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ValentinaL.Brashers,MD

ProfessorofNursingandWoodardClinicalScholar AttendingPhysicianinInternalMedicine UniversityofVirginiaHealthSystem Charlottesville,Virginia

NealS.Rote,PhD

AcademicVice-ChairandDirectorofResearch DepartmentofObstetricsandGynecology UniversityHospitalsCaseMedicalCenter

WilliamH.Weir,MD,ProfessorofReproductiveBiologyandPathology CaseWesternReserveUniversitySchoolofMedicine Cleveland,Ohio

TableofContents

Coverimage

TitlePage

HealthPromotionBoxes

Copyright Reviewers

Contributors

Preface

OrganizationandContent

FeaturestoPromoteLearning

ArtProgram

Teaching/LearningPackage

Acknowledgments

IntroductiontoPathophysiology

PartOneBasicConceptsofPathophysiology

Unit1TheCell

1CellularBiology

ProkaryotesandEukaryotes

CellularFunctions

StructureandFunctionofCellularComponents

Cell-to-CellAdhesions

CellularCommunicationandSignalTransduction

CellularMetabolism

MembraneTransport:CellularIntakeandOutput

CellularReproduction:TheCellCycle

Tissues

DidYouUnderstand?

KeyTerms

References

2GenesandGeneticDiseases

DNA,RNA,andProteins:HeredityattheMolecularLevel

Chromosomes

ElementsofFormalGenetics

TransmissionofGeneticDiseases

LinkageAnalysisandGeneMapping

MultifactorialInheritance

DidYouUnderstand?

KeyTerms

References

3EpigeneticsandDisease

EpigeneticMechanisms

EpigeneticsandHumanDevelopment

GenomicImprinting

InheritanceofEpigeneticStates

EpigeneticsandCancer

FutureDirections

DidYouUnderstand?

KeyTerms

References

4AlteredCellularandTissueBiology

CellularAdaptation

CellularInjury

ManifestationsofCellularInjury:Accumulations

CellularDeath

AgingandAlteredCellularandTissueBiology

SomaticDeath

DidYouUnderstand?

KeyTerms

References

5FluidsandElectrolytes,AcidsandBases

DidYouUnderstand?

KeyTerms

References

PartTwoBodySystemsandDiseases

Unit4TheNeurologicalSystem

13StructureandFunctionoftheNeurologicalSystem

OverviewandOrganizationoftheNervousSystem

CellsoftheNervousSystem

TheNerveImpulse

TheCentralNervousSystem

ThePeripheralNervousSystem

TheAutonomicNervousSystem

GeriatricConsiderations

DidYouUnderstand?

KeyTerms

References

14Pain,Temperature,Sleep,andSensoryFunction

Pain

TemperatureRegulation

Sleep

TheSpecialSenses

SomatosensoryFunction

GeriatricConsiderations

GeriatricConsiderations

GeriatricConsiderations

DidYouUnderstand?

KeyTerms

References

15AlterationsinCognitiveSystems,CerebralHemodynamics,andMotorFunction

AlterationsinCognitiveSystems

AlterationsinCerebralHemodynamics

AlterationsinNeuromotorFunction

AlterationsinComplexMotorPerformance

ExtrapyramidalMotorSyndromes

Unit7TheCardiovascularandLymphaticSystems

23StructureandFunctionoftheCardiovascularandLymphaticSystems

TheCirculatorySystem

TheHeart

TheSystemicCirculation

TheLymphaticSystem

DidYouUnderstand?

KeyTerms

References

24AlterationsofCardiovascularFunction

DiseasesoftheVeins

DiseasesoftheArteries

DisordersoftheHeartWall

ManifestationsofHeartDisease

Shock

DidYouUnderstand?

KeyTerms

References

25AlterationsofCardiovascularFunctioninChildren

CongenitalHeartDisease

AcquiredCardiovascularDisorders

DidYouUnderstand?

KeyTerms

References

Unit8ThePulmonarySystem

26StructureandFunctionofthePulmonarySystem

StructuresofthePulmonarySystem

FunctionofthePulmonarySystem

GeriatricConsiderations

DidYouUnderstand?

KeyTerms

References

KeyTerms

References

Unit11TheDigestiveSystem

35StructureandFunctionoftheDigestiveSystem

TheGastro-IntestinalTract

AccessoryOrgansofDigestion

GeriatricConsiderations

DidYouUnderstand?

KeyTerms

References

36AlterationsofDigestiveFunction

DisordersoftheGastro-IntestinalTract DisordersoftheAccessoryOrgansofDigestion CanceroftheDigestiveSystem

DidYouUnderstand?

KeyTerms

References

37AlterationsofDigestiveFunctioninChildren

DisordersoftheGastro-IntestinalTract DisordersoftheLiver

Gastro-IntestinalMalignanciesinChildren

DidYouUnderstand?

KeyTerms

References

Unit12TheMusculo-skeletalandIntegumentarySystems

38StructureandFunctionoftheMusculo-skeletalSystem

StructureandFunctionofBones

StructureandFunctionofJoints

StructureandFunctionofSkeletalMuscles

AgingandtheMusculo-skeletalSystem

DidYouUnderstand?

KeyTerms

References

39AlterationsofMusculo-skeletalFunction

Musculo-skeletalInjuries

DisordersofBones

DisordersofJoints

DisordersofSkeletalMuscle

Musculo-skeletalTumours

DidYouUnderstand?

KeyTerms

References

40AlterationsofMusculo-skeletalFunctioninChildren

CongenitalDefects

BoneInfection

JuvenileIdiopathicArthritis

Osteochondroses

Scoliosis

MuscularDystrophy

Musculo-skeletalTumours

NonaccidentalTrauma

DidYouUnderstand?

KeyTerms

References

41Structure,Function,andDisordersoftheIntegument

StructureandFunctionoftheSkin

DisordersoftheSkin

DisordersoftheHair

DisordersoftheNail

GeriatricConsiderations

DidYouUnderstand?

KeyTerms

References

42AlterationsoftheIntegumentinChildren

AcneVulgaris

Dermatitis

InfectionsoftheSkin

InsectBitesandParasites

CutaneousHemangiomasandVascularMalformations

OtherSkinDisorders

DidYouUnderstand?

KeyTerms

References

Index

PrefixesandSuffixesUsedinMedicalTerminology

WordRootsCommonlyUsedinMedicalTerminology

Copyright

UNDERSTANDINGPATHOPHYSIOLOGY,FIRSTCANADIANEDITION

ISBN:978-1-77172-117-2

Copyright©2018ElsevierCanada,adivisionofReedElsevierCanada,Ltd.

ThisadaptationofUnderstandingPathophysiology,SixthEdition,bySueE.HuetherandKathrynL. McCanceispublishedbyarrangementwithElsevier,Inc.

ISBN:978-0-323-35409-7

Copyright©2017,ElsevierInc.Allrightsreserved. Previouseditionscopyrighted2012,2008,2004,2000,1996.

Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,electronicor mechanical,includingphotocopying,recording,oranyinformationstorageandretrievalsystem,without permissioninwritingfromthepublisher.Reproducingpassagesfromthisbookwithoutsuchwritten permissionisaninfringementofcopyrightlaw.

Requestsforpermissiontomakecopiesofanypartoftheworkshouldbemailedto:CollegeLicensing Officer,access©,1YongeStreet,Suite1900,Toronto,ONM5E1E5.Fax:(416)868-1621.Allother inquiriesshouldbedirectedtothepublisher.

Everyreasonableefforthasbeenmadetoacquirepermissionforcopyrightedmaterialusedinthisedition andtoacknowledgeallsuchindebtednessaccurately.Anyerrorsandomissionscalledtothepublisher's attentionwillbecorrectedinfutureprintings

Notices

Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperience broadenourunderstanding,changesinresearchmethods,professionalpractices,ormedicaltreatment maybecomenecessary

Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingand usinganyinformation,methods,compounds,orexperimentsdescribedherein Inusingsuchinformation ormethodstheyshouldbemindfuloftheirownsafetyandthesafetyofothers,includingpartiesfor whomtheyhaveaprofessionalresponsibility.

Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemost currentinformationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproducttobe administered,toverifytherecommendeddoseorformula,themethodanddurationofadministration, andcontraindications Itistheresponsibilityofpractitioners,relyingontheirownexperienceand knowledgeoftheirpatients,tomakediagnoses,todeterminedosagesandthebesttreatmentforeach individualpatient,andtotakeallappropriatesafetyprecautions.

Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditorsassumeany liabilityforanyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability,negligence orotherwise,orfromanyuseoroperationofanymethods,products,instructions,orideascontainedin thematerialherein

Reviewers

ColleenBattistaBScN,RN,MN

NursingFaculty

CollaborativeBScNProgram

St.LawrenceCollege/LaurentianUniversity

St.LawrenceCollege,CornwallCampus Cornwall,Ontario

BrendaDafoeEnnsBA,RN,MN

NursingInstructor

BaccalaureateNursingProgram

SchoolofHealthSciencesandCommunityServices RedRiverCollege Winnipeg,Manitoba

DaphneGillBA,PhD SessionalLecturer DepartmentofBiology UniversityofPrinceEdwardIsland Charlottetown,PrinceEdwardIsland

HeatherHelpardBN,MN,PhD AssistantProfessor SchoolofNursing DalhousieUniversity Halifax,NovaScotia

Anne-MarieKowatschBSc,MSc Instructor

BaccalaureateNursingProgram RedRiverCollege Winnipeg,Manitoba

TaraLysterBScN,RN,MN SessionalLecturer SchoolofNursing ThompsonRiversUniversity Kamloops,BritishColumbia

JoanMillsRN,MN,CCN(C) AssistantProfessor FacultyofNursing MacEwanUniversity Edmonton,Alberta

DeborahMorrisonRN,BScN,MN NursingChair Interim SchoolofHealth&CommunityServices

DurhamCollege Oshawa,Ontario

MahaOthmanMD,MSc,PhD

Professor

SchoolofBaccalaureateNursing St LawrenceCollege Kingston,Ontario

JenniferPerryRN(EC),NP-PHC,PhD Professor

SchoolofNursing St.LawrenceCollege Kingston,Ontario

KaraSealockBN,RN,MEd,CNCC(C)

NursingInstructor FacultyofNursing UniversityofCalgary Calgary,Alberta

ToddCameronGreyMD ChiefMedicalExaminer OfficeoftheMedicalExaminer StateofUtah SaltLakeCity,Utah

RobertE.JonesMD,FACP,FACE ProfessorofMedicine EndocrinologyDivision UniversityofUtahSchoolofMedicine SaltLakeCity,Utah

LynnB.JordePhD

H.A.andEdnaBenningPresidentialProfessorandChair DepartmentofHumanGenetics UniversityofUtahSchoolofMedicine SaltLakeCity,Utah

LynneM.KerrMD,PhD AssociateProfessor DepartmentofPediatrics,DivisionofPediatricNeurology UniversityofUtahMedicalCenter SaltLakeCity,Utah

NancyE.KlinePhD,RN,CPNP,FAAN † Director,NursingResearch,Medicine PatientServices/EmergencyDepartment BostonChildren'sHospital Boston,Massachusetts

LauriA.LinderPhD,APRN,CPON AssistantProfessor CollegeofNursing UniversityofUtah ClinicalNurseSpecialist CancerTransplantCenter PrimaryChildren'sHospital SaltLakeCity,Utah

SueAnnMcCannMSN,RN,DNC ProgrammaticNurseSpecialist Nursing ClinicalResearchCoordinator Dermatology UniversityofPittsburghMedicalCenter Pittsburgh,Pennsylvania

NancyL.McDanielMD AssociateProfessorofPediatrics UniversityofVirginia Charlottesville,Virginia

AfsoonMoktarPhD,EMBA,CT(ASCP) AssociateProfessor SchoolofPhysicianAssistantStudies

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