Health Information Technology

Level-IV
Based on November 2021, Version IV Occupational
standard

MODULE TITLE: Performing Disease Classification and Coding

LG Code: HLT HIT4 M02 LO (1-4) LG (7-10)
TTLM Code: HLT HIT4 TTLM 0422v1

April, 2022
Addis Ababa, Ethiopia
 Table of contents

Introduction to the Module .......................................................................................................... 3

LO1- Identify and evaluate clinical data .................................................................................... 4
Instruction sheet 1 ................................................................................................................. 4
LG7-Information Sheet 1 ...................................................................................................... 5
1.1 Extracting Clinical data from medical records ........................................................ 5
1.2 Identifying and evaluating clinical Data .................................................................... 8
1.3. Basic clinical procedures, diagnosis, interventions and medications ..................... 93
1.4 Establishing detail level of clinical data to meet national standards. ...................... 99
1.5 Recording clear, accurate, complete and timely clinical data. ................................. 99
LO2- Assign codes to clinical data........................................................................................... 103
Instruction sheet 2 ............................................................................................................. 104
Information Sheet 2 ........................................................................................................... 104
2.1 Coding clinical data ............................................................................................... 105
2.2 National Classification of Diseases (NCoD) ......................................................... 111
2.3 Identifying Clinical coding current legislations, policies, procedures and
guidelines ..................................................................................................................... 122
2.4 Establishing sequence of code in NCoD .............................................................. 125
LO-3 Monitor and Ensure implementation of coding and disease classification ............. 129
Instruction sheet ................................................................................................................ 129
Information Sheet 3 ........................................................................................................... 130
3.1 Identifying the use of coded clinical data. ............................................................. 130
Advantages of using NCoD than ICD-10 coding system ............................................ 131
3.2 Monitoring NCoD implementation ........................................................................ 131
3.3 Identify gaps in coding compliance to standards ................................................... 131
LO4-Utilize software applications for coding and reporting ............................................... 134
Instruction sheet 4 ............................................................................................................. 134
Information Sheet 4 ........................................................................................................... 135
4.1 Identifying relevant Healthcare software and applications .................................... 135
4.2 Identifying and applying healthcare software for coding. ..................................... 135
Reference Materials .................................................................................................................. 143
AKNOWLEDGEMENT..................................................................Error! Bookmark not defined.
The experts who developed the learning guide .............................Error! Bookmark not defined.

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 Introduction to the Module
This module aims to provide the trainees with the knowledge, skills and right attitudes required
on identifying clinical data, fundamentals of medical terminology ,body system structures,
function, pathologies, diagnostic procedures, abbreviation, pharmacology and perform disease
classification and coding of clinical data based on National Classification of Disease (NCoD)
and international classification of disease version ten (ICD-10)
This learner’s module contains:

 Identifying and evaluate clinical data

 Assigning codes to clinical data
 Monitoring and Ensure implementation of coding and disease classification
 Utilizing software applications for coding and reporting

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 LG#7 LO1- Identify and evaluate clinical data

Instruction sheet 1
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
 Extracting Clinical data from medical records.
 Evaluating medical records to establish primary diagnosis and co-morbidities.
 Identifying Medical record procedures, interventions and medications
 Establishing detail level of clinical data to meet national standards.
 Recording clear, accurate, complete and timely clinical data.
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Extract Clinical data from medical records.
 Evaluate medical records to establish primary diagnosis and co-morbidities.
 Identify medical record procedures, interventions and medications
 Establish detail level of clinical data to meet national standards.
 Record clear, accurate, complete and timely clinical data.
Learning Instructions:
1. Read the specific objectives of this Learning Guide.
2. Follow the instructions described below.
3. Read the information written in the information Sheets
4. Accomplish the Self-checks

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LG7-Information Sheet 1

1.1 Extracting Clinical data from medical records

Various clinical data in health facilities is generated daily by different sources. Data available in
health care organizations are mostly in textual form and it can be paper based and electronically.
This kind of data is not usually friendly for decision support and statistical summarization. Non-
textual data are easier to analyze and summarized compared to textual data. In contrast to non-
textual data, textual medical data is flexible since it captures the patient's narrative which can be
told from a different perspective and allows expression of feelings. The volume of textual
medical data available shows that a manual review of such data will be time-consuming and
labor intensive.
The world today had provided many sources of medical information like the general web, social
media, journal articles, and hospital records. The hospital records is mostly paper based and
electronically. i.e Hospital Information System (HIS), Electronic Medical Record (EMR),
Electronic Patient Record (EPR), medical diagnosis systems as well as medical image systems
Thus automatic extraction of clearly identified, classified and coded clinical data from the
textual medical data makes vital information usually buried within more accessible. Therefore
HIT professional should have knowledge on those clinical in health facility.
1.1.1 Fundamentals Medical Terminology

The fundamentals of medical terminology deals with the origin of medical terms, word parts,
categories of health care terms and rules for building, spelling and pronouncing medical terms
used in common healthcare disciplines
Origin of medical terms
Medicine has a language of its own. Most medical vocabulary is built on Latin and Greek word
parts. The best way of learning medical terms is by learning word parts and how they fit
together. Categories of medical terms
 Decodable : Are those with Greek or Latin components that can be analyzed and defined
E.g. Gastr/itis: “gastr” means stomach, “itis” means inflammation. The definition is
“inflammation of the stomach”

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  Non decodable: these types of terms cannot be divided into components; the entire
definition must be memorized.
E.g Cataract (lenses of the eyes become opaque), Asthma (difficulty in breathing).
 Eponyms: these are words based on the name of a person, such as “Parkinson disease”,
Cesarean section and others.
 Acronyms /Abbreviations: is a word formed from the first letters of the words a phrase, such
as SARS (severe acute respiratory syndrome).
 Abbreviations: The term shortened for convenience e.g. Dr. (Doctor).
 Acronyms: abbreviations that are pronounced as words. E.g. SARS (Sever acute
respiratory system).
 Symbols: a graphic representation, such as sign for Red cross
Word parts

There are four types of word parts in medical terms.

 Word roots
 Suffixes
 Prefixes
 Combining vowels
Word roots: is the word part that contains the fundamental meaning of the term.
Examples:
• In the word ……Tonsill/itis, Tonsill is the word root
• In the word……..Hepat/it is, Hepat, (which means liver) is the word root
Prefix: it is a word part attached to the beginning of a word root to modify its meaning. It
usually indicates location, time or a number such as bi-, meaning two, sub meaning under, intra-,
meaning within, Brady-, meaning slow. Hyper, meaning high.
Examples:
 In the word…Postnatal/ post- (which means after) is the prefix. Post means just after
birth.
 In the word………………..intra/venous, intra- (which means within) is the prefix
Suffix: is a word part attached to the end of the word root to modify its meaning. It usually
indicates procedures, such as -Scopy: meaning visual examination, or- tomy (otomy), which
means surgical incision, or a disease, such as –oma, meaning tumor.

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Combining vowel: A combining form vowel is added to the end of a word root under certain
conditions to make the resulting medical term easier to pronounce.
 In the word………men/o/pause, o is the combing vowel used between two word roots.
 In the word…..….arthro/pathy, “o” has combined the word root arth, and the suffix –
pathy.
Table 1 common prefix, suffix and combining vowel in medical terminology
Common Prefix Common Suffix

Prefix Meaning -scope observe

hypo- deficient, below -stomy opening

hyper- excessive,too much, above -ectomy Surgical removal

Intra- beneath -it is inflammation

macro- large -pathy Disease

mal- bad, abnormal -plasty surgical repair

morph(o)- shape -logist One who studies

multi- many -algia pain

poly- many, much -cyte cell

Pre- Before -emesis vomiting

Post- After -tomy incision

Pseudo- False -trophy growth

Un- Not -rrhoea fluid discharge

Uni- One -plegia paralysis

Bi- Two -oedema excessive fluid

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1.2 Identifying and evaluating clinical Data
1.2.1Common epidemiological terms

Epidemiology is one of the public health sciences that deal with the study of the frequency,
distribution and determinants of health related states or events in specified populations, and
application of this study to control of health problems. Therefore, there are a number of terms
that you need to familiarize yourself in order to understand the environment of the public health
intervention programs towards health problems in a better way.

Health: a state of complete physical, mental, and social well-being and not merely the absence
of disease or infirmity.
Illness: is a subjective state of person who feels aware of not being well with evident sign and
symptoms.
Sickness: state of social dysfunction likes to remain away from social activities.
Disease: Is maladjustments (physiological or psychological) of human beings to his/her
environments.
Acute disease: a disease/condition that develops rapidly, but lasts only a short time.
Chronic disease: a disease/condition that develops slowly, may have mild symptoms or signs,
but is continual or recurrent for a long time. (E.g. Asthma, TB, HTN, DM etc.).
Contagious disease: a disease/condition that spreads easily from one person to another (e.g.
chicken pox).
Contact: exposure to a source of an infection, or a person so exposed.
Contagious: capable of being transmitted from one person to another by contact or close
proximity.
Etiology: study of the cause of a disease.
Etiologic Agent: are microorganisms and microbial toxins that cause disease in humans and
include bacteria, viruses, fungi, protozoans, and parasites.
Epidemiology: study of when and where diseases occur and how they are transmitted.
Epidemic: the occurrence of more cases of a disease than expected in a given area or among a
specific group of people over a particular period of time.
Sporadic disease: occurs only occasionally in population (e.g. typhoid).
Pandemic: an epidemic occurring over a very wide area (several countries or continents) and
usually affecting a large proportion of the population. (COVID-19)

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Endemic disease: the constant presence of a disease or infectious agent within a given
geographic area or population group. E.g. Kemisie is a malaria endemic area in Amhara Region.
Infection: invasion or colonization by pathogenic microbes.
Pathogens: disease causing microbes or microorganisms.
Pathology: is a study of disease causes, development, & effects on the host.
Incidence: is the number of new cases of disease or health conditions that develop in a
population at risk within a specified period of time.
Prevalence: it refers to the total number of people affected by a certain condition or disease at a
given point in time.
Risk: the probability that an event will occur. E.g. A chance of an individual will become ill or
die within a stated period of time or age.
Risk factor: an aspect of personal behavior or lifestyle, an environmental exposure, or an inborn
or inherited characteristic that is associated with an increased chance of occurrence of disease or
other health-related event or condition.
Syndrome: specific group of symptoms & signs that may accompany a particular disease.
Vector: an animate intermediary in the indirect transmission of an agent that carries the agent
from a reservoir to a susceptible host.
Zoonosis: an infectious disease that is transmissible under normal conditions from animals to
humans. E.g. Rabies
1.2.2 Body Systems and Directional Terminologies

Body organization

Within the body system there are different levels of organization and complexity. The lowest
level is the chemical level. Atoms combine to form molecules, and molecules combine to form
cells which are the smallest structural and functional units of living things. There are trillions of
cells in the body. Cells with similar structures and functions are found together, forming tissues.
Tissues with similar structure and function make up the different organs. Tissues and organs are
then organized into systems finally forms organism

Atoms- molecules --Cells---Tissues----organs----Body systems--- Human Organism

Tissues: Tissues are made up of a group of similar cells that perform a specific task. There are 4
main types of tissues:

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  Epithelial tissue
 Connective tissue
 Muscular tissue
 Nervous tissue

Organs: Two or more kinds of tissue that together perform special functions make up an organ.
Example: Skin is an organ formed from epithelial, connective, muscle and nerve tissue.
Systems: Systems are the most complex of the component units of the human body. A
system is an organization of varying numbers and kinds of organs that are arranged together
to perform complex functions for the body.

Figure 1.1 Human body organizations

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Anatomic reference of body parts

Anatomic references are used to describe the locations of the structural units of the body
based on anatomical reference.
Common anatomical references:
• Body planes
• Body directions
• Body cavities
• Structural units
Body planes

Body planes are imaginary vertical and horizontal lines used to divide the body into sections for
descriptive purposes.
a) Vertical plane: A vertical plane is an up-and-down plane that is a right angle to the horizon.
 The mid-sagittal plane (midline) is the sagittal plane that divides the body into equal
left and right halves.
 Frontal plane is a vertical plane that divides the body into anterior (front) and
posterior (back) portions. Also known as the coronal plane, it is located at right
angles to the mid-sagittal plane.
b) Horizontal plane (transverse plane): a horizontal plane is a flat crosswise plane, such as
the horizon. It i divides the body into superior (upper) and inferior (lower) portions. A
transverse plane can be at the waist or at any other level across the body

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 Figure 1.2 body planes and direction

Body direction

The relative location of sections of the body, or of an organ, can be described through the use
of pairs of contrasting body direction terms.
Anterior: situated in the front. It also means on the front or forward part of an organ For
example, the stomach is located anterior to (in front of) the pancreas.
Posterior: situated in the back. It also means on the back part of an organ. For example, the
pancreas is located posterior to (behind) the stomach. Posterior is the opposite of anterior.
Superior: uppermost, above, or toward the head. For example, the lungs are located superior
to (above) the diaphragm.
Inferior; refers to lowermost, below, or toward the feet. For example, the stomach is located
inferior to (below) the diaphragm. Inferior is the opposite of superior.
Ventral: refers to the front, or belly side, of the organ or body. It is the opposite of dorsal.
Dorsal: refers to the back of the organ or body
Cephalic: toward the head.
Caudal: toward the lower part of the body. Caudal is the opposite of Cephalic.

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Proximal: situated nearest the midline or beginning of a body structure. For example, the
proximal end of the humorous (bone of the upper arm) forms part of the shoulder.
Distal: situated farthest from the midline or beginning of a body structure. For example, the
distal end of the humorous forms part of the elbow.
Medial: the direction toward, or nearer, the midline. For example, the medial ligament of the
knee is near the inner surface of the leg.
Lateral: the direction toward or nearer the side or away from the midline. For example, the
lateral ligament of the knee is near the side of the leg.
Body cavities

The two major body cavities, which are the dorsal and the ventral cavities, are spaces within the
body that contain and protect internal organs.

A. Ventral Cavity
 Thoracic cavity: is a cavity which contains and protects the heart and lungs. It is
separated from the abdominal cavity by a muscle called diaphragm. It is also known as
chest cavity or thorax.
 Abdominal Cavity: contains primarily the major organs of digestive system. This cavity
is frequently referred to simply as the abdomen.
 Pelvic cavity: is the space formed by the hip bones and it contains primarily the organs of
the reproductive and excretory systems. There is no physical division between the
abdominal and pelvic cavities.
B. Dorsal Cavity
 Cranial cavity: a cavity which is located within the skull. It surrounds and protects the
brain.

 Spinal Cavity: is located within the spinal column, surrounds and protects the spinal
cord.

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 Figure 1.3 Human body cavities
Quadrants of the Abdomen

Describing where an abdominal organ or pain is located is made easier by dividing the
abdomen into four imaginary quadrants. The term quadrant means divided into four.

Figure 1.4 Abdominal Quadrants

1.3 Common terminologies related to body system structures, diagnosis, pathologies, and
medical specialties
Most of medical terms practiced in the healthcare facilities are related to body systems anatomy
(structures), functions, pathologies, and diagnostic and treatment procedures. In addition, the

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drugs or medications prescribed with their corresponding drug names, route of administration
and frequency of administration are source of common medical terms. Therefore, this topic
includes the descriptions of all body system structures, related pathologies, diagnostic &
treatment procedures and medical specialties
The following are list of the major body systems that compose the human body:
1. Skeletal system
2. Muscular system
3. Nervous system
4. Endocrine system
5. Cardiovascular system
6. Lymphatic system
7. Respiratory system
8. Digestive system
9. Urinary system
10. Reproductive system
11. Integumentary System

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Skeletal system

Human skeletal system is all of the bones in the body and the tissues such as tendons, ligaments and
cartilage that connect them.

 Types of bones and bone structure

The bones of the skeleton are divided into two groups: Axial skeleton and appendicular skeleton
 Axial skeleton: It forms the axis; the central bony part of the body. It consists of the skull, spine
and ribcage.
o Skull: is a bone that protects the delicate tissues of the brain, the eye and the ear. It in turn
consists of: Cranium and Facial bones

o Spine: It is made up of 26 bones called vertebrae. The bones of the spine include the
cervical (7), thoracic (12), Lumbar (5), Sacral (1), and Coccygeal (1) bones.
o Ribcage- which is made up of the ribs and sternum.
 Appendicular skeleton: It consists:
o The shoulder girdle: It consists of 2 scapula and 2 clavicles and the upper limbs.
o The pelvic girdle -It is formed from the hip bone and the lower limbs.
 Figure 1.5 Human skeletal systems

Function of skeletal system

The skeletal system also has many important functions:
 Bones act as the framework of the body
 Bones support and protect the internal organs
 Joints work in conjunction with muscles, ligaments, and tendons, making possible the body
movements
 Calcium, which is required for normal nerve and muscle function, is stored in bones
 Red bone marrow, which has an important function in the formation of blood cells.
Joints

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 They are also called articulation that hold our bones together and make movement and flexibility
possible.
Structural Classification of joint based on the presence or absence of a joint cavity.
• Fibrous joint: if there is no joint cavity and the bones are held together by fibrous
connective tissue.
• Cartilaginous joint: if there is no joint cavity and the bones are held together by
cartilage, a strong material that acts as a shock absorber. They have limited range of
motion.
• Synovial joints: are created when two bones articulate to permit a variety of
motions. based on the type of motion, such type of joints are further classified as Ball and
Socket joints which allow a wide range of movement in many directions( such as shoulder
and hip joints) and the Hinge joints which allow movements primarily in one direction.
Example: Knee and elbow joints.

Figure: 1.6 Basic structure of synovial joint

Pathologies
There are a number of disorders related to the skeletal system.

 Ostitis: is an inflammation of bone.

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  Osteomyelitis: is an inflammation of the bone marrow and adjacent bone (oste/o means
bone and myel means bone marrow).
 Osteomalacia: is softening of the bone due to lack of vitamin D or a problem with the body
to break down and use this vitamin. Malacia means softening.
 Osteoporosis: it is a condition of the thinning of one tissue and loss of bone density over
time.
 Rickets: is known as infantile Osteomalacia. it is vitamin D deficiency disease occurring in
children.
 Herniated disk: is known as a slipped or ruptured disk, is the breaking apart of an inter-
vertebral disk that results in pressure on spinal nerve roots.
 Abnormal curvature of the spinal column:
 Kyphosis is an increased out ward curvature of the spine at thoracic vertebrae,
 Lordosis is an increased in ward curvature of the spine at lumbar vertebrae and
 Scoliosis lateral deviation of the spinal column.
 Lumbago: is known as low back pain, is pain of the lumbar region of the spine (lumb means
lumbar, and -ago means diseased condition).
 Arthritis: is an inflammatory condition of one or more joints.
 Gouty arthritis: is known as gout, is a type of arthritis characterized by deposits of uric acid
in the joints.
 Dislocation: is the total displacement of a bone from its joint.
Diagnostic procedures

Common diagnostic procedures in the skeletal system are:

• Radiograph, also known as an x-ray, is the use of x-rays to visualize bone fractures and other
abnormalities.
• A bone marrow biopsy is a diagnostic test that is performed by taking tissues from the bone
marrow when it is necessary. Abnormal types or numbers of red or white blood cells may
necessitate the bone marrow biopsy to be done.
• Bone marrow aspiration is the use of a syringe to withdraw the liquid bone marrow.
Treatment Procedure

There are many treatment procedures carried out to cure disorders related to the skeletal system. Some
of these are:

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 •Prosthesis: is a substitute for a diseased or missing body part, such as a leg that has been
amputated.
•Arthroplasty: is surgical repair of a damaged joint. ‘Plasty’ means surgical.
•Craniotomy: is a surgical incision or opening into the skull (crani means skull).
•Closed reduction: is the attempted realignment of the bone involved in a fracture or joint
dislocation.
•External and Internal Fixation: a method used to immobilize fractured bone.
Medical specialties
The common medical specialties in skeletal system are:
• Orthopedic surgeon: is known as an orthopedist, is a physician who specializes in
diagnosing and treating diseases and disorders involving the bones, joints, and muscles.
• Podiatrist: A physician who specializes in diagnosing and treating disorders of the foot
(pod mean foot).
• Chiropractor: a physician who specializes in the manipulative treatment of disorders
originating from misalignment of the spine. Manipulative treatment involves manually
adjusting the positions of the bones.
Common Abbreviations/Acronyms

Fx …………………………………Bone fracture
CR …………………………………Closed reduction
OA ……………………………….Osteoarthritis
TMJ ……………………………….Tempro-mandibular joint
The Muscular system

The structure of muscular system

The body has more than 600 muscles, which make up about 40%–45% of the body’s weight. Skeletal
muscles are made up of fibers, are covered with fascia, and are attached to bones by tendons.

•Muscle Fibers: muscle fibers are the long, slender cells that make up muscles. Each muscle
consists of a group of fibers that are held together by connective tissue and enclosed in a
fibrous sheath.
•Fascia: fascia is the sheet of fibrous connective tissue that covers, supports, and separates
muscles or groups of muscles (plural, fasciae or fascias).

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 •Tendons: a tendon is a narrow band of non-elastic, dense, fibrous connective tissue that
attaches a muscle to a bone. Do not confuse tendons with ligaments, which connect one bone to
another bone. Example for Tendon: the Achilles tendon attaches the gastrocnemius muscle (the
major calf muscle of the leg) to the heel bone.

Types of Muscle Tissue

The three types of muscle tissue are skeletal, smooth, and myocardial. These muscle types are
described according to their appearance and function.
a. Skeletal Muscles: skeletal muscles are attached to the bones of the skeleton and make
body motions possible .they are also known as voluntary muscles because we have
conscious (voluntary) control over these muscles.
b. Smooth Muscles: smooth muscles are located in the walls of internal organs such as the
digestive tract, blood vessels, and ducts leading from glands. Smooth muscles are also known
as involuntary muscles because we are not able to contract or relax those muscles
consciously. Smooth and cardiac muscles are not focus areas of discussion under this topic.
c. Cardiac Muscle (Myocardial Muscle): are also known as myocardium (my/o means muscle,
cardi means heart, and -al means pertaining to). It is the muscle of the heart that constantly
contract and relax to cause the heart beats all the time life of an individual.

Medical Specialties
Common specialty areas of medicine by which physicians get trained to deal with the muscle tendon
and ligament related health problems are:
 Physiatrist: is a physician who specializes in physical medicine and rehabilitation with
the focus on restoring function. Rehabilitation is restoration, following disease, illness, or
injury, of the ability to function in a normal or near-normal manner.
 Rheumatologist: is a physician who specializes in the diagnosis and treatment of arthritis
and disorders such as osteoporosis, fibromyalgia and tendonitis that are characterized by
inflammation in the joints and connective tissues.

Pathologies
Common disorders of the muscle system are:

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  Fasciitis: is inflammation of a fascia.
 Tendinitis: is an inflammation of the tendons caused by excessive or unusual use of the joint.
 Adhesion: is a band of fibrous tissue that holds structures together abnormally. Adhesions can
form in muscles, or in internal organs, as the result of an injury or surgery.

 Atrophy: means weakness or wearing a way of body tissues and structures. Atrophy of a
muscle or muscles can be caused by pathology or by disuse of the muscle over a long
period of time.
 Myalgia: is pain in the muscles (my means muscle, and -algia means pain).
 Muscle Cramps: are sudden, involuntary contractions or spasms in one or more of the
muscles.
 Strain: is an injury to the body of the muscle or to the attachment of a tendon. Strains
usually are associated with overuse injuries that involve a stretched or torn muscle or
tendon attachment.
 Sprain: is an injury to a joint, such as ankle, knee, or wrist that usually involves a
stretched or torn ligament.

Treatment procedures
The common medication and treatment procedures for the muscle
 Neuromuscular blocker: also known as a neuromuscular blocking agent is a drug that
causes temporary paralysis by blocking the transmission of nerve stimuli to the muscles.
These drugs are used as an adjunct to anesthesia during surgery to cause skeletal muscles
to relax. As used here, adjunct means in addition to.
 Occupational and physical therapy: physical therapy (physiotherapy) is treatment to
prevent disability or to restore functioning through the use of exercise, heat, massage, and
other methods to improve circulation, flexibility, and muscle strength.
 Fasciotomy: is a surgical incision through the fascia to relieve tension or pressure (fasci
means fascia, and -otomy means a surgical incision).
 Fascioplasty: is the surgical repair of fascia (fasci/o means fascia, and –plasty means
surgical repair).
 Tenoplasty: is known as tendinoplasty, is the surgical repair of a tendon (ten/o means
tendon).

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  Tenotomy: is known as a tendotomy, is the surgical division of a tendon for relief of a
deformity caused by the abnormal shortening of a muscle,.
 Myoplasty: is the surgical repair of a muscle (my/o means muscle).
 Myotomy: is a surgical incision into a muscle.

Abbreviations/Acronyms
CTS…………………Carpal tunnel syndrome
EMG………………...Electromyography
Hemi…………………Hemiplegia/ic
MD……………………..Muscle dystrophy
RSD…………………….Repetitive Stress disorder
Cardiovascular System

The major structures of the cardiovascular system are the heart, blood vessels, and blood

Structure of cardio vascular system

The major structures of the cardiovascular system are the heart, blood vessels, and blood.

 Heart
Heart is a hollow, muscular organ located between the lungs. It is a very effective pump that
furnishes the power to maintain the blood flow needed throughout the entire body. The pointed
lower end of the heart is known as the apex.
Walls of the Heart: The walls of the heart are made up of three layers; Epicardium, Myocardium,
and Endocardium.
1. Epicardium: is the external layer of the heart and the inner layer of the pericardium.
2. Myocardium: is known as myocardial muscle, is the middle and thickest of the heart’s three
layers and consists of specialized cardiac muscle tissue.
3. Endo-cardium: consists of epithelial tissue, is the inner lining of the heart.

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Heart Chambers

The heart is divided into left and right sides. Each side is subdivided to form the four chambers of the
heart.
• Atria: are the two upper chambers of the heart.
• Ventricles: are the two lower chambers of the heart.

Heart Valves

The flow of blood through the heart is controlled by four valves: the tricuspid, pulmonary semi
lunar, mitral, and aortic semi lunar valves.

Figure 1.7 Four chambers of Heart

Blood Vessels: The blood vessels are the part of the circulatory system that transports blood
throughout the body. There are three major types of blood vessels: the arteries, which carry the
blood away from the heart; the capillaries, which enable the actual exchange of water and
chemicals between the blood and the tissues; and the veins, which carry blood from the capillaries
back to the heart.
Blood: Blood is a specialized bodily fluid that delivers necessary substances such as nutrients and
oxygen to the cells and transports metabolic waste products away from those same cells.

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 Three types of blood cells:
1. Red blood cells (RBC): used to delivers necessary substances such as nutrients and oxygen
to the cells.
2. Wight blood cells(WBC): used to promote immune system
3. Platelets: used for blood coagulation

Medical specialties
Major specialties of the cardiovascular system are:
 Cardiologist: is a physician who specializes in diagnosing and treating abnormalities,
diseases, and disorders of the heart
 Hematologist: is a physician who specializes in diagnosing and treating abnormalities,
diseases, and disorders of the blood and blood forming
 Vascular surgeon: is a physician who specializes in the diagnosis, medical management,
and surgical treatment of disorders of the blood vessels.

Common Cardiac disorders

• Congenital heart defects: are structural abnormalities caused by the failure of the heart to
develop normally before birth. Congenital means present at birth.
• Atherosclerosis of the coronary Artery: it is a coronary artery disease that involves
hardening and narrowing of the arteries due to a buildup of cholesterol plaque on the interior
walls of the arteries (ather/o means plaque or fatty substance, and sclerosis means abnormal
hardening). Atherosclerosis of the coronary arteries reduces the blood supply to the heart
muscle. This creates an insufficient supply of oxygen that can cause angina (pain), a
myocardial infarction leading to death.
• Ischemic heart disease: is a cardiac disability resulting from an insufficient supply of
oxygenated blood to the heart.
• Ischemia is a condition in which there is an insufficient oxygen supply due to a blood flow by
to a part of the body
• Angina: is also known as angina pectoris, is a condition of episodes of severe chest pain due
to inadequate blood flow to the myocardium.
• Myocardial infarction: a heart attack occurs when blood flow to a part of your heart is
blocked for a long enough time that part of the heart muscle is damaged or dies.

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 • Heart Failure: is a chronic condition in which the heart is unable to pump out all of the blood
that it receives. The decreased pumping action causes congestion. Congestion means a fluid
buildup.
 Cardiomegaly: is the abnormal enlargement of the heart that is frequently associated with
heart failure.
 Endocarditis: is an inflammation of the inner lining of the heart.
 Cardiac Arrest: is an event in which the heart abruptly stops. Sudden cardiac death results if
treatment is not provided within a few minutes.
 Bradycardia: is an abnormally slow resting heart rate. This term is usually applied to rates
less than 60 beats per minute.
 Tachycardia: is an abnormally rapid resting heart rate. This term is usually applied to rates
greater than 100 beats per minute.
 Palpitation: is a pounding or racing heart with or without irregularity in rhythm. This is
associated with certain heart disorders

Blood Vessels Disorders

The blood vessels disorder can be arterial or venous in origin. The common disorders are:
 Aneurysm: is a localized weak spot, or balloon-like enlargement.
 Arteriosclerosis: is known as hardening of the arteries, is any of a group of diseases
characterized by thickening and the loss of elasticity of arterial walls.
 Phlebitis: is the inflammation of a vein. This usually occurs in a superficial vein.
 Varicose veins: are abnormally swollen veins, usually occurring in the superficial veins of
the legs.
 Thrombosis: is the abnormal condition of having a thrombus. A thrombus is a blood clot
attached to the interior wall of an artery or vein.
 Embolism: Is the sudden blockage of a blood vessel by an embolus. The embolism is often
named for the causative factor, such as an air embolism or a fat embolism.

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 Figure: 1.8 A thrombotic lesion and arteriosclerotic plaque

Blood Disorders
 Leucopenia: describes any situation in which the total number of leukocytes in the circulating
blood is less than normal.
 Polycythemia: is an abnormal increase in the number of red cells in the blood due to excess
production of these cells by the bone marrow.
 Leukemia: a type of cancer characterized by a progressive increase in the number of abnormal
leukocytes (white blood cells) found in blood forming tissues, other organs, and in the
circulating blood.
 Anemia: is a lower number of red blood cells in the blood. The severity of this condition is
usually measured by a decrease in the amount of hemoglobin in the blood.
 Septicemia: is a systemic condition caused by the multiplication and spread of
microorganisms and their toxins in the circulating blood.
Other Cardiovascular disorder
 Hypertension: is the elevation of arterial blood pressure to a level that is likely to cause
damage to the cardiovascular system. Hypertension is also known as high blood pressure.
 Essential hypertension (primary or idiopathic hypertension) is a consistently elevated
blood pressure of unknown cause. Idiopathic means a disease of unknown cause.
 Secondary hypertension is elevation of blood pressure due to the presence of other
medical problems such as a kidney disorder or a tumor on the adrenal glands. When the
other problem is cured, the secondary hypertension is usually resolved.
 Hypotension: is lower arterial blood pressure than the normal level.

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 Diagnostic Procedures.
 Electrocardiography (EKG/ECG): is the noninvasive process of recording the electrical activity
of the myocardium. A noninvasive procedure does not require the insertion of an instrument
or device through the skin or a body opening for diagnosis or treatment.
Lymphatic and Immune system

Structure and Function

Lymph is a clear, watery fluid that transports waste products and proteins out of the spaces between
the cells of the body tissues. Lymphatic circulation transports lymph from tissues throughout the body
and eventually returns this fluid to the venous circulation.

The lymphatic and immune systems work in close cooperation to protect and maintain the health
of the body. Some functions and structures of these systems are performed by specialized
structures or shared structures.

Functions
The lymphatic system performs three primary functions in cooperation with other body systems.
These are:
a. Absorbing fats and fat-soluble vitamins from the small intestine.
b. Removing waste from the tissues.
c. Providing aid to the immune system.
Structure
The major structures of the lymphatic system consist of lymph, lymphatic vessels/ ducts, and
lymph nodes. Additional structures include the tonsils, thymus and spleen

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 Figure 1.9: Lymphatic system

Lymphatic Vessels and Ducts

Lymph flows from the lymphatic capillaries into the progressively larger lymphatic vessels,
which are located deeper within the tissues. Like veins, lymphatic vessels have valves to
prevent the backward flow of lymph. The larger lymphatic vessels eventually join together to
form two ducts. Each duct drains a specific part of the body and returns the lymph to the venous
circulation.
•The right lymphatic duct collects lymph from the right side of the head and neck, the upper
right quadrant of the body and the right arm.
•The thoracic duct, which is the largest lymphatic vessel in the body, collects lymph from
the left side of the head and neck, the upper left quadrant of the trunk, the left arm, and
the entire lower portion of the trunk and both legs.
Lymph Nodes
Each small, bean-shaped lymph node contains specialized lymphocytes that are capable of
destroying pathogens. Unfiltered lymph flows into the nodes, and here the lymphocytes destroy
harmful substances such as bacteria, viruses, and malignant cells. The body’s three major
groups of lymph nodes are:
• Cervical lymph nodes: are located along the sides of the neck.

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 • Axillary lymph nodes: are located under the arms in the area known as the armpits.
• Inguinal lymph nodes: are located in the inguinal (groin) area of the lower abdomen.

Additional Structures of the Lymphatic System

The remaining structures of this body system are made up of lymphoid tissue. The term
lymphoid means pertaining to the lymphatic system or resembling lymph or lymphatic tissue.
Although these structures consist of lymphoid tissue, their primary roles are in conjunction with
the immune system.

Pathologies and Diagnostic Procedures

Major diagnostic procedures and common disorders of the lymphatic system are:
Lymphadenitis: is an inflammation of the lymph nodes. The terms lymph nodes and lymph
glands are sometimes used interchangeably.
Lymphadenopathy: is any disease process affecting a lymph node or nodes.
Lymphedema: is swelling due to an abnormal accumulation of lymph fluid within the tissues.

Immune System
The primary function of the immune system is to maintain good health and to protect the body from
harmful substances including:
• Pathogens: are disease-producing microorganisms.
• Allergens: are substances that produce allergic reactions.
• Toxins: are poisonous or harmful substances.
• Malignant cells: are abnormally multiplying and potentially life threatening cancer
cells.
The immune system first attempts to prevent the entry of these harmful substances into the
body. If they do gain entry, the immune system immediately begins working to destroy them.
Unlike other body systems, the immune system is not contained within a single set of organs or
vessels. Instead, its functions depend on structures from several other body systems.

Types of immunity
Immunity is the state of being resistant to a specific disease. There are two type of immunity:
Innate and Adaptive.
• Innate Immunity is natural resistance to disease with which a person is born.

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 • Adaptive Immunity further can be sub divided as naturally or artificially acquired
immunity based on the way the immunity is acquired. Naturally acquired immunity: occurs
through contact with disease causing agent and when the contact is not deliberate (following
a disease condition or mother-to-child contact). Whereas artificially acquired immunity
occurs through deliberate action usually vaccination.
Depending on whether the immunity is induced in the host or passively transferred from immune
host, the immunity can be called active or passive respectively.
• Active immunity: is the production (inducing the immunity) of antibodies against a specific
antigen by the immune system either by contracting an infectious disease such as
chickenpox, or by vaccination against a disease such as poliomyelitis (polio).
• Passive immunity: is acquired through transfer of antibodies or activated T-cells from an
immune host, and is short lived—usually lasting only a few months.
Vaccination (also known as immunization) is providing protection for susceptible individuals
from communicable diseases by the administration of a vaccine to provide acquired immunity
against a specific disease. A vaccine is a preparation containing an antigen, consisting of whole
or part of disease causing organisms, which have been killed or weakened.

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 Figure 1.10 Types of immune system

Immune Response
An antigen-antibody reaction, also known as the immune reaction, involves binding antigens to
antibodies. This reaction labels a potentially dangerous antigen so it can be recognized, and
destroyed, by other cells of the immune system.
 Antigen: is any substance that the body regards as being foreign, and includes viruses,
bacteria, toxins, and transplanted tissues. The immune system immediately responds
to the presence of any antigen.
 Antibody: is a disease-fighting protein created by the immune system in response to
the presence of a specific antigen (the prefix anti means against). The terms antibody
and immunoglobulin are often used interchangeably.
A macrophage: is a type of white blood cell that surrounds and kills invading cells (macro-
means large, and -phage means a cell that eats). Macrophages also remove dead cells and
stimulate the action of other immune cells.
A phagocyte: is a large white blood cell that can destroy substances such as cell debris, dust,
pollen, and pathogens by the process of phago-cytosis (phag/o means to eat or swallow, and -
cyte means cell). Phago-cytosis is the process of destroying pathogens by surrounding and
swallowing them.

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 Complement: is a group of proteins that normally circulate in the blood in an inactive form and
are activated by contact with nonspecific antigens such as foreign blood cells or bacteria.
Complement then marks these foreign invaders and attracts phagocytes to destroy these
antigens.

Pathology and Diagnostic Procedures of the Immune System

• An allergic reaction occurs when the body’s immune system reacts to a harmless allergen
such as pollen, or food as if it were a dangerous invader.
• An allergy (also known as hypersensitivity) is an overreaction by the body to a particular
antigen.
• An autoimmune disorder: is known as an autoimmune disease, is any of a large group of
diseases characterized by a condition in which the immune system produces antibodies
against its own tissues. Autoimmune disorders affect most body systems.
• An immunodeficiency disorder: occurs when the immune response is compromised.
Compromised means weakened, reduced, absent, or not functioning properly.
• HIV (human immunodeficiency virus) is a retrovirus that primarily infects vital components
of the human immune system such as CD4+ T cells (a subset of T cells), macrophages and
dendritic cells. It impairs the body’s ability to fight infection and certain cancers. HIV
infection is diagnosable by antibody or antigen testing.
• Acquired immunodeficiency syndrome, commonly known as AIDS, is the most advanced,
and fatal, stage of an HIV infection.
• Opportunistic infection: is infection caused by a pathogen that does not normally produce an
illness in immune-competent (healthy) individuals. However, when the host is debilitated,
these pathogens are able to cause an infection. Debilitated means weakened by another
condition.

Treatment procedures
A variety of treatment procedures are used to correct or control the symptoms of disorders of the
immune system.
• Immunotherapy: is a disease treatment that involves either stimulating or repressing the
immune response. In the treatment of cancers, immunotherapy is used to stimulate the
immune response to fight the malignancy. Stimulate means to cause greater activity. In the
treatment of allergies, immunotherapy is used to repress the body’s sensitivity to a particular

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 allergen. Repress means to decrease, slow, or stop a normal response. This treatment is also
known as allergy desensitization.
• An immunosuppressant: is a substance that prevents or reduces the body’s normal immune
response. This medication is administered to prevent the rejection of donor tissue and to
depress autoimmune disorders.
• A cytotoxic drug: is a medication that kills or damages cells. These drugs are used as
immuno-suppressants or as anti-neo-plastics. Anti neoplastics are discussed under
“Chemotherapy”

Abbreviations /Acronyms

Abbreviation Meaning
AG, Ag Antigen

CA, Ca Carcinoma

CIS Carcinoma in situ

HIV Human immune deficiency virus

AIDS Acquired immune deficiency syndrome

IG Immunoglobulin

NHL Non-Hodgkin’s lymphoma

HL Hodgkin’s lymphoma

Oncology
Oncology is the study of the prevention, causes, and treatment of tumors. Most cancers are
named for the part of the body where the cancer originated. Cancer can attack all body systems
and is the second leading cause of death in the United States after heart conditions.
• A tumor: which is also known as a neoplasm, is a growth of tissue that forms an
abnormal mass. Within this mass, the multiplication of cells is uncontrolled, abnormally
rapid, and progressive. A tumor can be benign (not life-threatening) or malignant
(harmful, capable of spreading, and potentially life-threatening).

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 • Benign tumor: is a noncancerous growth; however, these tumors can cause problems by
placing pressure on adjacent structures. For example, a myoma is a benign tumor made
up of muscle tissue.
• Malignant tumor: is harmful, capable of spreading to distant body sites including other
body system, can become progressively worse, and is progressively life threatening. For
example, a myoma-sarcoma: is a malignant tumor derived from muscle tissue.
• A metastasis: is a new cancer site that result from the spreading process. The metastasis
can be within the same body system or within another body system at a distance from the
primary site (plural, metastases).

Respiratory System
As we breathe in (inspiration or inhalation) and breathe out (expiration or exhalation), the respiratory
system also filters, cleanses, moistens, and warms the air we breathe and aids in the production of
speech. The respiratory system also helps to regulate blood pH.

Structure and Function

The functions of the respiratory system are to:

 Bring oxygen from the inhaled air into the blood for delivery to the body cells.
 Expel waste products (carbon dioxide and some water waste) returned to the lungs by the
blood.
 Produce the airflow through the larynx that makes speech possible.
There are two kinds of respiration:
External respiration: exchanging O2 and CO2 between the external environment and
the lungs).
Internal respiration - the exchange of gases between the lungs and the blood.
For descriptive purpose, the respiratory system is divided into upper and lower respiratory tracts.
• Upper Respiratory tracts: it consists of the nose, mouth, pharynx, epiglottis, larynx and
trachea.
• Lower Respiratory tracts: consists of bronchi and lungs

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 Figure 1.11: Respiratory System

Bronchi: Are formed where the trachea divides into two branches known as primary bronchi
(single: bronchus), each of which enters the lung adjacent to it—one to the left, the other to the
right. Inside the lung, each bronchus then divides into increasingly smaller branches, the smallest
of which are the bronchioles. These bronchioles branch to form microscopic ducts from which
alveoli (sing., alveolus)
• Lungs: Are the main structures of the respiratory system. They are cone shaped organs,
each of which is divided into lobes. The right lung has three lobes—upper, middle, and
lower; the left lung has only two lobes. Together, this pair of highly elastic organs provides
a large surface area for the exchange of oxygen and carbon dioxide. The central portion of
the chest cavity, the space between the lungs, is the mediastinum. It contains the heart,
trachea, esophagus, bronchial tubes, major blood vessels, and other organs.
The most common signs and symptoms of respiratory disorders are:

 Dyspnea: (also called Shortness of breath-SOB) abnormal, difficult, or uncomfortable

breathing.
 Tachypnea: rapid, shallow breathing.

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  Orthopnea: is breathing that is difficult unless the person is in an upright position.
 Apnea: is an abnormal, periodic cessation of breathing, as in obstructive sleep apnea.
 Clubbing: an abnormal enlargement of the distal phalanges, if diminished state of
oxygenation lasts a long period of time.
 Hyperventilation: is abnormally increased breathing.
 Hemoptysis: is coughing up of blood or blood-stained sputum.
 Epistaxis: this is a nosebleed. Epistaxis is caused by the rupture of blood vessels in the
nose.
 Rhinorrhea: is a discharge from the nose other than blood.
 Pleural effusion: is the abnormal accumulation of fluid in the pleural space.
 Pectus escavatum (funnel chested): is characterized by a depression in the lower portion
of the sternum.
 Flail chest: is unstable chest resulting when multiple ribs are fractured.

Common Respiratory disorders

 Epiglotitis: is an inflammation of the epiglottis.

 Laryngitis: is an inflammation of the voice box.
 Pharyngitis: is an inflammation or infection of the pharynx (resulting in a sore throat most
of the time).
 Rhinitis: is an inflammation of the mucous membrane of the nose.
 Sinusitis: is an inflammation of one or more of the sinuses (space inside the bone).
 Croup: is an acute respiratory syndrome in children and infants characterized by
obstruction of larynx, hoarseness, and a barking cough.
 Chronic Bronchitis: is a respiratory disorder in which inflammatory changes to, and
narrowing of, the bronchi cause airflow limitation.
 Emphysema: is progressive loss of lung functions that is characterized by decrease number
of alveoli (air sacs), enlargement of the remaining alveoli and progressive destruction of
the wall of the remaining alveoli.
 Asthma: is a chronic allergic disorder characterized by episodes of server breathing
difficulty, coughing and wheezing.
 Pneumonia: is inflammation of the lings caused by a variety of pathogens.

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  Pulmonary tuberculosis (TB): is an infectious disease caused by bacteria called
mycobacterium tuberculosis that attacks the lungs; however, it can also affect other parts
of the body.
 Chronic Obstructive Pulmonary Disease (COPD): is characterized by a progressive and
irreversible diminishment in the lungs' inspiratory and expiratory capacity.
 Hemothorax: is the presence of blood in the pleural cavity, which causes the lung to
collapse.
 Pneumothorax: is the accumulation of air in the pleural space causing a pressure imbalance
that prevents the lung from expanding.
 Pleural effusion: is an accumulation of pus in the intra-pleural space in the pleural cavity is
called pyothorax or empyema.
Imaging Techniques:
• Chest x-ray: is the most commonly used diagnostic procedure in Ethiopia.
• Pulmonary angiography: This involves injection of a dye into the lung's blood vessels so
that an x-ray image will demonstrate the flow of blood through these vessels.
• Lung ventilation scan: Uses radiopharmaceuticals to produce an image of how air is
distributed in the lungs. This test measures the ability of the lungs to take in air.
• Lung perfusion scan: a nuclear medicine test that produces an image of blood flow to the
lungs to detect a pulmonary embolism.

Respiratory Function and other Tests:

o Pulmonary function test (PFT): To determine the capacity of lungs to exchange oxygen and
carbon dioxide efficiently.
o Throat culture: Cultivation of microorganisms a sample taken from throat.
o Gram stain: Microscopic study of sputum to test for the presence of bacteria, and identify type.
o Acid fast test: of sputum to identify the presence of mycobacterium bacteria (bacteria that
causes diseases such as tuberculosis and leprosy).
o Sputum culture: cultivation of microorganisms from sputum that has been collected from
expectoration.
o Mantoux skin test- is an intra-dermal injection of purified protein derivative (PPD) used to
diagnose tuberculosis.

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 Treatment Procedures

 Ventilation therapy: is treatment given to anyone who needs assistance in obtaining adequate
oxygen levels. A ventilator is a machine that provides positive pressure breathing (PPB), which
delivers air at greater than atmospheric pressure to the lungs.
 Tracheostomy: is an opening made into the trachea for an indwelling tube. This may be either
temporary or permanent.
 Pleurocentesis: is the aspiration of a substance from the pleural cavity (also a diagnostic
procedure).
 Pulmonary resection: is the excision of a portion, a lobe, or the entire lung. If an entire lobe is
excised, the procedure is called a lobectomy. And if the entire lung is removed, it is a
pneumonectomy.
 Adenoidectomy: is the excision of the pharyngeal tonsils, or adenoids.
 Laryngectomy: is excision of the voice box.
 Tonsillectomy: is the excision of the palatine tonsils.

Abbreviations/Acronyms
Abbreviation Meaning

URTI Upper respiratory tract infection

LRTI Lower respiratory tract infection

PPV Positive pressure ventilation

PCP Pneumocystis carinii pneumonia

SAS Sleep apnea syndromes

Digestive System
The digestive system helps your body convert food into usable nutrients through a chemical
breakdown process. The system includes alimentary canal, some accessory organs and a variety of
digestive processes that take place at different levels. The `alimentary canal begins at the mouth,
passes through the thorax, abdomen and pelvis and ends at the anus. The digestive process gradually
breaks down the ingested food until it is suitable for absorption and releases the nutrients to be used by
the body to produce energy and build new cells to replace the dead.

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 Structure of digestive systems
The structure includes the oral cavity, throat, esophagus, stomach, small intestine, large intestine
(collectively known as digestive tube) and accessory organs.
Digestive Tube

 Oral Cavity: The structures of the oral cavity include the mouth, tongue, palate, teeth and
salivary glands.
 Mouth: opening through which food passes into the body and is broken down by mastication
process.
 Tongue: found in the floor of the mouth; it is a skeletal muscle and provides movement for the
food.
 Palate: separates the nasal cavity from the oral cavity.
 Teeth: are attached to the facial bones and are used for mastication.
 Salivary glands: produce saliva which contains enzymes used in the digestion of food.
There are 3 pairs of glands, the parotid glands, the sublingual glands, and the sub-
mandibular glands.
 Throat: throat or the pharynx, connecting the oral cavity with the esophagus. It performs the
swallowing action (deglutition).
 Esophagus: it extends from the pharynx to the stomach, and by peristaltic movement the food
is propelled towards the stomach.
 Stomach: it is a J – shaped sac that mixes and stores food. It also secretes a chemical known as
gastric juice which is acidic, to aid in digestion of food.
 Small Intestine: it is about 6 meters long and extends from the stomach to the large
intestine. It has 3 parts called the duodenum, jejunum, and the ileum. About 1500 ml of
intestinal juice is secreted daily. Most of the chemical digestion is completed here.
 Large Intestine: large intestine is 1.5 meters long extends from the ileum to the anus. Here
absorption of mainly water, minerals and vitamins occurs. Certain types of bacteria help in
the production of Vitamin K and folic acid. Waste product is produced in the form of
faeces for elimination in the large intestine.

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 Figure: 1.12 Digestive system

Medical specialties
The major medical specialties of the digestive system include:
• Dentist specializes in diagnosing and treating diseases and disorders of teeth and tissues of
the oral cavity may hold a Doctor of Dental Surgery (DDS) or Doctor of Medical Dentistry
(DMD) degree.
• Orthodontist is a dental specialist who prevents or corrects malocclusion of the teeth and
related facial structures.
• Gastroenterologist is a physician who specializes in diagnosing and treating diseases and
disorders of the stomach and intestines.

41
 • Internist is a physician who specializes in diagnosing and treating diseases and disorders of
the internal organs and related body systems.
• Proctologist is a physician who specializes in disorders of the colon, rectum, and anus.

Common Pathologies and symptoms

There are a number of digestive system disorders. For the purpose of description, we have
categorized in to; disorders related to the digestive tube, accessory organs, and nutrition.

Disorders related to the digestive tube

• Herpes labialis: caused by the oral herpes simplex virus type 1 (HSV-1) also known as cold
sores or fever blisters, are blister-like sores on the lips and adjacent facial tissue.
• Oral thrush: are creamy white lesions on the tongue or inner cheeks developing when the fungus
Candida albicans grows out of control.
• Dental caries: known as tooth decay or a cavity is an infectious disease caused by bacteria that
destroy the enamel and dentin of the tooth.
• Gingivitis: is the earliest stage of periodontal disease, and the inflammation affects only the
gums.
• Gastro esophageal Reflux Disease (GERD): Weakness of the valve between the esophagus and
stomach may allow stomach acid to reflux into the esophagus and irritate and inflame the lining.
In laymen’s language called severe “heartburn”.
• Esophageal varices: bulging, engorged veins in the walls of the esophagus are often a
complication of chronic alcoholism. The thin-walled, swollen veins are at risk of tearing
resulting in severe, possibly fatal, bleeding.
• Gastritis: is a common inflammation of the stomach lining that is often caused by the bacterium
Helicobacter pylori.
• Gastroenteritis: is an inflammation of the mucous membrane lining the stomach and intestines.
• Peritonitis: inflammation of the lining of the abdominal cavity. Tender abdomen, rebound pain
(pain when manual pressure released from examining abdomen), board-like rigidity of
abdominal muscles.
• Peptic ulcers: are sores that affect the mucous membranes of the digestive system
• Gastric ulcers: are peptic ulcers that occur in the stomach.
• Duodenal ulcers: are peptic ulcers that occur in the upper part of the small intestine.

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 • Appendicitis: inflammation of the appendix, it can rupture and cause peritonitis, and abscess
formation and adhesions.
• Hernias: is the protrusion of an organ or part of an organ through a weak point. It can return to
its usual position or it can result in strangulation resulting in gangrene. The common hernias
are: Inguinal and femoral hernias.
• Enteritis: is an inflammation of the small intestine caused by eating or drinking substances
contaminated with viral and bacterial pathogens.
• Irritable Bowel Syndrome (IBS): also known as spastic colon is a common condition of
unknown cause with symptoms that can include intermittent cramping, abdominal pain,
bloating, constipation, and/or diarrhea.
• Anal fissure: is a small crack-like sore in the skin of the anus that can cause severe pain during a
bowel movement. As used here, a fissure is a groove or crack like sore of the skin.
• Bowel incontinence: is the inability to control the excretion of feces. Constipation is defined as
having a bowel movement fewer than three times per week.
• Hemorrhoid: is varicose vein in the rectum or anus.

Nutritional related symptoms

• Anorexia: is the loss of appetite for food, especially when caused by disease.
• Cachexia: is a condition of physical wasting away due to the loss of weight and muscle mass
that occurs in patients with diseases such as advanced cancer or AIDS.
• Dehydration: is a condition in which fluid loss exceeds fluid intake and disrupts the body’s
normal electrolyte balance.
• Malnutrition: is a lack of proper food or nutrients in the body due to a shortage of food, poor
eating habits, or the inability of the body to digest, absorb, and distribute these nutrients.
• Malabsorption: is a condition in which the small intestine cannot absorb nutrients from food
that passes through it.
• Obesity: this is an excessive accumulation of fat in the body. The term obese is usually used
to refer to individuals who are more than 20%–30% over the established weight standards
for their height, age, and gender.
• Aerophagia: is the excessive swallowing of air while eating or drinking, and is a common
cause of gas in the stomach.
• Dyspepsia: also known as indigestion is pain or discomfort in digestion.

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 • Emesis: also known as vomiting is the reflex ejection of the stomach contents through the
mouth.
• Halitosis: also known as bad breath is an unpleasant odor coming from the mouth
periodontal disease, also known as periodontitis, is an inflammation of the tissues that
surround and support the teeth.

Diagnostic procedures

There are several types of diagnostic procedures that are helpful to diagnose the digestive system
disorders. Some of these are:
•Abdominal ultrasound: is a noninvasive test used to visualize internal organs by using very
high frequency sound waves.
•Endoscopy: use of a flexible fiber optic instrument attached to a video camera that can be used
to directly visualize the esophagus, stomach and large bowel. Special names may be used
for each area explored such as colonoscopy.
•Sigmoidoscopy: is the endoscopic examination of the interior of the rectum, sigmoid colon,
and possibly a portion of the descending colon.
•Cholangiography: is a radiographic examination of the bile ducts with the use of a contrast
medium.
•Upper GI series: a series of X-rays of the esophagus and stomach and small intestines having
the patient swallow a “milkshake” of barium. The element barium is opaque, i.e. blocks, X-
rays.
•Lower GI series: a series of X-rays using a barium enema to show the large intestine and
rectum.
•Stool microscopic examination: specimens of feces are examined for content and
characteristics for the presence of bacteria or ova or parasite (O & P) in the stool.
•Cultures of the stool: sample can be examined in the laboratory for bacteria unable to detect
using direct microscopy.

Treatment /Procedures
Treatment approach for the digestive system disorder mainly depends on the diagnosis made to
the patient. The common treatment of procedures relevant to the digestive system problems are:

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 •Antacids: neutralizes the acids in the stomach, are taken to relieve the discomfort of conditions
such as pyrosis or to help peptic ulcers heal.
•Antiemetic: is a medication that is administered to prevent or relieve nausea and vomiting.
•Laxatives: are medications, or foods, given to stimulate bowel movements.
•Oral rehydration therapy (ORT): is a solution of electrolytes is that is administered in a liquid
preparation to counteract a dehydration caused by severe diarrhea, especially in young
children.
•Laparotomy: is a surgical procedure involving a large incision through the abdominal wall to
gain access into the abdominal cavity.
•Gastrectomy: is the surgical removal of all or a part of the stomach.
•Nasogastric intubation (NGT insertion): is the placement of a feeding tube through the nose
and into the stomach (see figure 4.16).
•Colostomy: is the surgical creation of an artificial excretory opening between the colon and the
body surface.
•Hemorrhoidectomy: is the surgical removal of hemorrhoids.
•Cholecystectomy: is the surgical removal of the gallbladder.

Abbreviations/Acronyms
Abbreviation Meaning
Bil, bili bilirubin
Jaund Jaundice
PUD Peptic Ulcer Disease
TMJ Tempro- mandibular Joint
CRC Colorectal Carcenoma
CIR,CIRR Cirrhosis
NGT Naso Gastric Tube
TPN Total parentral Nutrition

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Urinary System
The urinary system performs many functions that are important in maintaining constant internal
environment called homeostasis. It is a process through which the body maintains its function
constantly. It is composed of two Greek words (home/o means constant, and -stasis means control).
These functions of urinary system include:
a. Maintaining the proper balance of water, salts, and acids in the body by filtering the
blood as it flows through the kidneys.
b. Constantly filtering the blood to remove urea (the major waste product of protein
metabolism) and other waste materials from the bloodstream.
c. Converting waste products and excess fluids into urine in the kidneys and excreting
them from the body via the urinary bladder.
d. Produces and secrets erythropoietin hormone, which controls the production of red
blood cells.
e. Produce and secret rennin, an enzyme, which is important in the control of blood
pressure.

Structure of Urinary system

The urinary system, also referred to as the urinary tract, consists of two kidneys, two ureters, one
bladder, and a urethra.

a. Kidneys
The kidneys constantly filter the blood to remove waste products and excess water. These are
excreted as urine, which is 95% water and 5% other wastes.
• The term renal sometimes used alternatively instead of kidney which means pertaining to
the kidneys.
• The two kidneys are located retro-peritoneal with one on each side of the vertebral column
below the diaphragm. Retroperitoneal means pertaining to being located behind the
peritoneum. The peritoneum is the membrane that lines the abdominal cavity.
• Each kidney comprises of two main layers: Renal Cortex and Renal Medulla
• The outer layer of the kidney is called the renal cortex; it contains over one million
microscopic units called nephrons.

46
 • The inner layer of the kidney is called medulla is the; it contains most of the urine-
collecting tubules.

b. Nephrons
A nephron is a functional and structural unit of the kidney. These units form urine by the
processes of filtration, reabsorption, and secretion. Each nephron contains a glomerulus, which
is a cluster of capillaries surrounded by a cup-shaped membrane called the Bowman’s capsule
(see figure 4.18).

c. Renal Pelvis
The renal pelvis is the funnel-shaped area within each kidney that is surrounded by renal cortex
and medulla. This is where the newly formed urine collects before it flows into the ureters.

d. Ureters
The ureters are two narrow tubes, each about 10–12 inches long, which transport urine from the
kidney to the bladder. Peristalsis, which is a series of wave-like contractions, moves urine down
each ureter to the bladder. Urine drains from the ureters into the bladder through the uretral
orifices in the wall of the urinary bladder.

e. Urinary Bladder
The urinary bladder is a hollow muscular organ that is a reservoir for urine before it is excreted from
the body.

f. Urethra
The urethra is the tube extending from the bladder to the outside of the body. Caution: The
spellings of ureters (which is described earlier) and urethra are very similar. Two urinary
sphincters, one located at either end of the urethra, control the flow of urine from the bladder
into the urethra and out of the urethra through the urethral meatus. A sphincter is a ring-like
muscle that closes a passageway. The urethral meatus, also known as the urinary meatus, is the
external opening of the urethra. Meatus means the external opening of a canal. The prostate
gland, which is part of the male reproductive system, surrounds the urethra.

47
 Figure 1.13 urinary system

Medical Specialties
The two major specialty areas in the urinary system are:
• Nephrologist: is a physician who specializes in diagnosing and treating diseases and
disorders of the kidneys.
• Urologist: a physician specializing in diseases of the lower urinary tract, that is, the
bladder and urethra. Also, urology is the profession that takes care of problems of the
male reproductive system, sort of the male equivalent of a gynecologist.

Pathologies and symptoms

There are several disorders of the kidneys, ureters, bladder and urethras of human. Here, some of the
common disorders and symptoms of the urinary system are listed down.

48
 • Uremia: is a toxic condition resulting from renal failure in which kidney function is
compromised and urea is retained in the blood
• Acute renal failure (ARF): a sudden drop in blood volume or blood pressure due to injury or
surgery. It can be fatal if not reversed promptly. This condition can be caused by many
factors.
• Chronic renal failure: is the progressive loss of renal function, sometimes leading to uremia,
which is caused by a variety of conditions such as kidney disease, diabetes mellitus, or
hypertension.
• Nephrotic syndrome: is a condition in which very high levels of protein are lost in the urine
and abnormally low levels of protein are present in the blood.
• Nephrosis: is any degenerative kidney disease causing Nephrotic syndrome without
inflammation.
• Anuria: is the absence of urine formation by the kidneys.
• Hyperproteinuria: is the presence of abnormally high concentrations of protein in the urine.
• Hypoproteinemia: is the presence of abnormally low concentrations of protein in the blood.
Nephropathy: means any disease of the kidney (nephr means kidney and –pathy means
disease). This definition includes both degenerative and inflammatory conditions.
• Hydronephrosis: is the dilation (swelling) of one or both kidneys. This condition can be caused
by problems associated with the backing pressure of urine due to an obstruction such as a
stricture in the ureters or blockage in the opening from the bladder to the urethra, or in the
urethra itself
• Nephritis: is an inflammation of the kidney or kidneys. The two most common causes of
nephritis are infection or an autoimmune disease.
• Glomerulonephritis: is a type of kidney disease caused by inflammation of the glomeruli
that causes red blood cells and proteins to leak into the urine.
• Renal colic: is an acute pain in the kidney area that is caused by blockage during the
passage of a kidney stone. Colic means spasmodic pains in the abdomen. A stone, also
known as calculus, is an abnormal mineral deposit that has formed within the body (plural,
calculi). The term nephrolithiasis describes the presence of stones in the kidney.
• Nephrolithiasis: also known as renal calculus is the presence of stone is found in the
kidney.
• Ureterolithiasis: is a stone located anywhere along the ureters.

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 • Cystolithiasis: is a stone located within the urinary bladder.
• Urinary tract infection (UTI): usually begins in the bladder; however, these infections can
affect all, or parts, of the urinary system. Urethritis is an inflammation of the urethra.
• Cystitis: is an inflammation of the bladder.
• Pyelonephritis: is an inflammation of both the renal pelvis and of the kidney.
• Cystocele: also known as a fallen bladder is a hernia of the bladder through the vaginal
wall.
• Fistula: is an abnormal passage between two internal organs. E.g. Vesicovaginal fistula
which is an abnormal opening between the bladder and vagina that allows the constant flow
of urine from the bladder into the vagina
• Neurogenic bladder: is a urinary problem caused by interference with the normal nerve
pathways associated with urination. Depending on the type of neurological disorder
causing the problem, the bladder may empty spontaneously, resulting in incontinence.
• Urethrostenosis: is narrowing of the urethra. This condition occurs almost exclusively in
men and is often associated with prostate enlargement.
• Prostate cancer: is one of the most common cancers among men. The disease can grow
slowly with no symptoms, or it can grow aggressively and spread throughout the body.

Symptoms of urinary system

The most common symptoms of urinary system disorders are:
• Diuresis: increased output of urine.
• Dysuria: difficult or painful urination.
• Enuresis: the involuntary discharge of urine.
• Nocturnal enuresis: urinary incontinence during sleep. It is also known as bed-wetting.
Nocturnal means pertaining to night.
• Nocturia: excessive urination during the night. Oliguria: scanty urination.
• Polyuria: excessive urination.
• Urinary hesitancy: difficulty in starting a urinary stream. This condition is most common
in older men with enlarged prostate glands.
• Urinary retention: the inability to empty the bladder. This condition is also more common
in men, and is frequently associated with an enlarged prostate gland.
• Urinary incontinence: the inability to control the voiding of urine.

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 Diagnostic Procedures
The common diagnostic procedures used to diagnose those urinary system disorders are:
• Urinalysis: is the examination of urine to determine the presence of abnormal elements.
• Catheterization: is the insertion of a tube into the bladder in order to procure a sterile
specimen for diagnostic purposes. It is also used to remove urine from the bladder when
the patient is unable to urinate for other reasons. Another use is to place medication into
the bladder.
• Cystography: is a radiographic examination of the bladder after instillation of a contrast
medium via a urethral catheter. The resulting film is a cystogram.
• Cystoscopy: is the visual examination of the urinary bladder using a cystoscope.
• An intravenous pyelogram: also known as excretory urography: is a radiographic study of
the kidneys and ureters. A contrast medium is administered intravenously to clearly
define these structures in the resulting image. This examination is used to diagnose
changes in the urinary tract resulting from kidney stones, infections, enlarged prostate,
tumors, and internal injuries after an abdominal trauma.
• A KUB (Kidneys, Ureters, Bladder): is a radiographic study of these structures without the
use of a contrast medium. This study is also referred to as a flat-plate of the abdomen.

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 Treatment Procedures
Depending on the type of urinary system disorder, one or more treatment procedures can be
employed to cure the patient. The most common therapeutic procedures used to treat urinary
system disorders are:
a. Diuretics
Diuretics are medications administered to increase urine secretion in order to rid the body of
excess water and salt.
b. Dialysis
Dialysis is a procedure to remove waste products from the blood of a patient whose kidneys
no longer function.
c. Renal transplantation
It is also commonly known as a kidney transplant, is the grafting of a donor kidney into
the body to replace the recipient’s failed kidneys. A single transplanted kidney, from
either a living or nonliving donor, is capable of adequately performing all kidney.

c. Nephrolithotomy
Nephrolithotomy is the surgical removal of a nephrolith (kidney stone) through an incision
in the kidney.
e. Prostatectomy
It is the surgical removal of all or part of the prostate gland. This procedure is performed to
treat prostate cancer or to reduce an enlarged prostate gland.

f. Catheterization
Catheterization (is the insertion of catheter into the bladder to void urine) is performed
to withdraw urine for diagnostic purposes, to control incontinence, or to place fluid,
such as a chemotherapy solution, into the bladder.

Abbreviations/Acronyms
Abbreviation Meaning
Alb Albumin
BPH Benign prostatic hypertrophy
Cath Catheterization
CRF Chronic renal failure
KUB Kidney, ureter, bladder
UTI Urinary tract infection
IVP Intravenous pyelogram
U/A Urinalysis

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The Nervous System

Structure and Functions

Human body is made of a number of systems. The system that control and coordinates all the
body activities is known as Nervous system. It also can be described as the body’s
communication network. From the moment we are born to the moment we die, our every
thought, emotion, movement, and impression is controlled by this communication network.
Specialized communication cells create a network so complex that nothing in the world can
approach its complexity.

Figure: 1.14 Human nervous systems

The nervous system is subdivided anatomically (structurally) into the Central nervous system
(CNS) and Peripheral nervous system (PNS). Functionally, it is also divided as Somatic
nervous system and autonomic nervous system.
The entire nervous system is composed of tissues made up of neurons and neuroglia.
Neuroglias are supportive and connective cells of the nervous system. The neurons are the basic

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 cells of the nervous system. The body has billions of neurons which carry impulses throughout
the body via electrochemical process. each neuron consists of a cell body, several dendrities,
axon and terminal end fibers.
•Dendrites are the root-like processes (structures that extend out from the cell body) that receive
impulses and conduct them to the cell body.
•Cell body: is the largest part of the neuron cell which is made up of cytoplasm and nucleus. A
nucleus is the central controlling structure essential to the cell’s life.
•Axon: is a process that extends away from the cell body and conduct impulses away from the
nerve cell. Most of the axons are protected by a white fatty tissue called myelin sheath.
•Terminal end fibers: are the branching fibers at the end of the axon that lead the nerve impulse
from the axon to the synapse.
•A synapse: is the space between two neurons or between a neuron and a receptor organ. A single
neuron can have a few, or several hundred, synapses.

Nerves
A nerve is one or more bundles of neurons that connect the brain and the spinal cord (the Central
nervous system) with other parts of the body.
Sensory nerve fibers: nerve fibers receive external stimuli and transmit this information to the
brain where it is interpreted
Motor nerve fibers: nerve fibers that convey information from the brain that control the body’s’
voluntary muscular movement.

54
 Figure: 1.15 the structure of neurons (A) The motor neuron (B) The sensory neuron.

Ganglion: is nerve center made up of clusters of nerve cell bodies outside the central nervous
system. This term also describes a benign, tumor-like cyst.
Sensory signals originating in sensory receptors are transmitted through the nervous system along
sensory pathways, e.g., pain and temperature pathways and visual pathways. These signals may
reach consciousness or may be utilized at unconscious levels (reflexes). Neural messages for motor
activity are conveyed through the nervous system to the muscles and glands along motor pathways.
Both the sensory (ascending) and motor (descending) pathways include processing centers (e.g.,
ganglia) for each pathway located at different anatomic levels of the spinal cord and brain. The
processing centers are the computers of these complex high-speed systems.

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 Reflexes

A reflex is automatic response to change inside or outside of the body. Cough and sneezing are very
good examples of reflex action or response.

Somatic nervous system

It consists of the nervous system structure responsible for:
a. Conveying and processing conscious and unconscious sensory( afferent which means
‘towards’) information such as vision, pain and touch form the peripheral part of the
body to the central nervous system
b. Motor (efferent which means ‘away from’) control of the voluntary muscles
Autonomic nervous system:
It is composed of the nervous structure responsible for:
a. Conveying and processing the sensory input from the visceral organs (Visceral
referrers to internal organ s of the body such as heart, lung, kidney…etc.).
b. Motor control of involuntary muscles (of which we don’t have conscious to control it)
cardiac musculatures and glands of the visceral organs.

 Structure of the Central Nervous system (CNS)

The central nervous system is consists of brain and spinal cord. These structures are protected
the skull and the vertebral bones. Within this bony structure, there are membranous structures
called meninges and fluid (cerebro spinal fluid).These structures give the brain and the spinal
cord extra protection.

Meninges
These are membranous structures which enclose the brain and the spinal cord of the central
nervous system. These membranous structures are the Dura matter, arachnoids membrane and
pia matter.
• Dura Mater is the thick, tough outermost membrane
• Arachnoid is the middle layer which is loosely attached to the other membrane to allow
fluid to flow between the layers
• Pia mater is a delicate third layer of the meninges which is located nearest to the brain and
spinal cord tissues.

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Cerebrospinal fluid
The cerebro- spinal fluid is a clear, colorless, and watery fluid that flows throughout the brain
and the spinal cord. The CSF is produced by special blood vessels located in the brain
(cerebrum). In addition to the protective functions of CSF (cooling and cushion the delicate
organs from injury), it also provide nutrients and remove metabolic products of the brain and
spinal cord.

Brain
It is main part of the central nervous system which contains an estimated 12 billion neurons. It has
four major components. The largest part of the brain is cerebrum.
Cerebrum: it has an outer surface of gray matter called cerebral cortex which is responsible for
the generation of nerve impulses. The cortex is arranged in folds forming elevated ridges known
as gyri or convolutions. These gyri are separated by depressions called sulci or fissures. A deep
vertical fissure divides the cerebrum into halves called hemisphere. Others fissures in each
hemisphere into lobes.
Brain Stem: is one of the major divisions of the brain and is composed of several parts Medulla
oblongata, pons, and the midbrain. The midbrain connects the lower brain centers to the higher
centers. The pons, or bridge, is located between the midbrain and the medulla oblongata. The
medulla oblongata is continuous with the spinal cord and regulates heart action, breathing, and
circulation.

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 Figure
1.16 the major parts of brain and its protective structures

Cerebellum
The “little brain,” or cerebellum, is the second largest division of the brain. It consists of a
central body called the vermis and two lateral masses called the right and left cerebellar
hemispheres. The chief function of the cerebellum is to bring balance, harmony, and
coordination to motions of the body started by the cerebrum.

Diencephalon
The section of the brain between the midbrain and the cerebrum is referred to as the
diencephalon. It contains the thalamus, hypothalamus, and epithalamus. In the thalamus, the
nerve fibers from the spinal cord and the lower part of the brain provide synaptic connection
with neurons leading to the sensory areas of the cerebrum.
The hypothalamus contains centers for the control of body temperature, carbohydrate
metabolism, fat metabolism, and emotions that affect heartbeat, blood pressure, appetite, and
sexual reflexes. The epithalamus contains the pineal body, which secretes melatonin into the
blood to regulate the daily rhythm.

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 Spinal Cord
The spinal cord is part of the central nervous system which is long, fragile tube-like structure
which begins at the end of the brain stem and continues down to the bottom of the spinal
column.
It contains all the nerves that affect the limbs and the lower part of the body. Like that of brain it is
protected by the cerebrospinal fluid and the meninges.
The spinal cord performs the following two functions:
• Reflex activities: this involves the translation of a sensory message entering the cord
into a motor message as it leaves.
• Pathway: The spinal cord serves as a pathway for conducting sensory impulses from the
sensory nerve upward through the ascending tracts to the brain and moving motor
impulses through the descending tracts from the brain to the nerve that supply messages
to muscles and glands.
The spinal cord is divided into four parts: Cervical, thoracic, lumbar and sacral. It is comprised
of an inner core of gray matter and an outer covering of white matter. The gray matter is
composed of neuralgia and neuron networks of nerve fibers. The cord is covered with protective
structures similar to that of the brain. Injury of the spinal cord in any part can endanger any or
all of its functions.

 Peripheral nervous system (PNS)

The peripheral nervous system is composed of 31 pairs of spinal nerves that extend from the
spinal cord and 12 pairs of cranial nerves which extend from the brain.

Cranial Nerves
The 12 cranial nerves and their functions are listed below, including their Roman numeral reference.
Physicians often refer to cranial nerves by Roman numeral reference.

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Table 1: The cranial nervous and their corresponding functions
Nerve Function
I Olfactory Smell impulses to the brain
II Optic Vision
III Oculomotor Eye muscles and the pupil
IV Trochlear One eye ball muscles on each side
V Trigeminal Sensory nerve of the face and head
VI Abducens Eyeball muscle
VII Facial Largely motor to the face
VIII Acoustic Balance and hearing
IX Gloss- Taste, Saliva secretion, swallowing
pharyngeal
X Vagus Most organs in the thoracic and abdominal
cavities
XI Accessory Two muscles of the neck
XII Hypoglossal Muscles of the tongue

The 31 pairs of spinal nerves carry both voluntary and involuntary impulses and all emerge
from the spinal cord (figure 4:27). At different levels of the cord, these spinal nerves regulate
activities of different parts of the body .each spinal nerve is named after the corresponding
vertebra.
Within each region, the nerves are referred by number. The cervical nerves are [Link]
thoracic nerves are T1-T12, the Lumbar nerves are L1-L5, and the sacral nerves are S1-S5. The
spinal nerves sometimes join with others to form a plexus to innervate a certain area.

60
 Figure1.17 the spinal nerves and the nerve plexus.

Medical Specialties
The following specialties are related to the nervous system in their study and career.
• An Anesthesiologist: is a physician who studies and specializes in administering anesthetic
agents before and during surgery.
• Anesthetist: is a medical professional who specializes in administering anesthesia. Anesthetist
is not primarily a physician but a nurse or other medical professional.
• A neurologist: is a medical professional who specializes in diagnosing and treating diseases
and disorders of the nervous system.
• A neurosurgeon: is a physician who specializes in surgery of the nervous system.

61
 • A psychiatrist: is a physician who specializes in diagnosing and treating chemical
dependencies, emotional problems, and mental illness.

Pathologies
This topic will discuss those diseases and abnormal conditions (pathologies) occur primarily in the
nervous system.
Migraine Headache: It is a type of headache preceded by warning symptoms (warning aura)
perceived by the patient and characterized by throbbing pain on one side of the head. Theses
headaches primarily affect women and are accompanied by nausea, vomiting and increased
sensitivity to light and sound.
Meningocele: It is congenital condition where by the meninges herniated (protruded) through a gap
in the skull or the spinal column.
Hydrocephalus: is a condition in which excess cerebrospinal fluid accumulates in the ventricles
of the brain. This condition can occur at birth or develop later on in life from obstructions
related to meningitis, brain tumors or other causes.
Meningitis: it is an inflammation of the meninges of the brain and spinal cord. This condition
can be caused by bacteria or viral infection. It is characterized by fever, vomiting, headache and
neck stiffness.
Encephalitis: is an inflammation of the brain, can be caused by viral infections such as Rabies.
Tetanus: it is an acute and potentially fatal infection of the central nervous system caused by
toxin produced by the tetanus bacteria. It is also known as Lock jaw and can be prevented
through immunization by administering adequate dose of Tetanus toxoid (TT) vaccine.
Brain injuries: concussion is a violent shaking up of the brain which may result in a temporary loss
of consciousness and functions.
Hematoma: is a collection of blood trapped in the brain. Depending on where the blood is
accumulated or trapped in the brain the hematoma can have different names:
• Epidural hematoma: located above the Dura mater.
• Subdural hematoma: located below the Dura mater.

Coma: is a profound or deep state of unconsciousness marked by the absence spontaneous eye
movements, no response to painful stimuli and lack of speech. The term comatose refers to a
person who is in come.

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 Brain Tumors: is an abnormal growth (benign or malignant) located inside the skull. This may
cause increased intracranial pressure. Intracranial pressure is the amount of pressure inside the
skull. In addition to brain tumors, increased intracranial pressure can be due to brain injury or
improper drainage of cerebrospinal fluid.
Strokes: this is a condition of damaged brain tissue that occurs when the blood flow to the brain
is disrupted because of a blood vessel is either blocked or ruptured. It is also known as cerebro
vascular accident (CVA).
Sleep disorders: the most common sleep disorders are:
• Insomnia: it is condition in which a person has prolonged or abnormal inability to sleep.
• Narcolepsy: is a sleep disorder consisting of sudden and uncontrollable brief episodes of
falling asleep during the day time.
Poliomyelitis: also known as polio is highly infectious viral disease which affects spinal cord.
Bell’s palsy: it is the temporary paralysis of the seventh cranial nerve that causes the paralysis
of the affected side of the face. It is also known as facial nerve paralysis. The common
symptoms are: Inability to close eyes, pain, tearing drooling of saliva and impairment of taste.
Cerebral palsy: is a condition of neurologic deficiencies due to damage that affects the
cerebrum. It is characterized by poor muscle control, spasticity (a condition where certain
muscles are continuously contracted), speech defects and other neurological deficits. It is
frequently occurs in infants following injuries during pregnancy, birth or soon after birth.
Seizure: is a sudden surge (flow) of electrical activity in the brain that affects how a person feels or
acts for short period of time.
Epilepsy: is a chronic neurological condition characterized by recurrent episodes of seizures of
varying severity. It is also known as a Seizure disorder.
Peripheral neuropathy: is a Disorder of the nerves that carry information to and from the brain
and spinal cord. This condition produces pain, loss of sensation and inability to control muscles
particularly in the arms and legs. It is also known as peripheral neuritis.
Hemiplegia: is paralysis of one side (right or left) of the body extremities.
Paraplegia: paralysis of the lower limbs.
Monoplegia: paralysis of a single limb.
Quadriplegia: paralysis of all the limbs or extremities.

Diagnostic procedures of nerve system.

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 Lumbar puncture: this is a diagnostic procedure used to extract cerebrospinal fluid from the sub
arachnoid space where the fluid is found. The process is performed by inserting needle into the
space at the lumbar region of the vertebra. The fluid will be analyzed in laboratory for its physical
appearance, cells and chemical compositions.

Spinal/skull X-ray: spinal or skull x- rays are useful to diagnose some conditions of the nervous
system. The details about x-ray will be discussed under the topic of “diagnostic procedures”.
Myelography: it is a radiographic study of the spinal cord by injecting a radio-opaque substance
into the central canal of the spinal cord in order to assist the diagnosis of disease of the spinal
cord.
Magnetic resonance imaging (MRI) and Computed tomography (CT-scan): are important imaging
tools for the nervous system scanning for diseases and abnormal conditions.
Electro encephalography (EEG): is a process of recording electrical activities of the brain through
the use of electrodes attached to the scalp.
Echoencephalography: is a process of using ultrasound to diagnose some conditions in the brain.
Treatment Procedures
Disorder of the nervous systems can be treated with surgery or medications. Some of these
medications are pain suppressors, sedatives or anxiolytic.

Anesthesia

Anesthesia is a medications used to induce absence of normal sensation including sensitivity to

pain so that surgical (minor or major) procedures can be performed without causing pain to the
patient. There are various type of anesthesia based on the extent of causing anesthesia to the
body.
Topical Anesthesia: numbs (create pain insensitive area) only on the surface of a tissue and are
applied as a liquid, ointment or spray.
Local Anesthesia: causes loss of sensation in a limited area of the body by injecting an anesthetic
solution near that area.

64
 Neuroplasty: is a therapeutic procedure which involves the surgical repairing of a nerve or nerves.
Regional Anesthesia: causes temporary interruption of conduction by injecting anesthetic
solution near the nerve to be blocked so that the areas innervated by the blocked nerve will loss
sensation temporarily.
General anesthesia: involves the total loss of sensation and consciousness induced by
anesthetic agents administered by inhalation (through the airway) or intravenous injection
(through the blood vessels).
Common Abbreviations /Acronyms

Abbreviation Meaning

CP Cerebral palsy

CSF Cerebrospinal fluid

ECG Electro encephalography

ICP Intra cranial pressure

MS Multiple sclerosis

T10 At level of thoracic vertebrae number ten.

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The Special Senses
There are five different special senses known as Vision, hearing, touching, smelling and testing.
These special senses help human beings to analyze and understand their surroundings.
I. Eye
The eyes are the receptor organs of sight and their functions are to receive images and transmit them
to the brain. The eyes can distinguish brightness and color. The photoreceptors are rods and cones
located in a specialized epithelium called the retina. In each eye the retina contains about 6 million
cones and 120 million rods. In the peripheral region of the retina both rods and cones converge on
bipolar cells. The bipolar cells converge on ganglion cells giving rise to the one million nerve fibers
in each optic nerve. In addition, there are horizontal cells and amacrine cells in the retina. They
conduct impulses laterally.

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 Figure1.18 Anatomy of the Eye
Medical Specialties
Ophthalmologist is a physician who specializes in diagnosing and treating disorders of the eyes.
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of
the eye.
Optometrist is a doctor of Optometry degree and specializes in measuring the accuracy of vision to
determine whether corrective lenses are needed.

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Pathologies of Eyes
•Conjunctivitis: also known as pink eye is an inflammation of the conjunctiva that is usually caused by
an infection or allergy.
•Dacryoadenitis: is an inflammation of the lacrimal gland that can be caused by a bacterial, viral, or
fungal infection. Signs and symptoms of this condition include sudden severe pain, redness, and
pressure in the orbit of the eye.
•Sub-conjunctival hemorrhage: is bleeding between the conjunctiva and the sclera. This common
condition, which is usually caused by an injury, creates a red area over the white of the eye.
•Exophthalmia: also known as dry eye is drying of eye surfaces including the conjunctiva (xer means
dry, ophthalmic means eye, and -ia means abnormal condition). This condition is often associated
with aging. In addition, it can be due to systemic diseases such as rheumatoid arthritis or to a lack
of vitamin A.
•Trachoma: is the result of infection of the eye with Chlamydia trachomatis. Infection spreads from
person to person, and especially where there are shortages of water, numerous flies, and crowded
living conditions.
•Corneal ulcer: is a pitting of the cornea caused by an infection or injury. Although these ulcers heal
with treatment, they can leave a cloudy scar that impairs vision. Compare with corneal abrasion.
•Keratitis: is an inflammation of the cornea (kerat means cornea, and -itis means inflammation). This
condition can be due to many causes including bacterial, viral, or fungal infections.
•Cataract: is the loss of transparency of the lens that causes a progressive loss of visual clarity. The
formation of most cataracts is associated with aging; however, this condition can be congenital or
due to an injury or disease.
•Glaucoma: is a group of diseases characterized by increased intraocular pressure that cause damage to
the retinal nerve fibers and the optic nerve.
•Astigmatism: is a condition in which the eye does not focus properly because of uneven curvatures of
the cornea.
•Hyperopia: also known as farsightedness, is a defect in which light rays focus beyond the retina
(hyper- means excessive and –opia means vision condition).
•Myopia: also known as nearsightedness is a defect in which light rays focus in front of the retina.
•Presbyopia: loss of accommodation of the lens as it loses its elasticity.
•Keratomalacia: dryness of the cornea due to lack of tears, leading to corneal ulceration.

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•Retinopathy: is the damage to the retina /retinal vessels. It may be due to damage to the retinal artery
or due to diabetes.

Diagnostic Procedures
• A Snellen chart (SC) is used to measure visual acuity.
• Diopter: is the unit of measurement of a lens’ refractive power.
• Ophthalmoscopy: also known as funduscopy is the visual examination of the fundus (back
part) of the eye with an ophthalmoscope.
• Mydriatic drops: are medicated drops placed into the eyes that produce temporary paralysis.
This paralysis forces the pupils to remain dilated (wide open) even in the presence of bright
light.
• Slit-lamp ophthalmoscopy: is a diagnostic procedure in which a narrow beam of light is
focused onto parts of the eye to permit the ophthalmologist to examine the structures at the
front of the eye including the cornea, iris, and lens.
• Tonometry: is the measurement of intraocular pressure. Abnormally high pressure can be an
indication of glaucoma.
• Visual field testing: also known as perimetry is performed to determine losses in peripheral
vision. Peripheral means occurring away from the center

Treatment Procedures
 A corneal transplant: also known as keratoplasty is the surgical replacement of a scarred or
diseased cornea with clear corneal tissue from a donor.
 An ocular prosthesis: also known as an artificial eye may be fitted to wear over a malformed
eye or to replace an eyeball that is either congenitally missing or has been surgically
removed.
 An intraocular lens (IOL): is a surgically implanted replacement for a natural lens that has
been removed.
 Corrective Lenses: Refractive errors in the eye can often be corrected with lenses that alter
the angle of light rays before they reach the cornea.
 Contact lenses: are refractive lenses that float directly on the tear film in front of the eye.

Abbreviations /Acronyms

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 Abbreviation Meaning

CAT Cataract

Dptr Diopter

G,glc Glaucoma

VA Visual acuity

OS Right Eye

OD Left eye

II. Ear
The ears are the receptor organs of hearing, and their functions are to receive sound impulses and
transmit them to the brain. The inner ear also helps to maintain balance.
The term auditory means pertaining to the sense of hearing (audit means hearing or sense of hearing,
and -ory means pertaining to).
Acoustic means relating to sound or hearing (acous means hearing or sound, and –tic means
pertaining to).
Structure of the Ear
The ear is divided into three separate regions: the outer (pinna, the external auditory canal and
Cerumen), the middle (the tympanic membrane and the auditory ossicles) and the inner ear cochlea
and acoustic nerves (cranial nerve VIII)). The ear is the organ of both hearing and balance (see figure:
4.32).

Medical Specialties
Usually the specialty for ear, nose and throat is known to be otorhinolaryngologist. In addition to this
area of specialty, there are some that focuses on the ear.

 Otologist: is a physician has additional training in the medical and surgical management of
dizziness, hearing loss, and tumors of the ear.
 Audiologist: a professional who specializes in the measurement of hearing function and in the
rehabilitation of persons with hearing impairment.

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 Figure 1.19 Structure of the ear

Pathologies and symptoms

Common disorders and symptoms of the ear include:
• Impacted cerumen: is an accumulation of earwax that forms a solid mass by adhering to the
walls of the external auditory canal. Impacted means lodged or wedged firmly in place.
• Otalgia: also known as an earache is pain in the ear. Otitis: means any inflammation of the
ear. Otitis external is an inflammation of external auditory canal; otitis media is an
inflammation of the middle ear; and otitis internal is an inflammation of the inner ear.
• Otopyorrhea: is the flow of pus from the ear. Otorrhagia: is bleeding from the ear.
Mastoiditis: is an inflammation of any part of the mastoid bone cells. This condition may
develop when an infection in the middle ear that cannot be controlled with antibiotics
spreads to the mastoid cells.
• Otitis media: is an inflammation of the middle ear.
• Vertigo: is a sense of whirling, dizziness, and the loss of balance, that is often combined with
nausea and vomiting.
• Tinnitus: is a ringing, buzzing, or roaring sound in one or both ears. It is often associated
with

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 • Conductive hearing loss: is when sound waves are prevented from passing from the air to the
fluid filled inner ear. Sensorineural hearing loss: also known as nerve deafness develops
when the auditory nerve or hair cells in the inner ear are damaged.
Diagnostic Procedures
Audiometry test and otoscopye examinations are the two common diagnostic procedures used to
diagnose ear problems. Audiometry is an electronic device that produces acoustic stimuli of a set
frequency and intensity. Sound is measured in two different ways. A hertz (Hz) is a measure of
sound frequency that determines how high or low a pitch is. A decibel is commonly used as the
measurement of the loudness of sound. An otoscope is an instrument used to examine the external
ear canal.

Treatment Procedures
In addition to medical treatment, disorders may need surgical interventions and use of some devices to
help hearing. Some of these treatment procedures are:
• Mastoidectomy: is the surgical removal of mastoid cells. This procedure is used to treat a mastoiditis
that cannot be controlled with antibiotics or in preparation for the placement of a cochlear implant.
• Tympanoplasty: is the surgical correction of a damaged middle ear, either to cure chronic
inflammation or to restore function.
• Hearing aid: is an external electronic device that uses a microphone to detect sounds. The sounds
may be coded into a digital representation and are filtered to best compensate for the hearing loss
before being amplified into the ear canal.
Integumentary (Skin) System

The Integumentary system, which is made up of the skin and its related structures, performs
important functions in maintaining the health of the body. Skin covers the external surfaces of the
body. The terms cutaneous means relating to the skin (cutane means skin, and –ous means pertaining
to). The skin is a complex system of specialized tissues and is made up of three basic layers: the
epidermis, dermis, and the subcutaneous layer.

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 Figure 1.20 Skin layers.
The skin plays an important role in the immune system by blocking the entrance of pathogens into the
body and waterproofs the body and prevents fluid loss. It is the major receptor for the sense of touch
and helps the body manufacture vitamin D, an essential nutrient, from the sun’s ultraviolet light, while
screening out some harmful ultraviolet radiation. The skin is a complex system of specialized tissues
and is made up of three basic layers: the epidermis, dermis, and the subcutaneous layer
• The epidermis, which is the outermost layer of the skin, is made up of several specialized
epithelial tissues.
• The dermis, also known as the corium, is the thick layer of living tissue directly below the
epidermis. It contains connective tissue, blood and lymph vessels, and nerve fibers. It also
contains the associated structures of the skin, which are the hair follicles plus the sebaceous and
sweat glands.
• The subcutaneous layer, which is located just below the skin, connects the skin to the surface
muscles.
Associated structures of the skin include:
• The sebaceous glands secrete sebum (oil) that lubricates the skin and prevent the growth of
bacteria on the skin.
• The sweat glands help regulate body temperature and water content by secreting sweat. A small
amount of metabolic waste is also excreted through the sweat glands.

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 • Hair helps control the loss of body heat.
• Nails protect the dorsal surface of the last bone of each toe and finger.

Medical Specialities
• Dermatologist: is a physician who specializes in diagnosing and treating disorders of
the skin.
• Cosmetic surgeon: also known as a plastic surgeon is a physician who specializes in the
surgical restoration and reconstruction of body structures including skin.
Common pathologies and symptoms
In relation to the skin there are a number of disorders and symptoms to be explained. However, we
will describe to you only those that are very common to our healthcare settings.
• Seborrhea: is over activity of the sebaceous glands that results in the production of an excessive
amount of sebum.
• Dermatitis: synonymous with eczema is an itchy inflammation of the skin. It is not contagious or
dangerous, but it can be uncomfortable.
• Folliculitis: is an inflammation of the hair follicles. This condition is especially common on the
limbs and in the beard area of men.
• Petechiae: are very small, pinpoint hemorrhages that are less than 2 mm in diameter (singular,
petechial). These hemorrhages sometimes result from high fevers.
• Ulcer: is an open lesion of the skin or mucous membrane resulting in tissue loss around the edges.
• Erythema: is redness of the skin due to capillary dilation
• Dermatosis: is a general term used to denote skin lesions or eruptions of any type that are not
associated with inflammation. Carbuncle: is a cluster of connected furuncles (boils).
• Cellulitis: is an acute, rapidly spreading infection within the connective tissues that is
characterized by malaise, swelling, warmth, and red streaks. Malaise is a feeling of general
discomfort or uneasiness that is often the first indication of an infection or other disease.
• Furuncles: also known as boils are large, tender, swollen areas caused by a staphylococcal
infection around hair follicles or sebaceous glands.
• Gangrene: which is tissue necrosis (death) is most commonly caused by a loss of circulation to
the affected tissues.
• Impetigo: is a highly contagious bacterial skin infection that commonly occurs in children. This
condition is characterized by isolated pustules that become crusted and rupture.

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• Pediculosis: is an infestation with lice.
• Scabies: is a skin infection caused by an infestation with the itch mite, which causes small, itchy
bumps and blisters due to tiny mites that burrow into the top layer of human skin to lay their eggs.
Medications applied to the skin kill the mites; however, itching may persist for several weeks.
• Herpes zoster: also known as shingles. Painful blisters form along the nerve routes. It is caused by
the chicken pox virus.
• Burns and Scalds: Burns are injuries caused by dry heat, scalds by moist heat, but the two are
similar in symptoms and treatment.
• Psoriasis: is an autoimmune disease that affects the skin. It occurs when the immune system
mistakes the skin cells as a pathogen.

Diagnostic Procedures
The most commonly performed diagnostic procedures for skin disorders is biopsy. It is the removal of
a small piece of living tissue for examination to confirm or establish a diagnosis.

Treatment Procedures related to skin disorders

The most common treatment procedures for skin disorders are:
• Skin Graft: is when skin is transplanted to replace skin damaged or lost due to burns, ulcers,
and cancer.
• Laser therapy: removal or destruction of tissue, e.g. tattoos and warts.
• Cauterization: removing tissue by using heat.
• Cryosurgery: removing tissue by using liquid nitrogen, which is very cold.
• Curettage: is the removal of material from the surface by scraping. One use of this technique is
to remove basal cell tumors.
• Debridement: removal of dirt from skin wounds.
• Incision and drainage: the skin is cut and contents are removed.

Endocrine System
Structure and functions
The main function of endocrine system is to produce hormones (chemical substances) that work
together to maintain constant internal environment (homeostasis) throughout the body systems

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 Endocrinology is a science concerned with the function of glands that secret chemical compounds
known as Hormones into the circulation
The glands that made up the endocrine system are:
a. Pituitary gland
b. Thyroid gland
c. Parathyroid gland
d. Adrenal gland
e. Pancreas
f. Tests/ovaries and
g. pineal gland

I. Pituitary gland
The pituitary gland is a small gland about the size of a raisin located behind the optic nerve crossing.
It is surrounded by bone except for the area where it connects with the brain. The gland consists of
two parts: the anterior lobe and the posterior lobe.
The pituitary gland is called the master gland because it regulates the functions of the other
endocrine glands. In turn, the pituitary gets its direction from the hypothalamus region of the brain.

II. Thyroid gland

The thyroid gland is located in the neck just below the larynx. It has left and right lateral lobes
located on either side of the trachea and are connected by a narrow band called the isthmus. The
hormones thyroxin and triiodothyronine (T3) are produced by the thyroid gland. They regulate the
production of heat and energy in the body tissues and are necessary to maintain a normal level of
metabolism. The blood must have an adequate amount of iodine in order to produce the proper
supply of these hormones.
III. Parathyroid gland
On the back of the thyroid gland, there are four tiny epithelial bodies called parathyroid glands.
These glands produce parathyroid hormone (PTH). PTH regulates the levels of calcium and
phosphorus in the circulating blood and the amount of calcium retained in storage areas such as
bones and teeth.

IV. Adrenal gland

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 The two adrenal glands (also called simply the adrenals) are located above each kidney. The each
gland is consisting of two different parts, each part acting as a separate gland. The inner area is the
medulla, and the outer portion is the cortex. Hormones from the medulla are epinephrine
(adrenaline) and nor-epinephrine (noradrenaline). These are helpful when the body responds to
emergency situations and in maintaining blood pressure. The hormones from the adrenal cortex are
called steroids and have three main functions.
• Aldosterone: controls reabsorption of sodium in the kidney tubules and excretion of
potassium.
• Cortisol: maintains the carbohydrate reserve of the body and helps the body respond to
stress.
• Androgens, estrogens, and progestin’s: influence secondary sexual characteristics.
V. Pancreas
The pancreas is located behind the stomach. Small groups of specialized cells called islets or islands of
Langerhans are scattered throughout the pancreas and manufacture the hormones insulin (secreted by
beta cells) and glucagon (secreted by alpha cells).
Insulin is necessary for the normal use of glucose in the body tissues. If not enough insulin is
produced, sugar is not transformed into energy and remains in the blood. Insulin deficiency causes
diabetes mellitus.

VI. Tests/ovaries
The sex glands in males and females are called gonads. Hormones produced by the sex glands are
important in the development of sexual characteristics and in their maintenance once full development
has been attained. Testosterone is the hormone produced by the male sex glands. The female hormone
is estrogen. Another hormone is produced by the female sex glands to prepare the uterus for pregnancy
and to maintain the pregnancy; it is called progesterone.
VII. Pineal Gland
The pineal gland lies above the roof of the third ventricle of the brain, to which it is attached by the
pineal stalk. The pineal gland secretes the hormone melatonin into the blood.

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 Figure 1.21 Endocrine system
Medical Specialties
The medical specialty related to this system has been described earlier i.e. endocrinologist, a
physician who has specializes in diagnosing and treating diseases and malfunctions of the endocrine
glands.
Pathologies
• Acromegaly: is abnormal enlargement of the extremities (hands and feet) that is caused by
excessive secretion of growth hormone after puberty.
• Gigantism: Also known as giantism is abnormal overgrowth of the entire body that is caused by
excessive secretion of the growth hormone before puberty.
• Diabetes insipidus: is condition whereby there is insufficient quantity of antidiuretic hormone
(ADH) that causes too much fluid to be excreted by the kidneys. This causes polydipsia
(excessive thirst) and polyuria (excessive urination).

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• Hypothyroidism: a condition occurs due to deficiency of thyroid hormones. The congenital form of
hypothyroidism is called cretinism.
• Hyperthyroidism: also known as thyrotoxicosis is an imbalance of metabolism due to over
production of thyroid hormones.
• Goiter (thyromegaly): is an abnormal enlargement of the thyroid gland. This enlargement
produces a swelling in the front of the neck.
• Hyperglycemia: a condition characterized by abnormally high concentration of glucose in the
blood. Hypoglycemia is the opposite of hyperglycemia which is abnormally low concentration of
glucose in the blood.
• Diabetes Mellitus: is a group of metabolic disorders characterized by hyperglycemia resulting
from defects in insulin secretion. This condition classified as Type 1 and Type2 diabetes mellitus.
Diabetic coma also known as diabetic keto acidosis (DKA) is an emergency condition that occurs
when a diabetic patient develops high blood glucose level and dehydration with excess production
of keton bodies.

Diagnostic and treatment Procedures

Among several diagnostic and treatment procedures of endocrine disorders we will see only few of
them as follows.
Thyroidectomy is a surgical removal of thyroid gland and anti-thyroid drug is a medication
administered to slow the ability of the thyroid gland to produce thyroid hormones.
Fasting blood sugar (FBS) is measurement done in the morning, before the person has eaten. This test
together with random blood sugar test (RBS) is usually used to screen Diabetes mellitus.
Abbreviations/Acronyms
DI: diabetes insipidus
DM: diabetes mellitus
FBS: fasting blood sugar
RBS: Random Blood Sugar
DKA: Diabetic keto acidosis

Reproductive System
Human reproduction takes place as internal fertilization by sexual intercourse. During this process,
the erect penis of the male is inserted into the female's vagina until the male ejaculates semen, which
contains sperm, into the female's vagina. The sperm then travels through the vagina and cervix into

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the uterus or fallopian tubes for fertilization of the ovum. Upon successful fertilization and
implantation, gestation of the fetus then occurs within the female's uterus for approximately nine
months, this process is known as pregnancy in humans. Gestation ends with birth, the process of
birth is known as labor.
Labor consists of the muscles of the uterus contracting, the cervix dilating, and the baby passing out
the vagina (the female genital organ).

Male reproductive system functions and structures

The functions of the male reproductive
• produce, sustain and transport sperm cells
• produce the male hormone called testosterone
Male reproductive organs (male genitalia) are divided into two parts:
• Primary tissue: called parenchymal, or gonads produce sex cells.
• Secondary tissue: called stromal that includes all of the glands, nerves, ducts, that have
supportive functions.

Scrotum and Testicles

Scrotum is the saclike structure that surrounds, protects, and supports the testicles. This scrotum is
suspended from the pubic arch behind the penis and lies between the thighs.
Testicles also known as testes, are the two small, egg-shaped glands that produce the sperm
(singular, testis). These glands develop within the abdomen of the male fetus and normally descend
into the scrotum before, or soon after, birth.
Sperm are formed within the seminiferous tubules of each testicle
The epididymis is a coiled tube at the upper part of each testicle. This tube runs down the length of
the testicle then turns upward toward the body. Here, it narrows to form the tube known as the vas
deferens.
The spermatic cord extends upward from the epididymis and is attached to each testicle. Each cord
contains a vas deferens plus the arteries, veins, nerves, and lymphatic vessels required for each
testicle.
Penis
It is the male sex organ that transports the sperm into the female vagina. The penis is composed of
three columns of erectile tissue. During sexual stimulation, the erectile tissue fills with blood under

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high pressure. This causes the swelling, hardness, and stiffness known an erection. The adjectives
penile and phallic both mean relating to the penis (both pen/i and phall/i mean penis). The glans
penis: is known as the head of the penis, is the sensitive region located at the tip of the penis. The
foreskin, also known as the prepuce, is a retractable double-layered fold of skin and mucous
membrane that covers and protects the glans penis.

Prostate Gland
The prostate gland lies under the bladder and surrounds the end of the urethra in the region where the
vas Deferens enters the urethra. During ejaculation, the prostate gland secretes a thick, alkaline fluid
into the semen that aids the motility of the sperm. Motility means ability to move.
Urethra
The urethra passes through the penis to the outside of the body. In the male, the urethra serves both the
reproductive and the urinary systems.

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 Figure: 1.22 Male reproductive organ
Female reproductive system functions and structures
The primary function of the female reproductive system is the creation and support of new life.
• Ovaries produce mature eggs to be fertilized by the sperm cell.
• Uterus provides the environment and support for the developing child.
• After birth, the breasts produce milk to feed the child.
Structure of female reproductive organs also known as female genitalia are commonly divided as
external and internal female genitalia.

a. External female genitalia

A number of important structures exist in the external female genitalia, collectively called the vulva.
The vulva consists of the orifice or vaginal opening; the labia majora, two folds of skin surrounding
the opening; the labia minora (smaller folds); the clitoris, which is made up of sensitive, erectile
tissue; and the perineum, the area between the opening of the vagina and the anus. The Bartholin's
glands are paired glands in the vulva that secrete a mucous lubricant for the vagina, and the mons
pubis is the small, fatty cushion of tissue over the pubic bone.

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b. Internal female genitalia
The internal female genitalia includes the ovaries, fallopian tubes (collectively called adnexa), uterus,
the cervix and the vagina.
Ovary: is an ovum-producing reproductive organ, often found in pairs as part of the female
reproductive system. The ovaries are not attached to the fallopian tubes but to the outer layer of the
uterus via the ovarian ligaments. Usually each ovary takes turns releasing eggs every month; however,
if there was a case where one ovary was absent or dysfunctional then the other ovary would continue
providing eggs to be released. Ovaries in female individuals are similar to testes in male individuals, in
that they are both gonads and endocrine glands.
Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female into the
uterus. There are two Fallopian tubes, attached to either side of the end of the uterus, and each
terminating at or near one ovary. From the fallopian tube, the ovum moves into the uterus, or womb,
which has three layers: the perimetrium (the outer layer); the myometrium (the muscle layer); and
the endometrium (the lining of the uterus).
Besides these layers, the uterus can also be divided into three sections: the fundus, which is the top,
raised area of the uterus between the outlets for the fallopian tubes; the corpus or body, which is the
large central area; and the cervix, the lower narrowed area, which is also referred to as the neck of
the uterus. Vagina is an elastic muscular canal that extends from the cervix to the vulva.

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 A B
Figure 1.23 Female external (a) and internal (b) genitalia

Common terms related to pregnancy and child birth

The placenta is a highly vascular structure that provides communication between mother and
embryo for the exchange of nutrients and wastes. The embryo, which after the eighth week of
pregnancy is called the fetus, is anchored to the uterine wall by the placenta and is connected to the
placenta by the umbilical cord. Depending on the number of births a female experienced the
pregnancy can be called as:
• Primigravida: when a woman gets pregnant for the first time.
• Multigravida: when she had given two or more births earlier to the current pregnancy.
•Parity is the number of deliveries beyond 28 weeks birth given. Example: if a mother has
three children and no history of miscarriages or stillbirth, her parity is 3.
Parturition (Birth)
In humans, the average pregnancy lasts approximately 9 months. When that period concludes, labor,
the process that results in the birth of a newborn, begins with the onset of strong uterine
contractions. These contractions cause the cervix to dilate or widen, allowing the fetus to pass from

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the uterus through the vagina. The process of normal human childbirth is categorized in four stages
of labor:
First Stage: Contraction
The first stage of labor starts classically when the effaced (thinned) cervix is 3 cm dilated. The onset
of actual labor is defined when the cervix begins to progressively dilate. Rupture of the membranes,
or a blood stained 'show' may or may not occur at or around this stage. During effacement, the
cervix gets included into the lower segment of the uterus. This draws the cervix up over the baby's
head. Full dilatation is reached when the cervix is the size of the baby's head; at around 10 cm
dilation for a term baby.

Second stage: birth

This stage begins when the cervix is fully dilated, and ends when the baby is finally birthed. At the
beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of
the head has successfully passed through the pelvic brim.

Third stage: placenta

At this stage, the uterus expels the placenta (afterbirth). The placenta is usually birthed within 15-30
minutes of the baby being born. Maternal blood loss is limited by contraction of the uterus following
birth of the placenta. Normal blood loss is less than 600 mL. Breastfeeding soon after birth and
massaging of the top of the uterus causes uterine contractions that encourage birth of the placenta.
Active management utilizes oxytocic agents (e.g. ergometrine) and controlled cord traction. The
oxytocic agents increase uterine muscular contraction and the cord traction assists with rapid birth of
the placenta, reducing the risk of postpartum bleeding.
Forth stage of labor: stabilization stage: begins after the delivery of the placenta and continues for
one to four hours after delivery

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 Figure1.24 four stages of labor

Medical specialties of reproductive system and childhood

 Gynecologist: is a physician who specializes in diagnosing and treating diseases and
disorders of the female reproductive system (gynec means female, and ologist means
specialist).
 Obstetrician: is a physician who specializes in providing medical care to women during
pregnancy, childbirth, and immediately thereafter. This specialty is referred to as obstetrics.
 Neonatologist: is a physician who specialized in diagnosing and treating disorders of the
neonates (neonates are babies under 28 days of age.
 Pediatrician: is a physician who specialized in diagnosing, treating, and preventing disorders
and diseases of children. This specialty is known as pediatrics.

Common pathologies, conditions and symptoms

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Reproductive system diseases and conditions include several diseases and their symptoms. In
addition conditions related to pregnancy and child birth are included under this subtopic. We
describe to you only those diseases and conditions that are very common in our healthcare setup.
• Benign prostatic hypertrophy (BPH): abnormal enlargement of the prostate gland surrounding
the urethra, causing urinary obstruction.
• Epididymitis: inflammation of the epididymis.
• Hydrocele: collection of fluid in the testis.
• Orchitis: inflammation of the testicles (scrotum).
• Testicular torsion: twisting of the testicle on its spermatic cord.
• Sexually transmitted disease (STDs): infection of the reproductive organs that are caused by
bacteria or viral or fungal microbes and transmitted through sexual contact. E.g. Gonorrhea,
Syphilis, Chancroid, Candidiasis, Trichomoniasis, Genital wart, Genital ulcer.
• Cervicitis: is inflammation of the uterine cervix.

Pelvic inflammatory disorder (PID): PID is commonly associated with adhesions, which is simply
scar tissue that binds surfaces together which is a result of the inflammation.
Endometriosis is a condition in which endometrial tissue proliferates outside the uterine cavity.
This can interfere with the ability to conceive and is caused by the backward flow of tissue
fragments during menstruation.
Vaginitis: Inflammation of the vagina.
Vulvitis: inflammation of the vulva.
Vulvovaginitis: inflammation of both the vulva and the vagina:
Mastitis: it is the inflammation of breast tissue.
Breast Cancer: is a type of cancer originating from breast tissue.
Menstrual Cycle Disorders: The most common menstrual disorders are:
 Menorrhagia: is an abnormally heavy or prolonged menstrual period
 Polymenorrhea: is abnormally frequent menstrual flow.
 Dysmenorrhea: is a painful menstrual flow, or cramps.
 Premenstrual syndrome (PMS) includes both mood and physical symptoms of a similar
cyclic origin prior to menstruation cycle.
 Amenorrhea: is an absence of menstrual discharge.
 Oligomenorrhea: is light, scarce, or scanty menstrual flow.

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Complications of pregnancy and Birth
Miscarriage: is the miscarriage or spontaneous abortion, which is the abrupt termination of a
pregnancy before the fetus is viable.
Ectopic pregnancy: is the implantation of the embryo in any location other than the uterus.
Placenta previa: is a condition in which the placenta is mal-positioned in the uterus in such a way as
to cover, partially or completely, the cervical opening.
Abruptio placenta: is another potentially life-threatening condition that may occur during pregnancy. It
involves premature separation of the placenta from the uterine wall.

Figure:
1.25 Normal placenta, placenta Previa and placenta Abruptio

Maternal and fetal complications during birth

Intra partum asphyxia: is the impairment of oxygen to the brain and vital tissues of the baby during the
progress of labor.
Vaginal birth injury: Internal tissue tearing as well as nerve damage to the pelvic structures lead in a
proportion of women to problems with prolapse, incontinence of stool or urine and sexual dysfunction.
Antepartum Hemorrhage (APH): is bleeding from vagina during pregnancy after 28 weeks of
gestational age.

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Postpartum Hemorrhage (PPH): or heavy blood loss is still the leading cause of death of birthing
mothers in the world today, especially in the developing world. Heavy blood loss leads to shock,
insufficient perfusion of vital organs and death if not rapidly treated.
Eclampsia: is an extremely serious form of hypertension secondary to pregnancy.
Pre-eclampsia: is also marked by hypertension, along with edema and proteinuria. It is called toxemia
of pregnancy.
Polyhydramnios: This is a condition of excessive amniotic fluid. Oligohydramnios: low or missing
amniotic fluid.
Erythroblastosis fetalis: is a condition in which the mother's blood is Rh negative and her fetus is Rh
positive, causing the mother to form antibodies to the Rh-positive factor.

Diagnostic Procedures
There are a number of diagnostic procedures applied to various reproductive system disorders and
conditions. Some of these are:
• Hysterosalpingography: it involves the use of contrast medium x-rays to image the uterus and
fallopian tubes.
• Coldoscopy: is an endoscopic procedure used for cervical/vaginal biopsies
• Hysteroscopy, using a hysteroscope to remove either a fibroid or polyp from the uterus.
• Pap smear: is an exfoliative cytology procedure used for the detection of vaginal and cervical
cancer.
• Prostate specific antigen (PSA): used to diagnose prostate hypertrophy or prostate cancer.
• VDRL test: test for syphilis
• Sperm count: also known as a sperm analysis is the testing of freshly ejaculated semen to
determine the volume plus the number, shape, size, and motility of the sperm.

Treatment procedures

The common treatment procedures for reproductive system disorders and conditions are:
• Prostatectomy: removal of the prostate gland.
• Vasectomy: a permanent contraceptive method for male. It involves tying vas deferens of male
reproductive organ to sterilize the male permanently.

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 • D&C (Dilatation and curettage): involves dilating (widening) the cervix to insert a scraping
tool (curette) to remove the lining of the uterus. This procedure is used not only for treatment,
but also for diagnosis and for emptying the uterus of the products of conception.
• Hysterectomy: is resection of all or part of the uterus.
• Lumpectomy: excision of the localized breast tumor, while preserving the remaining breast
tissue.
• Mastectomy: the surgical removal of one or both breasts.
• Sterilization: procedures used to end fertility and cause sterilization in individuals who want to
ensure that they will produce no (or no more) children. The term sterilization refers to any
surgical procedure that accomplishes it. In women, such procedures include hysterectomy, or
tubal ligation
Pregnancy and delivery interventions:

 External cephalic-version; a procedure used when a fetus is not turned head down so that the
crown of its head will "present" first, the obstetrician will try to turn the baby so that the head
is at the cervical outlet for a vaginal delivery.

 Episiotomy: is widening the vaginal orifice, using an incision, this is done to avoid tearing
the tissue of the vulva during delivery.
 Instrumental delivery: is used when the fetus is in distress, when the woman is having
difficulty of pushing, and when labor is prolonged. Such complications are managed by:
 Vacuum extractor: which is a small cup made of a rubber like material that is connected to a
vacuum? It is inserted into the vagina and uses suction to attach to the fetus's head.
 Forceps: are metal surgical instruments with rounded edges that fit around the fetus's head.
Cesarean Section: Sometimes vaginal delivery is not possible because of either fetal distress
or a maternal condition. When this happens, the infant can be delivered through a surgical
incision made into the mother's abdomen called cesarean section or C-section (CS).
 Neonate Assessment: immediately after birth, a neonate's physical condition is assessed to
determine its ability to adapt to life outside of the uterus. The Apgar score rates the physical
health of the infant at 1 minute and 5 minutes after birth, using a set of five factors that
include the infant's heart rate, respiration, muscle tone, color, and response to skin
stimulation.
Abbreviation/acronyms

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 Abbreviation Meaning
HYS Hysteroscopy
APH Ante-partum Hemorrhage
PPH Postpartum Hemorrhage
PID Pelvic Inflammatory Disease
IUD Intra Uterine Device
D&C Dilatation and Curettage

E&C Evacuation and Curettage

AMN Amniocentesis

1.2.4 Identifying clinical data relating to Mental and behavioral Health

Mental health describes a level of psychological well-being, or an absence of a mental disorder.
From the perspective of 'positive psychology' or 'holism', mental health may include an individual's
ability to enjoy life, and create a balance between life activities and efforts to achieve psychological
resilience. Mental health can also be defined as an expression of emotions, and as signifying a
successful adaptation to a range of demands. There are different types of mental health problems,
some of which are common, such as depression and anxiety disorders, and some not so common,
such as schizophrenia.

Symptoms and disorders of mental health

Although there are several mental disorders and associated symptoms, only the most common once are
described here. These are:
• Apathy: lack of feeling, emotion, interest, or concern.
• Delusion: false belief based on incorrect inference about external reality that is firmly sustained
despite what almost everyone else believes and despite what constitutes incontrovertible and
obvious proof or evidence to the contrary.
• Flight of ideas: nearly continuous flow of accelerated speech with abrupt changes from topic to
topic that are usually based on understandable associations, distracting stimuli, or plays on words.
When severe, speech may be disorganized and incoherent.
• Hallucination: sensory perception that has the compelling sense of reality of a true perception but
that occurs without external stimulation of the relevant sensory organ.

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• Illusion: misperception or misinterpretation of a real external stimulus, such as hearing the rustling
of leaves as the sound of voices. See also hallucination.
• Incoherence: speech or thinking that is essentially incomprehensible to others because words or
phrases are joined together without a logical or meaningful connection. This disturbance occurs
within clauses, in contrast to derailment, in which the disturbance is between clauses.
• Insomnia: this is subjective complaint of difficulty in falling or staying asleep or poor sleep
quality.
• Phobia: persistent, irrational fear of a specific object, activity, or situation (the phobic stimulus)
that results in a compelling desire to avoid it. This often leads either to avoidance of the phobic
stimulus or to enduring it with dread.
• Psychosis: is abnormal condition of the mind, and is a generic psychiatric term for a mental state
often described as involving a “loss of contact with reality”. People suffering from psychosis are
described as psychotic. The term is originated from Greek word ‘psyche’ that means mind and
‘osis’ which mean of ‘abnormal condition’.
• Anxiety: is defined as anticipation of impending danger and dread, accompanied by restlessness,
tension, tachycardia, and breathing difficulty not associated with an apparent stimulus.
• Panic disorder: consists of recurrent, unpredictable attacks of severe anxiety (panic attacks) that
may not be restricted to any particular situation.
• Euphoria: is an exaggerated sense of physical and emotional well-being that is not based on reality,
is disproportionate to the cause, and/or is inappropriate to the situation.
• Bipolar Disorder: is characterized by swings between an elevation of mood and increased energy
and activity (hypomania and mania) and a lowering of mood.
• Mental retardation: a condition of below average intellectual ability.
• Autism: is condition of abnormal development of social interaction, impaired communication, and
repetitive behaviors.
• Withdrawal state: refers to a group of symptoms that can occur during the cessation of use of a
regularly taken substance.
• Dependence syndrome: difficulty in controlling use of a substance.
• Schizophrenia: it is mental disorder generally characterized by distortions of thinking and
perception, coupled with affects that are inappropriate or blunted. This "split" may refer to the
patient's characteristic inability to recognize an appropriate perception of reality despite an intact
intellectual capacity.

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• Psychotropic medication: is medication that affects thought processes or feeling states.

1.3. Basic clinical procedures, diagnosis, interventions and medications

1.3.1 Basic clinical Diagnostic procedure

A. Examination Procedures
Basic examination procedures are performed during the assessment of the patient’s condition. As
used in medicine, the term assessment means the evaluation or appraisal of a condition. This
information is used in reaching a diagnosis and in formulating a patient care plan. We will describe
you the most basic examination procedure that are supposed to be done to patients of a healthcare
facility i.e. Vital signs taking procedure.
Vital signs are those four key indications of life (that the body systems are functioning). These signs
of life are recorded for most patients who visit a health facility. It includes temperature, pulse,
respiration, and blood pressure.

 Temperature: temperature readings are named for the location in which they are taken: oral
(in the mouth),
 aural (in the ear)
 axillary under the arm)
 rectal (in the rectum).
 Hypothermia (high-poh-ther-mee-ah) is an abnormally low body temperature (hypo- means
deficient, therm means heat, and -ia means pertaining to).
 Hyperthermia (high-per-THER-mee-ah) is an extremely high fever (hyper- means excessive,
therm means heat, and -ia means pertaining to). An average normal temperature is 98.6°F
(Fahrenheit) or 37.0°C (Celsius).
 Pulse: the pulse is the rhythmic pressure against the walls of an artery caused by the
contraction of the heart. The pulse rate reflects the number of times the heart beats each
minute and is recorded as bpm (beats per minute).
 Respiration; also known as the respiratory rate (RR) is the number of complete respirations
per minute. One inhalation and one exhalation are counted as a single respiration. The
normal respiratory rate for adults ranges from 12 to 20 respirations per minute.

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  Blood Pressure: is the force of the blood against the walls of the arteries. This force is
measured using a sphygmomanometer. When using manual style, a stethoscope is required to
listen to the blood sounds. A digital sphygmomanometer is automated and does not require
the use of a stethoscope.

b. Examination Instruments
Depending on the specialty at which the patient is getting medical service, these basic examination
instruments can be applied to reach on a clinical diagnosis of the patient’s problem.
Speculum: is an instrument used to enlarge the opening of any canal or cavity to facilitate Inspection
of its interior.
Stethoscope: is an instrument used to listen to sounds within the body.
Otoscope: is an instrument used to visually examine the external ear canal and tympanic membrane.
Ophthalmoscope: is an instrument used to examine the interior of the eye.

C. Examination Positions

In clinical practice specific positions is needed to examine different parts of the body.
• Recumbent Positions: the term recumbent describes any position in which the patient is lying
down. This can be on the back, front, or side.
• Prone Position: in a prone position, the patient is lying on the belly with the face down. The
arms may be placed under the head for Comfort. This position is used for the examination and
treatment of the back and buttocks.
• Sims’ Position: in the Sims’ position, the patient is lying on the left side with the right knee
and thigh drawn up with the left arm placed along the back. This position is used in the
examination and treatment of the rectal area. The name of this position is also spelled as Sims
position.
• Knee-Chest Position: in the knee-chest position, the patient is lying face down with the hips
bent so that the knees and chest rest on this position is used for rectal examinations.
• Lithotomy Position: in the lithotomy position the patient is lying on the back with the feet and
legs raised and supported in stirrups. This position is used for vaginal and rectal examinations
and during childbirth. The term lithotomy is also used to describe the removal of a stone from
the urinary bladder.
1.3.2 Basic Laboratory Tests
The most common laboratory tests ordered by care providers are:

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 a. Blood Tests: When used in regard to laboratory tests, the term profile means tests that are
frequently performed as a group on automated multichannel laboratory testing equipment.
b. Obtaining Specimens: Phlebotomy which is also known as venipuncture is the puncture of a
vein for the purpose of drawing blood (phleb means vein, and -otomy means a surgical
incision). A capillary puncture is the technique used when only a small amount of blood is
needed as a specimen for a blood test. Named for where it is performed, a capillary puncture is
usually known as a finger, heel, or an earlobe stick.
c. Complete Blood Cell Counts (CBC): complete blood cell count is a series of tests performed
as a group to evaluate several blood conditions.
d. Erythrocyte sedimentation rate (ESR): is a test based on the speed at which the red blood
cells separate from the plasma and settle to the bottom of the container. An elevated sed rate
indicates the presence of inflammation in the body.
e. Hematocrit test: describes the percentage, by volume, of a blood sample occupied by red cells
(hemat/o means blood, and -crit means to separate). This test is used to diagnose abnormal
states of hydration (fluid levels in the body), polycythemia (excess red blood cells), and anemia
(deficient red blood cells).
f. Platelet count: measures the number of platelets in a specified amount of blood and is a
screening test to evaluate platelet function. It is also used to monitor changes in the blood
associated with chemotherapy and radiation therapy. These changes include thrombocytosis
(an abnormal increase in the number of platelets) and thrombocytopenia (an abnormal decrease
in the number of platelets).
[Link] test (Hg): is usually part of a complete blood count (hem/o means blood, and
globin means protein). Elevated Hg levels indicate a higher than normal hemoglobin
concentration in the plasma due to polycythemia or dehydration. Low Hg indicates lower than
normal hemoglobin concentration due to anemia, recent hemorrhage, or fluid retention.
h. White blood cell count (WBC): is a determination of the number of leukocytes in the blood.
An elevated count can be an indication of infection or inflammation.
i. White blood cell differential test (WBC differential count): determines what percentage of the
total count is composed of each of the five types of leukocyte. This test provides information
about the patient’s immune system, detects certain types of leukemia, and determines the
severity of infection.

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 j. Urinalysis: is the examination of the physical and chemical properties of urine to determine the
presence of abnormal elements.

1.3.3 Basic radiological investigations

In conventional radiology, also known as x-rays, an image of hard-tissue internal structures is
created by the exposure of sensitized film to x-radiation. The resulting film is known as a radiograph
or radiogram.
Computed tomography: also known as CT-Scan; is a scanning technology that uses a thin fan-
shaped x-ray beam to produce multiple cross-sectional views of the body of a patient. Information
gathered by radiation detectors is downloaded to a computer, analyzed, and converted into gray-scale
images corresponding to anatomic slices of the body.

1.3.4 Clinical data related to medication

Pharmacology is the study of the nature, uses, and effects of drugs for medical purposes. A pharmacist
is a licensed specialist who formulates and dispenses prescribed medications.

a. Prescription and Over-the-Counter Drugs

A prescription drug is a medication that can legally be dispensed only by a pharmacist with an order
from a licensed professional such as a physician or other health care provider. An over-the-counter
drug is a medication that can be purchased without a prescription.
Example: anti-pain such as Parcetamol name for diazepam.

b. Other common Terms

• Addiction: is compulsive, uncontrollable dependence on a drug, alcohol, or other substance. It
can also be a habit, or practice, which cannot be stopped without causing severe emotional,
mental, or physiologic reactions.
•Adverse drug reaction (ADR): also known as a side effect is an undesirable reaction that
accompanies the principal response for which the drug was taken.
• Compliance: is the patient’s consistency and accuracy in following the regimen prescribed by
a physician or other health care professional. As used here, regimen means directions or rules.
• Contraindication: is a factor in the patient’s condition that makes the use of a medication or
specific treatment dangerous or ill advised.

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 • Drug interaction: is the result of drugs reacting with each other, often in ways that are
unexpected or potentially harmful. Such interactions can also occur when medications are
taken along with herbal remedies.
• Idiosyncratic reaction: is an unexpected reaction to a drug that is peculiar to the individual.
• Placebo: is an inactive substance, such as a sugar pill or liquid that is administered only for its
suggestive effects. In medical research, a placebo is administered to one group and the drug
being studied is administered to another group.
• Antipyretic: is medication administered to prevent or reduce fever (anti- means against, pyret
means fever, and -ic means pertaining to). These medications, such as aspirin and
acetaminophen, act by lowering a raised body temperature; however, they do not affect a
normal body temperature when a fever is not present.
• Anti-inflammatory: relieves inflammation and pain without affecting consciousness.
• Analgesic: refers to the class of drugs that relieves pain without affecting consciousness.
These include such drugs as aspirin, acetaminophen, and ibuprofen.
c. Methods of drug administration
Drugs or medications can be given/administered to the body through several routes. The most common
methods or route of drug administration are:
• Inhalation: describes vapors and gases taken in through the nose or mouth and absorbed into
the bloodstream through the lungs. One example is the use of a metered-dose inhaler to treat
asthma or the gases used for general anesthesia.
• Oral administration: refers to medications taken by mouth to be absorbed through the walls
of the stomach or small intestine. These drugs can be in the form of liquids, tablets (pills), or
capsules.
• Rectal: is the insertion of medication in the rectum either in the form of a suppository or a
liquid. A suppository is medication in a semisolid form that is introduced into the rectum.
The suppository melts at body temperature, and the medication is absorbed through the
surrounding tissues.
• Sublingual: is the placement of medication under the tongue where it is allowed to dissolve
slowly.
• Topical application: is a liquid or ointment that is rubbed into the skin on the area to be
treated. Examples: Hydrocortisone 1% ointment is applied topically to relieve itching.

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 • Parenteral Administration: it is administering drugs into the body in a manner other than
through the digestive tract. These are: A subcutaneous injection (SC): is made into the fatty
layer just below the skin, Intra-dermal injection: injection made into the middle layer
(dermis) of the skin, Intramuscular injection (IM): is
• Injection made directly into muscle tissue and intravenous (IV): is an injection made into the
vein.

Abbreviation/Acronyms
Abbreviation Meaning

PRN As desired
BID Twice a day

Q.D Every day

QID Every six hourly

Stat Only once

TID Every eight hourly

BP Blood pressure
RR respiratory rate
BUN Blood urea nitrogen
ESR Erythrocyte sedimentation rate

Hct, hct Hematocrit

NPO nothing by mouth
P.O by mouth

PRN as needed

WBC white blood count

RBC red blood count

CBC Complete blood count

Rx prescription

Sig to be labeled accordingly

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1.4 Establishing detail level of clinical data to meet national standards.
Data standards as applied to healthcare include: methods, protocols, terminologies, and specifications
for the collection, exchange, storage, and retrieval of information associated with healthcare
applications, including medical records, medications, radiological images, payment and
reimbursement, medical devices and monitoring systems and administrative processes and those data
have detail level to meet national standards and as well as used for clinical decision making
This means that the data have sufficient detail. For example, an indicator requires the number of
individuals who received HIV counseling and testing and received their test results by sex of the
individual. An information system lacks precision if it is not designed to record age and sex of the
individual who received counseling and testing or one of them.
Classified and coded must be allow for different levels of details if it has a hierarchical structure with
subdivision. Disease classification should have the ability to identify specific disease entity and to
allow useful and understandable information to be obtained.

1.5 Recording clear, accurate, complete and timely clinical data.

Clinical data should be fit for their intended uses in operations, decision making, and planning.
Clinical data fit all dimensions of data quality. I.e legibility, accurate, completness and timeliness
Legibility: All data whether written, transcribed and/or printed should be readable.
Examples of legibility
 Handwritten demographic data are clearly written and readable.
 Handwritten notes on patient form, admission card, and any other medical records registers are
clear, concise, readable and understandable.
 Handwritten National classification of diagnosis (NCoD) clear and easily understandable to
transcribe in to Register In all medical/health records, cryptic codes or symbols cannot be used
in either manual or electronic patient records. If abbreviations are used, they are standard and
understood by all health care professionals involved in the service being provided to the
patient. Mostly this problem is seen at outpatient and inpatient department which are major
source for clinical data and NCoD.
Timeliness: Information, especially clinical information, should be documented as an event
occurs, treatment is performed or results noted. Delaying documentation could cause information
to be omitted and errors recorded. Example of timeliness

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 A patient’s identifying information is recorded at the time of first attendance and is readily
available to identify the patient at any given time.
On discharge or death of a patient in hospital, his or her medical records are processed and
completed, coded and indexed within a specified time frame.
Completeness: All required data should be present and the medical/health record should contain
all pertinent documents with complete and appropriate documentation.
Accuracy: collected clinical data should be coded accurately and matched from all card register,
tally and reports.

Self-check 1

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Name…………………………………………… ID………………………… Date…….
Directions: Answer all the questions listed below.
Test 1 Explain the following terms using your own words.
A. Eponym___________________________
B. Abbreviation_______________________
C. Decodable ________________________
D. Prefix____________________________
E. Suffix___________________________
Test 2: Describe the following terms using your own words.
a. Health__________________________________________
b. Disease_________________________________________
c. Illness _________________________________________
d. Sickness _________________________________________
e. Health indicators___________________________________
f.Incidence_________________________________________
g. Prevalence________________________________________
h. Epidemic________________________________________
Test 3: write the difference between the Axial and the appendicular skeleton?
_______________________________________________________________________
___________________________________________________________
Test 4: Discuss the structure and function of muscular system briefly.
_______________________________________________________________________________
_______________________________________________________________________________
__________________________________________________________
Test 5: Describe the Structure and function of cardiovascular system.
_______________________________________________________________________________
__________________________________________________________________
Test 6: Write common disorders of the cardiovascular system and its diagnostic procedures.
_______________________________________________________________________________
___________________________________________________________________
7. Identify the two major classification of the nervous system.
_________________________________________________________________________________
_____________________________________________________________________
Test 8 Explain the following terms:
a. Catheterization_____________________________________

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b. Diuretics_________________________________________
c. Dysuria__________________________________________
d. Lymphadenitis _______________________________
e. Autoimmune Disorders ________________________
f. Chemotherapy ______________________________
g. Metastasis _________________________________
h. Tumor ____________________________________
i. Malignant tumor____________________________
j. Benign tumor________________________________
k. Hallucination ___________________________________
l. Delusion ______________________________________
m. Anxiety________________________________________
n. Phobia________________________________________
o. Schizophrenia_________________________________
p. Depression______________________________________
Test 9: Choose the correct answer for the following multiple choice questions.

1. The visual examination of the sigmoid colon and lower rectum is known as

a. anoscopy b. colonoscopy c proctoscopy d .Sigmoidoscopy

2. A secretion secreted by liver and stored in the gallbladder for later use.

a. bile b. glycogen c. insulin d pepsin

3. The surgical removal of all or part of the stomach is

a. gastrectomy b. gastritis c. gastroenteritis d. gastrotomy

4. The medical term meaning difficulty in swallowing is

a. anorexia b. dyspepsia c. dysphagia d. pyrosi

5. Urinary bladder stone is known as _______________

a. Cholelithiasis b. Cystolithiasis [Link] d. Ureterolithiasis

6. Excessive urination is called ______________
a. Anuria b. Incontinence c. Polyuria d. Oliguria

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 7. The basic cells of the nervous system that allow different parts of the body to communicate
with each other are called ____________________.
a. Axons b. Neurons c. Dendrites d. Impulse

Test 10: Write in full word or statement for the listed abbreviations
a. PUD _________________________
b. DM ___________________________
c. NGT __________________________
d. KUB _____________________
e. UTI ______________________
f. UA _______________________
g. ESR______________________
h. P.O______________________
i. BP______________________
j. RR_______________________
k. RBC_____________________
l. CBC_______________________
Test 11: Answer the following question
a What are the first feces of the new born called?
b What is the term for the cord wrapped around the neck of the neonate?
c What is the term for a baby’s head being larger than the pelvic outlet?
d What is the term for a pregnancy that takes place anywhere but in the uterus?
e What is the term abnormally small amount of amniotic fluid?
f What is the term for excessive bleeding through vagina immediately after birth and most
common causes of maternal deaths?

LG8 LO2- Assign codes to clinical data

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Instruction sheet 2
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topics:
 Coding clinical data
 Identifying current policies, procedures and guide lines on Clinical coding
 Identifying nnational classification of diseases (NCoD)
 Eestablishing sequence of codes
 Recording coded data clearly, accurately and completely
 Eentering coded data into the appropriate format/technology
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Code clinical data
 Identify current policies, procedures and guide lines on Clinical coding
 Identify national classification of diseases (NCoD)
 Eestablish sequence of codes
 Record coded data clearly, accurately and completely
 Enter coded data into the appropriate format/technology
Learning Instructions:
5. Read the specific objectives of this Learning Guide.
6. Follow the instructions described below.
7. Read the information written in the information Sheets
8. Accomplish the Self-checks

LG8: Information Sheet 2

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2.1 Coding clinical data
2.1.1 Introduction to disease classification and coding system
The clinical data contained in a patient's medical record is of no value to medical or public health
science if it remains stored within a record without means of retrieval. The comparison of health care
data between facilities, regions, within a country or between countries is important to the growth and
dissemination of health information throughout the world. This possible sharing of health information
is meaningless if there is no use of standardized nomenclature, identification, disease classification and
coding systems
Disease nomenclature: is a system of naming diseases to produce lists of acceptable or approved
disease terminology and differs from disease classification which refers to grouping of diseases or
conditions and organizing into categories in a systematic way The purpose of disease nomenclature is
to promote the use of the most appropriate diagnostic term to describe a particular disease or
condition. A generally accepted standard medical vocabulary comprised of unambiguous medical
terminology is essential for precise and effective communication about disease.
Disease classification system: classification of disease can be defined as a system of categories to
which morbid entities or conditions are assigned according to established criteria (set of rules). The
aim of disease classification is to permit systematic record analysis, interpretation of mortality and
morbidity data collected in different areas and at different times.
Clinical coding system:-Clinical coding is a process of assigning a distinct numeric or alphanumeric
value to medical diagnosis, procedures and surgery, signs and symptoms of disease and ill-defined
conditions, poisoning and adverse effect of drugs, complications of surgery and medical care.
Collecting and reporting aggregate information through codes allows the health facility a simplified
way to provide information quickly and easily.
2.1.2 Historical development disease classification and coding
In the 18th century, diseases captured the attention of those determined to organize knowledge,
establish orderly groupings of natural objects, and develop encyclopedias (books containing general
information about all branches of knowledge or a particular branch of knowledge). Although some
groupings of diseases were evident since early writings of the Greeks and Romans, we will see two of
the most prominent scholars that influenced the current disease classification and coding systems.
In 1839, William Farr’s first attempt at a disease classification for statistical purposes appeared
in the first annual report of the registrar-general of births, deaths, and marriages in England. He

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 divided these into three classes, the first for those that occur endemically or epidemically, in
other words, the communicable diseases. The second class was for those diseases that arise
sporadically: these are further subdivided anatomically into diseases of the nervous system,
respiratory organs, etc., ending with a group for those of uncertain location such as tumors,
malformations, sudden death, and old age. In each anatomical group, he characterized the more
common conditions, ending with a residual category for the less common or ill-defined
conditions. His third group was for death due to violence.

Bertillon classification
Groupings concerning the nature of diseases tended to lose meaning over time, therefore,
Bertillon had adopted the anatomical site for main headings rather than the nature of disease.
Bertillon’s list included defined diseases most worthy of study by reason of their transmissible
nature or their frequency of occurrence. Bertillon’s main headings were:
 General diseases
 Diseases of nervous system and sense organs
 Diseases of circulatory system
 Diseases of respiratory system
 Diseases of digestive system
 Diseases of genitourinary system
 Puerperal diseases
 Diseases of skin and annexes
 Diseases of locomotors organs
 Malformations
 Diseases of early infancy
 Diseases of old age
 Effects of external causes
 Ill-defined disease

2.1.4 Importance of Disease Classification and Coding

The importance of disease classification and coding are summarized below with four key areas.

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a. Data collection:-Coding allows for gathering of important data on a variety of topics. For example,
a code for an infection due to a needle stick may be tracked over a period of time for risk and quality
management purposes.
b. Statistics Because each code relates to a diagnosis or procedure, it allows the health institutions to
provide statistical information on specific diseases and injuries. For example, statistics on Voluntary
Counseling and Testing are provided through codes.
c. Research Medical codes are often tracked for research purposes. For example, in abroad cancer-
related codes are reported regularly in order to determine the funding and resources needed for
research.
d. Resource Use Because medical codes have associated reimbursement, many abroad hospital
administrators and managers use coding reports to ensure that resources are being utilized properly
and to make further decisions about the most cost-effective services to offer for patients.
Types of coding system
a. Diagnostic coding system: are used to determine disease, disorders and symptoms and can be used to
measure morbidity and mortality. Ex. ICD-10, ICD-9-CM (International Classification of Diseases,
Ninth Revision, Clinical Modification).
b. Procedure coding system: Are numbers or alphanumeric codes used to identify specific health
interventions taken by healthcare providers? E.g. ICPM (International Classification of Procedures in
Medicine).
c. Pharmaceutical coding systems: Are used to identify medications e.g. NDC (National Drug Code).
d. Topographical coding system: Are codes that indicate a specific location of the body E.g. ICD-O
(International Classification of Diseases for Oncology)

International Classification of Diseases version 10 (ICD-10)

The ICD is published by the WHO and used worldwide for morbidity and mortality statistics,
reimbursement systems, and automated decision support in health care. This system is designed to
promote international comparability in the collection, processing, classification, and presentation of

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these statistics. ICD is the foundation for the identification of health trends and statistics globally, and
the international standard for reporting diseases and health conditions. It is the diagnostic classification
standard for all clinical and research purposes. ICD defines the universe of diseases, disorders, injuries
and other related health conditions, listed in a comprehensive, hierarchical fashion that allows for:
easy storage, retrieval and analysis of health information for evidenced-based decision-making sharing
and comparing health information between hospitals, regions, settings and countries and data
comparisons in the same location across different time periods

Basic Structure of ICD

The base for ICD is a single coded list of three-character categories, each of which can be further
divided into four-character subcategories. In place of the purely numeric coding system of previous
revisions, the Tenth Revision uses alphanumeric code with a letter in the first position and a number in
the second, third and fourth positions. The fourth character follows a decimal point. Possible code
numbers therefore range from A00.0 to Z99.9.
a. Volume: ICD-10 comprises three volumes: Volume-1 contains the main classifications; Volume-2
provides guidance to users of the ICD; and Volume-3 is the Alphabetical Index to the classification.
The focus of discussion in this context will be the content of volume I of ICD -10.
b. Chapter: The classification is divided into 21 chapters. Each chapter contains sufficient three-
character categories. The first character of ICD code is a letter and each letter is associated with a
particular chapter. Letter ‘U’ is not used in this three- character categories as it is preserved to be used
by world health organization for temporary assignment of new diseases of uncertain cause.
C. Blocks of categories: Each chapter is divided into homogeneous ‘Blocks’ of three character
categories. The range of categories is given in parentheses after each block title. See some of the
blocks of categories of chapter I as an example:
Chapter I: Certain infectious and parasitic diseases Blocks of Categories:
 A00-A09 Intestinal infectious disease
 A15-A19 Tuberculosis
 B15-B19 Viral Hepatitis
 B50-B64 Protozoal disease
 B65-B83 Helminthiases
d. Three character categories: Within each block, the three-character categories are for:

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Single Condition: Selected because of their frequency of occurrence, severity and susceptibility to
public health intervention. Example: A15-A19 Tuberculosis
Groups of disease with some common characteristics: Example: B95-B98 Bacterial, viral and other
infectious agents
e. Four –character subcategories Most of the three-character categories are subdivided by means of
a fourth numeric character after a decimal number allowing up to ten sub categories. Theses sub-
categories are not mandatory for reporting at international level.
Example: A15.0 Respiratory tuberculosis, bacteriologically and histologically confirmed
A18.1 Tuberculosis of genitourinary system
Table 1. ICD-10 List of Chapters, Block groups and Chapter titles.
Chapter Block Title
I A00-B99 Certain infectious and parasitic diseases
II C00-D48 Neoplasms
III D50-D89 Diseases of the blood and blood-forming organs and certain
disorders involving the immune mechanism
IV E00-E90 Endocrine, nutritional and metabolic diseases
V F00-F99 Mental and behavioural disorders
VI G00-G99 Diseases of the nervous system
VII H00-H59 Diseases of the eye and adnexa
VIII H60-H95 Diseases of the ear and mastoid process
IX I00-I99 Diseases of the circulatory system
X J00-J99 Diseases of the respiratory system
XI K00-K93 Diseases of the digestive system
XII L00-L99 Diseases of the skin and subcutaneous tissue
XIII M00-M99 Diseases of the musculoskeletal system and connective tissue
XIV N00-N99 Diseases of the genitourinary system
XV O00-O99 Pregnancy, childbirth and the puerperium
XVI P00-P96 Certain conditions originating in the perinatal period
XVII Q00-Q99 Congenital malformations, deformations and chromosomal
abnormalities

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XVIII R00-R99 Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
XIX S00-T98 Injury, poisoning and certain other consequences of external
causes
XX V01-Y98 External causes of morbidity and mortality
XXI Z00-Z99 Factors influencing health status and contact with health
services
XXII U00-U99 Codes for special purposes

International Classification of Diseases version 11 (ICD-11)

The ICD-11 is the eleventh revision of the International Classification of Diseases, and will replace
the ICD-10 as the global standard for coding health information and causes of death. The ICD is
developed and annually updated by the World Health Organization (WHO). Development of the ICD-
11 started in 2007 and spanned over a decade of work, involving over 300 specialists from 55
countries divided into 30 work groups. ICD-11 officially came into effect on 1 January 2022.
However, the WHO acknowledged in 2018 that "not many countries are likely to adapt that
quickly" Currently, no country has officially switched to the ICD-11 yet.

Goals ICD-11 Revision

 ICD-11 will function in an electronic environment
o Digital product
o Link with terminologies and other classifications
o Support electronic health records and information systems
 Multi-purpose and coherent classification
o Mortality, morbidity, primary care, clinical care, research, public health…
o Consistency and interoperability across different uses
o International multilingual reference standard for scientific comparability (Arabic, Chinese,
English, French, Russian, Spanish)
Advantages of ICD-11 than ICD-10
 Improve morbidity statistics
 Easier use

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  Manage national clinical modifications in more effective manner
 Improve integration of other classifications and terminologies
 Improve comparability of translations
 Capture advances in health science and medical practice
 Make better use of the digital revolution
 Better address multiple topics; e.g. quality & safety, traditional medicine, etc.
 Address persistent major gaps in basic use for mortality statistics
ICD-11 contains 27 chapters with blocks and 6 chapters are not exist in ICD-10
Newly added chapters In ICD- 11
1. Disorders of the Immune system
2. Dis. of blood & blood forming organs
3. Conditions related to Sexual Health
4. Sleep-wake disorders
5. Traditional medicine
6. Extension codes

2.2 National Classification of Diseases (NCoD)

In Ethiopia, before 2005, the Ministry of Health used the sixth edition of ICD which was released in
1948, as the national disease reporting system. As part of health management information system and
monitoring& Evaluation reform, federal ministry of health and regional health bureaus agreed on having a
disease classification system for the purpose of national reporting, epidemiological and statistical analysis.
Based on the agreement reached, several discussions was made focusing on whether to use ICD-10 in all health
facilities of the country regardless of their diagnostic capability or to develop a national disease classification
system reflecting the local/ national disease reporting needs and meeting the international standards.

In 2006, agreement was reached on adoption of the international classification of disease to meet the national
disease reporting need.

The NCoD was developed as part of the HMIS reform to organize health information. It is the national
standard system of defining, monitoring and reporting health conditions and their outcomes.

The preparation of the NCoD started with a countrywide study of samples from service points &
administrative units. It also includes the relationship of geographical setup in respect to a disease. This

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study produced a list of diseases, from which a selection of priority diseases was made. The disease
list was then harmonized with different international standards: Integrated Disease Surveillance and
Response (IDSR) protocols (using disease names in IDSR list), ICD-10 codes and Global Burden of
Disease (GBD) classification. The NCoD was finalized after the recommendations of healthcare
providers and specialists in each discipline were incorporated.

National disease classification system is based on priority for epidemic control and frequency of
disease occurrence in Ethiopia. The codes associated with the diseases are consisting of numerical
values. The HMIS disease code is given for each diagnostic term in the list. And each diagnostic term
has the corresponding ICD code. Some of the diseases from the list are reported either only from
outpatient or inpatient services while majority of them can be reported both from OPD and IPD
services (but not at a time for a patient who has got both services for a diagnosis). The diseases in the
list are grouped under the following headings. As the HMIS disease list contains all of diseases
known to be cause for morbidity and mortality in the Ethiopian health facilities including those
priority diseases and conditions reported for IDSR/PHEM (public health emergency management),
more detailed descriptions are provided to those diseases under the heading of ‘Infectious and parasitic
diseases ‘.

Epidemic prone diseases

Diseases occur in a community at different levels at a particular point in time. Some diseases are
usually present in a community at a certain predictable level. This level is called the expected level.
Epidemic refers to the occurrence of disease or health related condition in excess of the usual
frequency in a given area or among a specified group of people over a particular period of time. Some
of the diseases or conditions have tendency to occur above the expected level in the population for
various reasons. Such diseases or conditions are known as epidemic prone diseases.

For you to have more clear understanding of those diseases which are commonly occurs as epidemic
in Ethiopia, Each epidemic prone disease is briefly described with their associated HMIS and ICD-10
codes and description.

a. Malaria (clinical without laboratory confirmation)

HMIS code: 0101

ICD code: B54

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Disease Description

Malaria is a protozoan disease transmitted by the bite of infected anopheles mosquitoes. It is

transmitted in 108 countries containing 3 billion people and causes nearly 1 million deaths each year.
The four most common species of the genus plasmodium that cause nearly all malarial infections in
humans are P. falciparum, P. vivax, P. ovale, and P. malariae.

b. Malaria (confirmed with P. falciparum)

HMIS code: 0102

ICD code: B50

c. Malaria (confirmed with species other than P. falciparum)

HMIS code: 0103

ICD code: B51-B53

d. Diarrhoea (non-bloody)
HMIS code: 0104

ICD code: A09

Disease Description

Non-bloody diarrhea is Passage of loose stool three or more times per day without visible blood and it
can be acute or chronic (which lasts more than four weeks).

e. Diarrhea with dehydration

HMIS code: 0105

ICD code: A09

Disease Description

It is a diarrhea with excessive loss of body fluid/water. The dehydration can be sever or mild to
moderate. The patient with severe dehydration may have sunken eyes, drink eagerly, decreased skin
turgor, restlessness or may be lethargic or loss consciousness if the dehydration is severe.

f. Diarrhea with blood (dysentery)

HMIS code: 0106

ICD code: A02.0, A03, A04A06.0, A06.1, A07

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 Disease Description: Diarrhea containing blood.

g. Meningitis
HMIS code: 0107

ICD code: A39.0, G00-G03

Disease Description
Meningitis is inflammation of the meninges (which are membranous structure found in the central
nervous system). This may be caused by infectious agents like bacteria and virus or it can be a
manifestation of non-infectious disease. A patient with bacterial meningitis can have fever, headache,
and neck stiffness with or without altered consciousness.

h. Typhoid fever
HMIS code: 0108
ICD code: A01.0
Disease Description
Typhoid (Enteric) fever is a systemic disease characterized by fever and abdominal pain.
It is caused by a bacterial infection called salmonella.
i. Relapsing fever
HMIS code: 0108
ICD code: A68.0-A68.9

Disease Description
Relapsing fever is an illness characterized by recurring episodes of fever and nonspecific symptoms
(e.g. headache, myalgia, arthralgia, shaking chills, and abdominal symptoms) after infection with one
of several species of Borrelia.

[Link] typhus
HMIS code: 0110
ICD code: A75.0
Disease Description
Epidemic typhus is a louse born disease caused by a micro-organism called [Link]. The
symptoms are: sudden onset of the illness with prostration, severe headache, fever myalgia and cough.

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The disease commonly occurs in regions affected by war and disasters. An outbreak that involved
100,000 people occurred in refugee camps of Burundi in 1997.

k. Acute Febrile Illness (AFI)

HMIS code: 0111
ICD code: -----
Disease Description
AFI is a nonspecific term for an illness of sudden onset that manifests by fever and accompanied by
other nonspecific symptoms such as chills, headache and myalgia. Following laboratory investigations
a specific disease can be identified. The common diseases are malaria, meningitis, relapsing fever,
epidemic typhus, typhus, typhoid fever …etc.
2.4.2 Immediately reportable diseases
These are diseases which are under surveillance for purpose of eradication or elimination. Such
diseases should be reported as soon as (within 30 minutes following detection) possible to the next
higher level after detection.
a. Acute poliomyelitis/Acute flaccid paralysis
HMIS code: 0112
ICD code: A80.0-A80.9
Disease Description
Poliomyelitis, or polio, is a disease caused by poliovirus. The only way to spread poliovirus is through
the fecal/oral route. The virus enters the body through the mouth when people eat food or drink water
that is contaminated with faeces. The virus then multiplies in the intestine, enters the bloodstream, and
may invade certain types of nerve cells to damage or destroy them. Polioviruses spread very easily in
areas with poor hygiene.
Acute flaccid paralysis (AFP) is acute onset of focal weakness or paralysis characterized as flaccid
(reduced tone) without other obvious causes (e.g., trauma) in children less than 15 years old, including
Guillain Barré Syndrome (GBS). Transient weakness (e.g., postictal weakness) should not be reported.
This definition includes the paralytic acute poliomyelitis.

b. Measles
HMIS code: 0113
ICD code: B05.0-B05.9
Disease Description

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Measles is a serious viral infection characterized by high fever, cough, coryza, conjunctivitis, and skin
rash. After an incubation period of 8–12 days, the early phase begins with a mild fever followed by the
onset of conjunctivitis with photophobia, coryza, a prominent cough and increasing fever. The portal
of entry of measles virus to the body is through the respiratory tract or conjunctivae following contact
with large droplets or small droplet aerosols in which the virus is suspended.
c. Plague
HMIS code: 0114
ICD code: A20.0-A20.9
Disease Description
Plague is a systemic disease caused by yersiniapestis. It is transmitted to humans by flea. Less often,
infection follows contact with animal tissues or respiratory droplets. Plague is an acute febrile illness
that can be treated with antimicrobial agents, but mortality rates among untreated patients are high.
Patients can present with the bubonic, septicemia, or pneumonic form of the disease. Human plague
generally follows an outbreak in a host rodent/rat population. Between 1989 and 2003, 38,359 cases of
plague were reported to WHO and more than 80% of these cases were in Africa, and the percentage of
all cases in Africa increased over this period; the majority of cases were reported from East Africa and
Madagascar. Recent outbreaks of pneumonic plague have been recorded in Uganda, the Democratic
Republic of the Congo, and China.
d. Cholera
HMIS code: 0115
ICD code: A00.0-A00.9
Disease Description
Cholera is an acute diarrheal disease that can, in a matter of hours, result in excessive, rapidly
progressive dehydration and death. It is caused by V. cholera that has been responsible for epidemic.
Epidemic cholera remains a significant public health concern in the developing world today.

e. Yellow fever
HMIS code: 0116
ICD code: A95.0-A95.9
Disease Description
Yellow Fever is viral disease transmitted by aegypti mosquitoes; the mosquitoes are infected after
feeding on viremic humans and then spread the infection in subsequent feeding attempts. Yellow fever

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is a typical Hemorrhagic fever accompanied by significant liver damage. In severe cases, the
characteristic jaundice (yellowish discoloration of the eye), hemorrhages, black vomit, no/little urine
may occur.
f. Neonatal tetanus
HMIS code: 0118
ICD code: A33
Disease Description
Neonatal tetanus (also called tetanus neonatorum) is infantile (during infancy) form of generalized
tetanus, which is an acute, spastic paralytic illness caused by toxin produced by Clostridium tetani
(bacteria) that typically manifests within 3–12 days of birth as difficulty in feeding, associated hunger,
and crying, paralysis or decreased movement, stiffness and spasms, with or without opisthotonos
(special body position of a patient suffering from this condition), are characteristic.

g. Viral hemorrhagic fevers

HMIS code: 0119
ICD code: A96.0-A96.9, A98.0-A98.8, A99
Disease Description
Viral hemorrhagic fevers (VHFs) refer to a group of illnesses that are caused by several distinct
families of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe
multisystem syndrome (multisystem in that multiple organ systems in the body are affected).
Characteristically, the overall vascular system is damaged, and the body's ability to regulate itself is
impaired. These symptoms are often accompanied by hemorrhage (bleeding); however, the bleeding is
itself rarely life-threatening. While some types of hemorrhagic fever viruses can cause relatively mild
illnesses, many of these viruses cause severe, life-threatening disease.

h. Avian Human Influenza

HMIS code: 0120
ICD code: J09
Disease Description
Avian human Influenza is an acute respiratory illness caused by infection with influenza viruses type
A (A/H5N1). The illness affects the upper and/or lower respiratory tract and is often accompanied by
systemic signs and symptoms such as fever, headache, myalgia, and weakness. Transmission of the
virus to humans is due to Contact with infected poultry or birds.

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 i. Rift Valley Fever (RVF)
HMIS code: 0121
ICD code: A92.4
Disease Description
Rift valley fever is a viral disease caused by Rift valley virus which is transmitted in majority of the
cases from direct or indirect contact of blood or organs of infected animals. In most cases it causes
mild infection of feverish syndrome manifested by flulike fever, muscle pain, joint pain and headache.
The virus is first identified in the rift valley of Kenya in 1931 and a major outbreak occurred in Kenya,
Somalia and Tanzania from 1997 to 1998.
2.4.3 Other priority infectious diseases

a. Human immunodeficiency virus [HIV] disease

HMIS code: 0122.1
ICD code: B20-B24

Disease Description
It is a disease of the human immune system caused by the human immunodeficiency virus (HIV).
During the initial infection a person may experience a brief period of influenza-like illness. This is
typically followed by a prolonged period without symptoms. As the illness progresses it interferes
more and more with the immune system, making people much more likely to get infections, including
opportunistic infections, and tumors that do not usually affect people with working immune systems.
b. Human immunodeficiency virus infection / Acquired immunodeficiency syndrome
(HIV/AIDS)
HMIS code: 0122.2
ICD code: B20-B24
Description See above.
c. Tuberculosis
HMIS code: 0123
ICD code: A15-A19, B90
Disease description

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 Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which
most commonly affects the lungs. It is transmitted from person to person via droplets from the throat
and lungs of people with the active respiratory disease.
In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the
person's immune system prevent the bacteria to multiply and cause the disease. The symptoms of
active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight
loss, fever and night sweats. Tuberculosis is treatable with a six-month course of antibiotics. TB has
been further defined by TB prevention and control program for the following purposes:

Based on anatomical Site of TB Disease

• Pulmonary Tuberculosis: is a case of TB involving the lung tissues.
• Extra- pulmonary Tuberculosis: is a case of TB involving organs other than lung.

Based on Bacteriological Result

Smear Positive: case of TB when the bacteria are identified by microscopic smear examination or
culture. These are the most infectious and most likely to transmit their diseases to others.
Smear Negative: Case of TB when the bacteria are not identified by microscopic smear examination
but the clinician decides to treat the patient with full course of treatment clinically and or with
radiological findings.

Based on patient history of treatment

• New TB case: is case TB who has never had treatment for TB, or has taken anti TB drugs for less
than 1 month. New patient may have positive or negative bacteriology and may have disease at any
anatomical site.
• Previously treated patient (Relapse, Failure or Default): have received 1 month or more of anti-
TB drugs in the past, may have positive or negative bacteriology and may have disease at any
anatomical site.
d. Leprosy
HMIS code: 0124
ICD code: A30.0- A30.9, B92
Disease Description
Leprosy is caused by a slow-growing bacillus, Mycobacterium leprae. It is transmitted via droplets
from the nose and mouth of untreated patients with severe disease, but is not highly infectious. If left

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untreated, the disease can cause nerve damage, leading to muscle weakness and atrophy, and
permanent disabilities.

e. Pneumonia
HMIS code: 0125
ICD code: J12-J18
Disease Description
Pneumonia is an infection of lungs that is most commonly caused by viruses or bacteria. These
infections are generally spread by direct contact with infected people.
Other infectious disease

a. Diphtheria
HMIS code: 0129
ICD code: A36.0-A36.9
Disease Description
Diphtheria is an infectious disease spreading from person to person by respiratory droplets from the
throat through coughing and sneezing. The disease normally breaks out 2 to 5 days after infection.
Diphtheria usually affects the tonsils, pharynx, larynx and occasionally the skin. Symptoms range
from a moderately sore throat to toxic life threatening diphtheria of the larynx or of the lower and
upper respiratory tracts. Diphtheria is often complicated by diphtheria myocarditis (toxic damage to
heart muscles) and neuritis (toxic damage to peripheral nerves).

b. Pertussis
HMIS code: 0130
ICD code: A37.0-A37.9
Disease Description
Pertussis is a highly communicable bacterial disease of the respiratory tract, caused by Bordetella
Pertussis. It occurs mainly in infants and young children, and is easily transmitted from person to
person, mainly through droplets. The first symptoms generally appear 7–10 days after infection, and
include mild fever, runny nose, and cough, which in typical cases gradually develops into a
paroxysmal cough followed by whooping (hence the common name of whooping cough).
Pertussis (whooping cough) is an important cause of infant death worldwide and continues to be a
public health concern even in countries with high vaccination coverage. Estimates from WHO suggest

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that, in 2008, about 16 million cases of pertussis occurred worldwide, 95% of which were in
developing countries.

Table: 1 summary of disease list with NCoD and ICD-10 disease coding system
Heading HMIS code ICD code

Infectious and parasitic diseases 0100-0199 A00-B99

Neoplasm 0200-0299 C00-D48

Diseases of the blood and blood forming organs and

certain disorders involving the immune mechanism 0300-0399 D50-D89

Endocrine, nutritional and metabolic diseases 0400-0499 E00-E90

Mental and behavioral disorder

0500-0599 F00-F03

Diseases of the nervous system 0600-0699 G00-G99

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 Diseases of the eye and adnexa 0700-0799 H00-H59

Diseases of the ear and mastoid process 0800 H60-H95

Diseases of the Circulatory system 0900-0999 I00-I99

Diseases of the respiratory system 1000-1099 J00-J99

Diseases of the Digestive system 1100-1199 K00-K93

Diseases of the skin and subcutaneous tissue 1200-1299 L00-L99

Diseases of the musculoskeletal system and

connective tissue 1300 M00-M99

Diseases of the genitourinary system 140-1499 N00-N99

Pregnancy, childbirth and the puerperium 1500-1599 O00-O99

Certain conditions originating in the perinatal period 1600-1699 P00-P96

Congenital malformations, deformations and

chromosomal abnormalities 1700 Q00-Q99

Injury, poisoning and certain other consequences of

external causes 1800-1899 S00-T98

External causes of morbidity and mortality 1900-1999 V01-Y98

2.3 Identifying Clinical coding current legislations, policies, procedures and guidelines
Legislation for Disease Classification

Classification is a method of categorization. Several classifications methods may, therefore, be used

by countries with advantages: Healthcare providers, administrators and others, from their point of view
may legitimately classify diseases, causes of death and procedures in the way that they think it is best
adapted to their information need.

A statistical classification of disease must be confined to a limited number of mutually exclusive

categories that able you to include the whole range of morbid conditions. A specific disease
condition/entity which is of particular public health importance or that occurs frequently should have

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its own category. Otherwise, categories will be assigned to groups of separate but related conditions.
Example: Immediately reportable diseases; Epidemic prone diseases

Every disease or morbid condition must have well defined place in the list of categories and there will
be residual categories for other miscellaneous conditions that cannot be classified to the more specific
categories. As few conditions as possible should be classified to residual categories.

It is the element of grouping that distinguishes disease classification from a nomenclature, which must
have a separate title for each known morbid condition. The concepts of classification and
nomenclature are nevertheless closely related because a nomenclature (will be discussed under the
upcoming subtopic) is often arranged systematically.

Disease classification can allow for different levels of details if it has a hierarchical structure with
subdivision. Disease classification should have the ability to identify specific disease entity and to
allow useful and understandable information to be obtained.

Procedures for clinical coding

A. Conventions Used
1. Parentheses ()
Used to enclose supplementary words, which may follow a diagnostic term without affecting the code
number to which the words outside the parentheses would be assigned.

For example,
Mini Compact Extended Chapter Disease Name

Circulatory Hypertension (Essential (primary)

171 569 619 System hypertension)
‘Hypertension (Essential (primary) hypertension)’, implies that the code number for the word
‘Hypertension’ alone or when qualified by any, or any combination, of the words in parentheses is one
and the same.
2. Square brackets [ ]
Used for enclosing synonyms, alternative words or explanatory phrases; for example:
Mini Compact Extended Chapter Disease Name

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 Infectious Schistosomiasis (Schistosomiasis due to
& Schistosoma haematobium [urinary
85 197 213 Parasitic schistosomiasis])
3. Colon :
Colon is used in terms when the words that precede it are not complete terms for assignment to that
code. They require one or more of the modifying or qualifying words indented under them before they
can be assigned to the code. For example, the diagnosis ‘Malignant neoplasm’ is to be classified there
only if qualified by the word ‘Stomach, unspecified’.
Mini Compact Extended Chapter Disease Name

Malignant (Malignant neoplasm: Stomach,

103 244 261 Neoplasms unspecified)
4. Semicolon ;
Semicolon is used to provide description of a term.
Mini Compact Extended Chapter Disease Name
Digestive Dental Disorder (Fluorosis; Abnormalities of
204 661 744 System size and form of teeth)
5. ‘NOS’
The letter ‘NOS’ is an abbreviation for ‘not otherwise specified’, implying ‘unspecified’ or
‘unqualified’.

Mini Compact Extended Chapter Disease Name

103 244 976 Skin & Subcutaneous Alopecia (NOS)
6. Not elsewhere classified
Not elsewhere classified serves as a warning that certain specified variants of the listed conditions may
appear in other parts of the classification. For example:
Extended Chapter Disease Name
Infectious & Bacterial Diseases (Other bacterial diseases, not
79 Parasitic elsewhere classified)
7. ‘And’

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‘And’ stands for ‘and/or’. For example, cases of ‘tuberculosis of bones’, ‘tuberculosis of joints’ and
‘tuberculosis of bones and joints’ are to be classified in the code Tuberculosis of bones and joints.
Compact Extended Chapter Disease Name
46 49 Infectious & Tuberculosis of bones and
Parasitic joints

Basic Coding Guidelines

To find a code from NCoD editions;
1. Identify the statement to be coded
2. Find the chapter to which the condition belongs to
3. Locate the lead term for the condition from the list in the chapter.
4. Read any terms enclosed in parentheses after the lead term as well as any terms under the lead
term until all the words in the diagnostic expression have been accounted for.
5. The corresponding code in digits will be adjacent to the disease name in the tabular list.
6. Verify the suitability of the code number selected.
7. Assign the code.
2.4 Establishing sequence of code in NCoD
The NCoD is a simplified disease classification system; it is organized according to the ICD-10
framework with specification of ICD-codes corresponding to each diagnosis or disease categories. It
is also fully mapped to the ICD-10.

ICD-10 is a system of categorizing diseases and health problems. It translates their lengthy
descriptions into unique codes, which are easier to store, retrieve and analyses. It is used to
systematically record, analyze, interpret and compare mortality and morbidity data collected at
different times, at any level of the health system. ICD-10 constitutes about 12,000 diseases and
conditions distributed in 21 chapters: broken down into 261 groups containing a total of about 2,036
categories. Chapters’ I–XVII relate to diseases and other morbid conditions, and Chapter XIX relates
to Injury, poisoning and certain other consequences of external causes. Chapter XVIII covers
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified. Chapter XX,
External causes of morbidity and mortality. Finally, Chapter XXI, Factors influencing health status
and contact with health services, for the classification of data explaining the reason for contact with

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health-care services. The chapters are subdivided into homogeneous blocks of three-character
categories.

Features NCoD
The NCoD comprises of three documents that incorporate essential list of diseases corresponding to
the diagnostic capacity of the respective level of the health care system.
 The Health Post edition of the NCoD comprises of 45 diseases.
 The Mini Edition modified for the primary level health care contains a selection 617 diseases.
 The Compact Edition for use by secondary level facilities has 1,849 diseases.
 The Extended Edition with 2,055 diseases is developed as a reference and for tertiary level
health care providers.

2.5 Entering coded data into the appropriate format/technology

Clinical data or diseases data from OPD and IPD should be coded clearly (according to NCoD
procedures and guidelines), accurately and completely (all disease should be coded) during health care
provision. Currently, Ethiopia has prepared NCoD guide line on disease list with their code by
different edition at national level. Clinical data, collected from patients are coded and registered on
NCoD Summary sheet
NCoD Summary sheet
NCoD summary sheet is used to abstract the list of NCoD diseases from the OPD and IPD registers.
 From the NCoD summary sheet, case and death will be tallied to the NCoD disease tally sheet.
 From the tally sheet, gross data will be entered into the DHIS 2 software
NCoD Disease tally sheet
This tally sheet is used to simplify reporting of disease cases and deaths disaggregated by age, sex
and setting (OPD/IPD). The tally sheet is completed from the NCoD summary sheet. The age
disaggregation is as follows: =65 years. The total tally for each age and sex group should be
summed and put in the “count” column.

Table: NCoD summary sheet

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 N.B. Please use this link to access the Prepared NCoD by MOH:
[Link]
[Link]?sequence=1&isAllowed=y)

Self-check

Name…………………………………………… ID………………………… Date…….

Directions: Answer all the questions listed below.

Test 1 Define the following phrases

 Disease nomenclature
 Disease classification

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  Disease coding
Test 2 Write at a newly added chapters in ICD-11
a. _____________________________
b. _____________________________
c. _____________________________
d. _____________________________
e. ____________________________
f. ______________________________
Test 3. Discuss the advantages of ICD 11than ICD-10
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
____________________________________________

Test:4 Discuss at a least 5 Basic Coding Guidelines

__________________________________________________________________________________
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LG9 LO-3 Monitor and Ensure implementation of coding and disease
classification

Instruction sheet
This learning guide is developed to provide you the necessary information regarding the
following content coverage and topic
 Identifying the use of coded clinical data
 Ensuring all coded clinical data for compliance
 Monitoring NCoD implementation
 Monitoring, identifying and resolving coding compliance
 Identifying gaps in coding compliance to standards
This guide will also assist you to attain the learning outcomes stated in the cover page.
Specifically, upon completion of this learning guide, you will be able to:
 Identify the use of coded clinical data
 Ensure all coded clinical data for compliance
 Monitor NCoD implementation
 Identify and resolve coding compliance
 Identify gaps in coding compliance to standards
Learning Instructions:
9. Read the specific objectives of this Learning Guide.
10. Follow the instructions described below.
11. Read the information written in the information Sheets
12. Accomplish the Self-checks

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LG 9: Information Sheet 3

3.1 Identifying the use of coded clinical data.

3.1.1 The use of National classification of Disease (NCoD)

Along with the HMIS reform, healthcare data recording and reporting forms are redesigned based on
the overarching HMIS principles which are: Integrity of services and the related information,
standardization of infrastructures, clinical data ( including diagnosis list) and data collecting and
reporting formats, and simplicity of the recordable clinical data (amount) to reduce the burden from
health care providers.

The HMIS disease classification and coding system has been developed primarily to standardize the
data on morbidity and mortality conditions that need to be reported at national level because of their
public health importance. Thus, statistical analysis and comparisons in different regions at different
time can be possible.

Applying NCoD in health facilities provides the following benefits:

• Supports medical audit, training and research within healthcare providers’ practices due to the
ability to retrieve high quality information quickly.
• Supports the identification of patients suitable for preventative medicine interventions such as
immunization or screening programs.
• Supports the linkage of particular signs and symptoms with outcomes e.g. how many cases of
patients who present with weight loss in General Practice are eventually diagnosed with a
malignancy.
• Supports the exchange of information with Public Health and Hospital information systems
(EHR, HMIS).
• Provides higher-quality information for measuring healthcare service quality, safety, and
efficacy.
• Provides better data for quality measurement and medical error reduction (patient safety),
outcomes measurement, operational planning, and healthcare delivery systems design and
reporting.

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Advantages of using NCoD than ICD-10 coding system
 Since HMIS disease list is not too big to memorize, the health care provider can use it to
classify diseases effectively without the presence of electronic health record system in a
facility.
 Most of the health facilities in Ethiopia are of limited diagnostic capabilities. And as it is
discussed earlier, unlike ICD- 10, the HMIS disease classification doesn’t require high level
skill and sophisticated investigation means to reach on a diagnosis as it is a general (less
specific) classification of diseases. Therefore, it can be used in health facilities with any level
of diagnostic capabilities.
 In terms of training need to use such disease classification by the healthcare providers when
compared to that of ICD-10 disease classification, it costs insignificant amount of resources.
3.2 Monitoring NCoD implementation
The implementation of the disease classification in the Ethiopian healthcare facilities needs close
monitoring for the care providers to use it for the intended purpose together with the whole HMIS
implementation that includes the collected data on selected indicators, using standardized HMIS
recording and reporting formats and practicing information use for the performance improvement
of the health facility and higher level.. The federal ministry of Health (FMOH) and implementing
agencies have developed implementation supervisory checklist. This checklist includes
points/questions that focus on examining the implementation status of HMIS disease classification
and coding. It uses to collect information on the implementation status of HMIS disease
classification and coding system. Feedbacks and corrective measures based on the analysis of the
information gathered by the tool can be taken regularly.

3.3 Identify gaps in coding compliance to standards

As it was discussed earlier, no disease classification and coding system is perfect enough to suffice the
county’s information need for clinical, public health or statistical purposes. Thus, our disease
classification system may not fully satisfy those who need it for clinical purpose only or other
purposes.

The federal ministry of health (FMOH) is responsible for improvement of the population health status
via preventive and curative cares. Even though HMIS disease list developed at national level primarily

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for public health purpose, it is equally important to identify the gaps in HMIS disease classification to
meet the clinical information need. Following gap identification, it is important to resolve the
problems with regard to disease classification regularly as it is an ongoing process. The variation in
diagnosing capacity among the healthcare facilities remains major obstacle to resolve most of the
complaints arise from clinicians and communicate them nationwide.

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Self-check 3

Name…………………………………………… ID………………………… Date…….

Directions: Answer all the questions listed below.

Test [Link] at a least 5 benefits of NCoD in health setting

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Test 2 Discuss the reasons for poor utilization of NCoD.
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Test 3List the advantages of NCoD than usinICD-10
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 LG10 LO4-Utilize software applications for coding and reporting

Instruction sheet 4
This learning guide is developed to provide you the necessary information regarding the following
content coverage and topic
 Identifying relevant Healthcare software and applications

 Identifying and applying healthcare software for coding

 Sending report to the next level using e-mail services.
 Receiving feedback through Internet/intranet services
 Using software application for International classification of disease (ICD10)
This guide will also assist you to attain the learning outcomes stated in the cover page. Specifically,
upon completion of this learning guide, you will be able to:
 identify relevant Healthcare software and applications

 Identify and applying healthcare software for coding

 Send report to the next level using e-mail services.
 Receive feedback through Internet/intranet services
 Use software application for International classification of disease (ICD10)
Learning Instructions:
13. Read the specific objectives of this Learning Guide.
14. Follow the instructions described below.
15. Read the information written in the information Sheets
16. Accomplish the Self-checks

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 Information Sheet 4

4.1 Identifying relevant Healthcare software and applications

Following health management information system (HMIS) reform, Ethiopian ministry of health starts
utilizing different health care software and application to promote continuum health care. I.e clinical
data coding easily data collection, aggregation, analysis, presentation and data dissemination or data
exchange.
Common Health care software and applications.
Currently Ethiopia using different health care software and application to be discussed in module 9
 HRIS to manage human resource data.
 DHIS2 system to handle HMIS data.
 E-CHIS and m-Brana to handle household, client and Vaccine data.
 PHEM/IVR implementation weekly reporting
 LMIS to manage pharmaceutical data.
 MFR for facility data handling.
 ART software to manage HIV program data?

4.2 Identifying and applying healthcare software for coding.

Online Disease classification and coding is possible by using software application specifically for
ICD-10 version 2019 and National Health Data Dictionary (NHDD)
The Federal Ministry of Health has developed the National Health Data Dictionary (NHDD) to serve
as the authoritative source for indicator and information standards within the health system. The
dictionary provides a common language for clinicians, lab technicians, pharmacists, researchers and
administrators to communicate and exchange health information to ensure that meaning is not lost as
data is shared or aggregated into reporting systems. The NHDD harmonizes data definitions from
multiple programs and facilitates mapping of definitions to international standards, such as the
International Classification of Diseases (ICD-10), the Systematized Nomenclature for Medicine
(SNOMED-CT), or the Columbia International eHealth Laboratory (CIEL) interface terminology. The
NHDD was initially populated with indicators and data definitions from the HMIS Data Recording
and Reporting Guidelines, the NCoD, and CHIS Guidelines and mapped to ICD-10, SNOMED-CT
and CIEL. Plans are being developed to promote adoption and to expand the NHDD to other

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prioritized domains.

The NHDD is hosted on an open-source terminology management service (TMS), the Open Concept
Lab (OCL). OCL provides functionality to help the Ministry of Health and its partners to
collaboratively manage, publish, and use its indicator and data definitions. The standards-based
terminology management service also serves as a foundational component of the national eHealth
architecture as defined in the Information Revolution. Within the eHealth architecture, the NHDD
facilitates information exchange with other information systems by providing shared definitions to
other information systems through an Application Program Interface (API). Currently NHDD
application is on progress not implemented
Online application includes context sensitive which may help you to access by clicking on the icon
and writing the name of the disease to get disease code from the application
The importance of online Disease coding for both NHDD and ICD-10
 It is time saving and use friendly
 Identify disease categories
 It shows the blocks of disease
 Has advanced search
 Done by any computer or smart phone

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 Self-check-4

Name…………………………………………… ID………………………… Date…….

Directions: Answer all the questions listed below.

Test 1 Write at a least Five Common Healthcare software and applications in Ethiopia.
a. _____________________________
b. _____________________________
c. _____________________________
d. _____________________________
e. ____________________________
Test 2. Discuss the advantages of online disease coding
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Test 3 write the importance of using online advanced searching.

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 Operation Sheet 1: Techniques for ICD-10 online disease coding system
A. Required Materials
 Internet connection
 Register
 Pen
 Any types computer or
 Smart phone
B. Steps to be followed
Step 1: Open internet connection and click on any browser (chrom, mozila fire fox google etc
Step 2; write ICD-10 on URL and click on search
Step 3: select ICD-10 version 2019.

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Step 4 write the disease you are intended to code e.g falciparum malaria

Step 5 click on advanced search (if you want advanced search only)
 Title
 Description
 Inclusion
 Exclusion
 Note
 Coding hint
 Index
Step.6 Write the appropriate code on the register.
Note: click on info (version change, user manual, ICD online training) if applicable

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 Operation Sheet 4: Techniques for NCoD online disease coding
A. Required Materials
 Register NCoD summary sheet
 Any types computer or
 Smart phone
 Link:[Link]
l=US
B. Steps to be followed
Step 1 Install HNDD pocket software either on computer or smart phone form google play.
Step 2; Open installed NHDD pocket (if offline)
Step 3: select intended NCoD edition
e.g: Mini, compact, extended edition

Step 4write the name of the disease on Search box to search it [Link]

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 Step 5 select exact intended disease. if existed below
Step 6 write the displayed code on NCoD summery format clearly

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Reference

 Medical Terminology for health professionals 7th edition

 Intergrated medical science for Health information management system Version-1
 Applying Medical Terminologies and ICT for Managing Health Data
 International Statistical Classification of Diseases and Related Health Problems 10th Revision
Volume 2 Instruction manual 2010
 Improving the Quality of Clinical Coding through Mapping of National Classification of
Diseases (NCoD) and International Classification of Disease (ICD-10).
 ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 (October 1, 2018 -
September 30, 2019)
 Ethiopian National classification of Disease(NCoD) Compact edition march 2015
 Ethiopian National classification of Disease(NCoD) Compact edition march 2017
 Ethiopia health management information system participant manual june 2018
 Human Anatomy and physiology 11 edition
 Non-Communicable Diseases, Emergency Care and Mental Health Part 2 Mental Health
Problems Blended Learning Module for the Health Extension Programme
Web Addresses
 [Link]
%[Link]?sequence=1&isAllowed=y)
 [Link]

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