Pathologic Physiology Mechanisms of Disease Third EditionPDF电子书下载

PART Ⅰ．PATHOLOGIC PHYSIOLOGY 1

CHAPTER 1 Pathologic Physiology＆By WILLIAM A．SODEMAN 3

ETIOLOGY OF DISEASE 3

Primary Factors 3

Secondary Factors 4

BODY RESPONSES TO ETIOLOGIC AGENTS 5

REFERENCES 6

PART Ⅱ．GENETICS AND DISEASE 7

CHAPTER 2 Genetics and Disease＆By BENJAMIN R．GENDEL 9

INTRODUCTION 9

THE PHYSICAL BASIS OF INHERITANCE 9

Genes 9

Chromosomes 10

Mitosis and Meiosis 10

Determination of Sex 12

Nondisjunction 12

Hereditary Variations 12

MECHANISMS OF INHERITANCE 14

Dominant Inheritance 15

Recessive Inheritance 16

Intermediate Inheritance or Incomplete Dominance 17

Sex-Linked Inheritance 18

Sex-Influenced Inheritance 19

TYPES OF GENETIC DISEASES 20

The Mutant Gene and Mechanisms of Gene Action 20

Lethals 20

Morphologic-Embryologic Defects 20

Inborn Errors of Metabolism 21

Abiotrophic Disturbances 26

Immunologic Disturbances 26

Susceptibility to Infectious Diseases 27

Detoxification of Drugs 27

Chromosomal Accidents 29

Klinefelter＇s Syndrome 29

Turner＇s Syndrome 30

Mongolism 31

Miscellaneous Conditions 31

REFERENCES 32

PART Ⅲ．METABOLISM AND THE ENDOCRINE GLANDS 33

CHAPTER 3 Nutritional Factors;Protein and Fat Metabolism＆By WILLIAM A．SODEMAN 35

INTRODUCTION 35

PROTEINS 38

Protein Deficiency 41

FATS 43

CALORIES 45

General Metabolism 45

Obesity 47

Caloric Deficiency 48

VITAMINS 49

Vitamin A 50

The Vitamin B Complex 51

Ascorbic Acid(Vitamin C) 58

Vitamin D and Calcium 61

Vitamin E 63

Vitamin K 63

Hypervitaminoses 64

MINERALS 65

Magnesium 66

Cobalt 66

Copper 66

Iodine 66

Fluorine 67

Iron 67

REFERENCES 68

CHAPTER 4 Carbohydrate Metabolism＆By HENRY T．RICKETTS AND MAURICE E．KRAHL 70

THE CHEMISTRY OF CARBOHYDRATE UTILIZATION 70

REGULATORY MECHANISMS OF CARBOHYDRATE METABOLISM 71

The Pancreas 72

Other Endocrine Glands 73

PHYSIOLOGIC EFFECTS OF THE ORAL HYPOGLYCEMIC AGENTS 74

THE GLUCOSE TOLERANCE TEST 75

CLINICAL ABNORMALITIES OF CARBOHYDRATE METABOLISM 77

Inborn Metabolic Errors 77

Diabetes Mellitus 77

Hypoglycemia 82

Organic Hypoglycemia 82

Functional Hypoglycemia 83

REFERENCES 84

CHAPTER 5 Water and Electrolyte Balance＆By C．THORPE RAY 86

VOLUMES AND COMPOSITION OF BODY FLUIDS 88

Measurements of the Volumes of Body Fluids 88

Characteristics of Intracellular and Extracellular Fluids 89

Exchanges of Fluids between Cellular and Extracellular Spaces 90

Exchanges of Fluids between Vascular and Extravascular Spaces 91

EXTERNAL EXCHANGES OF FLUIDS—WATER BALANCE 93

The Effect of Solute Load on Water Excretion 94

The Effect of the Antidiuretic Hormone on Water Excretion 95

Turnover of Body Water 97

ELECTROLYTIC BALANCE 97

Sodium 97

Sodium Content of the Body 98

Shifts of Sodium Between Compartments 98

Sodium Balance 99

Factors Which Influence Sodium Excretion by the Kidneys 99

Clinical Examples of Disorders in Sodium Balance 100

Chloride 104

The Chloride Content of the Body 104

Chloride Balance 104

Factors Influencing Renal Excretion of Chloride 105

Clinical Examples of Disorders in Chloride Balance 105

Potassium 105

Potassium Content of the Body 106

Shifts of Potassium between Compartments 106

Potassium Balance 107

Factors Which Influence Renal Excretion of Potassium 108

Clinical Examples of Disorders in Potassium Balance 108

CALCIUM AND MAGNESIUM 113

Calcium 113

Magnesium 114

ACID-BASE EQUILIBRIUM 115

Mechanisms of Production of Alkalosis and Acidosis 116

Respiratory Acidosis 116

Respiratory Alkalosis 117

Metabolic Acidosis 117

Metabolic Alkalosis 119

REFERENCES 120

CHAPTER 6 Endocrine Glands＆By EDWARD C．REIFENSTEIN,JR． 122

GENERAL CONSIDERATIONS 122

Definitions 122

General Outline of Hormone Relations 122

Classification of Hormone Actions 123

Objectives of Hormone Therapy 124

Natural versus Artificial”Hormones＂ 125

The Hormone Content of the Glands 125

Intermediary Metabolism in Disease 126

RESUME OF GLANDULAR PHYSIOLOGY 126

Hypothalamus 126

Anterior Pituitary 127

Posterior Pituitary 128

Ovary 129

Testis 130

Adrenal Cortex 130

Adrenal Medulla 132

Thyroid 133

Parathyroids 133

Pancreas 134

Placenta 135

DYNAMIC PHYSIOLOGY OF THE HORMONES 136

PATHOLOGIC PHYSIOLOGY OF THE MAIN ENDOCRINE ABNORMALITIES 142

Hypothalamic Precocity 143

Fr？hlich＇s Syndrome 143

Adolescent Mammoplasia 144

Hypothalamic or Psychogenic Amenorrhea 144

Acromegaly 146

Panhypopituitarism(Simmonds＇ Cachexia,Sheehan＇s Syndrome,Pituitary Dwarfism) 149

Pituitary Amenorrhea 151

Cushing＇s Syndrome 151

Primary Hyperaldosteronism(Conn＇s Syndrome) 154

Primary Hypoaldosteronism 155

Adaptation Syndrome 155

Disorders of Adaptation;Effects of Pituitary Adrenocorticotropic Hormone and of Adrenal Cortical Steroid Hormones in Nonendocrine Disorders 156

Addison＇s Disease and Adrenal Cortical Insufficiency 159

Adrenogenital Syndrome 160

Adrenal Androgen Hyperfunction Syndromes(Stein-Leventhal Syndrome;Large,Pale Ovary Syndrome) 161

Pheochromocytoma 163

Diabetes Insipidus 163

Menopause and the Menopausal Syndrome 164

Postmenopausal and Senile Osteoporosis 165

Gonadal Dysgenesis(Ovarian Agenesis,Turner＇s Syndrome,Ovarian Short-Stature Syndrome,Functional Prepuberal Castration) 167

Amenorrhea 168

Dysfunctional Uterine Bleeding(Metropathia Hemorrhagica) 170

Presumptive Test for Pregnancy 172

Dysmenorrhea and Endometriosis 172

Premenstrual Tension 175

Anorexia Nervosa 175

Arrhenoblastoma 176

Granulosa Tumors,Theca Cell Tumors,and Luteomas 176

Hypoleydigism 176

Hypospermatogenesis 177

Seminiferous Tubule Dysgenesis(Gynecomastia-and-Small-Testes Syndrome,Klinefelter＇s Syndrome) 178

Cryptorchidism 179

Male＂Climacteric＂ 181

Teratoma,Chorio-epithelioma,and Choriocarcinoma 181

Leydig Cell Tumor 182

Cretinism and Myxedema(Hypothyroidism) 182

Thyrotoxicosis(Hyperthyroidism) 182

Exophthalmic Goiter(Graves＇ Disease) 184

Simple Goiter 185

Thyroiditis 185

Hypoparathyroidism 185

Pseudohypoparathyroidism 186

Hyperparathyroidism 186

Diabetes Mellitus 188

Hyperinsulinism 188

Pregnancy Toxemia Complicating Diabetes Mellitus 189

Recurrent and Theatened Abortion 190

Postpartum Breast Manifestations 191

Endocrine Therapy for Neoplastic Disease 192

SUMMARY 192

REFERENCES 193

PART Ⅳ．INFECTION AND ALLERGY 195

CHAPTER 7 Factors Affecting Infections＆By GEORGE T．HARRELL,JR． 197

FACTORS CONCERNED IN THE NUMBER OF INFECTING ORGANISMS 198

Sources of Infection 198

Agents of Disease 199

Portal of Entry 201

Transmission by Vectors 201

Growth in the Body 202

FACTORS CONCERNED IN THE VIRULENCE OF THE INFECTING ORGANISM 204

Primary and Secondary Infections 204

Conditions Necessary for Infection 205

Routes of Spread 205

Increase in Virulence 206

Reduction in Virulence 207

Variations in Strains 208

FACTORS CONCERNED IN RESISTANCE 209

Nonspecific Factors 210

Specific Resistance 214

REFERENCES 214

CHAPTER 8 Effects of Infection＆By GEORGE T．HARRELL,JR． 215

INFLAMMATION AND FEVER 215

DAMAGE TO ORGANS 216

Direct or Immediate Effects 216

Indirect or Long-Term Effects 221

The Lungs 221

The Kidneys 222

The Heart 223

Effects Not Accompanied by Anatomic Change 224

Circulatory Disturbances 224

Chills 224

Rash 225

Central Circulatory Failure 225

Peripheral Circulatory Failure 226

Disturbances of Venous Circulation 230

Disturbances of the Lymphatic Circulation 232

INDIRECT EFFECTS ASSOCIATED WITH DISTANT INFECTION 232

REFERENCES 233

CHAPTER 9 Recovery from Infection＆By GEORGE T．HARRELL,JR． 235

IMMUNITY 235

Application to Diagnosis 236

Circulating Antibodies 237

Cellular Antibodies 239

Criterion of Cure 240

Response to Reinfections 241

Harmful Effects 242

SUPPORTIVE THERAPY 243

Rest 243

Diet 244

Vitamins 245

Fluids 247

Minerals 248

Measures to Decrease Metabolism 248

Measures to Support the Circulation 249

REFERENCES 250

CHAPTER 10 Alteration of the Course of an Infection＆By GEORGE T．HARRELL,JR． 251

PREVENTION 251

Control of Environment 251

Active Immunization 253

Passive Immunization 254

CHEMOTHERAPY 255

Antiseptics 258

Sulfonamides 259

Antibiotics 260

Other Chemotherapeutic Agents 261

Toxic Effects 262

IMMUNE THERAPY 263

Hypersensitivity Reactions 265

OTHER MEASURES 265

Physical Therapy 265

Biologic Therapy 266

Desensitization 266

Breakdown of Granulomas 267

Inhibition of Antigen-Antibody Reactions 267

REFERENCES 268

CHAPTER 11 Allergy＆By ROBERT A．COOKE AND WILLIAM B．SHERMAN 269

INTRODUCTION 269

ANAPHYLAXIS IN EXPERIMENTAL ANIMALS 270

Arthus Phenomenon 272

ANAPHYLAXIS IN MAN 272

Serum Sickness 273

CLINICAL ALLERGIES 274

Allergies with Immediate Wheal Reactions 274

Late Reactions to Food Allergens 278

Asthma,Rhinitis and Urticaria Due to Infection 278

Delayed and Immediate Reactions to Infective Agents 279

Allergic Dermatitis 281

Drug Allergies 282

EFFECTS OF CORTISONE AND CORTICOTROPIN ON ALLERGIC REACTIONS 283

REFERENCES 283

PART Ⅴ．PHYSICAL,TOXIC AND CHEMICAL AGENTS 285

CHAPTER 12 Physical and Toxic Agents＆By WILLIAM BEAN 287

INTRODUCTION 287

ENVIRONMENTAL TEMPERATURE 288

Heat 288

Source of Heat 288

Heat Load 288

The Basic Heat Equation 289

Acclimatization 290

Syncope 293

Upper Environmental Limits 293

Disease Due to Effect of Heat 294

Cold 296

Source of Cold 296

Acclimatization 297

Effects of Cold 297

Treatment 299

AEROMEDICINE 300

Syndromes Produced by Free Gas 301

MECHANICAL AND HYDRAULIC FACTORS 306

Missile Injury 306

Blast 306

Motion Sickness and Seasickness 307

Gravity and Acceleration 307

RADIUM,ROENTGEN RAYS,RADIOACTIVE SUBSTANCES AND ATOMIC FACTORS 308

ELECTRICAL INJURIES 312

MAN IN SPACE:A NEW DIMENSION 313

CONCLUDING REMARKS 317

REFERENCES 318

CHAPTER 13 Chemical Agents and Disease＆By JOHN H．FOULGER 320

INTRODUCTION 320

GENERAL DISCUSSION OF THE ACTION OF CHEMICALS 321

ROUTES OF ENTRY OF CHEMICALS 324

Inhalation of Chemicals 324

Absorption through the Skin 327

Absorption by the Gastrointestinal Tract 328

SYMPTOMATOLOGY ASSOCIATED WITH TOXIC CHEMICAL AGENTS 328

Symptoms Arising from Irritation and Damage at the Site of Entrance 328

Symptoms Arising from Action at the Site of Excretion 329

Results of Selective Action of Chemicals on Metabolic Processes,Enzyme Systems and Other Cellular Functions 330

EVIDENCES OF ABSORPTION OF CHEMICALS 331

Early Results of Absorption of Chemicals 331

Changes in Blood Pressure 333

Pulse Rates 335

Changes in Low Frequency Cardiac Vibrations 335

Electrocardiographic Changes 336

Other Physiologic Changes 337

MECHANISMS OF ACTION OF FOREIGN CHEMICALS 337

REFERENCES 339

PART Ⅵ．CIRCULATORY SYSTEM 341

CHAPTER 14 Hemodynamics:The Blood Vessels＆By W．A．SODEMAN 343

GENERAL HEMODYNAMICS 343

The Effects of Elasticity 344

Arteriosclerosis 344

Changes in Velocity and Pressure 346

Arterial Pulse 349

Means of Recording and Studying the Pulse 349

Venous Pulse 353

EVIDENCES OF PERIPHERAL VASCULAR DISEASE 354

Pain 355

Skin Color 357

Skin Temperature 359

Oscillometric Index 360

Visualization of Vessels 360

BLOOD PRESSURE 361

Arterial Blood Pressure 362

Measurement 362

Factors Maintaining Pulse Pressure 366

Arterial Hypertension 370

Hypotension 376

Syncope 377

Shock 380

Venous Pressure 383

Measurement 385

Elevation of Venous Pressure 386

Reduction in Venous Pressure 387

Disturbances in Venous Circulation 388

CAPILLARIES 389

BLOOD VELOCITY AND CIRCULATION TIME 390

Circulation Time 391

Circulation Rate 392

THE LESSER CIRCULATION 392

THE LYMPHATICS 392

THE EFFECT OF PREGNANCY ON THE CIRCULATION 393

REFERENCES 393

CHAPTER 15 Dynamics and Circulation of Heart Muscles;Cardiac Reserve;Heart Pain;The Cardiac Cycle＆By J．T．ROBERTS 395

CARDIAC DYNAMICS 395

Structure of the Heart 395

Sino-Atrioventricular System 399

Muscle Fibers 401

Dynamic Properties of Cardiac Muscle 403

CIRCULATION IN THE HEART 408

Coronary Arteriosclerosis 414

Coronary Blood Flow 415

CARDIAC RESERVE 420

Measurement 423

CARDIAC PAIN AND CARDIAC NERVES 424

THE CARDIAC CYCLE 428

Dynamic Interval of Atrial Systole 429

Inflów Phase of Atrial Systole 430

Isometric Ventricular Contraction 430

Isotonic Ventricular Contraction with Maximum Ejection Phase 430

Ventricular Contraction with Reduced Ejection Phase 431

Protodiastolic Phase of Diastole 431

Isometric Relaxation Phase of Diastole 432

Rapid Inflow or Rapid Filling Phase of Ventricular Diastole 432

Diastasis Phase 433

Abnormalities of Cardiac Rate and Rhythm 433

CARDIAC SOUNDS,MURMURS AND THRILLS 441

REFERENCES 447

CHAPTER 16 The Electrocardiogram＆By F．D．JOHNSTON 449

STANDARD LEADS 453

SPREAD OF ACTIVATION WAVE 459

UNIPOLAR EXTREMITY LEADS 462

PRECORDIAL LEADS 463

T WAVES AND VENTRICULAR GRADIENT 468

REFERENCES 470

CHAPTER 17 Cardiac Output;Hypertrophy and Dilatation;Valvular Diseases;Congenital Defects;Pericardial Diseases;Extracardiac Factors＆By EDGAR HULL 472

THE OUTPUT OF THE HEART 472

Methods of Estimation 472

The Fick Principle 472

The Dye Dilution Principle 474

Dye Injection Method 474

Physical Methods 474

Expression of the Cardiac Output 477

Normal Cardiac Output 477

Abnormalities of Cardiac Output Not Related to Cardiovascular Disease 477

The Cardiac Output in Cardiovascular Abnormalities 478

Cardiac Arrhythmias 479

Valvular Disease 480

Heart Failure 480

Myocardial Infarction 481

Pericardial Disease 481

Vascular Fistulas and Septal Defects 481

HYPERTROPHY AND DILATATION OF THE HEART 481

Ventricular Dilatation and Hypertrophy 481

Dilatation 481

Hypertrophy 483

Hypertrophy and Dilatation of the Atria 486

VALVULAR DISEASE OF THE HEART 487

General Considerations 487

Mitral Valve Disease 488

Mitral Insufficiency 488

Mitral Stenosis 490

Mitral Insufficiency and Stenosis 493

Cardiac Catheterization in Mitral Disease 493

Surgery of the Mitral Valve 496

Disease of the Aortic Valve 496

Aortic Stenosis 496

Aortic Insufficiency 500

Aortic Stenosis and Insufficiency 503

Tricuspid Valve Disease 503

Tricuspid Insufficiency 504

Tricuspid Stenosis 504

Tricuspid Insufficiency and Stenosis 505

Pulmonary Valve Disease 505

Cardiac Catheterization in Pulmonary Stenosis 507

Surgery for Pulmonary Stenosis 507

Combined Valvular Disease 507

CONGENITAL CARDIOVASCULAR DEFECTS 508

Atrial Septal Defect 509

Anomalous Pulmonary Veins 512

Pulmonary Hypertension in Atrial Septum Defects 514

Right-to-Left Shunting in Atrial Septal Defect 514

Pulmonary Stenosis with Patent Atrial Septum 515

Ostium Primum Deficit 515

Lutembacher＇s Complex 515

Ventricular Septal Defect 516

Pulmonary Hypertension in Ventricular Septal Defect 517

Right-to-Left Shunting in Ventricular Septal Defect 518

Ventricular Septal Defect with Pulmonary Stenosis(Tetralogy of Fallot) 519

Patent Ductus Arteriosus 520

Coarctation of the Aorta 521

Pulse Pressures,Systolic Pressures,Pulse Forms 523

Mean Pressures 524

Diastolic Pressures 525

Cardiac Catheterization in the Study of Congenital Heart Disease 526

Data Obtainable by Comparative Oxygen Content of Blood Samples 526

Intracardiac and Pulmonary Arterial Pressures in Congenital Defects 530

Dye Injection Techniques in the Study of Congenital Anomalies 530

Gas Inhalation 531

Surgery for Congenital Cardiovascular Defects 532

Corrective Surgery 532

Palliative Surgery 533

PERICARDIAL DISEASE 534

Hemopericardium 534

Pericardial Effusion 534

Constrictive Pericarditis 534

Pulsus Paradoxus and Inspiratory Distention of the Neck Veins 537

Cardiac Catheterization in Constrictive Pericarditis 538

EXTRACARDIAC CONDITIONS AFFECTING FUNCTION OF THE HEART 538

Hypertension 539

Hypotension 539

Anemia 539

Hyperthyroidism 539

Hypothyroidism 540

Pulmonary Disease 540

Pulmonary Embolism and Thrombosis;Primary Pulmonary Hypertension 540

Fever 541

Infectious,Metabolic and Toxic States 541

REFERENCES 542

CHAPTER 18 Cardiac Failure and Function Tests＆By JOHN S．LA DUE 551

CARDIAC DECOMPENSATION 551

Mechanisms of Congestive Heart Failure 553

Pathologic 554

Metabolic 555

Hemodynamic 556

Mechanism of Compensation 561

Manifestations of Left-Sided Heart Failure 566

Dyspnea 566

Pulmonary Edema 568

Hydrothorax 568

Vital Capacity 568

Circulation Time 568

Other Findings 569

Right-Sided Heart Failure 569

Blood Volume 569

Edema 571

Cyanosis 573

Treatment of Congestive Heart Failure 573

ANGINA PECTORIS,CORONARY INSUFFICIENCY AND MYOCARDIAL INFARCTION 576

Angina Pectoris 577

Coronary Insufficiency(Myocardial Ischemia) 578

Myocardial Infarction 579

CARDIAC FUNCTION TESTS 581

Introduction 581

Anoxemia Test 582

Standard Exercise Test 583

Master＇s and Donoso＇s Criteria 584

Vital Capacity 585

Oxygen Debt 586

REFERENCES 587

PART Ⅶ．RESPIRATORY SYSTEM 589

CHAPTER 19 Pulmonary Ventilation and Respiration;Tests of Respiratory Function＆By JOHN H．SEABURY 591

INTRODUCTION 591

ANATOMICO-PHYSIOLOGIC RELATIONS 592

Intrathoracic Pressure 593

Work of Breathing 594

PULMONARY VOLUMINA 595

REGULATION OF PULMONARY VENTILATION 599

Reflex Control 601

Voluntary Control 602

PULMONARY RESPIRATION AND ITS REGULATION 603

The Circulation in the Lung 603

Control of the Pulmonary Circulation 605

Regulation of Pulmonary Respiration 606

Acid-Base Balance 608

Acidosis and Alkalosis 610

Anoxia 611

Cyanosis 613

ABNORMALITIES OF BREATHING 614

Quantitative Arrhythmias 614

Periodic Breathing 615

Qualitative Arrhythmias 616

THE CLINICAL EVALUATION OF PULMONARY FUNCTION 617

Measurement 618

PULMONARY FUNCTION IN DISEASE 624

REFERENCES 627

CHAPTER 20 Protective Mechanisms of the Lungs;Pulmonary Disease;Pleural Disease＆By JOHN H．KILLOUGH 629

INTRODUCTION 629

Nasopharynx 629

Trachea and Bronchi 630

Alveoli 631

PROTECTIVE MECHANISMS 631

PULMONARY DISEASE 634

Bronchial Asthma 634

Emphysema 635

Eosinophilic Pulmonary Infiltration(Loeffler＇s Syndrome) 637

Pulmonary Alveolar Proteinosis 638

Congenital Cystic Disease 639

Pulmonary Arteriosclerosis 639

Pulmonary Embolism 640

Pneumoconiosis 641

Pulmonary Fibrosis 642

Atelectasis 642

Tumor of the Lung 644

Pulmonary Infections 644

Acute Tracheitis and Bronchitis 645

Chronic Bronchitis 645

Lung Abscess 646

Bronchiectasis 647

Pneumonia 647

Lipid Pneumonia 649

Tuberculosis 650

Fungus Infections 652

Clubbing of Fingers and Toes 652

PLEURAL DISORDERS 653

Tumors of the Pleura 653

Pleuritis 653

Empyema 654

Epidemic Pleurodynia 655

Pneumothorax 655

REFERENCES 656

PART Ⅷ．DIGESTIVE SYSTEM 659

CHAPTER 21 The Esophagus＆By JOSEPH B．KIRSNER AND WALTER L．PALMER 661

MECHANISM OF ESOPHAGEAL PAIN 661

FUNCTIONAL DISORDERS OF THE ESOPHAGUS 662

Spasm of Functional Origin 662

Achalasia(Cardiospasm;Megaesophagus) 662

Anatomic Features 662

Pathogenesis 663

Symptoms 664

ORGANIC DISEASES OF THE ESOPHAGUS 665

Plummer-Vinson Syndrome 665

Lower Esophageal Ring 665

Non-specific Esophagitis 666

Peptic Esophagitis 666

Peptic Ulcer of the Esophagus 666

MECHANICAL OBSTRUCTION 667

Benign Stricture 667

Carcinoma of Esophagus 668

Esophageal Varices 669

Esophageal Diverticula 669

Pulsion Diverticula 669

Traction Diverticula 670

Diaphragmatic Hernia 670

Symptoms 672

REFERENCES 673

CHAPTER 22 The Stomach＆By JOSEPH B．KIRSNER AND WALTER L．PALMER 674

ANATOMIC VARIATIONS 674

CONGENITAL ANOMALIES 674

Hypertrophic Stenosis of the Pylorus 674

Diverticula 675

SENSORY DISTURBANCES 675

Appetite and Hunger 675

Vomiting 676

Nausea 676

Belching 676

MOTOR DISTURBANCES 677

SECRETORY DISTURBANCES 677

Physiologic Considerations 677

PATHOLOGIC DISTURBANCES IN GASTRIC SECRETION 679

MECHANISM OF PAIN 681

Location of Pain 682

Pain in Gastric Carcinoma 682

Transmission of Pain 682

Pain in Gastric Crises of Tabes Dorsalis 683

CHRONIC NONSPECIFIC GASTRITIS 683

BENIGN GASTRIC TUMORS 685

CARCINOMA OF THE STOMACH 685

Symptoms 687

PEPTIC ULCER 688

Pathogenesis 688

Symptoms 690

REFERENCES 692

CHAPTER 23 The Small Intestine＆By LEON SCHIFF 694

ANATOMICO-PHYSIOLOGIC CONSIDERATIONS 694

Motility 694

Innervation 695

Secretions 696

SYMPTOMATOLOGY OF SMALL INTESTINAL DISEASE 697

EFFECTS OF DISEASE OF THE SMALL INTESTINE＂ ON DISTURBANCES IN SMALL BOWEL FUNCTION:MECHANISMS OF SYMPTOM PRODUCTION 701

Intestinal Obstruction 701

Diverticula 707

Enteritis 708

Sprue and Spruelike Syndromes(Malabsorption Syndromes) 710

Blind Loop Syndrome 720

Massive Intestinal Resection 720

Irradiation Effects 721

＂Protein-Losing Gastroenteropathy＂ 721

REFERENCES 722

CHAPTER 24 ？e Large Intestine＆By LEON SCHIFF 729

Functions 730

SYMPTOMS AND SlGNS OF COLONIC DISEASE 734

Constipation 735

Diarrhea 737

DISEASES OF THE COLON AND THE MECHANISM OF SYMPTOM PRODUCTION 738

Irritable Colon 738

Ulcerative Colitis 739

Lymphopathia Venereum 743

Amebiasis 743

Shigella Infections 744

Diverticula 744

Tumors and Polyps 745

REFERENCES 747

CHAPTER 25 The Liver＆By FRANZ J．INGELFINGER 750

CHANGES IN HEPATIC STRUCTURE 750

Vascular Congestion 750

Parenchymatous Disorders 751

Biliary Disorders 754

Intrahepatic 754

Extrahepatic 754

Fatty Liver and the Relation of Nutrition to Structural Changes 755

Disorders of Hepatic Blood Flow 757

Pain Sensation 763

CHANGES IN HEPATIC FUNCTION 764

Correlation of Structure and Function 764

Enzyme Systems 765

Jaundice 767

Bile Constituents Other Than Bilirubin 773

Carbohydrate Metabolism 774

Nitrogen Metabolism 776

Lipid Metabolism 780

Vitamin Metabolism 783

Fat-Soluble Vitamins 782

Water-Soluble Vitamins 783

Inactivation and Detoxification 784

EFFECTS OF HEPATIC DISEASE ON OTHER ORGANS 786

Spleen 786

Blood 786

Kidney 787

Bones 787

Gastrointestinal Tract 788

Central Nervous System 788

Cardiovascular System 788

MANIFESTATIONS PRODUCED BY MULTIPLE FACTORS 789

Edema and Ascites 789

Hepatic Coma 791

Liver Failure 792

REFERENCES 792

CHAPTER 26 The Gallbladder and Pancreas＆By FRANZ GOLDSTEIN 795

THE GALLBLADDER 795

THE PANCREAS 801

REFERENCES 807

PART Ⅸ．URINARY TRACT 809

CHAPTER 27 The Kidney＆By A．C．CORCORAN 811

EXCRETORY FUNCTION 811

Renal Blood Flow 811

Glomerular Filtration 812

Proximal Tubule 814

Clearance 817

The Loop of Henle 818

Ion Exchange:Acidification 820

Stop-Flow Technique 822

Diuresis and Diuretics 822

Tests of Excretory Function 826

Tests of Rate of Excretion 827

Clearance Tests 828

Water Tests 829

PRESSOR-ANTIPRESSOR(ENDOCRINE) FUNCTIONS 831

Erythropoietin 833

CLINICAL MANIFESTATIONS OF RENAL DISEASE 833

Proteinuria and the Organized Sediment 833

Edema of Renal Origin 843

FUNCTIONAL PATTERNS IN RENAL DISEASE 847

Essential Hypertension 847

Renal Hypertensions 848

Tubular Dysfunctions 850

Renal Failure;Uremia 851

REFERENCES 856

PART Ⅹ．BLOOD AND SPLEEN 859

CHAPTER 28 Disorders of the Blood＆By WILLIAM B．CASTLE 861

GENERAL FUNCTIONS OF THE BLOOD 861

DISORDERS OF THE ERYTHROCYTES 862

Morphology of Erythrocyte Production 862

Physiology of Erythrocyte Production 865

Biochemistry of Erythrocyte and Hemoglobin Production 868

Production Rates of Erythrocytes and Hemoglobin 872

Erythrocyte Destruction 874

Splenic Functions 876

Hemoglobin Catabolism 880

Excretion of Bilirubin 881

Conservation of Iron 883

General Effects of Anemia 883

Erythrocyte Characteristics 885

Peripheral Blood in Anemia 890

Definition and Classification of Anemia 891

Anemia of Acute Erythrocyte Loss 892

Anemias of Increased Erythrocyte Destruction 894

Extrinsic Causes of Increased Erythrocyte Destruction 895

Intrinsic Causes of Increased Erythrocyte Destruction 901

Anemias of Decreased Erythrocyte Production 916

Nutritional Deficiency of Erythropoiesis 916

Immediate Deficiency Mechanisms in Pernicious and Related Macrocytic Anemias 926

Endocrine Deficiency of Erythropoiesis 936

Toxic Inhibition of Erythropoiesis 937

Physical Injury of Erythropoiesis 941

Mechanical Interference with Erythropoiesis 944

POLYCYTHEMIAS 948

Relative Polycythemia 948

Secondary Polycythemia 948

Polycythemia Vera 950

Neoplastic versus Physiologic Control of Erythropoiesis 951

General Aspects of Polycythemia Vera 954

DISORDERS OF THE LEUKOCYTES 955

Leukocyte Characteristics 956

Leukocytosis 958

Granulocytosis 959

Lymphocytosis 961

Monocytosis 961

Leukopenia 962

Agranulocytosis 966

Leukemias and Malignant Lymphomas 968

Clinical Features 972

Treatment 977

HEMORRHAGIC DISORDERS 981

Extravascular Factors 983

Vascular Factors 984

Intravascular Factors 986

Platelets 987

Coagulation Factors 993

REFERENCES 1004

CHAPTER 29 The Spleen and Reticuloendothelial System＆By CHARLES A．DOAN 1013

THE SPLEEN AS A LYMPHATIC ORGAN 1014

THE SPLEEN AND ITS MUSCULAR CAPSULE 1015

THE SPLEEN AND ITS VASCULAR SINUSES 1015

THE SPLEEN AND THE RETICULOENDOTHELIAL SYSTEM OF CELLS 1017

THE HYPERSPLENIC CLINICAL SYNDROMES 1018

ACCESSORY SPI EENS AND RECURRENT HYPERSPLENISM 1026

REFERENCES 1028

PART Ⅺ．LOCOMOTOR SYSTEM 1031

CHAPTER 30 The Joints＆By RICHARD H．FREYBERG 1033

ANATOMY AND PHYSIOLOGY OF JOINTS 1033

Articular Cartilage 1034

Joint Capsule and Synovium 1036

Synovial Fluid 1037

Exchange of Substances through the Articular Membrane 1038

Functional Alterations Produced by Disease 1039

Joints as Units 1039

Chemistry of Periarticular Connective Tissue 1040

Muscle Function in Relation to Movements of Joints 1041

PATHOLOGIC PHYSIOLOGY OF THE LOCOMOTOR SYSTEM 1042

Effects of Trauma 1042

Neuropathic Joint Disease 1044

Specific Infectious Arthritis 1045

CHRONIC INFLAMMATIONS OF JOINTS AND RELATED CONNECTIVE TISSUE 1046

Rheumatoid Arthritis 1047

Other Diffuse Connective Tissue Diseases(Collagen Diseases) 1053

Rheumatoid Spondylitis 1054

Rheumatic Fever 1055

Gouty Arthritis 1055

NON-ARTICULAR RHEUMATISM 1057

Primary Fibrositis 1057

Tenosynovitis and Other Forms of Fibrositis 1058

DISEASES OF MUSCLES 1058

NERVOUS SYSTEM DISEASE 1059

DISEASES OF BONE 1059

REFERENCES 1060

PART Ⅻ．NERVOUS SYSTEM 1063

CHAPTER 31 The Nervous System＆By BERNARD J．ALPERS AND ELLIOTT L．MANCALL 1065

INTRODUCTION 1065

THE MOTOR SYSTEM 1067

The Neuromuscular Junction and Muscle 1067

The Neuromuscular Junction 1068

The Sarcolemmal Membrane 1071

Muscular Contraction 1073

Electrodiagnosis in Muscle Disease 1077

The Peripheral Neuron 1079

Peripheral Nerve 1079

Anterior Horn 1080

PYRAMIDAL SYSTEM 1083

EXTRAPYRAMIDAL SYSTEM 1085

THE SENSORY SYSTEM 1087

Specificity of Sensory Receptors 1087

Posterior Column System 1088

Spinothalamic System 1089

VESTIBULAR SYSTEM 1091

Vertigo 1092

Nystagmus 1094

CEREBELLUM 1095

SPECIAL SENSES 1096

Olfaction 1096

Vision 1097

Hearing 1101

Taste 1103

THE AUTONOMIC NERVOUS SYSTEM 1104

Central Organization of Vegetative Activity 1104

The Hypothalamus 1104

The Cerebral Cortex 1106

The Amygdala 1107

Brain Stem Structures 1107

Peripheral Organization of Vegetative Activity 1108

CONSCIOUSNESS AND HIGHER INTEGRATIVE FUNCTIONS 1112

Consciousness 1112

Limbic System and Behavior 1115

Memory 1117

The Body Image 1118

Highest Integrative Functions 1120

SEIZURES 1121

VASCULAR SYSTEM 1125

Occlusive Vascular Disease 1126

Cerebral Embolism 1130

Cerebral Hemorrhage 1130

REFERENCES 1131

INDEX 1135