Текст книги "Английский язык для медиков"

Автор книги: Елена Беликова

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40. Pharynx and related areas

The pharynx is a passageway shared by the digestive and respira tory systems. It has lateral, posterior, and medial walls through out, but is open interiorly in its upper regions, communicating with the nasal cavity and the oral cavity. The anterior wall of the laryngopharynx is formed by the larynx. The pharyngeal wall con sists of a mucosa, a fibrous layer, and a muscularis, which is com posed of an inner longitudinal layer and an outer circular layer.

Nasopharynx is the region of the pharynx located directly poste rior to the nasal cavity. It communicates with the nasal cavity through the choanae.

The torus tubarius is the cartilaginous rim of the auditory The pharyngeal recess is the space located directly above and behind the torus tubarius; it contains the nasopharyn—geal tonsil. The salpingopharyngeal fold is a ridge consisting of mucosa and the underlying salpingopharyngeus muscle.

Oropharynx is the region of the pharynx located directly posterior to the oral cavity. It communicates with the oral cavity through a space called the fauces. The fauces are bounded by two folds, consisting of mucosa and muscle, known as the anterior and posterior pillars.

The tonsillar bed is the space between the pillars that houses the palatine tonsil.

Laryngopharynx is the region of the pharynx that surrounds the larynx. It extends from the tip of the epiglottis to the cricoid car tilage. Its lateral extensions are known as the piriform recess.

Oral cavity: the portion of the oral cavity that is posterior to the lips and anterior to the teeth is called the vestibule. The oral cavi ty proper has a floor formed by the mylohyo—id and geniohyoid muscles, which support the tongue. It has lateral walls, consisting of the buccinator muscles and buccal mucosa, and a roof formed by the hard palate an teriorly and the soft palate posteriorly. Its posterior wall is absent and is replaced by an opening to the oropharynx, which is flanked by the pillars of the fauces.

The palate separates the nasal and oral cavities.

Hard palate is formed by the palatine process of the maxilla and the horizontal palate of the palatine bone. Its mu—cosa is supplied with sensory fibers from CN V2.

Soft palate consists of a fibrous membrane, the palatine aponeurosis, covered with mucosa. The portion that hangs down in the midline is the uvula.

The tongue is a mobile, muscular organ necessary for speech. It is divisible into an anterior two—thirds and a posterior one—third by the sulcus terminalis.

Muscles of the tongue. These include the intrinsic and extrinsic muscles (i. e., palatoglossus, stylogiossus, hyo—glos – sus, genioglossus). All of the muscles are innervated by CN XII except the palatoglossus, which is supplied by CN X. Arterial supply: The tongue is supplied by the lingual branch of the external carotid aitery.

Venous drainage. The lingual veins, which lie on the un—der—surface of the tongue, drain to the internal jugular veins.

Lymphatic drainage. The tip of the tongue drains to the submental nodes, and the remainder of the anterior two—thirds drains first to submandibular, then to deep cervical nodes. The posterior one—third drains directly to deep cer—vi cal nodes.

New words

digestive – пищеварительный

pharyngeal – глоточный

mucosa – слизистая оболочка

fibrous layer – волокнистый слой

posterior nasal apertures – задние носовые апертуры

nasopharyngeal tonsil – миндалина

41. Oral cavity

The oral cavity forms in the embryo from an in—pocketing of the skin, stomodeum; it is, thus, lined by ectoderm. Functionally, the mouth forms the first portion of both the digestive and respiratory systems.

In humans the margins of the lips mark the junction between the outer skin and the inner mucous lining of the oral cavity. The roof of the mouth consists of the hard palate and, behind this, the soft palate which merges into the oropharynx. The lateral walls consist of the distensible cheeks. The floor of the mouth is formed principally by the tongue and the soft tissues that lie between the two sides of the lower jaw, or mandible.

The tongue, a muscular organ in the mouth, provides the sense of taste and assists in chewing, swallowing, and speaking. It is firmly anchored by connective tissues to the front and side walls of the pharynx, or throat, and to the hyoid bone in the neck.

The posterior limit of the oral cavity is marked by the fauces, an apperture which leads to the pharynx. On either side of the fauces are two muscular arches covered by mu—cosa, the glossopalatine and pharyngopalatine arches; between them lie masses of lymphoid tissue, the tonsils. Hiese are spongy lymphoid tissues composed mainly of lymphocytic cells held together by fibrous connective tissue. Suspended from the posterior portion of the soft palate is the soft retractable uvula. The palate develops from lateral folds of the primitive upper jaw. The hard palate, more anterior in position, underlies the nasal cavity. The soft palate hangs like a curtain between the mouth and nasal pharynx.

The hard palate has an intermediate layer of bone, supplied anteriorly by paired palatine processes of the maxil lary bones, and posteriorly by the horizontal part of each palate bone. The oral surface of the hard palate is a mucous membrane covered with a stratified squ—amous epithelium. A submucosal layer contains mucous glands and binds the membrane firmly to the periosteum of the bony component. Above the bone is the mucous membrane that forms the floor of the nasal cavity.

The soft palate is a backward continuation from the hard palate. Its free margin connects on each side with two folds of mucous membrane, the palatine arches, enclosing a palatine tonsil. In the midline the margin extends into a fingerlike projection called uvula. The oral side of the soft palate continues as the covering of the hard palate, and the submucosa contains mucous glands. The intermediate layer is a sheet of voluntary muscle.

Besides separating the nasal passages from the mouth, the hard palate is a firm plate, against which the tongue manipulates food. In swallowing and vomiting the soft palate is raised to separate the oral from the nasal portion of the pharynx. This closure prevents food from passing upward into the nasopharynx and nose.

New words

mouth – рот

lips – губы

junction – соединение

distensible – растяжимый

cheeks – щеки

tongue – язык

taste – вкус

chewing – жевание

swallowing – глотание

42. Oral glands

All mammals are well supplied with oral glands. There are labial glands of the lips, buccal glands of the cheeks, lingual glands of the tongue, and palatine glands of the palate. Besides these, there are larger paired salivary glands. The parotid gland, near each ear, discharges into the vestibule. The submaxillary or submandibular gland lies along the posterior part of the lower jaw; its duct opens well forward under the tongue. The sublingual gland lies in the floor of the mouth. Saliva is a viscid fluid containing a mixture of all the oral secretions. It contains mucus, proteins, salts, and the enzymes ptyalin and maltase. Most of the ptyalin in human saliva is furnished by the parotid gland. The digestive action of saliva is limited to starchy food. Other uses of saliva include the moistening of food for easier manipulation by the tongue, the consequent facilitation of swallowing, and a lubrication by mucus that ensures a smoother passage of food down the esophagus to the stomach. Tonsils are spongy lymphoid tissues at the back of the throat, composed mainly of lymphocytic cells held together by fibrous connective tissue. There are three types of tonsils. The palatine tonsils, usually referred to as «the tonsils», are visible between the arches that extend from the uvula to the floor of the mouth. The pharyngeal tonsils, usually referred to as the adenoids, lie at the back of the throat. The lingual tonsils are on the upper surface of each side of the back of the tongue. The tonsils function to protect the pharynx and the remainder of the body from infectious organisms that become trapped in the mucous membrane lining the mouth, nose and throat. Chronic or acute inflammation of the tonsilses, called the tonsillitis.

The tongue, a muscular organ in the mouth, provides the sense of taste and assists in chewing, swallowing, and speaking. It is firmly anchored by connective tissues to the front and side walls of the pharynx, or throat, and to the hyoid bone in the neck.

The mammalian tongue is divided into two parts by a V—shaped groove, the terminal sulcus. At the apex of this V is a small blind pit, the foramen cecum. The larger part, or body, of the tongue belongs to the floor of the mouth, whereas the root forms the front wall of the oral pharynx. The body of the tongue is separated from the teeth and gums by a deep groove. A midline fold, the frenu—lum, is near he tip on the undersurface. The upper surface of the body, called the dorsum, has a velvety appearance because of filiform papillae. Distributed among these are occasional larger, rounded fungiform papillae and some large conical papillae. Immediately in front of the groove separating the body of the tongue from the root is a series of still larger vallate papillae arranged in a V—shaped row. The apex of the V points down the throat. Posteriorly along each side of the body of the tongue and near the root, is a series of parallel folds constituting the foliate papillae. The surface of the root of the tongue, which belongs to the pharynx, has no papillae but bears nodules containing lymphoid tissue.

New words

buccal – относящийся ко рту или щеке

palatine – небный

salivary glands – слюнные железы

parotid gland – околоушная железа

sublingual – подязыковой

43. The digestive tract structure

The gastrointestinal tract and associated organs are collectively called the digestive system. This system is responsible for receiving food and breaking it down by using enzymes from the glands and by the movement of the various parts of the intestinal tract; for absorption of these components into the blood; and for eliminating undigested food and certain metabolic wastes from the body. The alimentary canal extends from the mouth to the anus. It is a long tube varying in size and shape depending on what function the particular part performs. The tract has a very good blood sup ply, because food, once it is broken down, has to be absorbed into the bloodstream. The mouth contains the tongue and the teeth and communicates with the salivary glands situated round it. Behind the nose and mouth is the pharynx. Leading from the pharynx is a mus cular tube called the esophagus which passes down the thoracic cavity to the stomach. The stomach lies below the diaphragm in the upper left side, of the abdominal cavity. The opening into the small intestine is called the pylorus and is closed by the pyloric sphincter. The small intestine is a muscular tube coiled up in the abdominal ca vity. It is divided into three parts; the duodenum, the jejunum, and the ilium. The large intestine, also a muscular tube but with wider lumen than the small intestine, is often called the colon. It is divided into several different parts: the, cecum, the ascending colon, the transverse colon, the descending colon, the rectum and the anal canal. The glands belonging to the digestive system are the salivary glands, the liver and the pancreas.

Stomach is probably the most distensible of any in the human body. The proximal portion is the cardiac portion; the portion above the entrance of the esophagus is the fundus; the distal portion is the pyloric part; and the body is between the fundus and the pyloric part.

The coats of the stomach are four: an outer, peritoneal or serous coat; a muscular coat, made up of longitudinal, oblique, and circular fibres; a submucous coat; and tine mucous coat or membrane forming the inner lining.

Gastric glands, which are in mucous coat, secrete gastric juice containing hydrochloric acid and other digestive enzymes into the cavity of the stomach. The glands of the fundus and body moot important in the secretion of gastric juice.

The shape of the stomach varies from individual to individual and from time to time in the same individual depending upon the degree of digestion, degree of contraction, and the age and the body—built of the individual. Frequently in more J—shaped than U—shaped so that its greater curvature can even lie in the greater pelvis. Cardia and fundus are relatively fixed and, hence, tend to move only with the respiratory excursions of the diaphragm.

New words

gastrointestinal tract – желудочно—кишечный тракт

food – пища (еда)

enzymes – ферменты

intestinal tract – кишечный тракт

anus – задний проход

esophagus – пищевод

diaphragm – диафрагма

abdominal – брюшной

pyloric sphincter – пилорический сфинктер

44. The digestion

The process of digestion begins when food is taken into the mouth. Chewing ^ еа^ the food into smaller pieces, thereby exposing more surfaces to the saliva. Saliva moistens the food, so facilitating swallowing, and it contains the enzyme which begins the conversion of carbohydrates into simple sugars.

The major processes of digestion do not occur until the food passes down through the esophagus into the stomach. The stomach has both a chemical and a physical function. The walls of the stomach, which are protected by a layer of mucus, secrete gastric juices composed of several enzymes and hydrochloric acid. The most powerful enzyme is pepsin, which begins the process of converting proteins into amino acids. In addition, waves of contraction and relaxation, known as peristalsis, move the walls of the stomach. They turn the food particles into a'semi—solid mass known as chyme.

From the stomach, the chyme passes into the small intestine through the pyloric sphincter. Proteins have not been completely broken down, carbohydrates are still being converted into simple sugars, and fats remain in large globules. In the small intestine the process of digestion is completed by the action of the bile, which is secreted by the liver and released by the gallbladder, and by the action of various enzymes which are secreted by the pancreas and walls of the small in testine. Absorption of the products of digestion taken place mainly through the wall of the small intestine.

Digestion

Chewing movements of the teeth, tongue, cheeks, lips and lower jaw break down food, mix it with saliva and roll it into a moist, soft mass called a bolus, suitable for swallowing.

Having been rendered suitable for swallowing the food is pushed back into the pharynx by the tongue, and enters the esopha gus to be transported rapidly down the neck and thorax, through the diaphragm to the stomach. The mucous membrane of the stomach is equipped with millions of glands secreting mucus, digestive enzymes and hydrochloric acid.

The small intestine is the region within which the process of digestion is completed and its products are absorbed. Although its epithelial lining forms many small glands, they mainly produce mucus. Most of the enzymes present are secreted by the pancreas, whose duct, opens into the duodenum. Bile from the liver also enters the duodenum.

The absorption of the product's of digestion also takes place in the small intestine, although water, salts, and glucose are ab sorbed from the stomach and the large intestine.

The large intestine is chiefly concerned with the preparation, storage and evacuation of undigestible and unab—sorbable food residue.

New words

process of digestion – процесс переваривания

dewing – жевание

saliva – слюна

to moisten – увлажнять

enzyme – фермент

carbohydrates – углеводы

stomach – живот

tongue – язык

hydrochloric acid – соляная кислота absorption – поглощение

45. The digestive system: the function

The digestive system, or gastrointestinal tract, begins with the mouth, where food enters the body, and ends with the anus, where solid waste material leaves the body. The primary function of the organs of the digestive system are threefold.

First, complex food material which is taken into the mouth must be digested mechanically and chemically, as it travels through, the gastrointestinal tract.

Second, the digested food must be absorbed by passage through the walls of the small intestine into the blood stream so that the valuable energy—carrying nutrients can travel to all cells of the body.

The third function of the gastrointestinal tract is to eliminate the solid waste materials which are unable to be absorbed by the small intestine.

In the man the food in the mouth is masticated, that is to say it is bitten and broken up by the teeth and rolled into the bolus by the tongue.

The act of swallowing is divided into three stages.

The first stage is under voluntary control. The food which has been transformed into a soft, mass by the act of mastication is brought into position upon the root of the tongue, and by the action of the lingual muscles is rolled backwards towards the base of the tongue.

The second stage is brief and is occupied in guiding the food through the pharynx and past the openings that lead from it. The muscular movements during this stage are purely reflex in nature. The third stage involves the passage of the food down the eso phagus. The food is seized by peristaltic wave which, traveling along the esophagus, carries the material before it into the stomach. The cardiac sphincter which guards the lower end of the esophagus and which at other times is kept tonically closed re laxes upon the ap proach of the bolus which is then swept into the stomach by the wave of constriction which follows.

Peristalsis is a type of muscular contraction characteristic of the gut and consists in waves of contraction, these running along the muscles, both circular and longitudinal, towards the anus.

If the food is fluid it enters the stomach six seconds after the beginning of the act, but If It is solid it takes much long er, up to fifteen minutes, to pass down the esophagus.

In the stomach the food is thoroughly mixed by the series of contractions, three or four a minute, the contraction waves pass ing from the middle of the stomach to the pylorus. These tend to drive the food in the same direction, but the pylorus being closed, there is axial reflex, owing to which the food is well mixed. After a time – a bout a minute when water has been swallowed – the pylorus relaxes at each wave, allowing some of the stomach contents to enter the duodenum. Fat stays in the stomach longer than carbo hydrate, but all food leaves generally in three or four hours. In the small intestine the food continues to be moved by peristalsis, the latter controlled by the deep nerve plexus. The small intestine undergoes segmentation movements, the food contents being thoroughly mired The wall becomes constricted into a number of segments and then about five seconds later the constrictions disappear, there being another set exactly out of phase with the first. The large intestine undergoes infrequent powerful contractions, food having entered it. From the large intestine the food enters the rectum.

New words

voluntary control – добровольный контроль

soft – мягкий

mastication – перетирание

position – положение

root – корень

46. The digestive system: liver and stomach. Sources of energy

Liver, the pancreas and the kidneys are the organs primarily engaged in the intermediary metabolism of the materials resorbed from the gasro – intestinal tract and in the excretion of metabolic waste products. Of these 3 organs the liver performs the most diverse func tions. It acts as the receiving depot and distributing center for the majority of the products of intestinal digestion and plays a major role in the intermediary metabolism of carbohydrates, fats, proteins and purines.

It controls the concentration of cholesterol esters in the blood and utilizes the sterol in the formation of bile acid. The liver takes in the regulation of the blood volume and in water metabolism and distribution. Its secretion, the bile, is necessary for fat diges tion.

The liver is a site for the formation of the proteins of the blood plasma, especially for fibrinogen, and also forms he—parin, also forms heparin, carbohydrate which prevents the clotting of the blood. It has important detoxicating functions and guards the organism against toxins of in testinal origin as well as other harmful substances. The liver in its detoxi—cating functions and manifold metabolic activities may well be ransidered the most important gland of the body.

The normal position of the empty human stomach is not hori zontal, as used to be thought before the development of rentgenology. This method of examination has revealed the stomach to be either somewhat J—shaped of comparable in outline to a reversed L. The majority of normal stomachs are J—shaped. In the J—shaped type the pylorus lies at a higher level than the lowest part of the greater curvature and the body of the stomach is nearly verti cal.

The stomach docs not empty itself by gravity, but through the contraction of its muscular wall like any other part of the diges tive tube, of which it is merely a segment.

Gastric motility shows great individual variation; in some types of stomach the wave travels very rapidly, completing its journey in from 10 to 15 seconds. In others the wave takes 30 seconds or go to pass from its origin to the pylorus. The slow waves are the more common.

Sources of energy

The fuels of the body are carbohydrates, fats and proteins. These are taken in the diet.

Carbohydrates are the principal source of energy in most diets. They are absorbed into the blood stream in the form of glu cose. Glucose not needed for immediate use is converted into glycogen and stored in the liver. When the blood sugar concentra tion goes down, the liver reconverts some of its stored glycogen into glucose.

Pats make up the second largest source of energy in most diets. They are stored in adipose tissue and round the principal internal organs. If excess carbohydrate is taken in, this can be converted into fat and stored. The stored fat is utilized when the liver is empty of glycogen.

Proteins are essential for the growth and rebuilding of tissue, but they can also be utilized as a source of energy. In some diets, such as the diet of the Eskimo, they form the main source of energy. Proteins are first broken down into amino acids. Then they are absorbed into the blood and pass round the body. Amino acids not used by the body are eventually excreted in the urine in the form of urea. Proteins, unlike—car—bohydrates and fats, cannot be stored for future use.

New words

fuels – топливо

principal source – основной источник

energy – энергия

glucose – глюкоза

glycogen – гликоген

stored – сохраненный

adipose – животный жир

amino acids – аминокислоты