PORTH PATHOPHYSIOLOGY CONCEPTS OF ALTERED HEALTH STATES FIRST CANADIAN EDITIONPDF电子书下载

UNITⅠCONCEPTS OF HEALTH AND DISEASE 1

CHAPTER 1Concepts of Health and Disease&Carol M. Porth 2

CONCEPTS OF HEALTH AND DISEASE 2

Health 2

Disease 3

HEALTH AND DISEASE IN POPULATIONS 5

Epidemiology and Patterns of Disease 5

Determination of Risk Factors 6

Natural History 7

Levels of Prevention 8

Evidence-Based Practice and Practice Guidelines 8

CHAPTER 2 Concepts of Altered Health in Children&Judy Wright Lott 10

GROWTH AND DEVELOPMENT 11

Prenatal Growth and Development 11

Birth Weight and Gestational Age 13

INFANCY 15

Growth and Development 16

Health Problems of the Neonate 18

Health Problems of the Infant 24

EARLY CHILDHOOD 26

Growth and Development 27

Common Health Problems 27

MIDDLE TO LATE CHILDHOOD 28

Growth and Development 28

Common Health Problems 29

ADOLESCENCE 30

Growth and Development 31

Common Health Problems 32

CHAPTER 3Concepts of Altered Health in OlderAdults&Janice Kuiper Pikna 35

THE ELDERLY AND THEORIES OF AGING 35

Who Are the Elderly? 35

Theories of Aging 37

PHYSIOLOGIC CHANGES OF AGING 37

Integumentary Changes 39

Stature and Musculoskeletal Function 39

Cardiovascular Function 39

Respiratory Function 40

Neurologic Function 40

Special Sensory Function 41

Immune Function 41

Gastrointestinal Function 42

Renal Function 42

Genitourinary Function 43

FUNCTIONAL PROBLEMS ASSOCIATED WITH AGING 43

Functional Assessment 44

Urinary Incontinence 44

Instability and Falls 45

Sensory Impairment 46

Depression and Cognitive Impairment 47

DRUG THERAPY IN THE OLDER ADULT 50

UNITⅡ CELL FUNCTION AND GROWTH 55

CHAPTER 4 Cell and Tissue Characteristics&Edward W. Carroll 56

FUNCTIONAL COMPONENTS OF THE CELL 56

Protoplasm 56

The Nucleus 58

The Cytoplasm and Its Organelles 58

The Cytoskeleton 61

The Cell （Plasma） Membrane 63

INTEGRATION OF CELL FUNCTION AND REPLICATION 64

Cell Communication 64

Cell Receptors 65

The Cell Cycle and Cell Division 67

Cell Metabolism and Energy Sources 68

MOVEMENT ACROSS THE CELL MEMBRANE AND MEMBRANE POTENTIALS 71

Movement of Substances Across the Cell Membrane 71

Movement Across Capillary Membranes 74

Membrane Potentials 74

BODY TISSUES 78

Cell Differentiation 78

Embryonic Origin of Tissue Types 79

Epithelial Tissue 80

Connective or Supportive Tissue 83

Muscle Tissue 84

Nervous Tissue 87

Extracellular Tissue Components 88

CHAPTER 5 Cellular Adaptation, Injury,and Death&Carrie J. Merkle 91

CELLULAR ADAPTATION 91

Atrophy 92

Hypertrophy 92

Hyperplasia 93

Metaplasia 94

Dysplasia 94

Intracellular Accumulations 94

Pathologic Calcifications 95

CELL INJURY AND DEATH 96

Causes of Cell Injury 96

Mechanisms of Cell Injury 100

Reversible Cell Injury and Cell Death 102

Cellular Aging 105

CHAPTER 6Genetic Control of Cell Functionand Inheritance&Edward W. Carroll 108

GENETIC CONTROL OF CELL FUNCTION 108

DNA Structure and Function 109

From Genes to Proteins 112

CHROMOSOMES 117

Cell Division 118

Chromosome Structure 119

PATTERNS OF INHERITANCE 120

Definitions 120

Genetic Imprinting 121

Mendel's Laws 121

Pedigree 122

GENE TECHNOLOGY 122

Genetic Mapping 123

Recombinant DNA Technology 124

RNA Interference Technology 126

CHAPTER 7Genetic and Congenital Disorders&Carol M. Porth 128

GENETIC AND CHROMOSOMAL DISORDERS 128

Single-Gene Disorders 129

Multifactorial Inheritance Disorders 134

Chromosomal Disorders 135

Mitochondrial Gene Disorders 140

DISORDERS DUE TO ENVIRONMENTAL INFLUENCES 141

Period of Vulnerability 141

Teratogenic Agents 141

DIAGNOSIS AND COUNSELLING 145

Genetic Assessment 145

Prenatal Screening and Diagnosis 145

CHAPTER 8Neoplasia&Carrie J. Merkle Adapted by Otto H. Sanchez 150

CONCEPTS OF CELL DIFFERENTIATION AND GROWTH 150

The Cell Cycle 151

Cell Proliferation 154

Cell Differentiation 154

CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS 156

Terminology 156

Benign Neoplasms 156

Malignant Neoplasms 157

ETIOLOGY OF CANCER 162

Genetic and Molecular Basis of Cancer 163

Host and Environmental Factors 167

CLINICAL MANIFESTATIONS 171

Tissue Integrity 171

Systemic Manifestations 171

Anemia 172

Paraneoplastic Syndromes 173

SCREENING, DIAGNOSIS, AND TREATMENT 174

Screening 174

Diagnostic Methods 174

Cancer Treatment 176

CHILDHOOD CANCERS 183

Incidence and Types 183

Biology of Childhood Cancers 184

Diagnosis and Treatment 184

Adult Survivors of Childhood and Adolescent Cancer 185

UNITⅢ DISORDERS OF INTEGRATIVE FUNCTION 189

CHAPTER 9 Stress and Adaptation&Mary Pat Kunert 190

HOMEOSTASIS 191

Constancy of the Internal Environment 191

Control Systems 191

STRESS AND ADAPTATION 192

The Stress Response 192

Coping and Adaptation to Stress 197

DISORDERS OF THE STRESS RESPONSE 200

Effects of Acute Stress 200

Effects of Chronic Stress 200

Post-traumatic Stress Disorder 200

Treatment and Research of Stress Disorders 202

CHAPTER 10Alterations in Temperature Regulation&Mary Pat Kunert 206

BODY TEMPERATURE REGULATION 206

Mechanisms of Heat Production 208

Mechanisms of Heat Loss 208

INCREASED BODY TEMPERATURE 210

Fever 210

Hyperthermia 215

DECREASED BODY TEMPERATURE 218

Hypothermia 218

CHAPTER 11Activity Tolerance and Fatigue&Mary Kay Jiricka 222

EXERCISE AND ACTIVITY TOLERANCE 222

Types of Exercise 223

Physiologic and Psychological Responses 224

Assessment of Activity and Exercise Tolerance 228

Exercise and Activity Tolerance in the Elderly 228

ACTIVITY INTOLERANCE AND FATIGUE 229

Mechanisms of Fatigue 230

Acute Physical Fatigue 230

Chronic Fatigue 230

BED REST AND IMMOBILITY 233

Physiologic Effects of Bed Rest 234

Psychosocial Responses 238

Time Course of Physiologic Responses 238

Interventions 239

UNIT Ⅳ DISORDERS OF THE HEMATOPOIETIC SYSTEM 243

CHAPTER 12 Blood Cells and the Hematopoietic System&Kathryn J. Gaspard 244

COMPOSITION OF BLOOD AND FORMATION OF BLOOD CELLS 244

Plasma 245

Blood Cells 245

Formation of Blood Cells （Hematopoiesis） 248

DIAGNOSTIC TESTS 250

Blood Count 250

Erythrocyte Sedimentation Rate 250

Bone Marrow Aspiration and Biopsy 251

CHAPTER 13Disorders of Hemostasis&Kathryn J. Gaspard 252

MECHANISMS OF HEMOSTASIS 252

Vessel Spasm 252

Formation of the Platelet Plug 253

Blood Coagulation 254

Clot Retraction 255

Clot Dissolution 258

HYPERCOAGULABILITY STATES 258

Hypercoagulability Associated With Increased Platelet Function 259

Hypercoagulability Associated With Increased Clotting Activity 259

BLEEDING DISORDERS 260

Bleeding Associated With Platelet Disorders 261

Bleeding Associated With Coagulation Factor Deficiencies 263

Bleeding Associated With Vascular Disorders 264

Disseminated Intravascular Coagulation 265

CHAPTER 14Disorders of Red Blood Cells&Kathryn J. Gaspard 268

THE RED BLOOD CELL 268

Hemoglobin Synthesis 270

Red Cell Production 270

Red Cell Destruction 271

Red Cell Metabolism and Hemoglobin Oxidation 272

Laboratory Tests 272

ANEMIA 274

Blood Loss Anemia 274

Hemolytic Anemias 275

Anemias of Deficient Red Cell Production 279

TRANSFUSION THERAPY 282

ABO Blood Groups 284

Rh Types 284

Blood Transfusion Reactions 284

POLYCYTHEMIA 285

AGE-RELATED CHANGES IN RED BLOOD CELLS 285

Red Cell Changes in the Neonate 286

Red Cell Changes With Aging 287

CHAPTER 15Disorders of White Blood Cells and Lymphoid Tissues&Carol M. Porth 290

HEMATOPOIETIC AND LYMPHOID TISSUES 290

Leukocytes （White Blood Cells） 290

Bone Marrow and Hematopoiesis 291

Lymphoid Tissues 292

NON-NEOPLASTIC DISORDERS OF WHITE BLOOD CELLS 293

Neutropenia （Agranulocytosis） 293

Infectious Mononucleosis 295

NEOPLASTIC DISORDERS OF HEMATOPOIETIC AND LYMPHOID ORIGIN 297

Malignant Lymphomas 297

Leukemias 301

Plasma Cell Dyscrasias 306

UNITⅤ INFECTION, INFLAMMATION, AND IMMUNITY 311

CHAPTER 16 Mechanisms of Infectious Disease&W. Michael Dunne, Jr. and Nathan A. Ledeboer 312

INFECTIOUS DISEASES 312

Terminology 312

Agents of Infectious Disease 313

MECHANISMS OF INFECTION 320

Epidemiology of Infectious Diseases 320

Portal of Entry 321

Source 322

Symptomatology 322

Disease Course 322

Site of Infection 323

Virulence Factors 323

DIAGNOSIS AND TREATMENT OF INFECTIOUS DISEASES 325

Diagnosis 325

Treatment 328

BIOTERRORISM AND EMERGING GLOBAL INFECTIOUS DISEASES 331

Bioterrorism 331

Global Infectious Diseases 332

CHAPTER 17Innate and Adaptive Immunity&Cynthia Sommer 334

IMMUNITY AND THE IMMUNE SYSTEM 334

Innate and Adaptive Immunity 335

Cells of the Immune System 335

Cytokines That Mediate and Regulate Immunity 338

INNATE IMMUNITY 341

Epithelial Barriers 341

Cells of Innate Immunity 342

Pathogen Recognition 342

Soluble Mediators of Innate Immunity 344

The Complement System 345

ADAPTIVE IMMUNITY 347

Antigens 348

Cells of Adaptive Immunity 349

B Lymphocytes and Humoral Immunity 352

T Lymphocytes and Cellular Immunity 355

Lymphoid Organs 357

Active Versus Passive Immunity 359

Regulation of the Immune Response 360

DEVELOPMENTAL ASPECTS OF THE IMMUNE SYSTEM 360

Transfer of Immunity from Mother to Infant 361

Immune Response in the Elderly 361

CHAPTER 18Inflammation, Tissue Repair,and Wound Healing&Carol M. Porth and Cynthia Sommer 363

THE INFLAMMATORY RESPONSE 363

Acute Inflammation 364

Chronic Inflammation 373

Systemic Manifestations of Inflammation 375

TISSUE REPAIR AND WOUND HEALING 376

Tissue Repair 376

Wound Healing 378

CHAPTER 19Disorders of the Immune Response&Carol M. Porth 385

IMMUNODEFICIENCY DISORDERS 385

Humoral （B-Cell） Immunodeficiencies 387

Cell-Mediated （T-Cell） Immunodeficiencies 390

Combined T -Cell and B-Cell Immunodeficiencies 391

Disorders of the Complement System 392

Disorders of Phagocytosis 393

Stem Cell Transplantation 394

HYPERSENSITIVITY DISORDERS 395

Type I, Immediate Hypersensitivity Disorders 395

Type Ⅱ, Antibody-Mediated Disorders 398

Type Ⅲ, Immune Complex-Mediated Disorders 399

Type IV, Cell-Mediated Hypersensitivity Disorders 400

Latex Allergy 402

TRANSPLANTATION IMMUNOPATHOLOGY 403

Mechanisms Involved in Transplant Rejection 403

AUTOIMMUNE DISEASE 405

Immunologic Tolerance 405

Mechanisms of Autoimmune Disease 407

Diagnosis and Treatment of Autoimmune Disease 408

CHAPTER 20Acquired Immunodeficiency Syndrome&Jason Faulhaber and Judith A. Aberg 411

THE AIDS EPIDEMIC AND TRANSMISSION OF HIV INFECTION 411

Emergence of the AIDS Epidemic 412

Transmission of HIV Infection 412

PATHOPHYSIOLOGY AND CLINICAL COURSE 414

Molecular and Biologic Features of HIV 414

Classification and Phases of HIV Infection 416

Clinical Course 417

PREVENTION, DIAGNOSIS, AND TREATMENT 422

Prevention 422

Diagnostic Methods 423

Early Management 424

Treatment 424

PsychosocialIssues 426

HIV INFECTION IN PREGNANCY AND IN INFANTS AND CHILDREN 427

UNITⅥ DISORDERS OF CARDIOVASCULAR FUNCTION 431

CHAPTER 21 Structure and Function of the Cardiovascular System&Carol M. Porth and Glenn Matfin 432

ORGANIZATION OF THE CIRCULATORY SYSTEM 432

Pulmonary and Systemic Circulations 433

Volume and Pressure Distribution 434

PRINCIPLES OF BLOOD FLOW 435

Relationships Between Blood Flow, Pressure,and Resistance 435

Wall Tension, Radius, and Pressure 438

Distension and Compliance 438

THE HEART AS A PUMP 439

Functional Anatomy of the Heart 439

Cardiac Cycle 442

Regulation of Cardiac Performance 444

THE SYSTEMIC CIRCULATION AND CONTROL OF BLOOD FLOW 447

Blood Vessels 447

Arterial System 448

Venous System 449

Local and Humoral Control of Blood Flow 450

THE MICROCIRCULATION AND LYMPHATIC SYSTEM 452

Structure and Function of the Microcirculation 452

Capillary-Interstitial Fluid Exchange 453

The Lymphatic System 454

NEURAL CONTROL OF CIRCULATORY FUNCTION 456

Autonomic Nervous System Regulation 456

Central Nervous System Responses 456

CHAPTER 22Disorders of Blood Flow in the Systemic Circulation&Glenn Matfin Adapted by Anna Barkman and Charlotte Pooler 458

BLOOD VESSEL STRUCTURE AND FUNCTION 458

Endothelial Cells 459

Vascular Smooth Muscle Cells 459

DISORDERS OF THE ARTERIAL CIRCULATION 460

Hyperlipidemia 461

Atherosclerosis 466

Vasculitis 469

Arterial Disease of the Extremities 472

Aneurysms and Dissection 475

DISORDERS OF THE VENOUS CIRCULATION 478

Venous Circulation of the Lower Extremities 478

Disorders of the Venous Circulation of the Lower Extremities 479

CHAPTER 23Disorders of Blood Pressure Regulation&Carol M. Porth Adapted by Anna Barkman 485

THE ARTERIAL BLOOD PRESSURE 485

Mechanisms of Blood Pressure Regulation 486

Blood Pressure Measurement 491

HYPERTENSION 492

Essential Hypertension 492

Secondary Hypertension 499

Malignant Hypertension 501

Hypertension Disorders in Pregnancy 501

High Blood Pressure in Children and Adolescents 503

High Blood Pressure in the Elderly 503

ORTHOSTATIC HYPOTENSION 505

Pathophysiology and Causative Factors 506

Diagnosis and Treatment 507

CHAPTER 24Disorders of Cardiac Function&Toni Balistrieri and Kathy Mussatto Adapted by Anna Barkman and Charlotte Pooler 511

DISORDERS OF THE PERICARDIUM 511

Acute Pericarditis 512

Pericardial Effusion and Cardiac Tamponade 513

Constrictive Pericarditis 514

CORONARY ARTERY DISEASE 515

Coronary Circulation 515

Acute Coronary Syndrome 522

Chronic Ischemic Heart Disease 530

CARDIOMYOPATHIES 532

Primary Card iomyopathies 532

Secondary Card iomyopathies 536

INFECTIOUS AND IMMUNOLOGIC DISORDERS 537

Infective Endocarditis 537

Rheumatic Heart Disease 539

VALVULAR HEART DISEASE 541

Hemodynamic Derangements 541

Mitral Valve Disorders 542

Aortic Valve Disorders 545

HEART DISEASE IN INFANTS AND CHILDREN 546

Embryonic Development of the Heart 547

Fetal and Perinatal Circulation 548

Congenital Heart Defects 549

Kawasaki Disease 557

CHAPTER25Disorders of Cardiac Conduction and Rhythm&Jill Winters Adapted by Anna Barkman and Charlotte Pooler 562

CARDIAC CONDUCTION SYSTEM 562

Action Potentials 564

Electrocardiography 567

DISORDERS OF CARDIAC RHYTHM AND CONDUCTION 568

Mechanisms of Arrhythmias and Conduction Disorders 569

Types of Arrhythmias and Conduction Disorders 570

Diagnostic Methods 577

Treatment 578

CHAPTER 26 Heart Failure and Circulatory Shock&Anna Barkman and Charlotte Pooler 583

HEART FAILURE 583

Pathophysiology of Heart Failure 584

Manifestations of Heart Failure 593

Diagnosis and Treatment 594

CIRCULATORY FAILURE （SHOCK） 598

Pathophysiology of Circulatory Shock 598

Cardiogenic Shock 600

Hypovolemic Shock 601

Distributive Shock 603

Obstructive Shock 606

Complications of Shock 606

HEART FAILURE IN CHILDREN AND THE ELDERLY 607

Heart Failure in Infants and Children 607

Heart Failure in the Elderly 609

UNITⅦ DISORDERS OF RESPIRATORY FUNCTION 613

CHAPTER 27 Structure and Function of the RespiratorySystem&Adapted by Charlotte Pooler 614

STRUCTURAL ORGANIZATION OF THE RESPIRATORY SYSTEM 614

Conducting Airways 615

Lungs and Respiratory Airways 618

Pulmonary Vasculature and Lymphatic Supply 621

Innervation 621

Pleura 622

EXCHANGE OF GASES BETWEEN THE ATMOSPHERE AND THE LUNGS 622

Basic Properties of Gases 623

Ventilation and the Mechanics of Breathing 623

Lung Volumes 627

Pulmonary Function Studies 628

Work of Breathing 629

EXCHANGE AND TRANSPORT OF GASES 630

Ventilation 631

Perfusion 632

Ventilation-Perfusion Mismatch 633

Diffusion 633

Oxygen and Carbon Dioxide Transport 635

CONTROL OF BREATHING 638

Respiratory Centre 639

Regulation of Breathing 639

Cough Reflex 640

Dyspnea 641

CHAPTER 28 Respiratory Tract Infections, Neoplasms,and Childhood Disorders&Carol M. Porth Adapted by Charlotte Pooler 643

RESPIRATORY TRACT INFECTIONS 643

The Common Cold 644

Rhinosinusitis 645

Influenza 646

Pneumonias 649

Tuberculosis 653

Fungal Infections 657

CANCER OF THE LUNG 659

Histologic Subtypes and Pathogenesis 659

Clinical Features 660

RESPIRATORY DISORDERS IN CHILDREN 662

Lung Development 662

Alterations in Breathing 664

Respiratory Disorders in the Neonate 665

Respiratory Infections in Children 666

CHAPTER 29Disorders of Ventilation and Gas Exchange&Charlotte Pooler 672

PHYSIOLOGIC EFFECTS OF VENTILATION AND DIFFUSION DISORDERS 672

Hypoxemia 673

Hypercapnia 674

DISORDERS OF LUNG INFLATION 675

Disorders of the Pleura 675

Atelectasis 679

OBSTRUCTIVE AIRWAY DISORDERS 680

Physiology of Airway Disease 680

Bronchial Asthma 680

Chronic Obstructive Pulmonary Disease 686

Bronchiectasis 691

Cystic Fibrosis 692

CHRONIC INTERSTITIAL （RESTRICTIVE） LUNG DISEASES 694

Etiology and Pathogenesis of Interstitial Lung Diseases 694

Occupational Lung Disease 695

Drug- and Radiation-Induced Lung Diseases 696

Sarcoidosis 696

DISORDERS OF THE PULMONARY CIRCULATION 697

Pulmonary Embolism 697

Pulmonary Hypertension 699

Cor Pulmonale 701

ACUTE RESPIRATORY DISORDERS 702

Acute Lung Injury/Acute RespiratoryDistress Syndrome 702

Acute Respiratory Failure 703

UNIT Ⅷ DISORDERS OF RENAL FUNCTION AND FLUIDS AND ELECTROLYTES 709

CHAPTER 30 Structure and Function of the Kidney&Carol M. Porth Adapted by Charlotte Pooler 710

KIDNEY STRUCTURE AND FUNCTION 710

Gross Structure and Location 711

Renal Blood Supply 711

The Nephron 711

Urine Formation 714

Regulation of Renal Blood Flow 720

Elimination Functions of the Kidney 721

Drug Elimination 723

Endocrine Functions of the Kidney 723

Action of Diuretics 724

TESTS OF RENAL FUNCTION 725

Urine Tests 726

Glomerular Filtration Rate 726

Blood Tests 727

Cystoscopy 728

Ultrasonography 728

Radiologic and Other Imaging Studies 728

CHAPTER 31 Disorders of Fluid and Electrolyte Balance&Glenn Matfin and Carol M. Porth Adapted by Linda Slater-MacLean and Charlotte Pooler 730

COMPOSITION AND COMPARTMENTAL DISTRIBUTION OF BODY FLUIDS 730

Introductory Concepts 731

Compartmental Distribution of Body Fluids 733

Capillary-Interstitial Fluid Exchange 734

SODIUM AND WATER BALANCE 739

Body Water Balance 739

Sodium Balance 740

Mechanisms of Regulation 740

Disorders of Thirst and Antidiuretic Hormone 741

Disorders of Sodium and Water Balance 744

POTASSIUM BALANCE 751

Regulation of Potassium Balance 752

Disorders of Potassium Balance 753

CALCIUM, PHOSPHOROUS, AND MAGNESIUM BALANCE 758

Mechanisms Regulating Calcium, Phosphorous,and Magnesium Balance 758

Disorders of Calcium Balance 760

Disorders of Phosphorous Balance 764

Disorders of Magnesium Balance 767

CHAPTER 32 Disorders of Acid-Base Balance&Carol M. Porth and Kim Litwack Adapted by Linda Slater-MacLean and Charlotte Pooler 772

MECHANISMS OF ACID-BASE BALANCE 772

Acid-Base Chemistry 773

Metabolic Acid and Bicarbonate Production 773

Calculation of pH 774

Regulation of pH 774

Laboratory Tests 779

DISORDERS OF ACID-BASE BALANCE 781

Metabolic Versus Respiratory Acid-Base Disorders 781

Compensatory Mechanisms 781

Metabolic Acidosis 782

Metabolic Alkalosis 786

Respiratory Acidosis 787

Respiratory Alkalosis 789

CHAPTER 33Disorders of Renal Function &Carol M. Porth Adapted by Linda Slater-MacLean and Charlotte Pooler 792

CONGENITAL AND INHERITED DISORDERS OF THE KIDNEYS 792

Congenital Disorders of the Kidneys 793

Cystic Kidney Diseases 794

OBSTRUCTIVE DISORDERS 796

Mechanisms of Renal Damage 797

Renal Calculi 798

URINARY TRACT INFECTIONS 801

Etiologic Factors 802

Clinical Features 803

Diagnosis and Treatment 803

Infections in Special Populations 804

DISORDERS OF GLOMERULAR FUNCTION 806

Etiology and Pathogenesis of Glomerular Injury 806

Types of Glomerular Disease 807

Glomerular Lesions Associated With Systemic Disease 812

TUBULOINTERSTITIAL DISORDERS 813

Renal Tubular Acidosis 813

Pyelonephritis 814

Drug-Related Nephropathies 815

MALIGNANT TUMOURS OF THE KIDNEY 816

Wilms Tumour 816

Renal Cell Carcinoma 816

CHAPTER 34Acute Renal Failure and Chronic Kidney Disease&Carol M. Porth Adapted by Linda Slater-MacLean and Charlotte Pooler 820

ACUTE RENAL FAILURE 820

Types of Acute Renal Failure 821

Diagnosis and Treatment 823

CHRONIC KIDNEY DISEASE 824

Definition and Classification 824

Assessment of Glomerular Filtration Rate and Other Indicators of Renal Function 825

Clinical Manifestations 827

Treatment 831

CHRONIC KIDNEY DISEASE IN CHILDREN AND ELDERLY PERSONS 835

Chronic Kidney Disease in Children 835

Chronic Kidney Disease in Elderly Persons 836

CHAPTER 35Disorders of the Bladder and Lower Urinary Tract&Carol M. Porth Adapted by Charlotte Pooler 839

CONTROL OF URINE ELIMINATION 839

Bladder Structure 839

Neural Control of Bladder Function 840

Diagnostic Methods of Evaluating Bladder Function 843

ALTERATIONS IN BLADDER FUNCTION 844

Lower Urinary Tract Obstruction and Stasis 845

Neurogenic Bladder Disorders 846

Urinary Incontinence 849

CANCER OF THE BLADDER 853

Etiology and Pathophysiology 854

Manifestations 854

Diagnosis and Treatment 854

UNITIⅨ DISORDERS OF GASTROINTESTINAL FUNCTION 857

CHAPTER 36Structure and Function of the Gastrointestinal System&Carol M. Porth STRUCTURE AND ORGANIZATION OF THE 858

GASTROINTESTINAL TRACT 858

Upper Gastrointestinal Tract 859

Middle Gastrointestinal Tract 860

Lower Gastrointestinal Tract 860

Gastrointestinal Wall Structure 861

MOTILITY 863

Control of Gastrointestinal Motility 863

Swallowing and Esophageal Motility 865

Gastric Motility 867

Small Intestinal Motility 867

Colonic Motility and Defecation 868

HORMONAL, SECRETORY, AND DIGESTIVE FUNCTIONS 869

Gastrointestinal Hormones 869

Gastrointestinal Secretions 869

Intestinal Flora 872

DIGESTION AND ABSORPTION 873

Carbohydrate Absorption 874

Fat Absorption 874

Protein Absorption 875

ANOREXIA, NAUSEA, AND VOMITING 876

Anorexia 876

Nausea 877

Retching and Vomiting 877

CHAPTER37Disorders of Gastrointestinal Function&Carol M. Porth 879

DISORDERS OF THE ESOPHAGUS 879

Congenital Anomalies 880

Dysphagia 880

Esophageal Diverticulum 881

Tears （Mallory-Weiss Syndrome） 881

Hiatal Hernia 881

Gastroesophageal Reflux 881

Cancer of the Esophagus 883

DISORDERS OF THE STOMACH 884

Gastric Mucosal Barrier 884

Gastritis 885

Peptic Ulcer Disease 887

Cancer of the Stomach 889

DISORDERS OF THE SMALL AND LARGE INTESTINES 890

Irritable Bowel Syndrome 890

Inflammatory Bowel Disease 891

Infectious Enterocolitis 894

Diverticular Disease 896

Appendicitis 897

Alterations in Intestinal Motility 898

Alterations in Intestinal Absorption 903

Neoplasms 905

CHAPTER 38Disorders of Hepatobiliary and Exocrine Pancreas Function&Carol M. Porth 911

THE LIVER AND HEPATOBILIARY SYSTEM 911

Metabolic Functions of the Liver 914

Bile Production and Cholestasis 916

Bilirubin Elimination and Jaundice 916

Tests of Hepatobiliary Function 918

DISORDERS OF HEPATIC AND BILIARY FUNCTION 919

Hepatotoxic Disorders 919

Viral Hepatitis 921

Autoimmune Hepatitis 925

Intrahepatic Biliary Disorders 926

Alcohol-Induced Liver Disease 926

Cirrhosis, Portal Hypertension, and Liver Failure 928

Cancer of the Liver 933

DISORDERS OF THE GALLBLADDER AND EXOCRINE PANCREAS 935

Disorders of the Gallbladder and Extrahepatic Bile Ducts 935

Disorders of the Exocrine Pancreas 938

CHAPTER 39Alterations in Nutritional Status&Joan Pleuss and Glenn Matfiin Adapted by Lesley L. Moisey 943

NUTRITIONAL STATUS 943

Energy Metabolism and Storage 944

Energy Expenditure 944

Energy Storage 945

NUTRITIONAL NEEDS 946

Recommended Dietary Allowances and DietaryReference Intakes 946

Nutritional Needs 947

Regulation of Food Intake and Energy Storage 950

Nutritional Assessment 951

OVERWEIGHT AND OBESITY 953

Causes of Obesity 954

Types of Obesity 954

Health Risks Associated With Obesity 956

Prevention and Treatment of Obesity 956

Childhood Obesity 957

UNDERNUTRITION AND EATING DISORDERS 959

Malnutrition and Starvation 959

Eating Disorders 961

UNITⅩ DISORDERS OF ENDOCRINE FUNCTION 967

CHAPTER 40 Mechanisms of Endocrine Control&Glenn Matfin 968

THE ENDOCRINE SYSTEM 968

Hormones 969

Control of Hormone Levels 974

Diagnostic Tests 976

CHAPTER 41Disorders of Endocrine Control of Growth and Metabolism&Glenn Matfin 980

GENERAL ASPECTS OF ALTERED ENDOCRINE FUNCTION 980

Hypofunction and Hyperfunction 980

Primary, Secondary, and TertiaryDisorders 981

PITUITARY AND GROWTH DISORDERS 981

Pituitary Tumours 981

Hypopituitarism 982

Assessment of Hypothalamic-Pituitary Function 982

Growth and Growth HormoneDisorders 982

Isosexual Precocious Puberty 988

THYROID DISORDERS 989

Control of Thyroid Function 989

Hypothyroidism 992

Hyperthyroidism 994

DISORDERS OF ADRENAL CORTICAL FUNCTION 996

Control of Adrenal Cortical Function 996

Congenital Adrenal Hyperplasia 998

Adrenal Cortical Insufficiency 999

Glucocorticoid Hormone Excess（Cushing Syndrome） 1001

Incidental Adrenal Mass 1002

CHAPTER 42Diabetes Mellitus and the Metabolic Syndrome&Safak Guven, Glenn Matfin, and Julie A. Kuenzi 1005

HORMONAL CONTROL OF GLUCOSE, FAT, AND PROTEIN METABOLISM 1005

Glucose, Fat, and Protein Metabolism 1005

Glucose-Regulating Hormones 1006

DIABETES MELLITUS 1011

Classification and Etiology 1012

Clinical Manifestations of Diabetes 1017

Diagnostic Tests 1018

Diabetes Management 1019

Acute Complications 1025

Counter-regulatory Mechanisms and the Somogyi Effect and Dawn Phenomenon 1027

Chronic Complications 1027

Infections 1032

UNITⅪ DISORDERS OF GENITOURINARY AND REPRODUCTIVE FUNCTION 1035

CHAPTER 43Structure and Function of the Male Genitourinary System&Glenn Matfin 1036

STRUCTURE OF THE MALE REPRODUCTIVE SYSTEM 1036

Embryonic Development 1036

Testes and Scrotum 1037

Genital Duct System 1038

Accessory Organs 1039

Penis 1040

SPERMATOGENESIS AND HORMONAL CONTROL OF MALE REPRODUCTIVE FUNCTION 1040

Spermatogenesis 1041

Hormonal Control of Male Reproductive Function 1041

NEURAL CONTROL OF SEXUAL FUNCTION AND AGING CHANGES 1044

Neural Control 1044

Aging Changes 1045

CHAPTER 44 Disorders of the Male Genitourinary System&Glenn Matfin 1048

DISORDERS OF THE PENIS 1048

Congenital and Acquired Disorders 1048

Disorders of Erectile Function 1050

Cancer of the Penis 1053

DISORDERS OF THE SCROTUM AND TESTES 1054

Congenital and Acquired Disorders 1054

Infection and Inflammation 1057

Neoplasms 1057

DISORDERS OF THE PROSTATE 1059

Infection and Inflammation 1059

Hyperplasia and Neoplasms 1061

CHAPTER 45 Structure and Function of the Female Reproductive System&Patricia McCowen Mehring 1068

REPRODUCTIVE STRUCTURES 1068

External Genitalia 1068

Internal Genitalia 1070

MENSTRUAL CYCLE 1072

Hormonal Control 1073

Ovarian Follicle Development and Ovulation 1076

Endometrial Changes 1077

Cervical Mucus Changes 1077

Menopause 1077

BREASTS 1080

Structure and Function 1080

CHAPTER 46 Disorders of the Female Reproductive System&Patricia McCowen Mehring 1084

DISORDERS OF THE EXTERNAL GENITALIA AND VAGINA 1084

Disorders of the External Genitalia 1085

Disorders of the Vagina 1087

DISORDERS OF THE CERVIX AND UTERUS 1088

Disorders of the Uterine Cervix 1088

Disorders of the Uterus 1092

DISORDERS OF THE FALLOPIAN TUBES AND OVARIES 1096

Pelvic Inflammatory Disease 1096

Ectopic Pregnancy 1097

Cancer of the Fallopian Tube 1098

Ovarian Cysts and Tumours 1098

DISORDERS OF PELVIC SUPPORT AND UTERINE POSITION 1102

Disorders of Pelvic Support 1102

Variations in Uterine Position 1104

MENSTRUAL DISORDERS 1105

Dysfunctional Menstrual Cycles 1105

Amenorrhea 1106

Dysmenorrhea 1106

Premenstrual Symptom Disorders 1106

DISORDERS OF THE BREAST 1108

Galactorrhea 1109

Mastitis 1109

Ductal Disorders 1109

Fibroadenoma and Fibrocystic Changes 1109

Breast Cancer 1110

INFERTILITY 1113

Male Factors 1113

Female Factors 1113

Assisted Reproductive Technologies （ART） 1115

CHAPTER 47 Sexually Transmitted Infections&Patricia McCowen Mehring 1119

INFECTIONS OF THE EXTERNAL GENITALIA 1119

Condylomata Acuminata （Genital Warts） 1120

Genital Herpes 1121

Molluscum Contagiosum 1123

Chancroid 1124

Granuloma Inguinale 1124

Lymphogranuloma Venereum 1124

VAGINAL INFECTIONS 1125

Candidiasis 1125

Trichomoniasis 1125

Bacterial Vaginosis 1126

VAGINAL-UROGENITAL-SYSTEMIC INFECTIONS 1127

ChlamydialInfections 1127

Gonorrhea 1129

Syphilis 1130

UNITⅫ DISORDERS OF NEURAL FUNCTION 1135

CHAPTER 48 Organization and Control of Neural Function&Edward W. Carroll and Robin Curtis 1136

NERVOUS TISSUE CELLS 1136

Neurons 1137

Neuroglial Cells 1138

Metabolic Requirements of Nervous Tissue 1141

NEUROPHYSIOLOGY 1141

Action Potentials 1141

Synaptic Transmission 1142

Messenger Molecules 1143

DEVELOPMENTAL ORGANIZATION OF THE NERVOUS SYSTEM 1146

Somatic and Visceral Development 1146

Segmental Organization 1148

STRUCTURE AND FUNCTION OF THE SPINAL CORD AND BRAIN 1155

Spinal Cord 1155

Spinal Nerves 1157

The Brain 1158

THE AUTONOMIC NERVOUS SYSTEM 1168

Autonomic Efferent Pathways 1169

Central Integrative Pathways 1172

Autonomic Neurotransmission 1173

CHAPTER 49 Somatosensory Function, Pain, and Headache&Kim Litwack 1177

ORGANIZATION AND CONTROL OF SOMATOSENSORY FUNCTION 1177

Sensory Systems 1178

Sensory Modalities 1182

Clinical Assessment of Somatosensory Function 1184

PAIN 1184

Pain Theories 1185

Pain Mechanisms and Pathways 1186

Pain Threshold and Tolerance 1190

Types of Pain 1190

Assessment of Pain 1193

Management of Pain 1194

ALTERATIONS IN PAIN SENSITIVITY AND SPECIAL TYPES OF PAIN 1198

Alterations in Pain Sensitivity 1198

Special Types of Pain 1199

HEADACHE AND ASSOCIATED PAIN 1201

Headache 1202

Temporomandibular Joint Pain 1205

PAIN IN CHILDREN AND OLDER ADULTS 1205

Pain in Children 1205

Pain in Older Adults 1206

CHAPTER 50 Disorders of Motor Function&Serena W. Hung Adapted by Joanna Pierazzo 1210

ORGANIZATION AND CONTROL OF MOTOR FUNCTION 1210

Organization of Movement 1211

The Motor Unit 1213

Spinal Reflexes 1214

Motor Pathways 1214

Assessment of Motor Function 1215

DISORDERS OF THE MOTOR UNIT 1219

Skeletal Muscle Disorders 1219

Disorders of the Neuromuscular Junction 1220

Lower Motor Neuron Disorders 1222

Peripheral Nerve Disorders 1222

DISORDERS OF THE CEREBELLUM AND BASAL GANGLIA 1227

Disorders of the Cerebellum 1227

Disorders of the Basal Ganglia 1228

UPPER MOTOR NEURON DISORDERS 1233

Amyotrophic Lateral Sclerosis 1233

Demyelinating Disorders of the Central Nervous System 1234

Vertebral and Spinal Cord Injury 1235

CHAPTER 51 Disorders of Brain Function&Diane S. Book Adapted by Joanna Pierazzo 1246

MECHANISMS AND MANIFESTATIONS OF BRAIN INJURY 1246

Mechanisms of Injury 1247

Traumatic Head Injury 1255

Manifestations of Global Brain Injury 1257

CEREBROVASCULAR DISEASE 1261

Cerebral Circulation 1261

Stroke （Brain Attack） 1263

INFECTIONS AND NEOPLASMS 1270

Infections 1270

Brain Tumours 1272

SEIZURE DISORDERS 1274

Etiology: Provoked and Unprovoked Seizures 1275

Classification 1275

Diagnosis and Treatment 1277

Generalized Convulsive Status Epilepticus 1278

CHAPTER 52Sleep and Sleep Disorders&Carol M. Porth 1281

NEUROBIOLOGY OF SLEEP 1281

Neural Structures and Pathways 1281

The Sleep-Wake Cycle 1282

Circadian Rhythms 1285

Melatonin 1285

SLEEP DISORDERS 1286

Diagnostic Methods 1287

Circadian Rhythm Disorders 1287

Insomnia 1289

Narcolepsy 1290

Sleep-Related Movement Disorders 1291

Sleep Apnea 1292

Parasomnias 1293

SLEEP AND SLEEP DISORDERS IN CHILDREN AND THE ELDERLY 1294

Sleep and Sleep Disorders in Children 1295

Sleep and Sleep Disorders in the Elderly 1295

CHAPTER 53 Disorders of Thought, Mood,and Memory&Sandra Kawczynski Pasch 1299

EVOLUTION IN UNDERSTANDING OF MENTAL ILLNESS 1299

Historical Perspectives 1299

The Role of Heredity in Mental Illness 1300

ANATOMIC AND NEUROCHEMICAL BASIS OF BEHAVIOUR 1302

Behavioural Anatomy of the Brain 1302

Physiology of Perception, Thought, and Memory 1304

Disorders of Perception 1305

Role of Neuromediators 1306

Neuroimaging 1307

DISORDERS OF THOUGHT AND VOLITION 1308

Schizophrenia 1308

DISORDERS OF MOOD 1311

Depressive Disorders 1311

ANXIETY DISORDERS 1314

Panic Disorder 1315

Generalized Anxiety Disorder 1315

Obsessive-Compulsive Disorder 1315

Social Phobia 1316

DISORDERS OF ABUSE AND ADDICTION 1316

DISORDERS OF MEMORY AND COGNITION 1317

Normal Cognitive Aging 1317

Dementia 1318

UNITⅩⅢ DISORDERS OF SPECIAL SENSORY FUNCTION 1327

CHAPTER 54 Disorders of Visual Function&Edward W. Carroll, Scott A. Jens, and Robin Curtis 1328

DISORDERS OF THE ACCESSORY STRUCTURES OF THE EYE 1328

Disorders of the Eyelids 1330

Disorders of the Lacrimal System 1331

DISORDERS OF THE CONJUNCTIVA, CORNEA,AND UVEAL TRACT 1332

Disorders of the Conjunctiva 1332

Disorders of the Cornea 1334

Disorders of the Uveal Tract 1337

The Pupil and Pupillary Reflexes 1337

INTRAOCULAR PRESSURE AND GLAUCOMA 1338

Control of Intraocular Pressure 1338

Glaucoma 1339

DISORDERS OF THE LENS AND LENS FUNCTION 1341

Disorders of Refraction and Accommodation 1341

Cataracts 1343

DISORDERS OF THE VITREOUS AND RETINA 1344

Disorders of the Vitreous 1344

Disorders of the Retina 1345

DISORDERS OF NEURAL PATHWAYS AND CORTICAL CENTRES 1355

Optic Pathways 1355

Visual Cortex 1355

Visual Fields 1356

DISORDERS OF EYE MOVEMENT 1358

Extraocular Eye Muscles and Their Innervation 1358

Strabismus 1360

Amblyopia 1362

Eye Examination in Infants and Children 1362

CHAPTER 55 Disorders of Hearing and Vestibular Function&Susan A. Fontana and Carol M. Porth 1365

DISORDERS OF THE AUDITORY SYSTEM 1365

Disorders of the External Ear 1366

Disorders of the Middle Ear and Eustachian Tube 1367

Disorders of the Inner Ear 1372

Disorders of the Central Auditory Pathways 1375

Hearing Loss 1375

DISORDERS OF VESTIBULAR FUNCTION 1380

The Vestibular System and Vestibular Reflexes 1380

Vertigo 1382

Motion Sickness 1383

Disorders of Peripheral Vestibular Function 1383

Disorders of Central Vestibular Function 1385

Diagnosis and Treatment of Vestibular Disorders 1385

UNITⅩⅣ DISORDERS OF MUSCULOSKELETAL AND INTEGUMENTARY FUNCTION 1389

CHAPTER 56 Structure and Function of the Musculoskeletal System&Carol M. Porth 1390

BONY STRUCTURES OF THE SKELETAL SYSTEM 1390

Bone Structures 1391

Bone Tissue 1392

Cartilage 1394

Hormonal Control of Bone Formation and Metabolism 1394

ARTICULATIONS AND JOINTS 1397

Tendons and Ligaments 1397

Types of Joints 1397

CHAPTER 57 Disorders of Musculoskeletal Function: Trauma, Infection, and Neoplasms&Kathleen E. Gunta 1400

INJURY AND TRAUMA OF MUSCULOSKELETAL STRUCTURES 1400

Athletic Injuries 1401

Soft Tissue Injuries 1401

Joint （Musculotendinous） Injuries 1401

Fractures 1406

Complications of Fractures and otherMusculoskeletalInjuries 1411

BONE INFECTIONS 1416

Osteomyelitis 1416

Tuberculosis of the Bone or Joint 1418

OSTEONECROSIS 1419

NEOPLASMS 1420

Characteristics of Bone Tumours 1421

Benign Neoplasms 1421

Malignant Bone Tumours 1421

Metastatic Bone Disease 1424

CHAPTER 58 Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders&Kathleen E. Gunta 1427

ALTERATIONS IN SKELETAL GROWTH AND DEVELOPMENT 1427

Bone Growth and Remodelling 1428

Alterations During Normal Growth Periods 1429

Hereditary and Congenital Deformities 1433

Juvenile Osteochondroses 1436

Scoliosis 1438

METABOLIC BONE DISEASE 1440

Osteopenia 1441

Osteoporosis 1441

Osteomalacia and Rickets 1446

Paget Disease 1448

CHAPTER 59 Disorders of Musculoskeletal Function: Rheumatic Disorders&Debra Bancroft Rizzo Adapted by Lynn Miles and Ruth A. Hannon 1452

SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES 1453

Rheumatoid Arthritis 1453

Systemic Lupus Erythematosus 1457

Systemic Sclerosis/Scleroderma 1459

Polymyositis and Dermatomyositis 1460

SERONEGATIVE SPONDYLOARTHROPATHIES 1460

Ankylosing Spondylitis 1461

Reactive Arthropathies 1463

Psoriatic Arthritis 1463

OSTEOARTHRITIS SYNDROME 1464

Epidemiology and Risk Factors 1465

Pathogenesis 1465

Clinical Manifestations 1466

Diagnosis and Treatment 1467

CRYSTAL-INDUCED ARTHROPATHIES 1468

Gout 1468

RHEUMATIC DISEASES IN CHILDREN AND THE ELDERLY 1470

Rheumatic Diseases in Children 1470

Rheumatic Diseases in the Elderly 1471

CHAPTER 60 Structure and Function of the Skin&Gladys Simandl 1476

STRUCTURE AND FUNCTION OF THE SKIN 1476

Functions of the Skin 1476

Skin Structures 1477

Epidermis 1477

Basement Membrane 1481

Dermis 1481

Subcutaneous Tissue 1482

Skin Appendages 1482

MANIFESTATIONS OF SKIN DISORDERS 1484

Lesions and Rashes 1484

Pruritus 1484

Dry Skin 1486

Variations in Dark-Skinned People 1486

CHAPTER 61 Disorders of Skin Integrity and Function&Gladys Simandl 1488

PRIMARY DISORDERS OF THE SKIN 1488

Pigmentary Skin Disorders 1489

Infectious Processes 1490

Acne and Rosacea 1498

Allergic and Hypersensitivity Dermatoses 1501

Papulosquamous Dermatoses 1506

Arthropod Infestations 1509

ULTRAVIOLET RADIATION, THERMAL, AND PRESSURE INJURY 1512

Skin Damage Caused by Ultraviolet Radiation 1512

Thermal Injury 1514

Pressure Ulcers 1517

NEVI AND SKIN CANCERS 1519

Nevi 1519

Skin Cancer 1519

AGE-RELATED SKIN MANIFESTATIONS 1523

Skin Manifestations of Infancy and Childhood 1524

Skin Manifestations and Disorders in the Elderly 1528

APPENDIX A: LAB VALUES 1533

APPENDIX B: DIETARY REFERENCE INTAKES （DRIs） 1535

GLOSSARY 1541

INDEX 1551