O.O. BOGOMOLETS NATIONAL MEDICAL UNIVERSITY
Olena Holik, Khrystyna Storozhuk
Professional English
for
Medical Purposes
Навчальний посібник
Kyiv — 2022
1
УДК 81.111 (075.8)
Г 60
Рецензенти:
І.М. Литовченко – д-р пед. наук, професор кафедри англійської мови технічного
спрямування №2 факультету лінгвістики КПІ ім. Ігоря Сікорського.
І.С. Бахов – д-р пед. наук, професор, завідувач кафедри іноземної філології та
перекладу ПрАТ ВНЗ МАУП.
Затверджено на засіданні циклової методичної комісії
з суспільно-лінгвістичних дисциплін НМУ імені О.О. Богомольця
як навчальний посібник для студентів медичних факультетів закладів
вищої освіти у галузі охорони здоров’я ІV рівня акредитації
(протокол №9 від 24.06.2022 )
Professional English for Medical Purposes – Англійська мова за професійним
Г 60 спрямуванням для студентів медичних спеціальностей: Навчальний
посібник / О.В. Голік, Х.В. Сторожук. – К.: МЕДПРИНТ, 2022 – 160 с.
ISBN 978-617-95220-7-9
Навчальний посібник укладено з урахуванням вимог програми вивчення
навчальної дисципліни «Англійська мова (за професійним спрямуванням)» для студентів
медичних факультетів закладів вищої освіти у галузі охорони здоров’я ІV рівня
акредитації.
У навчальному посібнику подано 4 основних розділи та 12 тематичних блоків.
Запропоновані оригінальні та адаптовані тексти з медичної тематики містять
фундаментальний англомовний термінологічний матеріал. Навчальний посібник
складається з комплексу вправ, який спрямований на ефективне засвоєння та
застосування лексико-граматичного матеріалу у формі усних та письмових повідомлень,
дискусій за ситуативно зумовлених обставин. У навчальному посібнику запропоновані
творчі завдання, виконання яких передбачає використання різноманітних засобів пошуку
інформації, її обробку та аналіз. Тексти для самостійного читання супроводжуються
завданнями, які поєднують можливість самоконтролю, формування та покращення
навичок складання резюме загальнонаукових текстів англійською мовою, створення
усних та письмових презентацій.
Навчальний посібник призначений для
студентів і викладачів медичних
факультетів закладів вищої освіти у галузі охорони здоров’я, а також може
використовуватися у системі післядипломної освіти, аспірантури чи самостійно.
УДК 81.111 (075.8)
© О.В. Голік, Х.В. Сторожук, 2022
ISBN 978-617-95220-7-9
2
CONTENTS
PART ONE
UNIT 1: Respiratory System .............................................................. 5
1.1 Anatomy and functions ........................................................................................ 5
1.2 Bronchitis .................................................................................. 14
Grammar: Present Perfect or Past Simple? ............................................................. 22
1.3 Tuberculosis ....................................................................................................... 25
Grammar: Comparatives and Superlatives............................................................... 32
UNIT 2: Cardiovascular System ....................................................... 34
2.1 Anatomy and Functions .............................................................. 34
2.2 Atherosclerosis ......................................................................... 43
Grammar: Present Perfect or Present Perfect Continuous? ................. 52
2.3 Myocardial Infarction ................................................................. 54
Grammar: Ways of Expressing Future ..................................................................... 64
UNIT 3: Digestive System ................................................................. 66
3.1 Anatomy and Functions ............................................................... 66
3.2 Gastritis ............................................................................................................... 74
Grammar: Simple Tenses Passive. Continuous Tenses Passive ........... 82
3.3 Stomach Cancer ......................................................................... 85
Grammar: Linking Words ....................................................................................... 94
UNIT 4: Liver .................................................................................. 97
4.1 Anatomy and Functions ............................................................... 97
4.2 Hepatitis .................................................................................. 103
Grammar: Perfect Tenses Passive .......................................................................... 111
4.3 Cirrhosis ............................................................................................................. 113
Grammar: Quantifiers with Countable and Uncountable Nouns .......................... 120
WORDLISTS ......................................................................................................... 123
REFERENCES ............................................................................. 156
3
ПЕРЕДМОВА
Англійська мова (за професійним спрямуванням) є обов’язковим
компонентом професійної освіти студентів медичних факультетів закладів вищої
освіти у галузі охорони здоров’я ІV рівня акредитації. Належний рівень володіння
іноземною мовою є однією з умов успішного навчання майбутнього лікаря,
важливим фактором продуктивної професійної та наукової діяльності в
майбутньому, а також дієвим інструментом, який забезпечує високу якість
надання сучасних медичних послуг та розвиток вітчизняної медицини відповідно
до міжнародних стандартів.
Навчальний посібник підготовлено з урахуванням вимог програми
навчальної дисципліни «Англійська мова (за професійним спрямуванням)» для
студентів медичних факультетів закладів вищої освіти у галузі охорони здоров’я
ІV рівня акредитації.
Навчальний посібник «Professional English for Medical Purposes» (Частина І)
призначений для навчально-методичного забезпечення професійної підготовки
студентів медичних спеціальностей під час вивчення дисципліни «Англійська
мова (за професійним спрямуванням)».
Матеріали навчального посібника систематизовано у чотири розділи
(Respiratory System, Cardiovascular System, Digestive System, Liver), кожний з яких
складається з трьох тематичних блоків, у яких подано фундаментальний
англомовний термінологічний матеріал щодо анатомії та функцій систем
організму та найпоширеніших захворювань і пов’язаних з ними проблем.
Тематичні блоки складаються з таких основних частин: Lead-in, Language
Development, Talking Points, More Reading, Grammar (тематичні блоки 1.2, 1.3, 2.2,
2.3, 3.2, 3.3, 4.2, 4.3).
Навчальний посібник містить комплекс лексичних вправ, які розроблені
відповідно до принципу системності та послідовності, тобто передбачають
послідовний перехід від простого відтворення до самостійних творчих дій з
засвоєним матеріалом. У навчальному посібнику пропонуються завдання, які
максимально наближені до реальних професійних ситуацій.
Граматичний матеріал та вправи, які подані в навчальному посібнику,
відтворюють базові теми, вивчення яких необхідне для належного оволодіння
навичками іншомовного професійно-орієнтованого спілкування.
Кожний тематичний блок містить оригінальні та автентичні тексти для
самостійного читання, які супроводжуються завданнями для самоконтролю,
формування та покращення навичок складання резюме загальнонаукових текстів
англійською мовою, створення усних та письмових презентацій.
Навчальний посібник призначений для студентів і викладачів медичних
факультетів закладів вищої освіти у галузі охорони здоров’я, а також може
використовуватися у системі післядипломної освіти, аспірантури чи самостійно.
4
UNIT 1
RESPIRATORY SYSTEM
1.1 ANATOMY AND FUNCTIONS
LEAD IN
1
Learn the following words.
respiratory
[ˈrespərətrɪ]
дихальний
[rəˈspɪrətrɪ]
bronchus
plural bronchi
[ˈbrɒŋkəs]
[ˈbrɒŋkaɪ]
бронх
(множ.) бронхи
trachea
[trəˈki:ə]
трахея
windpipe
[ˈwɪndpaɪp]
дихальне горло (трахея)
bronchiole
[ˈbrɒŋkiəʊl]
бронхіола
5
diaphragm
[ˈdaɪəfræm]
діафрагма
alveolus
plural alveoli
[ælˈvi:ələs]
альвеола
(множ.) альвеоли
naris
plural nares
[ˈnɛərɪs]
cilium
plural cilia
[ˈsɪlɪəm]
[ˈsɪlɪə]
війка
війки
humidify
[hju:ˈmɪdɪˌfaɪ]
зволожувати
airborne
[ˈeəbɔ:n]
аерогенний
propel
[prəˈpel]
проштовхувати
squamous
epithelium
[ˈskweɪməs
пласкоклітинний епітелій
spongy
[ˈspʌndʒɪ]
губчастий
pleura
[ˈplʊərə]
плевра
lung compliance
[lʌŋ kəmˈplaɪəns]
податливість (розтяжність) легень
residual volume
[rɪˈzɪdjuəl ˈvɒlju:m]
залишковий об’єм легень
cough
[kɒf]
кашель
sneeze
[sni:z]
чихати
2
[ælˈvi:əlaɪ]
ніздря
(множ.) ніздрі
[ˈnɛəri:z]
ˌɛpɪˈθi:lɪəm]
Get familiar with some of the facts about the respiratory system and search for
more information to present to the group.
1. The air we breathe in is composed of oxygen (21%), nitrogen (78%), and
small amounts of carbon dioxide, neon, and hydrogen.
2. Diffusion is the process of gas movement from an area of high pressure to one
of low pressure. It occurs during internal and external respiration.
3. Studies have demonstrated that the lower respiratory tract is never sterile or
germ-free.
4. The alveoli resemble balloons. Each has its own capacity for filling.
5. The term “stiff lung” is used when a lung has reduced compliance or
expandability.
6
6. Coughing and sneezing keep the lungs clear of foreign substances and
invaders that might be inhaled.
7. Yawning helps bring more oxygen to the lungs and brain.
8. A small amount of air, called residual volume, is always found inside the
lungs.
9. Breathing through the mouth results in a bladder contraction that creates an
urge to urinate in the middle of the night.
10. When at rest, humans exhale up to 17.5 milliliters of water per hour, but
during exercise it is about four times that amount.
3
Think about the anatomy of the respiratory system. Match the organs with their
location.
1. nose
a. located at the front of the neck between the third and seventh
cervical vertebrae, with its upper portion attached to the lower
part of the pharynx
2. pharynx
b. it originates from the lower part of the trachea and is located
in the upper portion of the lung
3. larynx
c. a flat, dome-shaped muscle located at the base of the lungs
and thoracic cavity
4. trachea
d. located on either side of the chest
5. primary bronchus e. located behind the nasal cavity and mouth and above the
larynx and esophagus
6. lungs
f. located in the thoracic cavity, in front of the esophagus,
running along the midline of the human body down to the back
of the sternum (breastbone)
7. diaphragm
g. triangular-shaped projection in the centre of the face
4
Read the text.
RESPIRATORY SYSTEM
The respiratory system consists of air passages, pulmonary vessels, the lungs, and
breathing muscles. The system provides the exchange of oxygen and carbon dioxide
between the atmosphere and the body cells during respiration.
The term “respiration” embraces ventilation, external respiration, transport of
gases, internal respiration, and cellular respiration.
The breathing process, or ventilation, includes the movement of air through air
passages into and out of the lungs during inhalation (inspiration) and exhalation
(expiration). Inhalation (inspiration) is the process of breathing in or taking air into the
7
lungs during which the diaphragm contracts, the thoracic cavity increases in volume,
and the intraalveolar pressure decreases. Exhalation (expiration) is the process of
breathing out or expelling air from the lungs during which the diaphragm relaxes, the
thoracic volume decreases, and the intraalveolar pressure increases.
The exchange of gases between the alveoli and lung capillaries is known as
external respiration. The bloodstream transports the gases to and from the tissue cells.
The exchange of gases between the tissue cells and capillaries is called internal
respiration. Cellular respiration occurs when the cells utilize oxygen for cellular
metabolism.
Most of the organs of the respiratory system are involved in air distribution, but
only the tiny alveoli and the alveolar ducts are responsible for gas exchange. Gas
exchange is important for maintaining the vital functions in the human body because the
cells use oxygen for their metabolic processes and produce a waste product called
carbon dioxide that must be removed.
In addition to air distribution and gas exchange, the respiratory system filters,
warms, and humidifies the inspired air. It helps the body maintain homeostasis. The
respiratory system organs are responsible for speech and the sense of smell.
The respiratory tract consists of the upper respiratory tract and the lower
respiratory tract. The upper respiratory tract includes the nose and nasal cavities,
pharynx, and larynx.
The nose is made up of bone and cartilage. The air enters the nasal cavity through
the nostrils, or external nares. The mucous membrane lines the nasal cavity where the
air we breathe in is warmed, filtered, and humidified. The mucus traps particles and
pathogens. The cilia (hair-like projections) help get rid of the trapped substances
through sneezing.
The pharynx (the throat) is the passage that receives air from the nasal cavity. Its
obstruction may prevent air from getting to the lungs. The pharynx opens into the larynx
and is divided into the nasopharynx, the oropharynx, and the laryngopharynx.
The larynx (the voicebox or glottis) is the air passage between the pharynx and
the trachea. It consists of the sublarynx, larynx, and supralarynx. It plays an important
role in human speech. The sound production includes the vocal cords that close together
and vibrate as the expelled air passes through them.
The lower respiratory tract is composed of the trachea, bronchi, bronchial tree,
and lungs.
The trachea (the windpipe) is the main airway into the lungs. It splits into the
right and left bronchi. Goblet cells produce mucus that traps airborne particles and
microorganisms, and cilia propel the mucus upward.
The primary bronchi branch into smaller passageways until they terminate in tiny
air sacs called alveoli. The smallest branch of the tracheobronchial tree is the
bronchioles and terminal bronchioles.
Exchange of gases between the air in the lungs and the blood in the capillaries
occurs across the walls of the alveolar ducts and alveoli. The simple squamous
epithelium of these structures allows rapid diffusion of oxygen and carbon dioxide.
The lungs are pyramid-shaped, paired organs that are soft and spongy because
they are mostly air spaces surrounded by the alveolar cells and connective tissue. The
8
lungs are connected to the trachea by the right and left bronchi. The right lung has a
greater volume than the left lung and it is shorter and wider. The right lung consists of
three lobes: the superior, middle and inferior lobes. The left lung is composed of two
lobes: the superior and inferior lobes. Each lung is covered by a serous membrane,
called the pleura. The space between the visceral and parietal pleura is the pleural
cavity. It contains serous fluid that acts as lubricant to reduce friction, and it helps to
hold the two layers of pleura together as the lungs inflate and deflate.
The base of the lung is found near the diaphragm (the midriff) that is the main
dome-shaped muscle of respiration. During normal inspiration, the diaphragm and
intercostal muscles contract, the diaphragm moves downward and the external
intercostal muscles move the ribs upward and outward which increases the volume of
the thoracic cavity. During normal expiration, the respiratory muscles relax and the
thoracic cavity and lungs decrease in volume, causing an increase in interpulmonary
pressure. The interpulmonary pressure rises above atmospheric pressure and it helps air
leave the lungs.
LANGUAGE DEVELOPMENT
5
Match the following terms with their definitions.
1. Ventilation
a. the gas movement from a high-pressure area to a lowpressure area during internal and external respiration
2. Diffusion
b. includes the organs and structures of the respiratory
system that are directly involved in gas exchange
3. Perfusion
c. the expandability of the lungs
4. Conducting
zone
d. includes movement of air through air passages into and
out of the lungs during inhalation (inspiration) and
exhalation (expiration)
5. Respiratory
zone
e. the number of breaths a person takes per minute
6. Respiratory
cycle
f. the region of the respiratory system that includes the
organs and structures responsible for air transport and
distribution and are not directly involved in gas exchange
7. Respiratory
rate
g. refers to the blood flow to tissues and organs
8. Pulmonary
compliance
h. consists of one sequence of inspiration, expiration, and a
very short respiratory pause
9
6
Complete the sentences with the word-combinations in the box.
rapid diffusion
breathing out
serous fluid
airborne particles
the expelled air
filtered and humidified
into and out of the lungs
gas exchange
1. The pleural cavity contains __________that acts as lubricant to reduce
friction.
2. The simple squamous epithelium of these structures permits ____________of
oxygen and carbon dioxide.
3. Goblet cells produce mucus that traps _______________.
4. The tiny alveoli and the alveolar ducts are responsible for ______________.
5. The sound production includes the vocal cords that close together and vibrate
as ________________ passes through them.
6. The mucous membrane lines the nasal cavity where the air we breathe in is
warmed, __________________.
7. Exhalation is the process of ______________or expelling air from the lungs.
8. The breathing process or ventilation includes movement of air through air
passages ________________.
7
Match the definitions with the phrases in the box.
quiet breathing
forced breathing
diaphragmatic breathing costal breathing
aerobic respiration anaerobic respiration
1. a shallow breath ___________________
2. taking place in the presence of oxygen to produce energy _________________
3. hyperpnea, a mode of breathing that occurs during exercise ________________
4. eupnea, a mode of breathing that occurs at rest ____________________
5. taking place in the absence of oxygen to produce energy __________________
6. deep breathing ___________________
8
Complete the sentences by choosing the appropriate prepositions.
Respiration supplies energy and provides a releasing process into/in all living
organisms. It is responsible about/for the conversion of food energy into/to
metabolically usable forms of chemical energy. The process is used to/for all cellular
activities, including metabolism and cell division. Various intermediate products of
10
glycolysis and the citric acid cycle are used in the synthesis of/on many organic
compounds. On/In a plant, the carbon dioxide required for/ under photosynthesis is
replenished by the carbon dioxide released by/with humans under/during respiration.
The oxygen needed for/at respiration is replenished with/by the oxygen released in
photosynthesis. Respiration and photosynthesis are complementary with/to each other
and maintain the balance of carbon dioxide and oxygen in nature.
9
Agree or disagree with the following statements. Comment on your answer.
1. The larynx is the air passage between the oropharynx and the trachea.
2. The sound production includes the windpipe that vibrates as the expelled air
passes through it.
3. The respiratory system filters, warms, and humidifies the expired air.
4. The right lung has a greater volume than the left lung.
5. The primary bronchi branch into the largest passageways until they terminate in
tiny air sacs called alveoli.
6. The nose is made up of soft tissue and is located in the lower face area.
7. The lungs are soft and spongy organs.
8. The term “breathing” is the same as “ventilation”.
10
Answer the following questions.
1. What major components does the respiratory system consist of? What does it
provide?
2. What does the term “respiration” include?
3. How is ventilation defined?
4. What processes occur during inhalation and expiration?
5. What is the difference between external and internal respiration?
6. What is gas exchange important for? Which structures of the respiratory system
are responsible for gas exchange?
7. What are the major functions of the respiratory system?
8. What organs does the upper respiratory tract consist of? Describe their location
and their main functions.
9. What organs belong to the lower respiratory tract? Describe their location and
their main functions.
10. How are diffusion and perfusion defined?
11
TALKING POINTS
1
Choose one of the points below and explore it. Present your findings to the
group.
 The main functions of the respiratory system and how tobacco smoke can
interfere with them.
 The medical specialties associated with the health of the respiratory system.
 Common diagnostic procedures related to the respiratory system.
 The abbreviations that stand for the terms referring to the anatomy of the
respiratory system.
Using additional information resources, find out what usually happens if:
2
•
•
•
•
you hold your breath for longer than 3 minutes;
you breathe in cold air during cold weather;
you breathe too fast;
you inhale airborne pathogens.
MORE READING
1
Read the text and answer the following questions.
1. What protective mechanisms are found in the respiratory tract? What do you
think their role is? What happens if they fail to function well?
2. What factors can increase the risk of upper respiratory tract infections?
3. What pathogens most frequently cause respiratory diseases?
4. What symptoms are typical for upper respiratory infections?
5. What groups of medications are usually prescribed for symptom relief?
6. How do you think upper respiratory infections contribute to the development of
complications?
UPPER RESPIRATORY TRACT INFECTION
Upper respiratory tract infections (URTI) are associated with self-limited
irritation and swelling of the upper airways accompanied by cough with no evidence of
pneumonia. URTIs involve the nose, sinuses, pharynx, larynx, and trachea that can be
affected by a variety of viruses and bacteria. The inhaled pathogens may cause rhinitis,
pharyngitis, tonsillitis, laryngitis, acute bronchitis, the common cold, influenza, and
respiratory distress syndromes. The pathogenic microorganisms are usually acquired by
inhaling infected droplets. Certain barriers prevent viruses and bacteria from penetrating
into the lower regions of the respiratory tract. The cilia and the mucus trap the
microorganisms. The angle between the pharynx and the nose prevents particles from
getting into the airways. Ciliated cells in the lower airways transport the pathogens back
12
to the pharynx. The adenoids and tonsils also contain immunological cells that attack
the pathogens.
The risk factors for a URTI include smoking, medical disorders such as asthma
and allergic rhinitis, immunocompromised conditions, especially cystic fibrosis, HIV,
anatomical anomalies including facial dysmorphic changes or nasal polyposis, use of
corticosteroids, transplantation, and post-splenectomy, working conditions, and
environmental factors.
The rhinovirus, a species of the Enterovirusgenus of the Picornaviridae family, is
the most common cause of the common cold and causes up to 80% of all respiratory
infections. Other viruses include the influenza virus, adenovirus, enterovirus, and
respiratory syncytial virus. Bacteria may cause about 15% of pharyngitis cases. The
most common bacteria are S. Pyogenes, a Group A streptococcus.
The onset of symptoms usually begins one to three days after exposure, lasts 7–10
days, and can persist for up to 3 weeks. Nasal mucosal infection, resulting in an
inflammatory response, causes vasodilation and increased vascular permeability. These
changes lead to nasal obstruction and rhinorrhea. Cholinergic stimulation induces
mucus production and sneezing. Other manifestations of URTIs commonly include
cough, sore throat, runny nose, nasal congestion, headache, low-grade fever, sneezing,
malaise, and myalgias.
The goal of treatment for the common cold is symptom relief. Cough, congestion,
and other symptoms can be relieved by decongestants and antihistamine/decongestant
combinations. H1-receptor antagonists may moderately reduce rhinorrhea and sneezing
during the first 2 days of a cold. The use of antibiotics in the treatment of the common
cold is not advised because they do not improve symptoms or shorten the course of
illness. Early antiviral treatment for influenza infection shortens the duration of
influenza symptoms, decreases the length of hospital stays, and reduces the risk of
complications.
Vaccination is the most effective method of preventing influenza.
Complications of upper respiratory tract infections are relatively rare, except for
influenza. Complications of influenza include primary influenza viral pneumonia,
secondary bacterial pneumonia, sinusitis, otitis media, coinfection with bacterial agents,
and exacerbation of chronic medical conditions, particularly asthma and chronic
obstructive pulmonary disease. Pneumonia is one of the most common complications of
influenza and contributes significantly to morbidity and mortality.
13
UNIT 1
RESPIRATORY SYSTEM
1.2 BRONCHITIS
LEAD IN
1
Learn the following words.
бронхіт
респіраторно-синцитіальний
вірус
гнійний
закладеність носа
нездужання
сухий свистячий хрип
сонорний хрип, який нагадуює
хропіння або низький стогін
bronchitis
syncytial virus
[brɒŋˈkaɪtɪs]
purulent
nasal congestion
malaise
wheeze
rhonchus
plural rhonchi
[ˈpjʊərələnt]
complete blood
count
[kəmˈpli:t blʌd
blood chemistry
egophony
[blʌd ˈkemɪstrɪ]
[i:ˈgæfənɪ]
біохімічний аналіз крові
бронхофонія мекаючого
характеру
fremitus
[ˈfrɛmɪtəs]
голосове тремтіння під час
пальпації
rale
antihistamine
[rɑ:l]
[ˌæntiˈhɪstəmi:n]
хрип, схожий на потріскування
антигістамінний препарат (ліки
від алергії)
decongestant
[ˌdi:kənˈdʒestənt]
протинабряковий лікарський
засіб
antitussive
expectorant
[ˌæntɪˈtʌsɪv]
bronchodilator
[ˈbrɒŋkəʊdaɪˌleɪtə]
препарат проти кашлю
відхаркувальний лікарський
засіб
бронхорозширювальний
лікарський засіб
antipyretic
recurrence
exacerbation
[ˌæntɪpaɪˈrɛtɪk]
[sɪnˈsɪtɪəl ˈvaɪrəs]
[ˈneɪzl kənˈdʒestʃən]
[məˈleɪz]
[wi:z]
[ˈrɒŋkəs]
[ˈrɒŋkaɪ]
kaʊnt]
[ɪkˈspektərənt]
[rɪˈkʌrəns]
[ɪɡˌzæsəˈbeɪʃn]
14
розгорнутий аналіз крові
жарознижувальний препарат
рецидив
загострення
2
Give the English equivalents of the Ukrainian word-combinations by matching
the adjectives in A to the nouns in B. Make sentences using English wordcombinations.
зміни запального
характеру
гнійне
мокротиння
надокучливий
кашель
частота дихання
підтримувальна
терапія
безрецептурні
препарати
хвороба, яка
проходить сама
вплив факторів
виробничого
середовища
3
A
1. inflammatory
a. rate
B
2. purulent
b. cough
3. disturbing
c. exposure
4. respiratory
5. supportive
d. changes
e. illness
6. over-the-counter
f. sputum
7. self-limiting
g. medication
8. occupational
h. care
Get familiar with some of the facts about bronchitis and search for more
information to present to the group.
1. Acute bronchitis is the most common disease of the bronchopulmonary
apparatus. Its annual incidence rate is 10% in children and 5% in adults.
2. The same viruses that cause the flu and the common cold are frequently
defined as the causative agents of acute bronchitis.
3. Bacterial infections cause less than 10% of cases of bronchitis.
4. Tobacco smoke, fumes, dust, and air pollution increase the risk of acute
bronchitis.
5. Acute bronchitis should be differentiated from asthma, which is usually
manifested by progressive cough, tachypnea, wheezing, hypoxemia, and
respiratory distress.
6. Chronic bronchitis is usually diagnosed in patients with chronic obstructive
pulmonary disease or in smokers. However, repeated episodes of acute
bronchitis, dust, fumes, and air pollution contribute to the development of
chronic bronchitis too.
7. Exacerbation of chronic bronchitis results in severe coughing, chest pain,
chest discomfort, and cyanosis (bluish or greyish skin coloration).
8. Pneumonia is the most common complication of bronchitis. One in 20 cases of
bronchitis leads to pneumonia.
15
4
Read the text.
BRONCHITIS
Acute bronchitis is a frequently diagnosed viral infection leading to inflammatory
changes within the bronchi. The viral pathogens of upper respiratory infections,
including those of the common cold, influenza A or B, parainfluenza, respiratory
syncytial virus, or coronavirus, most often cause acute bronchitis. Bacterial infections
cause less than 10% of cases of bronchitis.
Acute bronchitis is characterized by acute cough with or without sputum
production and can last up to 3 weeks. Clear, yellowish, and sometimes purulent sputum
may be present. Purulent sputum is not associated with bacterial infection and does not
require antibiotic use. Cough is commonly disturbing and slow to resolve. Patients may
experience chest pain when coughing. Besides cough and sputum, other signs and
symptoms of acute bronchitis include dyspnea, nasal congestion, headache, and fever.
Fever is not a typical symptom after the first few days. The first few days of acute
bronchitis may be mistaken for the common cold.
Acute bronchitis is diagnosed based on history, past medical history, a lung exam,
and other physical findings. The oxygen saturation plays an important role in assessing
the severity of the disease along with the pulse rate, temperature, and respiratory rate.
On physical examination, patients with acute bronchitis may be mildly illappearing and may present with malaise. During lung auscultation, wheezes as well as
rhonchi that typically improve with coughing may be revealed.
Laboratory testing is usually not indicated in the evaluation of acute bronchitis. A
complete blood count and chemistry may be ordered if a fever is present. The white
blood count might be mildly elevated in some cases of acute bronchitis. Blood
chemistry can reflect dehydration. Spirometry shows bronchial hyperresponsiveness and
airflow obstruction.
Chest radiography is primarily used to rule out pneumonia in patients with
symptoms of acute bronchitis. The indications for chest X-ray include dyspnea, bloody
sputum or rusty sputum colour, pulse exceeding 100 beats per minute, respiratory rate
exceeding 24 breaths per minute, oral body temperature exceeding 37,8 °C, egophony,
and fremitus on chest examination.
Supportive care and symptomatic treatment are prescribed for acute bronchitis.
The role of antibiotics is limited. For cough relief, nonpharmacological and
pharmacological therapy should be prescribed. Nonpharmacological therapy includes
warm tea, honey, and ginger. Over-the-counter medications are the first-line treatment
for acute bronchitis. Antihistamines are often used in combination with decongestants in
the treatment of acute cough. Antitussives reduce the cough reflex. Expectorants
stimulate respiratory tract secretions and increase respiratory fluid volumes and
decrease mucus viscosity. Patients with evidence of airflow obstruction should be
treated with bronchodilators. They relieve dyspnea and reduce coughing. Analgesic and
antipyretic agents may be used to treat malaise, myalgia, and fever. Lifestyle
modification, including smoking cessation and the avoidance of allergens and
pollutants, plays an important role in the prevention of recurrence and complications.
16
Acute bronchitis is regarded as a mild, self-limiting illness. That is why healthy
adults recover completely and are typically uncomplicated cases. However, patients
with underlying lung disease, congestive heart failure, or immune compromise are at
high risk for complications, such as chronic cough or progression to chronic bronchitis
or pneumonia.
Chronic bronchitis is defined as chronic cough and sputum production for at least
3 months in a year for 2 consecutive years. The risk factors for chronic bronchitis
include cigarette smoking, occupational exposure to harmful substances, exposure to
agricultural pesticides, use of domestic solid fuels, electronic cigarettes, marijuana
smoking, and air pollution.
Chronic bronchitis is linked to a decline in lung function as well as an increased
risk of chronic obstructive pulmonary disease.
Pharmacologic therapy for chronic bronchitis is directed towards relieving
symptoms during stable disease (mucoactive agents, beta-agonists, muscarinic
antagonists), reducing loss of lung function (smoking cessation), preventing
exacerbations (mucoactive agents, macrolides) and treating exacerbations (antibiotics,
glucocorticoids) when they develop.
LANGUAGE DEVELOPMENT
5
Match the following laboratory and instrumental procedures with their
description.
1. auscultation
a. a special type of an imaging method that uses x-rays to
receive three-dimensional pictures of the body
2. complete
blood count
b. microscopic analysis of cells in the thick mucus produced
in the lower airways that helps find out the cause of some
lung problems
3. blood
chemistry
study
c. listening to the sounds within the body through a
stethoscope
4. spirometry
d. an imaging test that uses electromagnetic waves to obtain
the pictures of the structures in and around the chest
5. chest X-ray
e. a series of breathing tests (spirometry, lung volume tests,
pulse oximetry, arterial blood gas tests) that evaluate
pulmonary function, lung size, air flow, oxygen
saturation
6. pulmonary
function
testing
f. a test that measures the amounts of certain chemical
substances released into the blood by certain organs and
tissues in the body
17
6
7. high
resolution
computed
tomography
g. a test that evaluates the volume of air entering and
leaving the lungs that is known as air capacity of the lung
8. sputum
examination
h. a test that provides full information about different
constituents and features of the blood
Match the medical terms referring to the most common symptoms of bronchitis
with the plain English phrases in the box. Which group of words or phrases is
recommended for effective doctor-patient communication?
chest pain
thick mucus
palpable vibration of the walls of the chest
high-pitched whistling sound
difficulty breathing
stuffy nose
fine or coarse crackles
high body temperature
muscle pain
low-pitched continuous breathing sound
purulent
resembles the bleating of a goat
1. myalgia _____________
2. wheezing _____________
3. with pus _______________
4. dyspnea _______________
5. thoracalgia _____________
6. sputum ________________
7. nasal congestion _____________
8. rales _________________
9. fever ______________
10. fremitus __________
11. egophony ____________
12. rhonchi _________________
7
Complete the patient’s case history using the words and phrases in the box.
environmental allergens
runny nose
wheezing
coated
mucous membranes
worsening dyspnea
edema
cyanosis or clubbing
irregular rate
erythema
breathing
orthopnea
sleep apnea
HISTORY: This 56-year-old male is presenting with a 2-week history of
______________not associated with exertion. He reports that the shortness of breath
has progressively gotten worse in the past 2-3 days. He notices _______________
18
sometimes when lying in bed. He has developed a cold and ______________over the
last 10 days. Patient does not report any leg or foot __________.
PAST HISTORY: The patient has a life history of asthma triggered by
_________– grass cutting, trees budding in the spring, street dust. He has a history of
congestive failure and _____________for which he uses a CPAP machine nightly.
PHYSICAL EXAMINATION: GENERAL APPEARANCE: The patient appears
laboring in__________. VITAL SIGNS: Temperature 97.1, pulse 88, blood pressure
121/86, weight 209 pounds, height 5 feet 8 inches. HEENT (the head, eyes, ears, nose
and throat) Eye exam PERRLA (Pupils, Equal, Round, Reactive to Light and
Accommodation). Normocephalic, atraumatic. Moist _____________. No
oropharyngeal___________. No signs of infection. Tongue is __________but tonsils
are clear. NECK: No lymphadenopathy. LUNGS: There is marked ________on
inspiration bilaterally. CARDIAC: _________and rhythm. EXTREMITIES: Some
ankle edema noted in low extremities. No _______________.
8
Ask questions to obtain the following information.
1. A _________________________?
B My throat infection went away after I started the antibiotics.
2. A _________________________?
B I wash my hands often to protect myself from viruses and bacteria.
3. A __________________________?
B X-ray helps rule out pneumonia.
4. A __________________________?
B Your mother’s blood count is almost back to normal.
5. A __________________________?
B Smoking puts you at risk of developing chronic bronchitis.
6. A __________________________?
B We are going to remove the inflammation by prescribing anti-inflammatory
drugs.
7. A __________________________?
B My previous doctor was concerned about my family history of lung cancer.
8. A __________________________?
B We have to do more X-rays because the first ones were inconclusive.
9
Complete the sentences. More than one variant is possible.
1. Acute bronchitis is regarded as …
2. Acute bronchitis is characterized by …
3. Cough is commonly …
4. Besides cough and sputum, other signs and symptoms of acute bronchitis
include …
5. …….. sputum may be present.
19
6. Oxygen saturation plays an important role in …
7. Spirometry shows …
8. The indications for chest X-ray include …
10 Correct the statements. Dwell on each point.
1. Surgical treatment is prescribed for acute bronchitis.
2. The role of antibiotics in the treatment of acute bronchitis is enormous.
3. Nonpharmacological therapy includes prescription drugs.
4. Antihistamines are often used in combination with antibiotics in the treatment of
acute cough.
5. Antitussives increase the cough reflex.
6. Expectorants reduce the release of respiratory tract secretions, decrease
respiratory fluid volumes, and increase mucus viscosity.
7. Bronchodilators exacerbate dyspnea and cause coughing.
8. Analgesic and antipyretic agents may be used to treat hypoxia, edema, and
dehydration.
11 Answer the following questions.
1. What causes inflammatory changes within the bronchi?
2. What is the difference between acute and chronic bronchitis?
3. How can cough and sputum be described when acute bronchitis is suspected?
4. What signs and symptoms manifest acute bronchitis?
5. What tests and procedures are ordered to diagnose acute bronchitis and rule
out pneumonia and other respiratory system abnormalities?
6. What groups of drugs are usually prescribed for acute bronchitis? What action
does each of them produce?
7. When do patients with acute bronchitis develop complications? What
complications are usually observed?
8. What risk factors for chronic bronchitis exist?
9. What is pharmacologic therapy for chronic bronchitis directed towards?
10. What complications are associated with chronic bronchitis?
TALKING POINTS
1
Ask your patient with suspected acute bronchitis about their complaints. Inform
your group about them and explain why you order certain laboratory tests and
instrumental studies, as well as why you prescribe certain drug groups.
20
2
Work in groups. Discuss these issues:
 The prevalence of chronic bronchitis in the world.
 Chronic bronchitis as a risk factor for more serious outcomes of COVID19.
 The prevention and control of chronic bronchitis.
 The impact of chronic bronchitis on daily life.
MORE READING
1
Read the text. Summarize the information on:
- the spread of the infection in the respiratory tract;
- damage that occurs when the lungs are involved;
-pathological changes seen on CT-scans and in histological samples.
COVID-19 PNEUMONIA
About 80% of patients with COVID-19 are asymptomatic or have mild
symptoms because the virus attacks the upper and conducting airways. However, some
patients experience severe organ failure.
In the first stage of the disease, the virus may infect epithelial cells in the nasal
cavity and starts replicating. Over the next few days, the upper and conducting airways
become infected. Consequently, the virus is detectable in nasal swabs or sputum
samples. At this time, clinical manifestations are observed, and the innate immune
response is induced.
In nearly 20% of patients, the infection gets into the gas exchange structures and
provokes hypoxia and ground-glass opacification. Type II epithelial cells in the lungs
are more sensitive to infection with SARS-CoV-2. The infected cells undergo apoptosis.
These cells are responsible for surfactant secretion, so the reduced surfactant level
causes the alveoli to collapse. It leads to pneumonia and acute respiratory distress
syndrome in severe cases.
The pulmonary damage caused by COVID-19 may be related to the viral
destruction of alveolar and bronchial epithelial cells or the intensive production of proinflammatory cytokines (cytokine storm). Massive alveolar damage and progressive
respiratory failure are the leading causes of mortality in critically ill patients. Even with
a decrease in the viral load of nasopharyngeal specimens 10–15 days after the onset of
symptoms in COVID-19 patients, pathological alveolar damage continues to worsen.
In patients with COVID-19-induced endotheliitis, damage to endothelial lung
cells impairs blood coagulation and fibrinolysis and can also cause disseminated
intravascular coagulation. These abnormalities lead to the progression of pneumonia
and induce systemic microcirculatory dysfunction in the lungs.
21
Computed tomography scans indicate the rapid progression of pneumonia in the
lungs. CT findings can show bilateral pneumonia with ground-glass opacification and
initial consolidations. More prominent consolidations appear over time and worsen over
the last few days before death.
Differentiation of COVID-19 from bacterial pneumonia is difficult. The main CT
feature of COVID-19 pneumonia is the presence of ground-glass opacification. In
COVID-19 cases, ground-glass opacification typically has a peripheral and subpleural
distribution, with the involvement of multiple lobes, particularly the lower lobes. The
features of COVID-19 pneumonia are distinctive due to the absence of centrilobular
nodules and mucoid impactions.
The main histological findings in the lungs represent patchy necrosis, hyaline
membrane formation, and hyperplasia of type II pneumocystis, which are associated
with diffuse alveolar damage and injury to gas-exchange units. The whole lung tissue
has a diffuse congestive appearance or shows partly hemorrhagic necrosis on gross
examination.
GRAMMAR
PRESENT PERFECT OR PAST SIMPLE?
Past Simple
Form
The form of the Past Simple is the same for all persons.
I left at three o’clock.
He (she, it) arrived two weeks ago.
We did not finish on time yesterday.
Did you visit your doctor? Yes, I did./
No, I didn’t.
When did they have their medical
practice?
Present Perfect
Form
have/has + past participle
I have worked for this hospital.
She (he) has worked for this hospital.
It has not rained for a long time.
We have not known the doctor.
Have you known the doctor? Yes, I
have./ No, I haven’t.
How long have they known the doctor?
The Present Perfect expresses unfinished actions. The Past Simple expresses
completed actions.
22
Present Perfect
He has worked for this hospital for 5
years.
(He still works there.)
The family doctor has received 8 patients.
(She/he can still receive some more
patients.)
Past Simple
He worked for this hospital for 5 years.
(Now he works somewhere else.)
The family doctor received 8 patients.
(She/he can’t receive any more patients.)
The Present Perfect refers to indefinite time. The Past Simple refers to definite
time. Notice the time expressions used with the two tenses.
Present Perfect - indefinite
for a long time
for 2 years
for ages
since July
since I was a child
since 2010
ever
never
before
recently
just
already
yet
Past Simple – definite
yesterday
yesterday morning
last week
two days ago
at 8 o’clock
in 2020
in summer
when I was a student
Be careful with this morning/this afternoon, etc.
Have you seen our surgeon this morning? (It’s still morning.)
Did you see our surgeon this morning? (It’s the afternoon or evening.)
The Present Perfect expresses a past action that has a clear present result. The
action is usually in the recent past. The Past Simple expresses actions that follow each
other in a story.
Present Perfect
The patient hasn’t arrived yet.
(The doctor is still waiting for him/her.)
What have you done to your arm?
(It is broken.)
Past Simple
The patient walked into the room and
stopped. He listened carefully to the
doctor.
The Present Perfect expresses an experience that happened at some time in one’s
life. The action is finished, but the effects of it are still felt in some way. The Past
Simple expresses a past situation or habit.
23
Present Perfect
Past Simple
Have ever had an operation?
When I was a student, I lived in the dorm.
(So, you know now what it’s like to have Every day, I walked to my university.
one.)
1
Use the correct verb form (Past Simple or Present Perfect) in the sentences.
1. Christophe has been/was in the hospital since 20th May.
2. He didn’t go/hasn’t been to the toilet for a few days.
3. She felt/has felt weak for two days.
4. He last had/has had a headache five days ago.
5. Jane hasn’t eaten/didn’t eat anything last night.
6. In fact, she hasn’t eaten/didn’t eat anything since yesterday lunchtime.
7. How long did/have you have/had a cough?
8. His wife has experienced/experienced problems getting in and out of the bath
when she was alive.
9. The doctor hasn’t discharged/didn’t discharge her patient from the hospital.
The patient has a slight fever.
10. Did/has it hurt when I pressed your abdomen just there?
2
Put the verbs in brackets into the correct tense form (Past Simple or Present
Perfect).
1. When she was young, she … (pay attention to) her health a lot.
2. … you already … (be) on holiday? No, I haven’t. I … (be) busy last month.
3. The patient … (speak) to the ward sister. There is a problem with his stay in
the patient’s room.
4. The parents … (visit) their ill daughter twice.
5. He … (use) a walking stick to go to Radiology yesterday.
6. …you ever … (wear) the patient’s identity bracelet in the hospital?
7. Jake’s appointment … (be) at 10 a.m.
8. Some part of the population … (receive) one dose of a vaccine. One more is
necessary.
9. The girl … (catch) chickenpox since she was 10.
10. Yesterday morning Ann … (feel) dizzy at the sight of blood.
24
UNIT 1
RESPIRATORY SYSTEM
1.3 TUBERCULOSIS
LEAD IN
1
2
Learn the following words.
tuberculosis
settle down
[tju:ˌbɜ:kjuˈləʊsɪs]
laryngeal
exhibit
prevalence
transmission
concomitant
immature
declining
[ləˈrɪndʒiəl]
susceptible
hemoptysis
exposure
droplet
smear
specimen
lesion
morbidity
mortality
[səˈseptəbl]
[ˈsetl daʊn]
[ɪɡˈzɪbɪt]
[ˈprevələns]
[trænzˈmɪʃn]
[kənˈkɒmɪtənt]
[ˌɪməˈtjʊə(r)]
[dɪˈklaɪnɪŋ]
[hiˈmɑptəsɪs]
[ɪkˈspəʊʒə(r)]
[ˈdrɒplət]
[smɪə(r)]
[ˈspesɪmən]
[ˈli:ʒn]
[mɔ:ˈbɪdɪtɪ]
[mɔ:ˈtæləti]
туберкульоз
зосереджуватися в (про
мікроорганізми)
гортанний
мати симптоми
поширеність
передача (про інфекцію)
супутній
незрілий
той, що погіршується (про стан
здоров’я)
сприйнятливий
кровохаркання
контакт з (про інфекцію)
крапелька
мазок
зразок
пошкодження
захворюваність
смертність
Give the English equivalents of the Ukrainian word-combinations by matching
the adjectives in A to the nouns in B. Make sentences using English wordcombinations.
особа сприйнятлива до хвороби
повітряно- крапельні частинки
погане харчування
супутня інфекція
переповнені людьми місця
A
1. susceptible
2. airborne
3. poor
4. concomitant
5. overcrowded
25
B
a. nutrition
b. areas
c. cough
d. prevalence
e. person
постійний кашель
висока поширеність
напівактивні бацили
3
6. persistent
7. high
8. semi-dormant
f. bacilli
g. infection
h. particles
Get familiar with some of the facts about tuberculosis and search for more
information to present to the group.
1. The immune systems of most people are able to fight the TB bacteria and
prevent them from multiplying.
2. People with latent TB don’t have symptoms and can’t spread the infection to
others.
3. People with dormant TB have a normal chest X-ray and a negative sputum
smear.
4. Patients with inactive TB should be treated to reduce the risk of the
development of active TB.
5. If the exposure to the TB bacteria was recent, the TB skin test reaction may
not be positive yet.
6. Some latent TB infection medicines may cause minor side effects such as
orange discoloration of body fluids including urine, saliva, tears, sweat, and
breast milk.
7. Drinking alcoholic beverages while taking treatment for latent TB infection or
TB disease can be dangerous.
8. It takes at least 3 months or even longer to kill the TB bacteria during latent
TB infection.
4
Read the text.
TUBERCULOSIS
Tuberculosis (TB) is an ancient disease. It has affected mankind for more than
4,000 years. TB is the first infectious disease declared by the World Health
Organization (WHO) as a global health emergency.
Tuberculosis is a chronic bacterial disease caused by the bacillus Mycobacterium
tuberculosis. TB usually affects the lungs (pulmonary TB), but it can also damage other
parts of the body, such as bones, skin, brain, intestines, kidneys, or spine
(extrapulmonary TB). It spreads from an infected person to a susceptible person in
airborne particles called water droplets when an individual with pulmonary or laryngeal
TB coughs, sneezes, or talks. However, tuberculosis bacteria are not transmitted by
surface contact or touching. Transmission takes place when a person inhales droplet
nuclei containing the bacillus Mycobacterium tuberculosis. Active tuberculosis is
observed when the immune system fails to kill the infection, allowing it to spread to the
lungs or other parts of the body. Individuals with latent TB have an immune system that
prevents it from spreading throughout the body, and they do not exhibit any symptoms.
The highest rates of TB are usually observed in the poorest sections of the
community as poverty may result in poor nutrition, leading to depressed immune
26
function. TB occurs more frequently among low-income people living in overcrowded
areas with poor ventilation and poor hygiene habits.
The risk of TB transmission increases among people living in areas with a high
prevalence of TB. Healthcare workers, children in schools, and prisoners are also at a
greater risk. Individuals with a depressed immune system that is caused by the
concomitant HIV-infection, medical conditions such as diabetes, immune disorders,
end-stage renal disease, gastrectomy, or jejuno-ileal bypass increase the risk of
developing TB. Immature immunity in babies and declining immunity in the elderly
makes these age groups susceptible to tuberculosis.
Symptoms of TB depend on where in the body the TB bacteria settle down. In
cases of pulmonary TB, it may cause persistent cough for longer than 3 weeks, chest
pain, hemoptysis, weakness or fatigue, unexplained weight loss, loss of appetite, fever,
and night sweats.
For TB diagnosis, a complete medical evaluation is necessary, including the
patient’s history of TB exposure, demographic factors (country of origin, age, ethnic or
racial group, occupation), and the presence of the medical conditions (especially HIV
infection) that increase the risk of latent TB infection progressing to TB disease.
The Mantoux tuberculin skin test (TST) or the TB blood test can be used to test
for M. tuberculosis infection. It measures the immune reaction to the tuberculosis
bacteria. A posterior-anterior chest X-ray is used to detect lesions in the lungs that may
differ in size, shape, density, and cavitation. These abnormalities may suggest TB but
cannot be used to make a final diagnosis. The presence of acid-fast-bacilli (AFB) on
a sputum smear or other specimen often indicates TB disease. However, a culture is
done on all initial samples to confirm the diagnosis as acid-fast microscopy does not
confirm a diagnosis of TB because some acid-fast bacilli are not M. tuberculosis. All
patients must have their initial M. tuberculosis isolate tested for drug resistance. It is
important to identify drug resistance as early as possible to ensure effective treatment.
Drug resistance results in increased morbidity and mortality due to tuberculosis.
The WHO reported an alarming rise in not only multidrug-resistant (MDR) TB, when
patients develop resistance to two antibiotics, but also of XDR TB (extensively drugresistant TB), when patients develop resistance to three or more antibiotics. The
development of MDR cases has been attributed to non-adherence to therapy, lack of
supervised treatment, limited or interrupted drug supplies, poor quality of drugs,
widespread availability of anti-TB drugs without a prescription, poor medical
management, and poorly-managed national control programmes.
Tuberculosis is a treatable and curable disease. A long course of antibiotics is
prescribed. Isoniazid and Rifampicin are first-line drugs. Pyrazimamide acts on slow
growing and semi-dormant bacilli that lie within the cells. Ethambutol also slowly
inhibits mycobacterial growth. The second-line drugs are used in cases of resistance to
and inefficacy of the first-line agents. These drugs include amikacin, capreomycin,
cycloserine, azithromycin, clarithromycin, moxifloxacin, levofloxacin, and others. A
six-month course of antibiotics is typically used to treat pulmonary tuberculosis.
Bacillus Calmette-Guérin (BCG) vaccine is used as part of TB-control
programme. Several new TB vaccines are being developed.
27
LANGUAGE DEVELOPMENT
5
Match the following medical terms with their definitions.
1. immature
immunity
6
a. an overall assessment of a patient’s case history and
current condition for making a diagnosis and creating a
treatment plan
2. prevalence of
infection
b. a rapid microscopic analysis of a person’s sputum or
other specimen to detect acid-fast bacteria; it is used to
get preliminary results while waiting for culture results
3. medical
evaluation
c. pertaining to babies’ immune systems that are not as
strong as those of adults
4. sputum
smear
microscopy
d. the rate of disease in a population
5. acid-fast
microscopy
e. the proportion of a population who are infected with
certain infectious agent in a given time period
6. drug
resistance
f. the number of deaths in a population and within a
particular period of time
7. morbidity
g. reduction in the effectiveness of a medication in treating
the disease due to the ability of bacteria to withstand it
8. mortality
h. a diagnostic test performed for all suspected cases of TB,
and in which two or three sputum samples are collected
on consecutive mornings
Complete the sentences with the correct form of the words in bold.
Antimicrobial _______ develops when bacteria, viruses, fungi
and parasites no ______ respond to medicines making infections
harder to treat and ______ the risk of disease spread, severe
_______ and death.
RESIST
LONG
INCREASE
ILL
Antibiotics and other ______ medicines become ________ MICROBE
EFFECT
and infections become difficult or __________ to treat.
POSSIBLE
The ________ and spread of drug-resistant pathogens continues
to ________ our ability to treat common infections. Especially
_______ is bacteria, also known as “superbugs”, that cause
infections that are not _______ with available antibiotics.
28
EMERGE
THREAT
ALARM
TREAT
7
Complete the patient’s case history using the words and phrases in the box.
a chronic smoker’s cough
culture
weight loss
gross hemoptysis
fatigue
Emergency Department
bilateral cavitary infiltrates
productive cough
heavy alcohol and drug use
sputum specimen
A 31-year-old male presented to the _______________ after experiencing
___________. He had a 2 month history of ___________, a 25 pound _____________,
night sweats, and __________. A CXR revealed ___________. The initial
_________was smear positive 4+ and was submitted for a Nucleic Acid Amplification
Test (NAAT), __________, and sensitivity. The patient has a history of ________. He
is HIV negative, Hepatitis B and C positive, has a long history of cigarette use, and
__________. The patient resides with his wife and three children (ages 9, 7, and 2 years
old).
8
Ask questions to obtain the following information.
1. A _________________________?
B The risk of TB transmission increases among people living in areas with a
high prevalence of TB.
2. A _________________________?
B A posterior-anterior chest X-ray was used to detect lesions in the lungs.
3. A __________________________?
B The development of MDR cases has been attributed to non-adherence to
therapy.
4. A __________________________?
B TB may cause persistent cough for longer than 3 weeks.
5. A __________________________?
B The first-line drugs include Isoniazid and Rifampicin.
6. A __________________________?
B Tuberculosis is a treatable and curable disease.
7. A __________________________?
B A culture will be done on all initial samples to confirm the diagnosis.
8. A __________________________?
B Bacillus Calmette-Guérin (BCG) vaccine is used as part of TB-control
programme.
9
Complete the sentences. More than one variant is possible.
1. Tuberculosis is a chronic bacterial disease…
2. It spreads from an infected person…
29
3. Tuberculosis bacteria are not transmitted…
4. Active tuberculosis is observed…
5. In the individuals with latent TB, the immune system…
6. The risk of TB transmission increases…
7. The Mantoux tuberculin skin test…
8. The development of MDR cases has been attributed to…
10
Correct the statements. Dwell on each point.
1. Tuberculosis is a novel disease.
2. TB only affects the lungs.
3. TB is transmitted by the faecal-oral route.
4. There is just one form of TB diagnosed in TB patients.
5. The highest rates of TB are usually observed in the most highly developed and
rich countries.
6. For TB confirmation, X-ray is the most reliable method of diagnostics.
7. Drug resistance is not associated with tuberculosis management.
8. Tuberculosis is a deadly condition that is not vaccine-preventable.
11 Answer the following questions.
1. What causes tuberculosis? What organs can be affected by TB?
2. How is TB transmitted?
3. What factors increase the risk of TB transmission?
4. What forms of TB are usually diagnosed depending on the affected organ and
the activity of the TB bacteria?
5. What symptoms are typically observed in TB patients?
6. What tests and procedures help to confirm the diagnosis of TB disease?
7. What treatment plan is usually advised for TB patients?
8. What problems may arise in the course of treatment?
TALKING POINTS
1
How important are the following for TB prevention? Rate each idea 1-5, with 1
being the most important and 5 being the least important. Discuss your ideas in
the group.
 Patients with active TB disease must get their treatment immediately.
 People must cover their mouth with a tissue when they cough and sneeze.
30
 Infants must undergo vaccination with BCG at birth.
 People must have their chest X-ray done every year.
 Everyone should wash their hands after coughing and sneezing, taking
public transportation, and so on.
2
Choose the photo you are going to talk about. Use specific words or expressions
pertaining to the topic.
MORE READING
1
Read the text. How are lung neoplasms classified, diagnosed, and managed?
Search for more information on lung cancer to present to the group.
LUNG NEOPLASMS
A lung neoplasm is an abnormal growth in or on the lung. Different types of
tumours can develop in the lungs. They are usually diagnosed with the use of medical
imaging studies and biopsy samples. Lung neoplasms can be benign or cancerous.
Benign growths are not necessarily harmless. Such neoplasms are unlikely to
spread, but they can become cancerous under certain conditions. They can also interfere
with normal lung function. A noncancerous malformation can contribute to the
31
development of complications, posing a risk to a patient. That is why such a tumor may
require treatment and follow-up activities and procedures.
Four cell types account for more than 95% of all primary cancerous lung
neoplasms: adenocarcinoma, squamous cell carcinoma, large-cell carcinoma, and smallcell carcinoma. Combinations of these cell types may occur within the same primary
neoplasm.
Lung cancer is relatively uncommon in patients under the age of 30 and is
typically diagnosed in 60- to 70-year-old men and women. People can develop lung
cancer as a result of environmental exposure to toxic and radioactive substances and
elements such as smoke, radon gas, and asbestos. Researchers believe there may be a
genetic component involved in the development of some types of lung neoplasms.
People with a family history of lung cancer may be advised to undergo regular
screening to detect cancer early if it develops.
The primary tumour commonly triggers the appearance of symptoms. Centrally
located tumours can cause coughing, wheezing, hemoptysis, and postobstructive
pneumonia. Tumours invading the chest wall, pleura, and mediastinal structures can
induce pleuritic or local chest pain, dyspnea, cough, the Pancoast syndrome, the
superior vena cava syndrome, or hoarseness.
When a lung neoplasm is detected and all necessary tests are performed to learn
more about the growth, the appropriate management of it is determined and suggested
to a patient. Chemotherapy, surgery, and radiation may be recommended to address the
growth. These therapies are carried out under the oncologist’s surveillance. The length
of time required for treatment varies, depending on the nature of the lung neoplasm and
the patient’s overall health status. A monitoring plan is developed and advised by a
doctor to check for recurrences and complications after treatment.
GRAMMAR
COMPARATIVES AND SUPERLATIVES
We use comparative adjectives and adverbs to compare one person or thing with
another person or thing.
Forms of regular comparatives and superlatives
We make comparatives by adding -er to the adjectives and adverbs with one or
two syllables or by putting more in front of the adjectives or adverbs with three or more
syllables.
This medicine is cheaper than the one.
The acute condition progresses faster than the chronic one.
Treatment in this hospital is more effective than in that one.
Dr. Smith spoke more accurately than Dr. Stevenson.
32
We make superlatives by adding -est to the adjectives and adverbs with one or
two syllables or by putting most in front of the adjectives or adverbs with three or more
syllables.
It's the cheapest pharmacy in the town.
He spoke the most confidently in the final interviews.
Forms of irregular comparatives and superlatives
Some adjectives and adverbs have irregular comparative and superlative forms.
Adjective:
Comparative:
Superlative:
good
better
best
bad
worse
worst
Adverb:
Comparative:
Superlative:
well
badly
better worse
best
worst
far
further
furthest
little
less
least
1
Give the comparative and superlative forms of the following adjectives and
adverbs.
 frequently
 active
 great
 infectious
 persistent
 fast
 early
 high
 long
 susceptible
 many
 severe
 slowly
 poor
2
Complete the sentences with the comparative and superlative forms of the
adjectives and adverbs in brackets.
1. Do the muscles in your arm feel … (strong) after the exercise sessions?
2. Her cough is … (good) in the evening.
3. His temperature is … (high) today.
4. The pain is getting … (bad).
5. He is walking … (slowly) now than yesterday.
6. It’s … (difficult) operation. There is still a lot to do.
7. I see you are … (well) today. That’s great.
8. Joe is … (conscious) patient the doctor has ever had.
9. The dose of the medication should be … (low).
10. The patient has done the exercise … (easily) after the medication.
33
UNIT 2
CARDIOVASCULAR SYSTEM
2.1 ANATOMY AND FUNCTIONS
LEAD IN
1
Learn the following words.
heart
[hɑ:t]
серце
aorta
[eɪˈɔ:tə]
аорта
artery
[ˈɑ:tərɪ]
артерія
arteriole
[ɑ:ˈtɪərɪəʊl]
артеріола
capillary
[kəˈpɪlərɪ]
капіляр
venule
[ˈvɛnju:l]
венула
vein
[veɪn]
вена
34
кисень
oxygen
[ˈɒksɪdʒən]
carbon dioxide
[ˌkɑ:bən daɪˈɒksaɪd] вуглекислий газ
chamber
[ˈtʃeɪmbə(r)]
камера
atrium
plural atria
[ˈeɪtrɪəm]
передсердя
ventricle
[ˈventrɪkl]
шлуночок
valve
[vælv]
клапан
bicuspid
[baɪˈkʌspɪd]
двостулковий
tricuspid
[traɪˈkʌspɪd]
тристулковий
supply
[səˈplaɪ]
постачати
convey
[kənˈveɪ]
переносити, транспортувати
drain (into)
[dreɪn]
впадати в
release
[rɪˈli:s]
виділяти
2
[ˈeɪtrɪə]
Get familiar with some of the facts about the cardiovascular system and search
for more information to present to the group.
1. During the average lifetime, a heart pumps 1 million barrels of blood, enough
to fill more than 3 super tankers.
2. The heart pumps about 100 gallons of blood through the body each hour. It is
enough to fill 1,600 drinking glasses.
3. A newborn baby has about one cup of blood in circulation. An adult human
has about four to five quarts.
4. It takes blood about 20 seconds to circulate through the vascular system.
5. Blood makes up 7% of your body weight.
6. Every year, the heart beats approximately 35 million times. That is 100,000
beats per day and 70 beats per minute.
7. In just one day, the heart creates enough energy to drive a truck 20 miles.
During an average lifetime, that is equivalent to driving to the moon and back.
8. The use of CPR dates all the way back to 1740, yet even today, most people
don’t know how to perform it.
35
3
Think about the anatomy of the cardiovascular system. Match the components
of the system with their definition.
1. Heart
a. two large veins conveying deoxygenated blood from the body
into the heart
2. Blood
b. muscular and elastic tubes that transport oxygenated blood under
a high pressure from the heart through the body
3. Aorta
c. the smallest arterial vessels with thick muscular walls that branch
out from the arteries and connect with capillaries
4. Venae cavae
d. an organ about the size of the fist, made of multiple layers of
tissue, that pumps blood through the body
5. Arteries
e. tiny, thin-walled vessels that are responsible for the delivery of
oxygen and nutrients from blood to tissues and the removal of
carbon dioxide and wastes from tissues
6. Veins
f. the largest artery in the body, originating from the left ventricle of
the heart and extending down to the abdomen, where it branches off
7. Arterioles
g. a constantly circulating fluid made up of plasma, red blood cells,
white blood cells and platelets, providing the body with nutrients,
oxygen, and waste removal
8. Venules
h. small veins that receive deoxygenated blood from the capillaries
9. Capillaries
i. elastic blood vessels, thinner and less muscular than arteries, that
transport deoxygenated blood from the organs back to the heart
4
Read the text.
CARDIOVASCULAR SYSTEM
The cardiovascular system consists of the heart, blood, and blood vessels. The
major functions of the cardiovascular system are transport of nutrients, gases, and waste
products around the body; protection of the body from infection and blood loss due to
red blood cells, white blood cells, and platelets; thermoregulation; and maintenance of
fluid balance within the body.
There are five general classes of blood vessels in the cardiovascular system:
arteries, arterioles, capillaries, venules, and veins. Arteries are elastic vessels that are
very strong because they carry blood away from the heart under high pressure. They
subdivide into thinner vessels that branch into finer arterioles.
The smallest blood vessels are capillaries. They are thin-walled structures
interconnected with arterioles and venules. Capillary walls allow the diffusion of blood
36
with a high level of oxygen and nutrients as well as help remove high levels of carbon
dioxide and waste products from the surrounding tissues. Venules are microscopic
vessels that link capillaries to veins. The veins carry blood back to the atrium. Many
veins have valves that facilitate the return of blood to the heart. Veins also serve as
reservoirs for blood in certain conditions, such as during arterial haemorrhage.
The human heart is a muscular organ situated to the left of the midline of the
thoracic cavity. Its posterior border is near the vertebral column, and its anterior border
is near the sternum. The heart is hollow and cone-shaped. An average adult has a heart
that is 14 cm long by 9 cm wide. The walls of the heart are composed of three layers:
the outer epicardium, middle myocardium, and inner endocardium. The heart is
enclosed in a tough fibrous sac known as the pericardium.
The heart is divided into four chambers. The upper two chambers (atria) are
separated from each other by the interatrial septum and receive blood returning to the
heart. The interventricular septum is found between the lower two chambers
(ventricles). The ventricles receive blood from the atria. The atrioventricular septum
keeps arterial blood from mixing with venous blood. The heart chambers are
coordinated so that their actions are effective. The atria contract (atrial systole) as the
ventricles relax (ventricular diastole). Likewise, the ventricles contract (ventricular
systole) as the atria relax (atrial diastole). Then a brief period of relaxation of both the
atria and ventricles occurs. This complete series of events makes a heartbeat known as a
cardiac cycle.
Between each atrium and ventricle, there are valves that allow blood to flow in
one direction and prevent backflow. The atrioventricular valves include the mitral
(bicuspid) valve on the left and the tricuspid valve on the right. The pulmonary and
aortic valves are known as semilunar valves.
There are two types of blood circulation: systemic and pulmonary.
Deoxygenated blood flows into the right atrium from the veins known as the
superior vena cava and inferior vena cava (the largest veins in the body) and the
coronary sinus. The superior vena cava carries blood from the head, neck, chest, and
arms. The inferior vena cava carries blood from the lower trunk and the legs. The
coronary sinus drains blood into the right atrium from the myocardium. Then the blood
flows through the right atrioventricular (tricuspid) valve into the right ventricle. The
pulmonary circulation begins. The blood is conveyed through the pulmonary valve into
the pulmonary trunk that splits into the right and left pulmonary arteries, the branches of
which supply the lungs. Then the blood becomes oxygenated while moving through the
capillaries of the alveoli of the lungs. It is here that carbon dioxide is released.
Four pulmonary veins supply the left atrium with oxygen-rich blood that is
transported from the lungs. Blood passes from the left atrium into the left ventricle
through the mitral valve (bicuspid valve). The systemic circulation begins. Blood is
directed through the aortic valve into the largest artery in the body, known as the aorta.
The first two branches of the aorta are called the right and left coronary arteries. They
supply blood to the heart tissue. Simultaneously, blood is pumped through the arterial
branches to the arterioles and through capillaries to the bodily tissues. Then carbon
dioxide and waste-rich blood drains into the veins through the venules and returns to the
right atrium of the heart through the vena cava.
37
LANGUAGE DEVELOPMENT
5
Match the following terms with their definitions.
1. blood volume
6
a. the contraction phase of the heart
2. cardiac
conduction
system
b. the volume of blood discharged from the ventricle
with each contraction
3. cardiac cycle
c. the relaxation phase of the heart
4. cardiac output
d. the relaxation of blood vessels, which increases their
diameter
5. systole
e. the initiation and distribution of impulses through the
myocardium that coordinates the cardiac cycle
6. diastole
f. a heartbeat; it consists of a complete series of systolic
and diastolic events
7. stroke volume
g. the contraction of blood vessels, which reduces their
diameter
8. vasoconstriction
h. the sum of formed elements and plasma volumes in
the vascular system; most adults have about 5 litres of
blood
9. vasodilation
i. the volume of blood discharged from the ventricle per
minute, calculated by multiplying stroke volume by
heart rate, in beats per minute
Complete the sentences with the words and word-combinations in the box.
deoxygenated blood
finer arterioles
reservoirs for blood
diffusion of blood
midline of the thoracic cavity
waste rich blood
mitral valve
backflow
1. Between each atrium and ventricle, there are valves that allow blood to flow in
one direction and prevent ___________.
2. Arteries subdivide into thinner vessels that branch into ____________.
3. The human heart is a muscular organ situated to the left of the _______.
4. Capillary walls allow the _____with high level of oxygen and nutrients.
5. ____________ flows into the right atrium from the veins known as the
superior vena cava and inferior vena cava (the largest veins in the body), and
the coronary sinus.
38
6. Veins also serve as __________in certain conditions, such as during arterial
haemorrhage.
7. Blood passes from the left atrium into the left ventricle through the
___________.
8. Then carbon dioxide and ________ drains into the veins through the venules
and returns to the right atrium of the heart through the vena cava.
7
Complete the sentences with the appropriate prepositions.
between
around
through
from
by
of
into
to
1. The heart is divided ____ four chambers.
2. The blood is conveyed _____ the pulmonary valve into the pulmonary trunk.
3. The ventricles receive blood ____ the atria.
4. Coronary arteries supply blood ____ the heart tissue.
5. The first two branches ___ the aorta are called the right and left coronary
arteries.
6. The interventricular septum is found ______ the lower two chambers
(ventricles).
7. The upper two chambers (atria) are separated from each other ____ the
interatrial septum.
8. The major functions of the cardiovascular system are transport of nutrients,
gases and waste products _______ the body.
8
Agree or disagree with the following statements. Comment on your answer.
1. The only function of the cardiovascular system is to transport nutrients and
gases.
2. There are two general classes of blood vessels in the cardiovascular system.
3. The smallest blood vessels are arterioles and venules.
4. The heart is divided into two chambers.
5. The atrioventricular valves include the mitral (bicuspid) valve on the left and
the tricuspid valve on the right.
6. The superior vena cava carries blood from the lower trunk and legs.
7. Four pulmonary arteries supply the left atrium with oxygen-rich blood that is
transported from the lungs.
8. Blood is directed through the aortic valve into the largest artery in the body,
known as the aorta.
39
9
Answer the following questions.
1. What major functions are performed by the cardiovascular system?
2. How are the five general classes of blood vessels defined?
3. Where is the heart located in the human body?
4. What general characteristics does the human heart have?
5. What chambers are found in the heart? How are they separated from each other?
How do they work?
6. What valves are found in the heart? Where are they located? What function do
they perform?
7. What is the definition of pulmonary circulation?
8. What is the definition of systemic circulation?
10 Review the anatomy of the cardiovascular system by completing the following
multiple-choice test. Discuss your answers in the group.
1. Blood leaving the left ventricle enters the
a) Pulmonary trunk
b) Pulmonary artery
c) Inferior vena cava
d) Aorta
2. The right ventricle pumps blood to the
a) Systemic circulation
b) Lungs
c) Left atrium
d) Right atrium
3. The mitral valve is located between the
a) Right atrium and right ventricle
b) Left atrium and left ventricle
c) Left ventricle and aorta
d) Right ventricle and pulmonary trunk
4. The heart wall is composed of how many layers?
a) Two
b) Three
c) Four
d) Five
5. The function of an atrium is to
a) Pump blood to the lungs
b) Pump blood into the systemic circuit
c) Pump blood to the heart muscle
d) Collect blood
40
6. The left and right pulmonary arteries carry blood to the
a) Brain
b) Liver
c) Lungs
d) Kidneys
7. Which of the following blood vessels returns blood to the left atrium?
a) Inferior vena cava
b) Superior vena cava
c) Pulmonary vein
d) Pulmonary trunk
TALKING POINTS
1
2
You are an examiner. Prepare 5 questions about the cardiovascular system for
the medical students who are going to pass their Anatomy exam. Assess their
answers and comment on them.




Using additional information resources, find out what usually happens if:
the heart beats too rapidly;
the heart beats too slowly;
the heart beats irregularly;
the heart stops beating.
MORE READING
1
Read the text. Choose one of the major risk factors for cardiovascular diseases
and prepare a presentation about it. Present it to your group. The presentation
should include the following aspects:
 the effect on the health of the cardiovascular system;
 what threat the consequences of this harmful influence may pose to
human life;
 how to remove the risk factor or minimize its influence if it is not
modifiable.
RISK FACTORS AND PREVENTION OF
CARDIOVASCULAR DISEASES
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood
vessels. They are as follows: coronary heart disease – a disease of the blood vessels that
supply the heart muscle; peripheral arterial disease – a disease of the blood vessels that
41
supply the arms and legs; rheumatic heart disease – damage to the heart muscle and
heart valves from rheumatic fever, caused by streptococcal bacteria; congenital heart
disease – birth defects that affect the normal development and functioning of the heart
caused by malformations of the heart structure from birth; and deep vein thrombosis and
pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the
heart and lungs.
An unhealthy diet, physical inactivity, tobacco use, and harmful alcohol use are
the most important behavioral risk factors for heart disease. The effects of behavioural
risk factors may result in raised blood pressure, elevated blood glucose and blood lipids,
overweight or obesity. These “intermediate risk factors” can be measured and indicate
an increased risk of heart attack, heart failure, and other complications.
Smoking is the most preventable risk factor. People should quit it to maintain and
improve their cardiovascular health. A diet low in cholesterol, saturated and trans fats, and
simple sugars and high in complex carbohydrates and good fats (omega-3s) helps lower
cholesterol levels and reduce the risk for heart disease. Regular exercise also aids in
lowering "bad" cholesterol and raising "good" cholesterol. Medications are often needed to
reach cholesterol goals. People should control their blood pressure through diet, exercise,
and weight management. Many people lead sedentary lives. Therefore, they have higher
rates of death and heart disease compared to people who perform even mild-to-moderate
amounts of physical activity. Most people should exercise for 30 minutes a day, at
moderate intensity, on most days. More vigorous activities are associated with more
benefits. People should limit their alcohol consumption to prevent the development of
cardiovascular conditions. Stress and anger management techniques decrease the risk of
CVDs too.
Health policies are required to encourage people to adopt and maintain healthy
behaviours, as well as to create environments that make healthy choices affordable and
available.
There are also a number of underlying determinants of CVD. These are a
reflection of the major social, economic, and cultural changes – globalization,
urbanization, and population ageing. Other determinants of CVD include poverty,
stress, and hereditary factors.
In addition, drug treatment of hypertension, diabetes, and high blood lipids is
necessary to reduce cardiovascular risk and prevent heart attacks among people with
these conditions.
Patients with cardiovascular disease should have access to appropriate technology
and medication. Basic medicines that should be available include: aspirin, betablockers, angiotensin-converting enzyme inhibitors, and statins.
Acute events should be promptly managed to decrease mortality among patients.
Sometimes, surgical operations are required to treat CVDs. They include: coronary
artery bypass, balloon angioplasty (where a small balloon-like device is threaded
through an artery to open the blockage), valve repair and replacement, heart
transplantation, and artificial heart operations.
42
UNIT 2
CARDIOVASCULAR SYSTEM
2.2 ATHEROSCLEROSIS
LEAD IN
1
Learn the following words.
atherosclerosis
[ˌæθərəʊsklɪəˈrəʊsɪs]
атеросклероз
build-up
[ˈbɪld ʌp]
накопичення
plaque
[plɑ:k]
бляшка
lumen
[ˈlu:mɪn]
отвір
impair
[ɪmˈpeə(r)]
debris
[ˈdebri:]
погіршувати, порушувати (про
процес)
залишки, рештки клітин
streak
[stri:k]
прожилка
trigger
[ˈtrɪɡə(r)]
призводити до, провокувати
lipoprotein
[ˈlɪpəprəʊti:n]
ліпопротеїн
[ˈlaɪpəprəʊti:n]
scavenger
[ˈskævɪndʒə(r)]
прибиральник, санітар
cholesterol
[kəˈlestərɒl]
холестерин
rupture
[ˈrʌptʃə(r)]
розриватися
occlude
[əˈklu:d]
закупорювати
modifiable
[ˈmɒdɪfaɪəbl]
те, на що можна вплинути або
те, що можна змінити
dyslipidemia
[ˌ dɪsˌlɪpɪˈdɪmɪə]
дисліпідемія
arrhythmia
[əˈrɪðmɪə]
аритмія
numbness
[ˈnʌmnəs]
оніміння
angiogram
[ˈændʒɪəʊˌɡræm]
ангіограма
43
2
Give the English equivalents of the Ukrainian word-combinations by matching
the adjectives in A to the nouns in B. Make sentences using English wordcombinations.
A
поступове
формування
(накопичення)
залишки клітин
видозмінений
холестерин
волокниста
оболонка
препарати, які
знижують рівень
ліпідів
холестеринові
бляшки
пацієнт з
непереносимістю
статинів
клінічний
результат
3
9. gradual
B
i. cholesterol
10. cellular
11. modified
j. medication
k. patient
12. fibrous
l. buildup
13. lipid-lowering
m. outcome
14. fatty
n. debris
15. statin-intolerant
o. cap
16. clinical
p. plaques
Get familiar with some of the facts about atherosclerosis and search for more
information to present to the group.
1. Arteriosclerotic cardiovascular disease is currently the most common cause of
death in the world.
2. Risk factors for the development of atherosclerosis are widespread and
associated with living in modern, resource-rich, technically advanced
countries.
3. In industrialized countries, many people are diagnosed with hypertension or
are taking antihypertensive medications, have high blood cholesterol, are
diabetic or obese, smoke cigarettes, and have no leisure-time physical activity.
4. The arterial atherosclerotic process begins in childhood as a result of the
presence of coronary risk factors and progresses into adult life.
5. Familial hypercholesterolemia is a condition that runs in the family where
people have very high LDL cholesterol levels in their blood - above 190
milligrams per deciliter (mg/ dL).
6. An atherosclerosis-related disease may cause fear, anxiety, depression, and
stress.
44
7. A healthy lifestyle may help people prevent or delay atherosclerosis and the
problems it can trigger.
8. If 20-year-old patients have a family history of early CVD, or if they have an
LDL of 160 mg/dL or more, it is necessary to assess their lifetime risk for
atherosclerosis.
4
Read the text.
ATHEROSCLEROSIS
Atherosclerosis is a disease of the large and medium-sized arteries.
Atherosclerosis is defined as the gradual buildup of fatty plaques within the arterial
wall. This may result in a significant narrowing of the vessel lumen as well as impair
blood flow. The plaques may become unstable and thrombose, leading to an acute
coronary syndrome.
The atherogenic process is characterized by dysfunction of the endothelial lining
of the vessel, associated with inflammation of the vascular wall. This leads to the
accumulation of lipids, foam cells, inflammatory cells, and cellular debris within the
intimal and subintimal layers of the vessel. The earliest lesions are known as “fatty
streaks”. These lesions develop into fibrous plaques. Further growth of the plaque
causes remodeling of the arterial wall. Progressive plaque accumulation results in
luminar narrowing and vessel obstruction.
The atherosclerotic process is triggered by endothelial cell injury from exposure
to tobacco toxins, oxidized low-density lipoprotein (LDL), advanced glycation end
products, elevated homocysteine, and infectious agents. Circulating leukocytes,
predominantly monocytes, are attracted to and bind to activated endothelial cells and
migrate into the subendothelial layer where they transform into macrophages. They act
as local “scavenger” cells, taking up modified LDL cholesterol, and becoming the
characteristic “foam cells” of established atherosclerosis. However, high-density
lipoprotein (HDL) is involved in reverse cholesterol transport from the peripheries to
the liver so that its increasing levels protect against the development of atherosclerosis.
Erosion of the endothelial layer or rupture of the overlying fibrous cap may
expose the highly thrombogenic, lipid-rich core of the plaque to circulating blood.
Collagen and tissue factors activate platelets and trigger the coagulation cascade,
leading to acute thrombosis, which may occlude the vessel. Myocardial infarction may
occur.
The nonmodifiable risk factors for atherosclerosis include age (because of the
degenerative process), gender (more common in men at an earlier age), menopausal
status, hormone replacement therapy, and a family history of atherosclerotic disease.
The modifiable risk factors are smoking, alcohol consumption, high blood pressure,
dyslipidemia, diabetes mellitus, obesity and the metabolic syndrome, psychological
stress, high-calorie and high-fat diet, and physical inactivity.
45
The symptoms of atherosclerosis depend on the artery that is affected. If
atherosclerosis is found in the coronary arteries, the symptoms include angina (chest
pain), shortness of breath, and arrhythmias (abnormal heartbeat). If atherosclerosis is
detected in the carotid arteries, the symptoms are weakness, paralysis or numbness in
the face, arms or legs, confusion, breathing problems, dizziness, and sudden and severe
headache. If atherosclerosis is observed in the peripheral arteries, the symptoms include
numbness and pain in the legs, arms, and pelvis. If atherosclerosis is established in the
renal arteries, it can lead to chronic kidney disease. As kidney disease progresses, the
symptoms include fatigue, changes in frequency of urination, loss of appetite, nausea,
itchiness, or numbness.
A diagnosis of atherosclerosis is made on the basis of a complete medical history
and physical examination, and diagnostic procedures for atherosclerosis. The
instrumental studies may include any, or a combination of, the following: coronary
angiogram, doppler sonography, blood pressure comparison, MUGA/radionuclide
angiography, thallium/myocardial perfusion scan.
The lipid-lowering medications are prescribed and include statins, fibrates, and
inhibitors of intestinal cholesterol absorption. Statins reduce cholesterol levels and
increase clearance of circulating LDL. Fibrates improve the lipid profile, which results
in a lowering of total and LDL cholesterol, a reduction in triglycerides, and an increase
in HDL. Inhibitors of intestinal cholesterol absorption reduce LDL cholesterol and are
sometimes used in statin-intolerant patients, but they should not be used as first-line
therapy as a substitute for statins as clinical outcome data are lacking.
Therapeutic lifestyle changes, including exercise, weight loss, and dietary
modifications, are the first step in the treatment of all patients.
LANGUAGE DEVELOPMENT
5
Match the following laboratory and instrumental procedures with their
description.
1. angiogram
2. doppler
sonography
(ultrasound)
a. uses a tiny amount of a radioactive substance,
called a radioactive tracer, that travels through the
bloodstream and is absorbed by the healthy heart
muscle. The areas that are damaged or don't have
good blood flow do not absorb the tracer. The
damaged areas may be called “cold spots” or
“defects.”
b. is used to check cholesterol levels and assess the
risk of the build-up of fatty deposits in the arteries
46
6
3. angiography
c. exercise or medicines are used to make the heart
work hard and beat fast in order to find out
abnormal changes in the heart rate or blood
pressure, heart rhythm or electrical activity,
shortness of breath or chest
4. myocardial
perfusion scan
d. is used to estimate the blood flow through the blood
vessels with the help of sound waves
5. cholesterol test
e. detects and records the electrical activity of the
heart and shows heart rate and rhythm, the strength
and timing of electrical signals
6. echocardiogram
(ECG)
f. uses X-ray-imaging to receive pictures of the blood
vessels. An X-ray picture appears on the screen and
the X-ray camera is moved around to create a 3D
image
7. electrocardiogram
(EKG)
g. uses a dye, which is injected into the arteries
through a thin catheter, and special X-rays to
visualize the insides of arteries and can reveal the
presence of the plaque
8. cardiac stress test
h. uses sound waves to create a moving picture of the
heart and provides information about the size and
shape of the heart, the work of the chambers and
valves
Match the medical terms with the plain English phrases in the box. Which
group of words or phrases is recommended for effective doctor-patient
communication?
abnormal concentration of fats in the blood
prone to rupture
irregular heartbeat
block the blood vessel
remote
fatty deposits
blood clotting
chest pain
opening
obstruct
1. plaques _____________
2. lumen _____________
3. thrombose _______________
4. coagulation _______________
5. occlude _____________
6. dyslipidemia ________________
7. angina _____________
8. arrhythmia_________________
9. peripheral ______________
10. become unstable _____________
47
7
Complete the patient’s case history using the words and phrases in the box.
smoking history
mild dyslipidemia
short of breath
obese stature
oxygen saturation
auscultation
elevated blood pressure
heaviness in his chest
reveal
regular rate and rhythm
A 21-year-old male college student felt _________ after walking a slight incline.
He was extremely ________, and collapsed on a nearby sofa to rest. He was rushed to
the hospital where diagnostic tests [electrocardiogram (ECG), chest X-ray, and cardiac
enzymes] did not __________any acute pathology. Vital signs showed _________ of
151/99 mmHg, pulse of 97 beats/minute (bpm), respirations of 20/minute, temperature
of 36.6 °C, and __________ of 98%. The patient was not in acute distress, and his heart
showed a __________without murmurs, S3 or S4. His lungs were clear to __________
and the chest discomfort was not reproducible. He was of _________, weighing 126 kg
and 183 cm tall (BMI 39.7). The patient’s extremities were well perfused. He had a 3
pack-year ________and a family history of CHD, including his maternal aunt and great
grandparents. The clinical diagnosis was stable angina, and the patient was discharged
home following short observation. Follow-up laboratory work revealed some insulin
resistance and ___________; LDL 78 mg/dL, HDL 30 mg/dL, triglycerides 199 mg/dL,
and Lp(a) 68.3 mg/dL.
8
Ask questions to obtain the following information.
1. A _________________________?
B The lipid-lowering medications are prescribed for atherosclerosis prevention
and treatment.
2. A _________________________?
B If atherosclerosis is established in the renal arteries, it can lead to chronic
kidney disease.
3. A __________________________?
B The plaques may become unstable and thrombose leading to an acute
coronary syndrome.
4. A __________________________?
B The arterial atherosclerotic process begins in childhood as a result of the
presence of coronary risk factors and progresses into adult life.
5. A __________________________?
B It is necessary to assess their lifetime risk for atherosclerosis to prevent its
development.
6. A __________________________?
B EKG detects and records the electrical activity of the heart and shows heart
rate and rhythm, the strength and timing of electrical signals
48
7. A __________________________?
B Inhibitors of intestinal cholesterol absorption reduce LDL cholesterol and
are sometimes used in statin-intolerant patients.
8. A __________________________?
B A healthy lifestyle may help people prevent or delay atherosclerosis and the
problems it can trigger.
9
Complete the sentences. More than one variant is possible.
1. Atherosclerosis is defined as …
2. The atherogenic process is characterized by …
3. The atherosclerotic process is triggered by …
4. High-density lipoprotein (HDL) is involved in …
5. Growth of the plaque causes …
6. The symptoms of atherosclerosis depend on …
7. Diagnosis of atherosclerosis is made on the basis of …
8. The lipid-lowering medications are prescribed and include …
10 Correct the statements. Dwell on each point.
1. Atherosclerosis may result in a significant widening of the vessel lumen as well
as restore blood flow.
2. Macrophages do not patrol for modified LDL cholesterol.
3. HDL is involved in the build-up of cholesterol plaques and induces the
development of atherosclerosis.
4. The nonmodifiable risk factors for atherosclerosis include smoking, alcohol
consumption, psychological stress, high-calorie and high-fat diet, and physical
inactivity.
5. The symptoms of atherosclerosis don’t depend on the artery that is affected.
6. Risk factors for the development of atherosclerosis are widespread and associated
with living in resource-poor and technically underdeveloped countries.
7. Therapeutic lifestyle changes, including exercise, weight loss, and dietary
modifications, do not show any favorable results in the treatment of all patients
with atherosclerosis.
8. A myocardial perfusion scan is used to check cholesterol levels and assess the
risk of the build-up of fatty deposits in the arteries.
11
Answer the following questions.
1. How is atherosclerosis defined? What does it result in?
2. What is the atherogenic process characterized by? What does it lead to?
3. What is the atherosclerotic process triggered by?
49
4. How do the characteristic “foam cells” of established atherosclerosis develop?
5. What modifiable and non-modifiable risk factors cause atherosclerosis? How
to minimize the risk of its development?
6. What signs and symptoms can be observed in patients with atherosclerosis
depending on the artery that is affected?
7. What instrumental and laboratory tests are ordered to diagnose
atherosclerosis? Describe them.
8. What treatment is prescribed to manage atherosclerosis?
TALKING POINTS
1
Drugs are usually chosen as a treatment for atherosclerosis. Sometimes, though,
surgical treatment is needed. However, it comes with risks and, therefore, is
typically reserved for emergency situations or when medications are not effective
in advanced atherosclerosis. Choose one of the following surgical methods of
atherosclerosis management, find out more information about it, and present it to
your group. Compare these methods and discuss their effectiveness in the group.
 Angioplasty and stenting
 Coronary bypass surgery
 Atherectomy
2
Work in groups. Discuss these issues.




The prevalence of atherosclerosis in the world.
Atherosclerosis as a risk factor for more serious cardiovascular conditions.
Prevention and control of atherosclerosis.
The impact of atherosclerosis on daily life.
MORE READING
1
Read the text. Write a case history of a patient with hypertension, namely its
INQUIRY part. Present it to the group. Include the following paragraphs:
 general information about the patient
 primary complaints (reported by the patient), secondary complaints (based
on a system review)
 the history of present illness (each principal symptom should be described
as to its location, severity, quality, quantity, timing, onset, duration,
frequency, the setting in which it occurs, factors that aggravate or relieve it,
associated manifestations)
50






allergy history
the medications the patient is on
bad habits
family history
social history
past medical history
HYPERTENSION
Hypertension is associated with high blood pressure. There is a relationship
between increasing blood pressure and cardiovascular risk. Systolic hypertension is a
major risk factor for coronary disease and stroke. Both the duration and degree of
hypertension are contributing factors. Blood pressure is classified as normal BP
(systolic blood pressure of 120 and diastolic blood pressure of 80), pre-hypertension
(systolic blood pressure between 120 and 139 and diastolic blood pressure between 80
and 89), stage-1 hypertension (systolic blood pressure between 140 and 159 and
diastolic blood pressure between 90 and 99), and stage-2 hypertension ((systolic blood
pressure over 160 and diastolic blood pressure over 100).
The majority of patients (95%) have essential (primary) hypertension, in which an
underlying cause for hypertension is not found. Others have secondary hypertension, in
which an etiology is known and may include renal disease (diabetic nephropathy,
glomerulonephritis, chronic pyelonephritis, and etc.), endocrine disease (Cushing’s
syndrome, acromegaly, hyperthyroidism, and etc.), obesity, excessive salt intake, some
drugs, obstructive sleep apnea. Malignant hypertension is diagnosed when severe
hypertension (systolic blood pressure over 200 or/and diastolic blood pressure over 130)
is identified together with grade III-IV retinopathy. The patient may have a headache
and visual disturbance. Proteinuria and hematuria are often present. This is a medical
emergency requiring immediate treatment to prevent rapid progression to renal failure,
heart failure, and/or stroke.
Hypertension is usually asymptomatic. Sometimes, a patient may complain of
headaches, nosebleeds, and shortness of breath. A history of cardiac and neurological
symptoms should be considered. All patients with hypertension should have an ECG,
fasting glucose, lipid profile, blood urea nitrogen, creatinine, and urinalysis for blood
and protein. If secondary hypertension is suspected, further investigation should focus
on the possible underlying cause.
Patients with malignant hypertension or with persistent hypertension should
receive drug treatment following the lifestyle modifications. In patients with diabetes,
chronic kidney disease, and cardiovascular disease, antihypertensive therapy is also
indicated when the systolic pressure is persistently above 130 and/or diastolic pressure
is above 80.
Lifestyle changes include minimization of dietary salt intake, limited alcohol
consumption, regular aerobic exercise, maintenance of a healthy body mass index,
reduction of dietary fat content, and cessation of smoking. These measures should be
51
implemented in all hypertensive individuals, regardless of whether or not drug therapy
is chosen.
The drug therapy includes diuretics, beta-blockers, angiotensin-converting
enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and calcium-channel
blockers (CCB).
GRAMMAR
PRESENT PERFECT OR PRESENT PERFECT CONTINUOUS?
Present Perfect Continuous
Form
have/has + been + ing
I have been studying for 2 years.
We have been taking this drug for 3 days.
He (she, it) has not been working here Have you been staying in the hospital for a
long.
week? Yes, I have. / No, I haven’t.
How long have they been examining the
patient?
The Present Perfect means activity is completed. The present result we talk about
is the reason we’ve been doing that activity. The Present Perfect Continuous expresses
an activity over a period of time, which may or may not be completed and the result is
not the purpose of that activity. However, some other result is connected with doing it.
Present Perfect
The patient has received the treatment.
He is healthy now.
(The result is effective treatment and a
healthy patient.)
Present Perfect Continuous
The patient has been receiving the
treatment. That’s why he has some sideeffects.
(The result is side-effects.)
The Present Perfect expresses the result with the final number or quantity. The
Present Perfect Continuous isn’t possible.
Present Perfect
Present Perfect Continuous
The patient has received two therapeutic The patient has been receiving the
procedures.
therapeutic procedures all day.
Notice some verbs that have the idea of a long time and, therefore, they are used
in the Present Perfect Continuous and some verbs that don’t have the idea of a long
time, therefore, they are mostly found in the Present Perfect.
52
Present Perfect
find
lose
start
stop
break
die
buy
1
Present Perfect Continuous
wait
work
play
try
learn
rain, etc.
Use the correct verb form (Present Perfect or Present Perfect Continuous) in
the sentences.
1. How many pills have you taken/been taking today?
2. How many patients has he examined/been examining? There are only five left.
3. The doctor has investigated/been investigating this case for three months – it’s
nearly completed.
4. How long has he smoked/been smoking?
5. How many cigarettes has he smoked/been smoking today?
6. The scientist has written/been writing an article. It was published last year.
7. The surgeon is so tired. He has operated/been operating all morning.
8. What rehabilitation package have they bought/been buying?
9. Who has the patient waited/been waiting for?
10. We have learned/been learning medicine for 5 years.
2
Put the verbs in brackets into the correct tense form (Present Perfect or Present
Perfect Continuous).
1. The patient … (suffer) from a genetically determined disease for three years.
2. The doctor … (establish) a final diagnosis based on the lab findings.
3. The student … just (understand) almost everything about this surgical
procedure.
4. He … (take) antibiotics for five days. He … (finish) the course yet.
5. She … (have) a very bad cold recently.
6. The patient … (complain) of a chest pain since he injured his chest.
7. The doctor … (asked) her about allergies to some medications yet.
8. She … (lead) a sedentary lifestyle since her retirement.
9. The doctor … (be aware) of his patient’s stressful life.
10. The patient … (sign) his consent already.
53
UNIT 2
CARDIOVASCULAR SYSTEM
2.3 MYOCARDIAL INFARCTION
LEAD IN
1
2
Learn the following words.
acute
myocardial
infarction
[əˈkju:t]
irreversible
ischemia
account (for)
obesity
scar
diaphoresis
[ˌɪrɪˈvɜ:səbl]
light-headedness
choking
tachycardia
pulse
tachypnea
distended
regurgitation
supplementation
[ˌlaɪt ˈhedɪdnəs]
nitroglycerin
prone (to)
[ˌnaɪtrəʊˈɡlɪsərɪn]
[ˌmaɪəʊˈkɑ:dɪəl
ɪnˈfɑ:kʃən]
[ɪˈski:mɪə]
[əˈkaʊnt]
[əʊˈbi:sətɪ]
[skɑ:(r)]
[ˌdaɪəfəˈri:sɪs]
[ˈtʃəʊkɪŋ]
[ˌtækɪˈkɑ:dɪə]
[pʌls]
[ˌtækɪpˈnɪə]
[dɪˈstendɪd]
[rɪˌɡɜ:dʒɪˈteɪʃn]
[ˌsʌplɪmenˈteɪʃn]
[prəʊn]
гострий
інфаркт міокарду
безповоротний (про процес)
ішемія
частка становить
ожиріння
рубець
діафорез (профузне
потовиділення)
запаморочення
задуха
тахікардія
пульс
пришвидшення дихання
розширений
відрижка
додаткове вживання
мікроелементів
нітрогліцерин
схильний до
Give the English equivalents of the Ukrainian word-combinations by matching
the adjectives in A to the nouns in B. Make sentences using English wordcombinations.
A
незворотне
пошкодження
1. irreversible
B
a. ischemia
54
розрив
атеросклеротичної
бляшки
викликана кокаїном
ішемія
рубцеві зміни в
міокарді
відчуття задухи
розширена вена
недостатність
мітрального клапана
уповільнена реперфузія
3
2. atherosclerotic
b. myocardium
3. cocaine-induced
c. vein
4. scarred
d. regurgitation
5. choking
6. distended
7. mitral
e. damage
f. reperfusion
g. rupture
8. delayed
h. sensation
Get familiar with some of the facts about myocardial infarction and search for
more information to present to the group.
1. Most heart attacks occur on Monday mornings because stress hormones (such as
cortisol) are increased, blood platelets are stickier, and a person is partially
dehydrated.
2. Women have nausea, indigestion, and shoulder aches as heart attack symptoms
compared to the classic chest pain that men may experience. 25% of all heart
attacks are silent.
3. Negative emotions are risk factors for heart attack. Laughter relaxes and expands
blood vessels, increasing blood flow by 20%.
4. CT scans of Egyptian mummies show that many had heart attacks.
5. A daily dose of aspirin may help prevent a second heart attack.
6. People who live alone are twice as likely to have a heart attack compared to those
who live with a partner or roommates.
7. Coronary heart disease alone costs the world many billions of dollars, including
the cost of health care services, medications, and lost productivity.
8. Drinking a diet soda a day increases the chance of suffering from a heart attack.
4
Read the text.
MYOCARDIAL INFARCTION
Acute myocardial infarction (MI) is one of the leading causes of death in the
world. The prevalence of the disease approaches three million people worldwide.
MI results in irreversible damage to the heart muscle due to a lack of oxygen. The
goal of the treatment is to reperfuse the heart and restore blood flow. The earlier the
treatment (less than 6 hours from symptom onset), the better the prognosis.
55
Acute myocardial infarction develops due to decreased coronary blood flow. The
available oxygen supply cannot meet the oxygen demand, resulting in cardiac ischemia.
Decreased coronary blood flow is multifactorial. Atherosclerotic rupture induces an
inflammatory cascade of monocytes and macrophages, thrombus formation, and platelet
aggregation. This results in decreased oxygen delivery through the coronary artery,
leading to decreased oxygenation of the myocardium. Other etiologies of decreased
oxygenation/myocardial ischemia include coronary artery embolism, cocaine-induced
ischemia, coronary dissection, and coronary vasospasm.
Modifiable risk factors account for 90% (men) and 94% (females) of myocardial
infarctions. Modifiable risk factors include cigarette smoking, exercise, hypertension,
obesity, cholesterol, LDL, and triglyceride levels. Age, gender, and family history are
non-modifiable risk factors for atherosclerosis. Other causes of MI are associated with
trauma, vasculitis, drug use (cocaine), coronary artery anomalies, coronary artery
emboli, aortic dissection, excess demand on the heart (hyperthyroidism, anemia).
MI is diagnosed when at least two of the following criteria are met: symptoms of
ischemia, new ST-segment changes or a left bundle branch block (LBBB), presence of
pathological Q waves on the ECG, imaging study showing new regional wall motion
abnormality, presence of an intracoronary thrombus at autopsy or angiography.
The histology of myocardial infarction changes over the course of the disease. At
time 0, there are no microscopic histologic changes. However, after 2 months, the
myocardium is scarred.
Cardiac biomarkers are useful in the diagnosis of acute myocardial infarction.
Troponin is the most specific lab test and has two isoforms, I and T. Troponins peak at
12 hours and persist for seven days.
The history of MI should focus on the onset and associated symptoms.
Diaphoresis and bilateral arm radiating chest pain are most often associated with
myocardial infarction. Light-headedness, anxiety, cough, and choking sensation are all
symptoms.
During the physical exam, vital signs and the patient’s appearance are evaluated,
including lung findings and cardiac auscultation. Heart rate may reveal tachycardia,
atrial fibrillation, or ventricular arrhythmia, irregular pulses if the patient has an aortic
dissection, blood pressure is usually high, but hypotension if the patient is in shock,
tachypnea and fever are not uncommon. Neck veins may be distended, indicating right
ventricular failure. Wheezing and rales are common if the patient has developed
pulmonary edema. Extremities may show edema or cyanosis and are cold.
Early and rapid ECG testing should be used in all patients presenting with chest
pain. It should be noted that women often have atypical symptoms such as abdominal
pain or dizziness and may present without any chest pain. Elderly patients more often
have shortness of breath.
Cardiac angiography is used to perform percutaneous coronary intervention (PCI)
or determine obstructions in the coronary vessels.
An echocardiogram is used to assess wall motion, degree of valve abnormality,
ischemic mitral regurgitation (MR), and the presence of cardiac tamponade.
Patients with MI require aspirin. They should have oxygen supplementation if
oxygen saturation is less than 91%. If the blood pressure is adequate, opioids may be
56
used for pain control in addition to sublingual nitroglycerin. Patients may routinely be
given high-dose statins, beta-blockers, and/or ACE-inhibitors. In addition to antiplatelet
therapy, parenteral anticoagulation is recommended for all patients.
MI may lead to impairment in diastolic and systolic function and make the patient
prone to arrhythmias. In addition, MI can lead to a number of serious complications,
such as new-onset mitral regurgitation, ventricular septal rupture, left ventricular
aneurysm, and emboli.
Acute MI still carries a high mortality rate. The overall prognosis depends on the
extent of muscle damage. The factors that negatively affect prognosis include diabetes,
advanced age, prior MI, peripheral vascular disease (PVD), or stroke, delayed
reperfusion, presence of congestive heart failure (CHF), and depression.
LANGUAGE DEVELOPMENT
5
Match the following medical terms with their definitions.
1. reperfuse
heart
the
a. the process by which the platelets adhere to each other
at sites of vascular injury and is part of the events
leading to the formation of a thrombus or hemostatic
plug
2. cardiac
ischemia
b. substances that are released into the blood and help
evaluate heart function
3. platelet
aggregation
c. the initial phase of ventricular depolarization
4. ST-segment
change
d. mitral insufficiency or mitral incompetence leading to
backflow of blood from the left ventricle to the left
atrium
5. Q waves
e. restore blood flow to the heart muscle
6. cardiac
biomarkers
f. indicated for the
thromboembolism
7. parenteral
anticoagulation
g. decreased blood flow and oxygen supply to the heart
muscle
8. mitral
regurgitation
h. the interval between ventricular depolarization and
repolarization that can be abnormally elevated or
depressed in the presence of myocardial ischemia or
infarction
57
prevention
and
treatment
of
6
Complete the sentences with the correct form of the words in bold.
Myocardial ischaemia is caused by a _______ between
oxygen demand and _______ blood flow supply, which
results in reversible myocardial ______ and, when
prolonged, in ________ injury. The main causes of
myocardial ischaemia include (1) _____ flow-limiting
stenoses which are _______ with chronic stable angina;
(2) coronary thrombus _____ on an atherosclerotic
plaque (3) coronary artery spasm which is ______ for
vasospastic angina; and (4) coronary ____________
_______ which is responsible for microvascular
angina.
7
MATCH
MYOCARDIUM
SUFFER
REVERSE
ATHEROSCLEROSIS
ASSOCIATE
IMPOSED
RESPONSE
MICROVESSEL
FUNCTION
Match the medical terms referring to the most common symptoms of
myocardial infarction with the plain English phrases in the box. Which group
of words or phrases is recommended for effective doctor-patient
communication?
irregular heart beat
choking sensation
swelling
whooshing or swishing heart sound
chest pain
heart beats varying in force
light-headedness
bluish colour of the skin and mucous membranes
fast resting heart rate
erratic twitching of the heart muscle
rapid breathing
sweating
1. diaphoresis _____________
2. angina _____________
3. presyncope _______________
4. globus sensation_______________
5. tachycardia _____________
6. atrial fibrillation ________________
7. arrhythmia _____________
8. unequal pulses _______________
9. tachypnoea ______________
10. edema __________
11. cyanosis ____________
12. murmur ____________
58
8
Complete the patient’s case history using the words and phrases in the box.
oxygen saturation
cardiovascular risk factors
radiating
diaphoresis
blood pressure
on examination
sublingually
crushing
chest pain
heart murmurs
regular
heart rate
A 57 year-old male lorry driver, presented to his local emergency department
with a 20-minute episode of _________ and chest pain. The _______was central,
________ to the left arm and _________in nature. The pain settled promptly following
300 mg aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray administered
_________by paramedics. He smoked 20 cigarettes daily (38 pack years) but was not
aware of any other _________. ________he appeared comfortable and was able to
complete sentences fully. There were no __________ present on cardiac auscultation.
________ was 180/105 mmHg, ________ was 83 bpm and ________, _________ was
97%.
9
Ask questions to obtain the following information.
1. A _________________________?
B The prevalence of the disease approaches three million people worldwide.
2. A _________________________?
B The earlier the treatment, the better the prognosis.
3. A __________________________?
B The histology of myocardial infarction changes over the course of the
disease.
4. A __________________________?
B Troponins peak at 12 hours and persist for seven days.
5. A __________________________?
B After 2 months, the myocardium is scarred.
6. A __________________________?
B Elderly patients more often have shortness of breath.
7. A __________________________?
B Patients with MI require aspirin.
8. A __________________________?
B Troponin is the most specific lab test and has two isoforms, I and T.
59
10 Complete the sentences. More than one variant is possible.
1. Acute myocardial infarction (MI) is …
2. Acute myocardial infarction develops due to …
3. Atherosclerotic rupture induces …
4. Modifiable risk factors include …
5. MI is diagnosed when …
6. Heart rate may reveal …
7. Cardiac angiography is used …
8. The factors that negatively affect prognosis for patients with MI include…
11 Correct the statements. Dwell on each point.
1. MI results in reversible damage to the heart muscle due to excess oxygen.
2. Modifiable risk factors rarely cause acute MI.
3. The histology of myocardial infarction does not change over the course of the
disease.
4. Time does not play an important role in the treatment of MI.
5. Cardiac biomarkers are not considered in the diagnosis of acute myocardial
infarction.
6. No instrumental studies are prescribed as they are not useful for the diagnosis
of acute MI.
7. MI does not result in severe complications.
8. The overall prognosis depends on age.
12 Answer the following questions.
1. What is the etiology of acute MI?
2. What risk factors contribute to the development of acute MI?
3. What diagnostic criteria are considered for the MI diagnosis?
4. What histologic changes are observed in MI?
5. What cardiac biomarker is the most reliable in the diagnosis of MI?
6. What symptoms and signs of MI can be revealed during a physical and
instrumental examination?
7. What groups of medications are administered for the effective management of
MI?
8. What complications may result from acute MI? What does the overall
prognosis depend on?
60
TALKING POINTS
1
In the group, discuss why it is important for the patients to be able to accurately
describe their pain. From the list below, choose the adjectives that can
characterize chest pain experienced by patients with acute MI.












2
burning
cramping
crushing
blinding
gripping
pounding
shooting
stabbing
tingling
throbbing
oppressive
squeezing
Choose one of the two conditions in the table below. Work with a partner. Take
the roles of a patient and a doctor. The patient is 63 years old. He/she is
suffering from pain in the left arm but doesn’t know what is causing it. The
doctor is interviewing the patient.
Feature
Location
Angina pectoris
retrosternal, throat, left
arm
typically to the throat or
Quality
left arm
Quantity/severity tight, gripping, a dull
ache
short, usually only a few
Timing
minutes
Aggravating
Alleviating
Associated
manifestations
Myocardial infarction
retrosternal, throat, left arm
typically to the throat or left arm
tight, gripping, a dull ache – but
more severe than as for angina
usually longer than 30 minutes
and terminated only by use of
opiate analgesia
exertion, stress, cold, usually none, but may have
emotion
similar precipitants to angina
rest,
nitro-glycerine often none except opiates
tablets
usually none
sweating, light-headedness,
palpitations, nausea, vomiting,
sense of imminent death
61
3
Choose the photo you are going to talk about. Use specific words or expressions
pertaining to the topic.
MORE READING
1
Read the text. Answer the questions.
1. What does heart failure result from?
2. How can acute heart failure be defined?
3. What risk factors can contribute to the development of acute heart failure?
4. Why can acute heart failure lead to sudden death?
5. What is the origin of symptoms of acute heart failure?
6. What signs and symptoms are observed in acute heart failure?
7. How is acute heart failure managed?
62
ACUTE HEART FAILURE
Heart failure (HF) is a progressive condition. HF can be defined as a clinical
syndrome that results from any structural or functional abnormality of the heart that
impairs the ability of the left ventricle to fill with or to eject blood. Coronary artery
disease and an aging population are the leading causes of HF. There are 23 million
people worldwide who have HF. The lifetime risk of developing HF increases with age,
with the mean age of the heart failure population being in their mid-70s. Other risk
factors include cigarette smoking, hypertension, physical inactivity, male sex, being
overweight, diabetes, and valvular heart disease.
Acute HF is described as acute-onset dyspnea and pulmonary edema, but it can
also be applied to cardiogenic shock where the patient is hypotensive and oliguric.
Acute deterioration may result from myocardial infarction, arrhythmia, or acute valve
dysfunction.
The major causes and precipitants of acute HF include inappropriate reduction in
therapy, cardiac arrhythmias, myocardial ischemia or infarction, infection, anemia,
concomitant drug therapy, alcohol, and pulmonary embolism.
It is characterized by dyspnea and fatigue on exertion (and occasionally at rest),
and evidence of fluid retention that may lead to peripheral edema or pulmonary
congestion.
Patients with acute HF can die suddenly as a result of ventricular
tachyarrhythmias or of worsening heart failure symptoms and fluid overload.
The origin of symptoms in acute HF is poorly understood. An initial event, such as
infarction, inflammation, or pressure/volume overload, causes myocardial damage,
resulting in an increase in myocardial wall stress. This is followed by the activation of
multiple neuroendocrine systems, including the renin-angiotensin-aldosterone system, the
sympathetic nervous system, and the release of cytokines such as tumour necrosis factor.
The diagnosis of acute HF is based on the history, physical exam, chest X-ray,
and other diagnostic tests (i.e., thransthoracic echocardiogram).
Common signs and symptoms of acute HF are dyspnea (exertion or at rest),
fatigue, nocturnal dyspnea, orthopnea, palpitations, hepatomegaly, peripheral edema,
chest pain, cachexia, sleep apnea.
Education of the patient and relatives is an important aspect of the management of
patients with acute HF. It is important to explain the role of treatment, self-weighing, and
exercise. Mild to moderate aerobic exercise can increase functional capacity in patients.
General recommendations include restriction of dietary salt and water intake,
smoking cessation, reducing alcohol intake, addressing obesity with a weight-reduction
program, and vaccinations.
The drug therapy includes diuretics, ACE inhibitors, beta-blockers, angiotensin II
receptor antagonists, aldosterone receptor antagonists, digoxin, vasodilators, antiplatelet
agents, and anticoagulants.
The device therapy consists of implantable cardiac defibrillators and cardiac
resynchronization.
Surgery can be indicated for HF and may include valve surgery, coronary artery
bypass grafting, or transplantation.
63
GRAMMAR
WAYS OF EXPRESSING FUTURE
will/going to/Present Continuous
Facts and predictions
Will expresses a future fact or prediction.
We will be away for two weeks.
The patient will not recover. He is not taking the medicines.
You will put on weight if you eat sweets.
Will for a prediction can be based more on an opinion than a fact.
I don’t think he will pass his exam. He doesn’t work.
Going to expresses a prediction, especially when there is evidence that something
is certain to happen. Often, there is no difference between will and going to.
She is going to have pneumonia. She is not serious about her treatment.
Plans, decisions, intentions, and arrangements
Will expresses a decision, intention, or offer made at the moment of speaking.
I’ll call my doctor.
Somebody is knocking on the door. I’ll open it.
Going to expresses a future plan, decision, or intention made before the moment
of speaking.
When I grow up, I am going to be a doctor.
We are going to visit our doctor. We’ve called him.
The Present Continuous expresses future arrangements. Sometimes there is no
difference between an arrangement and an intention.
He is meeting his patient in the morning.
The patient is having an operation tomorrow.
We are going to leave this clinic in a month.
We are leaving this clinic in a month.
64
1
Complete the sentences using will or be going to.
1. He thinks his son … be a great doctor one day.
2. They … prepare for their exam. It is scheduled for June.
3. He … order X-ray for his patient. There are many indications for it.
4. More people … recover from cancer in the future.
5. This test … probably be the last one necessary for making a diagnosis.
6. This patient … recover quickly. The results of the lab tests have improved.
7. The doctor believes he … help this seriously ill patient.
8. Look out! You … hurt your knee.
9. - I’ve got high blood pressure.
- I … call your doctor.
10. He … finish his working day at 7 p.m.
2
Complete the sentences using will or Present Continuous.
1. He is wearing a white coat because he … (see) his patient at 3 p.m.
2. A I’ve got a headache.
B I … (get) you some analgesic.
3. A Let your doctor know when you have an allergy.
B I … (give) him a ring immediately.
4. She … (exercise) this evening so she can’t go to eat out.
5. We … (have) a consultation on Friday.
6. She … (fly) to Prague to take part in the conference next week.
7. He … (run) a marathon in May in spite of the recent heart surgery.
8. A Your exam is in a month.
B I … (start) revising for it.
9. The nurse is sterilizing the instruments. The surgeon … (begin) the operation
in three hours.
10. He … (have) an appointment with a doctor on Monday
65
UNIT 3
DIGESTIVE SYSTEM
3.1 ANATOMY AND FUNCTIONS
LEAD IN
1
Learn the following words.
ingestion
consumption
propulsion
grind
moisten
consistency
enzyme
chyme
|ɪnˈdʒɛstʃ(ə)n|
|kənˈsʌm(p)ʃ(ə)n|
|prəˈpʌlʃ(ə)n|
|ɡrʌɪnd|
|ˈmɔɪs(ə)n|
|kənˈsɪst(ə)nsi|
|ˈɛnzʌɪm|
|kʌɪm|
66
прийом їжі
споживання
поштовх, просування
розтирати
зволожувати
консистенція
фермент, ензим
хімус
jejunum
ileum
eliminate
cecum
empty
alkaline
satiety
2
|dʒɪˈdʒuːnəm|
|ˈɪlɪəm|
|ɪˈlɪmɪneɪt|
|ˈsiːkəm|
|ˈɛm(p)ti|
|ˈalkəlʌɪn|
|səˈtʌɪɪti|
тонка кишка
клубова кишка
виводити
сліпа кишка
вивільняти
луг
ситість
Some facts about digestive system.
1. Our stomach does not play the biggest role in our digestion, the small intestine
does the most work.
2. The average person produces 1-2 liters of saliva per day.
3. The muscles of our esophagus work like a giant wave.
4. Our body can move food across the digestive system even while we are
standing on our heads it is not related to gravity because it works with the help
of muscles.
5. Aerobic exercises are the best to keep our digestive system healthy.
6. The stomach must protect itself from itself! It uses the hydrochloric acid to
digest the food and produces special mucous to protect itself from the acid
action.
7. Food takes approximately 7 seconds to move down the esophagus.
8. Our intestine and brain have special connection and our emotions and feelings
like anger or sadness influence the way we digest food.
9. The human intestine is home to a complex ecosystem of approximately 300500 bacteria.
10. The digestive system is prone to cancer than any other system in our body.
3
Components of the digestive system.
teeth descending colon oral cavity sigmoid colon mandible liver
salivary glands bile pharynx stomach duodenum jejunum
cecum ascending colon ileum transverse colon pancreas
gall bladder saliva tongue hard and soft palate anus gastric juice
Alimentary Canal
Accessory Organs
67
Digestive Juices
4
Read the text.
DIGESTIVE SYSTEM
The main function of the digestive system is to turn food we eat into nutrients,
which give our body energy, growth and cell repair ability. It is composed of 2 essential
parts: the alimentary canal and the accessory organs. All the organs of digestive system
are involved into the following seven processes:
1. Ingestion is the process of food consumption.
2. Propulsion is the process of food movement across the system.
3. Secretion of digestive enzymes.
4. Mechanical digestion is the process of food grinding into the small pieces.
5. Chemical digestion is the process of food breaking down into molecules.
6. Absorption of minerals and nutrients.
7. Defecation is the process of wastes elimination.
The alimentary canal is composed of mouth, throat, esophagus, stomach, small
and large intestines. Our mouth is the beginning of the digestive tract; digestion starts
here as soon as we consume a meal. Chewing grinds the food into smaller pieces, which
are moistened with saliva to begin the process of food breaking down. The throat
(pharynx) is the next destination for the food, from here, food gets into the esophagus.
The esophagus is a muscular tube expanding from the pharynx to the stomach. By
means of peristalsis, the esophagus brings food to the stomach. The stomach is a saclike organ with two sphincters, cardiac and pyloric. The stomach secretes acid and
enzymes that contribute to the process of breaking down the food. When food leaves the
stomach, it is the consistency of a liquid or paste, which is called chyme. Small intestine
is composed of three parts: duodenum, jejunum and ileum. It continues the process of
breaking down the food by means of enzymes released by the pancreas and bile from
the liver. Bile participates in the digestion of fats and eliminates waste substances from
the blood. The duodenum is mainly responsible for food processing, while the jejunum
and ileum are mainly responsible for the absorption of nutrients and minerals into the
bloodstream.
Three organs play an essential role in helping the stomach and small intestine in
the process of food digestion, pancreas, liver and gallbladder. Pancreas produces a
number of enzymes, among them trypsinogen, chymotrypsinogen, carboxypeptidase,
several elastases, pancreatic lipase, phospholipase, pancreatic amylase etc., which break
down proteins, fats, and carbohydrates. The liver has numerous functions, but the two
main functions are to produce and secrete bile, and to clean the blood that comes from
the small intestine enriched with the just absorbed nutrients. The gallbladder is a pearshaped organ that is located just under the liver and stores bile. The colon (large
intestine) is a long muscular tube that is divided into the cecum, the ascending colon,
the transverse colon, the descending colon, and the sigmoid colon. The feces composed
of food particles and bacteria accumulate in the sigmoid colon. The bacteria located in
our gut perform several functions, among them synthesizing various vitamins,
processing waste substances, and protecting against bad bacteria. The rectum connects
68
the colon to the anus, which is the last destination of the digestive tract. It is composed
of the pelvic floor muscles and the two sphincters (internal and external) that eliminate
the digested material from our body.
The work of our digestive system is regulated not only with the help of enzymes,
but also with the hormonal responses. When we see, smell or think of food the first
hormonal reaction is salivation. The endocrine system controls the reactions of the
glands and the release of hormones when it is necessary. One of the most important
factors under hormonal control is the acid production.
All the hormonal responses can be grouped into phases. During the gastric phase,
the hormone gastrin is released by the special cells in the stomach in response to the
presence of proteins. Gastrin stimulates the secretion of stomach acid, which helps in
the digestion process of the proteins. When the stomach is emptied, the acid is not
necessary and a hormone called somatostatin stops the production of hydrochloric acid.
In duodenum secretions from liver, pancreas, and gallbladder play an essential
role in the chyme digestion, which occurs during the intestinal phase. In order to
counteract the acidic chyme, a hormone called secretin stimulates the pancreas to
secrete alkaline bicarbonate solution and send it to the duodenum. Secretin acts together
with another hormone called cholecystokinin (CCK), which increases bile flow,
pancreatic activity and blocks acid production.
A hormone called gastric inhibitory peptide is produced by the small intestine to
decrease the peristaltic movements of the intestine to give more time for fatty food
processing and absorption.
The brain together with the endocrine system control all our digestive processes.
The brain regulates the feelings of hunger and satiety and the endocrine system in its
turn controls the secretion of hormones and enzymes necessary for the digestion.
LANGUAGE DEVELOPMENT
5
Match the English word combinations with Ukrainian equivalent.
1. chemical digestion
2. repair ability
3. mineral absorption
4. hormonal response
5. bile storage
6. alimentary canal
7. pear-shaped organ
8. defecation
a. спроможність до самовідновлення
b. процес виділення калових мас
c. травний канал
d. орган, що має грушоподібну форму
e. гормональна реакція організму
f. сукупність хімічних та біологічних
процесів, що забезпечують розщеплення
їжі на поживні речовини
g. накопичення або зберігання жовчі
h. всмоктування мінералів
69
6
Fill in the gaps with the words from the table.
start out
multiple
energy
secrete
accessory
undergo
series
breakdown
1. The gastrointestinal tract is a ________of hollow organs which are joined in a
long and twisting tube from the mouth to the anus.
2. The human digestive system is composed of the gastrointestinal tract and
________ organs.
3. Digestion includes the ___________of food into smaller components until they
can be absorbed.
4. Cells in the stomach lining ___________ a strong acid and enzymes which are
responsible for the breakdown process.
5. Contents of the small intestine ________semi-solid, and end in a liquid form
after moving through the organ.
6. Liver has ________ functions, but its main function within our digestive system
is to precede the nutrients absorbed from small intestine.
7. The ___________necessary for the processes and activities that occur in our
body is obtained from the food we eat.
8. Food that gets into our body _________ three types of processes: digestion,
absorption and elimination.
7
Match the terms with their definitions.
1. elimination
2. absorption
3. digestion
4. peristalsis
5. enzyme
6. mastication
7. metabolism
8. molecule
a. the symmetrical contraction and relaxation of the
muscles that primarily in the digestive tract.
b. the process in which the food is broken down
both mechanically and chemically and can be
absorbed to maintain the vital functions of the
human organism.
c. the process of removing something from the
organism.
d. a group of atoms that form the smallest
identifiable unit.
e. up-and-down or side-to-side movements of the
mandible necessary for food grinding
f. the chemical or mechanical process of taking
something into another substance.
g. the substance which acts as a catalyst in the
organism and regulates different chemical
reactions.
h. number of chemical reactions which take place in
the cells for the vital processes.
70
8
Complete the sentences using appropriate prepositions.
1. The digestive system is constructed to perform the specialized function …..
turning food ….. the energy.
2. Our mouth is the beginning ….. the alimentary canal and digestion starts there
when taking the first bite ….. food.
3. Small intestine consists ….. three parts: the duodenum, jejunum, and ileum.
4. Our pancreas releases digestive enzymes ….. the duodenum, the first part ….. the
small intestine.
5. Waste left ….. ….. the digestive process, is passed ….. the colon by means …..
peristalsis.
6. Our esophagus is a muscular tube that contracts ….. a synchronized way to move
food ….. the stomach.
7. Our digestive may suffer ….. numerous inflammatory processes and functional
disorders.
8. Digestion maintains all vitally important functions …. in human organism.
9
Answer the following questions.
1. What is the main function of digestive system?
2. Explain the difference between mechanical and chemical digestion.
3. Enumerate and explain seven processes in which our digestive system is
involved.
4. What are the principal parts of alimentary canal?
5. What accessory organs do you know?
6. What are the functions of alimentary canal organs?
7. What are the functions of accessory organs?
8. How is the work of digestive system regulated?
9. What enzymes does the pancreas produce?
10. What hormones necessary for digestion do you know?
11. What are the functions of the digestive hormones?
TALKING POINTS
1
Express your point of view concerning:
 importance of digestive system
 major components of digestive system
 major functions of the digestive system
 the process of digestion
 digestive hormones and enzymes
71
MORE READING
1
Read the text and be ready to answer the following questions.
1. What may trigger the gastrointestinal diseases?
2. What is gastroesophageal reflux disease (GERD)?
3. What are the most common reasons of gastroduodenal ulcers?
4. Why is irritable bowel syndrome (IBS) considered to be the disease of modern
society?
5. What is pancreatitis?
COMMON GASTROINTESTINAL DISEASES
There are many diseases of digestive system and they can be triggered by multiple
causes, but nowadays the most common are driven by modern lifestyle, including
irregular and imbalanced nutrition, chronic stress, unhealthy dietary habits and others.
Gastroesophageal reflux disease (GERD) appears when some acidic stomach
content rises into the esophagus and the esophageal wall is not supposed to withstand
this acidity, reflux provokes inflammation of the esophagus, causing burning and
irritation, which may lead to lesions and ulcers in future. This condition is provoked by
the dysfunction of the lower esophageal sphincter. Except burning sensation patient
may experience regurgitations, acidic or bitter taste, hoarse voice, especially after night,
chronic sore throat, asthma, chronic cough, hiccups, bad breath and loss of tooth
enamel. Treatment of GERD is focused on the severity of symptoms; it can range from
diet modifications and antacids to proton pump inhibitors and even surgery.
Gastroduodenal ulcers can be caused by H. pylori, nonsteroidal or NSAID antiinflammatory drugs, hyperacidity, smoking, excess alcohol consumption, chronic stress
and hereditary predisposition. Symptoms may include intermittent burning sensation in
the upper part of the abdomen. In case of stomach ulcers, the pain is worsened by
drinking or eating, in case of duodenal ulcers, the pain lessens while eating, but enlarges
within several hours after eating and on fasting stomach. The ulcer is a life-threatening
condition and it may cause internal bleeding. Treatment with antibiotics is necessary in
case of bacterial infection caused by H. pylori, which is the most common cause of
gastroduodenal ulcers. Those not provoked by H. pylori are treated the same way as
GERD.
Irritable bowel syndrome (IBS) is a condition characterized by frequent bowel
movements; it can be caused by certain food types, medications, and stress. Symptoms
of IBS may include abdominal cramps, flatulence, bloating, urgent stools, alternating
constipation and diarrhea. The treatment of condition predisposes avoiding caffeine,
increasing fiber in the diet, minimizing stress and dairy products.
Pancreatitis is inflammation in the pancreas. Pancreatitis can occur as acute
pancreatitis, which appears suddenly and lasts for several days, or chronic pancreatitis
72
lasting for many years. Mild cases of the disease can be relieved without treatment, but
severe cases can lead to life-threatening complications. The clinical pattern of acute
pancreatitis is described by upper abdominal pain that radiates to the back and worsens
after eating, fever, nausea and vomiting, rapid pulse. Chronic pancreatitis symptoms are
upper abdominal pain, unintentional weight loss and steatorrhea. Pancreatitis develops
when digestive enzymes become activated when they are still in pancreas, irritating the
cells of the pancreas and triggering its inflammation, with chronic bouts of pancreatitis
scar tissue may form leading to the loss of function, digestion problems and diabetes.
The list of gastrointestinal diseases is very extending and requires mainly the
change of the lifestyle and dietary habits, because improper work of digestive system
destabilizes the work of the whole body.
73
UNIT 3
DIGESTIVE SYSTEM
3.2 GASTRITIS
LEAD IN
1
Learn the following words.
multifaceted
intake
deficiency
acidity
experience
bloating
belching
starving
tarry
pallor
hiccups
extensive
embrace
predisposition
promote
decoction
scalded
flaxseed
2
|mʌltɪˈfasɪtɪd|
|ˈɪnteɪk|
|dɪˈfɪʃ(ə)nsi|
|əˈsɪdɪti|
|ɪkˈspɪərɪəns|
[ˈbləʊtɪŋ]
|ˈbeltʃɪŋ|
|ˈstɑːvɪŋ|
|ˈtɑːri|
|ˈpalə|
|ˈhɪkʌps|
|ɪkˈstɛnsɪv|
|ɪmˈbreɪs|
|priːdɪspəˈzɪʃn|
|prəˈməʊt|
|dɪˈkɒkʃ(ə)n|
|ˈskɔːldɪd|
|ˈflakssiːd|
багатопричинний
споживання
дефіцит
кислотність
відчувати
здуття
відрижка
голодний
смолянистий
блідість
гикавка
чималий
охоплювати
схильність
прискорювати
відвар
заварений
насіння льону
Match the English word combinations with Ukrainian equivalent.
a. мінеральні добавки
b. запальний стан
c. прийом їжі
d. прискорити одужання
e. незбалансоване харчування
f. постійне використання
g. дефіцит вітамінів
h. харчові звички
1. dietary habits
2. mineral supplements
3. imbalanced nutrition
4. routine use
5. vitamin deficiency
6. promote recovery
7. meal intake
8. inflammatory condition
74
3
Some facts about gastritis.
1. Gastritis increases the risk of other gastrointestinal diseases, such as ulcers
and cancer.
2. The main two types of gastritis are erosive and nonerosive.
3. People with gastritis complain of sharp, stabbing, burning or starving pain in
the upper-center or upper-left part of their abdomen.
4. Smokers and individuals who take NSAIDs are at risk of gastritis.
5. People suffering from gastritis should follow special diet.
6. There are different causes and types of gastritis.
7. Chronic stress gradually influences the health of our digestive system.
8. Dietary changes may relieve the symptoms but do not cure the disease.
4 Read the text.
GASTRITIS
Gastritis is an acute or chronic inflammation of the stomach protective lining.
Whereas, the disease is multifaceted and the most common causes include bacterial
infection (H. pylori), smoking, excessive alcohol and caffeine intake, chronic stress,
routine use of NASIDs, steroids, iron and potassium supplements, autoimmune
disorders, vitamin B 12 deficiency, irregular and imbalanced nutrition, bile reflux and
food allergies.
Numerous causes contribute to development of different types of the disease. The
classification of gastritis types focuses on time, it can be acute and chronic, acid level
production, some types of gastritis can be with high acidity and others with low acidity,
presence of bacteria, e.g. caused by H. pylori and histological features, e.g. erosive and
nonerosive.
Diagnostic procedure of gastritis requires the review of personal complaints and
specialized tests, among them endoscopy. Endoscopy helps to evaluate the inner lining
condition, detects the erosion and other lesions. Blood test is aimed at defining the
general blood cell count that determines if a patient has anemia. Stool test indicates the
presence of blood in feces, which is typical for the patients suffering from advanced
gastritis.
The clinical pattern of the disease depends on the type of gastritis, but usually
patient experiences pain in epigastrium, a full feeling in the abdomen after a meal
intake, bloating, nausea, vomiting, starving pain, tarry stool, loss of appetite, abnormal
stool, belching, weight loss, coated tongue, bad breath, skin pallor, and even hiccups.
Heartburn or burning sensation is typical for patients suffering from excess acid
production due to poor digestion.
The treatment of gastritis is a complex issue, based on the underlying reasons
which determine related clinical protocol. According to the type of gastritis patient can
75
be prescribed antacids, proton pump inhibitors, H-2 blockers, cytoprotective agents.
Several antibiotics are necessary for the treatment of bacterial gastritis. Gastritis
provoked by the vitamin B 12 deficiency demands the injections to renew the vitamin
supply of the organism. But conservative treatment is not enough. Treatment implies
strict dietary regimen and change of the lifestyle. Nutrition contributes to the recovery
process greatly. Patient with gastritis should eat well-balanced food cooked in a special
dietary way, all meals should be either boiled or baked and mashed, it is necessary to
avoid hot and spicy food. Diet helps not to overload the suffering stomach and promotes
recovery. Taking the decoction of scalded flaxseed on starving stomach helps to protect
the inner walls of the digestive system from destructive acid action. Based on the latest
research data mainly all types of gastritis require the prescription of sedatives.
Most patients with gastritis improve fast if treatment has begun, but if it is left
untreated, the condition may promote to a number of complications: anemia, atrophic
gastritis, peptic ulcer and even cancer. The disease never goes alone, whereas the
stomach is the central organ of digestion its dysfunction destabilizes all the system
leading to other inflammatory conditions: GERD, duodenitis, pancreatitis, cholecystitis,
etc. Relying on the following aspects the success of the treatment depends on the
thorough medical diagnostics and proper medical prescription.
The risk group for having gastritis is very extensive; it embraces people with
genetic predisposition, alcohol abusers, people with chronic stress experience,
overeaters, patients taking numerous medicines, e.g. NSAIDs. People who belong to the
risk group must follow a number of routines, undergo regular medical check-ups,
control nutrition and dietary habits, avoid taking of NSAIDs and any other stomach
irritating medications with no reason or prescription.
LANGUAGE DEVELOPMENT
5
Fill in the gaps with the words from the table.
options
weakness untreated reflux
underlining
secrete
swelling
1.
_________in the stomach lining allows digestive juices to damage and
inflame it, leading to gastritis.
2. The treatment of gastritis depends on the ________reason of the disease.
3. Medications called proton pump inhibitors act by blocking cells that
________gastric acid.
4. Antacids neutralize the acid in your stomach and rapid ________of gastritis
pain.
5. If gastritis left _________it can cause stomach bleeding and ulcers.
6. Acute gastritis is a sudden inflammation or __________of the stomach
lining.
76
7. Both gastritis and duodenitis have the same reasons and
treatment____________.
8. If you experience chronic acid ____________you may be at a risk of
developing esophageal cancer.
6 Fill in the gaps with the right form of the word.
Proton pump inhibitors
Proton pump ________ decrease the
___________ of acid in the stomach
that helps in the __________ of ulcers
that appear in esophagus, stomach, or
duodenum. PPIs are also prescribed for
the __________and treatment for acidrelated conditions, _________GERD,
ulcers, and Zollinger-Ellison syndrome.
Usually proton pump inhibitors are
well________; they may increase the
risk of osteoporosis-related fractures of
the hip, wrist, or spinal cord. Long-term
use also reduces the _________of
vitamin B12 and also can be associated
with low levels of magnesium. Analysis
of patients taking these drugs for a long
period showed an ________risk of heart
attacks.
7
inhibit
produce
heal
prevent
include
tolerate
absorb
increase
Match the terms with their definitions.
1. H. pylori
a. great worry caused by a difficult
situation, or something that
causes this condition
b. the burning sensation in
epigastrium
c. nonsteroidal anti-inflammatory
drugs used as the painkillers
2. gastritis diet
3. probiotics
4. ulcer
d. black stool, usually the result of
hemorrhage in the upper part of
gastrointestinal tract.
77
e. live bacteria and yeasts good for
our gut and work of
gastrointestinal system.
f. special nutrition which should be
followed by the patient with
gastritis.
g. lesion or sore in the lining of the
stomach, small intestine or
esophagus.
h. bacteria with the helical shape
usually found in the stomach
lining where it establishes
inflammation.
5. NSAIDs
6. heartburn
7. melena
8. stress
8
Complete the sentences using appropriate prepositions.
1. Diet is an area where patient may feel motivated to make changes even before he
has been diagnosed …. gastritis.
2. When the stomach lining is inflamed, it cannot produce enough of the gastric
juices necessary …. digestion.
3. If patient is prone to stomach irritation, he may find avoiding caffeine and spicy
meals to be a clue ….. preventing symptoms.
4. Gastritis may occur suddenly or appear slowly ….. time.
5. It's not really known how H. pylori spread, but there is strong evidence that it
could be transmitted …. person to person through contaminated food and water.
6. Chronic gastritis has a range of consequences …. good to poor if serious
complication develops.
7. Treatment for gastritis is a complex issue and depends ….. successful treatment
of its underlying cause.
8. Consuming carbohydrate-heavy meals can put a strain …. digestive system and
aggravate gastritis.
9
Add the word or words.
1. Eat 5 to 6 small meals a day, as that can reduce the influence…
2. Some foods and beverages can easily aggravate the symptoms…
3. Treatment of gastritis depends on…
4. An individual can decrease the risk of developing gastritis by following…
5. The foods eaten are an important option of gastritis ….
6. Gastritis can afflict people of…
7. H. pylori are considered to be the most widespread cause of….
8. Some studies have proved that probiotics help to clear out ….
78
10
Agree or disagree with these statements.
1. Some cases of gastritis can be easily cured at home with simple medicines.
2. Not all medicines work for everyone, so a patient may need to try several
types before finding what helps best for his case.
3. By keeping a special food diary, patients can identify which meals trigger
their symptoms.
4. Some research data suggests that garlic and its extract can help decrease the
symptoms of the disease.
5. All cases of gastritis require antacids.
6. Diet is not an essential option in the treatment of gastritis.
7. Smoking damages stomach lining and increases the risk of developing
stomach cancer.
8. While the causes of gastritis vary among the individuals, the symptoms are
always similar.
11 Correct the statements.
1. There are only two types of gastritis, acute and chronic.
2. Patients with gastritis do not experience symptoms.
3. All types of gastritis require different treatment options.
4. Left untreated, gastritis heals on its own within some period of time.
5. To diagnose gastritis doctor needs only physical examination and X-ray.
6. An endoscope, a tube with a tiny camera, is inserted through your skin to
check the stomach lining.
7. Gastritis is a life-threatening condition which provokes numerous
complications.
8. Chronic stress doesn’t influence the health of individuals.
12 Answer the questions.
1. What is gastritis?
2. What are the main causes of the disease?
3. What types of gastritis do you know?
4. What diagnostic procedures are necessary to establish the disease?
5. What are the symptoms of gastritis?
6. What are the treatment options of gastritis?
7. What complications can be caused by gastritis?
8. How to prevent gastritis?
9. What is the role of gastritis diet in the process of recovery?
79
13 What questions would you ask to obtain the following information?








possible disease triggers
clinical pattern
types of gastritis
diagnostic procedures
treatment options
complications
vitamin deficiency
nutrition of the gastritis patient
TALKING POINTS
1
Read and discuss the following case histories. Establish the diagnosis.
1. A 43-year-old accountant had experienced intermittent episodes of abdominal
pain during the previous 10 years and treated himself with frequent antacids. He
was comfortable for several years until 3 months prior to his visit when he noted
the onset of recurrent episodes of more severe upper abdominal discomfort which
were usually relieved by eating and, more recently, awakened him from sleep.
The pain was not well-localized, lasted 15 to 30 minutes, and did not radiate to
the back or chest. He took no analgesic medications, was a social drinker and
smoked 1 package of cigarettes per day. There is no family history peptic ulcer.
Physical examination showed no abnormality of the chest or heart. The abdomen
was soft, liver and spleen were not enlarged and no tenderness could be elicited.
A rectal examination showed brown stool which was negative for occult blood.
2. A 45-year-old woman presents to the emergency room with the complaint of
severe upper abdominal pain beginning 3 hours after her evening meal. The pain
was first noted in the epigastrium but seems to be more severe now in the right
upper quadrant. She vomited once, has no back pain or diarrhea. Physical
examination shows normal blood pressure and temperature. Her chest and heart
are unremarkable. Her bowel sounds are reduced but present. Right upper
quadrant and epigastriс tenderness with mild muscle guarding are noted. There is
no liver or spleen enlargement. The digital rectal examination is normal
80
3. A 62- year-old woman has experienced frequent heartburn for many years but has
noted difficulty in solid food swallowing for the past 2 weeks. The heartburn
seems to be less frequent recently. There has been no significant weight loss and
she denies chest or abdominal pain. She takes occasional aspirin for
osteoarthritis. Physical examination shows no significant abnormality in the chest
or abdomen. The rectal examination reveals brown stool which is negative for
occult blood.
MORE READING
1
Read the text and be ready to answer the following questions.
1. What is the role of diet while gastritis treatment?
2. What shouldn’t gastritis patient eat?
3. What healthy products should gastritis patient eat?
4. What dietary supplements are recommended for gastritis patient?
5. What aggravates gastritis?
GASTRITIS DIET
Gastritis is the main title used for any condition that provokes inflammation of the
stomach lining. Research has shown that eating a certain food causes or prevents
gastritis development.
For most people, gastritis is minor and will disappear quickly after treatment, but
diet is essential for the digestive system and overall health. What an individual puts in
his stomach can make a difference in the health of the digestive system. For example,
some forms of gastritis are caused by drinking alcohol permanently. Avoiding some
irritating foods and beverages can help manage the disease progression. By keeping a
special food diary, patients can identify which foods trigger their gastritis symptoms and
soothe them.
Patient should avoid eating spicy, hot, acidic, or high-fat foods. The following are
the foods that usually worsen gastritis symptoms: whole milk and chocolate milk, CocaCola and other soda beverages, drinks with caffeine, peppermint, green and black tea,
citrus juices, alcohol, dairy products, highly-seasoned meats, tomato and its products,
ginger.
Patient suffering from gastritis should eat a variety of healthy products from all food
groups: fruits, vegetables, low-fat dairy foods, whole grains. Whole grains contain
whole-wheat bread, pasta, cereals, brown and wild rice. It is better to eat lean meats,
poultry (chicken and turkey), fish, beans, boiled eggs, and nuts. A healthy and wellbalanced meal is low in fats, salt, and sugar. Healthy fats require the intake of essential
oils, like olive oil.
81
Omega-3 and probiotics are also helpful. Omega-3 polyunsaturated fatty acids have
been proved as essential fatty acids imposing both optimal health promotion and
prevention of chronic inflammatory diseases, including gastritis. Probiotics can help
improve the digestion and promote regular bowel peristalsis. Probiotic supplements
implement good bacteria into the digestive tract that helps stop the spreading of H.
pylori.
Eating large portions, carbohydrate-heavy dishes can have influence on the digestive
system and aggravate the symptoms of gastritis. That’s why it is better to take small
meals regularly over the course of the day that can help ease the digestive process and
reduce the symptoms of the disease.
The progress of gastritis will stop once you begin treatment which depends on the
type, cause, and severity of the disease. Be sure to talk with your physician before
changing your diet or before stopping or starting new medicines, including the over-thecounter ones.
GRAMMAR
SIMPLE TENSES PASSIVE. CONTINUOUS TENSES PASSIVE
We use the Passive when:
 We want to make the object more important
Gastritis is treated with proton pump inhibitors.
 We do not know the active subject
A new method of treatment is being developed.
We form the Simple Tenses Passive according to the next formula:
to be + Participle II
Digestive system is composed of alimentary canal and accessory organs.
The disease was revealed by the diagnostics.
The operation will be performed next week.
We form the Continuous Tenses Passive according to the next formula:
to be + being + Participle II
A patient is being treated now.
The operation was being performed the whole morning yesterday.
Note! We do not have Future Continuous Passive.
Together with the Passive we use prepositions by or with.
Stomach cancer is treated by the oncologist.
Stomach cancer is treated with chemotherapy.
82
1
Make up your own sentences.
Enzymes
Small intestine
Temperature
Test results
Treatment
2
is
are
is being
was
was being
were being
will be
produced by the pancreas.
composed of several parts.
taken at the moment.
discussed yesterday.
taken tomorrow.
prescribed a week ago.
controlled the whole month.
Put the verbs in brackets into correct tense form of passive.
1. The small intestine ___________ (to compose) of 3 parts: duodenum, jejunum
and ileum.
2. The digestive enzymes ___________ (to release) by the pancreas at the moment.
3. The patient ____________ (to prepare) for colonoscopy the whole week.
4. The new diagnostic procedure ___________ (to perform) next week.
5. The symptomatic treatment ______________ (to prescribe) before all diagnostic
procedures.
6. Stomach cancer ______________ (to detect) by biopsy and the treatment options
__________ (to prescribe).
7. The temperature _________ (to take) now.
8. The patient ________ (to discharge) next week.
3
Transform from active into passive.
1. Gastritis can provoke abdominal bloating and pain.
2. The doctor performs various blood tests to detect the disease.
3. The stool test detects the presence of blood in patient’s feces.
4. Autoimmune gastritis attacks the cells of the inner stomach lining.
5. Liver produces 400 to 800 ml of bile daily.
6. Treatment for stomach cancer includes surgery, radiation therapy, and
chemotherapy.
7. Doctors typically do not do the routine screening for stomach cancer.
8. Oncologists usually single out 4 stages of cancer flow.
83
4
Make these sentences interrogative.
1. Gastritis can be accompanied by numerous complications including stomach
cancer.
2. Pain in epigastrium can be defined as the most common symptom of gastritis.
3. Gastritis or inflammation of the stomach is caused by different reasons.
4. The damage of the stomach wall can be provoked by its weakness.
5. Stomach cancer should not be confused with other types of cancers that can
appear in our abdominal cavity.
6. Our stomach is composed of 5 parts.
7. The digestive enzymes and acid are produced in the stomach innermost layer.
8. The usual oncology team is made up of doctors and oncology certified nurses.
5
Find the sentences in passive voice. What tense are they? Translate them into
Ukrainian.
1. Bile reflux is caused by the backflow of bile into our stomach from the bile
ducts.
2. Symptoms of gastrointestinal diseases vary among the patients.
3. Patient may need a number of specialized procedures to detect the disease.
4. Irritating meal eliminating from the diet such as lactose or gluten helps the
patient to relieve the symptoms.
5. The heartburn is usually caused by excessive acid production in the stomach.
6. A patient was performed a blood test two weeks ago.
7. Last year the symptoms relief was achieved with the new treatment options.
8. The operation was postponed by the surgeon yesterday.
84
UNIT 3
DIGESTIVE SYSTEM
3.3 STOMACH CANCER
LEAD IN
1
Learn the following words.
explicit
distinguish
claim
pernicious
alarming
metastasis
cancerous
distant
flatulence
chemotherapy
detection
predisposition
occupational
eradication
cessation
2
|ɪkˈsplɪsɪt|
|dɪˈstɪŋɡwɪʃ|
|kleɪm|
|pəˈnɪʃəs|
|əˈlɑːmɪŋ|
|mɪˈtastəsɪs|
|ˈkans(ə)rəs|
|ˈdɪst(ə)nt|
|ˈflatjʊl(ə)ns|
|ˌkiːmə(ʊ)ˈθɛrəpi|
|dɪˈtɛkʃ(ə)n|
|priːdɪspəˈzɪʃn|
|ɒkjʊˈpeɪʃ(ə)n(ə)l|
|ɪˌradɪˈkeɪʃ(ə)n|
|sɛˈseɪʃ(ə)n|
визначений, очевидний
виокремлювати
стверджувати
злоякісний
тривожний
метастаз
злоякісний
віддалений
здуття, метеоризм
хіміотерапія
виявлення
схильність
професійний
викоренення
припинення
Match the English word combinations with Ukrainian equivalent.
1. explicit reasons
2. long-term inflammatory process
3. pernicious anemia
4. clinical pattern review
5. affected lymph node
6. presence of metastasis
7. genetic predisposition
8. smoked and pickled food
9. smoking cessation
10. second-hand smokers
85
a. копчена та маринована їжа
b. огляд клінічної картини
c. генетична схильність
d. припинення паління
e. наявність метастазування
f. тривалий запальний процес
g. уражений лімфатичний вузол
h. визначені причини
i. пасивне паління
j. злоякісна анемія
3
Some facts about stomach cancer.
1. A great risk of stomach cancer has been defined in areas where people eat
large amounts of smoked and salted foods and pickled vegetables.
2. Smoking doubles the risk of stomach cancer.
3. Genetic predisposition plays an essential role in stomach cancer
development.
4. The disease is more common for eastern part of Asia, southeast Europe and
Latin America.
5. Ethnically it is more often met in Asian-Americans, Hispanic-Americans
and African-Americans.
6. Diet high in vegetables and fruit can reduce the risk of stomach cancer.
7. Stomach cancer afflicts more men than women.
8. Stomach cancer is the third most common cancer type in the whole world.
4
Read the text.
STOMACH CANCER
Stomach cancer breaks down when cancer cells start to form in the stomach lining,
usually the disease develops slowly and the process takes many years. The explicit
reasons for cancer development have not been distinguished yet, but scientists claim the
wide range of causes may contribute to the development of the disease, among them
bacteria, e.g. H. pylori that leads to ulcer formation, long-term inflammatory process in
stomach or intestines, pernicious anemia, polyps.
Stomach cancer is an uncommon type of cancer, usually it progresses slowly and
most of the patients confuse the alarming symptoms with other conditions related to the
dysfunctions of gastrointestinal tract. The cancer is usually advanced by the time its
detection.
The diagnostic procedure requires several aspects: physical examination based on
clinical pattern review and specialized tests, e.g. biopsy, molecular testing of a growth,
X-ray, endoscopy, CT, MRI, laparoscopy.
The clinical pattern of the disease and its treatment depend on the stage of cancer
and type. Oncologists single out the following types of stomach cancer
adenocarcinomas, lymphomas, sarcomas and metastatic cancers which come from the
other organs. The stages of the disease are grouped according to the number of involved
tissue, lymph nodes and presence of metastasis. The most common method for defining
cancer stage is the TNM system, where letter “T” stands for “tumor” and its tissue
involvement, “N” indicates the number of the affected lymph nodes and “M”
demonstrates the presence of metastasizing process.
Stage 0. The lining of the stomach has a number of cancerous cells that may
promote the disease; the lymph nodes are not involved in the process.
Stage 1. The tumor has spread into the inner layer of the stomach involving some
lymph nodes.
86
Stage 2. Cancer has penetrated the deeper layers of the stomach and the nearby
lymph nodes.
Stage 3. Cancer has spread to all the layers of the stomach involving the greater
number of the lymph nodes and the nearby organs.
Stage 4. The advanced stage, cancer has affected the distant organs and all the area
around the stomach.
The symptoms that can indicate cancer can be the following: indigestion, bloating,
heartburn, nausea, loss of appetite and weight, pain in epigastrium, melena, swallowing
problems, yellowing of the skin and eyes, stool problems and fatigue.
The treatment of the disease depends on the defined stage of cancer. Stage 0 usually
requires surgery that removes the part of the stomach and the nearby lymph nodes.
Stage 1 and 2 involve the combination of methods; surgery and chemotherapy. Stage 3
also requires surgical intervention that removes the stomach completely, in case of poor
health condition surgery may be temporary replaced by chemotherapy and radiation
therapy; in extremely advanced cases both methods are applied. Stage 4 has very poor
recovery statistics, and in general stomach cancer statistics is far from being
satisfactory. The main aim of the treatment during the following stage is to relieve the
condition of the cancerous patient. Patient may be given chemotherapy, radiation
therapy, targeted therapy and palliative care.
The risk group for stomach cancer development is very extending, among them
smokers, second-hand smokers, obese people, alcohol abusers, smoked and pickled
food eaters, patients with chronic gastritis and after stomach surgery, people with
genetic predisposition and occupational diseases. The prevention strategies for stomach
cancer development are not introduced worldwide, but everyone must know that early
detection of the disease is the way to survive the disease. Lifestyle and diet changes,
eradication of H. pylori, knowing family history, regular screening and smoking
cessation are very effective in cancer prevention.
LANGUAGE DEVELOPMENT
5
Fill in the gaps with the words from the table.
significant extending disease
refrigeration cells
inner advanced
distant
1.
Stomach cancer usually starts in the mucus-producing ______
of the stomach.
2.
Before cancer develops, pre-cancerous changes often appear in the
_______ lining of the stomach.
3.
Advanced stomach cancer can be described as the cancer that has reached
________organs.
87
4.
The risk group for stomach cancer development is very_______.
5.
The treatment options and protocols depend on the stage of the ________.
6.
Stomach cancer tends not to demonstrate symptoms early, that is why it
does not often get noticed until it is at its ________ stage.
7.
Patients suffering from stomach cancer can experience a loss _________of
appetite.
8.
In countries, where _________ allows a greater consumption of fresh foods
rather than salt-preserved foods, stomach cancer morbidity has fallen over the
years.
6
Fill in the gaps with the right form of the word.
Targeted therapy
Targeted therapy is a specific cancer
_________ that uses medicines. But it
differs from _________ chemotherapy,
which also uses medicines to treat
cancer. Targeted therapy acts by
________ the cancer genes, proteins, or
the tissue environment that contributes
to cancer __________. These genes and
proteins are detected in cancer cells or
in cells _________with cancer growth.
Oncologists often apply targeted
therapy with chemotherapy and other
__________options. ____________are
also in the process of________ drugs
for new cancer targets.
7
treat
tradition
target
develop
associate
treat, research
test
Match the terms with their definitions.
1. chemotherapy
a. specialized medical care that provides
relief from pain and other symptoms of
cancer.
b. special medications which undergo
medical trials and designed as the
alternative way of treatment.
c. treatment with the help of highpowered rays of energy, including Xrays and protons to kill the cancer cells.
d. conservative type of treatment with
certain medications.
2. radiation therapy
3. targeted therapy
4. palliative care
88
5. medication therapy
e. manual intervention performed by a
surgeon.
6. experimental therapy
f. special medications that work to make
the immune system fight the cancer
cells as if they were foreign bodies,
such as viruses or bacteria.
g. treatment that uses intravenous
chemicals to kill cancer cells.
7. immunotherapy
8. surgery
8
h. special drugs that fight against specific
abnormalities within the cancer cells.
Complete the sentences using appropriate prepositions.
1. Person can live without stomach, but it will require life-changing adjustments ….
the diet and eating habits.
2. The number of people who gets established diagnosis with stomach cancer is
different …. the world.
3. Smoking, positive family history and exposure …. ionizing radiation are very
common risk factors for disease development.
4. Having a personal history ….. polyps in the stomach, known as adenomas,
increase the risk for stomach cancer development.
5. The exact treatment plan for stomach cancer will depend …. the origin and stage
of the disease.
6. The chances of the recovery are higher if the diagnosis is established …. the
early stages.
7. Commonly all stomach cancers are adenocarcinomas …. the stomach.
8. A loss of appetite and loss of weight go hand …. hand with other symptoms of
gastrointestinal upset.
9
Add the word or words.
1.
2.
3.
4.
5.
6.
7.
8.
Stomach cancer usually develops in ….
Detection of stomach cancer requires …
At the terminal stages of disease flow patient requires only…
The most alarming symptom is permanent…..
The most common method for defining cancer stage is ….
Stomach cancer is very insidious cause its early stages can be defined
as…
If oncologist suspects stomach cancer the patient will be referred to….
Oncologists single out the following types of stomach cancer….
89
10
Agree or disagree with these statements.
1. Family history is one of the most common risk factors for stomach
cancer development.
2. The prevention strategies for stomach cancer are extremely important.
3. H. pylori infection is considered to be one the most common cause of the
disease development.
4. The food we eat influences the health of our digestive system.
5. Stomach cancer is a common type of cancer.
6. Early detection of the disease doesn’t promote to the recovery.
7. The only way to survive is to remove stomach completely.
8. The new treatment options for stomach cancer treatment are not being
developed.
11
Correct the statements.
1. Stomach cancer is an incurable disease that strikes people of all ages.
2. Stomach cancer afflicts both stomach and duodenum.
3. Dietary habits do not influence the stomach cancer morbidity.
4. The prevention strategies for stomach cancer development are highly
introduced worldwide.
5. The treatment of disease doesn’t depend on the stage and requires similar
treatment options.
6. The cause of stomach cancer hasn’t been studied properly.
7. Usually cancer develops when mutation appears in a cell's DNA.
8. Diagnostic procedure isn’t complex and requires physical examination and
endoscopy.
12
Answer the questions.
1. When does stomach cancer develop?
2. What are the reasons of stomach cancer?
3. Why is it difficult to define stomach cancer at early stages?
4. What diagnostic methods are necessary for stomach cancer detection?
5. What cancer stages do you know and are they grouped?
6. What is the clinical pattern of the disease?
7. How to treat cancer?
8. Who can be afflicted by stomach cancer?
9. How to prevent the disease development?
90
13 What questions would you ask to obtain the following information?








the disease progression
diagnostics of the disease
disk factors
stages of the disease
possible treatment options
prevention strategies
recovery statistics
metastasizing process
TALKING POINTS
1
Discuss the stomach cancer stages according to TNM classification.
Stage 0
- carcinoma in situ, during the following stage cancer is defined
only in epithelium and it has not penetrated the other stomach
layers. (T, N0, MO).
STAGE 1A
- tumor has penetrated the inner layer of the stomach wall, but has
not spread to any lymph node. (T1, N0, M0).
STAGE 1B
- tumor has penetrated the inner layers of the stomach wall and
spread to 1 or 2 lymph nodes (T1, N1, M0), or cancer has
penetrated the outer muscle layer of the stomach , but no lymph
nodes are invaded (T2, N0, M0).
- tumor has penetrated the inner layer of the stomach wall and
spread to 3 or 6 lymph nodes (T1, N2, M0), or tumor has
penetrated the outer muscle layer of the stomach wall and spread
to 1 or 2 lymph nodes (T2, N1, M0). or tumor has penetrated all
the stomach layers ( T3, N0, M0).
STAGE 2A
Stage 2 B
- tumor has involved the inner layers of the stomach wall and
spread to 7 or 15 lymph nodes (T1, N3, M0), or the tumor has
invaded the outer muscle layers of the stomach wall and spread to
3 or 6 lymph nodes (T2, N2, M0), or tumor has invaded all the
stomach layers, but has not penetrated the serosa. It has also
spread to 1 or 2 lymph nodes (T3, N1, M0), or tumor has invaded
all the stomach layers and the connective tissue outside the
stomach, it has also penetrated the serosa. (T4, N0, M0).
91
Stage 3 A
- tumor has invaded the outer muscle layer of the stomach wall
and 5 or 7 lymph nodes (T2, N3, M0), tumor has invaded all the
muscle layers of the stomach and connective tissue outside it and
spread to 3 or 6 lymph nodes (T3, N2, M0), or cancer has invaded
all the muscle layers of the stomach and connective tissue outside
it, involved the serosa and spread to 1 or 2 lymph nodes (T4a, N1,
M0), or cancer has invaded all the stomach layers, connective
tissue outside it and spread to nearby organs ( T4b, N0, M0).
Stage 3 B
- tumor has invaded the inner layer of the stomach wall or its outer
muscle layer and spread to 16 lymph nodes (T1 or T2, N3, M0),
or tumor has invaded all the stomach layers, the connective tissue
outside it and penetrated the serosa involving 7-15 lymph nodes
(T3a, N3, M0), or tumor has invaded all the stomach layers, its
connective tissue and serosa, involving nearby organs and 7-15
lymph nodes (T4a, N3, M0), or tumor has invaded all the stomach
layers, its connective tissue, serosa and nearby organs, involving
1-6 lymph nodes and distant organs (T4b, N1 or N2, M1).
Stage 3 C
- tumor has invaded all the stomach layers, its connective tissue,
serosa, involving 16 or more lymph nodes (T3 or T4a, N3, M0),
or tumor has invaded all the stomach layers, its connective tissue,
serosa, nearby organs, involving 7 or more lymph nodes and
distant organs (T4b, N3, M1).
Stage 4
- defined as a tumor of any size that has invaded distant organs and
area around the stomach. (T4, N3, M1).
MORE READING
1
Read the text and be ready to answer the following questions.
1. What is colon cancer?
2. What are the causes of colon cancer?
3. What are the symptoms of the disease?
4. What are the risk factors for having colon cancer?
5. What are the prevention measures?
92
COLON CANCER
Colon cancer is a kind of cancer that starts in the large intestine and usually
affects older people, but it can also happen at any age. Typically, it develops as small,
benign polyps that grow on the inside wall of the colon. Polyps may be too small and
produce few or no symptoms at all. That is why doctors recommend undergo regular
screening tests to prevent colon cancer development. However, if colon cancer has been
confirmed, many treatments are available to manage it, among them surgery, radiation
therapy, chemotherapy, targeted therapy and even immunotherapy.
Clinical pattern of the disease can be described by the changes in the bowel
habits, diarrhea and constipation, change in the consistency of the stool, rectal bleeding
or presence of blood in the stool, abdominal discomfort, cramps and bloating, a
sensation that bowel doesn't empty fully, unintentional weight loss, fatigue. Sometimes
colon cancer can be asymptomatic, especially at the early stages.
When colon cancer is diagnosed, extra tests are performed to detect its progress.
This process is termed staging. Staging detects how advanced the colon cancer has
become. Stage I involves only the inner layers of the colon. This stage has excellent
prognosis, 90% of the patients recover completely after the appropriate treatment
options. Stage II is described by expanding growth and tumor extension through the
walls of the colon. Stage III colon cancer spreads through all the colon layers and to
local lymph nodes. Stage IV is characterized by metastatic process to distant and nearby
organs and the lymph nodes far from malignant tumor.
Colon cancer is not the most common type of cancer but certain factors may
increase the risk of its development, including older age, African-American race,
personal and family history of cancer or benign colon polyps, chronic inflammatory
conditions, low-fiber and high-fat nutrition, inherited syndromes, sedentary lifestyle,
diabetes and obesity, smoking, prior radiation therapy for cancer.
Oncologists recommend people with the risk of colon cancer to undergo colon
cancer screening around age 50, but people with an increased risk should do this earlier.
Several screening options can define disease at the early stages. Lifestyle changes can
lower the risk of the colon cancer. People should eat fruit, vegetables and whole grains,
which contain vitamins, minerals, fiber and that plays an essential role in cancer
prevention. Alcohol drinks should be taken in moderation, smoking cessation is also
important. Physical activity and healthy weight maintenance can also contribute to the
colon cancer prevention. Some medications can reduce the risk of precancerous polyps
transformation into colon cancer, among them aspirin or aspirin-like medicines, but
aspirin intake on routine basis has great risks, among them gastrointestinal bleeding and
ulcers.
93
GRAMMAR
LINKING WORDS
Linking words help us to connect our ideas and sentences. We can use them to give
the examples (for example, for instance, namely) add some information (and, in
addition, as well as, also, too, furthermore, apart from, besides), summarize something
(in short, in brief, in summary, to conclude, in conclusion), sequence information
(firstly, secondly, finally, the first point is, lastly, the following), give the reasons or
results (due to, owing to, because, because of, since, as, therefore, so, consequently, as a
result), or contrast different ideas (but, however, although, despite, in spite of,
nevertheless, nonetheless, while, whereas).
e.g. Because of his bad condition, he missed the classes.
Since the symptoms are increasing, we need to prescribe the painkillers.
Apart from antibiotics, he was also given the antiviral therapy.
1
Put the correct linking word.
1. ______________ his acute pain, he still went to walk his dog.
2. ______________ it was painful, they went on the procedure.
3. They went on the immunotherapy, __________ it was very expensive.
4. I phoned my doctor ___________ I need his help.
5. _________________ the doctors’ strike, all operations have been cancelled.
6. _________________ understand how the human organism works, you need
some knowledge of anatomy.
7. Ann stayed at home ____________ her flu-like symptoms.
8. She went on a diet _____________ relieve her chronic gastritis.
2
Fill in the gaps with appropriate linking words.
1.
He was ___________ unable to attend his doctor. (in particular, therefore,
as well as).
2.
________________, we are not satisfied with the treatment. (for example,
as well as, in general)
3.
This is an acute case and requires our immediate help ___________, it is a
long way from the medical center. (nonetheless, moreover, in particular).
94
4.
Everybody had heard of Covid – 19, ____________ hardly anyone could
understand its etiology. (and, but, of course)
5.
Can you help me in _____________? (anyway, by the way, anyway )
6.
The ambulance car broke down on the way. ____________, we managed to
react in time. (therefore, certainly, in spite of this)
7.
“Interesting case?” “____________, it was a waste of time”. (certainly,
however, on the contrary)
8.
It is true that alcohol does some good effect on our body. _____________,
addiction is basically dad. (of course, even so, in particular)
3
Complete the letter with the correct linking words.
Dear Mathew,
It is great to hear from you. Of course I remember you __________, you were my
first patient long ago. I am really proud of you! You were able to fight your stomach
cancer __________ that isn’t the complete victory. You must undergo all the post
therapeutic routine __________ you won’t get the relapse! ______________, you
should visit your doctor twice a year for a regular medical check-up.
___________, here are some of my news. I moved to Bristol __________ their
medical center experiences lack of oncologists and ________ that they invited me.
____________ the hospital financing is quite good; we experience problems with more
sophisticated equipment. _________ we hope for the best!
_______________ my letter, I ask you to take care about yourself! _________, I
know you are strong!
Best regards,
Dr. Jeremy
4
Read the statements and define whether the second sentence expresses an
additional or contrasting aspect. Join the sentences using necessary linking
words.
1. Alternative medicines cure the symptoms of a disease. Conventional medicines
cure the underlying reason of a disorder.
2. Alternative medicines are made of natural products rather than chemicals.
Alternative medicines are not tested on any animals.
3. Conventional doctors possess respected and recognizable qualifications.
Conventional treatment is widely available to any person.
95
4. Patients trust conventional treatment because they are proved scientifically.
Patients are often suspicious of alternative treatment which sometimes relies on a
"trial and error" method.
5. Alternative treatment causes fewer or no side-effects at all. Conventional
treatment can provoke life-threatening side-effects.
6. Conventional treatment sometimes fails. Alternative treatment gives hope.
7. Conventional treatment is trustworthy worldwide. Alternative treatment is also
helpful.
5
Make up your own sentences with the linking words to express your idea
about:








nutrition
causes of gastrointestinal diseases
fast food
alternative medicine
stomach cancer treatment
bad habits
substance addiction
enzyme insufficiency
96
UNIT 4
LIVER
4.1 ANATOMY AND FUNCTIONS
LEAD IN
1
Learn the following words.
attachment
cone-shaped
accessory
|əˈtatʃm(ə)nt|
|kəʊn ʃeɪpt|
|əkˈsɛs(ə)ri|
excretion
ammonia
maintenance
blood clotting
|ɪkˈskriːʃ(ə)n|
|əˈməʊnɪə|
|ˈmeɪnt(ə)nəns|
|ˈklɒtɪŋ|
97
приєднання
конусоподібний
додатковий,
допоміжний
виведення, екскреція
аміак
підтримка
згортання крові
2
jaundice
emerge
|ˈdʒɔːndɪs|
|ɪˈməːdʒ|
disturbance
ascites
disrupt
hereditary
storage
abuse
obesity
|dɪˈstəːb(ə)ns|
|əˈsʌɪtiːz|
|dɪsˈrʌpt|
|hɪˈrɛdɪt(ə)ri|
|ˈstɔːrɪdʒ|
|əˈbjuːs|
|ə(ʊ)ˈbiːsɪti|
жовтяниця
проявлятися,
виникати
порушення
асцит
руйнувати
спадковий
зберігання, сховище
зловживати
ожиріння
Some facts about digestive system.
If 75% of our liver were removed and only 25% left, that 25% could restore a
full size liver in 8 to 15 days!
2. Our liver has about 500 distinct functions in the body.
3. Our liver acts like a filter removing toxins from our body.
4. Our liver stores vitamins and minerals and uses them when our organism
needs them.
5. Liver is the largest gland in our body and the second largest organ after the
skin.
6. 10% of our liver is made up of fat.
7. Our liver participates in blood creation process.
8. Our brain functions somewhere depend on liver functions.
1.
3
The main liver functions.
Immunity:
Kupffer cells destroy pathogens
Metabolism:
creates bile
breaks down fats and proteins
involved in regulation of blood glucose
Blood:
creates blood
clotting factors
filters blood from toxins
destroys old or damaged blood cells
Storage:
fats
proteins
glycogen
vitamins
copper
iron
98
4 Read the text.
LIVER
Liver is the largest gland in our body that performs numerous metabolic and
secretory functions. It is located in the right upper part of our abdomen and covered by
fibrous tissue, known as Glisson’s capsule. Liver is a cone-shaped organ, dark reddishbrown in its color with the weight about 1.5 kg. It is also divided into the right and left
lobes by the special attachment, called the falciform ligament. There are two more
‘accessory’ lobes that appear from the right lobe, and they are located on the visceral
surface of the liver: caudate lobe is located in the upper part of the visceral surface and
quadrate lobe is located in the lower part of the visceral surface.
Liver tissue is composed of numerous cells (hepatocytes) tunneled through with
the bile ducts and the blood vessels. Hepatic cells compose about 60 percent of liver
tissue and perform metabolic functions. The second group of cells, called Kupffer cells,
is important for blood formation, antibody production and processing of foreign matter
and cellular wastes.
Every day our liver produces about 800 to 1000 ml of bile, which contains special
bile salts necessary for the breaking down of fats. Bile is also important for the
excretion of certain metabolic waste substances, drugs, and toxins. Bile is transported
from the liver to the common bile duct by the special system that empties into the
duodenum connected with the gallbladder, where it is stored.
Liver performs more than 500 vital functions some of the most known include
bile production, production of some proteins for blood plasma, cholesterol production,
transformation of excess glucose into glycogen, amino acids regulation, hemoglobin
processing for use of its iron content (the liver stores iron), transformation of poisonous
ammonia into urea, filtering the blood from drugs and poisonous substances, blood
clotting regulation, maintenance of immune factors and removing harmful bacteria
from the bloodstream, bilirubin removal and red blood cells formation.
A common sign of poor liver function is jaundice, a yellow color of the eyes and
skin emerging from excess bilirubin in the blood. Hepatic cells dysfunction can result
from hepatitis, cirrhosis, vascular obstruction, different tumors and poisoning. The other
symptoms indicating liver disturbance are weakness, easy bruising, low blood pressure,
bleeding, tremor and ascites. Blood tests can reveal the abnormally high levels of
bilirubin, serum proteins, cholesterol, ammonia, urea and different enzymes. A specific
diagnosis of the liver diseases can also be performed by biopsy.
Our liver can be disrupted by many disorders and diseases. Liver abscess can be
provoked by appendicitis. The parasites that cause amebic dysentery in the tropics can
contribute to the liver abscess either. Liver cancer is also common, arising mostly as the
secondary tumors from nearby and distant organs. Glycogen-storage diseases,
hereditary and genetic disorders, alcohol abuse, toxins and obesity can trigger numerous
life-threatening liver diseases.
99
LANGUAGE DEVELOPMENT
5
Match the English word combinations with Ukrainian equivalent.
1. secretory function
2. waste substances
3. liver disturbance
4. distant organs
5. secondary tumor
6. excess glucose
7. hemoglobin processing
8. harmful bacteria
6
a. шкідливі бактерії
b. вторинна пухлина
c. віддалені органи
d. порушення роботи печінки
e. переробка гемоглобіну
f. видільна функція
g. відходи
h. надмірна глюкоза
Fill in the gaps with the words from the table.
disturbance
junk food
blood
nutrition
renewal
jaundice
early
glandular
1. Our liver is the largest __________ organ in our body that performs numerous
functions.
2. When liver destroys harmful substances it excretes them into ________and bile.
3. You can prevent liver diseases maintaining a healthy weight and____________.
4. Most of liver diseases don’t cause symptoms at the ____________ stages.
5. The 3 main causes of liver _________are obesity, alcohol abuse and undiagnosed
hepatitis.
6. Liver has the ability of regeneration and quick _______________.
7. One of the main symptoms of liver disease is ________________.
8. Liver health can be aggravated by _________________.
7
Match the terms with their definitions.
1. lobe
2. jaundice
3. abuse
4. regeneration
5. hepatocyte
6. Kupffer cells
7. ligament
8. bilirubin
a. a yellow-reddish water-insoluble pigment
b. yellow pigmentation of skin and tissues
c. a fibrosis and tough band
d. a rounded or curved division
e. the renew ability
f. epithelial parenchymatous cells of our liver
g. taking something in an overdose
h. a fixed macrophage of the liver walls
100
8
Complete the sentences using appropriate prepositions.
1. The liver has 2 main sections both are made ….. of 8 segments.
2. Liver produces bile, a clear yellow or orange fluid that helps ….. food processing.
3. The liver is located…… the right hypochondrium and epigastrium, and extends
….. the left hypochondrium.
4. The cells of the liver (hepatocytes) are arranged ….. lobules.
5. Our liver has a unique blood supply obtained ….. hepatic artery and hepatic
portal vein.
6. The liver parenchyma is innervated by the hepatic plexus, which is composed ….
sympathetic and parasympathetic nerve fibers.
7. Liver is covered by a capsule known ….. Glisson’s capsule.
8. Because ….. the liver importance and functions, evolution has given it the regrow
ability.
9
Answer the following questions.
1. Speak on the liver location.
2. What is the liver structure?
3. What are the main liver functions?
4. What are the common signs and symptoms of poor liver function?
5. What are the causes of liver disturbance?
6. What diagnostic procedures can define liver diseases?
7. What are the most common liver diseases?
8. How to prevent liver diseases?
TALKING POINTS
1
Express your point of view concerning:





importance of the liver
major components of the liver
major functions of the liver
the liver regeneration ability
the liver diseases manifestations
101
MORE READING
1
Read the text and be ready to answer the following questions.
1. How many functions does our liver have?
2. What is the role of bile?
3. What is the role of vitamin K?
4. What vitamins are stored by the liver?
5. What is role of liver in our immunity?
THE MAIN LIVER FUNCTIONS
It is difficult to give an exact number of liver functions, as the organ is still being
investigated, but it is proved that the liver performs near 500 distinct roles.
The main liver functions comprise:
Bile production: bile helps the small intestine in processing and absorption of fats,
cholesterol, and vitamins.
Absorbing and metabolizing bilirubin: bilirubin is created by the breakdown of
hemoglobin and iron released from hemoglobin, it is stored in the liver or bone marrow
and used to make the next generation of blood cells.
Supporting blood clots: vitamin K is necessary for the creation of certain coagulants
that help clot the blood. Bile is essential for vitamin K absorption and is created in the
liver. If the liver does not produce enough bile, clotting factors cannot be produced.
Fat metabolization: bile breaks down fats and makes them easier to digest.
Metabolizing carbohydrates: carbohydrates are stored in the liver, where they are
broken down into glucose and siphoned into the bloodstream to maintain normal
glucose levels. They are stored as glycogen and released whenever a quick burst of
energy is needed.
Vitamin and mineral storage: the liver stores vitamins A, D, E, K, and B12. It
keeps significant amounts of these vitamins stored. In some cases, several years worth
of vitamins is held as a backup. The liver stores iron from hemoglobin in the form of
ferritin, ready to make new red blood cells. The liver also stores and releases copper.
Helps metabolize proteins: bile helps break down proteins for digestion.
Filters the blood: the liver filters and removes compounds from the body, including
hormones, such as estrogen and aldosterone, and compounds from outside the body,
including alcohol and other drugs.
Immunological function: the liver is part of the mononuclear phagocyte system. It
contains high numbers of Kupffer cells that are involved in immune activity. These cells
destroy any disease-causing agents that might enter the liver through the gut.
Production of albumin: albumin is the most common protein in blood serum. It
transports fatty acids and steroid hormones to help maintain the correct pressure and
prevent the leaking of blood vessels.
Synthesis of angiotensinogen: this hormone raises blood pressure by narrowing the
blood vessels when alerted by production of an enzyme called renin in the kidneys.
102
UNIT 4
LIVER
4.2 HEPATITIS
LEAD IN
1
Learn the following words.
experience
flow
icteric
pattern
flu-like
predispose
onset
perceptible
shellfish
single out
induce
cessation
exposure
confuse
psychic
2
|ɪkˈspɪərɪəns|
|fləʊ|
|ɪkˈterɪk|
|ˈpat(ə)n|
|fluː ˈlaɪk|
|ˌpriːdɪˈspəʊz|
|ˈɒnsɛt|
|pəˈsɛptɪb(ə)l|
|ˈʃɛlfɪʃ|
|ˈsɪŋɡ(ə)l|
|ɪnˈdjuːs|
|sɛˈseɪʃ(ə)n|
|ɪkˈspəʊʒə|
|kənˈfjuːz|
|ˈsʌɪkɪk|
відчувати
перебіг
жовтяний
картина
подібний до грипу
передбачати
початок
помітний
молюск
виокремлювати
спричиняти
припинення
контакт
плутати
психічний
Match the English word combinations with Ukrainian equivalent.
1. inflammatory condition
2. subfebrile temperature
3. personal hygiene
4. undercooked meat
5. poor sanitary conditions
6. poisonous substances
7. harmful object
8. vaccination schedule
a. субфебрильна температура
b. недостатньо термічно оброблене
м'ясо
c. небезпечний об’єкт
d. календар щеплень
e. запальний стан
f. погані санітарні умови
g. отруйні речовини
h. особиста гігієна
103
3
Some facts about hepatitis.
1. Every case of hepatitis is induced by inflammation of the liver tissue.
2. Contracting a virus is not the only way to develop hepatitis.
3. The most common symptom of hepatitis is jaundice.
4. Hepatitis types A and B can both be prevented against with special vaccines.
5. Hepatitis C is the most common type of viral hepatitis, but there's still no vaccine
against it.
6. Hepatitis C is also called “a tender killer” because it is asymptomatic until its
advanced stage.
7. Viral hepatitis kills more people than malaria.
8. Baby boomers, people born between 1945-1965, are 5 times more likely to contract
hepatitis C than the rest of humanity.
4
Read the text.
HEPATITIS
Hepatitis is an inflammatory condition of the liver, which is usually caused by
viral infection, medications, toxins, alcohol and autoimmune disorders.
Viral infections of the liver are defined as hepatitis A, B, C, D and E. Hepatitis A
is always an acute condition caused by infection with hepatitis virus A through oralfecal way of transmission as a result of poor personal hygiene, it is not usually a serious
condition, people recover within a couple of months, some people may not experience
any symptoms. As any acute infectious disease hepatitis A has a cyclic flow which can
be described by several periods: incubation period (5-70 days), preicteric period (3-7
days) can be characterized by flu-like symptoms, icteric period (7-10 days) and
posticteric period (2-3 weeks). The general clinical pattern of the disease can be
described by the following symptoms: fatigue, joint and muscle pain, subfebrile
temperature, loss of appetite, dull pain in the upper right quadrant under the ribs, dark
urine and pale stool, itchy skin jaundice. Treatment of the disease requires bed regimen,
drinking lots of fluids, antiviral therapy with immunomodulators and symptomatic
treatment. Prevention of hepatitis A predisposes strict personal hygiene and vaccine
against hepatitis A.
Hepatitis B is provoked by hepatitis B virus and mainly transmitted through
blood. Usually it is spread from infected pregnant women to their infant or as a result of
child-to-child contact, but also it can be obtained by unprotected sex and injections. The
incubation period lasts from 12 months up to 2-6 years, the onset of the disease can be
asymptomatic and as the disease develops the clinical pattern can be described by flulike symptoms including fatigue, fever, generalized aches, diarrhea, and jaundice.
Treatment of hepatitis B depends on how long the patient has been infected. If patient
suffers from acute form of hepatitis B he may require the treatment to fight against
symptoms, chronic form of hepatitis B requires lifelong treatment with antiviral therapy.
The WHO recommends Tenofovir and Entecavir for the treatment of chronic hepatitis
B, the action of these medications suppresses the viral activity and prevents cirrhosis
development.
104
The risk group for hepatitis B is recommended a vaccine; the vaccine is also
injected to infants as a part of the routine vaccination schedule.
Hepatitis C is provoked by hepatitis C virus. It is transmitted by blood and has
long-term incubation period (2 weeks – 6 months). Hepatitis C has no perceptible
symptoms, sometimes they can be described as the flu-like that is why the disease is often
called “tender or silent killer”. Chronic form of hepatitis C may provoke the formation of
2 conditions: cirrhosis and liver failure. Hepatitis C can be treated with special antiviral
drugs according to their viral genotype. The active substances of these medications are
usually ledipasvir and sofosbuvir. The up-to-date medical treatment protocols can be
defined as more sophisticated and profound with fewer complications either on
physiological or psychic background, but there is still no available vaccine today.
Hepatitis D is provoked by hepatitis D virus and affects people who are already
affected with hepatitis B. It is transmitted through blood and sexual intercourse. Chronic
hepatitis D may provoke cirrhosis and liver cancer. There is no vaccine against hepatitis
D, but vaccine against hepatitis B may protect a person. This disease is not typical for
European countries and often met in the Middle East, Africa and South America.
Hepatitis E is provoked by hepatitis E virus, it is an acute condition related to a
poor personal hygiene, consumption of raw or undercooked meat and shellfish. The
disease is not typical for European countries and mainly met in the Middle East, Africa
and South America. Symptoms of the disease are similar to hepatitis A together with the
way of transmission and incubation period. There is no vaccine against hepatitis E, so
while travelling to the parts of the world with poor sanitary conditions people should
follow all the rules of personal hygiene.
Liver inflammation is not always caused by viral infection, doctors single out
many other types of hepatitis, among them alcoholic hepatitis, autoimmune hepatitis
and drug-induced hepatitis.
Alcoholic hepatitis is caused by excess consumption of alcohol for many years.
Usually it has no symptoms, but it may cause sudden jaundice and liver failure. Alcohol
drinking cessation usually helps liver to recover. Symptoms of alcohol – related
hepatitis are fatigue, weight loss, loss of appetite, jaundice, swelling of the abdomen and
ankles, vomiting blood.
Other toxic substances can also cause liver damage and its inflammation, e.g. the
action of hepatotoxic drugs and exposure to poisonous substances.
Sometimes our immune system confuses our liver as a harmful object and starts
attacking it. It provokes serious inflammation leading to the liver dysfunction; this
condition is more often met in women and requires specific long-term treatment with
corticosteroids and immunosuppressant drugs.
Prevention of viral hepatitis requires following a number of routines while
travelling to endemic areas: do not consume local water and ice, avoid eating raw or
undercooked food.
Hepatitis B, C and D can be prevented by not sharing needles, razors and
toothbrushes, avoid visiting untrusted manicure and tattoo saloons, practice safe sex.
Vaccination is an important key to hepatitis prevention.
Complications of hepatitis can be fatal, among them chronic liver disease, cancer
and liver failure.
105
LANGUAGE DEVELOPMENT
5
Fill in the gaps with the words from the table.
complications
unfortunately induce different
symptoms term
viral reduce
1. Hepatitis is ________the used to detect inflammation of the liver.
2. Some types of hepatitis will pass without any __________, others can be become
chronic.
3. Acute hepatitis often has no _________, so you may not know you have it.
4. Hepatitis is not always caused by the virus and may be _______ by other causes.
5. You can ________ the risk of developing alcoholic hepatitis by controlling the
amount of alcohol you drink.
6. ____________ we cannot be vaccinated against all types of hepatitis.
7. ____________ each type of hepatitis has different ways of transmission.
8. The symptoms of __________ types of hepatitis are similar and laboratory tests can
detect the specific type of the virus.
6
Fill in the gaps with the right form of the word.
How interferon works
Interferon is a life-saving medicine,
used for _________ several chronic treat
forms of viral hepatitis, including
hepatitis B and C.
However, it is also _______ potent, and
not ________ for everyone. It’s
important to be aware of any _______
side effects. A person's cells begin
_________ interferon when they notice
viral infection. Interferon alerts all
nearby cells that a viral infection is
________, ________ the production of
proteins that block viral ________.
Interferon also causes cells to stop
__________ proteins that viruses need
to replicate.
extreme
suite
danger
secrete
come, trigger
replicate
produce
106
7
Match the terms with their definitions.
1. inflammation
2. vaccination
3. immunosuppressant
4. immunomodulator
5. organ failure
6. autoimmune disorder
7. complication
8. jaundice
8
a. drug that inhibits the activity of our immune
system
b. accumulation of bilirubin in blood
c. condition when organ doesn’t perform its
proper function
d. protection of people against harmful
diseases, mainly infectious ones, before they
contact with them
e. condition when immune system can't tell the
difference between own body cells and
foreign agents
f. secondary disease or condition worsening an
already existing disease or condition.
g. immune system process that defends our
body from harmful agents
h. the active agents of drug therapy
Complete the sentences using appropriate prepositions.
1. Hepatitis refers … an inflammatory condition of the liver tissue.
2. Treatment varies depending … which type of hepatitis patient has.
3. People can prevent some forms of hepatitis …. immunization and lifestyle
precautions.
4. Viral infections of the liver that are classified … hepatitis include A, B, C, D, and
E types.
5. A different virus is responsible … each type of virally transmitted hepatitis.
6. If person has infectious forms of hepatitis that are chronic, like hepatitis B and C,
he may not have symptoms … to the advanced stages.
7. Treatment is determined … the type of hepatitis patient has and whether the
infection is acute or chronic.
8. The use … vaccines is an important key to prevent hepatitis.
9
Add the word or words.
1. Inflammation is swelling of body tissues when they are injured or infected and it
can damage your … .
2. There are different types of viral and non-viral hepatitis, with different … .
3. Viral hepatitis has different ways of transmission and they depend on its … .
4. People drinking a lot of alcohol over long periods of time are at risk for … .
5. Early diagnosis and proper treatment of chronic hepatitis may prevent the … .
6. Hepatitis can be an acute or short-term infection and a chronic or long-term … .
107
7. Hepatitis A and E usually spread through contact with contaminated food or … .
8. Hepatitis B, C, and D can be spread through contact with the blood of someone
who is … .
10
Agree or disagree with these statements.
1. Some cases of hepatitis can be easily cured at home with simple antibiotics.
2. Hepatitis is always caused by viral infection.
3. Each type of viral hepatitis requires specific treatment and hospitalization.
4. The main symptom of hepatitis is jaundice,
5. All liver diseases require special diet, because it is an essential treatment
option of the disease.
6. Hepatitis can be prevented by vaccination.
7. All types of hepatitis have different ways of its transmission.
8. While the causes of hepatitis vary among the patients, the symptoms are
always similar.
11
Correct the statements.
1. Hepatitis can be either acute or chronic.
2. Patients with Hepatitis C do not experience any symptoms up to the advanced
stage of the disease.
3. All types of viral hepatitis require different treatment options.
4. Noninfectious hepatitis can be caused by alcohol and other toxins.
5. To diagnose hepatitis doctor needs only physical examination and laboratory
tests.
6. Signs and symptoms of acute viral hepatitis appear quickly.
7. Chronic hepatitis develops slowly with the periods of exacerbations and
remissions.
8. Chronic stress doesn’t influence the health of your liver.
12
Answer the questions.
1. What is hepatitis?
2. What are the main causes of the disease?
3. What types of hepatitis do you know?
4. What diagnostic procedures are necessary to establish the disease?
5. What are the symptoms of hepatitis and their incubation periods?
6. What are the treatment options for hepatitis?
7. What complications can be caused by hepatitis?
8. How to prevent hepatitis?
108
13
What questions would you ask to obtain the following information?








possible causes
incubation periods
diseases flow
clinical pattern
types of the disease
diagnostic procedures
treatment protocols
complications
TALKING POINTS
1
Read and discuss the following tips that help reduce the risk of contracting the
disease:












1
Always wash your hands thoroughly with soap and water.
Get the vaccines against hepatitis A and B.
Practice safe sex.
Practice good personal hygiene.
Get cosmetic (manicure/ pedicure, tattooing etc.) and dental procedures
only in a trusted place.
Don’t use an infected person’s personal stuff.
Avoid “street” food and drink only bottled water, especially in the
pandemic countries.
Heated food should be hot to the touch and eaten right away.
Avoid raw food and dairy products.
Injectable illegal drugs increase the risk of contracting the disease.
Quit alcohol.
Control your drugs intake and don’t self-medicate yourself.
MORE READING
1
Read the text and be ready to answer the following questions.
1. What is autoimmune hepatitis?
2. What can provoke the development of autoimmune hepatitis?
3. What types of immune hepatitis do you know?
4. What are the symptoms of autoimmune hepatitis?
5. What are the risk factors?
6. What are the most common complications?
109
AUTOIMMUNE HEPATITIS
Autoimmune hepatitis is inflammation of the liver that occurs when immune
system fights against liver cells. The cause of autoimmune hepatitis is unknown, but
genetic and environmental factors may trigger the disease.
Untreated autoimmune hepatitis leads to cirrhosis and liver failure. However,
autoimmune hepatitis can be controlled with drugs that suppress our immunity.
Autoimmune hepatitis appears when our immune system, which usually attacks
viruses, bacteria and other pathogens, instead attacks the liver. This attack on the liver
can lead to chronic inflammation and serious liver damage. The reason why the body’s
immune system turns against itself is still unclear, but researchers assume autoimmune
hepatitis can be caused by the interaction of genes that control immune system and
exposure to specific viruses or even drugs.
Doctors have defined two main forms of autoimmune hepatitis.
 Type 1 autoimmune hepatitis, which is the most common type of the disease. It
occurs at any age. About half of the patients with type 1 autoimmune hepatitis
suffer from other autoimmune disorders (celiac disease, rheumatoid arthritis or
ulcerative colitis).
 Type 2 autoimmune hepatitis, which can develop in adults, but mostly common
in children and young people.
Signs and symptoms of autoimmune hepatitis differ from person to person and
may appear suddenly. Some people have few symptoms, whereas others experience
signs and symptoms that may include: fatigue, abdominal discomfort, jaundice,
enlarged liver, spider angiomas, skin rashes, joint pains, loss of menstrual periods.
Factors that may increase the risk of autoimmune hepatitis include:
 Being female. Despite both males and females can develop autoimmune
hepatitis, the disease is more met in females.
 A history of particular infections. Autoimmune hepatitis may develop after
you're infected with measles, herpes simplex or Epstein-Barr virus. The disease is
also connected to hepatitis A, B or C infection.
 Heredity. Researchers claim that a predisposition to autoimmune hepatitis may
run even in families.
 Having an autoimmune disease. Patient who already has an autoimmune
disease, such as celiac disease, hyperthyroidism or rheumatoid arthritis may be
more likely to acquire autoimmune hepatitis.
The complications of autoimmune hepatitis are similar to any other type of
hepatitis, e.g. enlarged veins in your esophagus. When circulation through the portal
vein is hindered, blood backs up into other blood vessels — mainly in the stomach
and esophagus.
Ascites. Liver disease may provoke large amounts of fluid to accumulate in the
abdomen. Ascites is very uncomfortable and may interfere with respiration and is
usually a symptom of advanced cirrhosis.
Liver failure. It occurs when extensive damage to liver cells is done and it is
impossible for your liver to function properly and liver transplant is obligatory.
Liver cancer. Patients with cirrhosis have an increased risk of this complication.
110
GRAMMAR
PERFECT TENSES PASSIVE
The formulas for the Perfect Tenses Passive are different:
We form the Present Perfect Passive:
have/ has + been + Participle II
The treatment has already been performed.
We form the Past Perfect Passive:
had + been + Participle II
The procedure had been performed before the doctor came.
We form the Future Perfect Passive:
will have + been + Participle II
The medicine trials will have been by 2025.
1
Make up your own sentences.
The gastritis symptoms
The chemotherapy
Treatment
Liver transplantation
Test results
2
has been
have been
had been
will have been
managed by the end of his
treatment.
handled by the doctor today.
performed by the end of the
month.
discussed before the operation
started
Put the verbs in brackets into correct tense form of passive.
1. Little progress ___________ (to make) in fundamental theory.
2. The remarkable results __________ (to achieve) in analyzing and synthesizing
DNA.
3. A patient ________ (to prescribe) a proper course of treatment.
4. The following treatment _________ (to provide) in the general internal medicine
unit.
5. The interns_________ (to instruct) by Dr. House about their main duties.
6. The patient ___________( to explain) the course of treatment before the doctor
came.
7. The patient ____________(to discharge) by the end of the following month.
8. The biopsy ____________(to do) before the doctor established the diagnosis.
111
3
Transform from active into passive.
1. The doctor had examined the limbs and found a fracture.
2. These drugs have arrested the bleeding.
3. An endoscopic specialist has inserted the probe.
4. The tests have detected the congenital abnormalities.
5. Dr. Smith hasn’t examined the patient yet.
6. He said that he had made all the procedures before.
7. Medical students will have fulfilled the task by the end of the week.
8. The patient had survived the operation well.
4
Find the sentences in passive voice. What tense are they? Translate them
Ukrainian.
into
1. The efficiency of this medicine has been confirmed by numerous trials.
2. Fatal outcome of the diseases had been prevented by the surgeon.
3. The researcher has performed the results of investigation.
4. The doctor had completed a case history before the conference started.
5. All patients have been seen by family doctors or other specialists.
6. The patient will have been diagnosed by the end of the week.
7. Ten hours before the patient was admitted to the hospital he had suffered from a
sudden abdominal pain.
8. The diagnostic laboratory has been opened recently.
5
Correct the mistakes.
1. A patient had being prescribed a proper treatment.
2. The drug produced in the form of powder.
3. The patients has been examined on time.
4. The valuable information have been lost.
5. The potential effects of drugs hasn’t been assessed yet.
6. The pain has relieved by these tablets.
7. The diagnosis had been established today.
8. The operation have finally been completed.
112
UNIT 4
LIVER
4.3 CIRRHOSIS
LEAD IN
1
2
Learn the following words.
scarring
pallor
coagulation
epistaxis
cachexia
impotence
abuse
bulged
malnutrition
|ˈskɑːrɪŋ|
|ˈpælə|
|kəʊæɡjʊˈleɪʃ(ə)n|
|ˌepɪˈstaksɪs|
|kəˈkeksɪə|
|ˈɪmpət(ə)ns|
|əˈbjuːs|
|bʌldʒd|
|mælnjʊˈtrɪʃ(ə)n|
buildup
reverse
cessation
contraction
|ˈbɪlˌdəp|
|rɪˈvɜːs|
|seˈseɪʃ(ə)n|
|kənˈtrækʃ(ə)n|
рубцювання
блідість шкірних покривів
згортання
носова кровотеча
кахексія
імпотенція
зловживання
роздутий
недостатність поживних
речовин
утворення
призупинити розвиток
припинення
підхоплення (інфекції)
Match the English word combinations with Ukrainian equivalent.
a. біліарний цироз
b. алкогольний напій
c. пошкодження печінки
d. загальний набряк
e. процес рубцювання
f. збільшена печінка
g. набряклі поверхневі вени
h. проблеми з розумовими
процесами
i. невиліковний стан
j. втрата функції
1. liver damage
2. loss of function
3. alcoholic beverage
4. biliary cirrhosis
5. enlarged liver
6. trouble thinking
7. generalized edema
8. incurable condition
9. scarring process
10. swollen superficial veins
113
3
Some facts about cirrhosis.
1. Cirrhosis is a disease in which scar tissue replaces normal liver tissue.
2. Cirrhosis is a risk factor for liver cancer.
3. Cirrhosis can be provoked by numerous causes and excessive alcohol
doesn’t take the first place.
4. The 2d type of diabetes mellitus can cause cirrhosis.
5. Short-term or acute liver damage doesn’t cause cirrhosis.
6. Chronic hepatitis C is one of the most common cirrhosis causes.
7. Cirrhosis usually develops after years of chronic damage.
8. Cirrhosis is the most common cause of portal hypertension.
4
Read the text.
CIRRHOSIS
Cirrhosis is a result of permanent liver damage that causes its scarring and loss of
function.
The most common causes of the disease are hepatitis C, obesity and alcohol
abuse. Cirrhosis can develop in women who drink more than 2 alcoholic beverages per
day for several years (that also refers to beer and wine) in men the number of alcoholic
drinks is 3. Other causes that may provoke cirrhosis include infectious hepatitis B and
C, autoimmune hepatitis, damage to the bile ducts, hemochromatosis, Wilson’s disease
and hepatotoxic medications. According to the possible causes of cirrhosis it can be
classified into different types: alcoholic cirrhosis, postnecrotic cirrhosis caused by
infectious hepatitis, biliary cirrhosis, cardiac cirrhosis and nonspecific metabolic
cirrhosis.
The diagnosis of cirrhosis requires physical examination that reveals pallor,
reddened palms, enlarged liver, spleen and breast tissue in men; the study of medical
history that usually defines alcohol abuse, presence of hepatitis C and autoimmune
disorders and a wide range of tests: liver function tests, ultrasound scan, MRI, CT,
complete blood cell count test, albumin test, coagulation blood test, liver cancer
screening, endoscopy and even liver biopsy.
Clinical pattern of cirrhosis can be described by following symptoms: epistaxis,
jaundice, anorexia, cachexia, itchy skin, fatigue, small spider-like arteries under the
skin. The advanced symptoms include confusion, trouble thinking, edema of the legs,
impotence and gynecomastia, presence of caput medusa, the appearance of bulged and
swollen superficial epigastric veins. All the symptoms of cirrhosis appear due to the loss
of liver function.
Cirrhosis is a life-threatening condition accompanied by a number of
complications. High blood pressure in the veins provokes portal hypertension. Portal
hypertension may also provoke splenomegaly and internal bleeding. Generalized edema
and ascites are the causes of liver inability to produce albumin. Cirrhosis may contribute
114
to the development of different infections, e.g. bacterial peritonitis, and malnutrition as
a result of poor vitamins processing. A buildup of toxins in the blood provokes hepatic
encephalopathy. Besides, a large number of people may develop cancer if suffered
cirrhosis previously.
Cirrhosis is an incurable condition, and the proper treatment depends on the
severity of liver damage and aimed at stopping the disease progression, minimizing
liver damage and reducing its possible complications. Scientists are working to promote
current treatment options for cirrhosis. All the patients must stop alcohol drinking and
consult the intake of any medication with their doctor. According to the medical
treatment protocol patient can be prescribed medications that control the symptoms.
Diuretics can remove the excess fluid from the organism and prevent the formation of
edema and ascites. Laxatives like lactulose are given to absorb toxins and fasten their
removal from the body, it minimizes the manifestations of hepatic encephalopathy.
Cirrhosis may also contribute to the development of portal hypertension in this
condition the beta blockers are needed. In case of varices development, the patients are
prescribed the medicines that reduce the risk of bleeding. If cirrhosis is accompanied
with infections antibiotics must be prescribed. The more advanced stages of disease
progression may require surgery. The varices bleeding is repaired with transjugular
intrahepatic portosystemic shunt that reduces blood pressure in liver. When liver stops
functioning transplantation is the only treatment option.
Nowadays scientists are working on the target therapy that slows down and even
reverses the scarring process in liver, but the research is still in progress.
Prevention of cirrhosis is focused on cessation of alcohol intake, maintenance of
healthy nutrition and weight, reduction of hepatitis risk contraction with the help of
vaccines and personal hygiene.
LANGUAGE DEVELOPMENT
5
Fill in the gaps with the words from the table.
symptoms ducts damaged fibrosis jaundice failure prevent
patient
1.
Cirrhosis is ____________ of the liver caused by long-term damage.
2.
Cirrhosis can gradually lead to liver __________________ .
3.
The early stages of cirrhosis have no __________________ .
4.
As liver becomes more ________ patient feels very tired and weak.
5.
_______________ is one of the advanced symptoms of the disease.
6.
There is no cure for cirrhosis at the moment and __________ can be treated
symptomatically.
7.
Cirrhosis can also be caused by bile ________________ disorders.
8.
Vaccination against hepatitis B and C can ________ disease development.
115
6
Fill in the gaps with the right form of the word.
Liver Transplant
Cirrhosis can damage liver to the point
when it no _______ works. A transplant
means your ________ liver is _______
with a one from a ______donor. You
can wait on an organ list for a ________
donor, or obtain part of a liver from a
_______ friend or family member.
It can help you survive and live
longer, but it's difficult surgery that
comes with risks like ________ and
infection. After surgery, you'll need to
take pills to prevent your body from
__________ the new organ. Because the
drugs suppress the immune system, they
can increase your own risk for any
infection.
7
long
damage, replace
health
decease
live
bleed
reject
Match the types of cirrhosis with its definitions.
1. hepatitis C related cirrhosis
2. alcoholic cirrhosis
3. primary biliary cirrhosis
4. autoimmune cirrhosis
5. postnecrotic cirrhosis
6. cardiac cirrhosis
7. nonspecific metabolic cirrhosis
8. cryptogenic cirrhosis
a. is associated with severe long term
heart failure.
b. is the result of chronic biliary
obstruction and infection.
c. is the result of long term liver
inflammation that causes scarring of
the liver and death of its cells.
d. is the complication of untreated
hepatitis C.
e. is caused by the number of metabolic
conditions
leading
to
liver
inflammation.
f. is the complication of autoimmune
hepatitis.
g. is the most common type of cirrhosis,
caused by chronic alcoholism.
h. is cirrhosis of unknown origin.
116
8
Complete the sentences using appropriate prepositions.
1. Cirrhosis is often caused … alcohol abuse but that is not the only one reason.
2. Cirrhosis can cause weakness, loss … appetite and jaundice.
3. Diagnosis … cirrhosis includes the history, physical examination, and blood
tests.
4. Treatment … cirrhosis is designed to prevent further liver damage and to treat
the caused complications.
5. Transplantation … the liver is the main treatment option … patients …
advanced stage of cirrhosis.
6. Cirrhosis develops … 30-40% … patients suffering … hepatitis B and C.
7. Patients suffering from cirrhosis have very specific appearance, especially … the
terminal stages of disease flow.
8. Cirrhosis is an incurable condition, but it can be controlled … drugs … early
stages.
9
Add the word or words.
1.
2.
3.
4.
5.
6.
7.
8.
Cirrhosis is a result of chronic liver … .
The disease is mainly caused by alcohol abuse, hepatitis B and C, but has
other possible … .
The symptoms of various types of cirrhosis are similar and may develop … .
As the disease progresses complications may … .
Liver damage from cirrhosis cannot be stopped, but it can be … .
Prevention of cirrhosis is focused on cessation of alcohol intake, maintenance
of healthy nutrition and weight … .
Caput medusa is one of the main symptoms of the advanced ….
Jaundice is the result of decreased bilirubin … .
10 Agree or disagree with these statements.
1.
2.
3.
4.
5.
6.
7.
8.
Family history is one of the most common risk factors for cirrhosis
development.
Cirrhosis is often caused by prolonged alcohol abuse.
Patients may recover from cirrhosis completely and live their usual life.
Primary cirrhosis occurs due to the inflammation of the bile ducts in the liver.
Symptoms of various types of cirrhosis are similar.
Treatment of the disease prevents the further damage to the liver.
The symptoms of the disease depend on the stage of disease.
Liver transplantation is one of the most important treatment option for the
patients suffering from cirrhosis.
117
11
Correct the statements if necessary.
1. Just a small amount of alcohol per day for several years may cause
cirrhosis.
2. Cirrhosis is rarely caused by alcohol.
3. Cirrhosis has only one constitutional symptom – jaundice.
4. Liver transplantation is the only way to treat the disease.
5. Cirrhosis has many types and different symptoms.
6. Cirrhosis can be prevented by healthy lifestyle.
7. Ascites is the accumulation of fluid in peritoneal cavity.
8. Cirrhosis is an incurable disease, but patient can be supported
symptomatically.
12 Answer the questions.
1.
2.
3.
4.
5.
6.
7.
8.
What is cirrhosis?
What are the main causes of the disease?
What are the main types of the disease?
What are the symptoms of the disease?
What diagnostic methods are necessary for cirrhosis detection?
How to treat cirrhosis?
What are the complications of cirrhosis?
How to prevent the disease development?
13 What questions would you ask to obtain the following information?








the disease flow
diagnostics of the disease
types of the disease
risk factors
causes of disease development
clinical pattern
possible treatment options
prevention strategies
118
TALKING POINTS
1
1
Compare all known types of cirrhosis and focus on the following aspects.







cause
statistics
clinical pattern
possible complications
treatment
prevention
prognostics
1
MORE READING
1
Read the text and be ready to answer the following questions.
1. What is fatty liver disease?
2. What are the causes and types of the disease?
3. What are the symptoms of the disease?
4. What are the risk factors for having fatty liver disease?
5. What are the preventive measures?
FATTY LIVER DISEASE
Fatty liver disease or steatosis is a common condition caused by having too much
fat accumulation in the liver. A healthy liver contains a very small amount of fat and it
becomes a problem when fat build up reaches 5% to 10% of the liver’s weight. There
are 2 types of fatty liver disease: alcoholic fatty liver disease and nonalcoholic fatty
liver disease.
Alcoholic fatty liver disease is the accumulation of fat in the liver mostly as the
result of heavy drinking. Moderate drinking is detected as one alcohol drink a day for
women and up to two alcohol drinks per day for men. Nonalcoholic fatty liver disease
appears in patients who aren’t heavy drinkers. Scientists haven’t found the exact reason
for nonalcoholic fatty liver disease, but several factors, such as obesity and diabetes
increase your risk. Some patients develop fatty liver disease without any pre-existing
conditions, but some risk factors make it more likely to happen: being obese or
overweight, having type 2 diabetes or insulin resistance, having metabolic syndrome
(insulin resistance, high blood pressure, high cholesterol, and high triglyceride levels),
taking certain prescription medicines.
Patients with fatty liver disease often experience no symptoms until the disease
advances to cirrhosis. The clinical pattern may include: abdominal pain or feeling of
fullness in the upper right side of the abdomen, moderate or heavy nausea, loss of
119
appetite or weight loss, jaundice, swollen abdomen and legs, heavy tiredness or mental
problems.
There’s no cure specifically for fatty liver disease, but doctors focus on helping
the patient control factors that contribute to the disease. They also recommend making
profound lifestyle changes that can significantly improve health. Treatment contains
avoiding alcohol and losing weight, taking medicines to control diabetes, cholesterol
and triglycerides levels, taking vitamin E and thiazolidinediones.
The best way to prevent fatty liver disease is to improve overall body health, e.g.,
stay at a healthy normal weight, if the patient is overweight or obese, he should lose
weight gradually and exercise regularly, and limit alcohol consumption.
GRAMMAR
QUANTIFIERS WITH COUNTABLE AND UNCOUNTABLE
NOUNS
To answer the questions How much? and How many? - We can use certain
quantifiers. Some of them can go only with countable or uncountable nouns, some –
with both of them:
Only with uncountable Only with countable
With all types of nouns
no, none, not any
nouns
nouns
a little
a few
some
a bit of
a number of
any
a great deal of
several
a lot of, lots of
a large amount of
a great number of
plenty of
much
a large number of
many
Examples:
I always eat a little honey with tea when I have a bad cold.
I was prescribed some pills yesterday.
A few methods of treatment have been given to the patient.
1
Fill in the gaps with how much or how many to complete the questions.
1. __________ pills shall I bring you?
2. __________ substances shall I add to the mixture?
3. __________ patients do you have today?
4. __________ solution shall I use?
5. __________ drugs, which do not require a doctor’s prescription are available in
pharmacy?
6. __________ time do you need to complete this project?
7. __________ students receive financial assistance in the form of grants?
8. __________ information have you got about this patient?
120
2
Fill in some, any, no.
1. Scientists have learned a great deal about prevention and treatment of ______
diseases.
2. The doctor must know if the patient had had _____ mental and emotional
impairments.
3. ________ of the antibiotics are effective in the treating cold.
4. First aid is the initial assistance given to a casualty for _____ injury or sudden
illness.
5. The duty of a nurse is to give the patients the injections and carry out _____
doctor’s administrations.
6. Unfortunately they have got ____ time.
7. ________ investigations were performed to confirm the diagnosis.
8. ________ wanted to continue the discussion.
3
Complete the sentences with much, many, a lot of.
1. _____ help had been done to help this patient.
2. _____ substances have been used historically for the treatment of infectious
diseases.
3. A cough that produces _____ phlegm or sputum is associated with the illness of
the throat, chest and lungs.
4. _____ mild antiseptics and ointments are sold for the treatment of wounds.
5. Is there ____ difference between natural and acquired immunity?
6. It took her ____ time to fulfill the task.
7. He has done ____ work to be promoted.
8. The man injured in the accident lost ___ blood.
4
Choose the correct answers.
1. I think ____ drugs may improve his condition. (any, some, no)
2. I suppose she’ll respond to ____ drugs and surgery is indicated in this case.
(some, no, any)
3. _____ amount of ointment will relieve your pain. (little, a little, few)
4. Just _____ drugs can be prescribed in this case. (few, a few, little)
5. Is there ______ patients left outdoors? (much, many, a lot of)
6. Is there ______ solution left in the dropper? (much, many, a lot of)
7. She must check ____ patients’ case histories. (some, many, much)
8. Just _____ alcohol can irreversibly damage your liver. (little, a little, few)
121
5
Correct the mistakes.
1. Senior students spend many time in hospital wards.
2. Surgeons had asked much questions before they started the operation.
3. A little serious diseases develop due to bacterial multiplication.
4. Bacterial gastritis occurs when much bacteria invade the stomach.
5. Few cases of diarrhea and vomiting result from viral infections.
6. Much common diseases are caused by viruses.
7. There are little of methods of gastric ulcer treatment.
8. Are there much patients in the wards?
122
Wordlist Unit 1 “Respiratory System”
Here is a list of useful or new words or phrases from Unit 1 of Professional English
for Medical Purposes. Insert your own transcription and translation by consulting a
dictionary. Write a sentence for each word/phrase.
Anatomy and Functions
Word/Phrase Transcription
aerobic
respiration
Translation
air sacs
airborne
particles
alveolus
plural alveoli
anaerobic
respiration
breathe in
breathe out
bronchiole
bronchus
plural bronchi
carbon
dioxide
cilium
plural cilia
conducting
zone
123
Sentence
costal
breathing
cough
deep
breathing
diaphragm
diaphragmatic
breathing
diffusion
eupnea
exhale
expire
forced
breathing
humidify
hyperpnea
inhale
inspire
124
lung
compliance
naris
plural nares
oxygen
perfusion
pleura
propel
pulmonary
compliance
quiet
breathing
residual
volume
respiratory
respiratory
cycle
respiratory
rate
respiratory
zone
shallow breath
125
sneeze
spongy
squamous
epithelium
tonsils
trachea
ventilation
vocal cords
windpipe
Bronchitis
Word/Phrase Transcription
air pollution
Translation
antihistamine
antipyretic
antitussive
blood
chemistry
126
Sentence
bronchitis
bronchodilator
causative
agent
coarse
crackles
complete
blood count
decongestant
dust
egophony
exacerbation
expectorant
fine crackles
fremitus
fumes
hypoxemia
127
malaise
nasal
congestion
purulent
rale
recurrence
rhonchus
plural rhonchi
runny nose
sputum
sample
syncytial virus
tachypnea
wheeze
Tuberculosis
Word/Phrase Transcription
acid-fast
microscopy
Translation
bilateral
cavitary
infiltrates
128
Sentence
concomitant
confirm the
diagnosis
declining
droplet
drug
resistance
exhibit
exposure
first-line
drugs
follow-up
activities
hemoptysis
immature
laryngeal
lesion
medical
evaluation
129
morbidity
mortality
night sweats
non-adherence
to therapy
persistent
cough
prevalence
settle down
smear
specimen
susceptible
TB-control
programme
transmission
tuberculosis
130
Wordlist Unit 2 “Cardiovascular System”
Here is a list of useful or new words or phrases from Unit 2 of Professional English
for Medical Purposes. Insert your own transcription and translation by consulting a
dictionary. Write a sentence for each word/phrase.
Anatomy and Functions
Word/Phrase
aorta
Transcription
Translation
arteriole
artery
atrium
plural atria
backflow
bicuspid
blood volume
capillary
carbon dioxide
cardiac
conduction
system
cardiac cycle
cardiac output
131
Sentence
chamber
convey
deoxygenated
blood
diastole
drain (into)
heart
oxygen
oxygen-rich
blood
pulmonary
circulation
pump
release
stroke volume
supply
systemic
circulation
132
systole
tricuspid
valve
vasoconstriction
vasodilation
vein
ventricle
venule
waste rich
Atherosclerosis
Word/Phrase
angiogram
Transcription
Translation
angioplasty
arrhythmia
assess one’s
lifetime risk for
atherosclerosis
133
Sentence
atherectomy
atherosclerosis
atherosclerosisrelated disease
blood clotting
build-up
cardiac stress
test
cause of death
cholesterol
coronary bypass
surgery
debris
delay
atherosclerosis
dyslipidemia
elevated blood
pressure
fatty deposits
heaviness in the
chest
134
high blood
cholesterol
impair
irregular
heartbeat
lipid-lowering
medication
lipoprotein
lumen
modifiable
numbness
occlude
plaque
prevent
atherosclerosis
prone to rupture
regular rate and
rhythm
rupture
scavenger
135
short of breath
stenting
streak
trigger
thrombose
widespread
Myocardial Infarction
Word/Phrase
account (for)
Transcription
Translation
acute
aggravating
alleviating
antiplatelet
therapy
blinding pain
burning pain
cardiac
biomarkers
136
Sentence
choking
sensation
cramping pain
crushing pain
diaphoresis
distended
erratic twitching
of the heart
muscle
fast
resting
heart rate
globus
sensation
gripping pain
heart attack
heart murmur
irreversible
ischemia
lightheadedness
137
mitral
regurgitation
myocardial
infarction
nitroglycerin
obesity
oppressive pain
overall
prognosis
parenteral
anticoagulation
platelet
aggregation
pounding pain
presyncope
pulse
radiating
regurgitation
scar
138
severe
complication
shooting pain
squeezing pain
stabbing pain
sublingually
suffer from a
heart attack
supplementation
sweating
swelling
tachycardia
throbbing pain
whooshing or
swishing heart
sound
139
Wordlist Unit 3 “Digestive System”
Here is a list of useful or new words or phrases from Unit 3 of Professional English for
Medical Purposes. Insert your own transcription and translation by consulting a
dictionary. Write a sentence for each word/phrase.
Anatomy and Functions
Word/Phrase
absorption
Transcription Translation
anus
ascending colon
bladder
bolus
carbohydrate
cavity
cecum
chew
chyme
descending colon
digest
digestion
140
Sentence
duodenum
emulsify
enzyme
esophagus
essential
excrete
fat
feces
gastric gland
grind
gut
hard palate
hormone
ileum
intestine
141
jejunum
juice
lipid
liver
mandible
nutrient
moist
oral
pancreas
peristalsis
pharynx
protein
rectum
saliva
salivary
142
sigmoid colon
soft palate
stomach
swallow
tongue
tooth
plural teeth
transverse colon
Gastritis
Word/Phrase
acid
Transcription Translation
acidity
advanced gastritis
anemia
bacterium plural
bacteria
belching
bloating
143
Sentence
cytoprotective
diet
endoscopy
epigastrium
erosion
erosive
GERD
flatulence
heartburn
Helicobacter
pylorus plural
Helicobacter
pylori
hiccups
inflammation
inhibitor
irritating
144
lesion
lining
multiple
nonsteroidal
nutrition
pallor
pylorus
pylori
plural
reflux
starving pain
ulcer
underlying
Stomach cancer
Word/Phrase
adenocarcinoma
Transcription Translation
alarming
biopsy
145
Sentence
cancerous
cell
cessation
chemotherapy
detection
distant
growth
laparoscopy
lymph node
lymphoma
metastasis plural
metastases
metastatic cancer
molecular testing
MRI
146
palliative care
pernicious
predisposition
radiation therapy
regular screening
sarcoma
surgery
targeted therapy
tissue
tumor
147
Wordlist Unit 4 “LIVER”
Here is a list of useful or new words or phrases from Unit 4 of Professional English for
Medical Purposes. Insert your own transcription and translation by consulting a
dictionary. Write a sentence for each word/phrase.
Anatomy and Functions
Word/Phrase
abscess
Transcription Translation
albumin
aldosterone
angiotensinogen
amino acid
ammonia
ascites
attachment
bile duct
bile salt
bilirubin
bloodstream
capsule
148
Sentence
caudate lobe
cholesterol
copper
disrupt
disruption
easy bruising
estrogen
excretion
falciform
ligament
fibrous tissue
filter
gland
glucose
glycogen
hemoglobin
149
hepatocyte
immune factor
iron
jaundice
Kupffer cell
metabolic
poisonous
substance
processing
quadrate lobe
regulation
secretory
siphon
store
toxin
transformation
150
tremor
urea
Hepatitis
Word/Phrase
acute
Transcription Translation
alcoholic hepatitis
autoimmune
antiviral therapy
bed regimen
child-to-child
contact
chronic
condition
consumption
define
diarrhoea
151
Sentence
drug-induced
hepatitis
experience
fatigue
fever
flow
flu-like
generalized ache
harmful object
hygiene
icteric period
immunomodulator
incubation period
injection
liver failure
152
oral-fecal
poor
sanitary
conditions
predispose
preicteric period
prevention
sexual intercourse
single out
transmission
unprotected sex
vaccine
viral
Cirrhosis
Word/Phrase
albumin test
Transcription Translation
alcohol abuse
anorexia
153
Sentence
bile duct
biliary
cachexia
cardiac
coagulation blood
test
confusion
diuretic
edema
encephalopathy
enlarged
gynecomastia
hemochromatosis
hepatotoxic
intake
154
itchy skin
laxative
liver biopsy
malnutrition
permanent
portal
hypertension
scarring
shunt
spider-like
splenomegaly
superficial
swollen
transjugular
transplantation
155
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159
НАВЧАЛЬНЕ ВИДАННЯ
Olena Holik, Khrystyna Storozhuk
Professional English
for
Medical Purposes
Підписано до друку 05.08.2022 р.
Формат 60х84 1/16. Друк лазерний. Папір офсетний.
Гарнітура Times New Roman.
Ум. друк. арк. 10.
ТОВ «Медпринт»
Свідоцтво про внесення суб'єкта видавничої справи до державного реєстру
видавців, виготовлювачів і розповсюджувачів видавничої продукції
ДК № 7520 від 29.11.2021
160