Pathophysiology: A Practical Approach

Halftitle Page
The Pedagogy
Title Page
Copyright Page
Contents
Preface
Acknowledgments
Reviewers
Introduction to Pathophysiology
Chapter 1 Cellular Function
	Basic Cell Function
		Exchanging Material
		Energy Production
		Replication and Differentiation
	Emerging Research: Stem Cells
	Tissue
		Epithelial Tissue
		Connective Tissue
		Muscle Tissue
		Nervous Tissue
	Cellular Adaptation and Damage
		Cellular Adaptation
		Cellular Injury and Death
	Neoplasm
		Benign and Malignant Tumors
		Clinical Manifestations
		Diagnosis
		Treatment
		Prognosis
	Genetic and Congenital Alterations
		Genetics
		Patterns of Inheritance
		Autosomal Dominant Disorders
			Marfan Syndrome
			Neurofibromatosis
		Autosomal Recessive Disorders
			Phenylketonuria
			Clinical Manifestations
		Sex-Linked Disorders
			Fragile X Syndrome
		Multifactorial Disorders
			Cleft Lip and Cleft Palate
		Chromosomal Disorders
			Trisomy 21
			Monosomy X
			Polysomy X
	Summary
	References
Chapter 2 Immunity
	Stress
		The Stress Response
	Immunity
	Innate Versus Adaptive Immunity
		Innate Immunity
			Barriers
			Inflammatory Response
			Pyrogens
			Interferons
			Complement Proteins
		Adaptive Defenses
			Cellular Immunity
			Humoral Immunity
		Immunity Across the Life Span
		Altered Immune Response
			Hypersensitivity
	Transplant Reactions
	Autoimmunity
		Systemic Lupus Erythematosus
		Immunodeficiency
	AIDS
	Developing a Strong Immune System
	Summary
	References
Chapter 3 Hematopoietic Function
	Normal Hematopoietic Function
		Hematopoiesis
		Hemostasis
		Lymphatic System
	Diseases of the White Blood Cells
		Neutropenia
		Infectious Mononucleosis
		Lymphomas
			Hodgkin’s Lymphoma
			Non-Hodgkin’s Lymphoma
		Leukemias
		Multiple Myeloma
	Diseases of the Red Blood Cells
		Anemia
			Iron-Deficiency Anemia
			Pernicious Anemia
			Aplastic Anemia
			Hemolytic Anemia
			Sickle Cell Anemia
			Thalassemia
		Polycythemia Vera
	Diseases of the Platelets
		Hemophilia
		Von Willebrand Disease
		Disseminated Intravascular Coagulation
		Immune Thrombocytopenic Purpura
		Thrombotic Thrombocytopenic Purpura
	Summary
	References
Chapter 4 Cardiovascular Function
	Anatomy and Physiology
		Heart
		Cardiac Cycle
		Conduction System
		Blood Pressure
		Blood Vessels
		Lymphatic System
	Understanding Conditions That Affect the Cardiovascular System
	Alterations Resulting in Decreased Cardiac Output
		Pericarditis
		Infective Endocarditis
		Myocarditis
		Valvular Disorders
		Cardiomyopathy
		Electrical Alterations
		Heart Failure
		Congenital Heart Defects
	Conditions Resulting in Ineffective Tissue Perfusion
		Aneurysms
		Dyslipidemia
		Atherosclerosis
		Peripheral Vascular Disease
		Coronary Artery Disease
		Thrombi and Emboli
		Varicose Veins
		Lymphedema
		Myocardial Infarction
	Conditions Resulting in Decreased Cardiac Output and Ineffective Tissue Perfusion
		Hypertension
		Shock
	Summary
	References
Chapter 5 Respiratory Function
	Anatomy and Physiology
		Age Considerations
		Upper Respiratory Tract Infections
			Infectious Rhinitis
			Rhinosinusitis
			Epiglottitis
			Laryngitis
			Laryngotracheobronchitis
			Influenza
			COVID-19
		Lower Respiratory Tract Infections
			Acute Bronchitis
			Bronchiolitis
			Pneumonia
			Tuberculosis
		Asthma
		Chronic Obstructive Pulmonary Disease
		Chronic Obstructive Bronchitis
		Emphysema
		Cystic Fibrosis
		Lung Cancer
		Pleural Effusion
		Pneumothorax
		Acute Respiratory Distress Syndrome
		Atelectasis
		Acute Respiratory Failure
	Summary
	References
Chapter 6 Fluid, Electrolyte, and Acid–Base Homeostasis
	Fluid Balance
		Distribution
		Fluid Movement
		Fluid Excess
		Fluid Deficit
	Electrolyte Balance
		Sodium
			Hypernatremia
			Hyponatremia
		Chloride
			Hyperchloremia
			Hypochloremia
		Potassium
			Hyperkalemia
			Hypokalemia
		Calcium
			Hypercalcemia
			Hypocalcemia
		Phosphorus
			Hyperphosphatemia
			Hypophosphatemia
		Magnesium
			Hypermagnesemia
			Hypomagnesemia
	Acid–Base Balance
		pH Regulation
		Buffers
		Respiratory Regulation
		Renal Regulation
		Compensation
		Metabolic Acidosis
		Metabolic Alkalosis
		Respiratory Acidosis
		Respiratory Alkalosis
		Mixed Disorders
		Arterial Blood Gas Interpretation
		Practice Arterial Blood Gas Interpretation
			Practice 1
			Practice 2
			Practice 3
			Practice 4
			Practice 5
			Practice 6
			Practice 7
			Practice 8
	Summary
	References
Chapter 7 Urinary Function
	LEARNING OBJECTIVES
	KEY TERMS
	FIGURE 7-1 The urinary system. (A) Anterior view showing the relationship of the kidneys,ureters, urinary bladder, and urethra. (B) A cross section of the human kidney showing thecortex, medulla, and renal pelvis.
	Anatomy and Physiology
		TABLE 7-1Anatomy and PhysiologyThe urinary system regulates fluid volume (see the Fluid, Electrolyte,and Acid–Base Homeostasis chapter), blood pressure (see theCardiovascular Function chapter), metabolic waste and drugexcretion, vitamin D conversion, pH balance (see the Fluid,Electrolyte, and Acid–Base Homeostasis chapter), and hormonesynthesis. The system includes the kidneys, ureters, bladder, andurethra (TABLE 7-1).Components of the Urinary System and TheirFunctions
		FIGURE 7-2 Urination.
		FIGURE 7-3 Nephrons of the kidney. Part of the nephron is located in the cortex, and part islocated in the medulla. The electron micrograph to the left of the illustration is of a glomerulusfrom a human nephron.
		FIGURE 7-4 The glomerulus of the kidneys. The nephron carries out three processes:glomerular filtration, tubular reabsorption, and tubular secretion. All three processes contributeto the filtering of the blood.
		TABLE 7-2FIGURE 7-4 The glomerulus of the kidneys. The nephron carries out three processes:glomerular filtration, tubular reabsorption, and tubular secretion. All three processes contributeto the filtering of the blood.DescriptionComponents of the Nephron and Their Functions
		FIGURE 7-5 Formation of urine.
		FIGURE 7-6 Effects of antidiuretic hormone and aldosterone on the kidneys.
			ADHlevels
			DecreasedADHlevels
			Increasedaldosteronelevels
		TABLE 7-3FIGURE 7-6 Effects of antidiuretic hormone and aldosterone on the kidneys.DescriptionCells continuously produce waste products as they carry out theirinternal processes (TABLE 7-3). To maintain homeostasis, the bodyremoves these waste products through urine formation. The threemost significant metabolic wastes that the kidneys manage areammonia, urea, and uric acid.Important Metabolic Wastes and SubstancesExcreted from the Body
		TABLE 7-4bacteria. Urine should be pale yellow and clear. Additional substancesand changes in color or clarity can indicate renal pathology (TABLE7-4). Multiple diagnostic tests can be performed to determinewhether the kidneys are functioning properly.Renal Function Tests
		FIGURE 7-7 Age-related changes in the kidneys.
		UNDERSTANDING CONDITIONS THATAFFECT THE URINARY SYSTEM
			application to practice
			application to practice
			application to practice
		Conditions Resulting in Altered Urinary Elimination
			Incontinence
				FIGURE 7-8 Types of incontinence.
				Learning Points
			Neurogenic Bladder
			Interstitial Cystitis/Bladder Pain Syndrome
				FIGURE 7-9 Interstitial cystitis.
			Congenital Disorders
			Urinary Tract Infections
			FIGURE 7-10 Pathogenesis of urinary tract infections (UTI). (A) Uncomplicated UTIs beginwhen uropathogens that reside in the intestines can colonize the urethra. (B) Iatrogenic UTI asa result of urinary catheterization.
			Urinary Tract Obstructions
				FIGURE 7-11 Urinary tract obstruction and hydronephrosis. Causes of urinary tractobstruction. Hydronephrosis, marked dilation of the renal pelvis and calyces with thinning ofparenchyma.
				Nephrolithiasis
					FIGURE 7-12 Renal calculi.
					TABLE 7-5FIGURE 7-12 Renal calculi.© Eskimo71/Dreamstime.comCalculi may contain various combinations of chemicals (TABLE 7-5). The most frequently encountered type of calculus contains calciumin combination with either oxalate (70%) or phosphate (15%). Othertypes of calculi include uric acid stones (10%), magnesium ammoniumphosphate (struvite) stones (3%), and cystine stones (2%). Thecalculi may be smooth or jagged, and they are usually yellow orbrown.Types of Renal Calculi
					Myth Busters
				Hydronephrosis
					FIGURE 7-13 Hydronephrosis.
			Tumors and Cysts
				Renal Cysts
				Wilms Tumor
					Emerging Research: Wilms Tumor
				Renal Cell Carcinoma
					FIGURE 7-14 Renal cell carcinoma.
				Bladder Cancer
					FIGURE 7-15 Bladder cancer.
					Emerging Research: Bladder Cancer
				Benign Prostatic Hyperplasia
					FIGURE 7-16 Urethra and prostate gland.
					Learning Points
		Conditions Resulting in Impaired Renal Function
			Polycystic Kidney Disease
				FIGURE 7-17 Polycystic Kidney Disease.
			Glomerular Diseases
				FIGURE 7-18 A simplified cross-sectional view illustrating the events leading to crescentformation. (A) Normal glomerulus. (B) Glomerular disease leads to gaps or holes in theglomerular basement membrane (GBM), resulting in (C) proliferation of parietal epithelial cellsand ultimately (D) fibrocellular crescent formation.
				Glomerulonephritis
					FIGURE 7-19 Glomerulonephritis.
					FIGURE 7-20 Nephrotic and nephritic syndrome.
				Nephrotic Syndrome
				Nephritic Syndrome
			Kidney Injury and Disease
				Acute Kidney Injury
				Chronic Kidney Disease
					Chronic kidney disease (CKD)
						FIGURE 7-21 Classifications of chronic kidney disease using glomerular filtration rate (GFR)and albumin clearance rate (ACR) categories.
						TABLE 7-6Clinical manifestations are complex and depend on the degree ofrenal function lost. These manifestations also reflect thecomplications associated with CKD (TABLE 7-6). In addition tocomplications resulting from declining functioning, increased albuminlevels have been associated with increased mortality, cardiovascularevents, and progressive CKD. As mentioned, CKD is oftenasymptomatic initially because the remaining nephrons compensatefor those lost to the disease. Clinical manifestations developinsidiously as 50% of the nephrons are destroyed. Thesemanifestations include the following signs and symptoms:Complications of Chronic Kidney Disease
						TABLE 7-7Diagnosis of CKD is often difficult because the initial symptoms arevague and nonspecific. Additionally, distinguishing CKD from AKI canbe challenging (TABLE 7-7). Diagnosis is based on KDIGO (2012a,2012b) criteria, and diagnostic procedures focus on identifying thedisease and any complications that have developed as a result of itsdevelopment. These procedures include a history, physicalexamination, urinalysis, quantitative urine protein, blood chemistry(especially electrolytes, creatinine, and BUN), CT, MRI, renalultrasound, biopsy, CBC, and arterial blood gases.Distinguishing Acute Kidney Injury from ChronicKidney Disease
	S U M M A R Y
	R E F E R E N C E S
Chapter 8 Reproductive Function
	KEY TERMS
	Anatomy and Physiology
		Normal Male Reproductive System
			FIGURE 8-1 The male reproductive system. (A) Organs of the male reproductive system. (B)Interior view of the testis. (C) Muscle layer and deep tissues of the scrotum.
			TABLE 8-1FIGURE 8-1 The male reproductive system. (A) Organs of the male reproductive system. (B)Interior view of the testis. (C) Muscle layer and deep tissues of the scrotum.DescriptionThe Male Reproductive System
			Penis
			FIGURE 8-2 Anatomy of the penis.
			FIGURE 8-3 Variations of the male genitalia.
			Scrotum
			Testes
			FIGURE 8-4 The hypothalamic–pituitary–testicular axis.
			Duct System
			Accessory Glands
		Normal Female Reproductive System
			FIGURE 8-5 Side view of the female reproductive system.
			Ovaries
			Fallopian Tubes
			Uterus
			Vagina
			External Genitalia
			Mammary Glands
	Congenital Disorders
		Epispadias
		Hypospadias
		Cryptorchidism
	Infertility Issues
		Erectile Dysfunction
		Phimosis
		Priapism
	Disorders of the Testes and Scrotum
		Hydrocele
		Spermatocele
		Varicocele
		Testicular Torsion
	Menstrual Disorders
		Abnormal Uterine Bleeding
		Amenorrhea
		Dysmenorrhea
		Premenstrual Syndrome
		Pelvic Organ Prolapse
		Vaginal Wall Prolapse
		Uterine and Apical Prolapse
	Disorders of the Uterus
		Endometriosis
		Leiomyomas
	Disorders of the Ovaries
		Ovarian Cysts
	Disorders of the Breasts
		Benign Breast Masses
		Mastitis
	Miscellaneous Infectious and Inflammatory Disorders
		Prostatitis
		Epididymitis
		Candidiasis
		Pelvic Inflammatory Disease
	Sexually Transmitted Infections
		Bacterial STIs
			Chlamydia
			Gonorrhea
			Syphilis
		Viral STIs
			Genital Herpes
			Condylomata Acuminata
		Protozoan STIs
			Trichomoniasis
	Cancers
		Penile Cancer
		Prostate Cancer
		Testicular Cancer
		Breast Cancer
		Cervical Cancer
		Endometrial Cancer
		Ovarian Cancer
	Summary
	References
Chapter 9 Gastrointestinal Function
	Anatomy and Physiology
		Upper Gastrointestinal Tract
		Liver
		Pancreas
		Lower Gastrointestinal Tract
		Gastrointestinal Changes Associated with Aging
		Disorders of the Upper Gastrointestinal Tract
			Congenital Defects
			Dysphagia
			Vomiting
			Hiatal Hernia
			Gastroesophageal Reflux Disease
			Gastritis
			Peptic Ulcers
			Cholelithiasis
		Disorders of the Liver
			Hepatitis
			Cirrhosis
			Nonalcoholic Fatty Liver Disease
		Disorders of the Pancreas
			Pancreatitis
		Disorders of the Lower Gastrointestinal Tract
			Diarrhea
			Constipation
			Intestinal Obstruction
			Appendicitis
			Peritonitis
			Celiac Disease
			Inflammatory Bowel Disease
			Irritable Bowel Syndrome
			Diverticular Disease
		Cancers
			Oral Cancer
			Esophageal Cancer
			Gastric Cancer
			Liver Cancer
			Pancreatic Cancer
			Colorectal Cancer
	Summary
	References
Chapter 10 Endocrine Function
	Anatomy and Physiology
		Hypothalamus and Pituitary Gland
		Pancreas
		Thyroid Gland
		Parathyroid Glands
		Adrenal Glands
		Disorders of the Pituitary Gland
			Hypopituitarism
			Hyperpituitarism
		Diabetes Mellitus
			Type 1 Diabetes
			Prediabetes
			Type 2 Diabetes
			Gestational Diabetes
			Diabetes Due to Other Causes
			Metabolic Syndrome
		Disorders of the Thyroid
			Goiter and Thyroid Nodules
			Hypothyroidism
			Hyperthyroidism
		Disorders of the Parathyroid Glands
			Hypoparathyroidism
			Hyperparathyroidism
		Disorders of the Adrenal Gland
			Pheochromocytoma
			Cushing Syndrome
			Addison’s Disease
	Summary
	References
Chapter 11 Neural Function
	Anatomy and Physiology
		Central Nervous System
		Peripheral Nervous System
		Autonomic Nervous System
		Congenital Neurologic Disorders
			Hydrocephalus
			Spina Bifida
			Cerebral Palsy
		Infectious Neurologic Disorders
			Meningitis
			Encephalitis
			Zika Virus Disease
		Traumatic Neurologic Disorders
			Brain Injuries
			Spinal Cord Injuries
		Vascular Neurologic Disorders
			Transient Ischemic Attack
			Cerebrovascular Accident
			Cerebral Aneurysm
		Headache Disorders
			Primary Headache Disorders
			Secondary Headache Disorders
		Seizure Disorders
		Chronic Degenerative Disorders
			Multiple Sclerosis
			Parkinson’s Disease
		Amyotrophic Lateral Sclerosis
			Myasthenia Gravis
			Huntington’s Disease
		Dementia
			Alzheimer’s Disease
			Vascular Dementia
			Dementia with Lewy Bodies
			Frontotemporal Dementia
			Creutzfeldt-Jakob Disease
			AIDS Dementia Complex
		Psychiatric Disorders
			Neurodevelopmental Disorders
			Schizophrenia Spectrum and Other Psychotic Disorders
			Bipolar and Related Disorders
			Depressive Disorders
			Anxiety Disorders
			Obsessive–Compulsive and Related Disorders
			Trauma- and Stress-Related Disorders
			Dissociative Disorders
			Somatic Symptom and Related Disorders
			Substance-Related and Addictive Disorders
			Feeding and Eating Disorders
			Gender Dysphoria
			Disruptive, Impulse-Control, and Conduct Disorders
			Personality Disorders
			Paraphilic Disorders
			Sleep Disorders
		Cancers of the Nervous System
			Brain Tumors
	Summary
	References
Chapter 12 Musculoskeletal Function
	Anatomy and Physiology
		Bones
		Muscles
		Congenital Musculoskeletal Disorders
			Kyphosis
			Lordosis
			Scoliosis
			Developmental Hip Dysplasia
			Osteogenesis Imperfecta
		Traumatic Musculoskeletal Disorders
			Fractures
			Dislocation
			Sprains
			Strains
			Herniated Intervertebral Disk
		Metabolic Bone Disorders
			Osteoporosis
			Rickets and Osteomalacia
			Paget’s Disease
		Inflammatory Joint Disorders
			Osteoarthritis
			Rheumatoid Arthritis
			Gout
			Ankylosing Spondylitis
		Chronic Muscle Disorders
			Muscular Dystrophy
			Fibromyalgia
		Bone Tumors
	Summary
	References
Chapter 13 Integumentary Function
	Anatomy and Physiology
		Congenital Integumentary Disorders
			Birthmarks
			Disorders of Melanin
		Integumentary Changes Associated with Aging
		Inflammatory Integumentary Disorders
			Contact Dermatitis
			Atopic Dermatitis
			Urticaria
			Psoriasis
		Infectious Integumentary Disorders
			Bacterial Infections
			Viral Infections
			Parasitic Infections
		Traumatic Integumentary Disorders
			Burns
		Chronic Integumentary Disorders
			Pressure Injuries
		Chronic Integumentary Disorders
			Acne Vulgaris
			Rosacea
		Integumentary Cancers
	Summary
	References
Chapter 14 Sensory Function
	Anatomy and Physiology
		Eyes
		Ears
		Congenital Sensory Disorders
			Eyes
			Ears
		Sensory Conditions Associated with Aging
			Eyes
			Ears
		Infectious and Inflammatory Sensory Disorders
			Eyes
			Ears
		Traumatic Sensory Disorders
			Eyes
			Ears
		Chronic Sensory Disorders
			Eyes
			Ears
		Sensory Organ Cancers
			Eyes
		Miscellaneous Sensory Organ Conditions
			Eyes
			Ears
	Summary
	References
Appendix A Normal Lab Values
Appendix B Root Words and Combining Forms
Glossary
Index