originates in glandular tis-
stance that can impart color when sues, e.g., the breast, the pancreas, or
added or applied to a food, drug, or cos- the prostate. SYN: glandular carci-
metic. Use of color additives in the U.S. noma. adenocarcinomatous (-măt-ŭs),
is regulated by the FDA. Food Drug and adj.
Cosmetic (FDC) colors certified for food acinar a. Adenocarcinoma in which
use are FDC Blue No. 1, No. 2, and No. the cells are in the shape of alveoli.
3; Green No. 3; Red No. 3 and No. 40; SYN: alveolar a.
and Yellow No. 5 and No. 6. alveolar a. Acinar a.
food a. A substance added to food to fetal a. A rare form of adenocarci-
maintain or impart a certain consist- noma of the lung, resembling fetal lung
ency, to improve or maintain nutritive tissue when examined microscopically.
value, to enhance palatability or flavor, It consists of columnar cells that have a
to produce a light texture, or to control clear cytoplasm and oval nuclei.
pH. Food additives are used to help a. in situ ABBR: AIS. A localized
bread rise during baking, to keep bread cluster of malignant appearing cells
mold-free, to color margarine, to pre- found in a gland but not yet spreading
vent discoloration of some fruits, and to outside the basement membrane of the
prevent fats and oils from becoming gland.
rancid. The FDA regulates their use. adenocele (ad⬘ĕ-nō-sēl⬙) [adeno- ⫹
additive effect The therapeutic effect of a -cele] 1. A cystic tumor arising from a
combination of two or more drugs that gland. 2. A tumor of glandular struc-
is equal to the sum of the individual ture.
drug effects. adenoepithelioma (ad⬙ĕ-nō-ep⬙ı̆-thēl⬙ē-ō⬘
add-on therapy Any treatment given to mă) [adeno- ⫹ epithelioma] A tumor
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adenofibroma 48 adenoma

consisting of glandular and epithelial el- adenoids (ad⬘(ĕ-)noydz⬙) [aden- ⫹ -oid]


ements. 1. Lymphatic tissue forming a promi-
adenofibroma (ad⬙ĕ-nō-fı̄-brō⬘mă) [ad- nence on the wall of the pharyngeal re-
eno- ⫹ fibroma] A tumor of fibrous cess of the nasopharynx. 2. A colloquial
and glandular tissue. It is frequently term for enlarged or inflamed pharyn-
found in the uterus or breast. geal tonsils, esp. in children. SEE: pha-
adenofibrosis (ad⬙ĕ-nō-fı̄-brō⬘sis) [ad- ryngeal tonsil.
eno- ⫹ fibrosis] The abnormal growth adenolipoma (ad⬙ĕ-nō-li-pō⬘mă) [adeno-
of fibrous or connective tissue within ⫹ lipoma] A benign tumor having
glandular tissue. glandular characteristics but composed
adenohypophysis (ad⬙ĕ-nō-hı̄-pof⬘ı̆-sis) of fat.
[adeno- ⫹ hypophysis] The portion of adenoma (ad⬙ĕn-ō⬘mă, ad⬙ĕn-ō⬘măt-ă)
the pituitary gland containing secretory pl. adenomas, adenomata [aden- ⫹
cells that release the hormones adre- -oma] A benign tumor made of epithe-
nocorticotropic hormone (ACTH), folli- lial cells, usually arranged like a gland.
cle-stimulating hormone (FSH), growth adenomatous (ad⬙ĕn-ō⬘măt-ŭs), adj.
hormone (GH), luteinizing hormone PATIENT CARE: Initial care focuses
(LH), prolactin, and thyroid-stimulating on identifying the sites of tumors, per-
hormone (TSH). The adenohypophysis forming biopsies or noninvasive studies
makes up 80% of the pituitary gland. It to determine if they are benign or ma-
is an epithelial tissue that develops lignant, and discussing findings with
from the roof of the embryonic mouth. the patient, the patient’s family, and
SEE: anterior pituitary. adenohy- significant others. Disease-specific edu-
pophyseal (ad⬙ĕ-nō-hı̄⬙po⬙fı̆-sē⬘ăl), adj. cation is provided to explain diagnostic
adenohypophysial (ad⬙ĕ-nō-hı̄⬙pŏ-fiz⬘ē- options and support the patient. Malig-
ăl), adj. nant adenomata may need surgical re-
adenoid (ad⬘(ĕ-)noyd⬙) [aden- ⫹ -oid] moval; they may be treated with a com-
1. Looking like a gland; lymphoid. bination of therapies, including surgical
2. Pert. to the adenoids. 3. Pert. to or removal, radiation therapy, hormone
affected with inflamed pharyngeal therapy or chemotherapy. Patient edu-
tonsils. SEE: adenoids; pharyngeal cation, esp. with respect to the side ef-
tonsil. fects of therapies and implementing
adenoidal (ad⬘(ĕ-)noyd⬙ăl) 1. A collo- strategies to ameliorate the side effects,
quial term for pert. to or affected with is crucial. General emotional support of
abnormally enlarged pharyngeal tonsils the patient eases anxiety, isolation, and
in children. 2. A colloquial term for pert. suffering.
to a nasal tone in the voice. basophil a., basophilic a. An ade-
adenoidectomy (ad⬙ĕ-noy⬙dek⬘tŏ-mē) noma of the pituitary gland in which
[adenoid ⫹ -ectomy] Excision of the cells stain with basic dyes. The term
adenoids. SEE: tonsillectomy. was formerly used to suggest tumors
PATIENT CARE: Vital signs are mon- that secreted adrenocorticotrophin
itored, and the patient is observed for (ACTH), the cause of Cushing disease.
signs of shock. The mouth and pharynx Those tumors are now identified more
are checked for bleeding, large clot for- directly by the identification (by immu-
mation, or oozing; the patient is ob- nocytochemistry) of ACTH in tumor
served for frequent swallowing, which cells. The use of hematoxylin and eosin
indicates bleeding or large clot forma- staining to identify pituitary tumors is
tion. Clots should be prevented from ob- obsolete.
structing the oropharnyx. The patient is chromophobe a. An adenoma of the
placed in either a prone position with pituitary gland composed of cells that do
the head turned to the side or in a lat- not stain readily. The term has more
eral recumbent position to promote historical value than descriptive value
drainage. When the operative wound and is no longer in use.
has healed sufficiently, the oral intake cystic a. Cystadenoma.
of cool (not hot or iced) fluids and soft follicular a. An adenoma of the thy-
foods is encouraged. The patient is also roid.
advised not to gargle until the surgical Hürthle cell a. SEE: under Hürthle,
site has healed. Karl W.
Young patients: The child is reassured malignant a. Adenocarcinoma.
about routines and procedures in care. papillary a. An adenoma with nipple-
Emotional support is provided, and pa- shaped glands.
rental presence is encouraged. The child pituitary a. An adenoma of the pitu-
is evaluated for vomiting swallowed itary, often clinically silent, but occa-
blood and is monitored for ability to sionally producing excessive amounts of
swallow fluids. anterior pituitary hormones (such as
adenoiditis (ad⬙ĕ-noyd-ı̄t⬘is) [adenoid adrenocorticotrophic hormone, growth
⫹ -itis] Inflammation of adenoid tis- hormone, or prolactin).
sue. sebaceous a. Enlarged sebaceous
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adenoma 49 adermogenesis

glands, esp. of the face. SYN: adenoma to an injury and helps them aggregate
sebaceum. into a clot.
a. sebaceum Sebaceous a. a. monophosphate ABBR: AMP; 5⬘-
somatotroph a. A growth-hormone- AMP. A substance formed by conden-
secreting tumor of the anterior pituitary sation of adenosine and phosphoric acid.
that causes acromegaly or giantism. It is one of the hydrolytic products of nu-
villous a. A large polyp of the muco- cleic acids and is present in muscle, red
sal surface of the large intestine. It has blood cells, yeast, and other nuclear ma-
the potential to develop into cancer. terial. SYN: adenylic acid.
adenomatosis (ad⬙ĕn-ō⬙mă-tō⬘sis) [ade- a. triphosphatase ABBR: ATPase.
noma ⫹ -osis] The condition of mul- An enzyme that splits adenosine tri-
tiple glandular tissue overgrowths. phosphate to yield phosphate and en-
adenomectomy (ad⬙ĕn-ō-mek⬘tŏ-mē) ergy.
[adenoma ⫹ -ectomy] Surgical exci- a. triphosphate ABBR: ATP. A com-
sion of an adenoma (glandular tumor). pound of adenosine containing three
adenomyoma (ad⬙ĕn-ō⬙mı̄-ō⬘mă) [ad- phosphoric acid groups. Its chemical for-
eno- ⫹ myoma] A benign complex tu- mula is C10H16N5O13P3. ATP is present
mor containing glandular and smooth in all cells and is formed when energy is
muscular tissue. released from food molecules during cell
adenomyometritis (ad⬙ĕ-nō-mı̄⬙ŏ-mĕ- respiration. Cells contain enzymes to
trı̄t⬘is) [adeno- ⫹ myometritis] Ad- hydrolyze ATP into ADP, phosphate,
enomyosis. and energy, which is then available for
adenomyosarcoma (ad⬙ĕ-nō-mı̄⬙ŏ-sar- cellular functions such as mitosis.
kō⬘mă) [adeno- ⫹ myosarcoma] adenosis (ad⬙ĕ-nō⬘sis) [aden- ⫹ -osis]
Adenosarcoma that includes muscle tis- Any disease of a gland or of glandular
sue. tissue.
adenomyosis (ad⬙ĕ-nō-mı̄-ō⬘sis) [adeno- vaginal a. Disordered growth of the
⫹ myo- ⫹ -sis] Benign invasive glandular cells of the vagina. It is a com-
growth of the endometrium into the mon finding in women whose mothers
muscular layer of the uterus. SYN: ad- were exposed to diethylstilbesterol
enomyometritis. SEE: endometriosis for (DES) during pregnancy. Close follow-
illus. up of women with vaginal adenosis is
adenopathy (ad-ĕn-op⬘ă-thē) [adeno- ⫹ needed because the condition is occa-
-pathy] Any abnormal enlargement of sionally a sign of glandular cancer.
a lymph node, e.g., as a result of infec- adenosquamous (ad⬙ĕn-ō-skwā⬘mŭs)
tion or metastatic cancer. [adeno- ⫹ squamous] Pert. to or con-
adenopharyngitis (ad⬙ĕ-nō⬙far⬙in-jı̄t⬘is) taining a cellular architecture that is
[adeno- ⫹ pharyngitis] Inflammation partly glandular and partly epithelial
(squamous cell). It refers to some lung
of the tonsils and pharyngeal mucous
carcinomas.
membrane.
adenotome (ad⬘ĕ-nō⬙tōm⬙) [adeno- ⫹
adenosarcoma (ad⬙ĕ-nō⬙sar-kō⬘mă) [ad-
-tome] A device for excising a gland,
eno- ⫹ sarcoma] A tumor with ade-
esp. the adenoid glands.
nomatous and sarcomatous character-
adenotonsillectomy (ad⬙ĕ-nō⬙ton⬙sı̆-lek⬘
istics. tŏ-mē) [adeno- ⫹ tonsillectomy] Sur-
adenosclerosis (ad⬙ĕ-nō-sklĕ-rō⬘sis) [ad- gical removal of the tonsils and ade-
eno- ⫹ sclerosis] Glandular harden- noids.
ing. adenovirus (ad⬘ĕ-nō-vı̄⬘rŭs) [adeno- ⫹
adenosine (ă-den⬘ŏ-sēn⬙) [Ger. blend of virus] Any of a group of double-
adenine ⫹ ribose] A nucleotide con- stranded DNA viruses that can cause
taining adenine and ribose. infections of the upper respiratory tract.
a. 3ⴕ,5ⴕ-cyclic monophosphate A large number have been isolated. ad-
ABBR: AMP. A cyclic form of adeno- enoviral (-răl), adj.
sine. Its synthesis from adenosine tri- adenyl (ad⬘ĕ-nil) [aden- ⫹ -yl] The
phosphate (ATP) is stimulated by an en- radical C5H4N5; present in adenine.
zyme, adenylate cyclase (also called a. cyclase An enzyme that catalyzes
cyclic AMP synthetase). Adenosine the production of cyclic AMP (adenosine
3⬘,5⬘-cyclic monophosphate is important 3⬘,5⬘-cyclic monophosphate) from ATP
in a wide variety of metabolic responses (adenosine triphosphate). It is present
to cell stimuli. on most cell surfaces.
a. diphosphate ABBR: ADP. A com- adenylate cyclase (ă-den⬘ı̆-lăt sı̄⬘klās)
pound of adenosine containing two An enzyme important in the synthesis
phosphoric acid groups. ADP is used to of cyclic AMP (adenosine 3⬘,5⬘-cyclic
synthesize ATP with the energy re- monophosphate) from adenosine tri-
leased in cell respiration. When ATP is phosphate. SYN: cyclic AMP synthetase.
used for cellular functions such as pro- adermia (ă-dĕr⬘mē-ă) [a- ⫹ derm- ⫹
tein synthesis, ADP is reformed. ADP is -ia] Congenital or acquired defect in or
released from platelets during blood lack of skin.
clotting. It attracts additional platelets adermogenesis (ă-dĕr⬙mō-jen⬘ĕ-sis) [a-
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ADH 50 Adie, William John

⫹ dermo- ⫹ -genesis] Imperfect de- Strategies That Improve Patient


velopment of skin. Adherence to Medical Regimens
ADH antidiuretic hormone (vasopressin).
SEE: under hormone. Use of medications within a thera-
ADHA American Dental Hygienists’ As- peutic class that the patient prefers
sociation. Use of medications that the patient
ADHD attention-deficit hyperactivity dis- can afford
order. Use of medications with the simplest
adherence (ad⬘hēr-ĕns) [L. adhaerere, to dosing regimens
stick] 1. Stickiness. 2. The extent to Use of medications with the fewest
which a patient’s behavior coincides drug interactions or side effects
with medical advice. Adherence may be Patient education that is geared to
estimated by carefully questioning the the patient’s level of health literacy
patient and family members; evaluating Follow-up by health care providers, to
the degree of clinical response to ther- identify barriers to adherence and
apy or the presence or absence of side discuss patient concerns
effects from drugs; measuring serum
drug levels or testing for excretion of the
drug in the urine; and counting remain- healing. 2. A fibrous band of scar tissue
ing pills. SYN: compliance (1). SEE: ta- holding parts together that are nor-
bles. mally separated, as within the perito-
adherent (ăd-hē⬘rĕnt) [L. adhaerere, to neal cavity after surgery or penetrating
stick] Attached to. injuries. 3. An attraction to another sub-
adhesin (ăd-hēz⬘in) [adhes(ion) ⫹ -in] stance, e.g., of molecules or blood plate-
1. In conjugation of some bacteria, a pro- lets to each other or to dissimilar ma-
tein on the cell surface that causes ag- terials.
gregation of cells. 2. A protein found on abdominal a. The adherence of the
the cell wall of bacteria such as Esche- serous membranes of the peritoneal
richia coli that enables the bacteria to cavity to each other, causing fibrous tis-
bind to the host’s cells. sue to form around internal organs. The
adhesio interthalamica (ad-hē⬘zē-ō in⬙ adhered membranes form scar tissue.
tĕr-thă-lam⬘ı̆-kă) ABBR: AI. The massa Adhesions typically occur as a result of
intermedia that connects the two lobes inflammation, surgery, or penetrating
of the thalamus. trauma. As they bind internal organs,
adhesiolysis (ăd-hēz⬙ē-ol⬘ı̆-sı̆s) [adhe- they can cause gastrointestinal obstruc-
sion ⫹ -lysis] Surgery to cut or re- tion, visceral pain, or infertility. When
move intraperitoneal adhesions. these conditions do not respond to med-
adhesion (ad-hē⬘zhŏn) [L. adhaerere, to ical therapy, surgery may be used to cut
stick] 1. A holding together or uniting or remove adhesions.
of two surfaces or parts, as in wound pericardial a. A fibrous band that ad-
heres the visceral and parietal layers of
Factors That May Decrease Patient the pericardium to each other, obliter-
ating the pericardial cavity. Extensive
Adherence to Therapy in the U.S. adhesions may lead to restriction of the
Communication difficulties with normal contraction of the heart. SEE:
health care providers pericarditis.
Cultural barriers between patient adhesiotomy (ad-hē⬙zē-ot⬘ŏ-mē) [ad-
and provider hesi(on) ⫹ -otomy] Surgical division
Dementia and other forms of cogni- of adhesions.
tive dysfunction adhesive (ad-hē⬘siv) [L. adhaerere, to
Denial of illness stick] 1. Causing adhesion. 2. Sticky;
Depression or anxiety adhering. 3. A substance that causes
Lack of finances; excessive expense two bodies to adhere.
associated with obtaining care ADI acceptable daily intake.
Lack of time to arrange, wait for, and adiaspiromycosis (ā⬙dı̄⬙ă-spı̄⬙rō-mı̄-kō⬘
get to and from appointments sı̆s) [1an- ⫹ dia- ⫹ L. spirare, to
Lack of social support breathe ⫹ mycosis] A fungal lung in-
Language barriers fection found in animals and in pro-
Male gender foundly immunosuppressed people,
Marital status (unmarried) with a radiographic appearance that re-
Medical transportation difficulties sembles tuberculosis. It is caused by a
Mistrust of health care institutions or species of filamentous soil fungus of the
specific forms of therapy genus Emmonsia.
Personality disorders Adie, William John (ā⬘dē) Brit. neurol-
Psychoses ogist, 1886– 1935.
Religious proscriptions against par- A. syndrome An ocular syndrome
ticular forms of treatment marked by Adie pupil and absent or
Substance abuse lessened Achilles tendon reflex and
knee-jerk reflex. The absent or lessened
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adipectomy 51 adjuvant

deep tendon reflexes are permanent and 3. To manipulate a part of the body, e.g.,
may progress over time. with physical force.
adipectomy (ad⬙ı̆-pek⬘tŏ-mē) [adip- ⫹ adjustable gastric banding (ă-jŭs⬘tă-bl)
-ectomy] Excision of usually a large A bariatric surgical treatment for obe-
quantity of fat or adipose tissue. SEE: sity in which a Silastic belt encircles the
liposuction. proximal portion of the stomach, re-
adipic (ă-dip⬘ik) Pert. to adipose tissue. stricting the flow of food. The rest of the
adipo-, adip- [L. adeps, stem adip-, fat] gastrointestinal tract is left unmodified.
Prefixes meaning fat. The belt initially permits the proximal
adipocere (ad⬘ı̆-pō-sēr⬙) [adipo- ⫹ L. stomach to hold just an ounce of food.
cera, wax] A brown, waxlike substance The restriction gives patients a feeling
composed of fatty acids and calcium of premature fullness after a small
soaps. It is formed in animal tissues meal, which keeps them from overeat-
postmortem. adipocerous (ad⬙ı̆-pos⬘ĕ- ing. It can be loosened after significant
rŭs), adj. weight loss has occurred to permit
adipocyte (ad⬘ı̆-pō-sı̄t⬙) [adipo- ⫹ -cyte] slightly increased food intake. Weight
Any of the cells that compose adipose loss with gastric banding, which results
tissue. SYN: fat cell; lipocyte. SEE: fat. purely from limitations on food intake,
adipocytokine, adipokine (ad⬙ı̆-pō-sı̄t⬘ŏ- tends to be less than what can be
kı̄n⬙, ad⬘ı̆-pŏ-kı̄n⬙) [adipo- ⫹ cytokine] achieved with surgery, e.g., Roux-en-Y
A molecule secreted by fat cells that af- gastric bypass. Relatively common com-
fects the physiology of cells in other plications of banding include nausea
parts of the body. Some of these mole- and vomiting, erosion of the band into
cules influence appetite, the storage of the stomach, and wound infections.
fat in the body, and systemic inflam- Some patients learn to eat slowly but
mation. continuously and fail to lose weight.
adipogenous, adipogenic (ad⬙ı̆-poj⬘ĕn- adjuster (ă-jŭs⬘tĕr) A device for holding
ŭs, ad⬙ı̆-pŏ-jen⬘ik) [adipo- ⫹ -genic] together the ends of the wire forming a
Inducing the formation of fat. suture.
adipokinesis (ăd⬙ı̆-pō-kı̆-nē⬘sis, -kı̄-) adjustment (ă-jŭst⬘mĕnt) 1. Adaptation
[adipo- ⫹ kinesis] 1. Metabolism of to a different environment; a person’s
fat with production of free fatty acids. relation to the environment and the self.
2. Mobilization and metabolism of body 2. A change to improve function or con-
fat. dition. 3. A modification made to a tooth
adiponecrosis (ad⬙ı̆-pō-nĕ-krō⬘sis) [adipo- or a dental prosthesis to enhance fit,
⫹ necrosis] Necrosis affecting fatty tis- function, or the patient’s acceptance.
sue. 4. A statistical manipulation of data.
adiponectin (ad⬙ı̆-pŏ-nek⬘tı̆n) A protein occlusal a. SEE: equilibration.
derived from adipose tissue that circu- chiropractic a. Manipulation of a
lates in the blood. It reduces inflamma- body part with applied force to bring the
tion and insulin resistance. whole body into better or healthier
adipose (ad⬘ı̆-pōs⬙) [L. adiposus, fatty] alignment. Adjustments may be per-
Pert. to fat; fatty. formed by hand or with mechanical
adiposis (ad⬙ı̆-pō⬘sis) [adipo- ⫹ -sis] aids.
Obesity. cost of living a. ABBR: COLA. In
adipositis (ad⬙ı̆-pō-sı̄t⬘ı̆s) [adipose ⫹ determining Social Security payments
-itis] Inflammation in and beneath ad- and other financial benefits, a change in
ipose tissue. compensation based on the rate of infla-
adiposity (ăd⬙ı̆-pŏs⬘ı̆-tē) Obesity. tion, as demonstrated by the U.S. Con-
adiposogenital syndrome (ad⬙ı̆-pō⬙sō- sumer Price Index.
jen⬘ı̆-tăl) Fröhlich’s syndrome. adjustment, impaired Inability to modify
adjudicate (ă-jood⬘ı̆-kāt⬙) [L. adjudicare, lifestyle/behavior in a manner consist-
to award a judgment, judge] To issue ent with a change in health status.
or make a judgment in a court of law, adjustment disorder A maladaptive re-
e.g., regarding malpractice. adjudica- action to an identifiable psychological or
tion (-jood⬙ı̆-kā⬘shŏn), n. adjudicator social stress that occurs within 3
(-jood⬘ı̆-kāt⬙ŏr), n. months of the onset of the stressful sit-
adjunct (ad⬘jŭngkt⬙) [L. adjungere, to uation. The reaction is characterized by
join] 1. An addition to the principal pro- impaired function or symptoms in ex-
cedure or course of therapy. 2. An as- cess of what would be considered nor-
sistant or associate, esp. one without mal for that stress. The symptoms are
full employment or professional status expected to remit when the stress
at a hospital, college, or university. ad- ceases.
junct, adj. adjustment sleep disorder Any transient
adjust (ă-jŭst⬘) [Fr. ajuster, to gauge] sleep disorder, e.g., insomnia, hyper-
1. To adapt to a different environment; somnia, that occurs during periods of
to cope with new conditions or stressors. psychosocial upheaval or emotional
2. To change or modify something, esp. stress.
to improve its function or condition. adjuvant (ad⬘jŭ-vănt) [L. adjuvare, to
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adjuvant therapy 52 adrenalectomy

help] 1. That which assists, esp. a drug such degree or extent as to produce nau-
added to a prescription to hasten or in- sea.
crease the action of a principal ingredi- adnexa (ad-nek⬘să) [L. adnectere, annec-
ent. 2. In immunology, a chemical such tere, to attach] 1. The accessory parts
as aluminum hydroxide or aluminum of a structure. 2. The accessory struc-
phosphate added to an antigen to in- tures to the uterus, i.e., the ovaries and
crease the body’s immunologic re- fallopian tubes. adnexal (ad-nek⬘săl),
sponse. The adjuvants increase the size adj.
of the antigen, making it easier for B -adol A suffix used to designate an opiate
lymphocytes and phagocytes to recog- receptor agonist/antagonist.
nize it, promote chemotaxis, and stim- adolescence (ad⬙ŏl-es⬘ĕns) [Fr. fr. L.
ulate the release of cytokines. Adju- adolescentia] The period from the be-
vants are not effective with all antigens ginning of puberty until maturity. Be-
and do not stimulate T-cell activity. cause the onset of puberty and maturity
adjuvant therapy The use of additional is a gradual process and varies among
therapy in addition to the primary ther- individuals, it is not practical to set ex-
apy. In cancer care, for example, sur- act age or chronological limits in defin-
gery to remove a tumor may be the pri- ing the adolescent period.
mary treatment, and radiation therapy prolonged a. Emerging adulthood.
to destroy neighboring cells and tissues adolescent (ad⬙ŏl-es⬘ĕnt) [L. adolescere,
an adjuvant therapy. to grow up] 1. Pert. to adolescence. 2. A
ADL activities of daily living. young man or woman not fully grown.
Adler, Alfred (ad⬘lĕr) Austrian psychia- adolescent turmoil In psychology, the be-
trist, 1870– 1937, founder of the school lief that adolescence is invariably ac-
of individual psychology. SEE: individ- companied by behavioral or psychologi-
ual psychology; psychoanalysis. cal upheaval. This is no longer thought
ad lib (ad lib) SEE: ad libitum. to be inevitable or even the usual case.
ad libitum (ad lib⬘ı̆-tŭm) [L. ad libitum] adoption (ă-dop⬘shŏn) [L. adoptare, to
ABBR: ad lib. As desired, used as a di- choose] 1. In law, the assumption of re-
rection in writing prescriptions. sponsibility for the care of a child by a
adluminal (ad-loom⬘ı̆-năl) [ad- ⫹ lu- person or persons who are not the bio-
minal] Next to a lumen. logical parents. 2. In health care infor-
ADMA asymmetrical dimethylarginine. matics, the acceptance of computer
ADMET An acronym for absorption, dis- technology or software for use.
tribution, metabolism, excretion, and adoral (ad-ōr⬘ăl) [ad- ⫹ oral] Toward
toxicity. These are key elements that de- or near the mouth.
termine the safety, uptake, elimination, ADP Adenosine diphosphate.
metabolic behavior, and effectiveness of ADR adverse drug reaction; alternative
drugs. dispute resolution.
administration (ăd-min⬙ı̆-strā⬘shŏn) [L. adrenal (ă-drē⬘năl) [ad- ⫹ renal] Pert.
administrare, to assist, serve] 1. The to the adrenal gland or its secretions.
dispensing or application of a therapeu- adrenalectomy (ă-drē⬙nă-lek⬘tŏ-mē)
tic agent. 2. The managers and manage- [adrenal ⫹ -ectomy] Excision of one or
ment of a health care institution. SYN: both adrenal glands.
governance. PATIENT CARE: Vital signs, central
Administration on Aging ABBR: AOA. venous pressure, and urine output must
An agency of the U.S. Department of be monitored frequently. Signs and
Health and Human Services that con- symptoms of hypocorticism must be as-
ducts research in the field of aging and sessed hourly for the first 24 hr; signif-
assists federal, state, and local agencies icant changes must be reported to the
in planning and developing programs surgeon immediately. Additional IV
for the aged. SEE: Older Americans Act. glucocorticoids are given as prescribed.
admission (ăd-mish⬘ŏn) [L. admissio, fr The patient must be monitored for early
admittere, to send to, allow to come or indications of shock or infection and for
go] 1. Acceptance of a student into a alterations in blood glucose and electro-
program of study. 2. Hospitalization of lyte levels. To counteract shock, IV flu-
a patient. ids and vasopressors must be adminis-
bounce-back a. A readmission to an tered as prescribed, and the patient’s
emergency department or hospital for a response evaluated every 3 to 5 min. In-
previously evaluated or treated condi- creased steroids to meet metabolic de-
tion. mands are needed if additional stress,
admission of fact (ăd-mi⬘shŏn) A writ- e.g., infection, occurs. Other medica-
ten request to accept or deny mutually tions, including analgesics, are given as
agreed upon deeds, statements, or as- prescribed, and the patient’s response is
sertions of a lawsuit. evaluated. The room must be kept cool
admix (ad-miks⬘) [L. admixtus, mixed] and the patient’s clothing and bedding
To blend or combine. changed often if he or she perspires pro-
ad nauseam (ad no⬘zē-ăm) [L. ad nau- fusely (a side effect of surgery on the ad-
seam, to (the point of sea)sickness] Of renal gland). The abdomen must be as-
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adrenalectomy 53 adrenosterone

sessed for distention and return of to the sites in organs or tissues that are
bowel sounds. Physical and psychologi- acted on by adrenergic transmitters.
cal stresses must be kept to a minimum. adrenochrome (ă-drē⬘nŏ-krōm⬙) [ad-
Steroid medications may not be needed reno- ⫹ Gr. chrōma, color] C9H9NO3;
or may be discontinued in a few months a red pigment obtained by oxidation of
to a year after unilateral adrenalec- epinephrine.
tomy, but lifelong replacement therapy adrenocortical (ă-drē⬙nō-kort⬘ı̆-kăl) [ad-
will be needed after bilateral adrenalec- reno- ⫹ cortical] Pert. to the adrenal
tomy. The patient must learn to recog- cortex.
nize the signs of adrenal insufficiency, adrenocorticosteroid (ă-drē⬙nō-kor⬙tı̆-
that sudden withdrawal of steroids can kō-stēr⬘oyd⬙) [adreno- ⫹ corticoste-
precipitate adrenal crisis, and that con- roid] A hormone produced by the ad-
tinued medical follow-up will be needed renal cortex or a synthetic derivative of
so that steroid dosage can be adjusted such a hormone.
during stress or illness. Patients should adrenocorticotropic (ă-drē⬙nō-kor⬙tı̆-kō-
take steroids in a two-thirds A.M. and trō⬘pik, -trop⬘ik) [adreno- ⫹ cortico-
one-third P.M. dosing pattern to mimic tropic] Having a stimulating effect on
diurnal adrenal activity, with meals or the adrenal cortex.
antacids to minimize gastric irritation. adrenocorticotropin (ă-drē⬙nō-kor⬙tı̆-kō-
Adverse reactions to steroids, e.g., trō⬘pin) Adrenocorticotropic hormone.
weight gain, acne, headaches, diabetes, adrenogenital (ă-drē-nō-jen⬘ı̆-tăl) [ad-
and osteoporosis, must be explained. reno- ⫹ genital] Pert. to the adrenal
cortical-sparing a. An operation on glands and the genitalia.
the adrenal gland(s) in which the cortex adrenogenital syndrome A syndrome
of the gland is left in place and only the marked by abnormally early puberty in
diseased portion of the gland is re- children, overmasculinization in adults,
moved. This subtotal adrenal surgery virilism, and hirsutism, caused by the
leaves the corticosteroid-producing por- excessive production of adrenocortical
tion of the gland in place, increasing the hormones. SEE: congenital adrenal hy-
probability that the patient will be able perplasia.
to produce his or her own steroids after adrenoleukodystrophy (ă-drē⬙nō-loo⬙kō-
the surgery. dis⬘trŏ-fē) [adreno- ⫹ leukodystro-
adrenaline (ă-drĕn⬘ă-lı̆n) [adrenal ⫹ phy] An X-linked recessive disease in
-in] Epinephrine. The British Phar- which inability to metabolize very long
maceutical Code recognizes “adrena- chain fatty acids results in Addison’s
line” as the preferred term in the UK for disease. Treatments include replace-
“epinephrine.” ment of adrenal hormones, administra-
adrenalinemia (ă-dren⬙ă-lı̆-nē⬘mē-ă) tion of Lorenzo’s oil, or bone marrow
transplantation.
[adrenaline ⫹ -emia] Epinephrine in
the blood.
adrenomedullin (ă-drē⬙nō-mĕ-dŭl⬘ı̆n)
[adreno- ⫹ medullin, a renal prosta-
adrenalitis, adrenitis (ă-drē⬙nă-lı̄t⬘is, ăd⬙
glandin] ABBR: AM. A 52– amino acid
rē-nı̄t⬘is) Inflammation of the adrenal
regulatory peptide that influences many
glands.
body functions. These functions include
autoimmune a. ABBR: AA. De- blood vessel dilation (lowering blood
struction of the adrenal cortex by cir- pressure), cellular growth, circulation,
culating autoantibodies. In industrial- electrolyte balance, kidney function,
ized countries it is the most common and neurotransmission. The level of ad-
cause of Addison disease. The adrenal renomedullin in the blood is elevated
medulla is spared. Patients with auto- above normal in patients with conges-
immune adrenalitis may also have tive heart failure, kidney failure, and di-
other autoimmune conditions, esp. thy- abetes mellitus complicated by vascular
roiditis, vitiligo, and pernicious anemia. disease.
adrenalo-, adrenal-, adreno-, adren- [ad- adrenomegaly (ă-drēn⬙ō-meg⬘ă-lē) [ad-
⫹ L. ren, kidney] Prefixes meaning ad- reno- ⫹ -megaly] Enlargement of the
renal glands. adrenal gland or glands.
adrenarche (ad⬙rĕ-nar⬘kē) [adren- ⫹ adrenomyeloneuropathy (ă-drē⬙nō-mı̄⬙
Gr. archē, beginning] Changes that oc- ĕ-lō-noo-rop⬘ă-thē, -nū-) [adreno- ⫹
cur at puberty as a result of increased myelo- ⫹ neuropathy] ABBR: AMN.
secretion of adrenocortical hormones. A noninflammatory form of adrenoleu-
SEE: menarche; pubarche. kodystrophy in which the long tracts of
adrenergic (ad⬙rĕ-nĕr⬘jik) [adren- ⫹ the spinal cord are diseased, with lim-
ergo- ⫹ -ic] Pert. to nerve fibers that ited involvement of peripheral nerves
release norepinephrine or epinephrine and, in most instances, no evidence of
at synapses. adrenergically (ad⬙rĕ- cerebral disease. It is a disease of
nĕr⬘ji-k(ă-)lē), adv. SEE: sympathomi- adults, who gradually become weaker
metic. as their nerves accumulate excessive
adrenoceptive (ă-drē⬙nŏ-sep⬘tiv) [ad- quantities of very long-chain fatty acids.
reno- ⫹ L. recipere, to receive] Pert. adrenosterone (ădrē-nō-stĕ-rōn⬘) [ad-
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adrenotropic 54 advance directive

reno- ⫹ -sterone] An androgenic hor- sue reveals deposits of abnormal glyco-


mone secreted by the adrenal cortex. gen byproducts (polyglucosan bodies).
adrenotropic (ă-drē⬙nō-trō⬘pik , ă-drē⬙ TREATMENT: Since there is no cura-
nō-trop⬘ik) [adreno- ⫹ -tropic] Stim- tive treatment, support of the patient is
ulating the adrenal glands or the hor- paramount. Liver transplantation,
mones that stimulate adrenal gland when available, may slow the progress
function. of glycogen deposition in tissues.
Adson, Alfred Washington (ad⬘sŏn) PATIENT CARE: People with APBD
U.S. neurosurgeon, 1887– 1951. have significant problems thinking
A. forceps A surgical forceps to pick clearly, urinating, and walking. Opti-
up or hold soft tissues. The forceps may mal patient care includes behavioral
have a smooth or serrated tip. and psychological interventions, such as
A. maneuver A test for thoracic out- helping a person adapt to the illness and
let compression syndrome. The pa- preserve mastery over his or her envi-
tient’s arm is moved back into extension ronment. Cognitive aids, such as check-
and external rotation with the elbow ex- lists or written reminders to perform
tended and forearm supinated. The ra- certain tasks, can be used to preserve
dial pulse is palpated while the patient the patient’s independence and reduce
is asked to tuck the chin, side-bend the the burden the disease places on care-
head toward the opposite side, and ro- givers. Ambulatory aids and physical
tate the chin toward the side of the ex- therapy are employed to maintain the
tended arm. The patient is then asked patient’s mobility and prevent falls. In-
to inhale. A positive sign of numbness struction in bladder catheterization and
or tingling in the hand or diminished the appropriate use of medications for
pulse indicates the brachial plexus or bladder spasms assist with voiding.
blood vessels are compromised at the Because APBD is an inherited illness
site of the scalene muscle. whose signs and symptoms develop in
adsorb (ad-sŏrb⬘, zŏrb⬘) [ad- ⫹ L. sor- middle age, patients and their families
bere, to suck in] In chemistry, to take may want professional genetic counsel-
up and hold by adsorption. SEE: absorb; ing to help guide reproductive choices or
absorption. to identify the presence of the disease in
adsorbate (ad-sor⬘băt) [adsorb ⫹ -ate] offspring who are affected, but too
Anything that is adsorbed. young to be symptomatic. SYN: Ander-
adsorbent (ad-sor⬘bĕnt) [adsorb] sen disease; glycogen branching enzyme
1. Pert. to adsorption. 2. A substance, deficiency; glycogen storage disease type
e.g., activated charcoal, that readily IV.
draws other substances out of the body adult respiratory distress syndrome The
or out of solution. former name for acute respiratory dis-
adsorption (ad-sorp⬘shŏn) [adsorb] tress syndrome. SEE: acute respiratory
1. In chemistry, adhesion by a gas or liq- distress syndrome.
uid to the surface of a solid. 2. Viral en- advance (ăd-vans⬘) [Fr. avancer, to set
try into a host cell. forth] To carry out the surgical proce-
ADT admission, discharge, and transfer. dure of advancement.
adult (ă-dŭlt⬘, ad⬘ŭlt⬙) [L. adultus, advanced (ăd-vanst⬘) 1. Placed or being
grown up] The fully grown and mature ahead. 2. Of a disease, in a late or crit-
organism. ical stage of development. 3. Far along
adult entertainment Sex industry. in time or age; old or older.
adulteration (ă-dŭl⬙tĕ-rā⬘shŏn) [L. ad- advanced airway management The use
ulterare, to pollute] 1. The addition or of a supraglottic airway or endotracheal
substitution of an impure, weaker, intubation in patients with respiratory
cheaper, or possibly toxic substance in a failure.
formulation or product. 2. An impurity. Advanced Cardiac Life Support A train-
adult polycystic kidney disease SEE: ing course in resuscitation techniques
polycystic kidney disease. for health care providers offered by the
adult polyglucosan body disease (pol⬙ē- American Heart Association. SEE: life
gloo⬘kŏ-san⬙) ABBR: APBD. A rare au- support for illus.
tosomal recessive disorder caused by advanced glycation end product ABBR:
abnormal metabolism of glycogen. AGE. Any of the proteins that have
CAUSES: Abnormal byproducts of been nonenzymatically modified by the
glycogen accumulate in multiple organ addition of sugar residues to lysine.
systems, including the central nervous These altered proteins increase with ag-
system, peripheral nerves, liver, skin, ing and in patients with hyperglycemia
and sweat glands. and diabetes mellitus. SYN: glycotoxin.
SYMPTOMS AND SIGNS: Nerve dam- advance directive A written document in
age occurs in both upper motor neurons the form of a living will or durable
and peripheral nerves. Bowel and blad- power of attorney prepared by a com-
der dysfunction and dementia com- petent person and specifying what, if
monly occur. any, extraordinary procedures, surger-
DIAGNOSIS: Biopsy of neuronal tis- ies, medications, or treatments the pa-
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advanced liver disease 55 Aedes

tient desires in the future if the patient problem or event, including assessment
should become incompetent to make findings and interventions, all persons
such decisions. SYN: durable power of notified and their responses, dates and
attorney for health care. SEE: living times of these notifications, actions
will. taken by those informed, and patient’s
advanced liver disease ABBR: AdvLD. response to such interventions; 5) name
Cirrhosis, cirrhosis that has decompen- of the drug, its manufacturer, lot num-
sated, and hepatocellular carcinoma. ber, and expiration date on the pack-
Advanced Medical Life Support ABBR: aging (if available), dosage, frequency,
AMLS. A course offered by the Na- duration, route, and times of adminis-
tional Association of Emergency Medi- tration (any packaging or containers
cal Technicians that teaches health care should be retained or returned to the
providers how to recognize and respond pharmacy as evidence, depending on
effectively to common medical com- the facility’s policy); 6) name, title, and
plaints and crises. credentials of person making the report;
Advanced Research Projects Agency and 7) others who received the report,
Network ABBR: ARPANET. De- e.g., FDA MedWatch, pharmaceutical
signed in 1969 as a network to link cer- distributor, manufacturer. The FDA re-
tain U.S. Department of Defense com- quires MedWatch reports for serious
puters with university computers on ADRs that cause death or are life-
campuses performing defense-related threatening or cause initial or pro-
research. The ARPANET network be- longed hospitalization, disability, con-
came the basis for the Internet. genital anomaly or birth defect, or
advanced sleep-phase syndrome Sleep- medical or surgical intervention.
phase syndrome. adverse event Adverse reaction.
Advanced Trauma Life Support A course adverse reaction In pharmacology and
offered by the American College of Sur- therapeutics, an undesired side effect or
geons to prepare physicians to manage toxicity caused by a treatment. Adverse
critical trauma patients. reactions may be due to drug therapies,
advancement (ăd-vans⬘mĕnt) Surgical de- physical therapy, radiation, or surgery.
tachment of a segment of tissue with reat- The onset of the unwanted effect may be
tachment to a position beyond the initial immediate or may take days or months
site, as when, to remedy strabismus, an to develop. SYN: adverse event. SEE:
extrinsic ocular muscle is severed and adverse drug reaction; drug interac-
reattached farther from its origin. tion; drug reaction.
adventitia (ad⬙vĕn-tı̆sh⬘(ē-)ă) [L. adven- advisory (ăd-vı̄⬘zŏ-rē) 1. Pert. to advice.
ticius, coming from abroad] The outer- 2. Having the duty or authority to ad-
most part or layer of a structure or or- vise. 3. A report pert. to current or ex-
gan. pected conditions, e.g., tornadoes, with
adventitious (ad⬙ven-tı̆sh⬘ŭs) 1. Ac- suggestions or warnings on how to deal
quired; accidental. 2. Arising sporadi- with them. 3. A report issued by a drug
cally. 3. Pert. to adventitia. manufacturer or government agency
adverse drug event Adverse drug reac- about a medical product that may cause
tion. serious injury or death to patients.
adverse drug reaction (ad-vĕrs⬘, ad⬘vĕrs⬙) AdvLD advanced liver disease.
ABBR: ADR. An unwanted response to advocacy (ad⬘vŏ-kă-sē) [Fr. fr. L. advo-
a therapeutic drug. Health profession- care, to call to aid] In health care,
als must report all adverse events re- pleading or representation for a desired
lated to drugs or medical devices to the goal or interest group, e.g., patients,
manufacturer and the FDA to aid in staff, providers, or biomedical research-
monitoring the safety of marketed med- ers.
ical products. SYN: adverse drug event. adynamia (ā⬙dı̄-nām⬘ē-ă) [1an- ⫹ Gr.
SEE: drug reaction; MedWatch; post- dynamis, strength] Asthenia. adyn-
marketing surveillance. amic (-nam⬘ik), adj.
ADRs are expensive and hazardous, AE above elbow; term refers to the site of
accounting for more than 2 million in- amputation of an upper extremity prox-
juries and 100,000 deaths related to imal to the elbow.
prescription drugs annually. Aeby plane (ā⬘bē) [Christopher T. Aeby,
PATIENT CARE: Documentation of Swiss anatomist, 1835– 1885] A plane
adverse drug reactions should include: perpendicular to the median plane of the
1) patient information, including date of cranium through the basion and nasion.
birth, sex, race, weight, pre-existing or AED antiepileptic drug; automated exter-
coexisting medical conditions, other nal defibrillator.
medications taken, tobacco or alcohol Aedes (ā⬙ē⬘dēz⬙) [Gr. aēdēs, unpleasant]
use, allergies, relevant diagnostic and A genus of mosquitoes belonging to the
laboratory study results; 2) date and family Culicidae. Many species are trou-
time of the event; 3) specific patient out- blesome pests, and some transmit dis-
comes attributed to the ADR, e.g., ex- ease.
tended hospital stay; 4) history of the A. aegypti An aggressive species
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Aedes 56 Aesculapius

that feeds during daylight hours and masks may be available, ascents above
can transmit common viral illnesses in- 25,000 ft should be avoided except in
cluding chikungunya fever, dengue, and aircraft with pressurized cabins. SEE:
yellow fever. hyperbaric chamber.
A. albopictus A species that was ini- aerogenesis (ar⬙ō-jen⬘ĕ-sis) [aero- ⫹
tially endemic in South East Asia and -genesis] Formation of gas. aerogenic,
the Pacific Islands but has spread to aerogenous (ar⬙ō-jen⬘ik, ar⬙oj⬘ĕ-nŭs),
Central and North America and is a vec- adj.
tor of several tropical diseases, includ- aerometer (ar-om⬘ĕ-tĕr) [aero- ⫹
ing dengue and chikungunya viral in- -meter] A device for measuring gas den-
fections. sity.
A. triseriatus A species that trans- Aeromonas (a(-ĕ)r⬙ō-mō⬘năs) A genus of
mits Jamestown Canyon virus, La gram-negative, facultatively anaerobic,
Crosse virus, and other California en- non– spore-forming, motile bacilli found
cephalitis viruses. in water and soil. It may cause wound
AEL Acute erythroleukemia. infections or gastroenteritis, e.g., trav-
-aemia SEE: -emia. elers’ diarrhea.
aerated (ar⬘āt⬙ĕd) [Gr. aēr, air] Con- A. hydrophilia A species that is path-
taining air or gas. ogenic for humans; it is sensitive to
aeration (ar⬙ā⬘shŏn) 1. Act of airing. 2. A chloramphenicol, trimethoprim-sulfa-
process in which carbon dioxide and methoxazole, and some quinolones.
oxygen are exchanged between the pul- aeroparotitis (ar⬙ō-par⬙ŏ-tı̄t⬘ı̆s) [aero- ⫹
monary blood and the air in the lungs. parotitis] Swelling of one or both pa-
3. Saturating or charging a fluid with rotid glands due to introduction of air
gases. into the glands. This may occur in those
aerial (er⬘ē-ăl) [aero- ⫹ -al] 1. Pert. to who play wind instruments; it also oc-
or occurring in air. 2. Airborne. curs in nose blowing and Valsalva’s ma-
aero-, aer- [Gr. aēr, air] Prefixes mean- neuver if done too vigorously.
ing air or gas. aerophagia, aerophagy (ar⬙ŏ-fā⬘j(ē-)ă,
aeroallergen (ar⬙ō-al⬘ĕr-jen) [aero- ⫹ ar⬙of⬘ă-jē) [aero- ⫹ Gr. phagein, to
allergen] A particle of dust, pollen, or eat] Swallowing of air.
powder that stimulates an immune re- aerosol (ar⬘ŏ-sol⬙) [aero- ⫹ sol(ution)]
sponse in a sensitive person. 1. A solution dispensed as a mist. 2. Any
aerobe (ar⬘ōb⬙) [aero- ⫹ Gr. bios, life] suspension of particles in air or gas.
A microbe that is able to live and repro- aerosolization (ar⬙ŏ-sol⬙ı̆-zā⬘shŏn) The
duce in the presence of oxygen. suspension of minute solid or liquid par-
facultative a. A microorganism that ticles in a gas.
prefers an environment devoid of oxy- aerosol therapy The use of medicated
gen but has adapted so that it can live mists, such as bronchodilators, antivir-
and reproduce in the presence of oxy- als, corticosteroids, or mucolytic agents,
gen. to treat lung or bronchial diseases. SEE:
obligate a. A microorganism that inhalation therapy.
can live and reproduce only in the pres- aerotitis, aero-otitis (ar-ŏ-tı̄t⬘is, ar-ō-ŏ-
ence of oxygen. tı̄t⬘-is) [aero- ⫹ otitis] Inflammation
aerobic (ar-ō⬘bik) [aerobe ⫹ -ic] of the ear, esp. the middle ear, due to
1. Taking place in the presence of oxy- failure of the eustachian tube to remain
gen. 2. Pert. to an organism that lives open during sudden changes in baro-
and reproduces in the presence of oxy- metric pressure. It may occur during fly-
gen. ing, diving, or working in a pressure
aerodynamics (ar⬙ō-dı̄-nam⬘iks) [aero- chamber. SYN: barotitis.
⫹ dynamics] The science of air or aerotolerance (ar⬙ō-tol⬘ĕ-răns) [aero- ⫹
gases in motion. aerodynamic, adj. aer- tolerance] The ability to survive in the
odynamically (-i-k(ă-)lē), adv. presence of oxygen. The term applies to
aeroembolism (ar⬙ō-em⬘bŏ-lizm) [aero- some bacteria that do not use oxygen
⫹ embolism] A condition in which ni- metabolically and thrive best in anaer-
trogen bubbles form in body fluids and obic environments. aerotolerant (ar⬙ō-
tissues due to an excessively rapid de- tol⬘ĕ-rănt), adj.
crease in atmospheric pressure, occur- Aesculapius (es⬙kyŭ-lā⬘pē-ŭs) [L. Aes-
ring either during ascent to high alti- culapius, fr Gr. Asklēpios] The Latin
tudes or in resurfacing from deep-sea form of Asklēpios, the ancient Greek god
diving or in hyperbaric oxygen therapy. of medicine, son of Apollo and the
SYMPTOMS: Symptoms include a nymph Coronis.
boring, gnawing pain in the joints, itch- staff of A. A rod or crude stick with
ing of skin and eyelids, unconscious- a snake wound around it, signifying the
ness, convulsions, and paralysis. Symp- art of healing and adopted as the em-
toms are relieved by recompression, i.e., blem of some medical organizations,
return to lower altitudes or placement e.g., American Medical Association.
of the patient in a hyperbaric pressure Snakes were sacred to Aesculapius be-
chamber. Even though oxygen by cause they were believed to have the
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Aesculus hippocastanum 57 afterimage

power to renew their youth by shedding nursing or medical education, the ad-
their old skin and growing a new one. ministrative merger of two hospitals or
SEE: caduceus. schools of nursing. This enables stu-
Aesculus hippocastanum (es⬘kŭ-lŭs hip⬙ dents to obtain specialized training and
ō-kas⬘tă-nŭm) [L. aesculus hippocas- experience that might not otherwise be
tanum, horse-chestnut oak] SEE: horse available to them.
chestnut. affinity (ă-fin⬘ı̆-tē) [L. affinis, neighbor-
aesthesi- SEE: esthesi-. ing, related by marriage] Attraction.
aesthetics, esthetics (es-thet⬘iks) [Gr. chemical a. The force causing certain
aisthētikos, pert. to sensation] A phi- atoms to combine with others to form
losophy or theory of beauty and the fine molecules. SEE: chemoreceptor.
arts. Aesthetics are important in dental affix (a⬘fiks⬙) [L. affixus, fastened to] An
restorations and in plastic and cosmetic element attached to a word that alters
surgery. its meaning, e.g., a prefix or a suffix.
aetio- SEE: etio-. Affordable Care Act Patient Protection
AF atrial flutter; atrial fibrillation. and Affordable Care Act.
afebrile (ā⬙-feb⬘rı̄l⬙, -fēb⬘) [a- ⫹ febrile] afibrinogenemia (ā⬙fı̄-brin⬙ŏ-jĕ-nē⬘mē-ă)
Without fever; apyretic. [a- ⫹ fibrinogen ⫹ -emia] Absence
affect (af⬘ekt⬙) [L. affectus, acted on; or deficiency of fibrinogen in the blood-
mental or emotional state] In psychol- stream.
ogy, the emotional reaction associated aflatoxicosis (af⬙lă-tok⬙sı̆-kō⬘sis)
with an experience. SEE: mood. [A(spergillus) fla(vus) ⫹ toxicosis]
blunted a. Greatly diminished emo- Poisoning, esp. acute hepatic failure,
tional response to a situation or condi- caused by ingestion of aflatoxin. SYN: x-
tion. disease.
flat a. Virtual absence of emotional aflatoxin (af⬙lă-tok⬙sin) [A(spergillus)
response to a situation or condition. fla(vus) ⫹ toxin] A toxin produced by
affection (ă-fek⬘shŏn) [Fr. fr. L. affectio, some strains of Aspergillus flavus and A.
disposition] 1. A feeling of attachment; parasiticus that causes cancer in labo-
fondness. 2. Physical or mental disease. ratory animals. It may be present in
affective (a-fek⬘tiv) Pert. to an emotion peanuts and other seeds contaminated
or mental state. affectively (a-fek⬘tiv- with Aspergillus molds.
lē), adv. affectivity (a⬙fek⬙ti⬘vı̆-tē), n. AFO ankle-foot orthosis.
affective bias A cause of diagnostic error AFP alpha-fetoprotein.
in which a clinician’s emotional state af- AFRRI Armed Forces Radiobiological Re-
fects his or her ability to treat a patient. search Institute.
affective disorder A group of disorders afterbirth (af⬘tĕr-bı̆rth⬙) The placenta
marked by a disturbance of mood ac- and membranes expelled from the
companied by a full or partial manic or uterus after the birth of a child. SYN:
depressive syndrome that is not caused secundines.
by any other physical or mental disor- afterburn (af⬘tĕr-bŭrn⬙) An increase in
der. the resting metabolic rate that occurs
afferent (af⬘ĕ-rĕnt, a-fer⬘ĕnt) [L. afferre, after exercising.
to carry to] Transporting toward a cen- aftercare (af⬘tĕr-kar⬙) The care, treat-
ter, e.g., as a sensory nerve that carries ment, help, or supervision given to per-
impulses toward the central nervous son discharged from an institution (as a
system or to some blood vessels and hospital, mental-health care institu-
lymphatic vessels. SEE: efferent. tion, or other health care facility).
afferent loop syndrome A group of gas- afterdamp (af⬘tĕr-damp⬙) A gaseous
trointestinal symptoms that occur in mixture formed by the explosion of
some patients who have had partial gas- methane and air in a mine. It contains
tric resection with gastrojejunostomy. a large percentage of carbon dioxide, ni-
The condition is caused by partial ob- trogen, and carbon monoxide.
struction of an incompletely draining afterdepolarization (af⬙tĕr-dē-pō⬙lă-rı̆-
segment of bowel. In some cases there zā⬘shŏn) Abnormal electrical activity
is bacterial overgrowth in the afferent that occurs during repolarization of the
loop. Signs and symptoms may include pacemaker cells of the heart. This activ-
abdominal bloating, fever, jaundice, ity may prolong the action potential and
nausea, vomiting, and pain after eating. trigger abnormal atrial or ventricular
Patients may suffer intestinal obstruc- rhythms.
tion, or organ necrosis and perforation. afterdrop (af⬘tĕr-drop⬙) A continuing de-
affidavit (af⬙ı̆-dā⬘vit) [L. affidare, to cline in body temperature of a hypo-
swear an oath] A voluntary written or thermic patient even after rewarming
printed statement submitted to an offi- procedures are initiated.
cer of the court and whose truthfulness aftereffect (af⬘tĕr-ĕ-fekt⬙) A response oc-
is asserted by an oath or affirmation. curring some time after the original
affiliation (ă-fi-lē-ā⬘shŏn) [L. affiliare, to stimulus or condition has produced its
adopt as one’s child] 1. Membership in primary effect.
a larger organization. 2. Association. In afterimage (af⬘tĕr-im⬘ăj) An image that
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afterload 58 age

persists subjectively after cessation of lı̆-nē⬘mē-ă) [1an- ⫹ gamma globulin


the stimulus. If colors are the same as ⫹ -emia] Any of the disorders marked
those of the object, it is called positive; by an almost complete lack of immuno-
it is called negative if complementary globulins or antibodies. Agammaglobu-
colors are seen. In the former case, the linemias are caused by abnormal B lym-
image is seen in its natural bright colors phocyte function; they cause severe
without any alteration; in the latter, the immunodeficiencies, with recurrent in-
bright parts become dark, while dark fections. Treatments include immuno-
parts are light. globulins, antibiotics, and bone marrow
afterload (af⬘tĕr-lōd⬙) In cardiac physi- transplantation.
ology, the force that impedes the flow of
blood out of the heart. The heart con-
Immunization with oral poliovirus
tracts against a resistance primarily
vaccine and yellow fever vaccine
composed of the pressure in the periph-
are both contraindicated in agammaglob-
eral vasculature, the compliance of the
ulinemia.
aorta, and the mass and viscosity of
blood. SEE: preload.
afterloading (af⬘tĕr-lōd⬙ing) In brachy- agamogenesis (ā⬙gam⬙ŏ-jen⬘ĕ-sis) [a-
therapy, the insertion of the radioactive ⫹ gamogenesis] 1. Asexual reproduc-
source after the placement of the appli- tion. 2. Parthenogenesis. agamogenetic
cator has been confirmed. (-jĕ-net⬘ik), adj. agamogenetically (-i-
afterpain (af⬘tĕr-pān⬙) Uterine cramp- k(ă-)lē), adv.
ing caused by contraction of the uterus agape (ă-ga⬘pā, a⬘gă-pā⬙) [Gr. agapē,
and commonly seen in multiparas dur- love] Unselfish, unconditional love for
ing the first few days after childbirth. another, without sexual or romantic
The pains are more severe during feelings.
breastfeeding but rarely last longer agar, agar-agar (ag⬘ăr, ag⬘ăr-ag⬘ăr)
than 48 hr postpartum. [Malay agaragar, seaweed (from which
PATIENT CARE: Emptying the blad- gelatin is made)] 1. A dried mucilagi-
der can relieve pain. Nonsteroidal anti- nous product obtained from certain spe-
inflammatory drugs (NSAIDs) may be cies of algae, esp. of the genus Gelidium.
useful; they should be given with food Agar is unaffected by bacterial enzymes
before nursing. Some women obtain re- and therefore is widely used as a solid-
lief lying on their stomachs. Aspirin ifying agent for bacterial culture media.
should not be given if there is a ten- It is used as a laxative because of its
dency to bleed. The sooner an analgesic great increase in bulk on absorption of
is given, the less is needed. water. It is also used by vegetarians
aftertaste (af⬘tĕr-tāst⬙) 1. Persistence of when recipes call for gelatin. 2. A cul-
a flavor or taste after the stimulus ends. ture medium containing agar. 3. A con-
2. Persistence of an emotion, esp. an un- stituent of dental hydrocolloid impres-
favorable one, after the event or expe- sion materials.
rience. de Man– Rogosa– Sharpe a.’ A nu-
AFUD American Foundation for Urologic trient medium used in the laboratory to
Disease. identify bacteria that release lactic ac-
Ag [L. argentum] Symbol for the ele- ids. SYN: de Man-Rogosa-Sharpe me-
ment silver. dium.
AGA American Gastroenterological As- xylose-lysine-desoxycholate a.’, xy-
sociation; appropriate for gestational lose-lysine-deoxycholate a.’ A labora-
age. tory growth medium used to facilitate
against medical advice ABBR: AMA. A the identification of gram-negative en-
patient’s refusal of medically recom- teric bacteria, esp. Salmonella and Shi-
mended treatments, esp. in the hospi- gella species.
tal. Dropping out of care or leaving a agaric (ag⬘ă-rik, ă-gar⬘ik) [L. fr. Gr.
hospital AMA typically occurs when pa- agarikon, a sort of fungus] A toxic or
tients are dissatisfied with the pace or hallucinogenic mushroom, esp. species
course of their care, carry substance of the genus Agaricus.
abuse diagnoses, or have a history of agastria (ā⬙gas⬘trē-ă) [a- ⫹ gastr- ⫹
multiple hospitalizations. The action -ia] Absence of the stomach. agastric
may result in an increase in both mor- (gas⬘trı̆k), adj.
bidity and rehospitalization. Agatson score (ag⬘ăt-sŏn) [Arthur Agat-
PATIENT CARE: The patient is asked son, U.S. cardiologist, b. 1947] A mea-
to sign a release form indicating that surement of the amount of calcium in a
the health care facility and those re- coronary artery.
sponsible for medical care are not liable AGC atypical glandular cells.
for any adverse outcome that may result AgCl Symbol for silver chloride.
from the termination of care. AGE advanced glycation end products.
agamic (ā⬙gam⬘ı̆k) [a- ⫹ gam- ⫹ -ic] age (āj) [Fr. age, fr. L. aetas] 1. The
Asexual. time, measured in seconds, minutes,
agammaglobulinemia (ā⬙gam⬙ă-glob⬙yŭ- hours, days, months, or years that an or-
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age 59 agenesia

ganism has lived since its birth. 2. A or fetus as timed from the date of onset
particular period of life (such as middle of the last menstrual period. Gesta-
age or old age). 3. To grow old. 4. In psy- tional age is specified numerically by
chology, the degree of development of the following convention: 360/7 indi-
one individual as compared or con- cates an age of 36 weeks, 0 days. 295/7
trasted with another of comparable de- indicates an age of 29 weeks, 5 days. The
velopment or accomplishment. first two numbers are the number of
achievement a. ABBR: AA. The age weeks of gestation. The number desig-
of a person with regard to level of acquired nated as X/7 is the number of days
learning. It is determined by a proficiency since the completion of the last full
test and expressed in terms of the chron- week. SYN: menstrual age.
ological age of the average person showing menarcheal a. Elapsed time ex-
the same level of attainment. pressed in years from menarche.
advanced maternal a. ABBR: AMA. menstrual a. Gestational a.
The age of women for whom pregnancy mental a. ABBR: MA. The age of a
presents increased risks either to the fe- person with regard to mental ability, de-
tus or to the mother. In the medical lit- termined by a series of mental tests de-
erature, this age is variably stated as vised by Binet and expressed in terms
being over 35. of the chronological age of the average
anatomical a. An estimate of age as person showing the same level of attain-
judged by the stage of development or ment.
deterioration of the body or tissue as middle a. SEE: middle age.
compared with persons or tissues of ovulation a. Conceptional a.
known age. physiological a. The relative age of a
biological a. One’s present position person, esp. when comparing that indi-
in regard to the probability of survival. vidual’s physical status with those of
Determination of biological age requires other persons of the same chronological
assessment and measurement of the age.
functional capacities of the life-limiting postmenstrual a. In neonates, the
organ system, e.g., the cardiovascular length of time that begins with the first
system. day of the last menstrual period of the
bone a. An estimate of biological age expectant mother and that ends either
based on radiological studies of the de- at the time of birth, or at the postnatal
velopmental stage of ossification centers age.
of the long bones of the extremities. postnatal a. Chronological a.
SEE: epiphysis. preschool a. The age of a child ap-
chronological a. ABBR: CA. In ne- prox. between 3 and 5.
onates, the time that passes (the num- school a. The age of a child approx.
ber of hours, days, weeks, etc.) after the
between 6 and 17.
birth of the child. SYN: postnatal age.
aged (ājd, ā⬘jĕd) 1. To have grown older
conceptional a. 1. The estimated
or more mature. 2. Persons who have
gestational age as referenced from the
grown old. SEE: aging.
actual time of conception. It is usually
considered to be at least 14 days after
Age Discrimination Act Also known as
the first day of the last menstrual pe- Age Discrimination in Employment Act,
riod. 2. In neonates born after in vitro 29 U.S.C. subsection 621 (1967), a law
fertilization, the number of weeks and that prohibits unfair and discrimina-
days that pass from the time of fertiliza- tory treatment in hiring, promotion,
tion or implantation until the date of compensation, discharge, terms, condi-
birth. SYN: ovulation age. tions, or privileges of employment by an
a. of consent The age at which a mi- employer against anyone 40 years old or
nor no longer requires parental consent older. In health care, this act has been
to marry, or at which he or she may le- used to challenge the termination of ma-
gally engage in voluntary sexual inter- ture employees. Enforced by the Equal
course. It varies among states but is Employment Opportunity Commission
usually between ages 13 and 18. (EEOC).
developmental a. An index of mat- ageism, agism (ā⬘jizm) Age discrimi-
uration expressed in months or years, nation. ageist (ā⬘jist), adj.
which represents a value obtained by Agency for Healthcare Research and
comparing performance with scaled Quality ABBR: AHRQ. An office of the
norms for a particular age group. SEE: U.S. Department of Health and Human
achievement a. Services dedicated to supporting, con-
emotional a. The age of a person ducting, and disseminating research;
with respect to the stage of emotional promoting improvements in clinical
development. practice; and enhancing the quality, or-
functional a. Age defined in terms of ganization, financing, and delivery of
physical or functional capacity; fre- health care services.
quently applied to older adults. agenesia, agenesis (ā⬙jĕ-nē⬘zh(ē-)ă, ā⬙
gestational a. The age of an embryo jen⬘ĕ-sis) [1an- ⫹ -genesis] 1. Failure
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agent 60 agent

of an organ or part to develop or grow. cemia, bradycardia, and heart block.


2. Lack of potency. Rapid withdrawal from a beta-blocking
agent (ā⬘jĕnt) [L. agere, to do] Someone drug by a patient accustomed to its use
or something that causes an effect. For may produce tachycardia or other ar-
example, bacteria that cause disease rhythmias, rebound hypertension, or myo-
are agents of the specific diseases they cardial ischemia or infarction.
cause, and medicine is a therapeutic
agent.
binding a. Any agent used to form
alkylating a. Any agent that intro-
dusty or powdery medicines into pills.
duces an alkyl radical into a compound
buffering a. Buffer.
in place of a hydrogen atom. Alkylating
CBRNE a. Any chemical, biological,
agents are used to treat cancer because
radiologic, nuclear, or explosive agent
they interfere with cell metabolism and
that may be used as a weapon in mili-
growth. Examples include cis-platinum
tary or terrorist activities.
and cyclophosphamide.
alpha-adrenergic blocking a. A med- ceruminolytic a. An agent that dis-
solves cerumen in the external ear ca-
ication that interferes with excitatory
nal. Obstruction of the ear canal with
sympathetic nervous system stimuli.
cerumen can cause itching, pain, and
Agents from this class are used to treat
temporary conductive hearing loss. The
hypertension, prostatic hyperplasia and
first approach to treatment should be
kidney stones. SYN: alpha blocker.
removal of the obstruction manually
SEE: beta-adrenergic blocking a.
with a blunt curet or loop or by irriga-
anabolic a. Any of a class of steroid
tion. Cerumen solvents are not always
hormones resembling testosterone.
recommended because they often do not
These agents stimulate the growth or
eliminate the problem and frequently
manufacture of body tissues. They have
cause maceration of the skin of the ca-
been used, sometimes in high doses, by
nal and allergic reactions.
male and female athletes to improve
cervical-ripening a. Any agent that
performance. This use has been judged
promotes dilation of the cervix in antic-
to be illegal by a number of organiza-
ipation of childbirth.
tions that supervise sports, including
chaotropic a. An ion that disrupts
the International Olympic Committee
membranes, nucleic acids, and proteins.
and the U.S. Olympic Committee. These
chelating a. Chelator.
agents are also used to treat patients
cholinergic blocking a. Anticholin-
with wasting illnesses. SEE: doping; er-
ergic (2).
gonomic aid.
clearing a. 1. An agent that increases
the transparency of tissues prepared for
Indiscriminate use of anabolic microscopic examination. 2. In radio-
agents is inadvisable because of the graphic film processing, the active agent
undesirable side effects they may produce, in the fixer that clears undeveloped sil-
e.g., in women, hirsutism, masculiniza- ver bromide crystals from the film. The
tion, and clitoral hypertrophy; in men, ag- most common agent is ammonium thi-
gressiveness and testicular atrophy. osulfate. SYN: fixing a.
colon-cleansing a. An agent to force
the bowels to evacuate, e.g., in prepa-
antianxiety a. Anxiolytic. ration for colonoscopy.
antiulcer a. A drug to prevent or cytotoxic a. An agent that destroys
treat ulcers of the stomach or small in-
cells or prevents them from multiplying.
testine.
Cytotoxic agents are used to treat can-
beta-adrenergic a. A synthetic or cers and severe immunological disor-
natural drug that stimulates beta (sym-
ders, e.g., vasculitis and some forms of
pathetic) receptors, e.g., epinephrine
glomerulonephritis. An ideal agent
and norepinephrine.
would destroy proliferating cells with-
beta-adrenergic blocking a. Any out injuring the normal cells of the body.
drug that inhibits the activity of the
differentiating a. An agent such as
sympathetic nervous system and of ad-
all-trans-retinoic acid, used in differen-
renergic hormones.
tiation therapy.
Members of this class of drugs are
disclosing a. A diagnostic aid used in
used to treat hypertension, angina pec-
dentistry to stain areas of the teeth that
toris, myocardial infarction, aortic dis-
are not being cleaned adequately. A dye
section, arrhythmias, glaucoma, and
such as erythrosine sodium is used to
other conditions. Commonly prescribed
color dental plaque so that inadequately
beta blockers include atenolol, carvedi-
brushed surfaces can be shown to pa-
lol, metoprolol, nadolol, propranolol,
tients.
and pindolol. SYN: beta blocker.
Eaton a. SEE: Eaton agent.
erythropoiesis-stimulating a.
Side effects of beta blockers include ABBR: ESA. Any drug that binds to
worsening of asthma, blunting of cellular receptors for erythropoietin and
the cardiovascular symptoms of hypogly- encourages red blood cell production by
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agent 61 agent

the bone marrow. Members of this in type 2 diabetes mellitus. Commonly


class of drugs, which include epoietin used oral agents for diabetes include
and darbopoietin, are used to treat metformin (a biguanide), sulfonyl-
anemia, e.g., in patients with chronic ureas (such as glyburide), alpha-glu-
kidney disease, cancer, or aplastic cosidase inhibitors (acarbose), and
anemia. ESAs are used as an alter- thiazolidinediones (pioglitazone).
native to red blood cell transfusions. Used appropriately, OHAs lower he-
Potential side effects of treatment in- moglobin A1c levels by about 0.5 to
clude high blood pressure and an in- 1.5%. SEE: table.
creased risk of blood clots. progestational a. Progestin (1).
filling a. Filler. radioprotective a. Any substance
fixing a. SEE: clearing a. that shields the body from damage by
health care a. Health care proxy (2). radioactivity.
immunobiological a. Immunobiol- reducing a. A substance that loses
ogical. electrons easily and therefore causes
immunosuppressive a. SEE: immu- other substances to be reduced (such as
nosuppressant. hydrogen sulfide, sulfur dioxide). SYN:
luting a. Cementation. reducing substance.
nasal drying a. Any anticholinergic, reversal a. 1. A medication that
antihistaminic, or drug of a related class blocks the action of a previously admin-
that decreases watery discharge from istered drug. 2. An antidote.
the nose, e.g., in rhinitis. sclerosing a. A substance used to
Norwalk a. SEE: under virus. cause sclerosis, esp. of the lining of a
ocular hypotensive a. A drug that vein. SEE: varicose vein.
reduces intraocular pressure, e.g., in surface-active a. Surfactant.
glaucoma. thermal a. Heat or cold used to pro-
oral a. Any medication that dissolves mote healing. SEE: physical agent mo-
in the mouth, is chewed, or is swal- dality.
lowed, as opposed to medications given thrombolytic a. Any drug that de-
topically, by infusion, or by injection. grades blood clots. Examples include
oral hypoglycemic a. ABBR: OHA. streptokinase, tenecteplase, tissue plas-
Any drug taken by mouth that lowers or minogen activator, and urokinase. Such
maintains blood glucose (as opposed to drugs are used to treat the abnormal
insulin, a drug taken parenterally to blood clotting that occurs in heart at-
control blood sugar). In addition to diet tacks, some strokes, and pulmonary em-
and exercise regimens, OHAs are typi- boli. They are informally called “clot
cally used to control blood glucose levels busters.”

Oral Agents That Lower Blood Glucose*


Class of Drug Activity Adverse Features
Alpha-glucosidase in- Delay absorption of glu- Flatulence and other
hibitors, e.g., acar- cose from intestinal abdominal side ef-
bose tract fects
Biguanides, e.g., met- Improve sensitivity to Less weight gain than
formin insulin; decrease glu- with other agents;
cose production by avoid in patients with
the liver renal failure
Sulfonylureas, 1st gen- Cause beta cells to re- Resistance to drug may
eration, e.g., tolaza- lease insulin develop over time
mide
Sulfonylureas, 2nd gen- Same as 1st generation; Same as 1st generation
eration, e.g., glipi- also increase sensitiv-
zide, glyburide, oth- ity to insulin
ers
Thiazolidinediones, e.g., Improve sensitivity to Monthly monitoring of
pioglitazone insulin; improve lipid liver functions needed
profile for some drugs in this
class due to risk of
toxicity. Heart failure
and other heart dis-
eases.
* Combinations of these drugs, either with each other or with insulin, may be used in patients
with poorly controlled diabetes mellitus.
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agent 62 agglutination

age-specific (āj⬘spĕ-sif⬘ik) Pert. to con-


Thrombolytic drugs should not be ditions that vary with different stages of
given to patients with active bleed- development or years of life.
ing, a history of surgery or major trauma ageusia, ageustia (ă-gū⬘zē-ă, ă-gū⬘stē-ă)
within the preceding two weeks, a brain [a- ⫹ Gr. geuesthai, to taste] Absence,
tumor, or other known risks for intrace- partial loss, or impairment of the sense
rebral hemorrhage. of taste. SEE: dysgeusia; hypergeuses-
thesia; hypogeusia.
topical hemostatic a. Any substance ETIOLOGY: Ageusia may be caused
that can be applied to a wound or an in- by disease of the chorda tympani or of
cision to keep it from bleeding. Exam- the gustatory fibers, excessive use of
ples include adhesives derived from col- condiments, the effect of certain drugs,
lagen or glutaraldehyde, aging, or lesions involving sensory path-
cellulose-based products, fibrin seal- ways or taste centers in the brain.
ants, hydrogels, and thrombin. central a. Ageusia due to a cerebral
uricosuric a. A drug, e.g., probenecid lesion.
or sulfinpyrazone, that increases the conduction a. Ageusia due to a le-
urinary excretion of uric acid by block- sion involving sensory nerves of taste.
ing renal tubular absorption, thereby peripheral a. Ageusia due to a dis-
reducing the concentration of uric acid order of taste buds of the mucous mem-
in the blood. It is used to treat gout. brane of tongue.
PATIENT CARE: Probenecid and sul- agglomerate (ă-glom⬘ĕ-rāt⬙) [L. agglom-
finpyrazones are used to treat gout. Side erare, to roll into a ball] To congregate;
effects of both include headache, gastro- form a mass. agglomeratio (-rā⬘shŏn),
intestinal upset, epigastric pain, kidney n.
stone formation, and peptic ulcer. These agglutin-, agglutino- [L. agglutinare, to
drugs should be avoided by patients glue to] Prefixes meaning clumping or-
with diminished renal function. Any gluing.
uricosuric agent should be taken with agglutinant (ă-gloot⬘ı̆n-ănt) [L. aggluti-
milk, food, or antacids to reduce gastric nare, to glue] 1. A substance causing
distress. Patients should drink large adhesion. 2. Causing union by adhesion,
volumes of water. Sodium bicarbonate as in the healing of a wound. 3. Agglu-
(or potassium citrate) is prescribed tinin.
simultaneously with these agents to al- agglutination (ă-gloot⬙ı̆n-ā⬘shŏn) [L. ag-
kalinize urine and keep uric acid crys- glutinare, to glue to] 1. A type of anti-
tals in solution. gen-antibody reaction in which a solid
vascular disrupting a. Any of a class cell or particle coated with antigens
of medications used to destroy the blood drops out of solution when it is exposed
supply of malignant tumors. to a previously soluble antibody. The
wetting a. 1. Any agent, such as a particles involved commonly include red
surfactant, that allows a fluid to spread blood cells, bacteria, and inert carriers
over and coat a surface to which it is ap- such as latex. Agglutination also refers
plied. 2. In radiographic wet film pro- to laboratory tests used to detect specific
cessing, a solution used after washing to antigens or antibodies in disease states.
reduce surface tension and accelerate When agglutination involves red blood
water flow from the film to speed drying. cells, it is called hemagglutination.
Agent Orange A defoliant used exten- 2. Adhesion of surfaces of a wound.
sively by U.S. military forces in the Vi- direct a. The formation of an insolu-
etnam War. It was composed of 2,4-D ble network of antigens and their anti-
and 2,4,5-T. The 2,4,5-T was discovered bodies, when the antigen is mixed with
to be contaminated with TCDD. The de- specific antiserum. Direct agglutination
foliant was stored in 55-gallon drums reactions are used, for example, in typ-
painted with an orange stripe. ing blood or in assessing the presence of
PRESUMPTIVE DIAGNOSES: The antibodies against microorganisms.
U.S. government accepts that the fol- passive a. A test for the presence of
lowing illnesses are the result of expo- a specific antibody in which inert par-
sure to Agent Orange: AL amyloidosis, ticles or cells with no foreign antigenic
B-cell leukemias, chloracne, diabetes markers are coated with a known solu-
mellitus, Hodgkin and non-Hodgkin ble antigen and mixed with serum. If
lymphoma, ischemic heart disease, mul- clumping occurs, the patient’s blood
tiple myeloma, Parkinson disease, pros- contains antibodies specific to the anti-
tate cancers, porphyria cutánea tarda, gen. In the past, red blood cells were
respiratory cancers, and soft tissue sar- used as the carriers after they were
comas. SEE: chloracne for illus; TCDD. washed to remove any known antibod-
agerasia (ā⬙jĕ-rā⬘zh(ē-)ă) [a- ⫹ Gr. ies; currently, latex, bentonite, and
geras, old age] Healthy, vigorous old charcoal also are used.
age; youthful appearance of an old per- platelet a. Clumping of platelets in
son. response to immunological reactions.
age retardation Life extension. vulvar a. Adhesion of the vaginal la-
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agglutination test 63 aging

bia to each other, e.g., after inflamma- A. aphrophilus SEE: Actinobacil-


tory ulceration of the skin. lus actinomycetemcomitans.
agglutination test A widely used test in aggregation (ag⬙rĕ-gā⬘shŏn) A clump,
which adding an antiserum containing cluster, collection, or group of things.
antibodies to cells or bacteria causes cellular a. Clumping together of
them to agglutinate. blood cells, esp. platelets or red cells.
agglutinative (ă-gloot⬘ı̆n-ā⬙tiv, -ă-tiv) familial a. Multiple instances of a
Causing or capable of causing aggluti- disease in a group of related individu-
nation. als, due to shared genetic susceptibility,
agglutinin (ă-gloot⬘ı̆n-ı̆n) [L. aggluti- shared environmental exposure, or
nare, to glue to ⫹ -in] An antibody chance.
present in the blood that attaches to an aggregometry (ag⬙rĕ-gom⬘ĕ-trē) [aggre-
antigen present on cells or solid parti- gate ⫹ -metry] The measurement of
cles. The antibody causes the cells or the degree to which objects, e.g., plate-
particles to agglutinate. Agglutinins lets, stick together.
cause transfusion reactions when blood aggression (ă-gresh⬘ŏn) [L. aggredi, to
from a different group is given. These attack] 1. A forceful physical or verbal
antibodies are present at birth and re- act. 2. In psychiatry, hostility, either in-
quire no exposure to an antigen to be nate or due to frustration, and directed
created since they are genetically deter- against oneself or against another per-
mined. son or thing. The aggression may be ap-
anti-Rh a. An antibody produced by propriate and self-protective, indicating
people with Rh-negative blood who are healthy self-assertiveness, or it may be
exposed to blood containing the Rh an- inappropriate, disproportional, or ille-
tigen. This antibody develops in Rh-neg- gal.
ative people who receive Rh-positive aggressive (ă-gres⬘iv) 1. Pert. to or
blood and in Rh-negative women carry- showing aggression. 2. More intensive
ing an Rh-positive fetus. The antibody or concentrated than usual, e.g., chemo-
may cause hemolytic disease of the new- therapy. 3. Rapidly developing or grow-
born in subsequent Rh-positive preg- ing, e.g., a cancer.
nancies. aging (āj⬘ing) 1. Growing older. Most au-
cold a. An antibody in the serum of thorities confine the term to the matu-
patients with certain diseases that ration and physiological changes in or-
causes the agglutination of erythrocytes gan systems that occur after the 30th
(usually from sheep) at low tempera- year of life. 2. Maturing. 3. Any physio-
tures by the serum of these patients. logical, cellular, or biochemical change
warm a. An agglutinin effective only that occurs over time rather than from
at normal body temperature. injury or disease.
agglutinogen (ă-gloot-ı̆n⬘ŏ-jĕn) [agglu- a. in place Any of the services pro-
tin- ⫹ -gen] An antigen that stimu- vided to older patients that allow
lates the production of an agglutinin. them to continue to live independently
Agglutinogens are used primarily in rather than relocating them to care fa-
laboratory testing for antibodies against cilities.
specific blood types. SEE: blood group. primary a. Any of the universal
agglutinogenic, agglutogenic (ă- changes in structure and function that
gloot⬙ı̆n-ŏ-jen⬘ı̆k, ă-gloot⬙ŏ-jen⬘ik), adj. occur naturally during normal pro-
A and B a. SEE: blood group; ABO cesses of growing older, independent of
incompatibility. disease or excessive environmental
M and N a. Antigenic substances stress.
found on the membranes of human red productive a. Any of the activities
blood cells. Anti-M and anti-N aggluti- (such as volunteer work, caregiving,
nins are rarely found in normal serum. full- or part-time employment) through
The red blood cells may contain M or N, which older people contribute to society.
or both M and N agglutinogens, result- It includes examining the kinds and
ing in blood types M, N, or MN, respec- amount of productive activities that
tively. SEE: blood group. older people have and are capable of,
Rh a. SEE: Rh factor. maximizing their independence, and re-
aggrecan (ag⬘rĕ-kan⬙) [aggre(gate) ⫹ moving the barriers against older
(proteo)glycan] A large glycoprotein adults, e.g., ageism, sexism, and/or rac-
that provides stiffness and structural ism. SEE: successful a.
strength to many tissues, including secondary a. Any of the changes in
joint cartilage, tendons, and the aorta. structure and function due to diseases
aggregate (ag⬘rĕ-gāt⬙) [L. aggregare, to prevalent in aging rather than to uni-
flock together] 1. A sum or mass of versal aging processes.
units or substances. 2. To cluster or successful a. Aging in which emo-
come together. tional, intellectual, physical, social, or
Aggregatibacter The preferred name for spiritual interests are optimally main-
the genus Actinobacillus, which is still tained or developed. Whereas produc-
more common. SEE: Actinobacillus. tive aging focuses on activity, successful
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agitation 64 agonist

aging includes physical and social well- agnathia (ag-nā⬘thē-ă) [a- ⫹ gnath- ⫹
being. SEE: productive a. -ia] Absence of the mandible.
agitation (aj⬙ı̆-tā⬘shŏn) [L. agitare, to agnatic (ag-nat⬘ik) [L. agnatus, kinsman
drive] 1. Excessive restlessness, in- on one’s father’s side] Patrilineal.
creased mental, and, esp., physical ac- agnea (ag⬘nē-ă) Inability to recognize
tivity. objects.
PATIENT CARE: Agitation may com- AgNO3 Formula for silver nitrate.
plicate many medical and psychiatric agnogenic (ag⬙nō-jen⬘ik) [1an- ⫹ Gr.
conditions and make management of gnōsis, knowledge ⫹ -genic] Idio-
patients difficult, frustrating, and some- pathic.
times dangerous. Agitation is common agnosia (ag-nō⬘zhă, shă) [a- ⫹ Gr.
in older adults, patients with dementia, gnōsis, knowledge ⫹ -ia] Inability to
and in those with organic brain syn- recognize or comprehend sights, sounds,
dromes. The agitated patient should al- words, or other sensory information.
ways be addressed with respect; at- auditory a. Word deafness.
tempts should be made to calm him or color a. Inability to recognize or
her with supportive listening, a com- name specific colors.
posed affect, and genuine reassurance. finger a. Inability to identify the fin-
The presence of a calm and respected gers of one’s own hands or of others.
family member may be helpful. Reori- optic a. Inability to interpret seen
entation of the patient to his or her sur- images.
roundings and the reason for health tactile a. Inability to distinguish ob-
care interventions or hospitalization jects by touch. SYN: stereoagnosis.
should be provided. Medical therapies, time a. Unawareness of the sequence
including antipsychotic drugs, some- and duration of events.
times in combination with benzodiaze- unilateral spatial a. SEE: unilateral
pines or other sedatives, are variably ef- inattention.
fective. visual object a. Loss of the ability to
visually recognize presented objects
even though there is some degree of
Health care professionals who work ability to see.
with agitated patients are at a sig- agnostic (ag-nos⬘tik) [G. agnōstos, un-
nificant risk of being injured at work. In- known, not capable of being known ⫹
stitutional programs to limit staff injury -ic] Uncertain or doubtful of the ability
may decrease this hazard. Protocols for to prove the existence of something, but
defusing violent situations and de-escalat- esp. of God. agnostic, n. agnosticism
ing interpersonal tensions may also de- (tı̆-sı̆zm), n.
crease the risk. -agogue [Gr. agōgos, leading, inducing]
Suffix meaning producer, secretor, or
promoter of the excretion of a specific
2. Tremor. 3. Severe motor restless- substance.
ness, usually nonpurposeful, associated agonal (ag⬘ŏ-năl) [agon(y) ⫹ -al] Pert.
with anxiety. 4. Shaking of a container to agony, esp to that just before death.
so that the contents are rapidly moved agonist (ag⬘ŏ-nist) [Gr. agōn, contest,
and mixed. struggle ⫹ -ist] 1. The muscle that di-
Agkistrodon (ag-kis⬘trŏ-don⬙, ang-kis⬘ rectly produces a specific action. When
trŏ-don⬙) [L. fr. Gr. ankistron, fishhook bending the elbow, the distal biceps bra-
⫹ Gr. odōn, tooth] A genus of ovovi- chii tendon is the agonist and the tri-
viparous pit vipers found in the U.S. ceps muscle the antagonist. SYN: ago-
and Central America. nist muscle. 2. In pharmacology, a drug
A. contortrix SEE: copperhead. that binds to the receptor and stimu-
A. piscivorus SEE: cottonmouth. lates its function.
aglossia (ā⬙glos⬘ē-ă) [a- ⫹ glossa ⫹ adrenergic a. Any of a group of ther-
-ia] Congenital absence of the tongue. apeutic agents, e.g., epinephrine, that
aglossostomia (ā⬙glos-ŏ-stō⬘mē-ă) [a- mimic or stimulate the sympathetic ner-
⫹ glosso- ⫹ stoma] Congenital ab- vous system.
sence of the tongue and mouth. beta a. A drug that stimulates adre-
aglutition (ā⬙gloo-tish⬘ŏn) [a- ⫹ L. glu- nergic receptors in the lungs, heart,
tire, to swallow] Difficulty in swallow- uterus, and other organs. Beta agonists
ing or inability to swallow. are used to treat asthma and chronic ob-
aglycon, aglycone (a-glı̄⬘kon⬙, a-glı̄⬘kōn⬙ structive lung diseases and to manage
) [1an- ⫹ glyco- ⫹ -one] An isofla- pregnancy.
vone attached to the chemical structure beta-2 a. A medication that stimu-
of digitalis glycosides. It is responsible lates bronchodilation. Examples include
for the cardiotonic activity of those albuterol, salmeterol, and terbutaline.
agents. SEE: bronchodilator.
aglycosuric (ā⬙glı̄⬙kō-shoor⬘ik) [a- ⫹ PATIENT CARE: Beta-2 agonists are
glycosuria ⫹ -ic] Free from glycos- used to treat patients with asthma or
uria. any pulmonary disease associated with
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agonist 65 AGUS

bronchospasm. Patients given such or to use conjunctions, pronouns, verb


medications need to be monitored for tenses, or word endings appropriately.
side effects such as tremor, tachycardia, SEE: paragrammatism.
and nausea. agranulocyte (ā⬙gran⬘yŭ-lō-sı̄t⬙) [a- ⫹
dopamine a. An agent, such as ro- granulocyte] A nongranular, mononu-
pinirole or pramipexole, used to treat clear white blood cell (a lymphocyte or a
Parkinson disease. Such agents are of- monocyte). SYN: agranular leukocyte;
ten used in patients under 50 years of lymphoid leukocyte; nongranular leu-
age because they cause fewer side ef- kocyte.
fects, such as dyskinesia, than levodopa agranulocytosis (ā⬙gran⬙yŭ-lō-sı̄⬙tō⬘sis)
does. Levodopa is eventually used in [agranulocyte ⫹ -osis] A decrease in
most older patients, e.g. those over the the number of infection-fighting granu-
age of 70. locytes in the blood. It may occur in
ergot a. Any of a class of drugs, e.g., some leukemias or after exposure to cer-
pergolide, used to treat Parkinson dis- tain treatments that are toxic to the
ease. bone marrow; e.g., chemotherapeutic
long-acting beta a. ABBR: LABA. A agents; clozapine. SYN: agranulosis;
class of bronchodilators used as main- granulocytopenia; malignant neutro-
tenance therapy for patients who have penia. agranulocytic (-sit⬘ik), adj.
inadequate control of asthma with res- agranuloplastic (ā⬙gran⬙yŭ-lō-plas⬘tik)
cue medications. Such agonists include [a- ⫹ granulo(cyte) ⫹ -plastic] Un-
formoterol and salmeterol. able to form granular cells.
partial a. A chemical or drug that agraphesthesia (ā⬙graf⬙es-thē⬘zh(ē-)ă)
stimulates a cellular receptor incom- [1an- ⫹ graphesthesia] Inability to
pletely, producing a submaximal re- recognize letters or numbers drawn by
sponse in the cells it acts upon. the examiner on skin. SEE: graphesthe-
short-acting beta a. A group of bron- sia.
chodilators used to treat acute exacer- agraphia (ā⬙graf⬘ē-ă) [1an- ⫹ -graph
bations of asthma or chronic obstructive ⫹ -ia] Loss of the ability to write.
pulmonary disease, including albuterol, agraphic (ā⬙graf⬘ik), adj. SEE: motor
metaproterenol, and pirbuterol. aphasia.
thromobopoietin a. Any drug that absolute a. Complete inability to
stimulates the bone marrow to produce write.
platelets. SYN: thrombopoietin receptor acoustic a. Inability to write words
agonist. that are heard.
thrombopoietin receptor a. Thro- amnemonic a. Inability to write sen-
mobopoietin a. tences although letters or words can be
agony (ag⬘ŏ-nē) [L. agonia fr. Gr. written.
agōnia, anguish, struggle] 1. Extreme cerebral a. Inability to express
mental or physical suffering. 2. The thoughts in writing.
death struggle. motor a. Inability to write due to
agoraphobia (ag⬙(ŏ)-ră-fō⬘bē-ă) [Gr. muscular incoordination.
agora, marketplace ⫹ -phobia] A optic a. Inability to copy words.
form of social phobia in which one feels verbal a. Inability to write words al-
either: 1) overwhelming symptoms of though letters can be written.
anxiety on leaving home, or 2) fear of A/G ratio Albumin-globulin ratio.
being in places or situations from which agrimony (ag⬘rı̆-mōn⬙ē) [L. agrimonia,
escape may be difficult if symptoms of argemonia, argemone fr.Gr. argemōnē,
panic arise. The symptoms may occur in poppy] Any perennial flowering herb of
everyday situations (such as standing the genus Agrimomia, native to the
on line, eating in public) in which a per- temperate regions of the northern hemi-
son may be unable to escape or get help sphere, esp. A. eupatoria, which has
and may be embarrassed. Symptoms in- been used since ancient times in teas,
clude rapid heartbeat, chest pain, diffi- gargles, and compresses and in herbal
culty in breathing, gastrointestinal dis- medicine. Few clinical trials on A. eu-
tress, faintness, weakness, sweating, or patoria have been carried out.
fear of impending doom or of dying. Peo- agrypnocoma (ă-grip⬙nŏ-kō⬘mă) [Gr.
ple with these symptoms often avoid agrypnos, sleepless ⫹ coma] Coma in
phobic situations by rarely or never which a person is partially awake as if
leaving home. agoraphobe (ag⬘(ŏ)-ră- in an extreme lethargic state. It may be
fōb⬙), n. agoraphobic (ag⬙(ŏ)-ră-fō⬘bik), associated with delirium and lack of
n. agoraphobic, adj.; sleep.
-agra [Gr. agra, a seizure] Suffix mean- agrypnotic (ă⬙grip-not⬘ik) [Gr. agryp-
ing sudden, severe pain. nos, sleepless] 1. Afflicted with insom-
agrammatism (ā⬙gram⬘ă-tizm) [1an- ⫹ nia. 2. Causing wakefulness.
Gr. gramma, stem grammat-, letter ⫹ AGS American Geriatrics Society.
-ism] A language disturbance marked AGUS atypical glandular cells of unde-
by the misuse of grammar, esp. the in- termined significance. SEE: atypical
ability to make subjects and verbs agree glandular cells.
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agyria 66 aide

agyria (ā⬙jı̄⬘rē-ă) [a- ⫹ gyro- ⫹ -ia] performance. Some of these materials,


Incompletely developed convolutions of e.g., blood transfusions, anabolic ster-
the cerebral cortex. agyric (-rik), adj. oids, amphetamines, amino acids, and
AH50 A blood test to identify deficiencies human growth hormone, are standard
in the alternative complement pathway. medicines approved for uses other than
Low levels are associated with in- those intended by the athlete. Others
creased susceptibility to immune and are not indicated for any illness but may
infectious diseases. even be harmful, esp. when the amount
AHA alpha-hydroxy acid; American of the active ingredient in the product is
Heart Association; American Hospital unknown. Included in this latter group
Association. are cyproheptadine, taken to increase
AHF antihemophilic factor, coagulation appetite, strength, and, allegedly, tes-
factor VIII. SEE: coagulation factor. tosterone production; ginseng; pan-
AHFV Alkhurma hemorrhagic fever. gamic acid; octacosanol, a 28-carbon
AHG antihemophilic globulin, coagula- straight-chain alcohol obtained from
tion factor VIII. SEE: coagulation fac- wheat germ oil, the biological effects of
tor. which are unknown; guarana, prepared
AHIMA American Health Information from the seeds of the Paulliania cupana
Management Association. tree, used for its alleged ability to in-
AHRQ Agency for Healthcare Research crease energy; gamma-oryzanol, an iso-
and Quality. mer of oryzanol extracted from rice bran
AI Aortic insufficiency; artificial insem- oil, allegedly useful in decreasing recov-
ination; artificial intelligence. ery time after exercise; proteolytic en-
AIAN American Indian or Alaskan Native zymes, e.g., chymotrypsin, trypsin-chy-
(used by U.S. government agencies). motrypsin, and papain, the safety and
Aicardi-Goutières syndrome (e-kar-dē⬘- efficacy of which have not been estab-
goo-tyer⬘) [Jean François Marie Ai- lished, esp. when used with oral anti-
cardi, Fr. pediatrician, b. 1926; Franço- coagulants or by pregnant or lactating
ise Goutières] A rare inherited mental women; and bee pollen, which has
retardation in which affected infants shown no evidence of improving athletic
also have both encephalopathy and liver performance. SEE: anabolic agent;
disease. It may mimic TORCH or toxo- blood doping.
plasmosis. SYN: pseudo-TORCH syn- hearing a. An electroacoustical
drome. sound-amplifying apparatus used by
Aicardi syndrome (ı̄-kar⬘dē) [Jean Fran- those with impaired hearing. Common
çois Marie Aicardi, Fr. neurologist, b. forms of hearing aids are those that fit
1926] A rare cause of childhood sei- within the ear (“in the ear” [ITE]), or
zures, due to the congenital absence of within the auditory canal (“in the canal”
the corpus callosum. The disease is only [ITC]); those that are worn behind the
found in children with two X chromo- ear (BTE), and those that are carried on
somes or in those with Klinefelter’s syn- the body. The modern hearing aid may
drome. simply amplify sound or may be de-
aichmophobia (āk⬙mō-fō⬘bē-ă) [Gr. signed to attenuate certain portions of
aichmē, spear point ⫹ -phobia] A pho- the sound signal and amplify others.
bia of being touched by pointed objects The cost may vary from several hundred
or fingers. dollars to more than a thousand dollars.
AID Agency for International Develop- There are a variety of hearing aids
ment; artificial insemination donor. available, and therefore it is important
aid (ād) [Fr. aide, help] 1. Assistance that patients buy the type most suitable
provided to a person, esp. one who is for their needs and comfort. Patients
sick, injured, or troubled. 2. A resource should have a trial period before mak-
used by a person to improve function- ing the final decision to purchase the de-
ing; an assistive device. vice.
ambulation a. Any device that helps travel a. A device that makes it eas-
people walk upright, including canes, ier for people with sensory impairments
crutches, and walkers. to move freely in busy or unfamiliar en-
bone conduction hearing a., bone- vironments.
conduction hearing aid A hearing aid aide (ād) [Fr. aide, helper] 1. Assistant.
that amplifies sounds and transmits 2. A nurse’s aide or nursing assistant.
them through the skull or through an certified medication a. ABBR: CMA.
implant anchored in the skull. An unlicensed health care worker who
decision a. A clinical algorithm or can administer oral and topical medi-
educational tool to assist patients or cations in long-term or chronic care fa-
health care professionals in making cilities after successfully completing a
choices about aspects of care. SYN: de- state-approved medication administra-
cision instrument; decision rule. tion course. SYN: certified medication
ergogenic a. In sports medicine, the technician.
questionable and often harmful use of physical therapy a. A person trained
various substances to try to enhance by a physical therapist or physical ther-
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aid in dying 67 AIDS

apist assistant to provide clinical sup- drug-resistant clones and prolongs dis-
port services in physical therapy for ease-free survival. The destruction of
tasks that do not require clinical deci- cells needed for normal immunological
sion making or problem solving in pa- function produces susceptibility to dis-
tient care. Physical therapy aides eases that the body normally resists.
should function with continuous on-site This susceptibility is the hallmark of
supervision. AIDS. In the U.S., common pathogens
aid in dying Assisted suicide. that infect AIDS patients include Pneu-
AIDS (ādz) An advanced stage (techni- mocystis carinii (also known as P. jiro-
cally, the third stage) of infection with veci), Mycobacterium avium intracellu-
HIV (human immunodeficiency virus). lare (MAI), cytomegalovirus,
INCIDENCE: AIDS was unrecognized Toxoplasma gondii, Candida albicans,
before 1981, but it is now one of the most Cryptosporidium, and Histoplasma cap-
common causes of death worldwide. sulatum. AIDS patients are also suscep-
Most people with AIDS are between 15 tible to nonopportunistic infections
and 44 years old, are poor, and are het- (such as tuberculosis, syphilis, herpes-
erosexual. Most have limited access to virus infection, papillomavirus infec-
good care and live in resource-poor tions, and streptococcal pneumonia) at
nations in Africa and Asia. Worldwide rates and with a virulence far exceeding
about 2.3 million new HIV infections oc- those in the general population.
cur each year. More than 33 million peo- SYMPTOMS AND SIGNS: Primary ex-
ple live with HIV infection. Annual mor- posure to HIV is known as Stage 1 of the
tality is about 5.5%, and about 1.8 disease. It typically causes a severe, in-
million people die of HIV/AIDS an- fluenza-like infection, with fever, sore
nually. In the U.S., more than 1.2 mil- throat, swollen glands and muscle and
lion people are living with HIV/AIDS, joint pains. Stage 1 is followed by sero-
and about 40,000 Americans are in- conversion (the presence of HIV anti-
fected annually. Approximately half of bodies in the bloodstream). In Stage 2 of
the infected are unaware of their con- HIV/AIDS (latent infection), the virus
dition. The primary risk groups for HIV/ multiplies in the body but causes no
AIDS are people who have unprotected symptoms other than enlargement of
sexual intercourse, injection drug users, lymph nodes. In Stage 3, symptoms and
men who have sex with men, women signs begin to develop. These typically
and men with multiple sexual partners, include oral thrush, oral hairy leuko-
and children of infected mothers. plakia, weight loss, diarrhea, fever, ane-
CAUSES: Two human immuno- mia, and thrombopeni. The opportunis-
deficiency viruses, HIV-1 and HIV-2, tic infections that accompany Stage 4
have been identified. Both cause AIDS, AIDS (such as Pneumocystis pneumo-
but infection with HIV-2 has been pri- nia) cause fatigue, fevers, chills, sweats,
marily limited to West Africa. Infection breathlessness, oral ulceration, difficul-
occurs when a viral envelope glycopro- ties with swallowing, pneumonia, diar-
tein (gp120) binds to CD4 receptors and rhea, skin rashes, anorexia, weight loss,
coreceptors (called CXCR4 and CCR5) confusion, dementia, and strokelike
on lymphocytes, macrophages, and symptoms. Many people are so incapac-
other immune system cells, causing vi- itated by AIDS that they are unable to
ral uptake and, eventually, cellular de- carry out normal activities of daily liv-
struction and immune system dysfunc- ing; others have very few limitations but
tion. HIV is a retrovirus that uses the may periodically experience life-threat-
enzyme reverse transcriptase to convert ening illnesses. SEE: table.
its viral RNA to viral DNA. The viral DIAGNOSIS: The presence of antibod-
DNA incorporates into the host cell ies to HIV indicates infection. Criteria
DNA and is transcribed and translated for the diagnosis of AIDS include HIV
by host cells. New viral proteins are cre- infection with 1) a CD4⫹ helper T-cell
ated and assembled into virions by the count of less than 200 cells/mL, or 2) in-
viral enzyme protease. About 100 billion fection with an opportunistic pathogen,
virions, many with minor but protective and/or 3) the presence of an AIDS-defin-
mutations, are created during each re- ing malignancy. Enzyme-linked immu-
productive cycle of HIV. Most newly nosorbent assays (ELISA) or enzyme
formed viruses quickly infect circulat- immunoassays (EIA) are the primary
ing immune cells or take up residence tests used to screen for HIV antibodies.
in body reservoirs that are relatively in- These tests are sensitive but not specific
accessible to drug therapy. The ability for HIV infection. If antibodies are de-
of HIV to mutate and evade treatment tected by enzyme immunoassays, a
has made drug management of the dis- more specific Western blot test is re-
ease complicated and has hindered de- quired for confirmation. Point-of-care
velopment of a vaccine. Nonetheless, tests for HIV (in which samples of whole
treatment with combinations of drugs blood, plasma, or oral fluids are used)
(see below) decreases both the severity provide rapid results. Nucleic acid am-
of infection and the development of plification testing (NAAT), polymerase
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AIDS 68 AIDS

Clinical Conditions and Opportunistic Infections Indicating AIDS


AIDS wasting syndrome Kaposi sarcoma
Candida infections (candidiasis) of the Leukoencephalopathy, progressive mul-
trachea, bronchi, lungs, or esophagus tifocal
Cervical cancer, invasive Lymphoma: Burkitt; immunoblastic;
Cryptococcus neoformans: Extrapul- non-Hodgkin; primary brain
monary infections Mycobacterium avium complex or M.
Cryptosporidium: Chronic (lasting kansasii: Extrapulmonary or dissem-
more than a month) infections of the inated infections
GI tract* Mycobacterium tuberculosis: Pulmo-
Cytomegalovirus: Infections other than nary or extrapulmonary infections
those in the liver, spleen, or lymph Mycobacterium, other species: Extra-
nodes; cytomegalovirus retinitis with pulmonary or disseminated infec-
loss of vision tions
Encephalopathy, HIV-related Pneumonia, Pneumocystis carinii
Herpes simplex: Chronic (lasting more Pneumonia, recurrent
than a month) oral ulcers, bronchitis, Toxoplasma gondii: Infections (toxo-
pneumonitis, or esophagitis plasmosis) of the brain, heart, or
Histoplasma capsulatum: Extrapul- lung
monary or disseminated histoplasmo-
sis infections
Isosporiasis, chronic (lasting more than
a month) intestinal
Adapted from CDC:MMWR 41 (RR-17):2-3, 15, 1992.

chain reaction (PCR) tests, and mono- or bodily secretions of those infected,
clonal antibodies to viral p24 antigen usually through a break in the skin or
can also be used to detect HIV infection. across mucous membranes. In most
A PCR assay to detect viral RNA can be cases, it has been transmitted from per-
helpful in identifying acute infection be- son to person by one of three modes: sex-
cause seroconversion to positive anti- ually, by injection of blood products, or
body status may not be detectable for from mother to fetus (or mother to in-
two weeks after exposure to the virus. fant). All pregnant women should be
Measurement of the absolute levels of counseled about testing for the presence
helper T cells (CD4⫹ T lymphocytes) of HIV antibodies to prevent maternal-
and the level of HIV viremia (the viral child disease transmission. Antiretro-
load) are the principal tests used to viral therapies during and immediately
monitor the course of established infec- after pregnancy greatly reduce the ver-
tion and the effectiveness of adminis- tical transmission of HIV. The third
tered therapies. Many health care agen- mode of transmission concerns those
cies, such as the Centers for Disease who engage in unsafe sex or inject drugs
Control and Prevention and the U.S. with contaminated needles; they are at
Veterans Administration recommend the greatest risk for contracting the dis-
routine screening for HIV/AIDS in ease. Abstinence from such behavior
broad segments of the population to helps prevent the spread of the disease.
identify and diagnose the disease in Scrupulous screening of the blood sup-
asymptomatic patients. Mass screening ply and of organ donors has dramati-
in the U.S. is likely to be most cost-ef- cally reduced iatrogenic HIV transmis-
fective in large urban areas where the sion. To date, no vaccine has proved
vast majority of Americans infected effective in preventing the spread of the
with HIV live. In the U.S., new AIDs di- disease.
agnoses are much more common in Flor- TREATMENT: The use of highly ac-
ida, Georgia, Texas, North Carolina and tive antiretroviral therapies (HAART),
the other states of the Southeast in ad- typically including two drugs that block
dition to New York, Illinois, New Jer- viral nucleoside reverse transcriptases
sey, Maryland, Washington, D.C., and (NRTI), in addition to a non-NRTI, an
the rest of the Mid-Atlantic states; and integrase inhibitor, or a protease inhib-
California. AIDS is uncommon in Mon- itor has revolutionized the treatment of
tana, Idaho, Utah, Nevada, Colorado, HIV/AIDS. Combination-drug “cock-
the Dakotas, rural parts of Alaska, and tails” can decrease viral loads to unde-
Iowa. tectable levels and restore a level of im-
NATURAL HISTORY: Between 60% munological function to AIDS patients
and 80% of HIV-infected patients de- that, although imperfect, protects
velop AIDS within 10 years of serocon- against most opportunistic infections.
version. The timing of the initiation of antiretro-
PREVENTION: HIV infection is viral therapy depends on the public
spread by direct contact with the blood health resources available for HIV/
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AIDS 69 AIDS

AIDS treatment and the stage and pa- ease a burden for many patients, but
tient-specific disease presentation. In they must be encouraged to adhere to
developed nations, antiretroviral ther- these complicated drug regimens be-
apy should begin when an AIDS-defin- cause failure to do so may result in the
ing illness is experienced, when HIV-re- evolution of drug-resistant viruses.
lated renal disease is detected, or in Health care providers should antici-
patients who are coinfected with hepa- pate, assess, and assist patients to col-
titis B virus. The CD4 cell count level laborate in helping to prevent inconsist-
that should trigger antiretroviral treat- ent drug dosing or abandonment of
ment is uncertain. Clinical benefit may treatment. The cost of drug therapy and
begin at levels as high as 500 cells/mL; other services may be a factor in adher-
mortality benefit is found at 200 cells/ ing to medication. Health care providers
mL; but some experts recommend start- should be aware of referral agencies and
ing treatment at a level of 350. The po- resources for help in obtaining social
tential of antiretroviral therapies is re- service support; information about the
alized only when patients strictly disease; funds for housing, food, and
adhere to their prescription regimens medication; and inpatient, outpatient,
and avoid behavior that may place oth- and hospice care (when appropriate).
ers at risk for disease transmission. Health care providers should also be fa-
Treatments for established AIDS are miliar with support groups for partners
also directed against the opportunistic and families of patients with HIV/AIDS.
infections of AIDS. These include drugs The effectiveness of contemporary anti-
such as trimethoprim/sulfamethoxazole retroviral regimens allows adherent pa-
or pentamidine for Pneumocystis carinii tients to live, on average, 3 to 4 decades
pneumonia (P. jiroveci), clarithromycin after diagnosis. The disease now has a
and other antimicrobial agents for My- better prognosis than many other
cobacterium avium intracellulare, val- chronic illnesses.
ganciclovir and/or other antivirals for immunologic A. Severe immunosup-
cytomegalovirus, and antifungal drugs pression in HIV infection evidenced
(such as intraconazole and amphoteri- only by a very low CD4 helper cell count
cin) for histoplasmosis (Histoplasma (less than 200 cells/mm3). Patients have
capsulatum). Treatment for AIDS-re- not yet had an opportunistic infection
lated malignancies includes antiretro- but are highly likely to contract one.
viral therapy (augmented by anthracyc- perinatal A. Infection with HIV as a
lines or paclitaxel) for Kaposi sarcoma, result of vertical transmission of the vi-
and combination chemotherapies (ad- rus from an infected mother. World-
ministered systemically or regionally) wide, in 2002, 1500 children were in-
for non-Hodgkin lymphoma. About 10% fected every day by maternal to child
of patients with HIV/AIDS die of cardio- transmission of the disease; the over-
vascular disease. Cardiovascular risk
whelming majority of these children live
factor reduction, including the use of
in developing nations. In the U.S. be-
lipid-lowering therapies, is a necessary
tween 1992 and 1997, testing pregnant
component of therapy for those living
women to identify HIV infection and
with the disease.
treating affected people with zidovudine
OCCUPATIONAL CONCERNS: Stan-
dard infection control precautions pre- decreased the risk of perinatal AIDS by
vent the spread of HIV/AIDS to health about 70%.
care providers. Occupational exposure TRANSMISSION: Transmission of
to body fluids from AIDS patients is rel- HIV to infants occurs in utero, during
atively common in health care, but labor and delivery, and through breast-
transmission of the disease is rare. The feeding. Approx. 50% to 70% of infants
risk of HIV infection after a puncture are infected during childbirth, esp. dur-
wound from a contaminated needle is ing preterm birth with prolonged rup-
estimated to be about 0.3%; the risk of ture of membranes; 30% to 50% are in-
seroconversion after mucous mem- fected in utero; 20% of HIV-positive
branes are splashed with contaminated mothers can transmit the infection
blood or body fluids is 0.09%. Postexpo- through breastfeeding.
sure prophylaxis should be given to ex- DIAGNOSIS: The diagnosis is made
posed people as soon as is feasible, typ- through two positive blood test results
ically with a regimen of three drugs for the presence of HIV or the growth of
taken for 28 days. The virus does not HIV in culture. Transmission is un-
proliferate or readily survive outside likely to occur in women whose viral
the body, i.e., on counters or other sur- load of HIV RNA has been reduced by
faces. effective antiretroviral therapy. The
PATIENT CARE: Health care profes- Centers for Disease Control and Pre-
sionals should contribute actively to the vention (CDC) recommends that all
education of patients about preventing adults aged 13 to 64 years should be of-
the spread of HIV. Complex treatment fered routine HIV testing (with the
regimens make management of the dis- choice to opt out), as opposed to testing
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AIDS-related complex 70 air

only those patients with known risk fac- ing, fatigue, changes in mental status,
tors for the disease. or inadequate finances. Metabolic ab-
SYMPTOMS AND SIGNS: Infants may normalities include elevated serum cor-
be asymptomatic even when infected tisol, decreased anabolism, micronutri-
with HIV. Infection is monitored by ent deficiencies (vitamin B12,
measuring the absolute CD4⫹ T-cell pyridoxine, vitamin A, zinc, and sele-
count, measuring the amount of virus in nium), and decreased antioxidants.
the blood (viral load), and assessing for Malabsorption and diarrhea affect 60%
the presence of opportunistic infections to 100% of patients with AIDS. Primary
in infancy or early childhood. Over time, gastrointestinal pathogens that contrib-
the infected infant may present with ute to malnutrition include Cryptospor-
Pneumocystis carinii (P. jiroveci) pneu- idia, Microsporidia, and Mycobacterium
monia, chronic diarrhea, recurrent bac- avium intracellulare. Concerns about
terial infections, failure to thrive, devel- diarrhea and fecal incontinence may un-
opmental delays, and recurrent derlie a patient’s decreased oral intake.
Candida and herpes simplex infections. PATIENT CARE: Assessment and ed-
The majority of perinatally infected ucation of patients must begin as soon as
children develop an AIDS-defining ill- they are diagnosed as having HIV infec-
ness by the age of 4. Anemia and neu- tion. Obtaining a careful history of the
tropenia may occur as side effects of patient’s normal nutritional intake and
drug therapy. activity level provides the baseline for
TREATMENT: Zidovudine (AZT) is nutritional instruction. Patients are en-
given for 6 weeks to all infants born of couraged to maintain the recommended
HIV-positive mothers. Prophylaxis for daily allowance (RDA) for all foods by fol-
P. carinii (P. jiroveci) pneumonia with lowing MyPyramid; protein intake of 1 to
trimethoprim-sulfamethoxazole begins 2 g/kg of ideal body weight and vitamin
at 6 weeks and continues for 6 months and mineral intake three to four times
in children whose HIV test results are the RDA are also encouraged. Small fre-
negative and for 1 year in infected in- quent feedings, good oral hygiene, lim-
fants. The use of highly active antiretro- ited fluids with meals, and the use of pre-
viral therapy (HAART) is being studied. ferred foods are helpful strategies in
Breastfeeding is contraindicated for all countering anorexia. A written schedule
HIV-infected mothers to minimize the may help the patient adhere to the rec-
risk of transmission of the virus. ommended plan for intake. Any increase
PATIENT CARE: Women in their in exercise or activity must be accompa-
childbearing years who engage in high- nied by an increase in food intake.
risk behavior and whose husbands or AIH artificial insemination by husband
primary sexual partner may engage in (homologous insemination).
high risk behavior should be counseled AIHA American Industrial Hygiene Associ-
to be tested for HIV before becoming ation; autoimmune hemolytic anemia.
pregnant or as soon as they know they AIIR Airborne infection isolation room, a
are pregnant in order to reduce the risk room used for patients with respiratory
of infecting the fetus or infant. Women pathogens. The room typically has neg-
who are HIV-positive should begin anti- ative air pressure.
retroviral therapy immediately. Stan- ailment (al⬘mĕnt) A complaint, disease,
dard precautions are used with babies or physical disorder, esp. a mild or
born of HIV-positive mothers until di- chronic one.
agnostic tests indicate that they are not ailurophobia (ı̄-loor⬙ŏ-fō⬘bē-ă) [Gr. ail-
infected. Mothers and other care pro- ouros, cat ⫹ -phobia] A phobia of cats.
viders must be instructed in the use of ailurophobe (ı̄-loor⬙ŏ-fōb⬘), n.
these precautions and to watch for and AIMS test Abnormal Involuntary Move-
quickly report respiratory infections. ment Scale test.
AIDS-related complex SEE: under com- ainhum (ān⬘hŭm) [East African, to saw]
plex; AIDS. Spontaneous loss of fingers or toes, typ-
AIDS wasting syndrome Malnutrition in ically occurring in Africa, due to the for-
the HIV-infected patient, including both mation of a fissured, constricting band
starvation (weight loss from lack of forming around the digit. SYN: sponta-
food) and cachexia (loss of lean body neous dactylolysis.
mass). SEE: cachexia; cytokine; starva- air (ār) [Gr. aēr, air] The invisible,
tion. tasteless, odorless mixture of gases sur-
PATHOPHYSIOLOGY: The mecha- rounding the earth. Air at sea level con-
nisms by which HIV causes malnutri- sists of approx. 78% nitrogen and 21%
tion include decreased nutritional in- oxygen by volume. The remaining con-
take, metabolic abnormalities, and the stituents are water vapor, carbon diox-
combination of diarrhea and malabsorp- ide, and traces of ammonia, argon, he-
tion. Decreased oral intake may be re- lium, neon, krypton, xenon, rare gases,
lated to loss of appetite, oral or esoph- and some pollutants.
ageal ulcers (esp. from Candida or alveolar a. Air in the alveoli. It is in-
herpes simplex virus), difficulty chew- volved in the pulmonary exchange of
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air 71 airway

gases between air and the blood. Its con- respiratory tract, extending from the in-
tent is determined by sampling the last ner tip of the nose to the terminal bron-
portion of a maximal expiration. chioles, that channels air in and out of
liquid a. Air liquefied by great pres- the lungs but does not directly partici-
sure and/or low temperature. It pro- pate in the exchange of gases. 2. An ar-
duces intense cold on evaporation. tificial airway.
mechanical dead space a. Dead difficult a. An airway that is chal-
space air provided by artificial means. lenging or impossible to intubate. Intu-
Such means include mechanical venti- bation is increasingly difficult in: older
lation or the addition of plastic tubing patients, patients with head or neck
to a ventilator circuit. trauma, obese patients, and patients
minimal a. The small volume of air with craniofacial abnormalities.
trapped in the alveoli when lungs col- laryngeal mask a. ABBR: LMA. An
lapse. airway that can be blindly inserted into
room a. Unmodified, ambient air. the hypopharynx when advanced air-
The typical oxygen concentration is way control is needed during procedures
21%. that require brief anesthesia. It consists
air evacuation SEE: under evacuation. of a flexible airway tube with a proximal
airlock A small chamber with two air- cuff, which holds the middle of the tube
tight doors or openings to allow passage in place at the base of the tongue, and a
between two larger areas of different distal cuff to fix the end of the tube in
gases or of different atmospheric pres- the trachea.
sures.
air medical transportation The use of
helicopters or fixed-wing aircraft to It should not be used in patients at
transport patients from the scene of an high risk of aspiration.
incident or local hospital to a regional
trauma or specialty care center. SYN: laryngeal tracheal a.
airsickness (ar⬘sik⬙nĕs) A form of motion laryngeal tracheal a. ABBR: LTA.
sickness marked by dizziness, nausea, Laryngeal mask a.
vomiting, headache, or drowsiness that nasopharyngeal a. ABBR: NPA. A
occurs during travel in aircraft. SEE: soft, flexible, uncuffed tube placed
motion sickness; seasickness. airsick, through the nasal passages so that the
adj. distal tip rests in the nasopharynx. It is
air trapping SEE: hyperinflation. used to maintain the free passage of air
airway (ar⬘wā⬙) 1. A natural passage to and from the lungs in patients with
for air to enter and exit the lungs. 2. A facial trauma or lockjaw or in nearly co-
device to prevent or correct an ob- matose patients who are breathing
structed respiratory passage, esp. one spontaneously. Before the tube is in-
inserted into the trachea and used serted, the proper length is determined
during anesthesia or cardiopulmo- by comparing it to the distance from the
nary resuscitation. An open airway is tip of the patient’s nose to the earlobe.
essential to oxygenation and ventila- The diameter should match that of the
tion. Methods for opening the airway patient’s pinkie. Nasopharyngeal air-
are described in the following entries: ways are often used by respiratory ther-
cardiopulmonary resuscitation; chin- apists to reduce the trauma from repet-
lift airway technique, head tilt; jaw itive nasotracheal suctioning. SYN:
thrust; and tracheostomy. The follow- nasal trumpet. SEE: illus.
ing subentries highlight commonly
used airways in advanced cardiac life
support. SEE: jaw thrust.

If a patient has a mechanism of in-


jury involving potential trauma to
the clavicles or above, the airway should
be opened only with the jaw thrust ma-
neuver.

Combitube a. A trademark for a


dual-lumen airway consisting of a tra-
cheal tube linked to an esophageal tube.
It may be inserted blindly into the oro-
pharynx as an airway control device
when an endotracheal tube is not avail-
able or when tracheal intubation with
NASOPHARYNGEAL AIRWAY
direct visualization of the vocal cords is
difficult or challenging. A nasopharyngeal airway in proper
conducting a. 1. Any portion of the position
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airway 72 alar ligament test

refer to the site of an amputation of a


Bleeding from the nasopharynx lower extremity.
may occur during emergency place- akathisia (ā⬙ka-thi⬘zh(ē-)ă) [1an- ⫹ Gr.
ment of this airway. kathizein, to sit] Intolerance of inactiv-
ity; motor restlessness. The symptom
oropharyngeal a. ABBR: OPA. A may appear as a side effect of antipsy-
curved plastic device used to establish chotic drug therapy, e.g., treatment
an airway in a patient by displacing the with phenothiazines.
tongue from the posterior wall of the or- SYMPTOMS: Affected people cannot
opharynx. The device should be equal in sit still, are jumpy or fidgety, and may
length to the distance from either the appear distracted.
corner of the mouth to the earlobe or the TREATMENT: The urge to move re-
center of the mouth to the angle of the solves when the offending drug is with-
jaw. It has a flange on the end that re- drawn. Propranolol is also used to re-
mains outside the mouth to keep it from duce motor restlessness.
being swallowed or aspirated. This de- akee, ackee (ak⬘ē, ă-kē⬘) [Liberian] The
vice is used only in unconscious patients tropical tree Blighia sapida, of the soap-
who do not have a gag reflex. SEE: car- berry family. Ingestion of its unripe
diopulmonary resuscitation; illus. fruit can cause severe hypoglycemia.
akinesia, akinesis (ā⬙kı̄-nē⬘zh(ē-)ă, kı̆-nē⬘
sis) [1an- ⫹ -kinesia] Partial or com-
plete loss or suppression of muscle
movement. akinetic (-net⬘ik), adj.
a. algera Akinesia with intense pain
caused by voluntary movement.
Al Symbol for the element aluminum
(British: aluminium).
-al [L. adj. suffix -al-] 1. A suffix meaning
relating to, as in abdominal, intestinal.
2. In chemistry, a suffix indicating an
aldehyde.
ala (ā⬘lă, ā⬘lē⬙) pl. alae [L. ala, wing] An
expanded or winglike structure or ap-
pendage.
a. nasi The broad portion forming the
OROPHARYNGEAL AIRWAY lateral wall of each nostril; the wing of
An oropharyngeal airway in place the nose.
sacral a. The broad projection on each
side of the base (the superior end) of the
sacrum. The alae of the sacrum join the
The cervical spine of an uncon- main plates (alae) of the ilium bones
scious patient should be stabilized along the sacroiliac joints.
before the airway is inserted to reduce the alacrima (ā-lak⬘rı̆-mă) [1an- ⫹ lac-
likelihood of spinal cord injury and paral- rima] Dry eye.
ysis. Alagille syndrome (a-la-zhēl⬘) [Daniel
Alagille, Fr. physician, b. 1925] A rare
supraglottic a. Supralaryngeal a. congenital syndrome in which arterio-
supralaryngeal a. A device used as hepatic dysplasia is associated with de-
an alternative to tracheal intubation in velopmental anomalies of the face,
the ventilation of the critically ill pa- heart, kidneys, muscle, and nervous
tient. It contains both an esophageal system.
and a tracheal lumen and may be in- alalia (ā⬙lā⬘lē-ă, ă-lal⬘) [a- ⫹ Gr. lalein,
serted without visualization of the vocal to talk] Inability to speak due to a de-
cords. SYN: supraglottic a. fect in or a paralysis of the vocal organs;
airway clearance, ineffective Inability to aphasia. An organic brain disease is
clear secretions or obstructions from the usually responsible.
respiratory tract to maintain a clear air- alanine (al⬘ă-nēn⬙) [al(dehyde) ⫹ -ine]
way. SEE: Nursing Diagnoses Appendix. A naturally occurring amino acid,
AIVR Accelerated idioventricular C3H7NO2, considered nonessential in
rhythm. human nutrition.
Ajellomyces (a⬙jĕ-lō-mı̄⬘sēs⬙) A genus of Al-Anon (al⬘ă-non⬙) A nonprofit organi-
fungi of the family Ajellomycetaceae. zation that provides group support for
A. capsulatus The sexual, perfect, the family and close friends of alcohol-
form of the yeast Histoplasma capsula- ics. SEE: Alateen; Alcoholics Anony-
tum in its asexual form. mous; Nar-Anon; 12-step program.
A. dermatiditis The sexual form of alar (ā⬘lăr) [L. ala, wing] 1. Pert. to or
the pathogenic yeast Blastomycosis der- like a wing. 2. Axillary.
matidis. ALARA as low as reasonably achievable.
AK above the knee. The term is used to alar ligament test A test for the integrity
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alarmin 73 albuminoid

of the alar ligaments of the upper cer- white] An organism, esp. a person, with
vical spine. While the patient lies su- albinism.
pine, the examiner places one hand un- albuginea (al⬙byŭ-jin⬘ē-ă) [L. albugo,
der the patient’s occiput and the fingers stem albugin-, white spot, eye disease]
of the other hand on the spinous process A layer of firm white fibrous tissue form-
of the second cervical vertebra (C2). The ing the sheath of an organ or part, as of
examiner then laterally flexes the cer- the eye, testicle, ovary, or spleen. SYN:
vical spine. Movement of the spinous tunica albuginea. albugineous (al⬙byŭ-
process of C2 away from the lateral spi- jin⬘ē-ŭs), adj.
nal deflection indicates the alar liga- a. testis The thick, unyielding layer
ment is intact. The test should be re- of white fibrous tissue under the tunica
peated on the opposite side. vaginalis.
alarmin (ă-lar⬘min) Any molecule re- albumen (al-bū⬘mĕn) [L. albumen,
leased from a damaged or diseased cell white of egg] 1. The white of an egg.
that stimulates an immune response. 2. Albumin.
Heat-shock proteins, interleukin-1a, albumin (al-bū⬘mı̆n) [L. albumen, white
and nucleosomes are examples. of egg] Any of a group of simple pro-
alarm reaction The first stage in the gen- teins widely distributed in plant and an-
eral adaptation syndrome, which in- imal tissues. Albumin is found in the
cludes changes occurring in the body blood as serum albumin, in milk as lac-
when subjected to stressful stimuli. talbumin, and in the white of egg as
Physiological changes that occur are di- ovalbumin. In the blood, albumin acts
rect results of damage, shock, or both, as a carrier molecule and helps main-
or reactions of the body to defend itself tain blood volume and blood pressure.
against shock. In humans the principal function of al-
alarm therapy A behavioral treatment bumin is to provide colloid osmotic pres-
for nighttime bed-wetting in which sure, preventing plasma loss from the
urine in the patient’s bed or diaper trig- capillaries. Albumin, like all the plasma
gers an electrical circuit that makes an proteins, can act as a source for rapid
irritating sound, awakening and alert- replacement of tissue proteins. In the
ing the patient to stop voiding. stomach, coagulated albumins are made
ALARP as low as reasonably practicable. soluble by peptidases, which break
alarplasty (ā⬘lăr-plas⬙tē) [alar ⫹ them down to smaller polypeptides and
-plasty] Plastic surgery to correct de- amino acids. In general, albumins from
fects in or reduce the width of the nos- animal sources are of higher nutritional
trils. quality than those from vegetable
alastrim (al⬘ă-strim⬙) Variola minor. sources because animal proteins con-
Alateen (al⬘ă-tēn⬙) A nonprofit organi- tain greater quantities of essential
zation that provides support for chil- amino acids. SYN: albumen (2). SEE:
amino acid; peptone.
dren of alcoholics. SEE: Al-Anon; Alco-
blood a. Serum a.
holics Anonymous; Nar-Anon; 12-step
circulating a. Albumin present in
program.
body fluids.
alb- [L. albus, white] Prefix meaning egg a. Ovalbumin.
white. glycated a. The amount of circulat-
alba (al⬘bă) [L. albus, white] The white ing albumin in the blood that is chemi-
matter of the brain. cally bonded to sugar. It is serum
albedo (al-bē⬘dō) [L. albedo, whiteness] marker of blood glucose values during
The amount or degree of reflection of the preceding 2 to 4 weeks.
light from a surface. human a. A sterile colloidal solution
Albers-Schönberg disease (al⬘bĕrz- of 4% to 5% serum albumin obtained
shĕrn⬘bĕrg⬙) [Heinrich Ernst Albers- from healthy blood donors, suspended
Schönberg, Ger. radiologist, 1865– in sodium chloride and water. It is ad-
1921] SEE: osteopetrosis. ministered intravenously to restore
Albert disease (al⬘bĕrt) [Eduard Albert, blood volume.
Austrian surgeon, 1841– 1900] Achil- ovi a. Ovalbumin.
lobursitis. serum a. The main protein found in
albicans (al⬘bı̆-kanz⬙) [L. albicare, to the blood. SYN: blood a.; seralbumin.
make or become white] White; whitish. SEE: blood; simple protein.
albinism (al⬘bı̆-nizm) [albino ⫹ -ism] urinary a. Albumin in urine, a
An inherited partial or total absence of marker of glomerular diseases.
pigment in skin, hair, and eyes. It is of- vegetable a. Albumin in, or derived
ten accompanied by astigmatism, pho- from, plant tissue.
tophobia, and nystagmus because the albumin-globulin ratio ABBR: A/G r.
choroid is not sufficiently protected from The ratio of albumin to globulin in blood
light. It is usually transmitted as an au- plasma or serum. Normally this value is
tosomal recessive trait. albinotic 1.3:1 to 3.0:1.
(-not⬘ik), adj. albuminoid (al-bū⬘mı̆-noyd⬙) [albumen
albino (al-bı̄⬘nō) [Portuguese albino, ⫹ -oid] Resembling albumin.
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albuminolysis 74 alcoholism

albuminolysis (al-bū⬙mı̆-nol⬘ı̆-sis) [al- 1. Pert. to alcohol. 2. One afflicted with


bumen ⫹ -lysis] An uncommon syn- alcoholism.
onym for proteolysis. SEE: proteolysis. Alcoholics Anonymous ABBR: AA. An
albuminous, albuminose (al-bū⬘mı̆-nŭs, organization consisting of alcoholics
al-bū⬘mı̆-nōs⬙) Pert. to, resembling, or and recovering alcoholics who are trying
containing albumin. to help themselves and others abstain
albumin test Any chemical test for the from alcohol by offering encouragement
presence of albumin, usually with elec- and discussing experiences, problems,
trophoresis, chromatography, spectro- feelings, and techniques. The organiza-
photometry, spectrometry, or immuno- tion has groups in most U.S. cities; local
assay, and sometimes by simple chapters are listed in the telephone di-
chemical reactions on dipsticks. rectory. SEE: Al-Anon; Alateen; Nar-
albuminuria (al-bū-mı̆-noo⬘rē-ă) [albu- Anon; 12-step program.
men ⫹ -uria] The presence of easily alcoholism (al⬘kŏ-hol⬙izm) [alcohol ⫹
detectable amounts of albumin in the -ism] A chronic, frequently progressive,
urine. Albuminuria is a common sign of and sometimes fatal disease marked by
renal impairment, e.g., nephrotic syn- impaired control over consumption of
drome; it also occurs in fever, malignant alcohol despite its adverse effects. De-
hypertension, and in healthy people af- pendence on alcohol, tolerance of its ef-
ter vigorous exercise. SEE: microalbu- fects, and remissions and relapses are
minuria; nephritis; nephrosis. albumin- common. Psychological features include
uretic (al-bū-mı̆-noo-rĕt⬙ik), adj. preoccupation with consuming alcohol
albuminuric (al-bū-mı̆-noor⬘ik), adj. and denial of addiction even against ev-
cyclic a. Presence of small amounts idence to the contrary.
of albumin in the urine at regular di- Alcohol abuse is one of the major
urnal intervals, esp. in childhood and threats to health in the U.S., where it is
adolescence. estimated to affect between 2% and 9%
orthostatic a. Postural a. of the population. Each year 10% of all
postural a. Transient albuminuria in deaths are related to alcohol. Chronic
normal people who have been erect for alcoholism and alcohol-related disor-
a long time. SYN: orthostatic albumin- ders can be physically, psychologically,
uria. and economically devastating to pa-
albuterol (al-bū⬘tĕr-ŏl⬙) A beta-2 recep- tients and their families. SEE: sub-
tor agonist used to treat bronchospasm, stance abuse; fetal alcohol syndrome;
e.g. in patients with asthma or related table.
conditions. It is primarily administered ETIOLOGY: Psychological, physiolog-
by inhalation, but is sometimes given as ical, genetic, familial, and cultural fac-
a tablet. tors play parts in alcoholism. Family
Alcaligenes (al⬙kă-lij⬘ĕ-nēz⬙) [L. fr. Fr. members of alcoholics and males are
alcali, alkali ⫹ -gen] A genus of gram- most likely to be predisposed to the dis-
negative, aerobic bacilli normally found ease. Underage drinkers are more likely
in the human intestinal tract, in dairy to become alcohol-dependent than are
products, and in soil. those who do not use alcohol before 21,
A. faecalis A species normally found with youths who start drinking before
in the human intestine. It has been as- 15 having the highest risk of alcohol ad-
sociated with hospital-acquired septi- diction.
cemia and urinary tract infections. SYMPTOMS: Pathological effects of
A. xylosoxidans A species that does alcoholism are found in almost any or-
not ferment glucose. It has been impli- gan of the body but most commonly in
cated rarely in lung infections in pa- the nervous system, bone marrow, liver,
tients with cystic fibrosis and in other pancreas, stomach, and the other or-
health care associated infections in pa- gans of the gastrointestinal tract.
tients with immunosuppressing or ma- Symptoms arise both from organ-spe-
lignant illnesses. SYN: Achromobac- cific damage and from the psychological
ter xylosoxidans. effects of the drug. Alcoholics are more
ALCL Anaplastic large cell lymphoma. likely than nonalcoholics to suffer falls,
Alcohol, Drug Abuse, and Mental Health fractures, automotive accidents, job
Administration ABBR: ADAMHA. A loss, and imprisonment. They also suf-
U.S. government agency that is part of fer from hypertension, gastritis, pancre-
the National Institutes of Health. The atitis, hepatitis, cirrhosis, portal hyper-
agency administers grant programs tension, memory disturbances, and
supporting research, training, and ser- oropharyngeal and pancreatic cancers
vice programs in alcoholism, drug at higher rates than the general popu-
abuse, and mental health. lation. In severe alcoholism, abstinence
alcohol-dependent sleep disorder In- results in withdrawal symptoms and,
ability to sleep without consuming al- occasionally, hallucinosis, delirium tre-
cohol. The alcohol is used as a sedative/ mens, or withdrawal seizures. The life
hypnotic drug. expectancy of alcoholics is shorter than
alcoholic (al-kŏ-hol⬘ik) [alcohol ⫹ -ic] that of nonalcoholics.
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alcoholism 75 alcoholism

Levels of Alcohol Consumption: A Guide to Contemporary Usages


Type of Drinking Definition Comment
Non-problematic drink- ⬍1 standard drink daily Some evidence suggests
ing (see definition of “stan- that this level of alco-
dard drink” below) hol consumption is
healthful
Moderate drinking ⱕ2 drinks a day for
males under age 65.
ⱕ1 drink daily for
women and people
⬎65
At-risk drinking Males: ⬎4 drinks in any Also called “hazardous”
day or 14 drinks a drinking or “problem-
week. Females: ⬎3 atic alcohol use” by
drinks in a day or 7 some agencies.
drinks a week
Binge drinking ⬎5 drinks on any single Binge drinking carries
occasion an increased risk of
adverse consequences,
including motor vehi-
cle accidents, assaults
or aggressive behav-
iors, and alterations in
consciousness.
Harmful drinking Any quantity of drinking See “problem drinking”
that produces physical below.
or psychological injury.
Any drinking during
pregnancy, for exam-
ple.
Heavy drinking Males: ⬎2 drinks a day Note that “heavy drink-
on average Females: ing” begins at the up-
⬎1 drink a day on av- per limit of “moderate
erage drinking” and overlaps
with “at-risk drink-
ing.”
Problem drinking Drinking that causes life “Problem drinking” is
problems for the also called “alcohol
drinker, e.g. health-re- abuse,” or “alcoholism”
lated, legal, relation- when it persists for
ship, or occupational ⬎12 months.
difficulties.
Underage drinking Drinking before reaching Varies from one legal ju-
age 21 risdiction to another.
Driving while intoxicated A legal term, defined by Most states rely on both
(DWI) the states, for the a standard that in-
crime defined as oper- cludes observable im-
ating a motor vehicle pairment in motor
while influenced by al- function, speech, and
cohol (or other drugs). balance, and a blood
alcohol level (adults) of
0.8. Also called ”DUI”
(“driving under the in-
fluence”).
Standard drink: 1⁄2 oz alcohol (12 oz beer, 5 oz wine, 1.5 oz distilled spirits). Many habitual
users of alcohol drink larger quantities of alcohol, e.g., 8 oz of wine, 16 oz beer, mistakenly
believing these to represent a single drink.

DIAGNOSIS: Alcoholism is diag- cate liver damage; and elevated serum


nosed clinically. Although some alco- amylase levels may indicate acute pan-
holics have many abnormal laboratory creatitis. Anemia, thrombocytopenia,
findings, none of these is definitively leukopenia, increased prothrombin
diagnostic. In severe hepatic disease, time, and increased partial thrombo-
blood urea nitrogen is elevated, and se- plastin time may be noted from hema-
rum glucose levels are decreased. Ele- tologic studies.
vated liver function studies may indi- Screening for alcoholism is best un-
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alcoholism 76 alcohol withdrawal syndrome

dertaken with questionnaires, like the longer. Even a small amount of alcohol
Michigan Alcohol Screening Test will induce adverse reactions, e.g., nau-
(MAST) and the Alcohol Use Disorders sea, vomiting, facial flushing, headache.
Identification Test (AUDIT). CAGE, a The longer the patients drink alcohol,
widely used screening questionnaire, the greater their sensitivity; therefore,
asks the questions: Do you feel the need they must be warned to avoid medicinal
to cut down on drinking? Are you an- or hygienic sources of alcohol, e.g.,
noyed by people who complain about cough syrups, cold remedies, and
your drinking? Do you feel guilty about mouthwashes.
your drinking? Do you need an eye- The entire family is assisted to de-
opener when you wake up? These tests velop a long-term plan for follow-up and
are designed to determine when alcohol relapse prevention, including referral to
use has become physically, behavior- organizations such as AA, Al-Anon, and
ally, or emotionally problematic. Denial Alateen. Family involvement in reha-
is a major concern, and patients may bilitation helps reduce family stressors
give false information in their health and tensions. If the alcoholic patient has
histories and deny physical problems lost contact with family and friends and
associated with alcoholism. The useful- has a long history of unemployment,
ness of the assessment instrument de- trouble with the law, or financial diffi-
pends upon the patient’s honesty and culties, social services or other appro-
trust in the clinicians. The assessor priate agencies may assist with rehabil-
should be aware that indirect informa- itation efforts. These may involve job
tion obtained from the history and phys- training, sheltered workshops, and half-
ical examination often reveals more way houses.
than does direct questioning. acute a. Intoxication (2).
TREATMENT: Abstinence from alco- chronic a. Alcoholism.
hol remains the cornerstone of treat- alcohol withdrawal syndrome The neu-
ment for alcoholism. Support groups for rological, psychiatric, and cardiovascu-
alcoholics, such as Alcoholics Anony- lar signs and symptoms that result
mous (AA), have reported the highest when a person accustomed to consum-
rates of treatment success. SEE: Alco- ing large quantities of alcohol suddenly
holics Anonymous. becomes abstinent. Alcohol withdrawal
PATIENT CARE: During acute intox- usually follows a predictable pattern. In
ication or withdrawal, the patient is the first hours of abstinence, patients
carefully monitored. Assessments are often irritable, anxious, tremulous,
should include mental status, tempera- and easily startled. Their blood pres-
ture, heart rate, breath sounds, and sure and pulse rise, but they remain
blood pressure. Medications prescribed alert and oriented. If they do not con-
for symptom relief are administered, sume alcohol (or receive drug treat-
and desired and undesired effects are
ment) in the first 12 to 48 hours, they
evaluated. Evaluation for signs of in-
may suffer an alcohol withdrawal sei-
adequate nutrition and dehydration is
zure. Abstinence for 72 to 96 hours may
also necessary. Patients require orien-
result in severe agitation, hallucina-
tation to reality because they may have
tions, and marked fluctuations in blood
hallucinations or may try to harm them-
selves or others. A calm environment pressure and pulse. This stage of with-
with minimal noise and shadows re- drawal is known as delirium tremens,
duces the incidence of delusions and or alcoholic delirium; it may prove fatal
hallucinations. Seizure precautions are in as many as 15% of patients. SYN: al-
instituted; mechanical restraint is cohol withdrawal. SEE: delirium tre-
avoided. Health care professionals mens.
should approach patients in a nonthrea- PATIENT CARE: Benzodiazepines,
tening way and explain all procedures. e.g., chlordiazepoxide, are the preferred
Even if patients are verbally abusive, agents for managing alcohol with-
apathetic, or uninterested, care pro- drawal although other agents, e.g., car-
viders should listen attentively and re- bamazepine, may be useful in treating
ply with empathy. Patients are also mild cases. The patient should be com-
monitored for signs of depression or im- forted and reoriented as needed. Famil-
pending suicide. iar objects and people may aid reality
In long-term care of alcoholism, pa- orientation. Every effort should be
tients are assisted to accept their drink- made to prevent unintentional injury;
ing problem and the need for absti- bedrails should be padded to protect
nence. Patients should be confronted against seizures and trauma, and pa-
about alcohol-related behavior and tients should be protected from falling.
urged to examine actions. Patients tak- Excessive stimulation of the patient
ing disulfiram (or who have taken it should be avoided. Patients who are suf-
within the last 2 weeks) must be warned fering delirium tremens are typically
of the effects of alcohol ingestion, which cared for in an Intensive Care Unit,
may last from 30 minutes to 3 hr or where minute-to-minute monitoring of
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aldehyde 77 Alexander disease

vitals signs and invasive management bone and is used to treat and prevent
is readily available. osteoporosis and the fractures it causes.
aldehyde (al⬘dĕ-hı̄d⬙) [L. alcohol dehy-
drogenatum] 1. Oxidation product of a
Alendronate is administered as a
primary alcohol. It has the characteris-
pill, which should be given to pa-
tic group 9 CHO. 2. Acetaldehyde,
tients with a large glass of water to pre-
CH3CHO. It is an intermediate in yeast
vent it from lodging in the upper gastro-
fermentation and alcohol metabolism.
intestinal tract and causing esophagitis.
Alder-Reilly anomaly (al⬘dĕr-rı̄⬘lē) [Al-
Patients should also maintain an upright
bert von Alder, Swiss hematologist,
posture for at least 30 min after taking the
1888– 1951; William Anthony Reilly,
medicine.
U.S. pediatrician, b. 1901.] Large dark
leukocyte granules that stain lilac. They
consist of mucopolysaccharide deposits Aleppo boil (ă-lep’ō) [Aleppo, a city in
and are indicative of mucopolysaccha- NW Syria] Cutaneous leishmaniasis.
ridosis. aleukemia (ā⬙loo-kē⬘mē-ă) [a- ⫹ leu-
aldolase (al⬘dŏ-lās⬙) [aldol ⫹ -ase] An kemia] A deficiency of white blood cells
enzyme present in skeletal and heart in the circulating blood.
muscles and the liver. It breaks down Aleve Naproxen.
sugars to triose phosphates, liberating Alexander disease (al⬙ek-san⬘dĕr) [Wil-
energy. Its serum concentration in- liam Stewart Alexander, New Zealand
creases primarily in muscle and liver pathologist, 1919– 2013] ABBR: AD.
diseases. One of four rare, inherited leukodystro-
aldose (al⬘dōs⬙) [ald(ehyde) ⫹ -ose] A phy syndromes, the most common types
carbohydrate of the aldehyde group of which occur in infancy or early child-
( 9 CHO). hood.
aldosterone (al-dos⬘tĕ-rōn⬙, al⬙dō-stēr⬘ INCIDENCE: The disease is excep-
ōn⬙) [ald(ehyde) ⫹ -sterone] The most tionally rare; about 500 cases have been
biologically active mineralocorticoid reported.
hormone secreted by the adrenal cortex. CAUSES: Abnormal filaments, i.e.,
Aldosterone increases sodium reabsorp- Rosenthal bodies, accumulate in astro-
tion by the kidneys, thereby indirectly cytes. These result from an autosomal
regulating blood levels of potassium, dominant gain-of-function mutation of
chloride, and bicarbonate, as well as pH, glial fibrillary acidic proteins (GFAPs).
blood volume, and blood pressure. SEE: SYMPTOMS AND SIGNS: Type 1 (the
adrenal gland. early-onset form of AD) produces en-
aldosteronism (al⬙dos⬘tĕ-rō⬙nı̆zm) [al- largement of the infant’s head (megalo-
dosterone ⫹ -ism] An uncommon cephaly), along with failure to achieve
cause of hypertension in which the neurological and psychiatric milestones
blood contains abnormally high levels of and the occurrence of spasticity, failure
aldosterone. The syndrome results from to thrive, seizures, dementia, and, typ-
sodium retention and excretion of po- ically, early loss of life (by age 14).
tassium by the kidneys. Although it is DIAGNOSIS: This disease is diag-
frequently asymptomatic, patients may nosed by the presence of abnormal
occasionally experience frequent urina- white matter signal changes on mag-
tion, nocturia, or headache. If potas- netic resonance imaging or spectros-
sium losses are severe, muscular weak- copy. A crude diagnosis may be made
ness, cramps, tetany, or cardiac through clinical symptoms (including
arrhythmias may occur. SYN: hyperal- macrocephaly). Brain biopsy specimens
dosteronism. from patients show the accumulation of
primary a. Aldosteronism due to ex- abnormal inclusion bodies within astro-
cess secretion of aldosterone. This may cytes.
be due to a single aldosterone-secreting TREATMENT: There is no cure or
adenoma or a bilateral adrenal hyper- standard therapy for AD, but it may re-
plasia and can result in significant hy- spond to medications (such as ceftriax-
pertension and hypokalemia. Treat- one) that affect GFAP. However, care
ment, whether surgical or medical, s for most patients is supportive.
based on etiology, either surgical or IMPACT ON HEALTH: The prognosis
medical therapy. SYN: Conn syndrome. is poor. With early onset, death usually
secondary a. Aldosteronism due to occurs within 10 years; generally, the
extra-adrenal disorders. later the disease occurs, the slower its
aldrin (al⬘drı̆n) [Kurt Alder, Ger. chem- course.
ist, 1902– 1958 ⫹ -in] A derivative of PATIENT CARE: Seizures associated
chlorinated naphthalene used as an in- with AD are managed with anticonvul-
secticide. It is a potent environmental sant drugs. Genetic counseling may be
toxin lethal to fish and mammals. useful for family members although
alendronate (ă-len⬘drŏ-nāt⬙) A biphos- most cases of the disease are inherited
phonate that stops osteoclasts from ab- sporadically. Consultations with a psy-
sorbing bone. It increases the density of chologist may help with behavioral dif-
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Alexander technique 78 alien limb phenomenon

ficulties. Speech therapists may help in- algodystrophy (al⬙gō-dis⬘trŏ-fē) [Gr. al-
fants and children with feeding and gos, pain ⫹ dystrophy] Reflex sym-
language use. pathetic dystrophy.
Alexander technique (al⬙ek-san⬘dĕr) algolagnia (al⬙gō-lag⬘nē-ă) [Gr. algos,
[Frederick Matthias Alexander, Austra- pain ⫹ lagneia, lust] Sexual satisfac-
lian actor, 1869– 1955] A form of bodily tion derived by experiencing pain or by
training that promotes postural health, inflicting pain on others. algolagniac
esp. of the spine, head, and neck. (al⬙gō-lag⬘nē-ak⬙), n. algolagnist (al⬙gō-
alexia (ă-lek⬘sē-ă) [1an- ⫹ Gr. lexis, lag⬘nist), n. algolagnic (al⬙gō-lag⬘nik),
word ⫹ -ia] A loss of the ability to un- adj.
derstand written or printed words. al- active a. Sadism.
exic (ă-lek⬘sik), adj. SYN: visual apha- passive a. Masochism.
sia; word blindness. algometer (al⬙gom⬘ĕ-tĕr) [Gr. algos,
motor a. Inability to read aloud pain ⫹ -meter] An instrument for
while remaining able to understand measuring the degree of sensitivity to
what is written or printed. pain. algometry (ĕ-trē), n.
musical a. Inability to read music. It algorithm (al⬘gŏ-rithm) [Ult. fr. Arabic]
may be sensory, optic, or visual, but not A formula or set of instructions for solv-
motor. ing a particular problem. In health care,
optic a. Inability to understand what a set of steps used in diagnosing and
is written or printed. treating a disease. Appropriate use of
alexithymia (ă-lek⬙sē-thı̄⬘mē-ă) [1an- ⫹ algorithms in medicine may lead to
Gr. lexis, word ⫹ -thymia] The in- more efficient and accurate patient care
ability to identify and articulate feel- as well as reduced costs. algorithmic
ings, including those brought on by un- (al⬙gŏ-rith⬘mik), adj. algorithmically
pleasant mental or physical (mik(ă-)lē), adv.
experiences. It is often found in patients algor mortis (al⬘gor⬙ mor⬘tis) [L. cold-
with a history of child abuse, post-trau- ness of death] The lowering of body
matic stress disorder (PTSD), drug temperature after death.
abuse, and some somatoform disorders. aliasing (ā⬘lē-ăs-ing) [L. alias, at an-
ALG Antilymphocyte globulin other time, elsewhere] A jagged distor-
algae (al⬘jē) [Pl. of L. alga, seaweed] tion in a digitally generated visual im-
Photosynthetic organisms of several age. It may be produced during image
phyla in the kingdom Protista. They are reconstruction in magnetic resonance
nonparasitic and lack roots, stems, or imaging or Doppler ultrasonography,
leaves. They contain chlorophyll and e.g., the wrap-around artifact seen on
vary in size from microscopic forms to magnetic resonance images when a por-
massive seaweeds. They live in fresh or tion of the body extends beyond the im-
salt water and in moist places. Some aged field of view.
serve as a source of food or as nutri- Alice in Wonderland syndrome [Alice
tional supplements, e.g., kelp and Irish Liddell, from Lewis Carroll’s Alice in
moss. Wonderland] Perceptual distortions of
blue-green a. Photosynthetic orga- the size and/or shape of objects. It is of-
nisms in the kingdom Monera. Blooms ten characterized by the hallucination
may impart a disagreeable taste to that things are smaller than they really
freshwater and may cause the death of are and is sometimes experienced by pa-
fish. SEE: Cyanobacteria. tients suffering from migraine, infec-
-algia, -algesia [Gr. algos, pain] Suffixes tious mononucleosis, or an overdose of
meaning pain. SEE: -dynia. hallucinogenic drugs.
algicide (al⬘jı̆-sı̄d⬙) [algae ⫹ -cide] A alicyclic (al-ı̆-sı̄⬘klik, -sik⬘lik) [ali(phatic)
substance that kills algae. algicidal ⫹ cyclic] Having properties of both al-
(al⬙jı̆-sı̄d⬘ăl), adj. iphatic (open-chain) and cyclic (closed-
alginate (al⬘jı̆-nāt⬙) Any salt of alginic chain) compounds.
acid. It is derived from kelp and is used alienate (āl⬘ē-ĕ-nāt⬙) [L. alienus, some-
as a thickener in foods and as a phar- one else’s, alien] To isolate, estrange, or
maceutical aid. In dentistry it is used as dissociate.
a material for taking impressions. alienation (āl⬙ē-ĕ-nā⬘shŏn) [alienate]
alginate slime A polysaccharide polymer Isolation, estrangement, or dissociation,
that coats the surface of colonies of the esp. from society.
bacterium, Pseudomonas aeruginosa. occupational a. The sense of isola-
The slime forms a matrix which anchors tion or estrangement a person may ex-
bacteria to their environment and pro- perience when employed in a job that is
tects them from host defenses such as not personally meaningful or fulfilling.
antibodies, complement, lymphocytes, alien hand syndrome Alien limb phe-
phagocytes, and respiratory cilia. nomenon.
Strains of P. aeruginosa that produce al- alien limb phenomenon A rare disorder
ginate slime (called mucoid strains) are of movement and sensation in which
frequently isolated from the lungs of pa- sudden unexpected movements of a
tients with cystic fibrosis. hand or foot occur and are felt by the
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aliform 79 alkalosis

patient experiencing them to be either form salts, combine with fatty acids to
involuntary or initiated by others. SYN: form soap, neutralize acids, and turn lit-
alien hand syndrome; Dr. Strangelove mus paper blue. SEE: acid; base; pH.
syndrome. corrosive a. A strongly basic metallic
aliform (al⬘ı̆-form⬙) [ala ⫹ -form] hydroxide, most commonly of sodium,
Wing-shaped. ammonium, and potassium, as well as
aligner (ă-lı̄n⬘ĕr) A transparent plastic carbonates. Because of their great com-
mold used in orthodontics to move teeth bining power with water and their ac-
from one position to another. tion on the fatty tissues, they cause
alignment, alinement (ă-lı̄n⬘mĕnt) [Fr. rapid and deep tissue destruction. They
aligner, to put in a straight line] 1. The have a tendency to gelatinize tissue,
act of arranging in a straight line. 2. The turning it a somewhat grayish color and
state of being arranged in a straight forming a soapy, slippery surface, ac-
line. 3. In orthopedics, the placing of companied by pain and burning. SEE:
portions of a fractured bone into correct corrosion; corrosive poisoning.
anatomical position. 4. The anatomical alkali denaturation test A quantitative
presentation of one structure to an- test for hemoglobin F (fetal hemoglobin,
other, such as opposing joint surfaces. HbF). The test uses the spectrophoto-
5. In dentistry, bringing teeth into cor- metric absorbance of a mixture of sa-
rect position. 6. In radiography, the po- line-diluted and alkali-diluted blood.
sitioning of a body part in correct rela- alkalimetry (al⬙kă-lim⬘ĕ-trē) [alkali ⫹
tion to the radiographic source and -metry] Measurement of the alkalinity
receiver. 7. In chiropractic, the manip- of a mixture.
ulation of the spine to restore it to a alkaline (al⬘kă-lin, -lı̄n⬙) [alkali ⫹ -ine]
healthy anatomic position. Pert. to or having the reactions of an al-
aliment (al⬘ı̆-mĕnt) [L. alimentum, nour- kali, esp. of having a pH greater than 7.
ishment] Nutriment; food. alkalinity (lin⬘ı̆-tē), n.
alimentary (al⬙ı̆-men⬘tă-rē) [aliment] alkaline earth Any of the oxides of the al-
Pert. to food, nutrition, or the digestive kaline earth metals calcium, strontium,
tract. magnesium, and barium.
alimentary system Digestive system. alkalize, alkalinize (al⬘kă-lı̄z⬙, -lı̆-nı̄z⬙) To
alimentation (al⬙ı̆-mĕn-tā⬘shŏn) [ali- make alkaline. alkalinization (al⬙kă-
ment] The process of nourishing the lin⬙ı̆-zā⬘shŏn), n. alkalization (al⬙kă-lı̆-
body, including mastication, swallow- zā⬘shŏn), n.
ing, digestion, absorption, and assimi- alkaloid (al⬘kă-loyd⬙) [alkali ⫹ -oid]
lation. SEE: hyperalimentation; total Any of a group of organic alkaline sub-
parenteral nutrition. stances, e.g. morphine or nicotine, ob-
artificial a. Provision of nutrition, tained from plants. Alkaloids react with
usually intravenously or by a tube
acids to form salts that are used for
passed into the gastrointestinal tract of
medical purposes. alkaloidal (al⬙kă-
a patient unable to take or utilize nor-
loyd⬘ăl), adj.
mal nourishment. SEE: total parenteral
nutrition.
beta-carboline a. Any of a group of
neurologically active compounds simi-
forced a. 1. Feeding a patient un-
willing to eat. 2. Forcing a person to eat lar in structure to the amino acid L-
a greater quantity than desired. tryptophan, the neurotransmitter sero-
rectal a. Feeding by nutrient ene- tonin, and the hallucinogen
mas. dimethyltryptamine. They increase lev-
aliphatic (al⬙ı̆-fat⬘ik) [Gr. aleiphar, stem els of serotonin in the central and pe-
aleiphat-, fat, oil] Pert. or belonging to ripheral nervous system and inhibit the
that series of organic compounds char- action of monoamine oxidase.
acterized by chains of carbon atoms vinca a. A drug made from vinca
rather than by rings. plants and used in cancer therapy.
aliquot (al⬘ı̆-kwot⬙) [L. some, several] In alkalosis (al⬙kă-lō⬘sis) [alkali ⫹ -osis]
pharmacy and chemistry, a known frac- An actual or relative increase in blood
tion, constituting a sample of a whole. alkalinity due to an accumulation of al-
alisphenoid (ā⬙lis-fē⬘noyd⬙) [ala ⫹ kalies or reduction of acids. SEE: acid-
sphenoid] Pert. to the greater wing of base balance. alkalotic (-lot⬘ik), adj.
the sphenoid bone. altitude a. Alkalosis due to the in-
alkalemia (al⬙kă-lē⬘mē-ă) [alkal(i) ⫹ creased respiratory rate associated with
-emia] An increase in the arterial pH exposure to the decreased oxygen con-
above 7.45 due to a decrease in the hy- tent of air at high altitudes. This causes
drogen ion concentration or an increase respiratory alkalosis. SEE: respiratory
in hydroxyl ions. The blood is normally alkalosis.
slightly alkaline (pH 7.35 to 7.45). compensated a. Alkalosis in which
alkali (al⬘kă-lı̄⬙) pl. alkalis, alkalies [Ult. the pH of body fluids has been returned
fr. Arabic al-qalı̄, ashes of salt wort] A to normal. Compensatory mechanisms
strong base, esp. the metallic hydrox- maintain the normal ratio of bicarbon-
ides. Alkalies combine with acids to ate to carbonic acid (approx. 20:1) even
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alkalosis 80 alkylate

though the bicarbonate level is in- ety, panic attacks, fever, salicylate in-
creased. toxication, exercise, or excessive me-
hypochloremic a. Metabolic alkalo- chanical ventilation) is the primary
sis due to loss of chloride and produced cause of respiratory alkalosis.
by severe vomiting, gastric tube drain- SYMPTOMS: Patients may develop
age, or massive diuresis. paresthesias; air hunger; dry oral mu-
hypokalemic a. Metabolic alkalosis cosa; numbness or tingling of the nose,
associated with an excessive loss of po- circumoral area, or extremities; muscle
tassium. It may be caused by diuretic twitching; tetany and hyperreflexia;
therapy. lightheadedness; inability to concen-
metabolic a. Any process in which trate; mental confusion and agitation;
plasma bicarbonate is increased. This is lethargy; or coma.
usually the result of increased loss of TREATMENT: Therapy is given for
acid from the stomach or kidney, potas- the underlying cause. In acute hyper-
sium depletion accompanying diuretic ventilation produced by panic or anxi-
therapy, excessive alkali intake, or se- ety, treatment includes coaching a pa-
vere adrenal gland hyperactivity. SEE: tient to breathe in a slow, controlled,
acid-base balance. and relaxed fashion by providing reas-
SYMPTOMS: There are no specific surance and support.
signs or symptoms, but if the alkalosis PATIENT CARE: Preventive mea-
is severe, there may be apathy, confu- sures are taken, such as having the hy-
sion, stupor, and tetany as evidenced by perventilating patient breathe in a slow
a positive Chvostek’s sign. controlled fashion, using cues provided
TREATMENT: Therapy for the pri- by caregivers. The respiratory therapist
mary disorder is essential. Saline solu- prevents or corrects respiratory alkalo-
tion should be administered intra- sis in patients receiving mechanical
venously and, in patients with ventilation by increasing dead space or
hypokalemia due to diuretic therapy, decreasing volume. Arterial blood gas
potassium is administered. Only rarely values, vital signs, and neurological
is it necessary to administer acidifying status are monitored. In severe cases,
agents intravenously. serum potassium level is monitored for
PATIENT CARE: Arterial blood gas hypokalemia and cardiac status for dys-
values, serum potassium level, and fluid rhythmias. Prescribed therapy is ad-
balance are monitored. The patient is ministered to treat the cause. The pa-
assessed for anorexia, nausea and vom- tient is reassured, and a calm, quiet
iting, tremors, muscle hypertonicity, environment is maintained during pe-
muscle cramps, tetany, Chvostek’s sign, riods of extreme stress and anxiety. The
seizures, mental confusion progressing patient is helped to identify stressors
to stupor and coma, cardiac dysrhyth- and to learn coping mechanisms and an-
mias due to hypokalemia, and compen- xiety-reducing techniques, such as
satory hypoventilation with resulting guided imagery, controlled breathing,
hypoxia. Prescribed oxygen, oral or IV or meditation.
fluids, sodium chloride or ammonium alkaptonuria, alcaptonuria (al⬙kap-tŏ-
chloride, and potassium chloride if hy- noor⬘ē-ă) [alkapton ⫹ -uria] A rare
pokalemia is a factor, along with ther- inherited disorder marked by the excre-
apy prescribed to correct the cause, are tion of large amounts of homogentisic
administered. Seizure precautions are acid in the urine, due to incomplete me-
observed; a safe environment and reori- tabolism of tyrosine and phenylalanine.
entation as needed are provided for the It is a cause of painful, progressive de-
patient with altered thought processes. generation of cartilage, ligaments, ten-
The patient’s response to therapy is dons and bone that typically develops
evaluated, and the patient is taught insidiously and becomes clinically obvi-
about the dangers of excess sodium bi- ous at about 30 years of age. In infancy,
carbonate intake if that is a factor. The presence of the acid is indicated by the
ulcer patient is taught to recognize darkening of standing or alkalinated
signs of metabolic alkalosis, including urine and the dark staining of diapers
anorexia, weakness, lethargy, and a dis- or other linen. Also known as “black
taste for milk. If potassium-wasting di- bone disease.” alkaptonuric (-noor⬘ik),
uretics or potassium chloride supple- adj. SEE: ochronosis.
ments are prescribed, the patient’s alkene (al⬘kēn⬙) [alk(yl) ⫹ -ene] A bi-
understanding of the regimen’s pur- valent aliphatic hydrocarbon containing
pose, dosage, and possible adverse ef- one double bond.
fects is ascertained. alkyl (al⬘kı̆l) [al(cohol) ⫹ -yl] Any hy-
respiratory a. Alkalosis with an drocarbon radical with the general for-
acute reduction of carbon dioxide fol- mula CnH2n⫹1. The resulting substances
lowed by a proportionate reduction in are called alkyl groups or alkyl radicals.
plasma bicarbonate. alkylate (al⬘kı̆-lāt⬙) 1. To introduce one
ETIOLOGY: Hyperventilation or more alkyl groups into a compound.
(whether it is caused by hypoxia, anxi- 2. To provide therapy with an alkylating
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ALL 81 allergen

agent. alkylation (al⬙kı̆-lā⬘shŏn ), n. al- genic markers on the surface of cells.


kylator (al⬘kı̆-lāt⬙ŏr), n. SEE: histocompatibility locus antigen.
ALL acute lymphocytic leukemia. intermediate a. Premutation.
allachesthesia (al⬙ă-kes-thē⬘zh(ē-)ă) prothrombin 20210A a. A guanine-
[Gr. allachē, elsewhere ⫹ -esthesia] to-adenine substitution at nucleotide
Perception of tactile sensation as being 20210 in the prothrombin gene that in-
remote from the actual point of stimu- creases the risk for venous clotting. The
lation. gene is usually found in people of Eu-
allantochorion (ă-lan⬙tō-kōr⬘ē-on⬙) An ropean ancestry.
embryonic membrane in which the al- allelic gene Allele.
lantois and chorion are fused into one Allen Cognitive Level Screen A stan-
structure. dardized method of assessing informa-
allantoic (al⬙ăn-tō⬘ik) Pert. to the allan- tion processing based on a theory that
tois. postulates six levels of cognitive func-
allantoid (ă-lan⬘toyd⬙) [Gr. allantos, sau- tion. It is used widely by occupational
sage, ⫹ -oid] 1. Sausage-shaped. therapists.
2. Pert. to the allantois. Allen test (ăl⬘ĕn) 1. A bedside test used
allantoin (ă-lan⬘tŏ-ı̆n) [allanto(is) ⫹ to evaluate the patency of the arteries
-in] C4H6N4O3; a white crystalline sub- of the hand before arterial puncture.
stance in allantoic fluid, amniotic fluid, The patient elevates the hand and re-
and fetal urine. It is the end product of peatedly makes a fist while the exam-
purine metabolism in mammals other iner places digital occlusive pressure
than primates. It is produced syntheti- over the radial and ulnar arteries at the
cally by the oxidation of uric acid and is wrist. The hand will lose its normal pink
used in some cosmetics, mouthwashes, color. Digital pressure is released from
and pharmaceuticals. one artery (usually the ulnar), while the
allantois (ă-lan⬘tŏ-wı̆s, al⬙ăn-tō⬘ı̆-dēz⬙) pl. other, i.e., the radial, remains com-
allantoides [L. fr. Gr. allantoeidēs] A pressed. If there is normal blood flow
transient embryonic structure that is through the unobstructed artery, color
the tubular outpouching from the bot- should return to the hand within 10 sec.
tom of the caudal end of the 3-week-old The return of color indicates that the
human embryo. Later, the allantois, its hand has a good collateral supply of
adjacent connecting stalk, and the yolk blood and that arterial puncture of the
stalk merge to form the umbilical cord. compressed artery can be safely per-
The walls of the allantois give rise to the formed. 2. A procedure to identify the
umbilical vein and arteries, and part of presence of thoracic outlet compression
the cavity of the allantois remains as a syndrome caused by tightness of the
tube (the urachus) that connects the de- pectoralis minor muscle. With the pa-
veloping bladder with the umbilical tient seated, the examiner abducts the
cord. involved shoulder to 90⬚ and flexes the
allay (ă-lād⬘) To put anger, doubt, fear, elbow to 90⬚. While palpating the radial
or suspicion to rest; to calm, lessen, mit- pulse, the examiner externally rotates
igate or relieve. the humerus while the patient actively
Allegra Fexofenadine. rotates the head to the opposite side. A
allele (ă-lēl⬘, ă-lel⬘) [Gr. allēlōn, of one diminished or absent radial pulse is in-
another] Any of two or more different dicative of the pectoralis minor muscle’s
genes containing specific inheritable compressing the neurovascular bundle.
characteristics that occupy correspond- This procedure often produces false-pos-
ing loci on paired chromosomes. A pair itive results. SEE: illus.; thoracic outlet
of alleles is usually indicated by a capi- compression syndrome.
tal letter for the dominant and a low- allergen (al⬘ĕr-jĕn) [aller(gy) ⫹ -gen]
ercase letter for the recessive. An indi-
vidual with a pair of identical alleles,
either dominant or recessive, is said to
be homozygous for this gene. The union
of a dominant gene and its recessive al-
lele produces a heterozygous individual
for that characteristic. Some traits may
have more than two alleles, but an in-
dividual has only two of them. For ex-
ample, the genes for blood type, A, B,
and O, are at the same position on the
chromosome pair, but an individual has
only two of these genes, which may be
the same or different. SYN: allelic gene;
allelomorph. allelic (ă-lel⬘ik), adj.
histocompatibility a. Any of many
different forms of the histocompatibility
gene. Each allele creates specific anti- ALLEN TEST
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allergen 82 allergy

Any substance that causes a hypersen- richly endowed with alien antigens.
sitivity reaction or abnormal immune Once the immune system has been sen-
response. Allergens do not stimulate an sitized, subsequent exposure results in
immune response in everyone, only in the binding of specific immunoglobulins
those sensitized to them. Common aller- (esp. IgE) or the activation of immuno-
gens include inhalants (dusts, pollen), logically active cells, e.g., mast cells, ba-
foods (wheat, eggs), drugs (aspirin, se- sophils, or T cells. These can release in-
rum), infectious agents (e.g., bacteria, flammatory chemicals (histamines,
viruses), contactants (chemicals, ani- kinins, interleukins) that create allergic
mals), and physical agents (heat, cold). symptoms.
SEE: allergy; antigen; irritation; sensi- SYMPTOMS: Nasal inflammation,
tization; table. mucus production, watery eyes, itching,
polymerized a. A chemically altered rashes, tissue swelling, bronchospasm,
allergen made into a macromolecule, stridor, and shock are all symptoms of
used in immunotherapy to stimulate a allergy.
blocking antibody response stronger DIAGNOSIS: A history of exposure
than the allergen’s normal allergic re- and reaction is crucial to the diagnosis
sponse. of allergy. Tests for specific allergies in-
allergenic (al⬙ĕr-jen⬘ik) Producing al- clude skin prick tests, intradermal in-
lergy. allergenicity (-jĕ-nis⬘ı̆t-ē), n. jections, or blood tests (measurements
allergic (ă-lĕr⬘jik) Pert. to, sensitive to, of antigen-specific immunoglobulins).
or caused by an allergen. TREATMENT: Avoiding allergens is
allergic reaction A reaction resulting the first step in treatment. Effective
from hypersensitivity to an antigen. drugs for allergic symptoms include an-
SEE: allergy for illus.; hypersensitivity. tihistamines, corticosteroids, and epi-
allergic salute A colloquial term for wip- nephrine, depending on the severity of
ing the fingers or the hand upward the reaction. Antigen desensitization
across the nose, a sign of nasal inflam- (immunotherapy) may be used by ex-
mation resulting from allergies. perienced professionals, but this tech-
allergist (al⬘ĕr-jist) A physician who spe- nique may occasionally trigger severe
cializes in diagnosing and treating al- systemic reactions.
lergies. PATIENT CARE: Before any drug is
allergoid (al⬘ĕr-goyd⬙) [allergy ⫹ -oid] given, the health care provider should
A chemically altered allergen used in determine if the patient has a history of
immunotherapy to induce tolerance to allergy. Patients receiving injected
an antigen. Allergoids differ from the al- drugs or blood products are closely ob-
lergens they derive from in that they served for rash, itch, wheezing, or hy-
produce an IgG antibody response potension. If an allergic reaction begins,
stronger than an IgE (hypersensitivity) medications are prescribed for immedi-
response. ate management. Patients are taught to
allergy (al⬘ĕr-jē) [allo- ⫹ Gr. -ergia, identify and avoid common allergens
work, activity] An immune response to and to recognize an allergic reaction.
a foreign antigen that results in inflam- The use of drugs for the chronic man-
mation and organ dysfunction. Allergies agement of allergies is explained, and
range from annoying to life-threaten- the patient is advised about potential
ing. They include systemic anaphylaxis, adverse effects. If a patient needs in-
urticaria, eczematous dermatitis, hay jectable epinephrine for emergency out-
fever, and rhinitis. They affect about patient treatment of anaphylaxis, both
20% of Americans and can be triggered the patient and family are instructed in
by inhalation (pollen, dust mites), direct its use.
contact (poison ivy), ingestion (drugs, atopic a. Atopy.
foods), or injection (stinging insects, contact a. A type IV hypersensitivity
drugs). Allergic responses may be initi- reaction following direct contact with an
ated and sustained by occupational ex- allergen, usually affecting the skin.
posure to allergens, and by foods, ani- SEE: contact dermatitis.
mals, fungal spores, metals, and rubber drug a. A type I, IgE-mediated hy-
products. The most severe cases are of- persensitivity reaction to an adminis-
ten associated with Hymenoptera tered drug, e.g., penicillin.
stings, penicillin products, radiological food a. An immunologic reaction to a
contrast media, and latex. SYN: hyper- food to which a patient has become sen-
sensitivity reaction. SEE: allergen; sitized. Sensitivity to almost any food
atopy. may develop, but it develops most fre-
ETIOLOGY: The immune system has quently to milk, eggs, wheat, shellfish,
two main functions: first, to identify and chocolate. Because food allergies
germs and parasites that may harm the are type I reactions, symptoms can ap-
body; and second, to use toxic defenses pear within minutes. Mild symptoms
against attacks by these organisms. Al- urticaria, abdominal cramps, and gas-
lergic reactions occur when immune trointestinal upset) are most common,
functions are turned on by an agent but food allergies can also cause sys-
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allergy 83 allergy

Common Allergies and Allergens


Common Scientific Allergen Allergen Representative
Name Name(s) Designation Class Illnesses
Aspirin Acetylsalicylic Asa Drug aller- asthma, rhinitis,
acid; other gen anaphylaxis
nonsteroidal
anti-inflam-
matory drugs
Birch Betula Bet Aeroallergen hay fever
(inhaled, or
“outdoor”
allergen)
Cat Felis domesticus Fel Pet-associ- asthma, atopy,
ated (in- hives
door)
Cockroach Blatella ger- Bla g Pest-associ- asthma, atopy,
manica ated aller- hives
gen (in-
door)
Dog Canis familiaris Can Pet-associ- asthma, atopy,
ated (in- hives
door)
Dust mite Blomia tropi- Blo t; Der f; Indoor allergic rhinitis;
calis; Derma- Eur contact derma-
tophagoides titis; asthma
farinae; Euro-
glyphus
Egg Apovitellin; Gad d Gal Food allergen
ovalbumin;
ovomucoid
Imported fire Solenopsis in- Sol i Insect venom anaphylaxis
ant victa
Iodine Radiologic con- Io Drug aller- anaphylaxis
trast gen
Latex Hevea brasilen- Hev b Occupational asthma, contact
(rubber) sis exposures dermatitis,
rhinitis
Molds Alternaria alter- Alt a; Asp f; Indoor and allergic rhinitis,
nata; Asper- Cla h; Pen outdoor asthma
gillus fumiga- n
tus;
Cladosporium
herbarum;
Penicillium
notatum
Mugwort Artemisia vul- Art v Outdoor al- hay fever
garis lergen
Olive Olea europaea Ole e Food allergen anaphylaxis
Peanut Arachis hypo- Ara h Food allergen anaphylaxis
gaea
Penicillin Beta-lactam Pcn Drug aller- anaphylaxis;
gen rashes
Ragweed Ambrosia ar- Amb Outdoor al- hay fever
temisiifolia lergen
and others
Timothy Phleum pra- Phl p Outdoor al- hay fever
grass tense lergen
Yellow jacket Vespula vul- Ves v Insect venom anaphylaxis
venom garis and oth-
ers
Wheat Gliadins glutens Tri a Food allergy anaphylaxis,
“Baker’s
asthma,” rhi-
nitis
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allergy 84 allied health professional

temic anaphylaxis and vasovagal syn- onset of a hypersensitivity reaction. (Re-


cope. peated use may be necessary in persist-
Food allergies are identified by elim- ent reactions.) Cross-reactivity to other
inating any foods suspected of causing legumes (peas, soy products) may affect
symptoms and reintroducing them one some people and pose important health
at a time. Blood tests for IgE are useful risks. Affected people should wear med-
in separating food allergies from abnor- ical alert bracelets or necklaces identi-
mal metabolic or digestive responses to fying their condition. Densensitization
food. Desensitization to food allergies is can be accomplished with modified pea-
impossible, and use of antihistamines, nut allergens.
epinephrine, and corticosteroids cannot penicillin a. A hypersensitivity reac-
be used for prophylaxis. Many adverse tion to penicillin.
reactions to foods are not allergic in na- INCIDENCE: The condition is present
ture but may be caused by toxic, meta- in about 0.5% to 8% of the population.
bolic, or pharmacological reactions. CAUSES: Although different types of
SEE: anaphylaxis; desensitization. hypersensitivity reactions may occur,
glove a. A colloquial term for latex the most common and potentially dan-
a. gerous are the type I (immediate) reac-
latex a. An immune reaction result- tions mediated by immunoglobulin E.
ing from contact with products derived SYMPTOMS AND SIGNS: Common
from the rubber tree, Hevea brasiliensis, symptoms include itching and swelling
or the chemicals added to latex in man- of the skin and mucous membranes, or,
ufacturing. Latex antigens can be in- in cases of systemic anaphylaxis, cough,
haled or absorbed through the skin. The shortness of breath, wheezing, or car-
allergic reaction may be mild (rashes, diovascular collapse after taking peni-
reddened skin) or severe (broncho- cillin.
spasm, anaphylaxis). In health care DIAGNOSIS: A skin test can deter-
workplaces, where wearing latex gloves mine sensitivity to the drug but should
is common, nonlatex products have been only be done by an allergist in a con-
substituted to reduce exposure. A non- trolled setting in which epinephrine is
allergic contact dermatitis caused by available as a rescue medication, and
the powder used in latex gloves may be trained professional staff are prepared
mistaken for a true latex allergy and is to respond to anaphylactic reactions.
much more common. TREATMENT: No penicillin or other
peanut a. An IgE-mediated immedi- beta-lactam antibiotics (such as cepha-
ate hypersensitivity reaction to the con- losporins) should be given to penicillin-
sumption of peanuts (the seeds of Ara- allergic patients. In those very rare sit-
chis hypogaea). Peanut allergens are uations in which an infection is
designated Ara by the World Health susceptible only to penicillin and the in-
Organization. fection is serious enough to risk the dan-
INCIDENCE: Peanut allergy is the ger of anaphylaxis, the patient may be
most important food allergy in the U.S., desensitized with gradually increasing
affecting more than a million people. doses of penicillin.
SYMPTOMS: Reactions range from PATIENT CARE: After the adminis-
mild (rashes) to life-threatening (clo- tration of penicillins, the patient should
sure of the airway, cardiac dysrhyth- be monitored for anaphylaxis or adverse
mias, coma). reactions such as hives or rashes. Ani-
PREVENTION: Dietary exposure to thistamines can be given for orally or
peanuts in infancy may limit the likeli- parenterally for rashes or hives; epi-
hood of developing peanut allergy in nephrine is administered by injection
childhood. for anaphylaxis.
IMPACT ON HEALTH: About 50 peo- allergy response, latex An allergic re-
ple die of peanut allergy in the U.S. each sponse to natural latex rubber products.
year. Most affected people remain sen- allergy response, risk for Vulnerable to
sitive throughout their lives; approx. an exaggerated immune response or re-
20% of children affected by peanut al- action to substances, which may com-
lergy become tolerant to peanuts over promise health. SEE: Nursing Diagno-
time. ses Appendix.
PATIENT CARE: People with known alleviate (ă-lē⬘vē-āt⬙) [L. alleviare, to
allergies to peanuts must avoid eating lighten] To lessen the effect of. allevi-
raw or processed peanuts and products ation (-lē⬙vē-ā⬘shŏn), n.
containing or prepared with peanut oil. allicin (al⬘ı̆-sı̆n) [L. allium, garlic ⫹ -in]
Those affected by peanut allergy should A yellow oil released from garlic when it
learn to watch for the signs of anaphy- is bruised, crushed, or chewed. The oil
laxis (hives, pruritus, rashes in the skin is antibacterial and antifungal and used
creases, shortness of breath, choking, to treat hyperlipidemia.
wheezing, stridor). People with known allied health professional One who has
anaphylaxis to peanuts should carry ep- received professional training and cre-
inephrine injectors and use them at the dentials in an allied health field, such
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Allis, Oscar 85 allotransplantation

as clinical laboratory science, radiology, Alloiococcus otitis, Alloiococcus otitidis


emergency medical services, physical (ăl-oy⬙ŏ-kŏk’ŭs) [Gr. alloios, another
therapy, respiratory therapy, medical kind of ⫹ coccus] A species of aerobic
assisting, athletic training, dental hy- gram-positive bacteria often found in
giene, or occupational therapy. patients with otitis media with effusion.
Allis, Oscar (al⬘ı̆s) Oscar Huntington Al- allomerism (ă-lom⬘ĕr-ı̆zm) [allo- ⫹
lis, U.S. surgeon, 1836– 1921. -mere ⫹-ism] A change in chemical con-
A. forceps Forceps with curved, ser- stitution without a change in crystalline
rated edges. They are used to grasp tis- composition. SEE: allomorphism.
sue firmly but without crushing. allomorphism (al⬙ŏ-mor⬘fı̆zm) [allo- ⫹
A. sign A clinical finding in pa- morph- ⫹ -ism] A change in form
tients with a fractured or dislocated without a change in chemical constitu-
femoral head, in which a finger can be tion. SEE: allomerism.
pressed into the fascia lata femoris be- allopath (al⬘ŏ-path⬙) One who practices
tween the greater trochanter and the allopathy.
iliac crest. allopathy (ă⬙lop⬘ă-thē) [allo- ⫹ -pathy]
alliteration (ă-lit⬙ĕ-rā⬘shŏn) 1. Repeti- 1. A system of treating disease by in-
tion of consonant sounds in initial or ducing a pathological reaction antago-
stressed syllables, esp. in poetry. 2. A nistic to the disease being treated. 2. A
speech disorder in alliteration is used to term erroneously used for the regular
excess. practice of medicine to differentiate it
Allium sativum (al⬘ē-ŭm să-tē⬘vŭm, să- from homeopathy. allopathic (al⬙ŏ-
tı̄⬘vŭm) [L. allium sativum, planted path⬘ik), adj. allopathically (al⬙ŏ-
garlic] SEE: garlic. path⬘ik(ă-)lē), adv.
allo-, all- [Gr. allos, other, another] Pre- alloplasty (al⬘ŏ-plas⬙tē) [allo- ⫹
fixes meaning divergence, difference -plasty] 1. Plastic surgery using inert
from, or opposition to the normal. materials or those obtained from a tis-
alloantigen (al⬙ō-an⬘tı̆-jĕn) [allo- ⫹ an- sue bank, e.g., cornea, bone. 2. In psy-
tigen] An antigen in the blood or tissue chiatry, adaptation by altering the ex-
of an organ donor that is not present in ternal environment rather than
the recipient. The alloantigen can trig- changing oneself. SEE: autoplasty.
ger an immune response after trans- allopsychic (al⬙ō-sı̄⬘kı̆k) [allo- ⫹ psy-
plantation or transfusion. alloantigenic chic] Pert. to mental processes in rela-
(-an⬙tı̆-jĕn⬘ik), adj. tion to the external environment.
allocation (al⬙ŏ-kā⬘-shŏn) The assign- allopurinol (al⬙ō-pūr⬘ı̆-nol⬙) A drug that
ment or distribution of assets or duties. inhibits the enzyme xanthine oxidase.
allocative efficiency (al⬘ŏ-kāt⬙ı̆v) In ec- Because allopurinol causes a reduction
onomics and sociology, the extent to in both serum and urine levels of uric
which a product or a service, e.g., he- acid, it is used in the treatment of gout
modialysis, is provided to an entire com- and of renal calculi caused by uric acid.
munity, rather than just to a subgroup A potentially fatal rash is a rare but
of that community. significant side effect
allodiploidy (al⬙ŏ-dip⬘loyd⬙ē) [allo- ⫹ alloreactive (al⬙ō-rē-ak⬘tiv) [allo- ⫹ re-
diploid] Possession of two sets of chro- active] Pert. to certain classes of T lym-
mosomes, each from a different species, phocytes, immunologically reactive
like a hybrid. against a transplanted tissue or organ.
allodynia (al⬙ŏ-din⬘ē-ă) [allo- ⫹ allostasis (ă-los⬘-tă-sı̆s) Physiological
-odynia] The perception of an ordinar- adaptation to stress.
ily painless stimulus as painful. allosteric modulator (al⬙ō-ster⬘ik) A
allogeneic, allogenic (al⬙ō-jĕ-nē⬘ik, al⬙ō- chemical that modifies the allosteric
jĕn⬘ik) Having a different genetic con- binding site of an enzyme, changing its
stitution but belonging to the same spe- catalytic kinetics. SYN: enzyme modu-
cies. SEE: isogeneic. lator.
allograft (al⬘ŏ-graft⬙) [allo- ⫹ graft] allostery (al⬙ō-ster⬘ē) [allo- ⫹ steric]
An organ or tissue transplanted from 1. In bacteria, alteration of a regulatory
one member of a species to another ge- site on a protein that changes its shape
netically dissimilar member of the same and activity. This change is important
species. Common transplanted organs in altering the way the organism re-
include the cornea, bone, artery, carti- sponds to its molecular environment.
lage, kidney, liver, lung, heart, and pan- 2. In enzymology, the ability of a factor
creas. Recipients of allografts take im- to bind to a site on an enzyme other than
munosuppressive drugs to prevent its substrate-binding site and cause a
tissue rejection. SYN: allogeneic graft; change in the conformation of the en-
homograft. SEE: autograft; heterograft; zyme and its ability to catalyze a chem-
transplantation. ical reaction. allosteric (al⬙ō-ster⬘ik),
alloimmune (al⬙ō-i-mūn⬘) [allo- ⫹ im- adj.
mune] Pert. to the immune response to allotransplantation (al⬙ō-trans⬙plan⬙tā⬘
antigens on blood or tissue cells received shŏn) [allo- ⫹ transplantation]
from a donor of the same species. Grafting or transplantation of tissue
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allotropic 86 alopecia

from one individual into another of the an anesthetic for tooth aches and as a
same species. allotransplant (al⬙ō- digestive aid.
trans⬘plant⬙), v. allyl (al⬘ı̆l) [L. allium, garlic ⫹ -yl]
allotropic (al⬙ŏ-trop⬘ik) [allo- ⫹ C3H5; a univalent unsaturated radical
-tropic] 1. Pert. to the existence of an found in garlic and mustard. allylic (ă-
element in two or more distinct forms lil⬘ik), adj.
with different physical properties. 2. Al- Alma-Ata Declaration (al⬘mă ă-tah⬘)
tered by digestion so as to be changed in [Capital of Kazakhstan] A declaration
its nutritive value. 3. Concerned with made in 1978 at the Conference on Pri-
the welfare and interests of others; dis- mary Health Care in Alma-Ata, USSR.
interested. It stated that primary health care is the
allotype (al⬘ŏ-tı̄p⬙) [allo- ⫹ type] Any key to attaining health for all by the
of the genetic variants of protein that year 2000. Eight elements were defined
occur in a single species. The serum as essential to this: education, food sup-
from a person with one form of allotype ply, safe water, maternal and child
could be antigenic to another person. al- health (including family planning), im-
lotypic (al⬙ŏ-tip⬘ik), adj. allotypically (-i- munization, prevention and control of
k(ă-)lē), adv. endemic diseases, appropriate treat-
allow natural death An alternative to “do ment of common diseases and injuries,
not resuscitate” or “do not attempt re- and provision of essential drugs.
suscitation” in which a patient or family ALOC altered level of consciousness.
permits a person’s vital functions to alochia (ā⬙lō⬘kē-ă) [a- ⫹ lochos, child-
cease without medical intervention, birth] Absence of lochia.
such as the maintenance of an artificial aloe (al⬘ō) [L. fr. Gr. aloē] The dried
airway or the provision of advanced car- juice of one of several species of plants
diac life support. SEE: do not attempt of the genus Aloe, used to treat skin con-
resuscitation; do not resuscitate. ditions. The most common species is
alloy (ăl⬘oy⬙, ă-loy⬘) [Fr. aloyer, to com- Aloe vera.
bine] 1. A metal, e.g., brass, that is the alogia (ā⬙lō⬘j(ē-)ă) [1an- ⫹ Gr. logos,
fusion or mixture of two or more metals. word] 1. Complete speechlessness.
2. A metal, e.g., steel, that is the fusion 2. Poverty of speech. It is one of the neg-
or mixture of a metal and a nonmetal. ative symptoms of schizophrenia.
In dentistry, several alloys are used to alopecia (al⬙ŏ-pē⬘sh(ē-)ă ) [Gr. alōpekia,
restore teeth. Alloys used to construct fox mange] Absence or loss of hair, esp.
cast restorations are often gold- and of the head.
copper-based alloys. Common so-called ETIOLOGY: Alopecia may result from
silver fillings are alloys of silver, copper, serious illness, drugs, endocrine disor-
tin, and mercury. The silver-tin-mer- ders, dermatitis, hereditary factors, ra-
cury alloys are called amalgams. SEE: diation, or physiological changes during
dental amalgam. aging.
base metal a. An alloy that does not TREATMENT: Treatments include
contain noble metals such as gold or sil- drugs, such as minoxidil or finasteride;
ver. Stainless steel is the most common surgeries, such as hair transplantation;
base metal alloy used in dentistry. or prostheses (wigs).
androgenetic a. Male-pattern bald-
ness.
Base metal alloys should not be
a. areata Alopecia in sharply defined
cleaned with sodium hypochlorite
patches, usually involving the scalp or
solutions.
beard. SEE: illus.

dental casting gold a. A hard or ex-


tra-hard alloy used to manufacture
crowns, inlays, and onlays.
noble-metal a. An alloy of which one
metal is noble (gold, silver, platinum, or
palladium). Noble-metal alloys are gen-
erally nonreactive and corrosion-resis-
tant.
allozyme (al⬘ŏ-zı̄m⬙) [allo- ⫹ (en)zyme]
An enzyme that has small substitutions
in its genetic coding and protein struc-
ture.
allspice (al⬘spı̄s⬙) The dried, unripe ber-
ries of Pimenta dioica, an aromatic Mex-
ican and Central American evergreen ALOPECIA AREATA OF SCALP
shrub, used as a flavoring agent in cook-
ing and toothpaste and in alternative a. capitis totalis Complete or near
and herbal medicine. Eugenol, the prin- complete alopecia on the scalp. SEE: il-
cipal essential oil in allspice, is used as lus.
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alopecia 87 Alphavirus

mal in persons with diabetes, multiple


pregnancies, or obesity.
alpha-fetoprotein kit ABBR: AFP test. A
monoclonal antibody test for the pres-
ence of alpha-fetoprotein (AFP) in vagi-
nal secretions, used in cases of sus-
pected premature rupture of
membranes. In healthy pregnancies
AFP is detectable in the amniotic fluid
but is present only in very low concen-
trations in vaginal secretions. If there is
leakage of amniotic fluid into the vagina
as a result of premature rupture of
ALOPECIA CAPITIS TOTALIS membranes, AFP levels in the vagina
rise significantly.
alpha-globulin Any of the serum globu-
cicatricial a. Alopecia due to forma- lins. It is so named because of its posi-
tion of scar tissue. tion as it migrates in a buffered elec-
a. congenitalis Alopecia due to con- trified solution. Alpha globulins include
genital absence of hair bulbs. many clinically important proteins, e.g.,
a. follicularis Alopecia due to inflam- alpha-1-antitrypsin, angiotensinogen,
mation of the hair follicles of the scalp. ceruloplasmin and haptoglobin. SEE:
a. liminaris Loss of hair along the globulin, serum.
hairline, both front and back, of the alpha granule deficiency syndrome A
scalp. rare autosomal dominant bleeding dis-
male-pattern a. Male-pattern bald- order in which the alpha granules of
ness. platelets lack adenosine diphosphate,
a. medicamentosa Alopecia as a re- which is critical for proper platelet tar-
sult of medical treatment, esp. with geting and clumping in response to in-
drugs used in chemotherapy for cancer. jury. The platelet count may be abnor-
a. pityroides Loss of both scalp and mally decreased, and the bleeding time
body hair accompanied by desquama- is usually prolonged. The abnormality
tion of branlike scales. in platelet granulation is visible with an
a. prematura Premature baldness, electron microscope. The most common
esp. during one’s 20s. clinical evidence of the disease is easy
a. symptomatica Alopecia after pro- bruising in response to injury. SYN:
longed fevers or during the course of a gray platelet syndrome.
disease. This baldness may be due to alpha-linolenic acid (al⬘fă-lin⬙ŏ-lē⬘nik)
systemic or psychogenic factors. SEE: under acid.
a. totalis Alopecia capitis totalis. alpha-methylacyl-CoA racemase ABBR:
a. toxica Alopecia thought to be due AMACR. An antibody that is primarily
to toxins of infectious disease. used in histopathology to stain tissues
a. universalis Loss of hair from the suspected of representing carcinoma of
entire body. the prostate gland. Its presence sub-
alpha (al⬘fă) 1. A or ␣, the uppercase and stantiates the diagnosis. AMACR is also
lowercase symbols, respectively, for the present in some colonic and some kid-
first letter of the Greek alphabet. In ney cancer specimens.
chemistry, the first in a series of iso- alpha-methyltryptamine (al⬙fă-meth⬙ı̆l-
meric compounds or the position adja- trip⬘tă-mēn⬙, mı̆n) [alpha ⫹ methyl
cent to a carboxyl group. 2. First in a ⫹ tryptamine] ABBR: AMT. A hallu-
series. 3. Prototype. 4. The dominant cinogenic compound derived from tryp-
figure, personality, or role. tamine, a crystalline amine formed from
alpha-fetoprotein ABBR: AFP. An an- tryptophan. It is known colloquially as
tigen present in the human fetus and in “spirals.”
pathological conditions in the adult. The alpha particles, alpha rays Radioactive,
maternal serum level should be evalu- positively charged particles, equivalent
ated at 15 to 22 weeks’ gestation. Dur- to a helium nucleus (two protons and
ing pregnancy, elevated levels are as- two neutrons), ejected at high speeds in
sociated with open neural tube defects, certain atomic reactions.
anencephaly, omphalocele, gastros- alpha-rhythm In electroencephalogra-
chisis, and fetal death. Decreased levels phy, rhythmic oscillations in electric po-
may indicate an increased risk of having tential occurring at an average rate of
a baby with Down syndrome. If an ab- 10/sec. SYN: alpha-wave.
normal level of AFP is found, further alpha-tocopherol The most active form of
tests such as ultrasound or amniocen- vitamin E found in food.
tesis need to be done. Elevated serum Alphavirus (al⬘fă-vı̄⬘rŭs) A genus of the
levels of AFP are found in adults with family of Togaviridae viruses (e.g. East-
hepatic carcinomas or chemical injuries. ern Equine Encephalitis virus, Western
Examination results also may be abnor- Equine Encephalitis virus) transmitted
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alpha-wave 88 alveolus

to humans by mosquito bite. Alphavi- ⫹ -osis] Chronic inflammation of the


ruses have a single-stranded RNA ge- lungs in alum workers due to alum par-
nome. Infection may cause fever, joint ticles in inspired air.
pains, rash, or central nervous system Alvarado score (al-vă-rod⬘ō) [A. Alva-
infection. rado, U.S. physician] A diagnostic tool
alpha-wave Alpha-rhythm. to estimate the likelihood that a patient
Alport syndrome (al⬘port⬙) [Arthur with abdominal pain has appendicitis.
Cecil Alport, South African physician, It includes the following clinical fea-
1880– 1959] Congenital glomerulone- tures: 1) an elevated white blood cell
phritis associated with deafness and a count (esp. when associated with a left
decrease in large thrombocytes. Occa- shift); 2) abdominal pain that migrates
sionally there are eye abnormalities to the right lower quadrant of the ab-
such as cataracts. Although there is no domen; 3) loss of appetite; 4) nausea
specific treatment for this condition, di- and/or vomiting; 5) tenderness in the
alysis or kidney transplantation is used right lower quadrant; 6) rebound ten-
to treat affected patients with kidney derness; and 7) fever. Patients with few
failure. SYN: hereditary nephritis. of these clinical features are unlikely to
SEE: macrothrombocyte. have an inflamed appendix; patients
alprazolam (al-prā⬘zŏ-lam⬙) A benzodi- with most of these findings are likely to
azepine and antianxiety agent, admin- benefit from appendectomy.
istered orally to treat anxiety and panic ALVD asymptomatic left ventricular dys-
attacks. Trade name is Xanax. function.
ALS amyotrophic lateral sclerosis. alveobronchiolitis, alveobronchitis (al⬙
Alstrom syndrome (ol⬘strom⬙) [Carl- vē-ō-brong⬙kē-ŏ-lı̄⬘tis, -brong-kı̄⬘tis) In-
Henry Alström, Swedish psychiatrist, flammation of the bronchioles and pul-
1907– 1993] A rare autosomal reces- monary alveoli.
sive syndrome marked by blindness re- alveolar (ăl-vē⬘ŏ-lăr) 1. Pert. to an alve-
sulting from retinal dystrophy, type 2 olus. 2. Pert. to a consonant, such as a t
diabetes mellitus, hearing loss, heart or d in English, pronounced with the tip
failure, insulin resistance, obesity, and of the tongue near or touching the inner
renal failure. ridge of the gums of the upper front
ALT alanine aminotransferase; antibi- teeth, i.e., the alveolar ridge. English t
otic lock therapy. and d are informally, less accurately
alternans (al-ter⬘nans⬙) [L. alternare, to called dental. SEE: dental consonant.
alternate] 1. Alternation, as in contrac- alveolar hydatid disease Alveolar echi-
tions of the heart. 2. Alternating, as in nococcosis.
contractions of the heart. alveolate (al-vē⬘ŏ-lăt, al-vē⬘ŏ-lāt⬙) [L. al-
Alternaria (al⬙tĕr-na⬘rē-ă) A genus of veolatus, hollowed out like a small tray]
fungi of the Dematiaceae family. These Pitted like a honeycomb; faveolate. al-
fungi cause phaeohyphomycosis. They veolation (al-vē⬙ŏ-lā⬘shŏn⬙), n.
can also cause onychomycosis, sinusitis, alveoli-, alveolo- Prefixes meaning alve-
ulcerated cutaneous infections, and ker- olus.
atitis, visceral infections and osteomy- alveolitis (al⬙vē-ŏ-lı̄t⬘ı̆s) [alveoli- ⫹
elitis in immunocompromised persons. -itis] Inflammation of the alveoli.
In immunocompetent patients, Alter- allergic a. Inflammation of the bron-
naria colonizes the paranasal sinuses, chial tree, interstitial tissue, and alveoli
leading to chronic hypertrophic sinusi- of the lung caused by a hypersensitivity
tis. reaction to an inhaled antigen. With re-
alternation of generations Reproduction peated exposure, large numbers of mac-
in which a sexual generation alternates rophages form granulomas, which dam-
with an asexual generation, character- age and scar lung tissue. The inhaled
istic of some fungi and protozoa. SYN: allergens that most often trigger aller-
metagenesis. gic alveolitis are molds and other fungi,
alternator (al-tĕr-nā⬘tŏr) An electrical vegetables, mushrooms and mushroom
generator that produces alternating compost, flour, tree bark, detergents,
current. and contaminated humidifiers. In the
altitude sickness SEE: under sickness. acute stage, patients may present with
altricious (al-trı̆sh⬘ŭs) [L. altrix, stem al- cough, fever, chills, malaise, and short-
tric-, nourisher] 1. Slow in developing. ness of breath. In the subacute and
2. Requiring long-term nursing care. chronic forms, the onset of symptoms is
altruism (al⬘troo-ı̆z-ı̆m) [Fr. altruisme] gradual and prolonged. Farmer’s lung
Acting for the benefit of others regard- and bagassosis are two common names
less of the consequences for oneself. for forms of allergic alveolitis. SYN: hy-
involuntary a. An action that is persensitivity pneumonitis.
taken on behalf of others not because of alveolotomy (al⬙vē-ŏ-lot⬘ŏ-mē) [alveolo-
one’s own choosing but because of coer- ⫹ -tomy, incision] Surgical incision of
cion, fiat, or legislation. altruist (al⬘troo- the alveolus of a tooth.
ist⬙), n. altruistic (al⬙troo-is⬘tik), adj. alveolus (al-vē⬘ŏ-lŭs , al-vē⬘ŏ-lı̄⬙ , al-vē⬘ŏ-
aluminosis (ă-loo⬙mı̆-nō⬘sis) [aluminum lē⬙ ) pl. alveoli [L. alveolus, small hol-
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alveolus 89 Alzheimer, Alois

low, cavity] 1. A small hollow. 2. The alveus collect to form the fimbria of the
bony socket of a tooth. 3. An air sac of fornix).
the lungs. SEE: illus. 4. Any of the hon- Alzheimer, Alois (alts⬘hı̄⬙mĕr) Ger. neu-
eycombed depressions of the gastric mu- rologist, 1864– 1915.
cous membrane. 5. A follicle of a race- A. disease ABBR: AD. A chronic,
mose gland. progressive, degenerative cognitive dis-
alveoli of the breast Glandular order that causes deterioration in think-
structures arranged in clusters ing and everyday functioning among
throughout the breast and the site of older adults. The diseases costs $80 to
milk synthesis. $100 billion for health care and lost
pulmonary a. Any of the terminal ep- wages in the U.S. annually. The number
ithelial sacs of an alveolar duct where of patients is expected to more than tri-
gases are exchanged in respiration. It is ple in the next 30 years (14 million by
informally called an “air sac.” SYN: al- 2050) as more people live into their 80s
veolar sac. and 90s. SYN: senile dementia of the
alveoli pulmonis Pulmonary alveoli. Alzheimer type. SEE: positron emission
alveus (al⬘vē-ŭs, al⬘vē-ı̄⬙, al⬘vē-ē⬙) pl. al- tomography for illus.
vei [L. alveus, hollow vessel, basket] A INCIDENCE: It is the most common
channel or groove. form of dementia in mature adults, ac-
a. hippocampi A layer of white mat- counting for more than 60% of all de-
ter covering the ventricular surface of mentia patients. The illness affects
the hippocampus. The axons forming more than 4.5 million older Americans
the alveus are from the hippocampus (some estimates are as high as 5.1 mil-
and subicular cortex. The axons of the lion). One in 10 people over the age of

Mediastinum Bronchiole

Right lung
Left lung
Visceral pleura Base of lung
Diaphragm
Pleural cavity
Parietal pleura

Deoxygenated
blood from heart
Bronchiole

Alveoli

Alveolus O
2

CO2

Pulmonary capillary
Oxygenated
blood to heart Exchange of gases between an
alveolus and a pulmonary capillary
Pulmonary capillaries

ALVEOLUS OF LUNGS
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Alzheimer, Alois 90 Alzheimer, Alois

65 is likely to develop Alzheimer dis- normalities in cranial neurotransmit-


ease. The prevalence is expected to in- ters may occur. Acetylcholine, for ex-
crease over the next few decades, as the ample, may be reduced by as much as
population ages. 75%, contributing to cognitive impair-
CAUSES: Alzheimer disease likely ment.
has more than one cause. Some of these TREATMENT: The treatment of Alz-
appear to be inherited (such as the in- heimer disease includes environmental
heritance of the apolipoprotein E structuring and drug therapy. Environ-
[APOE] gene), although genetics alone mental structuring means provision of a
does not account for all cases of the dis- safe, stimulating milieu that offers con-
ease. The final pathway leading to brain sistency and comfort for the patient.
cell injury in Alzheimer disease is the Drug therapy is to improve memory
excessive build up of abnormal proteins rather than cure the disease. Several
(called amyloid beta and tau) deposit in cholinergic drugs, e.g., donepezil HCl
neurons, which produce amyloid (Aricept), or memantine are used to
plaques, gliosis, and neurofibrillary tan- slow the decline in cognitive function.
gles visible on microscopic examination Antidepressants and psychotropic med-
of brain tissue. Neuronal loss eventu- ications are used to treat patients who
ally occurs. have secondary diagnoses such as de-
SYMPTOMS AND SIGNS: The disease pression and hallucinations.
begins with a mild memory loss (Stage PATIENT CARE: Reality orientation
I), which then progresses to deteriora- is helpful for patients in early stages of
tion of intellectual functions, personal- the disease. Validation therapy is most
ity changes, and speech and language appropriate for patients in Stage II or
problems (Stage II). In the terminal III.
stage (Stage III), patients depend on In collaboration with the physical and
others for activities of daily living. Sei- occupational therapists, the nurse as-
zures, hallucinations, delusions, para- sesses the patient’s need for assistance
noia, or depression can occur in either with activities of daily living. Self-care,
Stage II or III. Persons with Alzheimer exercise, and other activities are en-
disease will eventually develop macular couraged as much as possible. If sleep
degeneration SEE: table. disturbances occur, the patient should
DIAGNOSIS: The diagnosis is usually rest between daytime activities, but
made on clinical grounds, by ruling out sleeping during daytime hours is to be
other causes of cognitive dysfunction. A discouraged. Neurological function, in-
definitive diagnosis is made during cluding mental and emotional states
brain biopsy (which is very rarely per- and motor capabilities, is monitored for
formed), or after death, during autopsy. further deterioration. Vital signs and
PATHOPHYSIOLOGY: Characteristic respiratory status are assessed for
pathophysiological changes in the brain pneumonia and other infections. The
include neuritic plaques, neurofibrillary patient is evaluated for gastrointestinal
tangles, and marked cerebral atrophy. or urinary problems (anorexia, dyspha-
In addition to structural changes, ab- gia, and urinary or fecal incontinence);

Stages of Alzheimer Disease


Stage Common Behaviors
Stage I (early stage, Loss of short-term memory
mild dementia) Decreased judgment (safety concern)
Inability to perform mathematical calculations
Inability to comprehend abstract ideas
Stage II (middle Difficulty with speech and language (aphasia, anomia)
stage, moderate Labile personality changes
dementia) Changes in usual grooming habits
Inability to remember purpose of items (apraxia)
Urinary incontinence
Wandering
Seizures
Psychotic behaviors, such as hallucinations and paranoia
Depression
Stage III (late stage, Inability to perform activities of daily living, such as eat-
severe dementia) ing, dressing, and bathing; requires total care
Inability to walk, toilet, swallow
Minimal or no communication
Eventually becomes bedridden and develops complications
of immobility, such as pneumonia, pressure ulcers, and
constipation
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Alzheimer, Alois 91 amalgamate

fluid and food intake is monitored to de- others, the progression of the disease,
tect imbalances. The nurse or assistive and the need for placement in a nursing
nursing personnel takes the patient to home if this becomes necessary. Sup-
the bathroom or bedside commode be- port groups can help with this process.
fore and after meals and every 2 hr in Respite care can give life-sustaining re-
between. Skin is inspected for evidence lief to both partners. Friends who want
of trauma. The occupational therapist, to help may not even know what to offer,
home health nurse, or case manager as- and caregivers must learn how to ask
sesses the patient’s living environment for help with specific tasks.
to eliminate hazards and teaches the The local chapter of the Alzheimer’s
family to monitor the patient’s activity Disease and Related Disorders Associ-
to prevent falls, burns, and other inju- ation (ADRDA), sometimes simply re-
ries. Expectations should not exceed the ferred to as the Alzheimer’s Association,
patient’s ability to perform tasks. Be- is an excellent resource. A list of local
cause the patient may misperceive the chapters can be found through the na-
environment, health professionals tional ADRDA at 919 N. Michigan Av-
should speak softly and calmly and al- enue, Suite 1000, Chicago, IL 60611-
low sufficient time for answers because 1676 or at their website at www.alz.org.
of the patient’s slowed thought pro- early-onset A. disease Alzheimer
cesses and impaired ability to speak. disease that occurs before the age of 65.
The case manager or nurse evaluates late-onset A. disease ABBR: LOAD.
the caregiver’s ability to manage the pa- Alzheimer disease occurring after the
tient at home and makes the appropri- age of 65. It is the most common form of
ate referrals to available local resources the disease
such as counseling, support groups, and Am 1. mixed astigmatism. 2. ametropia.
respite care. 3. Symbol for the element americium.
Loneliness, helplessness, and bore- AMA against medical advice; Aerospace
dom, all associated with institutional- Medical Association; American Medical
ization, can be reduced by incorporating Association.
into the environment plants, pets, avi- amaas (a⬘mas) [Afrikaans] Variola mi-
aries, and children as well as opportu- nor.
nities to handle objects having different AMACR alpha-Methylacyl-CoA race-
tactile surfaces. A decor similar to the mase.
patient’s familiar surroundings may amacrine, amacrinal (am⬘ă-krı̄n⬙, am⬙ă-
provide comfort. Music therapy may en- krı̄n⬙ăl) [1an- macr- ⫹ Gr. is, stem -in-,
hance emotional and physical well-be- fiber] Lacking a long process.
ing, cognitive skills, ability to commu- amalgam (ă-mal⬘găm) [L. amalgama fr.
nicate, and social functioning. Activity Gr. malagma, soft mass] An alloy used
therapy should include the patient’s in dentistry to restore teeth. It is made
known earlier interests and prefer- predominantly of silver and mercury.
ences. Such activities benefit the pa- dental a. A dental restorative mate-
tient by encouraging interaction with rial made by mixing approx. equal parts
others and by providing intellectual of elemental liquid mercury (43% to
stimulation. 54%) and an alloy powder (57% to 46%)
If mild cognitive impairment or early composed of silver, tin, copper, and
stage Alzheimer disease is suspected, sometimes smaller amounts of zinc, pal-
the person should be evaluated by his ladium, or indium. Dental amalgam has
physician or referred to a neurologist or been used for over 150 years. A fraction
gerontologist for evaluation. Early di- of the mercury in amalgam is absorbed
agnosis allows family members to plan by the body, and people with amalgam
and prepare for the future. The physical restorations in their teeth have higher
and emotional health of the primary concentrations of mercury in tissues (in-
caregiver is an additional concern for cluding the blood, urine, kidneys, and
the health team. Support groups can be brain) than those without amalgam fill-
a great help to family members by dis- ings. In 1993 the Public Health Service
cussing care issues and exchanging in- of the U.S. Department of Health and
formation and by considering the care- Human Services published a report ac-
givers’ feelings and coping skills in an knowledging that scientific data are in-
accepting atmosphere. Caregivers ex- sufficient to conclude that amalgam fill-
perience grief and loss during and after ings have compromised health. There is
the illness and need help in expressing no evidence that removal of amalgam
their grief and pain. Some male care- fillings has a beneficial effect on health.
givers may face unique challenges in A dental amalgam is colloquially called
taking over many of the tasks tradition- a silver amalgam or a silver filling.
ally done by an ill wife or mother. All silver a. A colloquial term for dental
caregivers share the struggle with the amalgam.
common elements of acceptance: accept- amalgamate (ă-mal⬘gă-māt⬙) To com-
ing the diagnosis, the devastating bine mercury with silver, tin, and cop-
changes, the limited understanding of per to produce amalgam. amalgama-
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ambulatory blood pressure


amanita 92 monitoring

tion (ă-mal⬙gă-mā⬘shŏn), n. ambivert (am⬘bi-vĕrt⬙) [ambi- ⫹ (ex-


amalgamator (ă-mal⬙gă-māt⬙ŏr), n. tro)version or (intro)version] A person
amanita (am⬙ă-nı̄t⬘ă, am⬙ă-nēt⬘ă) [Gr. whose personality type shows tend-
amanitai, mushrooms] Any of various encies of both introversion and extro-
mushrooms of the genus Amanita, e.g., version. ambiversion (am⬙bi-vĕr⬘zhŏn),
A. muscaria and A. phalloides. Most are n.
toxic to the liver, hallucinogenic, or le- amblyo-, ambly- [Gr. amblys, dull] Pre-
thal. fixes meaning dull or dim.
amastia (ā⬙mas⬘tē-ă) [a- ⫹ mast- ⫹ Amblyomma (am⬙blē-om⬘ă) [ambly- ⫹
-ia] Absence of breast tissue. It may be Gr. omma, eye] A genus of ticks that
due to a rare congenital anomaly or, includes the Lone Star tick (A. ameri-
more often, a bilateral mastectomy. canum) and the Gulf Coast tick (A. ma-
SEE: amazia. culatum). Some species cause tick bite
amastigote (ā⬙mas⬘tı̆-gōt⬙) [a- ⫹ mas- paralysis; others are vectors of human
tigote] Leishman-Donovan body. ehrlichiosis, rickettsial diseases, or tu-
amatoxin (am⬙ă-tok⬘sin) [ama(nita) ⫹ laremia.
toxin] The chemical component of poi- amblyopia (am⬙blē-ō⬘pē-ă) [ambly- ⫹
sonous mushrooms that causes early -opia] Unilateral or bilateral decrease
onset of gastrointestinal upset. Liver of best corrected vision in an otherwise
failure follows about 36 hr later. healthy eye, commonly due to asymmet-
amazia (ā⬙mā⬘zē-ă) [a- ⫹ Gr. mazos, ric refractive error or strabismus. am-
breast] Absence of all breast tissue ex- blyopic (am⬙blē-ō⬘pik), adj.
cept the nipple. SEE: amastia. deprivation a. Amblyopia resulting
ambi- [L. ambi-, on both sides] Prefix from nonuse of the eye. It is usually sec-
meaning both, both sides, or around. ondary to an organic problem such as
ambidextrous (am⬙bi-dek⬘strŭs) [ambi- cataract or ptosis.
⫹ L. dexter, right, on the right] Being a. ex anopsia Amblyopia resulting
able to work equally well with either from disuse. It usually occurs in one eye
hand. ambidexterity (-dek-ster⬘ı̆-tē), n. and is associated with convergent
ambidextrously (-dek⬘strŭs-lē), adv. squint or very poor visual acuity.
Ambien (am⬘bē-ı̆n) SEE: zolpidem. strabismic a. Amblyopia secondary
ambient (am⬘bē-ĕnt) [L. ambiens, going to malalignment of the eyes. In this con-
around] On all sides; surrounding. dition the brain suppresses the visual
ambient temperature and pressure, sat- image from the deviating eye to prevent
urated ABBR: ATPS. In respiratory double vision. About 50% of childhood
physiology, the physical characteristics amblyopia is strabismic.
of a gas after its expiration from the air- toxic a. Amblyopia due to the effects
ways, as found at the barometric pres- of alcohol, tobacco, lead, drugs, or other
sure and temperature present in the toxic substances.
room in which the measurements are amboceptor unit (am⬘bō-sep⬙tŏr) [ambi-
made. The ATPS differs from the gas ⫹ (re)ceptor] The smallest quantity of
conditions at “body temperature and anti– red blood cell (anti-RBC) antibody
pressure, saturated” in that the temper- needed to hemolyze in an excess of com-
ature of the expired gas has decreased plement.
from body temperature to ambient tem- ambos (am⬘bos⬙) [Ger. Amboss, anvil]
perature. The expired gas remains fully Incus or anvil bone of the middle ear.
saturated with water vapor. SYN: at- Ambrosia (am-brō⬘zh(e-)ă) [Gr. ambro-
mospheric temperature and pressure, sia, immortality, the food of the Olym-
saturated. SEE: body temperature and pian gods] SEE: ragweed.
pressure, saturated. ambulance (am⬘byŭ-lăns) [ambulate] A
ambiguous (am-big⬘ū-ŭs) [L. ambiguus, vehicle for transporting the sick or in-
uncertain] 1. Having more than one jured. It is staffed with certified or li-
meaning. 2. In anatomy, difficult to clas- censed personnel and equipped with
sify, e.g., the genitalia of a newborn such out-of-hospital emergency supplies
whose sexual organs are difficult to dis- as are dictated by local or regional laws,
tinguish as a clitoris or a penis. e.g., adjunctive airway devices, band-
ambilateral (am⬙bi-lat⬘ĕ-răl) [ambi- ⫹ ages, defibrillator, patient-carrying de-
lateral] Pert. to both sides; bilateral. vices, and oxygen.
ambilaterally (am⬙bi-lat⬘ĕ-ră-lē), adv. ambulant, ambulatory (am⬘byŭ-lănt, -lă-
ambisexual (am⬙bi-seksh⬘ŭ-ăl) [ambi- tor⬙ē) [ambulate] Able to walk; not
⫹ sexual] Sexually attracted and re- confined to bed.
sponsive to both sexes. ambisexuality ambulate (am⬘byŭ-lāt⬙) [L. ambulare, to
(am⬙bi-sek⬙shŭ-al⬘ı̆t-ē), n. SEE: bisex- move about] To walk or move about
ual. freely. ambulation (am⬙byŭ-lā⬘shŏn), n.
ambivalence (am-biv⬘ă-lĕns) [ambi- ⫹ ambulatory blood pressure monitoring
L. valentia, strength] In psychology, co- The measurement with a portable blood
existence of contradictory feelings about pressure monitor of blood pressure of
an object, person, or idea. ambivalent outpatients. It is used to record the pa-
(am-biv⬘ă-lĕnt), adj. tient’s diastolic and systolic pressures
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ambulatory care sensitive


condition 93 amelioration

during activity and rest throughout the puted tomography); and positive sero-
day. logical tests for E. histolytica.
PATIENT CARE: The U.S. Preventive SYMPTOMS: Most infected patients
Services Task Force recommends that have no tissue invasion and are asymp-
ABPM be used as the reference stan- tomatic. Acute colitis, when it occurs, is
dard for confirming the diagnosis of marked by bloody diarrhea, abdominal
high blood pressure. It has been shown pain, tenesmus, and weakness. The
to correlate with the risk of stroke and symptoms may be confused with those
other adverse cardiovascular outcomes. of ulcerative colitis. The dysentery lasts
ambulatory care sensitive condition, am- 3 to 4 weeks. Complications occasionally
bulatory care-sensitive condition include toxic megacolon and ulcer per-
ABBR: ACSC. Any of the common foration. Patients who develop liver ab-
health problems that are frequent scesses present with severe upper right
causes of potentially avoidable hospital- quadrant pain and fever. Massive diar-
izations. Examples of ACSCs are rhea is not usually present.
asthma, chronic obstructive lung dis- TREATMENT: Asymptomatic pa-
ease, and heart failure. When these con- tients are treated with paromomycin
ditions are well managed by primary (500 mg orally tid for 7 days) or iodo-
care providers, rates of hospitalization quinol (650 mg orally tid for 20 days).
decline. Dysentery and liver abscess are treated
ambulatory difficulty Mobility disabil- with metronidazole (750 mg orally tid
ity. for 10 days), followed by iodoquinol (650
Ambulatory Payment Classification mg orally tid for 20 days).
ABBR: APC. A U.S. federal system for PATIENT CARE: People traveling to
grouping outpatient services provided developing countries, esp. India and
by hospitals according to similar costs Mexico, should avoid unboiled water,
and clinical indications. It is used by the ice, and fresh fruits and vegetables, all
Centers for Medicare and Medicaid Ser- of which may be infected with amebic
vices to set reimbursement rates for out- cysts.
patient care. SEE: Centers for Medicare hepatic a. Infection of the liver by E.
and Medicaid Services. histolytica, resulting in hepatitis and
Ambystoma mexicanum (am-bis⬘tŏ-mă abscess formation, and usually a sequel
mek⬙sı̆-kan⬘ŭm) SEE: axolotl. to amebic dysentery.
ameba Variant of amoeba. SEE: amoeba. amebic (ă-mē⬘bik) [Gr. amoibē, change
amebiasis (am⬙ĕ-bı̄⬘ă-sis) [ameba ⫹ ⫹ -ic] Caused by amoebas, e.g., “ame-
-iasis] Infection or colonization with bic dysentery.” SYN: amoebic (2).
amebas, esp. Entamoeba histolytica. amebicide, amebacide (ă-mē⬘bı̆-sı̄d⬙)
About 500 million people in tropical [ameba ⫹ -cide] An agent that kills
countries are infected. The infection amebas. amebicidal, adj. amebacidal
typically begins in the colon but may (-mē⬙bı̆-sı̄d⬘ăl), adj.
spread to other organs, e.g., the liver or, amebiform (ă-mē⬘bı̆-form⬙) [ameba ⫹
less often, the skin or lungs. SYN: ame- -form] Shaped like an ameba.
bic dysentery; amebic colitis. SEE: amebocyte, amoebocyte (ă-mē⬘bŏ-sı̄t⬙)
amoebapore; cyst; dysentery. [ameba ⫹ -cyte] In invertebrates such
ETIOLOGY: Amebiasis is acquired by as the horseshoe crab, a mobile cell that
ingesting contaminated food or drink moves like an amoeba. Among their
that contains E. histolytica cysts, which other functions, amebocytes behave like
gastric acid does not destroy. The cysts the white blood cells of vertebrates,
enter the intestines, where they release playing a role in the defense of the or-
trophozoites, the feeding form of the or- ganism against pathogens. SEE: ame-
ganism, which may invade the walls of bocyte; horseshoe crab; limulus amebo-
the colon or spread to the liver by the cyte lysate test.
portal vein. Trophozoites divide to form ameboid (ă-mē⬘boyd⬙) [ameba ⫹ -oid]
new cysts, which may subsequently be Resembling an ameba.
excreted in stool. ameboma (am⬙ē-bō⬘mă) [ameba ⫹
DIAGNOSIS: The diagnosis of amebi- -oma] A tumor composed of inflamma-
asis is based on the detection of cysts or tory tissue caused by amebiasis.
trophozoites of E. histolytica in stools amelanotic (ā⬙mel⬙ă-not⬘ik) [a- ⫹ mel-
and the presence of antibodies to the anotic] Lacking melanin; unpig-
amebas in the blood. Antiamebic anti- mented.
bodies appear by the seventh day of in- amelia (ă-mē⬘lē-ă) [a- ⫹ 1melo- ⫹ -ia]
fection. A colonoscopy may be performed Congenital absence of one or more
to obtain tissue samples to differentiate limbs. SEE: phocomelia.
amebiasis from inflammatory bowel dis- amelification (ă-mel⬙ı̆-fı̆-kā⬘shŏn) [Fr.
ease. A liver abscess is diagnosed when amel, enamel ⫹ L. facere, to make]
a patient has right upper quadrant Formation of dental enamel by amelob-
pain, jaundice, and fever; a mass in the lasts.
liver (found by ultrasonography or com- amelioration (ă-mēl⬙yŏ-rā⬘shŏn) [Fr.
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ameloblast 94 amenorrhea

amélioration] Improvement of a condi- diagnoses include metabolic disorders,


tion. ameliorate (-rāt⬙), v. e.g., diabetes, polycystic ovarian syn-
ameloblast (am⬘ĕ-lō-blast⬙) [Fr. émail, drome (PCOS), malnutrition, or obesity;
enamel ⫹ -blast] A cell from which emotional and stress-related disorders,
tooth enamel is formed. ameloblastic e.g., anorexia nervosa; and systemic dis-
(am⬙ĕ-lō-blas⬘tik), adj. eases, e.g., cancer, lupus, or tuberculo-
ameloblastoma (am⬙ĕ-lō-blas-tō⬘mă) sis.
[ameloblast ⫹ -oma] A benign, slow TREATMENT: The underlying cause
growing, locally aggressive tumor of the should be determined and corrected. If
jaws. It is most often found in the pos- hormone deficiencies exist, substitu-
terior mandible or ramus area and can tional therapy is recommended. Repro-
be involved with a dentigerous cyst. ductive age and need for contraception
SYN: adamantinoma. must also be considered for treatment.
amelogenesis (am⬙ĕ-lō-jen⬘ĕ-sis) [Fr. PATIENT CARE: The patient is as-
émail, enamel ⫹ -genesis] The for- sessed for other symptoms and is en-
mation of dental enamel by amelob- couraged to seek medical attention if ab-
lasts. sence of menses is not related to
a. imperfecta ABBR: AI. Any of sev- pregnancy, menopause, or hormonal
eral hereditary disorders that produce therapy.
inadequately mineralized enamel. dietary a. Amenorrhea in women of
There are four types of AI: hypoplastic, reproductive age due to inadequate nu-
hypocalcified, hypomaturation, and hy- trition.
poplastic-hypomaturation. The clinical emotional a. Amenorrhea resulting
appearances range from pitted enamel from shock, fright, or hysteria.
throughout the dentition, snow-capped exercise a. Amenorrhea due to phys-
incisal/occlusal thirds of the teeth (ex- ical stress. It is often seen in women
cept mandibular anteriors), and a yel- who participate in intensive workouts
low to brown pitted enamel. or exercise programs. SEE: stress a.
hyperprolactinemic a. Amenorrhea
due to an excessive secretion of prolac-
Acidulated phosphate fluoride may
tin by the pituitary. SEE: prolactin.
further damage enamel in patients
hypothalamic a. Amenorrhea re-
with amelogenesis imperfecta.
lated to interference with release of go-
nadotropin-releasing hormone (GnRH)
SYMPTOMS: Symptoms include or with pituitary release of follicle-stim-
enamel that may be pitted, local, ulating hormone or luteinizing hor-
smooth, rough, or lacking. Enamel may mone. Hypothalamic dysfunction may
also be of normal thickness but poorly be drug-induced, e.g., related to abuse of
calcified or with a mottled appearance. marijuana or tranquilizers; psycho-
amelus (am⬘ĕ-lŭs) [a- ⫹ 1mel-] An in- genic, e.g., related to chronic anxiety;
dividual with congenitally absent arms functional, e.g., related to excessive ex-
and legs. ercise, anorexia, or obesity; or related to
amenity (ă-men⬘ı̆t-ē) [L. amoenitas, chronic medical illness, head injuries, or
pleasantness] In medicine, an element cancer.
of health care delivery that increases lactational a. Amenorrheas resulting
patient satisfaction whether or not it from breast-feeding.
improves clinical outcomes. pathological a. Amenorrhea due to
amenorrhea (ā⬙men⬙ŏ-rē⬘ă) [1an- ⫹ organic damage, disease, or dysfunc-
meno- ⫹ -rrhea] Absence of menstru- tion. Common causes include hypotha-
ation or menarche. Amenorrhea may be lamic-pituitary dysfunction; ovarian
either primary (a failure to begin men- dysfunction; alteration or obstruction of
struating by age 16), or secondary (an the genital outflow tract; congenital ab-
absence of menstruation for more than normalities; neoplasms; and injuries.
3 months in women who used to men- Disease-related amenorrheas include
struate and who are not pregnant). Ascherman syndrome, Savage syn-
Amenorrhea may be classed as physio- drome, Sheehan syndrome, and Turner
logical when it occurs during pregnancy, syndrome.
during early lactation, or after meno- physiological a. Amenorrhea due to
pause or is caused by medications, e.g., normal body function. The amenorrhea
by some forms of hormonal contracep- may be due to immaturity in the pre-
tion. Pathological, secondary, amenor- pubescent girl, aging in the postmeno-
rhea is caused by several conditions. pausal woman, or hormonal interrup-
amenorrheic (ā⬙men⬙ŏ-rē⬘ı̆k), adj. tions in the gonadotropic feedback loop
ETIOLOGY: The primary causes of as occur during pregnancy and lacta-
secondary amenorrhea are related ei- tion; it is not related to organic disease.
ther to an underlying hypothalamic-pi- postpartum a. Amenorrhea follow-
tuitary-endocrine dysfunction or to con- ing childbirth. The amenorrhea may
genital or acquired abnormalities of the last for only a month or two and thus be
reproductive tract. Common abnormal within normal limits, or it may be per-
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American Federation for Aging


amenorrhea 95 Research

manent and therefore abnormal. piratory therapists, and physicians who


NOTE: The onset of menstruation after aim to improve the health and survival
childbirth may be delayed by continued of patients with cardiovascular and lung
breast-feeding. SEE: Sheehan syn- diseases.
drome. American Association of Diabetes Edu-
post-pill a., postpill a. Amenorrhea cators ABBR: AADE. A multidiscipli-
after stopping contraceptive therapy. nary association dedicated to empow-
primary a. Delay of menarche until ering health care professionals with the
after age 16 or the absence of secondary knowledge and skills to provide diabe-
sex characteristics after age 14. Typical tes education, management, and sup-
causes include congenital abnormalities port.
of reproductive structures, e.g., the mül- American Association for Clinical Chem-
lerian ducts; absence of the uterus and/ istry ABBR: AACC. A U.S.-based in-
or vagina; imperforate hymen; or ovar- ternational association of clinical labo-
ian failure secondary to chromosomal ratory scientists including clinical
abnormalities, as in Turner’s syndrome. chemists, microbiologists, pathologists,
secondary a. Amenorrhea in women hematologists, and medical technolo-
who have menstruated previously but gists.
have not had a period in 6 months. Preg- American Association for Respiratory
nancy is the single most common cause Care ABBR: AARC. The professional
of secondary amenorrhea and should be association for respiratory care practi-
excluded before other causes are sought. tioners in the U.S.
stress a. Amenorrheas secondary to American Association of Retired Persons
extreme mental or physical stress. The ABBR: AARP. The largest voluntary
condition was first identified in women association of older adults (retired or
inmates in concentration camps and has not) in the U.S., with a membership of
been observed in female athletes under- more than 30 million. The association
going intensive, rigorous training. It lobbies on behalf of its members, spon-
may be related to hormonal changes sors research on aging, operates a mail-
caused by stress or to the concomitant order pharmaceutical service and insur-
alteration in the ratio of muscle to fat as ance plan, and publishes magazines and
training intensity increases. SEE: pseu- other literature for older adults.
docyesis. American Board of Internal Medicine
amentia (ā⬙men⬘ch(ē-)ă) [L. amentia, ABBR: ABIM. The professional over-
madness, insanity] 1. Congenital men- sight group in the U.S. that sets the
tal deficiency; mental retardation. standards for the training and profes-
2. Mental disorder characterized by con- sional certification of internists and
fusion, disorientation, and occasionally subspecialists in internal medicine.
stupor. SEE: dementia. American Botanical Council ABBR:
nevoid a. Sturge-Weber syndrome. ABC. A nonprofit organization that dis-
phenylpyruvic a. Mental retardation seminates information about herbal
due to phenylketonuria. medicines to the media, the public, and
American Academy of Nurse Practition- the scientific and professional commu-
ers A national professional advocacy nities. ABC publishes HerbalGram, a
group that represents the interests of quarterly journal, and other reference
nurse practitioners in the U.S. website: material.
www.aanp.org American College of Rheumatology
American Academy of Nursing An or- ABBR: ACR. An organization of health
ganization formed by the American care professionals and scientists whose
Nurses’ Association. Membership in primary goals are to study and treat ar-
this honorary association indicates that thritis and other diseases of bones and
the person selected has contributed sig- joints. The organization also educates
nificantly to nursing. A member is titled the public and the profession about
Fellow of the American Academy of rheumatological diseases and works as
Nursing, abbreviated FAAN. an advocate in the formulation of public
American Academy of Sleep Medicine A policy concerning the care of rheumatic
professional society for specialists in and arthritic patients.
sleep medicine. American College of Sports Medicine An
American Association of Blood Banks organization that promotes and inte-
ABBR: AABB. The professional orga- grates scientific research, education,
nization, more commonly referred to as and practical applications of sports
the AABB, whose mission is to promul- medicine and exercise science to main-
gate standard practices in immunohe- tain and enhance physical performance,
matology. fitness, health, and quality of life.
American Association of Cardiovascular American College of Toxicology The cur-
and Pulmonary Rehabilitation A pro- rent name of the American Board of
fessional association made up of a net- Medical Toxicology. Website: http://
work of nurses, exercise physiologists, www.actox.org/
nutritionists, physical therapists, res- American Federation for Aging Research
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American Geriatrics Society 96 American Standard Safety System

ABBR: AFAR. An association of phy- improve mental health care for individ-
sicians, scientists, and other individuals uals, families, groups, and communi-
involved or interested in research on ties; and shape health policy for the de-
biological aging and associated dis- livery of mental health services.
eases. Its purpose is to encourage and American Red Cross A branch of the in-
fund research on aging. ternational philanthropic organization
American Geriatrics Society ABBR: Red Cross Society. It provides emer-
AGS. An association of health care pro- gency aid during civil disasters such as
fessionals interested in the problems of floods and earthquakes, offers humani-
older adults. It encourages the study of tarian services for armed forces person-
geriatrics and stresses the importance nel and their families, and operates cen-
of medical research in the field of aging. ters for collecting and processing blood
American Health Information Manage- and blood products.
ment Association ABBR: AHIMA. A American Sign Language ABBR: ASL.
professional organization for the man- A nonverbal method of communicating
agement of medical records. AHIMA of- in which the fingers, hands, facial ex-
fers seven credentials in four areas of pressions, and body postures are used to
practice: health information manage- indicate words and concepts. SYN: Am-
ment, coding, data analysis, and pri- eslan.
vacy. Two credentials require formal ed- American Society of Clinical Oncology
ucation; the other credentials are ABBR: ASCO. A not-for-profit profes-
acquired by testing and work experi- sional organization of physicians who
ence. AHIMA requires regular continu- treat cancer. The group includes medi-
ing education of its members to main- cal, radiological, and surgical oncolo-
tain their credentials. Website: gists. Website: www.asco.org
www.ahima.org American Society for Biochemistry and
American Nurses Association ABBR: Molecular Biology ABBR: ASBMB. A
ANA. The only full-service professional nonprofit organization composed of sci-
organization representing the 3.1 mil- entists and educators who seek to ad-
lion registered nurses in the U.S. It vance the sciences of biochemistry and
comprises 53 State Nurses Associations. molecular biology. Website: http://
The organization fosters high standards asbmb.org/
of nursing practice, promotes the eco- American Society for Clinical Pathology
nomic and general welfare of nurses in ABBR: ASCP. A professional, educa-
the work environment, projects a real- tional, and advocacy group for patholo-
istic, positive view of nursing, and lob- gists, clinical laboratory scientists, and
bies Congress and regulatory agencies technologists. Website: http://ascp.org/
about health care issues affecting American Society of Hematology ABBR:
nurses and the public. SEE: Code for ASH. An organization of professional
Nurses. hematologists that provides care to pa-
American Nurses Association Network tients with diseases of the blood and
ABBR: ANA*NET. A wide-area com- promotes education, research, and
puter network linking the 53 constitu- training within the field. ASH also
ent State Nurses Associations with the serves as an advocacy group for the pro-
national headquarters. It provides da- fession.
tabases pert. to workplace and practice American Speech-Language Hearing As-
issues and various databases and ser- sociation ABBR: ASHA. A profes-
vices related to nursing practice. Future sional association for speech and/or lan-
plans include subscriber service for all guage pathologists, audiologists, and
nurses, nursing organizations, and speech, language, and hearing scien-
nursing schools. tists in the U.S. and abroad. Its mission
American Occupational Therapy Associ- is to promote the professional interests
ation ABBR: AOTA. A national pro- of and provide services to professionals
fessional organization concerned with in audiology, speech and/or language
establishing and promoting education, pathology, and to advocate for those
research, and standards of practice for with communication disabilities.
occupational therapy. The website is American Standard Safety System
http://www.aota.org ABBR: ASSS. Any of the specifications
American Physical Therapy Association that govern the manufacture and use of
ABBR: APTA. The national profes- threaded systems that link high-pres-
sional association that establishes and sure, medical gas cylinders and the
promotes standards of practice for phys- pressure-reducing valves that release
ical therapists and physical therapist the gases for clinical use to the patient.
assistants. The website is http:// ASSS specifications differ for each type
www.apta.org of medical gas in order to prevent med-
American Psychiatric Nurses Association ical errors, for example, to keep users
ABBR: APNA. An organization that from administering nitrogen or carbon
provides leadership to advance psychi- dioxide to a patient for whom oxygen
atric-mental health nursing practice; has been prescribed.
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Americans with Disabilities Act 97 amino acid

( 9 OH) group of the 9 COOH by the


Whenever gases, e.g., anesthetics, 9 NH2 group.
nebulized medications, oxygen are amidin (am⬘ı̆-din) [L. amidum, amylum,
administered to patients, care should be starch ⫹ -in] The soluble component
taken to definitively identify the source of starch. SEE: amylopectin.
gas and to monitor its concentration and amido- Prefix indicating the presence of
flow rate. the radical CONH2.
amikacin sulfate (am⬙ı̆-kā⬘sı̆n) An ami-
Americans with Disabilities Act ABBR: noglycoside antibiotic.
ADA. Legislation passed by the U.S. amimia (ā⬙mim⬘ē-ă) [a- ⫹ mimos, a
Congress in 1990 and amended in 2008 mime, actor ⫹ -ia] Loss of power to
to ensure the rights of persons with dis- express ideas by signs or gestures.
abilities and to prohibit discrimination amnesic a. Loss of the ability to ex-
on the basis of disability in employment, press oneself with signs or gesturesor to
public services, transportation, public understand them.
accommodation, communications, state amine (ă-mēn⬘, am⬘ēn⬙) [am(monium)
and local governments, and the U.S. ⫹ -ine] Any of a group of nitrogen-con-
Congress. An individual with a disabil- taining organic compounds formed
ity is defined by ADA as one who has a when one or more of the hydrogens of
physical or mental impairment that ammonia have been replaced by one or
limits one or more major activities, a more hydrocarbon radicals.
person with a history or record of an im- biogenic a. An amine such as nor-
pairment, or a person perceived by oth- epinephrine, histamine, serotonin, or
ers to have such an impairment. Also dopamine, that is important in neuro-
called Public Law 101-336. transmission.
American Type Culture Collection amino- [Fr. amine] Prefix meaning the
presence of an amino group (NH2).
ABBR: ATCC. A nonprofit scientific or-
amino acid (ă-mē⬘nō) [amino-] Any of a
ganization dedicated to maintaining
large group of organic compounds
collections of microorganisms and other
marked by the presence of both an
biological resources for use in academic,
amino (NH2) group and a carboxyl
governmental, or industrial laborato- (COOH) group. Amino acids are the
ries. The ATCC also provides educa- building blocks of proteins and the end
tional and technical support about mi- products of protein digestion.
crobiology and biological resources. Approximately 80 amino acids are
Phone: 703– 365– 2700. found in nature, but only 20 are nec-
americium (a⬙mĕ-ris(h)⬘ē-ŭm) [America essary for human metabolism or
⫹ -ium] SYMB: Am. A metallic radio- growth. Of these, some can be pro-
active element, atomic weight (mass) duced by the liver; the rest, the “‘es-
(longest-lived isotope) 243, atomic num- sential’ amino acids,” must be sup-
ber 95. plied by food. Oral preparations of
Ameslan (a⬘mĕs-lan⬙) American Sign amino acids may be used as dietary
Language. supplements.
Ames test (āmz) [Bruce Nathan Ames, Arginine is nonessential for adults
U.S. biochemist, b. 1928] A laboratory but cannot be formed quickly enough to
test of the mutagenicity of chemicals. supply the demand in infants and thus
Special strains of organisms are incu- is classed as essential in early life.
bated with the test chemical, and their Some proteins containing all the es-
growth is an indicator of the mutagenic- sential amino acids are called complete
ity of the substance. Most chemicals proteins. Examples are milk, cheese,
that test positive are carcinogens. Use eggs, and meat. Proteins that do not
of the test has helped reduce the use of contain all the essential amino acids are
mammals for tests of mutagenicity. called incomplete proteins. Examples
ametria (ā⬙mē⬘trē-ă) [a- ⫹ metra- ⫹ are vegetables and grains. Amino acids
-ia] Congenital absence of the uterus. pass unchanged through the intestinal
ametropia (am⬙ĕ-trō⬘pē-ă) [Gr. ametros, wall into the blood, then through the
disproportionate ⫹ -opia] Imperfect portal vein to the liver and into the gen-
refractive powers of the eye in which the eral circulation, from which they are ab-
principal focus does not lie on the retina, sorbed by the tissues according to the
as in hyperopia, myopia, or astigma- specific amino acid needed by that tis-
tism. ametropic (am⬙ĕ-trō⬘pik), adj. sue to make its own protein. Amino ac-
AMI acute myocardial infarction. ids, if not otherwise metabolized, may
amidase (am⬘ı̆-dās⬙) [amide ⫹ -ase] be converted into urea. SEE: deamini-
An enzyme that catalyzes the hydroly- zation; digestion; protein.
sis of amides; a deamidizing enzyme. branched-chain a.a. ABBR: BCAA.
amide (am⬘ı̄d⬙) [am(monia) ⫹ -ide] The essential amino acids, leucine, iso-
Any organic substance that contains the leucine, and valine. “Branched-chain”
monovalent radical 9 CONH2. It is usu- refers to their chemical structure. They
ally formed by replacing the hydroxyl are therapeutically valuable because
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amino acid 98 amitriptyline hydrochloride

they bypass the liver and are available aminophylline (am⬙ı̆-nof⬘ı̆-lı̆n) [amino-
for cellular uptake from the circulation. ⫹ Gr. phyllon, plant ⫹ -ine] A mix-
Parenteral administration, alone or ture of theophylline and ethylenediam-
mixed with other amino acids, is ine. It is used to treat patients with
thought to be beneficial whenever ca- reactive airway disease that does not re-
tabolism due to physiological stress oc- spond to safer medications, e.g., beta-
curs. Skeletal muscles use BCAAs for agonist drugs, other bronchodilators, or
their anticatabolic effects. inhaled or injected corticosteroids. Be-
conditionally dispensable a.a. An sides stimulating diaphragmatic move-
amino acid that becomes essential un- ment, it is a bronchodilator and in-
der specific clinical conditions, e.g., creases heart rate. Common side effects
when their rate of synthesis is lim- include gastrointestinal upset and
ited. tachycardia. Aminophylline counteracts
essential a.a. An amino acid that is the effect of adenosine. SYN: theophyl-
required for growth and development line ethylenediamine.
but that cannot be produced by the body aminopterin (am-ı̆-nop⬘tĕr-ı̆n) A folic
and must be obtained from food. The es- acid antagonist used to treat acute leu-
sential amino acids are histidine, isoleu- kemia.
cine, leucine, lysine, methionine, cyste- aminopurine (ă-mē⬙nō-pū⬘rı̆n, ăm⬙ı̆-nō)
ine, phenylalanine, tyrosine, threonine, [amino- ⫹ purine] An oxidation prod-
tryptophan, and valine. SYN: indispens- uct of purine. It includes adenine and
able a.a. guanine. SEE: methyl purine; oxypu-
indispensable a.a. Essential amino rine.
acid. aminotransferase (ă-mē⬙nō-trans⬘fĕ-rās⬙)
nonessential a.a. An amino acid [amino ⫹ transferase] An enzyme that
that can be produced by the body and transfers an amino group from one mol-
is not required in the diet. The non- ecule to another. Aminotransferases,
essential amino acids are alanine, as- e.g., aspartate aminotransferase and al-
partic acid, arginine, citrulline, glu- anine aminotransferase, are important,
tamic acid, glycine, hydroxyglutamic frequently measured liver enzymes.
acid, hydroxyproline, norleucine, pro- SEE: transaminase.
line, and serine. alanine a. ABBR: ALT. An intracel-
semi-essential a.a. An amino acid of lular enzyme involved in amino acid and
which an adequate amount must be con- carbohydrate metabolism. It is present
sumed in the diet to prevent the use of in high concentrations in muscle, liver,
essential amino acids to synthesize it. and brain. An increased level of ALT in
An example is tyrosine. Without ade- the blood indicates necrosis or disease
quate dietary intake, the essential in these tissues. Its measurement is
most commonly used as part of the dif-
amino acid phenylalanine is used to
ferential diagnosis of liver disease and
make tyrosine.
in tracking the disease. SYN: glutamic-
aminoacidemia (ă-mē⬙nō-as⬙ı̆-dē⬘mē-ă,
pyruvic transaminase; serum glutamic-
ăm⬙ı̆-nō-) [amino acid ⫹ -emia] An
pyruvic transaminase.
excess of amino acids in the blood.
aspartate a. ABBR: AST. An intra-
aminoacidopathy (am⬙ı̆-nō-as⬙ı̆-dop⬘ă- cellular enzyme involved in amino acid
thē) [amino acid ⫹ -pathy] Any of and carbohydrate metabolism. It is
about 100 disorders of amino acid me- present in high concentrations in mus-
tabolism, including cystinuria, alkap- cle, liver, and brain. An increased level
tonuria, and albinism. of this enzyme in the blood indicates ne-
aminoaciduria (ă-mē⬙nō-, ă-mē⬙nō-a⬙sı̆- crosis or disease in these tissues. SYN:
doo⬘rē-ă) [amino acid ⫹ -uria] An ex- glutamic-oxaloacetictransaminase.
cess of amino acids in the urine. amiodarone (ă-mē-ō⬘dă-rōn⬙) An anti-
aminobenzene (ă-mē⬙nō-ben⬘zēn, ăm⬙ı̆- arrhythmic drug with a complex phar-
nō-, ben-zēn⬘) Aniline. macology that is effective in the treat-
aminoglycoside (ă-mē⬙nō-glı̄⬘kŏ-sı̄d⬙) ment of both atrial and ventricular
[amino- ⫹ glycoside] Any of a class of rhythm disturbances. Its side effects in-
antibiotics derived from Streptomyces clude pulmonary fibrosis and thyroid
that prevent bacterial cells from making dysfunction.
proteins necessary for their survival. amitosis (ā⬙mı̄-tō⬘sis) [a- ⫹ mitosis]
Examples include gentamicin and to- Simple division of the nucleus and cell
bramycin. without formation of a mitotic spindle;
direct cell division. amitotic (ā⬙mı̄-
tot⬘ik), adj.
Monitoring of drug levels is re- amitriptyline hydrochloride (am⬙ı̆-trip⬘
quired during the use of parenteral tı̆-lēn⬙) [am(ino)- ⫹ trypt(ophan) ⫹
aminoglycosides because they may cause (meth)yl ⫹ -ine] A tricyclic antide-
permanent hearing loss and kidney dam- pressant administered orally or intra-
age. muscularly. Common side effects are
drowsiness, sedation, and dry mouth.
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AML 99 amnesia

AML acute myelocytic leukemia. SYN: anterograde memory; anterograde


amlodipine (am-lō⬘dı̆-pēn⬙) A calcium memory loss.
channel blocker and antihypertensive, dissociative a. Amnesia for impor-
administered orally to control high tant personal information, usually of a
blood pressure, angina pectoris, and traumatic or stressful nature, that is too
variant angina. extensive to be explained by ordinary
AMLS Advanced medical life support. forgetfulness. SYN: psychogenic amne-
ammeter (am⬘mēt-ĕr) [am(pere) ⫹ sia.
-meter] An instrument, calibrated in post-traumatic a. ABBR: PTA. Am-
amperes, that measures the quantity nesia, agitation, and confusion affecting
(number of electrons) in an electric cur- a patient with traumatic brain injury
rent. SEE: milliammeter. (TBI) soon after the injury or on awak-
Ammi visnaga (am⬘ē vis-nag⬘ă) A peren- ening from coma. Edema, hemorrhage,
nial herb with a taproot, related to contusions, shearing of axons, and
Queen Anne’s lace, used in traditional metabolic disturbances impair the abil-
Egyptian medicine as a diuretic and ity of the brain to process information
treatment for kidney stones. It is also accurately, resulting in unusual behav-
used as a coronary vasodilator but is iors that are often difficult to manage.
poorly tolerated when given orally. Trauma patients with normal brain
Compounds developed from its furan scans may have mild TBI and display
ring include amiodarone (an antiar- some of the symptoms of PTA. Post-
rhythmic drug). traumatic amnesia can last for months
ammonia (ă-mōn⬘yă) [L. sal ammoni- but usually resolves within a few weeks.
acum, ult. fr. Ammon, Egyptian deity During PTA, the patient moves from a
near whose temple it was originally ob- cognitive level of internal confusion to a
tained] An alkaline gas, NH3, formed level of confusion about the environ-
by decomposition of nitrogen-containing ment. SEE: Rancho Los Amigos Guide
substances such as proteins and amino to Cognitive Levels.
acids. Ammonia is converted into urea SYMPTOMS: Symptoms include rest-
in the liver. It is related to many poison- lessness, moaning or crying out, unin-
ous substances but also to the proteins hibited behavior (often sexual or angry),
and many useful chemicals. Dissolved hallucinations (often paranoid), lack of
in water, it neutralizes acids and turns continuous memory, confabulation,
litmus paper blue. combative behavior, confused language,
blood a. SEE: ammoniemia. disorientation, perseveration, and sleep
ammoniacal (am⬙ŏ-nı̄⬘ă-kăl) Pert. to or disturbances. Problem-solving ability,
having the characteristics of ammonia. reasoning, and carrying out planned
ammoniated (ă-mō⬘nē-āt⬙ĕd) Contain- motor movements (as in activities of
ing ammonia. daily living) may also be impaired.
ammoniemia, ammonemia (ă-mō⬙nē- PATIENT CARE: The patient is con-
ē⬘mē-ă, ă-mō-nē⬘mē-ă) [ammonia ⫹ tinually reoriented by a large calendar
-emia] Excessive ammonia in the and clock within sight; each interaction
blood. Normally, only faint traces of with the patient begins with a repeti-
ammonia are found in the blood. In- tion of who is in attendance, why the at-
creased amounts are due to a patho- tendant is present, and what activity is
logical condition such as impaired planned; and the patient is kept safe
liver function. and comfortable and is allowed as much
amnesia (am-nē⬘zhă) [Gr. amnēsia, am- freedom of movement as possible.
nēstia, oblivion, forgetfulness] Loss of As the patient becomes confused, he
memory, whether partial, total, perma- or she may show agitation. Health care
nent, or transient. The term is often ap- professionals can limit agitation and
plied to episodes during which patients confusion by speaking softly in simple
forget recent events although they may phrases, using gestures as necessary,
conduct themselves appropriately, and and allowing time for the patient to re-
after which no memory of the period spond. Regular visits from family are
persists. Such episodes are often caused important; the family should be pre-
by strokes, seizures, trauma, senility, pared for the patient’s appearance and
alcoholism, or intoxication. The cause is behavior; they should be encouraged to
often unknown. help the patient with activities of daily
anterograde a. Amnesia for events living.
that occurred after a precipitating event Equipment for agitated patients is
or medication. used; wrist restraints are avoided if pos-
sible. Urinary catheters may increase
agitation due to physical discomfort (in-
Short-term memory loss may be in- continence briefs can be used during the
duced in people who use benzodi- training period of a toileting program).
azepine drugs (such as triazolam, loraze- The patient’s swallowing function is
pam, or flurazepam). evaluated as soon as possible to avoid
feeding tubes, but swallowing precau-
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amnesia 100 amnioinfusion

tions are observed. A list of stimulations amniocentesis (am⬙nē-ō-sen-tē⬘sı̆s)


that increase or decrease the patient’s [amnion ⫹ -centesis] Transabdominal
agitation is posted for the use of every- puncture and aspiration of the amniotic
one in contact with the patient. Dis- sac by ultrasound to remove amniotic
tance is maintained during aggressive fluid. The sample is studied chemically
outbursts. The patient’s personal space and cytologically to detect genetic and
should not be invaded without warning, biochemical disorders and maternal-fe-
e.g., the patient should be told in ad- tal blood incompatibility and, later in
vance that his or her body parts are go- the pregnancy, to determine fetal ma-
ing to be touched or washed. The patient turity. The procedure also allows for
should be approached from the front, transfusion of the fetus with platelets or
and items should be placed where the blood and instillation of drugs for treat-
patient can best see them. ing the fetus.
Health care professionals should This procedure is usually performed
watch closely for impulsive movement no earlier than at 14 weeks’ gestation.
that can jeopardize the patient. They It is important that the analysis be done
should warn others that the patient by experts in chemistry, cytogenetics,
cannot monitor his or her own behavior and cell culture. Cell cultures may re-
and that words and actions may occur quire 30 days, and, if the test has to be
without awareness or forethought. In- repeated, the time required may be in-
dependent behavior and self-care are sufficient to allow corrective action.
encouraged. The patient is engaged in SEE: illus.
short activities with a motor compo-
nent. One action at a time should be
The procedure can cause abortion
monitored if the patient performs sev-
or trauma to the fetus.
eral actions that interfere with treat-
ment. To promote abstract reasoning,
humor should be used if the patient un- PATIENT CARE: The patient’s knowl-
derstands it. A consistent daily schedule edge about the procedure is evaluated,
provides structure. The patient is misconceptions corrected, and informa-
taught to use compensatory cues (a tion provided as necessary. The patient
watch or written activity schedule) to is informed about sensations that she
aid memory. The patient is also as- may experience and signs a consent
sessed for posttraumatic headache, form. The amniocentesis equipment is
which is treated with prescribed medi- assembled; amber-colored test tubes are
cations. used (or clear test tubes covered with
psychogenic a. Dissociative a. aluminum foil) to shield the fluid from
retrograde a. Amnesia for events light, which could break down bilirubin.
that occurred before a specific precipi- Baseline vital signs and fetal heart rate
tating event (such as a drug overdose, are obtained, and the fundus is palpated
surgical operation, stroke, or trauma). for fetal position and fetal and uterine
SYN: retrograde memory. activity for 30 min before, during, and
selective a. Amnesia for events that 30 min after the procedure. The patient
occurred at the same time as other ex- is assessed for light-headedness, nau-
periences that are recalled. sea, and diaphoresis as well as for anx-
transient global a. Short-term am- iety, pain, and labor onset. During the
nesia in otherwise healthy people. Re- procedure, emotional support is pro-
mote memory is retained. vided. After the procedure, the patient
traumatic a. Amnesia caused by sud- is positioned on her left side and is in-
den injury to the brain. structed to report unusual fetal hyper-
amnesiac, amnesic (am-nē⬘z(h)ē-ak⬙, activity or hypoactivity, clear or bloody
am-nē⬘zik) 1. Pert. to, affected with, or vaginal drainage, uterine contractions,
caused by amnesia. 2. A person who has abdominal pain, or fever and chills, any
amnesia. of which is indicative of complications.
amnestic (am-nes⬘tik) 1. A drug that im- Rh-negative women with an Rh-positive
pairs memory. 2. Pert. to, or caused by, fetus should be given RhoGam. SEE:
amnesia. chorionic villus sampling.
amnestic disorder (am-nes⬘tik) Any of a therapeutic a. Amniodrainage.
group of disorders marked by memory amniochorial, amniochorionic (am⬙nē-ō-
disturbance that is due either to the di- kō⬘rē-ăl, -kō-rē-on⬘ik) Pert. to both the
rect physiological effects of a general amnion and chorion.
medical condition or to the persistent ef- amniogenesis (am⬙nē-ō-jen⬘ĕ-sı̆s) [am-
fects of a drug, toxin, or similar sub- nion ⫹ -genesis] Formation of the am-
stance. Affected patients are unable to nion.
recall previously learned information or amnioinfusion (am⬙nē-ō-in-fū⬘zhŏn)
past events. Social or occupational func- The instillation of fluid, usually normal
tioning is significantly impaired. saline, into the amniotic sac to increase
amnestic syndrome (am-nes⬘tik) Wer- the amniotic fluid volume. This is usu-
nicke encephalopathy ally done after rupture of membranes,
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amnion 101 amniote

Centrifuge Amniotic
fluid
Biochemical
analysis

Fetal cells

Ultrasound
Amniotic fluid Cell culture
monitor
Amniotic fluid

Urinary DNA and


bladder chromosome
Placenta
analysis

Vagina

AMNIOCENTESIS

with a catheter passed through the cer- lamb] The innermost fetal membrane.
vix into the uterus. It is a thin, transparent sac that holds
INDICATIONS: The main indication the fetus suspended in amniotic fluid.
for amnioinfusion is the treatment of The amnion grows rapidly at the ex-
repeated severe variable decelera- pense of the extraembryonic coelom,
tions and fetal bradycardia unrespon- and by the end of the third month it
sive to conventional therapies. It may fuses with the chorion, forming the am-
also be used to reduce the risk of me- niochorionic sac. SYN: bag of waters.
conium aspiration syndrome in labors amniotic (am⬙nē-ot⬘ik), adj. SEE: oli-
where thick meconium fluid is noted gohydramnios.
or to protect against cord compression a. nodosum A mass of rounded or
due to oligohydramnios. There is con- oval opaque elevations in the placenta,
troversy whether the benefits of per- 1 to 6 mm in diameter, seen in the part
forming this procedure outweigh the of the amnion in contact with the cho-
risks in the latter two cases. Several rionic plate and near the insertion of the
other clinical applications are being cord into the placenta. They are usually
investigated. associated with prolonged oligohydram-
CONTRAINDICATIONS: Contraindi- nios.
cations include amnionitis, known fetal amnionitis (am⬙nē-ō-nı̄⬘tis) Chorioam-
or uterine anomaly, placenta previa or nionitis.
abruption, severe fetal distress, poly- amnioscope (am⬘nē-ŏ-skōp⬙) [amnion
hydramnios, hypertonic uterus, and ⫹ -scope] An endoscope for observing
multiple gestation. the fetus and amniotic fluid through the
COMPLICATIONS: Complications are intact amniotic membrane.
rare but include uterine overdistention amnioscopy (am⬙nē-os⬘kŏ-pē) Direct vi-
and increased uterine resting tone, am- sual examination of the fetus through
niotic fluid embolus, umbilical cord pro- an endoscope inserted into the amniotic
lapse, and disruption of a previous uter- cavity.
ine scar. amniote (am⬘nē-ōt⬙) [amnion] Any of
PATIENT CARE: Consult local proto- the vertebrate group Amniota, compris-
cols for amnioinfusion because these ing reptiles, birds, and mammals,
vary from hospital to hospital. whose members develop an amnion.
amnion (am⬘nē-on⬙, -ŏn) [Gr. amnion, amniotic band disruption sequence syn-
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amniotic band disruption


sequence syndrome 102 amphetamine

drome (am⬙nē-ot⬘ik) Any of several fe- e.g., Entamoeba. It has pseudopodia, by


tal malformations associated with mul- which it constantly changes its shape.
tiple fibrous strands of amnion that Oxygen and carbon dioxide are ex-
appear to develop or entangle fetal changed by simple diffusion through the
parts in utero. The disrupted sequence cell membrane. Reproduction is by bi-
leads to structural malformations and nary fission. Some species of Entamoeba
deformations and disruption of func- are parasitic in humans.
tion. The defects include limb defects SEE: Amoeba.
and amputations; abnormal dermal amoebapore, amebapore (ă-mē⬘bă-por⬙)
ridge patterns; simian creases; clubbed [amoeba ⫹ pore] A family of three
feet; craniofacial defects, including cleft pore-forming peptides (amoebapore A
lip and palate; and visceral defects such [AP-A], AP-B, and AP-C). They insert
as gastroschisis and omphalocele. Fail- into the membranes of bacteria or eu-
ure to understand the cause of this con- karyotic cells and form tiny holes that
dition can lead to misdiagnosis and in- result in lysis of the target cells.
appropriate family and genetic amoebic (ă-mē⬘bik) [amoeba ⫹ -ic]
counseling. SEE: multiple malforma- 1. Pert. to or resembling an amoeba.
tion syndrome. 2. Amebic.
amniotitis (am⬙nē-ŏ-tı̄t⬘ı̆s) Chorioam- amok, amuck (ă-mok⬘, ă-mŭk⬘) [Malay,
nionitis. āmok, to engage furiously in battle]
amniotomy (am⬙nē-ot⬘ŏ-mē) [amnion 1. A culture-bound, one-time outburst of
⫹ -tomy] The intentional rupture of murderous frenzy observed chiefly in
the amniotic sac with a sterile amnio- Malaysia. 2. Pert. to or being in a mur-
hook, Allis’ forceps, or amniotome to derous frenzy. 3. Pert. to or being in an
stimulate or augment labor. SYN: arti- uncontrolled state.
ficial rupture of membranes. amotivational syndrome (ā⬙mōt⬙ı̆-vā⬘
PATIENT CARE: The procedure is ex- shŏn-ăl) [1an- ⫹ motivational] Lack
plained to the patient. The patient is po- of interest in activities, reduced atten-
sitioned and draped correctly, and the tion and concentration, apathy, and
perineum is thoroughly cleaned. Before passivity. It has been reported in asso-
the procedure, baseline information is ciation with some neuropsychiatric dis-
obtained on fetal heart rate (FHR) and orders, e.g., depression, schizophrenia,
uterine contractions, which are moni- and traumatic brain injury, and with
tored during and after the procedure. use of drugs, e.g., marijuana and selec-
Immediately after the amniotomy, the tive serotonin reuptake inhibitors.
FHR is auscultated, or the electronic re- amotosalen C17H20ClNO4, a synthetic
cording of FHR is checked because the psoralen compound used with ultravio-
procedure increases the risk of cord let light to inactivate potential patho-
compression or prolapse. The color, gens in donated blood components.
odor, consistency, and approximate amoxicillin (ă-moks⬙ı̆-sı̆l⬘ı̆n) A semisyn-
amount of amniotic fluid expelled are thetic penicillin used primarily to treat
assessed and documented. If any ques- infections of the sinuses and the middle
tion exists as to its origin (amniotic fluid ear.
versus urine), the pH of the fluid is Amoxil (ă-mok⬘sı̆l) SEE: amoxicillin.
tested with nitrazine paper, which will AMP adenosine monophosphate
turn blue in the presence of amniotic amperage (am⬘pĕ⬘răj, am-pēr⬘ăj) The
fluid. Bloody show or insufficient amni- rate of flow of electrons in an electrical
otic fluid can cause a false test result. circuit.
The patient is evaluated for onset of la- ampere (am⬘pēr⬙) [André-Marie Am-
bor, which should begin within 12 hr of père, Fr. physicist, 1775– 1836] ABBR:
rupture, and for fever or other signs of amp. The basic unit of current, defined
infection in prolonged rupture. Oxytocin as the flow of 6.25 ⫻ 10⫺18 electrons
induction is often used with amniotomy per sec (1 coulomb of charge flowing per
to limit this possibility. sec). SEE: electromotive force.
A-mode (ā⬘mōd⬙) A-mode ultrasound. amphetamine (am-fet⬘ă-mēn⬙, am-fet⬘ă-
A-mode (amplitude modulation) display mı̆n) [a(lpha) ⫹ m(ethyl) ⫹ ph(enyl)
A-mode ultrasound. ⫹ eth(yl) ⫹ amine] A central nervous
Amoeba (ă-mē⬘ba) [Gr. amoibē, change] system stimulant, C9H13N (or related
A large genus of protozoa of the class agents), used therapeutically to treat
Sarcodina, in the kingdom Protista, attention deficit hyperactivity disorder,
found in fresh and salt water and moist narcolepsy, and obesity, and misused or
soil. Some species are parasitic in hu- abused for energizing or euphoriant ef-
mans, but most parasitic species have fects. SEE: a. sulfate.
been reclassified in the genus Ent- a. sulfate (C9H13N)2SO4, a synthetic
amoeba. SEE: amoeba. white crystalline substance that acts as
amoeba, ameba (ă-mē⬘bă, ă-mē⬘bē) pl. a central nervous system stimulant. It
amoebas, amoebae, amebas, amebae is used to treat narcolepsy and certain
[Gr. amoibē, change] Any member of types of mental depression. Use of am-
the genus Amoeba or of related genera, phetamine sulfate to control appetite is
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amphetamine 103 ampulla

contraindicated. High doses are toxic, photeric ⫹ -in] An antibiotic obtained


and prolonged use may cause drug de- from a strain of Streptomyces nodosus.
pendence. The drug is usually administered intra-
substituted a. An amphetamine venously to treat deep-seated fungal in-
whose structure has been altered by the fections. Premedication with antipyret-
addition of a chemical side chain. Drugs ics, antihistamines, or corticosteroids is
synthesized from amphetamine (such as often necessary to decrease febrile hy-
ecstasy) are often used as both stimu- persensitivity reactions. Patients must
lants and hallucinogens. SEE: ecstasy be monitored for hypokalemia or renal
(2). failure.
amphi-, amph- [Gr. amphi, on both sides] ampicillin (am⬙pı̆-sı̆l⬘ı̆n) A semisynthetic
Prefixes meaning on both sides, on all penicillin. Trade names include Amcill,
sides, double. In chemistry, it denotes Omnipen, Polycillin, and Principen.
certain positions or configurations of amplicon (am⬘plı̆-kon⬙) An amplified
molecules. SEE: ampho-. segment of specific DNA or RNA se-
amphiaster (am⬙fē-as⬘tĕr) [amphi- ⫹ quences in which multiple copies of the
aster] Diaster. nucleic acid sequences are found. Am-
Amphibia (am-fı̆b⬘ē-ă) [Gr. amphibia plicons can be made during polymerase
(zōia), (animals) living a double life] A chain reactions or may occur spontane-
class of cold-blooded tetrapod verte- ously, e.g., in the nucleic acid content of
brates that live on land and in water certain organisms or tumors.
and includes frogs, toads, and salaman- amplification (am⬙plı̆-fı̆-kā⬘shŏn) [L.
ders. Amphibians breathe through gills amplificatio,enlargement] 1. Magnifi-
during their aquatic larval stage but cation, expansion, or enlargement. 2. In
through lungs in their adult stage. pharmacology, the slope of the dose-ef-
amphibian (am-fı̆b⬘ē-ăn) An animal of fect curve, i.e., how much the effect of a
the class Amphibia. amphibian, adj. drug increases as the dosage of the drug
amphibious (ăm-fı̆b⬘ē-ŭs) Able to live or increases.
function both on land and in water. amplifier (am⬘plı̆-fı̄⬙ĕr) 1. That which en-
amphibolism (am⬙fı̆b⬘ŏ-lı̆zm) [Gr. amp- larges, extends, increases, or makes
hibolos, doubtful, ambiguous ⫹ -ism] more powerful. 2. In electronics, a de-
The sum of the metabolic pathways that vice for increasing the electric current
lead to both catabolic and anabolic out- or signal.
comes, such as beta-oxidation of fatty amplitude (am⬘plı̆-tood⬙) [L. amplitudo]
acids by the liver. The resulting acetyl 1. Amount, extent, size, abundance, or
groups may enter the citric acid cycle for fullness. 2. In physics, the extent of
energy production or be used for the movement, as of a pendulum or sound
synthesis of other lipids or steroids. wave. The maximum displacement of a
amphipathic (am⬙fı̆-path⬘ik) [amphi- ⫹ particle, as that of a string vibrating, as
-pathic] In chemistry, having polar and
measured from the mean to the ex-
nonpolar (water-soluble and water-in-
treme. 3. Magnitude of an action poten-
soluble) regions within a single mole-
tial. 4. In radiography, the extent of
cule. This two-part structure allows
tube travel during tomography.
these chemicals to link, or to segregate,
oils and water. Phospholipids, bile salts, a. of accommodation The difference
and detergents are amphipathic mole- in the refractive power of the eye when
cules. accommodating for near and far vision.
amphitheater (am⬙fı̆-thē⬘ă-tĕr) [amphi- It is measured in diopters (D) and nor-
⫹ theater] An auditorium with tiers of mally diminishes progressively from
seats around it for students and other childhood to old age. It is approx. 16 D
observers. at age 12, 6.5 D at age 30, and 1 D at
ampho- [Gr. amphō, both] Prefix mean- age 50.
ing both, on both sides, of both kinds, or amplitude modulation Altering the
double. SEE: amphi-. height (amplitude) of an electrical or
ampholyte (am⬘fŏ-lı̄t⬙) [ampho- ⫹ acoustical wave. SEE: A-mode ultra-
(electro)lyte] A substance that acts as sound.
a base or an acid, depending on the pH ampule (am⬘pūl⬙) [Fr. ampoule] A
of the solution into which it is intro- small glass container for containing hy-
duced. ampholytic (-lit⬘ik), adj. podermic solutions. It can be sealed and
amphophilic (am⬙fŏ-fil⬘ik) [ampho- ⫹ its contents sterilized.
-philic] Pert. to an amphophilic cell. ampulla (am-pu⬘lă, am-pu⬘lē⬙) pl. am-
SEE: amphophilic cell. SYN: ampho- pullae [L. ampulla, little jar] A saclike
phil. dilatation of a canal or duct.
amphoteric, amphoterous (am⬙fŏ-ter⬘ik, a. of fallopian tube Ampulla of uter-
am-fot⬘ĕr-ŭs) [Gr. amphoteros, each or ine tube.
both of two] Being able to react as both hepatopancreatic a. SEE: papilla
an acid and a base. amphoterism of Vater.
(am⬙fŏ-ter⬘izm), n. a. of uterine tube The dilated distal
amphotericin B (am⬙fŏ-ter⬘ı̆-sı̆n) [am- end of a uterine tube terminating in a
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ampulla 104 Amsterdam criteria

funnel-like infundibulum. SYN: am- a residual limb sock, and proper care of
pulla of fallopian tube. the prosthesis are explained. The pa-
a. of Vater SEE: under Vater, Abra- tient is encouraged to verbalize anger
ham. and frustration; to cope with grief, self-
ampullitis (am⬙pŭ-lı̄t⬘ı̆s) [ampulla ⫹ image, and lifestyle adjustments; and to
-itis] Inflammation of an ampulla, esp. deal with phantom limb sensation if this
of the ductus deferens or ampulla of Va- occurs. The patient may require referral
ter. to a local support group or for further
amputation (am⬙pyŭ-tā⬘shŏn) [L. am- psychological counseling.
putare, to cut around] Removal of a Chopart a. SEE: under Chopart,
limb, body part, or organ, usually as a François.
result of surgery but, occasionally, of congenital a. Amputation of parts of
trauma. In western countries during the fetus in utero. It was formerly be-
peace time, the most common reason for lieved to be caused by constricting
loss of a limb is peripheral vascular dis- bands but is now believed to be a devel-
ease, e.g., a blockage to blood flow to the opmental defect.
legs caused by cigarette smoking, hy- double-flap a. Amputation in which
pertension, high cholesterol, physical two flaps of soft tissue are formed to
inactivity, or uncontrolled diabetes mel- cover the end of the bone.
litus. Amputation can also result from a. in contiguity Amputation at a
injuries occurring accidentally, e.g., in joint.
battle or while working. a. in continuity Amputation at a site
INCIDENCE: Each year, about other than a joint.
185,000 Americans undergo limb am- Jaboulay a. SEE: Jaboulay ampu-
putation. Vascular disease and injuries tation.
are responsible for most limb removals. Pirogoff a. SEE: Pirogoff amputa-
Approx. 2 million living Americans have tion.
undergone amputation of a limb. primary a. Amputation performed
PATIENT CARE: Immediately after before inflammation or infection sets in.
amputation, vital signs are assessed; pulp a. The technique of removing
the dressing is observed for bleeding at the coronal portion of an exposed or in-
least every 2 hr; drain patency is volved vital pulp in an effort to retain
checked; and the amount and character the radicular pulp in a healthy, vital
of drainage are documented. Limb cir- condition. SYN: pulpotomy.
culation is ascertained by checking secondary a. Amputation performed
pulses, skin color, and temperature. after onset of infection.
Postoperative pain is managed by intra- spontaneous a. Nonsurgical sepa-
venous and, later, by oral analgesics. To ration of an extremity or digit. SEE: ain-
prevent formation of contractures, the hum.
patient is encouraged to walk, change traumatic a. The sudden amputation
position, rest in proper body alignment of some part of the body due to an acci-
with the residual limb extended rather dental injury.
than bent, do range-of-motion exercises Tripier a. SEE: Tripier amputation.
(esp. extensions), and, finally, muscle- amputee (am⬙pyŭ-tē⬘) A person who has
strengthening exercises as soon as these lost all or part of one or more limbs as a
are prescribed. Residual limb-condition- result of amputation. The amputation
ing exercises and correct residual limb may be congenital or acquired through
bandaging (application of graded, mod- trauma or surgery.
erate pressure to mold the residual limb AMS Anticoagulation management ser-
into a cone shape that allows a good vice; anticoagulation monitoring service.
prosthesis fit) assist limb shrinkage. Amsler grid (omz⬘lĕr) [Marc Amsler,
The residual limb may initially have a Swiss ophthalmologist, 1891– 1968] A
rigid cast. The patient is instructed in grid of lines with a center black dot used
skin hygiene; to massage the limb; to ex- by patients with macular degeneration
amine the entire limb daily, using a mir- to detect early worsening of their dis-
ror to see hidden areas; and to report ease. Loss of vision in part of the grid or
symptoms such as swelling, redness, ex- distortion of the lines (metamorphopsia)
cessive drainage, increased pain, and requires emergent evaluation for possi-
residual limb skin changes (rashes, blis- ble fluid or blood in the macula.
ters, or abrasions). The patient is taught Amsterdam criteria (am⬘stĕr-dam⬙) A
to bandage the resi