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دانلود کتاب 市场营销: 原理与实践（第16版·全新版）
دانلود کتاب 市场营销: 原理与实践（第16版·全新版）
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市场营销: 原理与实践（第16版·全新版）
ویرایش: [16 ed.] نویسندگان: 菲利普·科特勒 (Philip Kotler), 加里·阿姆斯特朗 سری: ISBN (شابک) : 9780739326756 ناشر: 中国人民大学出版社 سال نشر: 2015 تعداد صفحات: [6857] زبان: Chinese فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 173 Mb
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World renowned harvard symbologist Robert Langdon must uncover clues that point to the resurgance of an ancient secret society.
فهرست مطالب
Front Cover IFC Pathophysiology Copyright Dedication CONTRIBUTORS REVIEWERS PREFACE ACKNOWLEDGMENTS CONTENTS I - Pathophysiologic Processes 1 - Introduction to Pathophysiology FRAMEWORK FOR PATHOPHYSIOLOGY Etiology Pathogenesis Clinical Manifestations Stages and Clinical Course Treatment Implications Statistical Normality Reliability, Validity, and Predictive Value Individual Factors Influencing Normality Cultural Considerations Age Differences Gender Differences Situational Differences Time Variations PATTERNS OF DISEASE IN POPULATIONS Concepts of Epidemiology Endemic, Pandemic, and Epidemic Diseases Aggregate Factors . In one sense, life is entirely different during the 9 months of gestation. The structures and functions of tissues are differe... . It is difficult to differentiate precisely between the effects of ethnicity on patterns of disease and the socioeconomic facto... . Particular diseases of the genital system obviously show important differences between the sexes; men do not have endometriosi... . The envi�ronment and the political climate of countries determine how people live and the health problems that are likely to e... . Patterns of disease vary greatly by geographic location. Certainly there is considerable overlap with ethnicity, socioeconomic... Levels of Prevention . The prolongation of life has resulted largely from decreased mortality from infectious disease. Primary prevention in terms of... . Annual physical examinations and routine screening are examples of secondary prevention that lead to the early diagnosis of di... . Once a disease becomes established, treatment—within the context of traditional Western medicine—generally falls into one of t... SUMMARY 2 - Homeostasis, Allostasis, and Adaptive Responses to Stressors HOMEOSTASIS AND ALLOSTASIS Homeostasis Allostasis STRESS AS A CONCEPT The General Adaptation Syndrome and Allostasis Alarm Stage Resistance or Adaptation Stage Exhaustion Stage Stressors, Sex and Developmental Influences, and Risk Factors NEUROHORMONAL MEDIATORS OF STRESS AND ADAPTATION Catecholamines: Norepinephrine and Epinephrine Adrenocortical Steroids: Cortisol and Aldosterone Endorphins, Enkephalins, and Immune Cytokines Growth Hormone, Prolactin, and Oxytocin ADAPTATION, COPING, AND ILLNESS Adaptation, Coping, and Resilience Allostatic Overload and Illness SUMMARY II - Cellular Function 3 - Cell Structure and Function PLASMA MEMBRANE Membrane Structure Lipid Bilayer Membrane Proteins ORGANIZATION OF CELLULAR COMPARTMENTS Cytoskeleton Nucleus Endoplasmic Reticulum Golgi Apparatus Lysosomes and Peroxisomes Mitochondria CELLULAR METABOLISM Glycolysis Citric Acid Cycle Oxidative Phosphorylation FUNCTIONS OF THE PLASMA MEMBRANE Membrane Transport of Macromolecules Endocytosis and Exocytosis Membrane Transport of Small Molecules Active Transport Pumps . The sodium–potassium (Na+–K+) pump is a P-type ATPase present in the plasma membranes of virtually all animal cells. It serves... . Numerous important cellular processes, such as cell contraction and growth initiation, are dependent on the intracellular calc... . Another important class of ATP-driven transporters is the ABC transporter family. These transporters all have a common ATP-bin... Membrane Transport Carriers . In animal cells, the Na+ gradient created by the Na+–K+ pump is used to power a variety of transporters by secondary active tr... . Some carriers are not linked to the Na+ gradient and move substances across the membrane passively. The glucose transporters i... Membrane Channel Proteins Cellular Membrane Potentials Resting Membrane Potential Action Potential INTERCELLULAR COMMUNICATION AND GROWTH Cell Signaling Strategies Cell Surface Receptor–Mediated Responses Intracellular Receptor–Mediated Responses Regulation of Cellular Growth and Proliferation SUMMARY 4 - Cell Injury, Aging, and Death REVERSIBLE CELL INJURY Hydropic Swelling Intracellular Accumulations CELLULAR ADAPTATION Atrophy Hypertrophy Hyperplasia Metaplasia Dysplasia IRREVERSIBLE CELL INJURY Necrosis Apoptosis ETIOLOGY OF CELLULAR INJURY Ischemia and Hypoxic Injury Nutritional Injury Infectious and Immunologic Injury Chemical Injury Physical and Mechanical Injury CELLULAR AGING Cellular Basis of Aging Physiologic Changes of Aging SOMATIC DEATH SUMMARY 5 - Genome Structure, Regulation, and Tissue Differentiation Structure of Deoxyribonucleic Acid Deoxyribonucleic Acid Replication Genetic Code Transcription Translation REGULATION OF THE GENOME Transcriptional Controls DIFFERENTIATION OF TISSUES Cell Diversification and Cell Memory Mechanisms of Development Differentiated Tissues Epithelial Tissue Connective Tissue Muscle Tissue Nervous Tissue SUMMARY 6 - Genetic and Developmental Disorders PRINCIPLES OF INHERITANCE DNA Mutation and Repair GENETIC DISORDERS CHROMOSOMAL ABNORMALITIES Aberrant Number of Chromosomes Abnormal Chromosome Structure Examples of Autosomal Chromosome Disorders Trisomy 21 (Down Syndrome) Trisomy 18 (Edwards Syndrome) and Trisomy 13 (Patau Syndrome) Cri du Chat Syndrome Examples of Sex Chromosome Disorders Klinefelter Syndrome Turner Syndrome Multiple X Females and Double Y Males MENDELIAN SINGLE-GENE DISORDERS Autosomal-Dominant Disorders Marfan Syndrome Huntington Disease Autosomal-Recessive Disorders Albinism Phenylketonuria Cystic Fibrosis Sex-Linked (X-Linked) Disorders Hemophilia A NONMENDELIAN SINGLE-GENE DISORDERS Anticipation Mitochondrial Gene Mutations Genomic Imprinting POLYGENIC AND MULTIFACTORIAL DISORDERS Periods of Fetal Vulnerability Teratogenic Agents Chemicals and Drugs Infectious Agents Radiation Other Disorders of Infancy DIAGNOSIS, COUNSELING, AND GENE THERAPY Prenatal Diagnosis and Counseling Genetic Analysis and Therapy Recombinant DNA Technology SUMMARY 7 - Neoplasia BENIGN VERSUS MALIGNANT GROWTH Characteristics of Benign and Malignant Tumors Tumor Terminology Malignant Phenotype EPIDEMIOLOGY AND CANCER RISK FACTORS Tobacco Use Nutrition Antioxidants The Microbiome GENETIC MECHANISMS OF CANCER Proto-�Oncogenes Growth Factors (Mitogens) Growth Factor Receptors Cytoplasmic Signaling Pathways Transcription Factors From Proto-�Oncogene to Oncogene Tumor Suppressor Genes The Rb Gene The P53 Gene BRCA1 and BRCA2 Genes MULTISTEP NATURE OF CARCINOGENESIS Initiation Promotion Progression INVASION AND METASTASIS Patterns of Spread Angiogenesis Grading and Staging of Tumors Genetic/Molecular Testing EFFECTS OF CANCER ON THE BODY CANCER THERAPY Surgery Radiation Therapy Chemotherapy Immunotherapy Molecular/Targeted Therapy Gene Therapy Stem Cell Transplantation SUMMARY III - Defense 8 - Infectious Processes HOST–MICROBE RELATIONSHIP The Human Microbiome Host Characteristics Physical and Mechanical Barriers Impaired Immune Function Pathogen Characteristics Adherence and Invasion Bacterial Endotoxin Bacterial Exotoxins and Enzymes Evasion of Immune Cells Endospore Formation Antimicrobial Resistance TRANSMISSION OF INFECTION Routes of Transmission Emerging Infectious Diseases Weapons of Bioterrorism TYPES OF PATHOGENIC ORGANISMS Bacteria Viruses Fungi Parasites SUMMARY 9 - Inflammation and Immunity COMPONENTS OF THE IMMUNE SYSTEM EPITHELIAL BARRIERS MONONUCLEAR PHAGOCYTE SYSTEM LYMPHOID SYSTEM Primary Lymphoid Organs Secondary Lymphoid Organs Tonsils Spleen Lymph Nodes and Lymphatics Peyer Patches LEUKOCYTES Neutrophils Eosinophils Basophils and Mast Cells Monocytes and Macrophages Dendritic Cells Lymphocytes Natural Killer Cells T Lymphocytes B Lymphocytes CHEMICAL MEDIATORS OF IMMUNE FUNCTION Complement Kinins Clotting Factors Cytokines and Chemokines INNATE DEFENSES AND INFLAMMATION INFLAMMATION Increased Vascular Permeability Emigration of Leukocytes Phagocytosis Chronic Inflammation HEALING INFLAMMATORY EXUDATES SYSTEMIC MANIFESTATIONS OF INFLAMMATION SPECIFIC ADAPTIVE IMMUNITY MAJOR HISTOCOMPATIBILITY COMPLEX Major Histocompatibility Complex Class I Presentation Major Histocompatibility Complex Class II Presentation MECHANISMS OF CELL-�MEDIATED IMMUNITY T Helper Cells (CD4+) Cytotoxic T Cells (CD8+) MECHANISMS OF HUMORAL IMMUNITY Antigen Recognition by B Cells ANTIBODY STRUCTURE Class Switching and Affinity Maturation Antibody Functions PASSIVE AND ACTIVE IMMUNITY Passive Immunity Active Immunity INTEGRATED RESPONSE TO MICROBIAL ANTIGEN INTEGRATED RESPONSE TO MICROBIAL ANTIGEN INTEGRATED RESPONSE TO VIRAL ANTIGEN REGULATION OF IMMUNE FUNCTION SUMMARY 10 - Alterations in Immune Function EXCESSIVE IMMUNE RESPONSES AUTOIMMUNITY Genetic Factors Environmental Triggers Pharmacotherapies HYPERSENSITIVITY Type I Hypersensitivity Etiology Pathogenesis Clinical Manifestations Treatment Prevention Pharmacotherapeutic Prevention Type IIa Hypersensitivity Etiology and Pathogenesis Transfusion Reaction Hemolytic Disease of the Newborn Myasthenia Gravis Hyperacute Graft Rejection Type IIb Hypersensitivity Graves Disease Type III Hypersensitivity Etiology Pathogenesis Tissue Deposition Immune Complex Glomerulonephritis . Immune complex glomerulonephritis (an inflammatory renal disorder often noted after infection) is an example of a type III hyp... . This deposition causes glomerular inflammation, activation of mesangial cells, and ultimately damage to the glomerular basemen... Systemic Lupus Erythematosus . SLE is an example of a type III hypersensitivity reaction caused by autoantibody production. It is primarily characterized by ... Type IV Hypersensitivity Type IVa—Granulomatous Hypersensitivity Type IVa—Tuberculin-Type Hypersensitivity Type IVa—Allergic Contact Dermatitis Type IVb—Persistent Asthma Type IVc—Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Type IVd—Pustular Psoriasis DEFICIENT IMMUNE RESPONSES PRIMARY IMMUNODEFICIENCY DISORDERS B- and T-Cell Combined Disorders Severe Combined Immunodeficiency Disorders . SCIDs are inherited PIDs that arise from a variety of genetic defects. There is wide phenotypic and immunologic variability in... . Untreated infants with SCIDs are severely ill with high early mortality—usually at less than 1 year. They are usually ill with... Wiskott–Aldrich Syndrome . Wiskott–Aldrich syndrome is an X-linked immunodeficiency disorder occurring only in males. It is caused by a mutation of the W... . Wiskott–Aldrich syndrome is clinically characterized by the presence of microthrombocytopenia, eczema, and increased susceptib... T-Cell Disorders 22q11.2 Deletion Syndrome (DiGeorge Syndrome) . 22q11.2 deletion syndrome, also known as DiGeorge syndrome, is an autosomal-dominant developmental T-cell disorder caused by a... . Because 22q11.2 deletion syndrome is a congenital disorder of fetal organ development, it is associated with congenital proble... Chronic Mucocutaneous Candidiasis Disease . Chronic mucocutaneous candidiasis disease (CMCD) is a T-cell disorder caused by an autosomal-dominant gain of function mutatio... . The goal of treatment is to reduce the severity of skin and mucous membrane infections and to decrease the disfigurement from ... B-Cell Disorders IgA Deficiency . The most common B-cell PID is selective IgA deficiency. The incidence of this disorder varies geographically, affecting 1 in 6... . People with this disorder often exhibit no symptoms. However, when symptoms occur, they are prone to comprise respiratory, gas... X-Linked Agammaglobulinemia . X-linked agammaglobulinemia (XLA) (also known as Bruton X-linked agammaglobulinemia) is a B-cell genetic disorder caused by a ... . Patients exhibit failure to thrive and frequent serious infections. The infections are most often attributable to Haemophilus ... Transient Hypogammaglobulinemia Common Variable Immunodeficiency Disease . CVID is characterized by recurrent and severe infections, particularly respiratory tract disorders, including sinusitis, otiti... SECONDARY IMMUNODEFICIENCY DISORDERS SUMMARY 11 - Malignant Disorders of White Blood Cells CLASSIFICATION OF HEMATOLOGIC NEOPLASMS GENERAL PRINCIPLES OF MANAGEMENT Diagnosis of Hematologic Neoplasms Principles of Treatment Prevention and Management of Complications MYELOID NEOPLASMS Chronic Myeloid Leukemia Pathogenesis and Clinical Manifestations Prognosis and Treatment Acute Myeloid Leukemia Pathogenesis and Clinical Manifestations Prognosis and Treatment LYMPHOID NEOPLASMS Chronic Lymphoid Leukemia/Small Lymphocytic Lymphoma Pathogenesis and Clinical Manifestations Prognosis and Treatment Acute Lymphoid Leukemia/Lymphoma Pathogenesis and Clinical Manifestations Prognosis and Treatment Hairy Cell Leukemia Pathogenesis and Clinical Manifestations Prognosis and Treatment Plasma Cell Myeloma (Multiple Myeloma) Pathogenesis and Clinical Manifestations Prognosis and Treatment Hodgkin Disease Pathogenesis and Clinical Manifestations Prognosis and Treatment Pathogenesis and Clinical Manifestations Prognosis and Treatment SUMMARY 12 - HIV Disease and AIDS EPIDEMIOLOGY History Types of HIV Transmission Prevention of Transmission ETIOLOGY HIV Structure HIV Binding and Infection PATHOGENESIS Effect of HIV on Immune Cells at the Cellular Level Viral Production and Cell Death CDC HIV Classification System DIAGNOSTIC TESTING MONITORING THE PROGRESSION OF HIV CLINICAL MANIFESTATIONS Systemic Manifestations Gastrointestinal Manifestations Pulmonary Manifestations Mucocutaneous Manifestations Gynecologic Manifestations Neurologic Manifestations Ocular Manifestations Cardiovascular Manifestations Manifestations in Other Systems Manifestations in Children TREATMENT Antiretroviral Therapy Recommendations Nucleoside Reverse Transcriptase Inhibitors Nucleotide Reverse Transcriptase Inhibitors Nonnucleoside Reverse Transcriptase Inhibitors Protease Inhibitors Fusion Inhibitors CCR5 Inhibitors Cytochrome P4503A (CVP3A) Inhibitors Integrase Strand Transfer Inhibitors Post-attachment Inhibitors Other Treatments and Vaccines SUMMARY IV - Oxygen Transport, Blood Coagulation, Blood Flow, andBlood Pressure 13 - Alterations in Oxygen Transport COMPOSITION OF BLOOD Organic and Inorganic Components Cellular Components Erythrocytes Leukocytes Platelets STRUCTURE AND FUNCTION OF RED BLOOD CELLS Hematopoiesis Hemoglobin Synthesis Hemoglobin Synthesis in Infants Nutritional Requirements for Erythropoiesis Energy and Maintenance of Erythrocytes Red Cell Production Red Cell Destruction GAS TRANSPORT AND ACID–BASE BALANCE Oxygen Transport Carbon Dioxide Transport Alterations in Oxygen Transport ANEMIA General Effects of Anemia Aplastic Anemia Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Anemia of Chronic Kidney Disease Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Anemia Related to Vitamin B12 (Cobalamin) or Folate Deficiency Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Iron Deficiency Anemia Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Thalassemia Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Sickle Cell Anemia Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Hereditary Spherocytosis Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Glucose-�6-�Phosphate Dehydrogenase Deficiency Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Hemolytic Disease of the Newborn Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Antibody-�Mediated Drug Reactions Etiology and Pathogenesis Hapten Mechanisms Neoantigen Formation Membrane Modification Autoantibody Induction Laboratory Features Clinical Manifestations Treatment Course and Prognosis Acute Blood Loss Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Other Extrinsic Abnormalities TRANSFUSION THERAPY POLYCYTHEMIA Polycythemia Vera Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Secondary Polycythemia Etiology and Pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis Relative Polycythemia Etiology and pathogenesis Laboratory Features Clinical Manifestations Treatment Course and Prognosis SUMMARY 14 - Alterations in Hemostasis and Blood Coagulation THE PROCESS OF HEMOSTASIS Stages of Hemostasis Platelets Blood Coagulation Factors Fibrin Clot Fibrinolysis EVALUATION OF HEMOSTASIS AND COAGULATION Clinical Assessment Laboratory Tests VASCULAR AND PLATELET DISORDERS Vascular Disorders Vascular Purpura Hereditary Hemorrhagic Telangiectasia Platelet Disorders Thrombocytopenia Thrombocytosis Qualitative Platelet Disorders COAGULATION DISORDERS Hemophilia von Willebrand Disease Vitamin K Deficiency Bleeding in Infancy Acquired Vitamin K Deficiency Disseminated Intravascular Coagulation Hepatic Disease SUMMARY 15 - Alterations in Blood Flow ORGANIZATION OF THE CIRCULATORY AND LYMPHATIC SYSTEMS Vessel Structure Anatomy of Arteries and Veins Anatomy of Capillaries Lymphatic Structure PRINCIPLES OF FLOW Hemodynamics of the Circulatory System Blood Flow, Pressure, and Resistance Velocity and Laminar and Turbulent Flow Wall Tension and Compliance Dynamics in the Microcirculation: Capillaries and Lymphatics CONTROL OF FLOW Control of Blood Flow Central Mechanisms Intrinsic Mechanisms Control of Lymphatic Flow Blood Vessels: Obstructions Thrombus . Thrombosis refers to the pathologic formation of clots at these sites, to differentiate it from the clotting process that take... Pathogenesis . The significance of thrombosis rests in the ability of a clot within a blood vessel to reduce flow and increase turbulence, wh... . In the venous system, thrombosis alters venous return, impairing removal of metabolic wastes and producing swelling (edema). W... . Arterial thrombosis is usually manifested by intermittent claudication (pain with activity) in the affected limb that improves... Embolus . An embolus is most often a blood clot, a thromboembolus, having begun as a thrombus that was subsequently dislodged from the v... . An embolism exiting the left ventricle may lodge in the cerebral vasculature, leading to an ischemic stroke. Manifestations di... . Embolectomy, the surgical removal of an embolus, is usually confined to thromboemboli. The use of this surgical technique is c... . Various other materials, some totally foreign to the bloodstream, can also form emboli if present in sufficient quantity. Fat ... Vasospasm Inflammation Mechanical Compression Blood Vessels: Structural Alterations Types of Structural Alterations . The intimal folds of veins that form the valves can be damaged, interfering with the effective flow of blood through a portion... . Arteriosclerosis is a general term for the thickening and hardening of arteries. Atherosclerosis is a type of arteriosclerosis... . An aneurysm is a localized dilation of an arterial wall. Aneurysms vary in the severity of their consequences, depending on th... Arteriovenous fistulas. An arteriovenous fistula (AVF) is an abnormal communication between arteries and veins. It is usually co... Lymphatic Vessels ALTERATIONS IN ARTERIAL FLOW Arteriosclerosis/Atherosclerosis Etiology and Pathogenesis Risk Factors . Fortunately, there are far more modifiable risk factors than nonmodifiable ones, and the changes individuals make have documen... . Certain risk factors are not modifiable and cannot be manipulated for prevention or to decrease the severity of atherosclerosi... Clinical Manifestations and Diagnosis Treatment Thromboangiitis Obliterans (Buerger Disease) Raynaud Syndrome Aneurysms Classifications Clinical Manifestations and Diagnosis Treatment Acute Arterial Occlusion ALTERATIONS IN VENOUS FLOW Valvular Incompetence Etiology and Pathogenesis Clinical Manifestations and Treatment Varicose Veins Etiology and Pathogenesis Clinical Manifestations and Treatment Chronic Venous Insufficiency Etiology and Pathogenesis Clinical Manifestations and Treatment Deep Vein Thrombosis Etiology and Pathogenesis Clinical Manifestations and Treatment ALTERATIONS IN LYMPHATIC FLOW Lymphedema Etiology and Pathogenesis Clinical Manifestations, Diagnosis, and Treatment SUMMARY 16 - Alterations in Blood Pressure 16 Measurement of Blood Pressure Components of Blood Pressure Measurement Direct Measurement of Blood Pressure Indirect Measurement of Blood Pressure MECHANISMS OF BLOOD PRESSURE REGULATION Short-�Term Regulation of Systemic Blood Pressure Long-�Term Regulation of Systemic Blood Pressure Normal Fluctuations in Systemic Blood Pressure HYPERTENSION Definition and Classification Primary Hypertension Subtypes Risk Factors Outcomes Treatment Interventions Secondary Hypertension Hypertensive Emergencies and Urgency LOW BLOOD PRESSURE SUMMARY V - Cardiac Function 17 - Cardiac Function CARDIOVASCULAR ANATOMY Heart Circulatory System CARDIAC CYCLE Isovolumic Contraction Ventricular Ejection Isovolumic Relaxation Atrial Events Aortic and Pulmonary Artery Events CORONARY CIRCULATION Anatomy of the Coronary Vessels Regulation of Coronary Blood Flow CARDIAC MYOCYTES Myocyte Structure and Activation Structure of the Contractile Apparatus Characteristics of Contractile Filaments MOLECULAR BASIS OF CONTRACTION Overview of Contraction Role of Calcium in Muscle Contraction Energy of Muscle Relaxation CARDIAC ENERGY METABOLISM Oxygen Utilization Substrate Utilization CARDIAC ELECTROPHYSIOLOGY Cardiac Resting Potential Cardiac Action Potential Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 Rhythmicity of Myocardial Cells Specialized Conduction System of the Heart Autonomic Regulation of Rhythmicity ELECTROCARDIOGRAPHY DETERMINANTS OF CARDIAC OUTPUT Determinants of Heart Rate Determinants of Stroke Volume Volume of Blood in the Heart (Preload) Contractile Capabilities of the Heart (Contractility) Impedance to Ejection From the Ventricle (Afterload) Cardiac Workload ENDOCRINE FUNCTION OF THE HEART TESTS OF CARDIAC FUNCTION Electrocardiography Echocardiography Nuclear Cardiography Cardiac Catheterization/Coronary Angiography SUMMARY 18 - Alterations in Cardiac Function CORONARY HEART DISEASE Etiology of Coronary Heart Disease Pathophysiology of Ischemia Angina Pectoris . Stable angina is the most common form and is therefore called classic or typical angina. Stable angina is characterized by ste... . Vasospastic angina (VSA) was first described by Prinzmetal and colleagues as a variant angina characterized by unpredictable a... Acute Coronary Syndrome . MI results when prolonged or total disruption of blood flow to the myocardium causes cellular death by necrosis or apoptosis. ... . The diagnosis of MI is based on three primary indicators: signs and symptoms, electrocardiographic changes, and elevations in ... . Myocardial ischemia and infarction often result in characteristic changes on ECG waveforms. Injury and ischemia are indicated ... . The appearance of certain proteins in the blood after myocardial cell death is a sensitive and reliable indicator of MI. Myoca... . In addition to chest pain, electrocardiographic abnormalities, and serum protein marker elevations, a person experiencing an M... . An overall prognosis for acute MI is difficult to determine because many variables affect the outcome, including the extent an... Sudden Cardiac Arrest Chronic Ischemic Cardiomyopathy ENDOCARDIAL AND VALVULAR DISEASES Disorders of the Mitral Valve Mitral Stenosis Mitral Regurgitation Mitral Valve Prolapse Disorders of the Aortic Valve Aortic Stenosis Aortic Regurgitation Diseases of the Endocardium Rheumatic Heart Disease Infective Endocarditis MYOCARDIAL DISEASES Myocarditis Cardiomyopathy Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Restrictive Cardiomyopathy PERICARDIAL DISEASES Pericardial Effusion Cardiac Tamponade Pericarditis Acute Pericarditis Chronic Pericarditis CONGENITAL HEART DISEASES Embryologic Development Etiology and Incidence of Congenital Heart Disease Pathophysiology of Congenital Heart Disease Acyanotic Congenital Defects Atrial Septal Defect Ventricular Septal Defect Patent Ductus Arteriosus Coarctation of the Aorta Pulmonary Stenosis or Atresia Aortic Stenosis or Atresia Cyanotic Congenital Defects Tetralogy of Fallot Transposition of the Great Arteries Truncus Arteriosus Tricuspid Atresia SUMMARY 19 - Heart Failure and Dysrhythmias: Common Sequelae of Cardiac Diseases HEART FAILURE Pathogenesis and Diagnosis Heart Failure with Low Ejection Fraction or Systolic Dysfunction Heart Failure with Preserved Ejection Fraction or Diastolic Dysfunction Sympathetic Nervous System Activation Increased Preload Myocardial Remodeling and Progression Clinical Manifestations Left-Sided Heart Failure Right-Sided Heart Failure Biventricular Heart Failure Class and Stage of Heart Failure Treatment CARDIAC DYSRHYTHMIAS Dysrhythmia Mechanisms Automaticity Triggered Activity Reentry Dysrhythmia Analysis Normal Sinus Rhythm Abnormal Rates of Sinus Rhythm Sinus Tachycardia Sinus Bradycardia Sinus Arrhythmia Sinus Arrest Abnormal Site of Impulse Initiation Escape Rhythms Atrial Dysrhythmias . Premature atrial complexes (PACs) originate in the atria but not at the SA node. The PAC occurs earlier than normal, is preced... . Atrial flutter is typically manifested by a rapid atrial rate of 240 to 350 beats per minute and a characteristic sawtooth pat... Junctional Dysrhythmias Ventricular Dysrhythmias . Premature ventricular complexes (PVCs) arise from the ventricular myocardium. The impulse depolarizes the ventricles but does ... . Ventricular tachycardia consists of three or more consecutive ventricular complexes at a rate greater than 100 beats per minut... . Ventricular fibrillation is a rapid, uncoordinated cardiac rhythm that results in ventricular quivering and lack of effective ... Conduction Pathway Disturbances Disturbances of Atrioventricular Conduction Abnormal Conduction Pathways Intraventricular Conduction Defects Treatment SUMMARY 20 - Shock PATHOGENESIS OF SHOCK Impaired Tissue Oxygenation Compensatory Mechanisms and Stages of Shock TYPES OF SHOCK Cardiogenic Shock Etiology and Pathogenesis Clinical Manifestations Treatment . Positive inotropic drugs are frequently used in the management of cardiogenic shock to increase contractility. Positive inotro... . Cardiogenic shock is sometimes managed by mechanical assist devices. For temporary management, intra-aortic balloon counterpul... Obstructive Shock Etiology and Pathogenesis Clinical Manifestations Treatment Hypovolemic Shock Etiology and Pathogenesis Classification Clinical Manifestations Treatment Distributive Shock Anaphylactic Shock . Type I anaphylactic reactions involve an antigen/immunoglobulin E (IgE) antibody reaction on the surface of mast cells and bas... . The onset of symptoms is usually within 2 to 30 minutes of exposure to the antigen; however, symptoms may not develop for seve... . Prevention of anaphylactic shock is achieved by avoidance of precipitating allergens. Anaphylactic shock is most frequently as... Neurogenic Shock Septic Shock . Sepsis results from an inappropriate host response to the presence of pathogens. Noninfectious causes of systemic inflammatory... . Septic shock commonly is associated with gram-negative infections. Gram-negative bacteria include Escherichia coli, Klebsiella... . In contrast to other forms of shock, the clinical manifestation of early septic shock is a hyperdynamic state characterized by... . The primary treatment in early septic shock is buffered isotonic fluid administration to restore adequate ventricular preload.... ASSESSMENT AND HEMODYNAMIC MONITORING Cardiac Output Arterial Oxygen Content Distribution of Blood Flow Hemodynamic Monitoring COMPLICATIONS OF SHOCK Acute Respiratory Distress Syndrome Disseminated Intravascular Coagulation Acute Renal Failure Multiple Organ Dysfunction Syndrome SUMMARY VI - Respiratory Function 21 - Respiratory Function and Alterations in Gas Exchange FUNCTIONAL ANATOMY Development of the Pulmonary System Upper Airway Structures Lower Airway Structures Pulmonary Circulation Age-�Related Variations VENTILATION Lung Volumes and Capacities Dead Space Minute Ventilation Alveolar Ventilation/Oxygenation Mechanics of Breathing Airway Resistance Lung Compliance Distribution of Ventilation Neurologic Control of Ventilation PULMONARY BLOOD FLOW Pulmonary Vasculature Distribution of Blood Flow Ventilation–Perfusion Ratios Hypoxic Vasoconstriction Barriers to Diffusion Oxygen Transport Carbon Dioxide Transport ALTERATIONS IN PULMONARY FUNCTION Hypoventilation and Hyperventilation Hypoxemia and Hypoxia Acute Respiratory Failure Etiology . Respiratory failure can develop from any abnormality in the airways, alveoli, central nervous system, peripheral nervous syste... Clinical Manifestations Diagnosis Treatment DIAGNOSTIC TESTS Pulmonary Function Testing Bronchial Provocation Tests ALTERATIONS IN PULMONARY VASCULATURE Pulmonary Hypertension Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Pulmonary Venous Thromboembolism Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment PULMONARY MALIGNANCIES Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment SUMMARY 22 - Obstructive Pulmonary Disorders OBSTRUCTION FROM CONDITIONS IN THE WALL OF THE LUMEN Asthma Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Acute Bronchitis Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Chronic Bronchitis Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Emphysema Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment OBSTRUCTION OF THE AIRWAY LUMEN Bronchiectasis Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Bronchiolitis Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Cystic Fibrosis Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Acute Tracheobronchial Obstruction Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Epiglottitis Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Croup Syndrome Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment SUMMARY 23 - Restrictive Pulmonary Disorders LUNG PARENCHYMA DISORDERS Fibrotic Interstitial Lung Diseases Diffuse Interstitial Lung Disease . Diffuse interstitial lung disease (diffuse interstitial pulmonary fibrosis) is the name typically used for restrictive disease... . Pathogenesis of the disease is not well understood but is possibly related to an immune reaction that usually begins with inju... . The most common patient complaint is progressive dyspnea with nonproductive cough. Clinical features also include rapid, shall... . Chest radiographs show a honeycomb appearance and a coarse reticular pattern indicating late stage of disease. Ground-�glass h... . The patient should be encouraged to avoid tobacco use and environmental exposure to offending agents. Primary therapy consists... Sarcoidosis . Sarcoidosis is categorized as an acute or chronic systemic disease of unknown cause, although an immunologic basis appears lik... . The disease is characterized by the development of multiple uniform, noncaseating epithelioid granulomas that affect multiple ... . Sarcoidosis is characterized by malaise, fatigue, weight loss, fever, chest discomfort, dyspnea of insidious onset, and a dry,... . Common laboratory findings in patients with sarcoidosis include leukopenia, anemia, increased eosinophil count, elevated sedim... . Administration of corticosteroids and management of symptoms are the mainstays of treatment for patients whose disease process... Hypersensitivity Pneumonitis . Hypersensitivity pneumonitis, also called extrinsic allergic alveolitis, is classified as a restrictive and occupational disea... . The causative agent is suggested by the patient’s history and confirmed by demonstration of precipitating antibodies in the se... . In the acute stage of the disease, symptoms start 4 to 6 hours after exposure and resolve in 18 to 24 hours. General symptoms ... . During the acute/subacute phase, transient bilateral pulmonary infiltrates or increased bronchial markings with alveolar nodul... . The goal of therapy is to identify the offending agent and prevent further exposure. This may require a change in environment ... Occupational Lung Diseases . Occupational lung diseases result from the inhalation of toxic gases or foreign particles. Traditionally, occupational lung di... . The respiratory tract is protected by two interrelated systems: the mucociliary system and alveolar macrophages. The inhalatio... . Pneumoconioses (anthracosis, asbestosis, silicosis) generally produce no symptoms in the early stages. Physical evidence of th... . The reliability of pulmonary changes noted on chest radiographs varies with the severity of the disease. When the patient is s... . The primary goal of therapy is to halt symptom progression. Preventive measures are the key to limiting the onset and severity... ATELECTATIC DISORDERS Acute (Adult) Respiratory Distress Syndrome Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Infant Respiratory Distress Syndrome Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment PLEURAL SPACE DISORDERS Pneumothorax Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Pleural Effusion Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Neuromuscular Disorders Poliomyelitis Amyotrophic Lateral Sclerosis Muscular Dystrophies Guillain–Barré Syndrome Myasthenia Gravis Chest Wall Deformities Kyphoscoliosis . Kyphoscoliosis may develop from an unknown cause (80% to 90% cases) (idiopathic) or may be related to congenital (Pott disease... . Commonly, a bony deformity of the chest wall occurs as a result of kyphosis (hunchback appearance; posterior curvature deformi... . Common clinical features include dyspnea on exertion; rapid, shallow breathing; and chest wall deformity as evidenced by ribs ... . Diagnostic findings include hypercapnia, hypoxemia (resulting from V.A/Q. mismatch), and decreased lung volumes and lung capac... . Treatment depends on the severity of the deformity and the age of the patient. Kyphosis in elderly persons, especially women, ... Ankylosing Spondylitis . Ankylosing spondylitis occurs in both genders (male/female ratio of 3:1) and is commonly seen in the age range of 15 to 35 yea... . Ankylosing spondylitis is a progressive inflammatory disease leading to immobility of the vertebral joints and fixation of the... . Initial symptoms include low to middle back pain and stiffness that is more severe after prolonged rest. With exercise, the pa... . Pulmonary function tests show decreased VC, decreased TLC, and decreased compliance of the respiratory system, mainly the ches... . General therapy includes development of an exercise program that comprises breathing exercises and mobility exercises with spi... Flail Chest . Flail chest results from multiple rib fractures as a result of trauma to the chest wall. The ribs are fractured at two distant... . Chest wall instability attributable to fracture at two distant sites on the same rib leads to an impairment of negative intrap... . Patients present after a trauma with paradoxical motion of the chest wall, either unilateral or bilateral. The injury to the c... . Serial blood gas results help to determine the treatment regimen. Flail chest with large segments resulting in acute respirato... Disorders of Obesity Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment INFECTION OR INFLAMMATION OF THE LUNG Pneumonia Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment Severe Acute Respiratory Syndrome Middle East Respiratory Syndrome Severe Acute Respiratory Syndrome Coronavirus-�2 Pulmonary Tuberculosis Etiology Pathogenesis Clinical Manifestations Diagnosis Treatment SUMMARY VII - Fluid, Electrolyte, and Acid–Base Homeostasis 24 - Fluid and Electrolyte Homeostasis and Imbalances 24 BODY FLUID HOMEOSTASIS Fluid Intake and Absorption Fluid Distribution Fluid Excretion Fluid Loss Through Abnormal Routes FLUID IMBALANCES Extracellular Fluid Volume Volume Deficit Volume Excess Body Fluid Concentration Hyponatremia Hypernatremia Both Volume and Concentration Clinical Dehydration Interstitial Fluid Volume Edema PRINCIPLES OF ELECTROLYTE HOMEOSTASIS Electrolyte Intake and Absorption Electrolyte Distribution Electrolyte Excretion Electrolyte Loss Through Abnormal Routes ELECTROLYTE IMBALANCES Plasma Potassium Hypokalemia Hyperkalemia Plasma Calcium Hypocalcemia Hypercalcemia Plasma Magnesium Hypomagnesemia Hypermagnesemia Plasma Phosphate Hypophosphatemia Hyperphosphatemia SUMMARY 25 - Acid–Base Homeostasis and Imbalances Respiratory Contribution Renal Contribution ACID–BASE IMBALANCES Metabolic Acidosis . Metabolic acidosis is a condition that tends to cause a relative excess of any acid except carbonic acid. Metabolic acidosis m... . Signs and symptoms of metabolic acidosis include headache, abdominal pain, and central nervous system depression (confusion, l... . The respiratory compensation for metabolic acidosis is hyperventilation. The low blood pH stimulates the chemoreceptors, which... Respiratory Acidosis . Respiratory acidosis is a condition that tends to cause an excess of carbonic acid. This condition is aptly named because carb... . Signs and symptoms of respiratory acidosis are headache, tachycardia, cardiac dysrhythmias, and neurologic abnormalities such ... . The compensatory response to respiratory acidosis is increased renal excretion of metabolic acid. This mechanism requires seve... Metabolic Alkalosis . Metabolic alkalosis is a condition that tends to cause a relative deficit of any acid except carbonic acid. Metabolic alkalosi... . Signs and symptoms in patients who have metabolic alkalosis may arise from the extracellular fluid volume depletion that cause... . The compensatory response to metabolic alkalosis is hypoventilation. This shallow breathing retains carbonic acid within the b... Respiratory Alkalosis . Respiratory alkalosis is a condition that tends to cause a carbonic acid deficit. With a deficit of carbonic acid, the blood i... . Clinical manifestations of respiratory alkalosis arise from increased neuromuscular excitability. Paresthesias (numbness and t... . The compensatory response to respiratory alkalosis is decreased renal excretion of metabolic acid. As metabolic acids accumula... Mixed Acid–Base Imbalances SUMMARY VIII - Renal and Bladder Function 26 - Renal Function RENAL ANATOMY Renal Parenchyma Renal Lymphatics and Innervation Renal Blood Supply OVERVIEW OF NEPHRON STRUCTURE AND FUNCTION Glomerulus Proximal Convoluted Tubule Loop of Henle Distal Convoluted Tubule Collecting Duct REGULATION OF GLOMERULAR FILTRATION Physics of Filtration Factors Affecting Filtration Pressure Tubuloglomerular Feedback Effects of Glucose and Amino Acids Role of Mesangial Cells TRANSPORT ACROSS RENAL TUBULES Reabsorption of Glucose Regulation of Acid–Base Balance Renal Compensation Process Secretion of Potassium REGULATION OF BLOOD VOLUME AND OSMOLALITY Antidiuretic Hormone Aldosterone, Angiotensin II, Natriuretic Peptides, Urodilatin, Uroguanylin, and Guanylin Diuretic Agents ENDOCRINE FUNCTIONS Erythropoietin Vitamin D AGE-RELATED CHANGES IN RENAL FUNCTION Infant Adult and Elderly TESTS OF RENAL STRUCTURE AND FUNCTION Urine and Blood Studies Urinalysis Serum Creatinine and Blood Urea Nitrogen Measures of Glomerular Filtration Rate Diagnostic Tests Kidney, Ureter, and Bladder Roentgenography Intravenous Urography/Pyelography Radionuclide Studies Ultrasonography Computed Tomography Magnetic Resonance Imaging Renal Biopsy SUMMARY 27 - Intrarenal Disorders COMMON MANIFESTATIONS OF KIDNEY DISEASE Pain Abnormal Urinalysis Findings Other Diagnostic Tests CONGENITAL ABNORMALITIES Renal Agenesis and Hypoplasia Cystic Kidney Diseases Autosomal Recessive Polycystic Kidney Disease Autosomal Dominant Polycystic Kidney Disease NEOPLASMS Benign Renal Neoplasms Diagnosis and Treatment Renal Cell Carcinoma Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment Nephroblastoma (Wilms Tumor) Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment INFECTION Acute Pyelonephritis Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment Chronic Pyelonephritis Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment OBSTRUCTION Renal Calculi (Nephrolithiasis) Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment GLOMERULAR DISORDERS (GLOMERULOPATHIES) Glomerulonephritis Acute Glomerulonephritis Crescentic Glomerulonephritis/Rapidly Progressive Glomerulonephritis Chronic Glomerulonephritis Nephrotic Syndrome Membranous Nephropathy Focal Segmental Glomerulosclerosis Minimal Change Disease SUMMARY 28 - Acute Kidney Injury and Chronic Kidney Disease 28 Etiology and Pathophysiology Prerenal Kidney Injury Postrenal Kidney Injury Intrinsic/Intrarenal Kidney Injury Clinical Presentation of Acute Kidney Injury Prodromal Phase Oliguric Phase Postoliguric Phase CHRONIC KIDNEY DISEASE Risk Factors Stages of Chronic Kidney Disease Complications of Chronic Kidney Disease Hypertension and Cardiovascular Disease Uremic Syndrome Metabolic Acidosis Electrolyte Imbalances Mineral and Bone Disorders Malnutrition Anemia Pain Depression CLINICAL MANAGEMENT Acute Kidney Injury Chronic Kidney Disease Hypertension and Cardiovascular Disease Metabolic Acidosis Fluid and Electrolyte Imbalances Bone and Mineral Disorders Malnutrition Anemia Pain Depression Acute-�on-�Chronic Kidney Disease Dialysis Kidney Transplant Chronic Kidney Disease in Older Adults SUMMARY 29 - Disorders of the Lower Urinary Tract LOWER URINARY TRACT Functional Anatomy Physiology of Micturition Nervous System Innervation of the Lower Urinary Tract Mechanism of Micturition Diagnostic Tests Incontinence Enuresis Overactive Bladder Syndrome Bladder Pain Syndrome/Interstitial Cystitis NEUROGENIC BLADDER CONGENITAL DISORDERS Primary Vesicoureteral Reflux Obstruction of the Ureteropelvic Junction Ureteral Ectopy Ureterocele NEOPLASMS INFLAMMATION AND INFECTION Urethritis Cystitis OBSTRUCTION Lower Urinary Tract Calculi Ureteral Calculi Bladder (Vesical) Calculi SUMMARY IX - Genital and Reproductive Function 30 - Male Genital and Reproductive Function ANATOMY Upper Genitourinary Tract Lower Genitourinary Tract Bladder Urethra Auxiliary Genital Glands Prostate Seminal Vesicles Bulbourethral Glands External Genitalia Scrotum Testes Epididymis and Ductus Deferens Penis EMBRYOLOGY Nephric System Vesicourethral Unit Gonads Genital Duct System External Genitalia MALE REPRODUCTIVE PHYSIOLOGY Hypothalamic-�Pituitary-�Testicular Axis Spermatogenesis Anatomy of Spermatozoa Transport of Spermatozoa Erection, Emission, and Ejaculation Capacitation Acrosome Reaction SUMMARY RESOURCES 31 - Alterations in Male Genital and Reproductive Function 31 Urethral Valves Urethrorectal and Vesicourethral Fistulas Hypospadias Epispadias Acquired Disorders Priapism Phimosis and Paraphimosis Peyronie Disease Urethral Strictures Erectile Dysfunction Premature Ejaculation Infectious Disorders Neoplastic Disorders Neoplasms of the Penis DISORDERS OF THE SCROTUM AND TESTES Congenital Disorders Cryptorchidism Acquired Disorders Hypogonadism Hydrocele Spermatocele Varicocele Testicular Torsion Male Infertility Infectious Disorders Epididymitis Fournier Gangrene Neoplastic Disorders Neoplasms of the Testis DISORDERS OF THE PROSTATE Benign Prostatic Hyperplasia Etiology and Pathogenesis Clinical Manifestations Treatment Prostatitis Etiology and Pathogenesis Clinical Manifestations, Diagnosis, and Treatment Prostate Cancer Etiology and Pathogenesis Diagnosis and Clinical Manifestations Treatment SUMMARY 32 - Female Genital and Reproductive Function Oviducts Uterus Vagina External Genitalia MENSTRUAL CYCLE BREAST Structure of the Breast Breast Development Lactation PREGNANCY Early Human Development Implantation Fetal Membranes and Placenta Development of the Human Embryo and Fetus First Month Second Month Third Month Second Trimester Third Trimester Parturition Hormonal Changes Mechanical Changes Response of the Mother’s Body to Pregnancy Metabolism During Pregnancy Changes in the Female Reproductive Organs Changes in the Circulatory System Changes in the Respiratory System Changes in the Urinary System Weight Gain and Nutrition During Pregnancy MENOPAUSE SUMMARY 33 - Alterations in Female Genital and Reproductive Function MENSTRUAL DISORDERS Amenorrhea Etiology and Pathogenesis Treatment Abnormal Uterine Bleeding Patterns Etiology, Clinical Manifestations, and Treatment Dysmenorrhea Etiology and Clinical Manifestations Treatment Uterine Prolapse Etiology Clinical Manifestations Treatment Retrodisplacement of the Uterus Etiology and Clinical Manifestations Treatment Cystocele Etiology Clinical Manifestations and Treatment Rectocele Etiology Clinical Manifestations and Treatment Pelvic Inflammatory Disease Etiology Clinical Manifestations Treatment Vulvovaginitis Etiology Clinical Manifestations Treatment Bartholinitis Clinical Manifestations and Treatment Uterine Leiomyomas Etiology Clinical Manifestations Treatment Ovarian Cysts Etiology Clinical Manifestations and Treatment Endometriosis Etiology Clinical Manifestations Treatment CANCER OF THE FEMALE GENITAL STRUCTURES Cancer of the Cervix Etiology Clinical Manifestations Treatment Prevention Endometrial Cancer Clinical Manifestations and Treatment Ovarian Cancer Clinical Manifestations and Treatment Vaginal Cancer Clinical Manifestations and Treatment Cancer of the Vulva Clinical Manifestations and Treatment DISORDERS OF PREGNANCY Pregnancy-�Induced Hypertension Etiology, Clinical Manifestations, and Treatment Hyperemesis Gravidarum Clinical Manifestations and Treatment Placenta Previa and Abruptio Placentae Etiology and Clinical Manifestations Treatment Spontaneous Abortion Etiology Clinical Manifestations and Treatment DISORDERS OF THE BREAST Reactive-�Inflammatory Breast Disorders Mammary Duct Ectasia . Over time, the ducts become distended with cellular debris, and the debris begins to have an irritating effect on the duct wal... . In addition to a palpable mass and dimpling or distortion of the breast or areola, women with mammary duct ectasia may have a ... Breast Abscess . Multiple factors may contribute to the formation of nonlactational breast abscesses. In some women, the presence of a congenit... . Signs and symptoms of these abscesses include an area of tenderness, redness, and induration under the periareolar skin. Unfor... Fat Necrosis . Fat necrosis of the breast may have many of the same clinical signs as breast malignancy, including a painless mass in the bre... Reactions to Foreign Material Benign Breast Disorders Fibrocystic Breast Changes . Hormonal imbalance in the reproductive years is thought to contribute to fibrocystic breast changes. Fibrocystic breast change... . Diagnostic studies can include ultrasound and needle aspiration of a cyst for histologic analysis. Oral contraceptives have be... Specific Benign Neoplasms Malignant Disorder of the Breast Cancer of the Breast . A substantial number of studies conducted in the past 30 years have begun to establish the risk factors and possible causes of... . Several hormonal factors have been shown to be linked to the development of breast cancer. Length of exposure to the hormones ... . It has been observed in many research studies that giving birth at a young age (younger than 18 years) is associated with a de... . It has been suggested that the amount of fat in the diet is a risk factor for breast cancer. Researchers who favor this theory... . The role of heredity in contributing to breast cancer has long been recognized. Specific gene mutations such as BRCA1 and BRCA... . Breast cancer is extremely rare in young women. The incidence begins to increase by 25 to 30 years of age and continues to inc... . Other factors, such as radiation exposure and a history of cancer, have been shown to be risk factors for the development of b... . Many breast cancers are discovered by the woman herself through detection of changes in how the breast normally looks and feel... . Treatment for breast cancer includes surgery, chemotherapy, radiation therapy, and supportive measures. Surgical therapy is a ... . Breast cancer is characterized by a wide variation in clinical course. Many patients who undergo therapy for breast carcinoma ... SUMMARY 34 - Sexually Transmitted Infections 34 Gonococcal Infection . In gonorrhea, disease transmission occurs through contact with exudates from the mucous membranes of infected persons, usually... . Resistance of N. gonorrheae to antimicrobial agents continues to spread and intensify, causing concern nationally and internat... Nongonococcal Infection—Chlamydia trachomatis . Nongonococcal urethritis and cervicitis are often caused by strains of C. trachomatis that act on columnar epithelium in a man... . Single-�dose azithromycin is recommended for treatment of chlamydia. Treatment should be prompt to prevent serious potential c... DISEASES WITH SYSTEMIC INVOLVEMENT Syphilis . Syphilis is caused by Treponema pallidum, an anaerobic spirochete. The disease is acquired when T. pallidum penetrates intact ... . During all stages of syphilis, invasion of tissue by T. pallidum results in pathologic changes in the vascular system. The inf... . Benzathine penicillin G is the first choice for the management of syphilis. If the affected person is allergic to penicillin, ... Lymphogranuloma Venereum . LGV is a highly contagious systemic infection caused by a number of closely related strains of Chlamydia. The disease occurs m... . Like syphilis, LGV has stages of development in which an initial lesion forms and systemic disease occurs after dissemination ... . Doxycycline is the recommended antibiotic, with erythromycin being the alternative. Surgical treatment may include aspiration ... Herpesvirus Infections . HSV types 1 and 2 have certain characteristics in common. Both produce an initial infection that is self-�limiting. The lesion... . Genital infection with HSV-2 is manifested by the appearance of fluid-�filled vesicles after a 3-� to 7-�day incubation period... . Normally, HSV-1 lesions are self-�limiting and respond to measures that promote good oral hygiene. HSV-2 genital lesions are u... DISEASES WITH LOCALIZED LESIONS Ulcerative Lesions Chancroid . Chancroid is an ulcerative, infectious disease of the genital tract caused by the sexually transmitted anaerobic bacillus Haem... . H. ducreyi initially invades the genital skin or mucous membranes at sites traumatized by sexual contact. The patient generall... . Antiinfective agents recommended for management of chancroid include azithromycin, erythromycin, ceftriaxone, and ciprofloxaci... Granuloma Inguinale . Klebsiella granulomatis is the causative agent of granuloma inguinale. This intracellular bacterium is also referred to as a D... . Transmission of granuloma inguinale is not clearly understood. It is generally thought to be an STI, but the disease is also s... . Azithromycin is given once a week for at least 3 weeks or until all lesions are healed. Alternative agents include doxycycline... Nonulcerative Lesions Molluscum Contagiosum . Molluscum contagiosum is a viral skin disease caused by a member of the poxvirus family. (The term poxvirus refers to a viral ... . After invasion of the epidermis by the virus, pink to white lesions with an exudative core appear on the genitalia. The lesion... . The goal of treatment is primarily to prevent spread of the infection for cosmetic reasons. The lesions can be removed by mino... Human Papilloma Virus Infections . HPV infections cause epithelial lesions of the anogenital region. Approximately 100 types of HPV have been identified, with mo... . After invasion of the epidermis by HPV, an incubation period of 1 to 20 months (usually approximately 4 months) precedes the a... . External genital warts may be treated with patient-�applied podofilox or imiquimod topical preparations. Providers can perform... ENTERIC INFECTIONS SUMMARY X - Gastrointestinal Function 35 - Gastrointestinal Function 35 Embryology Functional Anatomy Oral Cavity and Pharynx Esophagus Stomach Small Intestine Large Intestine GASTROINTESTINAL MOTILITY Characteristics of the Intestinal Wall Neural Control Parasympathetic Innervation Sympathetic Innervation Afferent Nerve Fibers Electrical Activity of Gastrointestinal Smooth Muscle Hormonal Control Movement in the Gastrointestinal Tract Contraction of Gastrointestinal Smooth Muscle Propulsive Movements Mixing Movements Movement of Nutrients Chewing Swallowing Motor Functions of the Stomach Motility of the Small Intestine Ileocecal Sphincter Motility of the Colon SECRETORY FUNCTION Secretion of Gastrointestinal Juices Gastrointestinal Hormones DIGESTION AND ABSORPTION Digestion of Carbohydrates Digestion of Lipids Digestion of Proteins Absorption Carbohydrates Lipids Proteins Water and Electrolytes GASTROINTESTINAL FUNCTION ACROSS THE LIFE SPAN Maturation Age-Related Changes SUMMARY 36 - Gastrointestinal Disorders Dysphagia Esophageal Pain Abdominal Pain Vomiting Intestinal Gas Alterations in Bowel Patterns Constipation Diarrhea Pathophysiologic mechanisms Four major categories of diarrhea have been identified based on identifiable pathophysiologic mechan... DISORDERS OF THE MOUTH AND ESOPHAGUS ORAL INFECTIONS Stomatitis . Among its many causes are mechanical trauma; exposure to such irritants as alcohol, tobacco, and other chemical substances; pa... . The antiviral drugs acyclovir, famciclovir, and valacyclovir have been approved for treating acute herpetic stomatitis. There ... ESOPHAGEAL DISORDERS Gastroesophageal Reflux Disease . Any condition or agent that alters the closure strength and efficacy of the LES or increases intra-�abdominal pressure may pre... . The most common manifestations of this condition are heartburn, regurgitation, chest pain, and dysphagia. Complications of per... . Dietary and behavioral changes, such as avoiding tobacco and aggravating food and drink, are advised for all patients, whereas... . It carries a significant risk for esophageal cancer, approximately thirtyfold compared with the general population, or 0.1% to... Hiatal Hernia . Conditions in which intra-�abdominal pressure increases, such as ascites, pregnancy, obesity, and chronic straining or coughin... . Ulcerations can develop along the mucosal surface of the stomach as it slides through the diaphragmatic opening, so-�called Ca... Mallory–Weiss Syndrome . The tear is usually longitudinal, caused by forceful or prolonged vomiting during which the upper esophageal sphincter fails t... . Epigastric or back pain may also be present. Bleeding may range in severity from mild to massive. It is often profuse when the... Esophageal Varices Gastritis . Acute gastritis may be triggered by ingestion of toxins such as alcohol, aspirin, or other irritating substances or may occur ... . The factors promoting the condition have always been poorly understood. However, in 1983 identification of the bacterium H. py... . Occasionally, hematemesis may occur in response to damage to the gastric epithelial mucosa. These manifestations usually resol... Gastroenteritis . Chronic gastroenteritis is usually the result of a primary inflammatory disorder, such as CD, and is discussed in a later sect... . An elevated temperature and profound weakness and malaise may also be present (the so-�called stomach flu). The manifestations... Peptic Ulcer Disease . Although the precise mechanisms of ulcer formation remain poorly understood, the process involves the interplay of mucosal def... . The pain of GUs typically occurs on an empty stomach but may present soon after a meal. DU pain classically occurs 2 to 3 hour... . PPIs are generally given to block acid secretion. Agents such as sucralfate form a protective coating over the injured mucosa ... INFLAMMATORY BOWEL DISEASE Ulcerative Colitis . The main mechanism appears to be autoimmunity to colonic mucosa, mediated by cytotoxic T cells. UC begins as an inflammation a... . Systemic corticosteroids have long been the mainstay of treatment of acute exacerbations, but side effects limit their long-�t... Crohn Disease . Many of the factors identified in the pathogenesis (e.g., abnormal epithelial homeostasis, defects in immune regulation) are i... . Complications such as perianal fissures, fistulas, and abscesses are common in CD and may be the symptoms that lead individual... . Therapeutic strategies for CD are focused on alleviating and reducing inflammation and symptoms. Therapeutic drug categories a... ENTEROCOLITIS Clostridioides Difficile Colitis (Antibiotic-�Associated or Pseudomembranous Colitis) . C. difficile colitis is an acute inflammation and necrosis of the large intestine, usually affecting the mucosa but sometimes ... . difficile colitis include profuse watery and foul-�smelling diarrhea, abdominal pain, fever, leukocytosis, and, rarely, toxic ... Necrotizing Enterocolitis .25 kg). This disorder is characterized by diffuse or patchy intestinal necrosis accompanied by sepsis. A special form of NEC ca... . The major complication of NEC is ischemia leading to intestinal perforation, which may necessitate surgery. Various theories r... Appendicitis . The appendix represents a vestigial component of the GI tract that may have been important in maintaining GI flora and assisti... . The peak incidence is between ages 10 and 19 years. The earliest manifestation of appendicitis is generalized periumbilical pa... Diverticular Disease and Diverticulitis . Diverticula are acquired herniations of the mucosa and submucosa through the muscular coat of the colon (Fig. 36.10) that like... . Manifestations of diverticulitis include acute lower abdominal pain (usually left lower quadrant in location, although occasio... MOTILITY DISORDERS Irritable Bowel Syndrome . Most evidence seems to show that IBS is primarily a disorder of bowel motility. Studies have demonstrated that the myoelectric... . In addition to cramping abdominal pain, manifestations such as nausea and mucus in the stool may be present. The severity of m... Intestinal Obstruction . The most frequent contributing factors are previous abdominal surgery with adhesions and congenital abnormalities of the bowel... . Obstructions in the upper jejunal area usually result in vomiting, dehydration, and electrolyte depletion. In obstructions of ... Volvulus Intussusception Megacolon Hirschsprung Disease MUCOSAL MALABSORPTION DISORDERS Celiac Disease . Current research suggests that celiac sprue is an immune disorder triggered by exposure to gliadin (a specific wheat gluten) i... . Newer blood tests that assay for anti–tissue immunoglobulin A transglutaminase (tTG-�IgA) antibody and the more specific endom... Tropical Sprue . Current theory suggests that bacterial overgrowth of the large intestine produces products of fermentation that damage intesti... . Massive malabsorption may result from failure of the mucosa to produce the enzymes needed for digestion. Manifestations includ... Dumping Syndrome . 36.13). This loss of normal, gradual pyloric emptying may occur after removal of all or part of the stomach (gastrectomy), a p... . The hyperosmolar contents of the small intestine draw water into the lumen and stimulate bowel motility, with manifestations o... . Restriction of carbohydrate intake may be needed to limit glucose absorption. Medications to reduce bowel motility have been h... Short Bowel Syndrome Anchor 604 . In particular, removal of the distal two thirds of the ileum and the ileocecal valve may result in severe malabsorption. Becau... . The remaining villi may enlarge and lengthen, thus increasing the absorptive surface area of the bowel. The presence of orally... Esophageal Cancer . It usually develops in men older than 60 years, with an overall 5-�year survival rate of 18%. Although the cause of esophageal... . Invasion of surrounding structures may lead to the formation of esophagobronchial or esophagopleural fistulas, with subsequent... Gastric Carcinoma . A recent consensus committee of the World Health Organization affirmed the role that H. pylori plays in development of gastric... . Gastric carcinoma extends rapidly to the regional lymph nodes and surrounding organs by way of the lymphatic system and the bl... Small Intestinal Neoplasms . Bleeding and ulceration of small intestinal tumors are common manifestations, as is obstruction and, less commonly, intussusce... COLONIC POLYPS AND COLON CANCER Colon Polyps Colon Cancer . The risk increases with advancing age. After age 40 the annual incidence of colon cancer accelerates, doubling every decade un... . On the right side of the colon, the site of water and electrolyte absorption, tumor growth tends to extend along the bowel rat... . The 5-�year survival rate is directly related to the extent of tissue invasion. The traditional Dukes classification scheme (T... Stress of Lifestyle Changes SUMMARY 37 - Alterations in Function of the Gallbladder and Exocrine Pancreas PHYSIOLOGY OF BILE FUNCTIONAL ANATOMY OF THE PANCREAS DISORDERS OF THE GALLBLADDER Pathophysiology of Cholesterol Gallstone Formation Cholelithiasis and Cholecystitis Chronic Cholelithiasis Acute Cholecystitis Chronic Cholecystitis Biliary Malignancy DISORDERS OF THE PANCREAS Pancreatitis Acute Pancreatitis Chronic Pancreatitis Pancreatic Cancer SUMMARY 38 - Liver Diseases STRUCTURE AND FUNCTION OF THE LIVER GENERAL MANIFESTATIONS OF LIVER DISEASE Hepatocellular Failure Jaundice . Jaundice, the green-�yellow staining of tissues by bilirubin, is the consequence of impaired bilirubin metabolism and is one o... . The most common causes of prehepatic jaundice are hemolysis and ineffective erythropoiesis. The resorption of large hematomas ... . Dysfunction of any of the hepatic steps in bilirubin metabolism may cause jaundice. In the neonate, immature UDPGT levels may ... . At the level of canalicular bilirubin transport, the rare inherited Dubin–Johnson and Rotor syndromes cause conjugated hyperbi... . After a complete history and physical examination are obtained and routine laboratory data reviewed, specific liver-�related t... . Biochemical test abnormalities usually fall into one of several categories. A significant elevation in the levels of transamin... Portal Hypertension Gastroesophageal Varices . Esophageal varices result from portal hypertension, which in Western society is generally the result of cirrhosis caused by ch... . Gastroesophageal varices are one of a number of collateral venous pathways that dilate in response to elevated portal pressure... . Varices will affect more than half of cirrhotic patients, and approximately 30% of them will experience an episode of variceal... . Initial treatment is directed at performing fluid resuscitation, correcting the coagulopathy, and stopping further bleeding. O... Portal Systemic Encephalopathy Hepatic Encephalopathy . Hepatic encephalopathy is a complex neuro�psychiatric syndrome characterized by symptoms ranging from mild confusion and letha... . Hepatic encephalopathy is usually precipitated by certain well-�defined clinical developments, including hypokalemia, hyponatr... . The first step in treatment of hepatic encephalopathy consists of correcting any identifiable precipitating factors, such as G... Cerebral Edema . Swelling of the brain (cerebral edema) is a serious complication in patients with grade 3 or 4 hepatic encephalopathy, which r... . Clinically, cerebral edema is characterized first by systolic hypertension, irregular respirations and bradycardia—Cushing tri... . Cerebral edema is managed primarily by the intravenous infusion of hypertonic saline and mannitol, which by increasing serum o... Complications of Advanced Liver Disease Ascites . Ascites, or the pathologic accumulation of fluid in the peritoneal cavity, is a typical concomitant of advanced liver disease ... . Dietary sodium should be restricted to 88 mEq (2000 mg) per day in patients with ascites. In motivated patients, this is perha... Spontaneous Bacterial Peritonitis . Patients with cirrhosis and ascites suffer from a variety of defects in host defense predisposing to infection in the peritone... . Antimicrobial therapy should be initiated promptly in suspected cases of SBP pending culture results. Third-�generation cephal... Hepatorenal Syndrome . Hepatorenal syndrome is a dire complication of patients with liver failure. Such patients may experience acute kidney failure ... . The prognosis of hepatorenal syndrome depends on the severity of the underlying liver disease and is generally poor. Treatment... DISORDERS OF THE LIVER Acute Viral Hepatitis Hepatitis A . Hepatitis A virus (HAV) is an RNA virus that is spread by enteric means (i.e., by the fecal-�oral route). The infection has a ... . HAV infection is diagnosed through serologic testing. The presence of anti-�HAV immunoglobulin G (IgG) indicates previous infe... Hepatitis B . HBV is a partially double-�stranded DNA virus that is highly prevalent worldwide. Probably 300 million persons, or 5% of the w... . The serologic diagnosis is more complicated than with hepatitis A (see Fig. 38.14). A typical screening panel for HBV infectio... . Fulminant hepatitis is a life-�threatening illness with high mortality. Care for patients with acute hepatitis is largely supp... . The HBV vaccine is a recombinant vaccine that is highly immunogenic with no material of human origin. (Thus there is no risk o... Hepatitis C . HCV (previously categorized as non-�A, non-�B hepatitis virus) is a single-�stranded RNA virus that belongs to the Flavivirida... . Management of acute HCV infection is the same as for other acute viral strains (i.e., supportive and expectant unless complica... Hepatitis D (Delta) . HDV is an incomplete viral organism that requires the presence of HBV for replication. It may occur coincident with or subsequ... . HDV infection is controlled through the same measures used to prevent transmission of other hepatitis viruses: following safe ... Hepatitis E . HEV is a common cause of acute hepatitis in developing countries but has been recognized more recently in resource-�rich count... . Treatment of acute infection is generally supportive, with studies showing efficacy for ribavirin in immunocompromised patient... Chronic Hepatitis Chronic Persistent Hepatitis Chronic Active Hepatitis . Patients with chronic active hepatitis may be grouped into several categories based on etiology. First, as discussed earlier, ... . The diagnosis of chronic hepatitis is made on the basis of the clinical setting and abnormal liver enzymes, particularly trans... . Treatment depends on the cause; management of HBV and HCV infection has already been discussed. Managing toxic hepatitis invol... Autoimmune Hepatitis . Autoimmune hepatitis is a progressive liver inflammation characterized by the presence of several distinctive autoantibodies, ... . Corticosteroids and immunosuppressive drugs have been used since the early 1960s for the management of autoimmune chronic acti... CIRRHOSIS Biliary Cirrhosis Etiology and Pathogenesis Diagnosis and Treatment Biliary Flukes Primary Sclerosing Cholangitis . PSC is characterized by recurrent episodes of cholangitis, with progressive biliary scarring and obstruction. Secondary forms ... . A majority of patients with PSC will have a positive perinuclear antinuclear cytoplasmic antibody test, although this is not n... Alcoholic Liver Disease Alcoholic Fatty Liver . Alcoholic fatty liver (also termed alcoholic steatohepatitis) is an accumulation of fat in the liver cells caused by more fat ... . Steatohepatitis is commonly alcohol related but can also result from diabetes mellitus, obesity, protein malnutrition, total p... Alcoholic Hepatitis . Alcoholic hepatitis is an active inflammation of the centrilobular region of the liver. The liver cells show pathologic change... . The diagnosis is suggested by the history. The finding of a serum AST (SGOT) level markedly higher than the serum ALT (SGPT) l... TOXIC LIVER DISORDERS Metal Storage Diseases Hereditary Hemochromatosis . Hereditary hemochromatosis (HH) is one of the most common autosomal recessive disorders in the world. In European populations,... . The diagnosis is suggested by clinical features and family history. Plasma iron and transferrin saturation is increased, and s... . Observational studies have shown that asymptomatic patients with a relatively low iron load have an essentially normal life sp... Wilson Disease (Hepatolenticular Degeneration) . Wilson disease, or hepatolenticular degeneration, is a rare autosomal recessive disorder in which excessive amounts of copper ... . Hepatic disease is more common in children than adults and begins as hepatomegaly, fatty infiltration of the liver, and elevat... . Clinical signs and symptoms suggest the diagnosis, in particular, the finding on slit-�lamp examination of the brownish Kayser... . Treatment involves dietary modification and copper removal therapy. Patients should eliminate copper-�rich foods from their di... Toxic Metabolic Agents Acetaminophen Poisoning . Many drugs and toxins cause liver damage. Unfortunately, treatment is often limited to withdrawal of the offending agent and a... . Acetaminophen (trade name Tylenol, also known as paracetamol in Britain and Europe) is a widely used, nonprescription analgesi... . Initial treatment, as for any poisoning, involves decontamination with induced emesis or lavage and activated charcoal, which ... OTHER STRUCTURAL LIVER CONDITIONS Liver Abscess . Pyogenic liver abscess is a common condition worldwide. In the United States it commonly results from one of three situations:... . Large (2.0 cm) solitary or multiple liver abscesses require drainage, formerly a surgical procedure. Currently, CT-� or ultras... Trauma . The liver is the most common solid organ to be injured by penetrating abdominal trauma (e.g., gunshot wounds, stab wounds, or ... . Treatment entails the administration of fresh whole blood or packed red cells and fresh frozen plasma, as well as massive flui... Malignancy . Malignancy in the liver may be primary or secondary, with the latter being much more common. Because of the vascularity and ly... . The most common form of primary hepatic malignancy is HCC, often referred to as hepatoma. HCC is a malignancy of middle-�aged ... . Treatment for HCC has evolved significantly over the past decade. Unfortunately, because of advanced liver disease or multifoc... TRANSPLANTATION Evaluation of the Transplantation Patient Posttransplantation Management Liver Diseases and Pediatric Considerations Abnormal Bilirubin Metabolism in the Neonatal Period Infectious and Acquired Hepatitides in Children Congenital Liver Disease Multisystem Enzyme Deficiencies Disorders of Bilirubin Metabolism Inborn Errors of Metabolism Intrahepatic Cholestatic Conditions Extrahepatic Cholestatic Conditions (Biliary Atresia) SUMMARY XI - Endocrine Function, Metabolism, and Nutrition 39 - Endocrine Physiology and Mechanisms of Hypothalamic-Pituitary Regulation HORMONE STRUCTURE AND ACTION Chemical Structure of Hormone Classes Mechanisms of Hormone Action Hormones With Cell Membrane Receptors . Hormones can be described as “first messengers”; the hormone carries a message from the secreting cell to the target cell. A s... . A second class of surface receptors important in endocrine signaling is the protein kinase receptor family. These receptors ei... Amplification of Hormone Activity Hormones With Intracellular Receptors HORMONE REGULATION Hormone Synthesis, Secretion, and Metabolism Factors Affecting Hormone Secretion Feedback Control of Secretion Hormone Metabolism and Excretion Pharmacologic Hormone Concentrations Regulation of Receptor Responses Receptor Specificity and Affinity Receptor Down-Regulation and Up-Regulation Permissiveness Hormone Agonists and Antagonists HYPOTHALAMIC-PITUITARY ENDOCRINE SYSTEM Hormones of the Posterior Pituitary Gland Antidiuretic Hormone Oxytocin Growth Hormone Prolactin Gonadotropins Thyroid-Stimulating Hormone Adrenocorticotropic Hormone THYROID HORMONES Thyroid Hormone Synthesis and Secretion Thyroid Action on Target Cells STEROID HORMONES Steroid Hormone Synthesis and Secretion Steroid Action on Target Cells CATEGORIES OF ENDOCRINE DISEASE Hyposecretion Hypersecretion Hyporesponsiveness SUMMARY 40 - Disorders of Endocrine Function 40 Classification of Endocrine Disorders GROWTH HORMONE DISORDERS Growth Hormone Deficiency Growth Hormone Excess THYROID HORMONE DISORDERS Hypothyroidism Hyperthyroidism ADRENOCORTICAL HORMONE DISORDERS Adrenocortical Insufficiency Congenital Adrenal Hyperplasia Hypercortisolism Hyperaldosteronism ADRENAL MEDULLA DISORDER PARATHYROID GLAND DISORDERS Regulation and Actions of Parathyroid Hormone Hyperparathyroidism Hypoparathyroidism ANTIDIURETIC HORMONE DISORDERS Diabetes Insipidus Syndrome of Inappropriate Antidiuretic Hormone Secretion SUMMARY 41 - Diabetes Mellitus REGULATION OF GLUCOSE METABOLISM Hormonal Regulation Neural Regulation Exercise Stress GLUCOSE INTOLERANCE DISORDERS Classification of Glucose Intolerance Disorders Prediabetes Impaired Glucose Tolerance and Impaired Fasting Glucose Diabetes Mellitus Type 1 Diabetes Mellitus . The two forms of type 1 diabetes are type 1A immune-mediated diabetes, which is the most common, and type 1B idiopathic, which... . Type 1A diabetes is the result of destruction of the pancreatic β cells. The process is mediated by macrophages and T lymphocy... Type 2 Diabetes Mellitus . Individuals with type 2 diabetes mellitus are resistant to the action of insulin on peripheral tissues. Type 2 diabetes mellit... . Type 2 diabetes is characterized by a relative lack of insulin. The processes instrumental in producing the relative lack of i... Other Specific Types of Diabetes Gestational Diabetes Mellitus . In its pathophysiologic characteristics, GDM closely resembles type 2 diabetes mellitus. As in type 2 diabetes, tissue insulin... . Management of GDM includes education regarding appropriate dietary choices, implementation of an exercise regimen, and observa... Screening for Diabetes CLINICAL MANIFESTATIONS AND COMPLICATIONS Acute Hyperglycemia . Acute hyperglycemia is most commonly caused by alterations in nutrition, inactivity, inadequate use of antidiabetic medication... . A primary concern both of health care providers and of individuals with diabetes is avoiding the acute and chronic complicatio... Diabetic Ketoacidosis Nonketotic Hyperglycemic Hyperosmolar Syndrome Complications of Chronic Hyperglycemia Vascular Complications . Macrovascular complications of diabetes mellitus are defined as damage to the large blood vessels providing circulation to the... . The microvascular complications of diabetes—retinopathy and nephropathy—are thought to result from abnormal thickening of the ... Neuropathic Complications Complications in Pregnancy TREATMENT AND EDUCATION Nutrition Obesity and Eating Disorders Exercise Pharmacologic Agents Oral Antidiabetic Agents Incretin Enhancers, Incretins, and Amylins Insulin . Hypoglycemia is the most common complication of hyperglycemic therapy and the most hazardous. Neural tissue depends on a const... . Another typical complication of insulin therapy is lipodystrophy. Lipoatrophy has been linked to the use of insulin from anima... Stress Management Assessment of Efficacy PEDIATRIC CONSIDERATIONS Goals of Therapy Acute Complications Chronic Complications Treatment GERIATRIC CONSIDERATIONS Goals of Therapy Acute Complications Chronic Complications Treatment SUMMARY 42 - Alterations in Metabolism and Nutrition METABOLIC PROCESSES Anabolism and Catabolism Metabolic Rate NUTRIENT METABOLISM Carbohydrates Lipids Proteins Role of Genetics, Epigenetics, and Environment Hormonal Regulation of Nutrient Intake and Appetite Insulin Glucagon Catecholamines Growth Hormone Cortisol OBESITY AND METABOLIC SYNDROME Obesity Metabolic Syndrome Starvation and Protein-�Energy Malnutrition Physiologic Stress Aging Infection, Sepsis, and Fever Surgery Trauma Burns Cancer Immobility SUMMARY XII - Neural Function 43 - Structure and Function of the Nervous System STRUCTURAL ORGANIZATION NEURONAL STRUCTURE AND FUNCTION 44 - Acute Disorders of Brain Function MECHANISMS OF BRAIN INJURY Ischemia and Hypoxia Cellular Energy Failure Excitatory Amino Acids Reperfusion Injury Abnormal Autoregulation Increased Intracranial Pressure Etiology Manifestations Brain Compression and Herniation Management MANIFESTATIONS OF BRAIN INJURY Level of Consciousness Glasgow Coma Scale Cranial Nerve Reflexes Pupil Reflex Oculovestibular Reflex Corneal Reflex TRAUMATIC BRAIN INJURY EPIDEMIOLOGY TYPES OF TRAUMATIC BRAIN INJURY PRIMARY INJURY Intracranial Hematomas Epidural Hematoma Subdural Hematoma Subarachnoid Hemorrhage SECONDARY INJURY TREATMENT CEREBROVASCULAR DISEASE AND STROKE EPIDEMIOLOGY ISCHEMIC STROKE HEMORRHAGIC STROKE TREATMENT STROKE SEQUELAE Motor and Sensory Deficits Language Deficits Cognitive Deficits CEREBRAL ANEURYSMS Etiology Pathogenesis and Manifestations Treatment ARTERIOVENOUS MALFORMATION Etiology Pathogenesis and Manifestations Treatment CENTRAL NERVOUS SYSTEM INFECTIONS MENINGITIS Etiology Pathogenesis and Clinical Manifestations Treatment ENCEPHALITIS Etiology Pathogenesis and Manifestations Treatment BRAIN ABSCESS Etiology Pathogenesis and Manifestations Treatment SUMMARY 45 - Chronic Disorders of Neurologic Function BRAIN AND CEREBELLAR DISORDERS Seizures and Epilepsy Etiology Pathogenesis Clinical Manifestations . The ILAE 2017 classification of seizure types include three types: (1) focal onset, (2) generalized onset, and (3) unknown ons... . Episodes in which the entire brain is involved from the onset of the seizure are referred to as generalized onset seizures. In... . Focal seizures are those in which activity is restricted to one brain hemisphere. They are divided into two categories: (1) aw... . Seizures that are not witnessed can be classified as motor (tonic-�clonic, epileptic spasm) or nonmotor (behavior arrest), or ... . Some people may have a subjective sense of an impending seizure. This prodromal period may be characterized by any one of seve... Diagnosis and Treatment Dementia Etiology Alzheimer Disease Pathogenesis Vascular Dementia Pathogenesis Clinical Manifestations Diagnosis and Treatment Parkinson Disease Etiology Pathogenesis Clinical Manifestations Treatment Cerebral Palsy Etiology and Pathogenesis Clinical Manifestations Treatment Hydrocephalus Etiology Pathogenesis and Clinical Manifestations Treatment Cerebellar Disorders Etiology and Clinical Manifestations Multiple Sclerosis Etiology Pathogenesis Clinical Manifestations and Treatment Spina Bifida Etiology and Pathogenesis Clinical Manifestations . Treatment for this common disorder is based on the severity of the defect and neurologic dysfunction. Myelomeningocele at birt... Amyotrophic Lateral Sclerosis Etiology and Pathogenesis Clinical Manifestations and Treatment Spinal Cord Injury Etiology Pathogenesis Clinical Manifestations Treatment Guillain–Barré Syndrome Etiology and Pathogenesis Clinical Manifestations and Treatment Facial Nerve Palsy/Bell Palsy Etiology and Pathogenesis Clinical Manifestations and Treatment SUMMARY 46 - Alterations in Special Sensory Function 46 External Ear Middle Ear Inner Ear Balance Vertigo HEARING IMPAIRMENT DISORDERS Conductive Hearing Impairment Loss Caused by Cerumen Impaction and Foreign Body Occlusion . Cerumen impaction is a common and frequently overlooked cause of conductive hearing loss, especially in the elderly. In most c... . Sometimes no symptoms are present and the foreign body is discovered on routine examination. If the foreign body is an insect,... Otosclerosis . Otosclerosis is a localized, inflammatory disease of the metabolism of endochondral bone of the otic capsule. It is characteri... . The diagnosis of otosclerosis is made through careful history taking, audiogram/tuning fork testing, and radiologic studies, s... Sensorineural Hearing Impairment Loss Caused by Ototoxic Medications Loss Caused by Trauma . Acquired sensorineural hearing loss caused by chronic, repeated exposure to loud sounds is common in the U.S. population. Four... . Individuals with hearing loss caused by noise trauma report that they are unable to discriminate words, particularly in noisy ... Presbycusis . In the elderly, hearing loss represents the convergence of many risk factors, including noise and ototoxic medication exposure... . Assessment of an individual with suspected presbycusis should begin with exclusion of all other causes of hearing impairment. ... Meniere Disease . Meniere disease is an idiopathic disorder in which there is an impairment of the ability of the inner ear to regulate normal h... . Clinical manifestations of Meniere disease include episodic tinnitus, fluctuating sensorineural hearing loss, vertigo, and sen... . Physical examination, including neurologic and otolaryngologic examination, is generally normal in those with Meniere disease.... OTITIS MEDIA Acute Otitis Media Chronic Otitis Media VISION STRUCTURE OF THE EYE VISUAL PATHWAYS DISORDERS OF THE EYE Errors of Refraction Myopia, Hyperopia, Presbyopia, and Astigmatism Age-�Related Disorders Strabismus Amblyopia Cataracts Retinopathy Retinal Detachment Diabetic Retinopathy . Diabetic retinopathy is one of the most common complications of diabetes, afflicting about 20% of adults with the disease. Sym... . Diabetic retinopathy is associated with complaints of blurred, darkened, and distorted vision. Visual changes may fluctuate in... . The diagnosis of diabetic retinopathy is made through careful history taking, visual acuity testing, and ophthalmologic examin... Age-�Related Macular Degeneration . Age-�related macular degeneration (AMD) is the leading cause of blindness among older adults in the developed world. The exact... . AMD is generally painless. In the atrophic form, the initial symptom is slightly blurred vision and decreased ability to see f... . AMD is diagnosed with thorough history and physical examination to rule out other causes of visual loss, visual acuity testing... Glaucoma Chronic Open-�Angle Glaucoma . The cause of open-�angle glaucoma is not clear. The drainage channels for aqueous humor appear normal. The disease is often bi... . The diagnosis of open-�angle glaucoma is made through intraocular pressure measurement, ophthalmoscopic examination of the opt... Acute Angle-�Closure Glaucoma . Primary acute angle-�closure glaucoma is caused by abnormality of the angle between the pupil and lateral cornea. This angle i... . Diagnosis of angle-�closure glaucoma involves the same tests as used for diagnosis of open-�angle glaucoma. Treatment again in... Visual Field Deficits Visual Field Loss . Visual field loss can be caused by changes in the eye itself, as is the case in cataracts, or result from tumors, vascular les... . Visual field deficits are easily and rapidly assessed through confrontation (i.e., comparison of the patient’s vision to the e... SMELL AND TASTE Disorders of Smell and Taste . Olfactory disorders range from loss or reduction in the sense of smell to distortions and olfactory hallucinations. Commonly t... . Individuals with smell dysfunction frequently complain of a diminished ability to taste. They may experience a decreased appet... . Assessment of the sense of smell is done by asking the individual to smell different known odors while keeping the eyes closed... SUMMARY 47 - Pain PHYSIOLOGY OF PAIN Transduction Transmission Perception Modulation TYPES OF PAIN ACUTE PAIN Headache Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment CHRONIC PAIN Fibromyalgia Syndrome Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment CANCER-�RELATED PAIN NEUROPATHIC PAIN Trigeminal Neuralgia Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment Diabetic Neuropathy Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment Postherpetic Neuralgia Etiology and Pathogenesis Clinical Manifestations Diagnosis and Treatment ISCHEMIC PAIN REFERRED PAIN PHYSIOLOGIC RESPONSES TO PAIN PAIN IN THE YOUNG AND THE ELDERLY Interrupting Peripheral Transmission of Pain Modulating Pain Transmission at the Spinal Cord Altering the Perception and Integration of Pain SUMMARY XIII - Neuropsychological Function 48 - Neurobiology of Psychotic Illnesses SCHIZOPHRENIA Etiology and Neurobiology Dopamine Effects GABAergic Interneuron Origin Genetic Effects Gestational Effects Marijuana Use in Adolescents and Schizophrenia Neurologic Effects Clinical Manifestations Pharmacologic Treatment Nonpharmacologic Treatment MAJOR DEPRESSIVE AND PERSISTENT DEPRESSIVE DISORDERS Etiology and Neurobiology Clinical Manifestations Pharmacologic Treatment Nonpharmacologic Treatment BIPOLAR DISORDER Etiology and Neurobiology Clinical Manifestations Pharmacologic Treatment Nonpharmacologic Treatment POPULATION CONSIDERATIONS Women and Mental Illness Cultural Considerations Geriatric Considerations SUMMARY 49 - Neurobiology of Nonpsychotic Illnesses ANXIETY DISORDERS Panic Disorder 49 Etiology and Neurobiology Clinical Manifestations Treatment Generalized Anxiety Disorder Etiology and Neurobiology Clinical Manifestations Pharmacologic Treatment Nonpharmacologic Treatment Obsessive-Compulsive Disorder Etiology and Neurobiology Clinical Manifestations Treatment Posttraumatic Stress Disorder Etiology and Neurobiology Clinical Manifestations Pharmacologic Treatment Nonpharmacologic Treatment NEURODEVELOPMENTAL DISORDERS Attention-Deficit/Hyperactivity Disorder Etiology and Neurobiology Clinical Manifestations Pharmacologic Treatment Nonpharmacologic Treatment Autism Spectrum Disorder Etiology and Neurobiology Clinical Manifestations Treatment SUMMARY XIV - Musculoskeletal Support and Movement 50 - Structure and Function of the Musculoskeletal System STRUCTURE AND FUNCTION OF BONE Composition Functional Properties Growth and Ossification Continuous Growth Bone Remodeling Calcium Homeostasis Response to Injury, Stress, and Aging Fracture Healing STRUCTURE AND FUNCTION OF JOINTS Synarthroses Fibrous Structure Cartilaginous Structure Diarthroses Synovial Structure . Synovial fluid contains hyaluronic acid, a high-molecular-weight polysaccharide, and lubricin, a glycoprotein. Hyaluronic acid... Range of Movement STRUCTURE AND FUNCTION OF ARTICULAR CARTILAGE Composition Functional Properties Response to Injury, Stress, and Aging STRUCTURE AND FUNCTION OF TENDONS AND LIGAMENTS Composition Functional Properties Response to Injury, Stress, and Aging STRUCTURE AND FUNCTION OF SKELETAL MUSCLE Composition Contractile Apparatus MECHANICS OF MUSCLE CONTRACTION Sliding Filament Theory Role of Calcium Electromechanical Coupling Types of Muscle Contraction Twitch Contraction Concentric, Eccentric, and Isometric Contractions Mechanical Principles Length–Tension Relationship Load–Velocity Relationship Force–Time Relationship Effects of Temperature Change Effects of Fatigue Response to Movement and Exercise SUMMARY 51 - Alterations in Musculoskeletal Function: Trauma, Infection, and Disease SOFT TISSUE INJURIES INERT SOFT TISSUE INJURIES Ligament Injuries Clinical Manifestations Treatment Joint Capsule Injuries Adhesive Capsulitis Internal Joint Derangement Injuries to Fasciae and Bursae Fasciae Bursae Injuries to Nerves, Nerve Roots, or Dura Mater CONTRACTILE SOFT TISSUE INJURIES Injury to Tendons Muscle and Tendon Strains Blunt Trauma Compartment Syndrome Soft Tissue Healing After Trauma Wound Repair Types of Bone Fracture Types of Fracture Extent of Fracture Diagnosis of Fracture Treatment of Fracture Healing Process Complications of Fractures Dislocations and Subluxations INFECTIONS OF THE BONE Osteomyelitis Etiology and Pathogenesis Clinical Manifestations Healing Complications Treatment Tuberculosis Etiology and Pathogenesis Clinical Manifestations Risk Factors Treatment BONE STRUCTURE DISORDERS Scoliosis Etiology and Pathogenesis Clinical Manifestations Treatment METABOLIC BONE DISEASES Osteoporosis Etiology and Pathogenesis Clinical Manifestations Treatment Other Causes of Osteoporosis Rickets and Osteomalacia Clinical Manifestations Treatment Paget Disease Etiology and Pathogenesis Clinical Manifestations Treatment BONE TUMORS Benign Tumors Osteochondroma Chondroma Osteoid Osteoma Giant Cell Tumor Malignant Bone Tumors Osteosarcoma Chondrosarcoma Ewing Sarcoma Multiple Myeloma (Plasma Cell Myeloma) DISEASES OF SKELETAL MUSCLE IDIOPATHIC INFLAMMATORY MYOPATHY Polymyositis and Dermatomyositis Clinical Manifestations Treatment MUSCULAR DYSTROPHY Duchenne Muscular Dystrophy Etiology and Pathogenesis Clinical Manifestations Treatment Becker Muscular Dystrophy Etiology, Pathogenesis, and Clinical Manifestations Facioscapulohumeral Muscular Dystrophy Etiology and Pathogenesis Myotonic Dystrophies Clinical Manifestations Treatment CHRONIC MUSCLE PAIN Fibromyalgia Syndrome Etiology and Pathogenesis Clinical Manifestations Treatment SUMMARY 52 - Alterations in Musculoskeletal Function: Rheumatic Disorders LOCAL DISORDERS OF JOINT FUNCTION Osteoarthritis Etiology and Pathogenesis Clinical Manifestations Treatment Infectious Arthritis Etiology and Pathogenesis Clinical Manifestations Treatment Joint Prosthesis Infection Lyme Disease Clinical Manifestations and Treatment SYSTEMIC DISORDERS OF JOINT FUNCTION Immune-�Mediated Disorders Rheumatoid Arthritis Systemic Lupus Erythematosus Sjögren Syndrome Scleroderma Ankylosing Spondylitis Postinfectious Systemic Disorders Reactive Arthritis (Reiter Syndrome) Acute Rheumatic Fever Psoriatic Arthritis Etiology and Pathogenesis Clinical Manifestations Treatment Enteropathic Arthritis Clinical Manifestations Treatment Neuropathic Osteoarthropathy Clinical Manifestations and Treatment Hemophilic Arthropathy Clinical Manifestations Gout Clinical Manifestations Asymptomatic Hyperuricemia Acute Gouty Arthritis Intercritical Gout Chronic Tophaceous Gout Treatment Adult-�Onset Still Disease Clinical Manifestations and Treatment PEDIATRIC JOINT DISORDERS Nonarticular Rheumatism Hypermobility of Joints Juvenile Idiopathic Arthritis Clinical Manifestations Treatment SUMMARY XV - Integumentary System 53 - Alterations in the Integumentary System AGE-RELATED CHANGES Epidermis Dermis and Subcutaneous Tissue Appendages Hair Nails Glands EVALUATION OF THE INTEGUMENTARY SYSTEM Primary and Secondary Lesions Lesion Descriptors SELECTED SKIN DISORDERS INFECTIOUS PROCESSES Viral Infections Verrucae . Verrucae, or warts (Fig. 53.4), are common benign papillomas caused by DNA-containing papillomaviruses. Although warts vary in... Herpes Simplex Virus . Herpes simplex virus (HSV) infections of the skin and mucous membranes are common (Fig. 53.5). Two types of herpesviruses infe... . No cure for herpes simplex is known, and most treatment measures are palliative. Lidocaine (Xylocaine) or diphenhydramine (Ben... Herpes Zoster Virus . Herpes zoster (shingles) is an acute localized inflammatory disease of a dermatomal segment of the skin (Fig. 53.6). It is cau... . The clinical manifestations of shingles include the eruption of vesicles with erythematous bases that are restricted to skin a... . Management of shingles includes oral antiviral drugs; acyclovir (Zovirax) is one example. Topical agents such as Burow compres... Fungal Infections Superficial Fungal Infections . The clinical signs of superficial fungal infection vary depending on the physical location and the host’s response to the inva... . Topical management of localized superficial dermatophyte infections is very effective. Among the topical antifungal preparatio... Yeast Infections Bacterial Infections Impetigo . Impetigo is an acute, contagious skin disease characterized by the formation of vesicles, pustules, and yellowish crusts (Fig.... . Treatment for impetigo includes topical application of 2% mupirocin ointment (Bactroban) or 1% retapamulin (Altabax) ointment.... Syphilis . A variety of sexually transmitted diseases caused by bacteria can infect the genitalia. The most serious is syphilis, which is... . Laboratory tests to detect serum antibodies against syphilis (e.g. VDRL) and examination of the pustules for the spirochete ar... Leprosy INFLAMMATORY CONDITIONS Lupus Erythematosus Seborrheic Dermatitis Clinical Manifestations and Treatment Psoriasis Etiology and Clinical Manifestations Treatment Lichen Planus Etiology and Pathogenesis Treatment Pityriasis Rosea Etiology, Pathogenesis, and Treatment Acne Vulgaris Etiology and Pathogenesis Treatment Pemphigus ALLERGIC SKIN RESPONSES Atopic Dermatitis Etiology and Clinical Manifestations Treatment Contact Dermatitis Etiologies and Clinical Manifestations Treatment Drug Eruptions Etiology and Clinical Manifestations Treatment Vasculitis Etiology Treatment PARASITIC INFESTATIONS Scabies Fleas Lice Chiggers Bedbugs Mosquitoes Blood Flukes Ticks Alpha-Gal Syndrome Rocky Mountain Spotted Fever Lyme Disease OTHER DISORDERS OF THE DERMIS Scleroderma Localized Scleroderma Diffuse Scleroderma Sunburn and Photosensitivity Effects of Sunlight Ulcers Altered Cell Growth: Epidermal Proliferation Tumors Cancer Pigmentation Alterations Vitiligo Albinism . Melanocytes produce melanin. A partial or total absence of melanin arises as an inborn error in metabolism in individuals with... SPECIAL CHARACTERISTICS OF DARK SKIN Skin Color Sensation Texture Temperature Hair Growth Amount Color Texture Lubrication Nails Shape Color Texture TREATMENT IMPLICATIONS Topical Treatment Wet Dressings Lotions Gels Creams Ointments Aerosols and Foams Intralesional Injection Selection of a Delivery System Corticosteroids Systemic Steroids Topical Steroids DEVELOPMENTAL CONSIDERATIONS Infancy Childhood Skin Disorders Rubella . Rubella (3-day measles, German measles) is a childhood disease caused by the rubella virus. It is characterized by a diffuse p... . Most states require immunization to prevent the transmission of rubella to pregnant women. Immunization is with a live virus v... Roseola Infantum . Roseola infantum is a contagious viral disease that generally affects children younger than 4 years and usually children appro... . Management of roseola infantum is palliative. As with rubella, antipyretic drugs such as acetaminophen (Tylenol) and cooling b... Measles . Hard measles, or 7-day measles (rubeola), is a communicable viral disease caused by the Morbillivirus. The characteristic rash... . Measles is preventable by vaccine (MMR), and immunization is required by law in most states. Immunization is accomplished by t... Chickenpox . Chickenpox (varicella) is a common communicable childhood disease. It is caused by the varicella zoster virus, which is also t... . Treatment is based on symptoms. Antipyretic drugs such as acetaminophen are given for fever reduction; they may also relieve l... Scarlet Fever . Scarlet fever is a systemic reaction to the toxins produced by group A β-hemolytic streptococci. It occurs when the individual... Adolescence and Young Adulthood Geriatric Considerations SUMMARY 54 - Burn Injuries THERMAL INJURY Etiology, Incidence, and Mortality Risk Factors Integument Effects Depth Classification Extent of Injury Severity Classification Acute Management Assessment Burn Shock and Acute Resuscitation Organ Dysfunction Cardiovascular Dysfunction Respiratory Dysfunction Renal Dysfunction Metabolic Changes Cellular Changes Immune Response Elements of Burn Injury Survival Management of Wounds Burn Surgery Excision and Grafting Skin Substitutes Nutritional Support Rehabilitation Phase Wound Healing ELECTRICAL INJURY Incidence and Mortality Pathophysiology Management and Complications CHEMICAL INJURY Management and Complications Common Agents and Treatment Hydrofluoric Acid Anhydrous Ammonia Cement Burns Chemicals Associated With Automobile Airbag Burns Tar and Asphalt SPECIAL POPULATIONS Introduction Geriatric Pediatric Obese SUMMARY GLOSSARY A B C D E F G H I J K L M N O P R S T U V W X Z INDEX A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Hollywood Propaganda: How TV, Movies, and Music Shape Our Culture by Dice, Mark Introduction The Politics of Entertainment War on Trump War on America Immigration War on White People Film and Television Liaison Offices Climate Change Sports “News” Late-Night Comedy Shows Award Shows Feminism The LGBT Agenda Sexual Deviants Crimes Inspired by Hollywood Conclusion Copyright Info Footnotes The Liberal Media Industrial Complex by Dice, Mark Summary of Mark Dice's the Bohemian Grove by Everest Media Insights from Chapter 1 Insights from Chapter 2 Insights from Chapter 3 Insights from Chapter 4 Insights from Chapter 5 Insights from Chapter 6 Insights from Chapter 7 Insights from Chapter 8 Insights from Chapter 9 Insights from Chapter 10 Insights from Chapter 11 The Bohemian Grove: Facts & Fiction by Mark Dice Introduction History of the Grove Their Symbols, Saint, and Motto The Different Subcamps The Cremation of Care Ritual The Lakeside Talks Infiltrations and Leaks Hookers and Homosexuality Allegations of Murder Talk Radio Hosts Dodge the Topic The Belizean Grove Depictions in Television and Film Conclusion Further Reading About the Author Footnotes Causing Trouble: High School Pranks, College Craziness, and Moving to California by Dice, Mark Table of Contents Introduction High School College Craziness Middle School Moving to California Looking Back on it All Inside the Illuminati: Evidence, Objectives, and Methods of Operation by Mark Dice Introduction Early Evidence The Thirteen Bloodlines Theory Affiliated Secret Societies Spiritual Beliefs Symbolism Insiders’ Hints “Ex-Illuminati Members” Conclusion Further Reading About the Author Copyright Info Footnotes The New World Order: Facts & Fiction by Dice, Mark About the Author Introduction Calls for a New World Order World Governed by the Elite Through Occult Secret Societies Mainstream Media Controlled High Level Officials and Institutions within the NWO are Above the Law Immorality and Destructive Behavior is Encouraged Banking, Money, and Taxes One World Currency Population Reduction One World Religion A Global Dictator Claiming to be God Global Police and Military Force A Nation of Spies Elimination of the Right to Bear Arms Elimination of National Sovereignty Monitoring the Population with Big Brother. A Medicated and Sedated Population Science and Technology Global Warming / Climate Change Fringe Topics Conclusion Footnotes The Bilderberg Group: Facts & Fiction by Mark Dice Introduction The Attendees Recent Meetings How Were They First Discovered? Tax Returns Politicians Silent Actions and Effects Talk Show Hosts Play Dumb Bilderberg’s Goals Conclusion Further Reading About the Author Copyright Info Footnotes Illuminati in the Music Industry by Dice, Mark Introduction Rap and Hip Hop Pop Music Rock and Heavy Metal Country Music Conclusion Footnotes The New World Order: Facts & Fiction by Mark Dice About the Author Introduction Calls for a New World Order World Governed by the Elite Through Occult Secret Societies Mainstream Media Controlled High Level Officials and Institutions within the NWO are Above the Law Immorality and Destructive Behavior is Encouraged Banking, Money, and Taxes One World Currency Population Reduction One World Religion A Global Dictator Claiming to be God Global Police and Military Force A Nation of Spies Elimination of the Right to Bear Arms Elimination of National Sovereignty Monitoring the Population with Big Brother A Medicated and Sedated Population Science and Technology Global Warming / Climate Change Fringe Topics Conclusion Bibliography Footnotes Big Brother: The Orwellian Nightmare Come True by Mark Dice Introduction Surveillance Cameras Global Positioning Systems Radio Frequency Identification Devices (RFID) Mind-Reading Machines Neural Interfaces Psychotronic Weapons Information Technology Orwellian Government Programs The Nanny State Orwellian Weapons Artificial Intelligence Cybernetic Organisms A Closer Look at Nineteen Eighty-Four Conclusion Further Reading About the Author Copyright Footnotes Big Brother: The Orwellian Nightmare Come True by Mark Dice Introduction Surveillance Cameras Global Positioning Systems Radio Frequency Identification Devices (RFID) Mind-Reading Machines Neural Interfaces Psychotronic Weapons Information Technology Orwellian Government Programs The Nanny State Orwellian Weapons Artificial Intelligence Cybernetic Organisms A Closer Look at Nineteen Eighty-Four Conclusion Further Reading About the Author Copyright Footnotes True Story of Fake News by Mark Dice Introduction Real Fake News The Media Circus The Power of Propaganda Lying by Omission Fake Hate Crimes Operation Mockingbird White House Correspondents’ Dinner Liberal Bias Confirmed The Sun Valley Conference The New Media Facebook Twitter YouTube Google Wikipedia CNN NBC News CBS News ABC News MSNBC Conclusion Further Reading About the Author Copyright Info Footnotes The Liberal Media Industrial Complex by Mark Dice Introduction Censorship The Memory Hole The War on Trump The War on Trump Supporters The War on Families TV “News” Internet “News” Sites Wikipedia Google Rise of Social Media Facebook Twitter YouTube The Future of Fake News Conclusion Copyright Info Footnotes True Story of Fake News by Mark Dice Introduction Real Fake News The Media Circus The Power of Propaganda Lying by Omission Fake Hate Crimes Operation Mockingbird White House Correspondents’ Dinner Liberal Bias Confirmed The Sun Valley Conference The New Media Facebook Twitter YouTube Google Wikipedia CNN NBC News CBS News ABC News MSNBC Conclusion Further Reading About the Author Copyright Info Footnotes Big Brother: The Orwellian Nightmare Come True by Mark Dice Introduction Surveillance Cameras Global Positioning Systems Radio Frequency Identification Devices (RFID) Mind-Reading Machines Neural Interfaces Psychotronic Weapons Information Technology Orwellian Government Programs The Nanny State Orwellian Weapons Artificial Intelligence Cybernetic Organisms A Closer Look at Nineteen Eighty-Four Conclusion Further Reading About the Author Copyright Footnotes B003Z0CUNC EBOK by Mark Dice The Illuminati Facts & Fiction Mark Dice Table of Contents Preface About the Author Introduction Pre Illuminati Organizations The Luciferian Doctrine Inside the Mindset of the Illuminati Why are the Jews Always Blamed? Fixing the Fight Mainstream Media Economic Control Nonfiction Books Proofs of a Conspiracy Memoirs Illustrating the History of Jacobinism Proof of the Illuminati Secret Societies and Subversive Movements Occult Theocrasy None Dare Call It Conspiracy Bloodlines of the Illuminati The Lexicon of Freemasonry Morals and Dogma The Secret Teachings of All Ages Bohemian Grove: Cult of Conspiracy Common Sense Renewed Tragedy and Hope The New World Order America’s Secret Establishment Fleshing Out Skull and Bones Secrets of the Tomb September 11th 2001 Terrorist Attacks The Creature from Jekyll Island The Satanic Bible The Book of the Law Magick: In Theory and Practice The Secret Doctrine The Externalization of the Hierarchy Codex Magica Jim Tucker’s Bilderberg Diary The True Story of the Bilderberg Group The Search for the Manchurian Candidate The Reappearance of the Christ and the Masters of Wisdom The Franklin Cover-Up The most disgusting and disturbing book ever written is possibly The Franklin Cover-Up which was first published in 1992 and later released with revisions in 2005. The book was written by former Nebraska Senator John DeCamp, and uncovers a scandal so large and perverted, that most people simply do not want to hear about it, let alone believe it actually happened. Furthermore, Bonacci says that a man named “Hunter Thompson” was the one who took video of this entire ordeal. Later, a man named Rusty Nelson, who was connected to the Franklin Cover-Up claimed that Hunter S. Thompson, the famous gonzo journalist offered him $100,000 to produce a snuff film when the two had met at a party.[102] (See Fear and Loathing in Las Vegas page 318) Rusty Nelson was the personal photographer for Lawrence E. King, the key perpetrator in the Franklin Cover-Up. Nelson admits that it was his job to secretly take photos of people who attended King’s parties when they were in “compromising positions with children.” Nelson denies taking any pornographic photos, but does admit that he would often witness and photograph grown men “making out with boys.” The men who attended these parties were often politicians who King would then blackmail with the photos. On April 27, 1996 Colby died in what was called a canoeing accident. The incident happened at night which is strange, because Colby wouldn’t go canoeing after dark. He was alone when the incident happened, and had not told his wife that he was going canoeing. He was not wearing a life jacket, which his friends said he usually wore, and many believe he was murdered for aiding DeCamp or for knowing to much about such things. David Rockefeller’s Memoirs Foreign Affairs Purported Illuminati Texts The Necronomicon Emerald Tablet The Book of Thoth The Book of Shadows The Illuminati Manifesto The Book of Dzyan The Report From Iron Mountain Protocols of the Elders of Zion Excerpt from Protocol 1 Excerpt from Protocol 2 Excerpt from Protocol 3 Excerpt from Protocol 4 Excerpt from Protocol 5 Excerpt from Protocol 6 Excerpt from Protocol 7 Excerpt from Protocol 8 Excerpt from Protocol 10 Excerpt from Protocol 11 Excerpt from Protocol 12 Excerpt from Protocol 13 Excerpt from Protocol 14 The Holy Grail Alleged Defectors and Victims John Todd Bill Schnoebelen Mike Warnke Cathy O’Brien Johnny Gosch MK-ULTRA Victims Testimony Activists and Eyewitnesses William Morgan JFK Warns Against Secret Societies Chris Jones Ted Gunderson One of the highest ranking government officials to publicly talk about the Illuminati and admit that organized child kidnapping rings were active in the United States is Ted Gunderson. Gunderson is a retired FBI agent who worked as the Senior Special Agent-in-Charge of the Los Angeles office who retired in March of 1979 and then became a private investigator. Benjamin Fulford Hal Turner Anthony J. Hilder In today’s modern world with the Internet, mp3s and YouTube, it can be somewhat simple to open the floodgates of information regarding the Illuminati and secret societies. Since 2006 and the creation of YouTube and Google Video, countless video clips and documentaries about such issues are literally a click away. But as we know, books on the Illuminati have been around since at least the late 1700s as in the case of John Robison’s Proofs of a Conspiracy and Abbe Barruel’s Memoirs Illustrating the History of Jacobinism. There seems to be a tremendous gap in history from the time these books were published, until other authors and researchers continued the work such as Nesta Webster and Edith Miller in the 1920s and 30s, and later Gary Allen with his 1972 book None Dare Call It Conspiracy. Aliens and Reptilians David Icke William Cooper Phil Schneider Mentions in Mainstream Media CNBC Gerald Celente Fox News Business The Colbert Report Fox News Channel 60 Minutes NBC’s Meet the Press Geronimo’s Skull Controversy Inside Edition CNN CNN in London PBS News Hour with Jim Laher C-Span Lou Dobbs Tonight C-Span’s Washington Journal Brian Lamb, the director of C-Span dedicated a segment of the show Washington Journal to the Bohemian Grove and slanted the coverage in an attempt to remove any suspicions surrounding the club. Professor Michael Barkun was the guest for the segment, who is the author of a book titled A Culture of Conspiracy. National Geographic ABC News Report on Bohemian Grove On July 23, 1981 ABC News aired a segment about the Bohemian Grove which someone had obtained from their archives and posted on YouTube in 2006. This segment would mark possibly the only attention given to the Bohemian Grove by a mainstream news source. The fact that no other television news stations have since devoted any attention to the subject speaks volumes as to the control the organization has over the media. Pitching the Bohemian Grove to Producers The Mancow Show Walter Cronkite Henry Kissinger President Bush at the United Nations Maxim Magazine Charlie Sheen’s 9/11 Comments Jesse Ventura on Hannity & Colmes The View On March 6th, 2007 actress Christine Ebersole was a guest on the popular woman’s talk show The View when she brought up the topic of this author’s YouTube videos which consist of me visiting various college campuses in southern California and educating the students about 9/11. Rosie O’Donnell jumps in to explain, “He goes around the country with a bullhorn, like to UCLA or wherever he wants, and he says, “9/11 was an inside job! 9/11 was an inside job!” and within five or ten minutes, the police show up and his friends videotape him getting arrested, and boy does it annoy people, I can tell you that much.” Operation Inform the Soldiers On June 10th 2008, this author made an appearance on the Fox News Channel’s show America’s Newsroom, to discuss a campaign that I had started called Operation Inform the Soldiers, which involved mailing DVDs to troops stationed in Iraq to help educate them about the lies surrounding 9/11 and the war. Kevin Barrett’s Comments Coast to Coast AM The largest syndicated radio show in America that deals with secret societies and conspiracies is Coast to Coast AM, which airs seven days a week from 10pm to 2am Pacific time. The show was created by UFO buff Art Bell, who has since retired. George Noory is currently the primary host. Documentary Films Dark Secrets: Inside Bohemian Grove Secret Rulers of the World British journalist Jon Ronson produced a series of four television programs titled The Secret Rulers of the World which included one episode about the Bohemian Grove, and another about the Bilderberg group where he investigated the claims of what he called “conspiracy theorists” surrounding such groups. Ronson takes a very skeptical approach to the subject matter, and seems as if his purpose is to prove the allegations wrong and “debunk” the claims surrounding these organizations. Nazis: The Occult Conspiracy In the show, it is also presented that the Nazis wanted to eliminate all Jews, and probably all non-whites, to create a New World Order comprised only of Aryans so that the purified race could then reawaken the mystical powers that they had lost since the destruction of the city of Atlantis. The Nazis believed that the white race is descended from a civilization that lived in the mythical lost city of Atlantis. They believed Atlantis was a real city, and not just a myth, and that its inhabitants were god-like supermen. Terrorstorm Loose Change: Final Cut Fabled Enemies The 9/11 Chronicles: Truth Rising Endgame: Blueprint for Global Enslavement Zeitgeist the Movie The Clinton Chronicles Monopoly Men The Money Masters Money as Debt Riddles in Stone The History Channel: Secret Societies Conspiracy of Silence Decoding the Past: The Templar Code Another well done History Channel production is the two hour Decoding the Past episode titled The Templar Code. The program covers some interesting history surrounding the formation of the Knights Templar, and their ultimate demise. The show begins with the narrator saying they were “a society so secret that its true purpose is debated even to this day.” Mysteries of the Freemasons Hacking Democracy Other films Snuff Films Sex Magic Fictional Books The Illuminatus! Trilogy The Illuminati by Larry Burkett Angels & Demons Fear and Loathing in Las Vegas Nineteen Eighty-Four Games & Collector Cards The Illuminati Card Game New World Order Trading Cards Conspiracy Cards Fictional Films V for Vendetta The Matrix Angels & Demons The Texas Chainsaw Massacre Teddy Bears’ Picnic The Brandon Corey Story The Long Kiss Goodnight Network Star Wars Lara Croft: Tomb Raider They Live Hackers The plotline involves a rivalry between groups of hackers, but there is a scene that stuck out to those aware of the New World Order when Eugene “The Plague” Belford (played by Fisher Stevens) sent a laptop containing a video message to a fellow hacker “Zero Cool” (played by Jonny Lee Miller). The message was, “You wanted to know who I am Zero Cool. Well let me explain the New World Order. Governments and corporations need people like you and me. We are samurai. The keyboard cowboys, and all those other people out there who have no idea what’s going on are the cattle. Moooo. I need your help. You need my help. let me help you earn your spurs. Think about it.” The Skulls The Good Shepherd The Lord of the Rings Eyes Wide Shut The Brotherhood of the Bell A Scanner Darkly National Treasure Shooter Air America Air America is actually the name of a cargo airline that was owned and operated by the CIA from 1950 to 1976 which supplied covert operations in Southeast Asia during the Vietnam War. This airline was believed to be used to also transport heroine into the United States. This would ultimately be the inspiration for Christopher Robbins’ book and Air America the film. Wag the Dog Oliver Stone’s JFK Bulworth Conspiracy Theory The Manchurian Candidate Enemy of the State Batman Returns Dragnet Television Show References South Park Rescue Me The Lone Gunmen 24 Gargoyles A cartoon airing on the Disney Channel from 1994 to 1997 called Gargoyles included several episodes which mentioned the Illuminati and one of the main characters was shown to be a member. Wild Palms The Simpsons In a 1995 episode of the popular animated cartoon, The Simpsons, Homer joins an all-male fraternity in Springfield called the Stonecutters, an obvious reference to the Freemasons. The Freemason fraternity evolved out of ancient stone masons and trade guilds who kept knowledge secret about how to work with stone and build cathedrals and castles. The episode is titled “Homer the Great” and starts of with Homer noticing that two of his friends, Lenny and Carl, are enjoying special privileges around town and at work such as comfortable chairs and premium parking spots. After Homer becomes suspicious, he finds out that they are members of the Stonecutters secret society, and is allowed to become a member himself. The Cartoon Network Corporate Logos Music References Eminem Dr. Dre Neil Young Don Henley “It was an inside job by the well-connected” Henley sings. Other lyrics include that they know what you’ve had for breakfast and what you’ve hid beneath the mattress. “Chalk it up to business as usual,” Henley concludes. Megadeth Ministry Jadakiss Flowbots Conspirituality Paris Immortal Technique Sean “P. Diddy” Colmes Prodigy Jay-Z Nas Tupac Shakur Black Eyed Peas Fat Boy Slim Skinny Puppy Poker Face Killarmy Meat Beat Manifesto The Jurassic 5 Gamma Ray The KLF Agent Steel Killer Squirrel Hed PE Bobby Conn Malice Mizer Infected Mushrooms The Matthew Good Band The Alan Parsons Project Solutions Illuminati Controlled Organizations The Bilderberg Group Council on Foreign Relations The Trilateral Commission The Bohemian Grove The Federal Reserve Freemasonry Skull and Bones The Military The Vatican Knights of Malta Radical Islam Communism World Council of Churches Election Fraud The British Monarch Royal Order of the Garter MI-5 and MI-6 Council of Chatham House The Group The Triads The CIA The NSA The FBI The DEA Pharmaceuticals Entertainment The Mormon Church Jehovah’s Witnesses Rhodes Trust The Cosmos Club Club of Rome DARPA Supreme Council of Wise Men The Council of 13 The Committee of 300 The Jasons MJ-12 The Mothers of Darkness Castle The Pilgrims Society The Priory of Sion Satanic Cults and Churches United Nations International Monetary Fund The World Bank Foundations Bank for International Settlements Central Banks Global Environmental Facility Monopoly Corporations Regional Federations The United Grand Lodge of England Unity Church Unitarian Universalist Association Unification Church Temple of Understanding Bahai Rosicrucians The Aspen Institute World Trade Organization KGB La Cosa Nostra FEMA Mossad UNESCO Planetary Congress Environmental Groups Lucis Trust World Union Esalen Institute Commission on Global Governance Interpol Information Awareness Office Tavistock Institute Underground Bases and Tunnels The Project for a New American Century Others Bibliography Books Other Documents Footnotes
