Body Structure and Directional Terminology

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Body Structure and Directional Terminology

ICD-10-CM Example from Tabular

Organization of the Human Body

The human body and its general state of health and disease may be understood by studying the various body systems, such as the digestive and respiratory systems. Each body system is composed of different organs, such as the stomach and lungs. These organs are made up of combinations of tissues, such as epithelial and muscular tissue, which in turn are composed of various cells that have very specialized functions.

All of these levels of organization are involved in a continual process of sensing and responding to conditions in the organism’s environment. A negative change at one level of one system may cause a reaction throughout the entire body. Homeostasis is the normal dynamic process of balance needed to maintain a healthy body. When the body can no longer compensate for trauma or pathogens, disease, disorder, and dysfunction result.

Cells

The smallest unit of the human body is the cell. Although there are a number of different types of cells, all of them share certain characteristics, one of them being metabolism. Metabolism is the act of converting energy by continually building up substances by anabolism and breaking down substances by catabolism for use by the body. Metabolism can be described as an equation:

< ?xml:namespace prefix = "mml" />Metabolism=Anabolism+Catabolism

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See Fig. 2-1 for an illustration of a cell and the corresponding table below for a brief description of the pictured organelles and their functions.

Cell Parts

Cell Part Word Origin Function
cytoplasm cyt/o cell
-plasm formation
Holds the organelles of the cell.
lysosome lys/o dissolving
-some body
Organelle that serves a digestive function for the cell.
ribosome rib/o ribose
-some body
Site of protein formation; contains RNA.
mitochondrion (pl. mitochondria) mitochondri/o mitochondria
-on structure
Converts nutrients to energy in the presence of oxygen.
nucleus (pl. nuclei) nucle/o nucleus
-us structure
Control center of cell; contains DNA, which carries genetic information.

Tissues

There are four major categories of tissues. Within each type, the tissue either supports (stromal tissue) or does the actual work (parenchymal tissue) of the organ. For example, parenchymal nerve cells are the neurons that conduct the nervous impulse. Neuroglia are stromal nerve cells that enhance and support the functions of the nervous system. The four types of tissue include the following:

Epithelial: acts as an internal or external covering for organs, for example, the outer layer of the skin or the lining of the digestive tract. Note that the derivation of the term includes a combining form for the nipple (thel/e). Originally the term epithelium was used to describe the membrane covering the nipple. Later, the usage was expanded to include all surface membranes, whether on the skin or mucosal membrane surfaces, that communicate with the outside of the body.

Connective: includes a variety of types, all of which have an internal structural network. Examples include bone, blood, and fat.

Muscular: includes three types: heart muscle, skeletal muscle, and visceral muscle, all of which share the unique property of being able to contract and relax.

Nervous: includes cells that provide transmission of information to regulate a variety of functions, for example, neurons (nerve cells).

When tissue is destroyed by disease or trauma, the possibility of tissue replacement may be an option. Autologous tissue is that which is taken from one part of an individual’s body and is transplanted to another location. Auto- means “self.” An example would be a vein that is used to bypass a blocked coronary artery. If nonautologous tissue is used, it would mean that it is not from one’s self, but from another human. A synonym for nonautologous is allogenic, this time referring to being produced by a different human being. Allo- means “different.” Zooplastic tissue is that which is derived from an animal, for example, a cow or pig heart valve that is used to temporarily replace a structure until human donor tissue is available. Zo/o means “animal.” If tissue is syngeneic, as in the case of identical twins, it refers to a genetically identical individual. Syn- means “together or joined,” as in the sharing of the same DNA. Synonyms for the term syngeneic are isoplastic, isogeneic, and isologous. The combining form is/o means “equal.” Note that the synonyms use all of the previous suffixes: -plastic, -geneic, and -logous.

Organs

Organs, also referred to as viscera (sing. viscus), are arrangements of various types of tissue that accomplish specific purposes. The heart, for example, is made up of muscle tissue, called myocardium, and it is lined with epithelial tissue known as endocardium. Organs are grouped within body systems but do have specific terms to describe their parts.

Parts of Organs

Organs can be divided into parts and have a set of terms that describe these various parts.

Parts of Organs

  Term Combining Form Definition
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apex apic/o The pointed extremity of a conical structure (pl. apices).
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body (corporis) corpor/o,
som/o,
somat/o
The largest or most important part of an organ.
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fornix fornic/o Any vaultlike or arched structure (pl. fornices).
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fundus fund/o The base or deepest part of a hollow organ that is farthest from the mouth of the organ (pl. fundi).
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hilum hil/o Recess, exit, or entrance of a duct into a gland, or of a nerve and vessels into an organ (pl. hila).
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lumen lumin/o The space within an artery, vein, intestine, or tube (pl. lumina).
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sinus sin/o, sinus/o A cavity or channel in bone, a dilated channel for blood, or a cavity that permits the escape of purulent (pus-filled) material (pl. sinuses). Antrum (pl. antra) and sinus are synonyms.
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vestibule vestibul/o A small space or cavity at the beginning of a canal.

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Body Systems

The organs of the body systems work together to perform certain defined functions. For example, movement is a function of the musculoskeletal system. Although each system has a number of functions, one must remember that the systems interact, and problems with one system can affect the function of other systems. For example, in the condition called secondary hypertension, disease in one body system (usually the lungs) causes a pathologic increase in blood pressure in the cardiovascular system. This hypertensive pressure is secondary to the primary cause (lung disease). Once the disorder of the initial system resolves, the hypertension disappears.

The following table lists each body system and its function.

Body Systems

Body System Functions
musculoskeletal Support, movement, protection
integumentary Cover and protection
gastrointestinal Nutrition
urinary Elimination of nitrogenous waste
reproductive Reproduction
blood/lymphatic/immune Transportation of nutrients/waste, protection
cardiovascular Transportation of blood
respiratory Delivers oxygen to cells and removes carbon dioxide
nervous/behavioral Receive/process information
special senses (eye and ear) Information gathering
endocrine Effects changes through chemical messengers

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Combining Forms for Body Organization

Meaning Combining Form
blood hem/o, hemat/o
bone oste/o, osse/o
breakdown, dissolve lys/o
cell cyt/o, cellul/o
epithelium epitheli/o
fat adip/o, lip/o
heart cardi/o
heart muscle myocardi/o
juice chym/o
muscle my/o, muscul/o
nerve neur/o
nipple thel/e
nucleus kary/o, nucle/o
organ, viscera organ/o, viscer/o
same home/o
stroma strom/o
system system/o
to throw, throwing bol/o
tissue hist/o

Prefixes for Body Organization

Prefix Meaning
ana- up, apart, away
cata- down
en- in
endo- within
epi- above, upon
meta- beyond, change
para- near, beside, abnormal

Suffixes for Body Organization

Suffix Meaning
-al, -ous pertaining to
-ia, -ism condition, state of
-on structure
-plasm formation
-some body
-stasis controlling, stopping
-um structure, thing, membrane
-us structure

Specialties/Specialists and General Terms

The levels of organization of the body are accompanied by a number of specialties and their associated specialists.
Term Word Origin Definition
cytology cyt/o cell
-logy study of
The study of the cells. A cytologist specializes in the study of the cell. The suffix -logist means “one who specializes in the study of.”
histology hist/o tissue
-logy study of
The study of tissues. A histologist specializes in the study of tissues.
anatomy ana- up, apart, away
-tomy cutting
To cut apart, the study of the structure of the body. An anatomist specializes in the structure of the body.
physiology physi/o growth
-logy study of
The study of growth; the study of the function of the body. A physiologist specializes in the study of the function of the body.
pathology path/o disease
-logy study of
The study of disease. A pathologist specializes in the study of disease.
biopsy bi/o life, living
-opsy viewing
Process of viewing living tissue that has been removed for the purpose of diagnosis and/or treatment.
necropsy necr/o death, dead
-opsy viewing
Process of viewing dead tissue.
autopsy auto- self
-opsy viewing
Process of viewing by self; term commonly used to describe the examination of a dead body to determine cause(s) of death.

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Anatomical Position and Surface Anatomy

Now that you understand the levels of organization of the body, you need the terms that describe locations, positions, and directions on the body. A standard frame of reference, the anatomical position, is the position in which the body stands erect with face forward, arms at the sides, palms forward, with toes pointed forward. This position is used to describe the surface anatomy of the body, both front (ventral) and back (dorsal). Figure 2-2 shows the anatomical position, both front and back, and is labeled with all the surface anatomy labels you will encounter throughout this text.

Ventral Surface Anatomy Terms (Head and Neck)

Term Word Origin Definition
buccal bucc/o cheek
-al pertaining to
Pertaining to the cheek.
cephalic cephal/o head
-ic pertaining to
Pertaining to the head.
cervical cervic/o neck
-al pertaining to
Pertaining to the neck. Collum is a term that refers to the entire neck.
cranial crani/o skull
-al pertaining to
Pertaining to the skull.
facial faci/o face
-al pertaining to
Pertaining to the face.
frontal front/o front
al pertaining to
Pertaining to the front, the forehead.
mental ment/o chin
al pertaining to
Pertaining to the chin.
nasal nas/o nose
-al pertaining to
Pertaining to the nose.
ocular ocul/o eye
-ar pertaining to
Pertaining to the eye.
oral or/o mouth
-al pertaining to
Pertaining to the mouth.
otic ot/o ear
-ic pertaining to
Pertaining to the ear. Also called auricular.

Ventral Surface Anatomy (Trunk)

Term Word Origin Definition
abdominal abdomin/o abdomen
-al pertaining to
Pertaining to the abdomen.
axillary axill/o axilla (armpit)
-ary pertaining to
Pertaining to the armpit.
coxal cox/o hip
-al pertaining to
Pertaining to the hip.
deltoid delt/o triangular
-oid resembling
Pertaining to the deltoid muscle covering the shoulder. The combining form om/o is often used for the shoulder.
inguinal inguin/o groin
-al pertaining to
Pertaining to the groin.
mammary mamm/o breast
-ary pertaining to
Pertaining to the breast.
pelvic pelv/o, pelv/i pelvis
-ic pertaining to
Pertaining to the pelvis.
pubic pub/o pubis
-ic pertaining to
Pertaining to the pubis.
sternal stern/o sternum (breastbone)
al pertaining to
Pertaining to the breastbone.
thoracic thorac/o chest
-ic pertaining to
Pertaining to the chest. Also called pectoral.
umbilical umbilic/o umbilicus (navel)
-al pertaining to
Pertaining to the umbilicus.

Ventral Surface Anatomy (Arms and Legs)

Term Word Origin Definition
antecubital ante- forward, in front of, before
cubit/o elbow
-al pertaining to
Pertaining to the front of the elbow.
brachial brachi/o arm
-al pertaining to
Pertaining to the arm. Antebrachial means pertaining to the forearm.
carpal carp/o wrist
-al pertaining to
Pertaining to the wrist.
crural crur/o leg
-al pertaining to
Pertaining to the leg.
digital digit/o finger/toe
-al pertaining to
Pertaining to the finger/toe. Phalangeal means pertaining to the bones in the fingers/toes.
femoral femor/o thigh
-al pertaining to
Pertaining to the thigh.
manual man/u hand
-al pertaining to
Pertaining to the hand.
palmar palm/o palm
-ar pertaining to
Pertaining to the palm. Also termed volar.
patellar patell/o, patell/a kneecap
-ar pertaining to
Pertaining to the kneecap.
pedal ped/o foot
-al pertaining to
Pertaining to the foot.
plantar plant/o sole
-ar pertaining to
Pertaining to the sole of the foot.
tarsal tars/o ankle
-al pertaining to
Pertaining to the ankle.

Dorsal Surface Anatomy Terms

Term Word Origin Definition
acromial acromi/o acromion
-al pertaining to
Pertaining to the acromion (highest point of shoulder).
dorsal dors/o back
-al pertaining to
Pertaining to the back.
gluteal glute/o buttocks
-al pertaining to
Pertaining to the buttocks.
lumbar lumb/o lower back, loin
-ar pertaining to
Pertaining to the lower back.
nuchal nuch/o neck
-al pertaining to
Pertaining to the neck, especially the back of the neck.
olecranal olecran/o elbow
-al pertaining to
Pertaining to the elbow.
perineal perine/o perineum
-al pertaining to
Pertaining to the perineum. The perineum is the space between the external genitalia and the anus.
popliteal poplite/o back of knee
-eal pertaining to
Pertaining to the back of the knee.
sacral sacr/o sacrum
-al pertaining to
Pertaining to the sacrum.
scapular scapul/o scapula, shoulder blade
-ar pertaining to
Pertaining to the scapula.
sural sur/o calf
-al pertaining to
Pertaining to the calf.
vertebral vertebr/o vertebra, spine
-al pertaining to
Pertaining to the spine.

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Positional and Directional Terms

Positional and directional terms are used in healthcare terminology to describe up and down, middle and side, and front and back. Because people may be lying down, raising their arms, and so on, standard English terms cannot be used to describe direction. The following table lists directional and positional terms as opposite pairs, with their respective combining forms or prefixes and illustrations. For example, x-rays may be taken from the front of the body to the back—an anteroposterior (AP) view—or from the back to the front—a posteroanterior (PA) view (Figs. 2-3 and 2-4). The midline of the body is an imaginary line drawn from the crown of the head down between the eyes, through the chest, and separating the legs.

Positional and Directional Terms

  Term Word Origin Definition
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anterior (ant)
ventral
anter/o front
-ior pertaining to
ventr/o belly
-al pertaining to
Pertaining to the front.
Pertaining to the belly side.
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posterior (pos)
dorsal
poster/o back
-ior pertaining to
dors/o back
-al pertaining to
Pertaining to the back.
Pertaining to the back of the body.
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superior (sup)
cephalad
super/o upward
-ior pertaining to
cephal/o head
-ad toward
Pertaining to upward.
Toward the head.
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inferior (inf)
caudad
infer/o downward
-ior pertaining to
caud/o tail
-ad toward
Pertaining to downward.
Toward the tail.
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medial medi/o middle
-al pertaining to
Pertaining to the middle (midline).
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lateral (lat) later/o side
-al pertaining to
Pertaining to the side.
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ipsilateral ipsi- same
later/o side
-al pertaining to
Pertaining to the same side.

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contralateral contra- opposite
later/o side
-al pertaining to
Pertaining to the opposite side.
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unilateral uni- one
later/o side
-al pertaining to
Pertaining to one side.
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bilateral bi- two
later/o side
-al pertaining to
Pertaining to two sides.
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superficial (external)   On the surface of the body.
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deep (internal)   Away from the surface of the body.
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proximal proxim/o near
-al pertaining to
Pertaining to near the origin.
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distal dist/o far
-al pertaining to
Pertaining to far from the origin.
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dextrad* dextr/o right
-ad toward
Toward the right.

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sinistrad* sinistr/o left
-ad toward
Toward the left.
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afferent af- toward
fer/o to carry
-ent pertaining to
Pertaining to carrying toward a structure.
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efferent ef- away from
fer/o to carry
-ent pertaining to
Pertaining to carrying away from a structure.
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supine   Lying on one’s back.
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prone   Lying on one’s belly.

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*This is the patient’s, not the reader’s, right and left.

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Body Cavities

The body is divided into five cavities (Fig. 2-5). Two of these five cavities are in the back of the body and are called the dorsal cavities. The other three cavities are in the front of the body and are called the ventral cavities. Most of the body’s organs are in one of these five body cavities.

Ventral Cavities

The thoracic cavity contains the heart, lungs, esophagus, and trachea (windpipe) and is protected by the ribs, the sternum (breastbone), and the vertebrae (backbones). This chest cavity is further divided into the two pleural cavities that contain the lungs; the mediastinum, the space between the lungs; and the pericardial cavity, which holds the heart.

The pleura is a double-folded serous (watery) membrane that provides a small amount of lubrication that allows the lungs to contract and expand with minimal friction. The side of the membrane that is closest to the lung is called the visceral pleura, whereas the side that is closest to the body wall is the parietal pleura.

The pericardial cavity shares a similar structure to the pleural cavity, again having a double-folded serous membrane designed to avoid friction on the organ that it encloses. This time the inner membrane is termed the visceral pericardium, whereas the outer membrane is the parietal pericardium.

The abdominopelvic cavity is composed of two cavities (abdominal and pelvic) that are not separated by any physical structure. Because nothing physically separates the abdominal and pelvic cavities, they are often collectively referred to as the abdominopelvic cavity.

The abdominal cavity contains the stomach, liver, gallbladder, pancreas, spleen, and intestines, whereas the pelvic cavity contains the bladder and reproductive organs. The only anterior protections for the abdominal cavity are the skin and muscles covering it, and in the back, just the vertebrae. It is separated from the thoracic cavity by a broad dome-shaped muscle called the diaphragm.

The pelvic cavity contains the bladder and reproductive organs. These organs are cradled on the sides and in the back by the pelvic bones.

The entire abdominopelvic cavity is lined with yet another serous membrane called the peritoneum. The parietal layer of the peritoneum lines the abdominopelvic cavity, whereas the visceral layer surrounds its organs. The term parietal is derived from a Latin term for “the wall”; hence this layer is always the one closest to the body wall. The visceral layer of the peritoneum (or pericardium) is the one that is closest to the organ or organs that it encloses. The greater and lesser omenta are extensions of the visceral peritoneum that hold and support the cavity’s organs. The fold of the peritoneum that joins the parietal and visceral layers and attaches it to the posterior wall of the abdominal cavity is called the mesentery.

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Body Regions

In ICD-10-PCS, knowledge of the organization of the body is essential to accurate coding. At times, coders will not be able to assign a procedure to a specific part of a body system. In these cases, general anatomical regions are used (character 2 of the code). The choices can include a body part (ex. head); a body cavity (ex. pelvic cavity); or a tract (ex. respiratory tract).

Abdominopelvic Regions

The abdominopelvic regions are the nine regions that lie over the abdominopelvic cavity (Fig. 2-6). The area in the center of the abdominopelvic region is called the umbilical area. Laterally, to the left and right of this area, are the lumbar regions. They are called the lumbar regions because they are bound by the lumbar vertebrae. Superior to the lumbar regions, and below the ribs, are the hypochondriac regions. Medial to the hypochondriac regions, and superior to the umbilical region, is the epigastric region. Inferior to the umbilical region is the hypogastric region, and lateral to the sides of the hypogastric region are, respectively, the right and left iliac regions, sometimes referred to as the inguinal regions.

Abdominopelvic Quadrants

A simpler method of naming a location in the abdominopelvic area is to divide the area into quadrants, using the navel as the intersection. These quadrants are referred to as either right or left, upper or lower (Fig. 2-7). In the right upper quadrant (RUQ) lies the liver. In the left upper quadrant (LUQ) lie the stomach and the spleen. The appendix is in the right lower quadrant (RLQ). If a patient complains of pain in the area of McBurney’s point, the area that is approximately two thirds of the distance between the navel and the hip bone in the RLQ, appendicitis is suspected. Except for the appendix, the left lower quadrant (LLQ) contains organs similar to the lower right. In the LLQ, halfway between the navel and the hip bone, is Munro’s point. This is a standard site of entrance for surgeons who perform laparoscopic surgery.

Planes of the Body

Another way of describing the body is by dividing it into planes, or flat surfaces, that are imaginary cuts or sections through the body. The use of plane terminology is common when imaging of internal body parts by computed tomography (CT) scans, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, or other imaging techniques is described. Figs. 2-8 to 2-10 show the three body planes and corresponding views of the brain.

Sagittal planes are vertical planes that separate the sides from each other (see Fig. 2-8). A midsagittal plane, also termed the median plane, separates the body into equal right and left halves. The frontal (or coronal) plane divides the body into front and back portions (see Fig. 2-9). The transverse plane (also called cross-sectional) divides the body horizontally into an upper part and a lower part (see Fig. 2-10). And finally, the oblique plane, not as commonly used as the first three, divides the body at a slanted angle.

Combining Forms for Body Cavities, Abdominopelvic Quadrants and Regions, and Planes

Meaning Combining Form
abdomen abdomin/o, celi/o, lapar/o
back dors/o
cartilage chondr/o
cranium (skull) crani/o
diaphragm diaphragmat/o, diaphragm/o, phren/o
front, bellyside front/o, ventr/o
groin inguin/o
ileum ile/o
ilium ili/o
lower back, loin lumb/o
mediastinum mediastin/o
organ viscer/o, organ/o
pelvis pelv/i, pelv/o
peritoneum peritone/o
pleura pleur/o
spine spin/o
sternum stern/o
stomach gastr/o
thorax (chest) thorac/o
umbilicus (navel) umbilic/o, omphal/o
vertebra vertebr/o
wall pariet/o

Prefixes for Body Cavities, Abdominopelvic Quadrants and Regions, and Planes

Prefix Meaning
epi- above, upon
hyper- excessive, above
hypo- deficient, below, under
mid- middle
trans- through, across

Abbreviations

Abbreviation Definition
ant anterior
AP anteroposterior
CT computed tomography
inf inferior
lat lateral
LLQ left lower quadrant
LUQ left upper quadrant
MRI magnetic resonance imaging
PA posteroanterior
PET positron emission tomography
pos posterior
RLQ right lower quadrant
RUQ right upper quadrant
sup superior