UNIT I Pathophysiologic Processes
1 Introduction to Pathophysiology, 1
Lee-Ellen C. Copstead
Framework for Pathophysiology, 2
Etiology, 2
Pathogenesis, 2
Clinical Manifestations, 3
Treatment Implications, 3
Concepts of Normality in Health and Disease, 4
Statistical Normality, 4
Individual Factors Influencing Normality, 5
Patterns of Disease in Populations, 6
Concepts of Epidemiology, 6
2 Homeostasis, Allostasis, and Adaptive Responses to Stressors, 12
Debra A. Jansen and Roberta J. Emerson
Homeostasis and Allostasis, 12
Homeostasis, 12
Allostasis, 13
Stress as a Concept, 13
The General Adaptation Syndrome and Allostasis, 14
Stressors, Gender and Developmental Influences, and Risk Factors, 16
Neurohormonal Mediators of Stress and
Adaptation, 17
Catecholamines: Norepinephrine and Epinephrine, 17
Adrenocortical Steroids: Cortisol and
Aldosterone, 18
Endorphins, Enkephalins, and Immune
Cytokines, 19
Sex Hormones: Estrogen, Testosterone, and
Dehydroepiandrosterone, 19
Growth Hormone, Prolactin, and
Oxytocin, 19
Adaptation, Coping, and Illness, 20
Adaptation, Coping, and Resilience, 20
Allostatic Overload and Illness, 21
UNIT II Cellular Function
3 Cell Structure and Function, 26
Jacquelyn L. Banasik and Brianne N. Banasik
Plasma Membrane, 27
Membrane Structure, 27
Lipid Bilayer, 27
Membrane Proteins, 29
Organization of Cellular Compartments, 30
Cytoskeleton, 30
Nucleus, 30
Endoplasmic Reticulum, 31
Golgi Apparatus, 32
Lysosomes and Peroxisomes, 33
Mitochondria, 34
Cellular Metabolism, 34
Glycolysis, 36
Citric Acid Cycle, 36
Oxidative Phosphorylation, 36
Functions of the Plasma Membrane, 39
Membrane Transport of Macromolecules, 39
Membrane Transport of Small Molecules, 40
Cellular Membrane Potentials, 45
Intercellular Communication and Growth, 48
Cell Signaling Strategies, 48
Cell Surface Receptor–Mediated Responses, 49
Intracellular Receptor–Mediated Responses, 53
Regulation of Cellular Growth and Proliferation, 54
4 Cell Injury, Aging, and Death, 59
Jacquelyn L. Banasik
Reversible Cell Injury, 59
Hydropic Swelling, 60
Intracellular Accumulations, 60
Cellular Adaptation, 63
Atrophy, 63
Hypertrophy, 63
Hyperplasia, 63
Metaplasia, 63
Dysplasia, 64
Irreversible Cell Injury, 64
Necrosis, 64
Apoptosis, 66
Etiology of Cellular Injury, 68
Ischemia and Hypoxic Injury, 68
Nutritional Injury, 70
Infectious and Immunologic Injury, 70
Chemical Injury, 72
Physical and Mechanical Injury, 72
Cellular Aging, 74
Cellular Basis of Aging, 74
Physiologic Changes of Aging, 75
Somatic Death, 75
5 Genome Structure, Regulation, and Tissue
Differentiation, 77
Jacquelyn L. Banasik
Structure and Function of DNA, 78
Structure of DNA, 78
DNA Replication, 79
Genetic Code, 80
Transcription, 81
Translation, 82
Regulation of the Genome, 84
Transcriptional Controls, 84
Differentiation of Tissues, 86
Cell Diversification and Cell Memory, 86
Mechanisms of Development, 86
Differentiated Tissues, 87
6 Genetic and Developmental Disorders, 94
Linda D. Ward
Principles of Inheritance, 95
DNA Mutation and Repair, 96
GENETIC DISORDERS, 98
Chromosomal Abnormalities, 99
Aberrant Number of Chromosomes, 99
Abnormal Chromosome Structure, 100
Examples of Autosomal Chromosome Disorders, 100
Examples of Sex Chromosome Disorders, 101
Mendelian Single-Gene Disorders, 102
Autosomal-Dominant Disorders, 103
Autosomal-Recessive Disorders, 104
Sex-Linked (X-Linked) Disorders, 106
Nonmendelian Single-Gene Disorders, 107
Anticipation, 109
Mitochondrial Gene Mutations, 109
Genomic Imprinting, 110
Polygenic and Multifactorial Disorders, 110
Environmentally Induced Congenital Disorders, 111
Periods of Fetal Vulnerability, 111
Teratogenic Agents, 111
Other Disorders of Infancy, 113
Diagnosis, Counseling, and Gene Therapy, 113
Prenatal Diagnosis and Counseling, 113
Genetic Analysis and Therapy, 114
Recombinant DNA Technology, 114
7 Neoplasia, 117
Jacquelyn L. Banasik
Benign Versus Malignant Growth, 118
Characteristics of Benign and Malignant Tumors, 118
Tumor Terminology, 118
The Malignant Phenotype, 118
Epidemiology and Cancer Risk Factors, 120
Tobacco Use, 120
Nutrition, 120
Genetic Mechanisms of Cancer, 123
Proto-Oncogenes, 124
Tumor Suppressor Genes, 127
Multistep Nature of Carcinogenesis, 129
Initiation, 129
Promotion, 131
Progression, 131
Metastasis, 132
Patterns of Spread, 132
Angiogenesis, 133
Grading and Staging of Tumors, 134
Effects of Cancer on the Body, 136
Cancer Therapy, 137
Surgery, 137
Radiation Therapy, 138
Drug Therapy, 138
Immunotherapy, 138
Gene and Molecular Therapy, 138
Stem Cell Transplantation, 139
UNIT III Defense
8 Infectious Processes, 141
Brent A. Banasik
Host–Microbe Relationship, 142
The Human Microbiome, 142
Host Characteristics, 142
Pathogen Characteristics, 144
Transmission of Infection, 147
Routes of Transmission, 148
Emerging Infectious Diseases, 148
Weapons of Bioterrorism, 149
Types of Pathogenic Organisms, 149
Bacteria, 149
Viruses, 150
Fungi, 151
Parasites, 152
9 Inflammation and Immunity, 158
Jacquelyn
L. Banasik
COMPONENTS OF THE IMMUNE
SYSTEM, 159
Epithelial Barriers, 159
Mononuclear Phagocyte System, 159
Lymphoid System, 160
Primary Lymphoid Organs, 160
Secondary Lymphoid Organs, 161
Leukocytes, 162
Neutrophils, 162
Eosinophils, 163
Basophils and Mast Cells, 164
Monocytes and Macrophages, 164
Dendritic Cells, 165
Lymphocytes, 165
Chemical Mediators of Immune Function, 167
Complement, 167
Kinins, 169
Clotting Factors, 169
Cytokines and Chemokines, 169
INNATE DEFENSES AND INFLAMMATION, 169
Inflammation, 171
Increased Vascular Permeability, 171
Emigration of Leukocytes, 172
Phagocytosis, 172
Chronic Inflammation, 174
Healing, 174
Inflammatory Exudates, 175
Systemic Manifestations of Inflammation, 175
SPECIFIC ADAPTIVE IMMUNITY, 176
Major Histocompatibility Complex, 176
Antigen Presentation by MHC, 176
MHC Class I Presentation, 177
MHC Class II Presentation, 177
Mechanisms of Cell-Mediated Immunity, 178
T Helper Cells (CD4+ ), 178
Cytotoxic T Cells (CD8+ ), 181
Mechanisms of Humoral Immunity, 181
Antigen Recognition by B Cells, 181
Antibody Structure, 183
Class Switching and Affinity Maturation, 185
Antibody Functions, 186
Passive and Active Immunity, 187
Passive Immunity, 187
Active Immunity, 187
INTEGRATED FUNCTION AND REGULATION OF THE IMMUNE SYSTEM, 189
Integrated Response to Microbial Antigen, 189
Integrated Response to Viral Antigen, 191
Regulation of Immune Function, 192
10 Alterations in Immune Function, 194
Faith Young Peterson
EXCESSIVE IMMUNE RESPONSES, 195
Autoimmunity, 195
Genetic Factors, 196
Environmental Triggers, 196
Pharmacotherapies, 197
Hypersensitivity, 198
Type I Hypersensitivity, 199
Type IIa Hypersensitivity, 201
Type IIb Hypersensitivity, 204
Type III Hypersensitivity, 204
Type IV Hypersensitivity, 207
DEFICIENT IMMUNE RESPONSES,
210
Primary Immunodeficiency Disorders, 210
B-Cell and T-Cell Combined Disorders, 210
T-Cell Disorders, 211
B-Cell Disorders, 212
Secondary Immunodeficiency Disorders, 212
11 Malignant Disorders of White Blood Cells, 215
Marie L. Kotter and Jacquelyn L. Banasik
Classification of Hematologic Neoplasms, 215
Etiology of Myeloid and Lymphoid Neoplasms, 216
General Principles of Management, 217
Diagnosis of Hematologic Neoplasms, 217
Principles of Treatment, 218
Prevention and Management of Complications, 219
Myeloid Neoplasms, 221
Chronic Myeloid Leukemia, 221
Acute Myeloid Leukemia, 222
Lymphoid Neoplasms, 223
Chronic Lymphoid Leukemia, 223
Acute Lymphoblastic Leukemia/Lymphoma, 223
Hairy Cell Leukemia, 224
Plasma Cell Myeloma (Multiple Myeloma), 224
Hodgkin Disease, 227
B-Cell, T-Cell, and NK-Cell Lymphoma
(Non-Hodgkin), 229
12 HIV Disease and AIDS, 233
Faith Young Peterson
Epidemiology, 234
History, 234
Types of HIV, 234
Transmission, 236
Prevention of Transmission, 238
Etiology, 239
HIV Structure, 239
HIV Binding and Infection, 239
Pathogenesis, 242
Effect of HIV on Immune Cells at the Cellular
Level, 242
Viral Production and Cell Death, 242
Progression of HIV Infection From Seroconversion
to AIDS, 244
CDC HIV Classification System, 245
Diagnostic Testing, 245
Monitoring the Progression of HIV, 246
Clinical Manifestations, 248
Systemic Manifestations, 248
Gastrointestinal Manifestations, 249
Pulmonary Manifestations, 249
Mucocutaneous Manifestations, 250
Gynecologic Manifestations, 251
Neurologic Manifestations, 252
Ocular Manifestations, 253
Cardiovascular Manifestations, 253
Manifestations in Other Systems, 253
Manifestations in Children, 254
Treatment, 254
Antiretroviral Therapy Recommendations, 254
Nucleoside Reverse Transcriptase Inhibitors, 255
Nucleotide Reverse Transcriptase Inhibitors, 255
Nonnucleoside Reverse Transcriptase
Inhibitors, 255
Protease Inhibitors, 257
Fusion Inhibitors, 257
CCR5 Inhibitors, 257
Integrase Strand Transfer Inhibitors, 257
Other Treatments and Vaccines, 257
UNIT IV Oxygen Transport, Blood Coagulation, Blood Flow, and Blood Pressure
13 Alterations in Oxygen Transport, 259
Susan G. Trevithick
Composition of Blood, 260
Organic and Inorganic Components, 261
Cellular Components, 261
Structure and Function of Red Blood Cells, 262
Hematopoiesis, 263
Hemoglobin Synthesis, 265
Nutritional Requirements for Erythropoiesis, 266
Energy and Maintenance of Erythrocytes, 267
Red Cell Production, 267
Red Cell Destruction, 268
Gas Transport and Acid–Base Balance, 268
Oxygen Transport, 268
Carbon Dioxide Transport, 270
Alterations in Oxygen Transport, 270
Anemia, 272
General Effects of Anemia, 272
Anemia Related to Decreased Red Cell
Production, 277
Aplastic Anemia, 277
Anemia of Chronic Renal Failure, 277
Anemia Related to Vitamin B12 (Cobalamin)
or Folate Deficiency, 278
Iron Deficiency Anemia, 279
Anemia Related to Inherited Disorders of the Red
Cell, 279
Thalassemia, 279
Sickle Cell Anemia, 281
Hereditary Spherocytosis, 282
Glucose-6-Phosphate Dehydrogenase
Deficiency, 282
Anemia Related to Extrinsic Red Cell Destruction or Loss, 284
Hemolytic Disease of the Newborn, 284
Antibody-Mediated Drug Reactions, 284
Acute Blood Loss, 285
Other Extrinsic Abnormalities, 285
Transfusion Therapy, 286
Polycythemia, 286
Polycythemia Vera, 286
Secondary Polycythemia, 292
Relative Polycythemia, 293
14 Alterations in Hemostasis and Blood Coagulation, 298
Cheryl Rockwell
The Process of Hemostasis, 298
Stages of Hemostasis, 298
Platelets, 299
Blood Coagulation Factors, 299
Fibrin Clot, 299
Fibrinolysis, 301
Evaluation of Hemostasis and Coagulation, 301
Clinical Assessment, 301
Laboratory Tests, 304
Vascular and Platelet Disorders, 304
Vascular Disorders, 304
Platelet Disorders, 306
Coagulation Disorders, 308
15 Alterations in Blood Flow, 313
Teresa Grigsby Loftsgaarden
Organization of the Circulatory and Lymphatic Systems, 315
Vessel Structure, 315
Lymphatic Structure, 317
Principles of Flow, 317
Hemodynamics of the Circulatory System, 317
Control of Flow, 322
Control of Blood Flow, 322
Control of Lymphatic Flow, 323
General Mechanisms That Cause Altered Flow, 323
Blood Vessels: Obstructions, 323
Blood Vessels: Structural Alterations, 325
Lymphatic Vessels, 326
Alterations in Arterial Flow, 326
Arteriosclerosis/Atherosclerosis, 326
Thromboangiitis Obliterans (Buerger Disease), 330
Raynaud Syndrome, 330
Aneurysms, 330
Acute Arterial Occlusion, 331
Alterations in Venous Flow, 332
Valvular Incompetence, 332
Varicose Veins, 332
Chronic Venous Insufficiency, 333
Deep Vein Thrombosis, 333
Alterations in Lymphatic Flow, 333
Lymphedema, 333
16 Alterations in Blood Pressure, 337
Benjamin J. Miller
Arterial Blood Pressure, 337
Determinants of Systemic Blood Pressure, 337
Measurement of Blood Pressure, 338
Mechanisms of Blood Pressure Regulation, 341
Short-Term Regulation of Systemic Blood Pressure, 341
Long-Term Regulation of Systemic Blood Pressure, 341
Normal
Fluctuations in Systemic Blood Pressure, 343
Hypertension, 343
Definition and Classification, 343
Primary Hypertension, 344
Secondary Hypertension, 348
Hypertensive Emergencies and Urgency, 349
Low Blood Pressure, 350
UNIT V Cardiac Function
17 Cardiac Function, 354
Jacquelyn L. Banasik
Cardiovascular Anatomy, 355
Heart, 355
Circulatory System, 356
Cardiac Cycle, 358
Isovolumic Contraction, 359
Ventricular Ejection, 360
Isovolumic Relaxation, 360
Atrial Events, 360
Aortic and Pulmonary Artery Events, 360
Coronary Circulation, 360
Anatomy of the Coronary Vessels, 360
Regulation of Coronary Blood Flow, 361
Cardiac Myocytes, 363
Myocyte Structure, 363
Structure of the Contractile Apparatus, 363
Characteristics of Contractile Filaments, 365
Molecular Basis of Contraction, 366
Overview of Contraction, 366
Sliding Filament/Cross-Bridge Theory of Muscle
Contraction, 366
Role of Calcium in Muscle Contraction, 367
Energy of Muscle Relaxation, 367
Cardiac Energy Metabolism, 368
Oxygen Utilization, 368
Substrate Utilization, 369
Cardiac Electrophysiology, 369
Cardiac Resting Potential, 369
Cardiac Action Potential, 369
Rhythmicity of Myocardial Cells, 370
Specialized Conduction System of the Heart, 371
Autonomic Regulation of Rhythmicity, 372
Electrocardiography, 372
Determinants of Cardiac Output, 374
Determinants of Heart Rate, 374
Determinants of Stroke Volume, 375
Cardiac Workload, 376
Endocrine Function of the Heart, 376
Tests of Cardiac Function, 376
Electrocardiography, 376
Magnetic Resonance Imaging and Computed
Tomography, 378
Echocardiography, 378
Nuclear Cardiography, 379
Cardiac Catheterization/Coronary
Angiography, 379
18 Alterations in Cardiac Function, 382
Jacquelyn L. Banasik
Coronary Heart Disease, 383
Etiology of Coronary Heart Disease, 383
Risk Factors and Mechanisms of Coronary
Atherosclerosis, 383
Pathophysiology of Ischemia, 385
Clinical Features and Management of Coronary Syndromes, 388
Endocardial and Valvular Diseases, 394
Disorders of the Mitral Valve, 394
Disorders of the Aortic Valve, 397
Diseases of the Endocardium, 398
Myocardial Diseases, 399
Myocarditis, 399
Cardiomyopathy, 400
Pericardial Diseases, 402
Pericardial Effusion, 402
Pericarditis, 402
Congenital Heart Diseases, 403
Embryologic Development, 403
Etiology and Incidence of Congenital Heart
Disease, 404
Pathophysiology of Congenital Heart
Disease, 405
Acyanotic Congenital Defects, 406
Cyanotic Congenital Defects, 408
19 Heart Failure and Dysrhythmias: Common Sequelae of
Cardiac Diseases, 411
Benjamin J. Miller and Jacquelyn L. Banasik Heart Failure, 412
Pathogenesis and Diagnosis, 412
Compensatory Mechanisms, Remodeling, and Progression, 413
Clinical Manifestations, 417
Class and Stage of Heart Failure, 420
Treatment, 421
Cardiac Dysrhythmias, 421
Dysrhythmia Mechanisms, 421
Dysrhythmia Analysis, 423
Abnormal Rates of Sinus Rhythm, 424
Abnormal Site of Impulse Initiation, 425
Conduction Pathway Disturbances, 428
Treatment, 431
20 Shock, 434
Benjamin J. Miller
Pathogenesis of Shock, 434
Impaired Tissue Oxygenation, 435
Compensatory Mechanisms and Stages of Shock, 437
Types of Shock, 439
Cardiogenic Shock, 439
Obstructive Shock, 441
Hypovolemic Shock, 442
Distributive Shock, 443
Assessment and Hemodynamic Monitoring, 447
Cardiac Output, 447
Arterial Oxygen Content, 447
Distribution of Blood Flow, 448
Hemodynamic Monitoring, 448
Complications of Shock, 449
Acute Respiratory Distress Syndrome, 449
Disseminated Intravascular Coagulation, 449
Acute Renal Failure, 449
Multiple Organ Dysfunction Syndrome, 449
UNIT VI Respiratory Function
21 Respiratory Function and Alterations in Gas Exchange, 451
Lorna L. Schumann
Functional Anatomy, 452
Development of the Pulmonary System, 452
Upper Airway Structures, 452
Lower Airway Structures, 453
Pulmonary Circulation, 457
Age-Related Variations, 457
Ventilation, 460
Lung Volumes and Capacities, 460
Dead Space, 460
Minute Ventilation, 460
Alveolar Ventilation/Oxygenation, 461
Mechanics of Breathing, 461
Airway Resistance, 461
Lung Compliance, 462
Distribution of Ventilation, 462
Neurologic Control of Ventilation, 462
Pulmonary Blood Flow, 465
Pulmonary Vasculature, 465
Distribution of Blood Flow, 465
Ventilation–Perfusion Ratios, 465
Hypoxic Vasoconstriction, 466
Diffusion and Transport of Respiratory Gases, 466
Barriers to Diffusion, 466
Oxygen Transport, 467
Carbon Dioxide Transport, 467
Alterations in Pulmonary Function, 468
Hypoventilation and Hyperventilation, 468
Hypoxemia and Hypoxia, 468
Acute Respiratory Failure, 469
Diagnostic Tests, 471
Pulmonary Function Testing, 471
Bronchial Provocation Tests, 472
Alterations in Pulmonary Vasculature, 472
Pulmonary Hypertension, 472
Pulmonary Venous Thromboembolism, 473
Pulmonary Malignancies, 475
Etiology, 475
Pathogenesis, 475
Clinical Manifestations, 476
Diagnosis, 476
Treatment, 476
22 Obstructive Pulmonary Disorders, 478
Benjamin J. Miller and Lorna L. Schumann
Obstruction From Conditions in the Wall of the
Lumen, 479
Asthma, 479
Acute Bronchitis, 483
Chronic Bronchitis, 485
Obstruction Related to Loss of Lung
Parenchyma, 488
Emphysema, 488
Obstruction of the Airway Lumen, 491
Bronchiectasis, 491
Bronchiolitis, 493
Cystic Fibrosis, 494
Acute Tracheobronchial Obstruction, 495
Epiglottitis, 496
Croup Syndrome, 496
23 Restrictive Pulmonary Disorders, 499
Lorna L. Schumann and Benjamin J. Miller
Lung Parenchyma Disorders, 500
Fibrotic Interstitial Lung Diseases, 500
Atelectatic Disorders, 504
Pleural Space Disorders, 508
Neuromuscular, Chest Wall, and Obesity
Disorders, 511
Neuromuscular Disorders, 511
Chest Wall Deformities, 511
Disorders of Obesity, 513
Infection or Inflammation of the Lung, 514
UNIT VII Fluid, Electrolyte, and Acid-Base
Homeostasis
24 Fluid and Electrolyte Homeostasis and Imbalances, 521
Linda Felver
Body Fluid Homeostasis, 522
Fluid Intake and Absorption, 522
Fluid Distribution, 523
Fluid Excretion, 524
Fluid Loss Through Abnormal Routes, 524
Fluid Imbalances, 525
Extracellular Fluid Volume, 525
Body Fluid Concentration, 526
Both Volume and Concentration, 528
Interstitial Fluid Volume, 528
Principles of Electrolyte Homeostasis, 529
Electrolyte Intake and Absorption, 529
Electrolyte Distribution, 531
Electrolyte Excretion, 531
Electrolyte Loss Through Abnormal Routes, 531
Electrolyte Imbalances, 531
Plasma Potassium, 531
Plasma Calcium, 533
Plasma Magnesium, 534
Plasma Phosphate, 535
25 Acid–Base Homeostasis and Imbalances, 541
Linda Felver
Acid–Base Homeostasis, 541
Buffers, 542
Respiratory Contribution, 542
Renal Contribution, 543
Acid–Base Imbalances, 545
Mixed Acid–Base Imbalances, 549
UNIT VIII Renal and Bladder Function
26 Renal Function, 551
Jacquelyn L. Banasik
Renal Anatomy, 552
Renal Parenchyma, 552
Renal Lymphatics and Innervation, 552
Renal Blood Supply, 553
Overview of Nephron Structure and Function, 554
Glomerulus, 555
Proximal Convoluted Tubule, 557
Loop of Henle, 558
Distal Convoluted Tubule, 559
Collecting Duct, 559
Regulation of Glomerular Filtration, 560
Physics of Filtration, 560
Factors Affecting Filtration Pressure, 562
Tubuloglomerular Feedback, 563
Effects of Glucose and Amino Acids, 563
Role of Mesangial Cells, 564
Transport Across Renal Tubules, 565
Reabsorption of Glucose, 565
Regulation of Acid–Base Balance, 565
Secretion of Potassium, 566
Regulation of Blood Volume and Osmolality, 567
Antidiuretic Hormone, 567
Aldosterone, Angiotensin II, Natriuretic
Peptides, Urodilatin, Uroguanylin, and
Guanylin, 568
Diuretic Agents, 569
Endocrine Functions, 570
Erythropoietin, 570
Vitamin D, 570
Age-Related Changes in Renal Function, 570
Infant, 570
Adult and Elderly, 570
Tests of Renal Structure and Function, 570
Urine and Blood Studies, 570
Diagnostic Tests, 572
27 Intrarenal Disorders, 575
Jacquelyn L. Banasik and Roberta J. Emerson
Common Manifestations of Kidney Disease, 575
Pain, 575
Abnormal Urinalysis Findings, 576
Other Diagnostic Tests, 576
Congenital Abnormalities, 577
Renal Agenesis and Hypoplasia, 577
Cystic Kidney Diseases, 578
Neoplasms, 579
Infection, 581
Obstruction, 583
Glomerular Disorders (Glomerulopathies), 586
Glomerulonephritis, 587
Nephrotic Syndrome, 589
28 Acute Kidney Injury and Chronic Kidney Disease, 593
Cheryl Rockwell and Robin Y. Beeman
Acute Kidney Injury, 593
Etiology and Pathophysiology, 594
Clinical Presentation of Acute Kidney Injury, 596
Chronic Kidney Disease, 601
Risk Factors, 601
Pathophysiology of Progression of Chronic
Kidney Disease, 602
Stages of Chronic Kidney Disease, 602
Complications of Chronic Kidney Disease, 602
Clinical Management, 604
29 Disorders of the Lower Urinary Tract, 609
Cheryl L. Brandt
Lower Urinary Tract, 609
Functional Anatomy, 609
Physiology of Micturition, 610
Diagnostic Tests, 611
Lower Urinary Tract Symptoms and Syndromes, 611
Neurogenic Bladder, 614
Congenital Disorders, 615
Neoplasms, 617
Inflammation and Infection, 619
Obstruction, 622
Lower Urinary Tract Calculi, 622
UNIT IX Genital and Reproductive Function
30 Male Genital and Reproductive Function, 626
Marvin Van Every
Anatomy, 626
Upper Genitourinary Tract, 626
Lower Genitourinary Tract, 627
Auxiliary Genital Glands, 628
External Genitalia, 629
Embryology, 632
Nephric System, 632
Vesicourethral Unit, 633
Gonads, 633
Genital Duct System, 633
External Genitalia, 633
Male Reproductive Physiology, 633
Hypothalamic-Pituitary-Testicular Axis, 633
Spermatogenesis, 637
Anatomy of Spermatozoa, 637
Transport of Spermatozoa, 637
31 Alterations in Male Genital and Reproductive Function, 641
Marvin Van Every
Disorders of the Penis and Male Urethra, 641
Congenital Anomalies, 641
Acquired Disorders, 643
Infectious Disorders, 645
Neoplastic Disorders, 647
Disorders of the Scrotum and Testes, 647
Congenital Disorders, 647
Acquired Disorders, 648
Infectious Disorders, 650
Neoplastic Disorders, 650
Disorders of the Prostate, 651
32 Female Genital and Reproductive Function, 656
Rosemary A. Jadack
Reproductive Structures, 656
Organization of the Female Reproductive
Organs, 656
Menstrual Cycle, 659
Breast, 662
Structure of the Breast, 662
Breast Development, 662
Lactation, 663
Pregnancy, 663
Early Human Development, 663
Implantation, 663
Fetal Membranes and Placenta, 663
Development of the Human Embryo and Fetus, 664
Parturition, 665
Response of the Mother’s Body to Pregnancy, 667
Menopause, 668
33 Alterations in Female Genital and Reproductive
Function, 671
Rosemary A. Jadack
Menstrual Disorders, 672
Alterations in Uterine Position and Pelvic
Support, 674
Inflammation and Infection of the Female
Reproductive Tract, 676
Benign Growths and Aberrant Tissue of the Female
Reproductive Tract, 678
Cancer of the Female Genital Structures, 679
Disorders of Pregnancy, 681
Disorders of the Breast, 682
Reactive-Inflammatory Breast Disorders, 682
Benign Breast Disorders, 683
Malignant Disorder of the Breast, 684
34 Sexually Transmitted Infections, 689
Rosemary A. Jadack
Urethritis, Cervicitis, Salpingitis, and Pelvic
Inflammatory Disease, 690
Diseases With Systemic Involvement, 691
Diseases With Localized Lesions, 694
Ulcerative Lesions, 694
Nonulcerative Lesions, 694
Enteric Infections, 695
UNIT X Gastrointestinal Function
35 Gastrointestinal Function, 697
Jeffrey S. Sartin
Structure and Organization of the Gastrointestinal
Tract, 698
Embryology, 698
Functional Anatomy, 699
Gastrointestinal Motility, 704
Characteristics of the Intestinal Wall, 704
Neural Control, 704
Hormonal Control, 706
Movement in the Gastrointestinal Tract, 706
Movement of Nutrients, 707
Secretory Function, 712
Secretion of Gastrointestinal Juices, 712
Gastrointestinal Hormones, 712
Digestion and Absorption, 712
Digestion of Carbohydrates, 713
Digestion of Lipids, 713
Digestion of Proteins, 714
Absorption, 715
Gastrointestinal Function Across the Life
Span, 717
Maturation, 717
Age-Related Changes, 717
36 Gastrointestinal Disorders, 720
Jeffrey S. Sartin
Manifestations of Gastrointestinal Tract
Disorders, 721
Dysphagia, 721
Esophageal Pain, 721
Abdominal Pain, 721
Vomiting, 723
Intestinal Gas, 723
Alterations in Bowel Patterns, 723
DISORDERS OF THE MOUTH AND ESOPHAGUS, 724
Oral Infections, 724
Esophageal Disorders, 724
ALTERATIONS IN THE INTEGRITY OF THE GASTROINTESTINAL TRACT
WALL, 726
Inflammation of the Stomach and
Intestines, 726
Inflammatory Bowel Disease, 728
Enterocolitis, 731
ALTERATIONS IN MOTILITY OF THE
GASTROINTESTINAL TRACT, 733
Motility Disorders, 733
Disorders of Malabsorption, 735
Mucosal Disorders, 735
Malabsorption Disorders After Surgical
Intervention, 735
NEOPLASMS OF THE
GASTROINTESTINAL
TRACT, 737
Esophageal, Gastric, and Small Intestinal
Cancers, 737
Colonic Polyps and Colon Cancer, 738
Psychosocial Aspects of Gastrointestinal
Disorders, 739
Stress of Lifestyle Changes, 739
37 Alterations in Function of the Gallbladder and Exocrine Pancreas, 742
Jeffrey S. Sartin
Structure and Function of the Pancreaticobiliary System, 742
Embryology of the Pancreaticobiliary System, 743
Physiology of Bile, 743
Functional Anatomy of the Pancreas, 744
Disorders of the Gallbladder, 744
Pathophysiology of Cholesterol Gallstone
Formation, 744
Cholelithiasis and Cholecystitis, 745
Disorders of the Pancreas, 748
Pancreatitis, 748
38 Liver Diseases, 754
Jeffrey S. Sartin
Structure and Function of the Liver, 755
General Manifestations of Liver Disease, 755
Hepatocellular Failure, 755
Portal Hypertension, 759
Portal Systemic Encephalopathy, 763
Complications of Advanced Liver
Disease, 764
Disorders of the Liver, 767
Hepatitis, 767
Chronic Hepatitis, 772
Cirrhosis, 773
Alcoholic Liver Disease, 773
Toxic Liver Disorders, 774
Metal Storage Diseases, 774
Toxic Metabolic Agents, 775
Other Structural Liver Conditions, 775
Transplantation, 776
Evaluation of the Transplantation
Patient, 777
Posttransplantation Management, 777
Age-Related Liver Disorders, 778
Liver Diseases and Pediatric Considerations, 778
Abnormal Bilirubin Metabolism in the Neonatal Period, 778
Infectious and Acquired Hepatitides in Children, 778
Congenital Liver Disease, 779
Liver Diseases and Geriatric Considerations, 780
UNIT XI Endocrine Function, Metabolism, and Nutrition
39 Endocrine Physiology and Mechanisms of Hypothalamic-Pituitary Regulation, 783
Jacquelyn L. Banasik
Hormone Structure and Action, 784
Chemical Structure of Hormone Classes, 784
Mechanisms of Hormone Action, 784
Hormone Regulation, 786
Hormone Synthesis, Secretion, and Metabolism, 786
Regulation of Receptor Responses, 787
Hypothalamic-Pituitary Endocrine System, 788
Hormones of the Posterior Pituitary Gland, 788
Hormones of the Hypothalamus and Anterior
Pituitary Gland, 790
Thyroid Hormones, 793
Thyroid Hormone Synthesis and Secretion, 793
Thyroid Action on Target Cells, 793
Steroid Hormones, 794
Steroid Hormone Synthesis and Secretion, 794
Steroid Action on Target Cells, 795
Categories of Endocrine Disease, 797
Hyposecretion, 797
Hypersecretion, 797
Hyporesponsiveness, 797
40 Disorders of Endocrine Function, 799
Jacquelyn L. Banasik
Basic Concepts of Endocrine Disorders, 799
Etiology of Endocrine Disorders, 799
Classification of Endocrine Disorders, 800
Growth Hormone Disorders, 801
Thyroid Hormone Disorders, 803
Adrenocortical Hormone Disorders, 806
Adrenal Medulla Disorder, 810
Parathyroid Gland Disorders, 811
Regulation and Actions of Parathyroid
Hormone, 811
Antidiuretic Hormone Disorders, 812
41 Diabetes Mellitus, 815
Benjamin J. Miller
Regulation of Glucose Metabolism, 816
Hormonal Regulation, 816
Neural Regulation, 817
Exercise, 818
Stress, 818
Glucose Intolerance Disorders, 820
Classification of Glucose Intolerance
Disorders, 820
Prediabetes, 820
Diabetes Mellitus, 821
Screening for Diabetes, 824
Clinical Manifestations and Complications, 825
Acute Hyperglycemia, 825
Diabetic Ketoacidosis, 825
Nonketotic Hyperglycemic Hyperosmolar Syndrome, 826
Chronic Hyperglycemia, 826
Vascular Complications, 826
Neuropathic Complications, 827
Complications in Pregnancy, 827
Treatment and Education, 827
Nutrition, 828
Obesity and Eating Disorders, 828
Exercise, 829
Pharmacologic Agents, 829
Stress Management, 831
Assessment of Efficacy, 831
Pediatric Considerations, 833
Goals of Therapy, 834
Acute Complications, 834
Chronic Complications, 834
Treatment, 834
Geriatric Considerations, 834
Goals of Therapy, 835
Acute Complications, 835
Chronic Complications, 835
Treatment, 835
42 Nutritional and Metabolic Disorders, 838
Brent A. Banasik
Metabolic Processes, 838
Anabolism and Catabolism, 839
Metabolic Rate, 839
Nutrient Metabolism, 839
Carbohydrates, 839
Lipids, 840
Proteins, 841
Regulation of Appetite and Nutrient
Metabolism, 841
Role of Genetics, Epigenetics, and
Environment, 841
Hormonal Regulation of Nutrient Intake and Appetite, 842
Hormonal Regulation of Nutrient Storage, Distribution, and Metabolism, 843
Obesity and Metabolic Syndrome, 844
Obesity, 844
Metabolic Syndrome, 844
Metabolic Responses to Starvation and Physiologic
Stress, 844
Starvation and Protein-Energy Malnutrition, 845
Physiologic Stress, 845
Nutritional Considerations for Aging and Altered
Health States, 846
Aging, 846
Infection, Sepsis, and Fever, 846
Surgery, 848
Trauma, 848
Burns, 848
Cancer, 848
Immobility, 848
UNIT XII Neural Function
43 Structure and Function of the Nervous System, 850
Jacquelyn L. Banasik
STRUCTURAL ORGANIZATION, 851
Central Nervous System, 851
Support and Protection of the Central Nervous System, 851
The Brain, 853
The Spinal Cord, 861
Peripheral Nervous System, 863
Cranial Nerves, 863
Spinal Nerves, 864
Autonomic Nervous System, 867
NEURONAL STRUCTURE AND FUNCTION, 868
Neurons and Supportive Cells, 868
Neurons, 868
Glia, 868
Neuronal Communication, 872
Membrane Potentials, 872
Synaptic Transmission, 874
Neurotransmitters, 875
Neuronal Circuits, 880
Neural Development, Aging, and Injury, 880
Development, 880
Aging, 881
Injury, 881
SENSORY FUNCTION,
882
Sensory Receptors, 882
Sensory Pathways, 883
Somatosensory Cortex, 883
MOTOR FUNCTION, 883
Motor Neurons, 884
Spinal Reflexes, 884
Central Control of Motor Function, 885
CONSCIOUSNESS, MEMORY, AND SLEEP, 886
Consciousness and Memory, 886
Sleep, 888
44 Acute Disorders of Brain Function, 891
Joni D. Marsh and Jacquelyn L. Banasik
Mechanisms of Brain Injury, 892
Ischemia and Hypoxia, 892
Increased Intracranial Pressure, 895
Manifestations of Brain Injury, 900
Level of Consciousness, 900
Glasgow Coma Scale, 900
Cranial Nerve Reflexes, 901
TRAUMATIC BRAIN INJURY, 902
Epidemiology, 902
Types of Traumatic Brain Injury, 903
Primary Injury, 903
Intracranial Hematomas, 903
Secondary Injury, 905
Treatment, 905
CEREBROVASCULAR DISEASE AND STROKE, 905
Epidemiology, 906
Ischemic Stroke, 906
Hemorrhagic Stroke, 906
Treatment, 906
Stroke Sequelae, 908
Motor and Sensory Deficits, 908
Language Deficits, 908
Cognitive Deficits, 908
CREBRAL ANEURYSM AND ARTERIOVENOUS
MALFORMATION, 909
Cerebral Aneurysm, 909
Etiology, 909
Pathogenesis and Manifestations, 910
Treatment, 910
Arteriovenous Malformation, 911
Etiology, 911
Pathogenesis and Manifestations, 911
Treatment, 911
CENTRAL NERVOUS SYSTEM INFECTIONS, 911
Meningitis, 911
Etiology, 911
Pathogenesis and Clinical Manifestations, 911
Treatment, 911
Encephalitis, 912
Etiology, 912
Pathogenesis and Manifestations, 912
Treatment, 912
Brain Abscess, 912
Etiology, 912
Pathogenesis and Manifestations, 912
Treatment, 913
45 Chronic Disorders of Neurologic Function, 915
Joni D. Marsh
Brain and Cerebellar Disorders, 916
Seizure Disorder, 916
Dementia, 918
Parkinson Disease, 920
Cerebral Palsy, 922
Hydrocephalus, 923
Cerebellar Disorders, 924
Spinal Cord and Peripheral Nerve Disorders, 925
Multiple Sclerosis, 925
Spina Bifida, 927
Amyotrophic Lateral Sclerosis, 928
Spinal Cord Injury, 928
Guillain-Barré Syndrome, 931
Bell Palsy, 932
46 Alterations in Special Sensory Function, 936
Joni D. Marsh
HEARING AND BALANCE, 937
Structure and Function of the Ear, 937
External Ear, 937
Middle Ear, 937
Inner Ear, 937
Balance, 938
General Manifestations of Hearing Impairment, 938
Hearing Impairment Disorders, 939
Conductive Hearing Impairment, 939
Sensorineural Hearing Impairment, 939
Otitis Media, 941
Interventions for Individuals With Hearing
Impairment, 942
VISION, 942
Structure of the Eye, 942
Visual Pathways, 943
General Manifestations of Visual Impairment, 944
Disorders of the Eye, 944
Errors of Refraction, 944
Age-Related Disorders, 945
Retinopathy, 947
Glaucoma, 948
Visual Field Deficits, 950
Interventions for Individuals With Vision
Impairment, 950
SMELL AND TASTE, 952
47 Pain, 955
Joni D. Marsh
Physiology of Pain, 955
Transduction, 956
Transmission, 956
Perception, 958
Modulation, 958
TYPES OF PAIN, 960
Acute Pain, 961
Headache, 962
Chronic Pain, 962
Fibromyalgia Syndrome, 963
Cancer-Related Pain, 964
Neuropathic Pain, 964
Trigeminal Neuralgia, 965
Diabetic Neuropathy, 965
Postherpetic Neuralgia, 966
Ischemic Pain, 966
Referred Pain, 966
Physiologic Responses to Pain, 967
Pain in the Young and the Elderly, 967
TREATMENT MODALITIES, 967
Pharmacologic and Nonpharmacologic Pain
Management, 967
Interrupting Peripheral Transmission of Pain, 968
Modulating Pain Transmission at the Spinal Cord, 968
Altering the Perception and Integration of Pain, 968
UNIT XIII Neuropsychological Function
48 Neurobiology of Psychotic Illnesses, 971
Ann Futterman Collier and Samantha Cody Russell
Schizophrenia, 972
Etiology and Neurobiology, 972
Clinical Manifestations, 976
Pharmacologic Treatment, 976
Nonpharmacologic Treatment, 977
Major Depressive and Persistent Depressive Disorders, 978
Etiology and Neurobiology, 979
Clinical Manifestations, 980
Pharmacologic Treatment, 981
Nonpharmacologic Treatment, 981
Bipolar Disorder, 982
Etiology and Neurobiology, 982
Clinical Manifestations, 983
Pharmacologic Treatment, 983
Nonpharmacologic Treatment, 984
Population Considerations, 984
Women and Mental Illness, 984
Cultural Considerations, 984
Geriatric Considerations, 984
49 Neurobiology of Nonpsychotic Illnesses, 989
Ann Futterman Collier and Samantha Cody Russell
Anxiety Disorders, 989
Panic Disorder, 990
Generalized Anxiety Disorder, 991
Obsessive-Compulsive Disorder, 992
Posttraumatic Stress Disorder, 994
Neurodevelopmental Disorders, 995
Attention-Deficit/Hyperactivity Disorder, 996
Autism Spectrum Disorder, 997
UNIT XIV Musculoskeletal Support and Movement
50 Structure and Function of the Musculoskeletal System, 1001
Carol L. Danning
Structure and Function of Bone, 1002
Composition, 1002
Functional Properties, 1003
Response to Injury, Stress, and Aging, 1004
Structure and Function of Joints, 1006
Synarthroses, 1007
Diarthroses, 1007
Structure and Function of Articular Cartilage, 1011
Composition, 1011
Functional Properties, 1011
Response to Injury, Stress, and Aging, 1012
Structure and Function of Tendons and Ligaments, 1012
Composition, 1012
Functional Properties, 1013
Response to Injury, Stress, and Aging, 1013
Structure and Function of Skeletal Muscle, 1013
Composition, 1014
Mechanics of Muscle Contraction, 1015
Sliding Filament Theory, 1015
Role of Calcium, 1015
Electromechanical Coupling, 1015
Types of Muscle Contraction, 1016
Mechanical Principles, 1017
Response to Movement and Exercise, 1017
51 Alterations in Musculoskeletal Function: Trauma,
Infection, and Disease, 1020
Carol L. Danning
SOFT TISSUE INJURIES, 1021
Inert Soft Tissue Injuries, 1021
Ligament Injuries, 1021
Joint Capsule Injuries, 1022
Internal Joint Derangement, 1023
Injuries to Fasciae and Bursae, 1023
Injuries to Nerves, Nerve Roots, or Dura
Mater, 1023
Contractile Soft Tissue Injuries, 1023
Injury to Tendons, 1023
Muscle and Tendon Strains, 1024
Blunt Trauma, 1024
Compartment Syndrome, 1024
Soft Tissue Healing After Trauma, 1024
BONE INJURIES AND INFECTIONS, 1026
Bone and Joint Trauma, 1026
Types of Bone, 1026
Fracture, 1026
Dislocations and Subluxations, 1030
Infections of the Bone, 1031
Osteomyelitis, 1031
Tuberculosis, 1032
ALTERATIONS IN BONE STRUCTURE AND
MASS, 1032
Bone Structure Disorders, 1032
Scoliosis, 1032
Metabolic Bone Diseases, 1033
Osteoporosis, 1033
Rickets and Osteomalacia, 1035
Paget Disease, 1035
Bone Tumors, 1036
Benign Tumors, 1036
Malignant Bone Tumors, 1037
DISEASES OF SKELETAL MUSCLE, 1038
Idiopathic Inflammatory Myopathy, 1038
Polymyositis and Dermatomyositis, 1038
Muscular Dystrophy, 1039
Duchenne Muscular Dystrophy, 1039
Becker Muscular Dystrophy, 1039
Facioscapulohumeral Muscular Dystrophy, 1039
Myotonic Dystrophies, 1039
OTHER DISORDERS OF MUSCLE, 1039
Myasthenia Gravis, 1039
Treatment, 1039
Chronic Muscle Pain, 1040
Fibromyalgia Syndrome, 1040
52 Alterations in Musculoskeletal Function: Rheumatic Disorders, 1042
Carol L. Danning
Local Disorders of Joint Function, 1042
Osteoarthritis, 1042
Infectious Arthritis, 1045
Lyme Disease, 1045
Systemic Disorders of Joint Function, 1046
Immune-Mediated Disorders, 1046
Postinfectious Systemic Disorders, 1052
Joint Dysfunction Secondary to Other Diseases, 1053
Psoriatic Arthritis, 1053
Enteropathic Arthritis, 1053
Neuropathic Osteoarthropathy, 1054
Hemophilic Arthropathy, 1054
Gout, 1054
Adult-Onset Still Disease, 1055
Pediatric Joint Disorders, 1056
Nonarticular Rheumatism, 1056
Hypermobility of Joints, 1056
Juvenile Idiopathic Arthritis, 1056
UNIT XV Integumentary System
53 Alterations in the Integumentary System, 1058
Lee-Ellen C. Copstead, Ruth E. Diestelmeier, and
Michael R. Diestelmeier
Age-Related Changes, 1059
Epidermis, 1060
Dermis and Subcutaneous Tissue, 1060
Appendages, 1061
Evaluation of the Integumentary System, 1061
Primary and Secondary Lesions, 1061
Lesion Descriptors, 1062
Selected Skin Disorders, 1063
Infectious Processes, 1064
Viral Infections, 1064
Fungal Infections, 1065
Bacterial Infections, 1067
Inflammatory Conditions, 1069
Allergic Skin Responses, 1072
Parasitic Infestations, 1075
Other Disorders of the Dermis, 1076
Scleroderma, 1076
Sunburn and Photosensitivity, 1077
Ulcers, 1078
Altered Cell Growth: Epidermal Proliferation, 1078
Pigmentation Alterations, 1080
Special Characteristics of Dark Skin, 1081
Integumentary Manifestations of Systemic
Disease, 1083
Skin, 1083
Hair, 1084
Nails, 1084
Treatment Implications, 1086
Topical Treatment, 1086
Intralesional Injection, 1086
Selection of a Delivery System, 1087
Corticosteroids, 1087
Developmental Considerations, 1087
Infancy, 1087
Childhood Skin Disorders, 1088
Adolescence and Young Adulthood, 1090
Geriatric Considerations, 1090
54 Burn Injuries, 1093
Sarah Ogle and Nirav Patel
Thermal Injury, 1094
Etiology, Incidence, and Mortality, 1094
Risk Factors, 1094
Integument Effects, 1094
Depth Classification, 1096
Extent of Injury, 1097
Severity Classification, 1097
Acute Management, 1097
Assessment, 1099
Burn Shock and Acute Resuscitation, 1099
Organ Dysfunction, 1101
Metabolic Changes, 1102
Cellular Changes, 1102
Immune Response, 1103
Elements of Burn Injury Survival, 1103
Rehabilitation Phase, 1106
Electrical Injury, 1107
Incidence and Mortality, 1107
Pathophysiology, 1107
Management and Complications, 1108
Chemical Injury, 1109
Management and Complications, 1109
Common Agents and Treatment, 1109
Special Populations, 1110
Introduction, 1110
Glossary, 1114
Index, 1143
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