Pathophysiology Concepts Of Altered Health States

868 Pages·2007·26.22 MB·English

Preface
The widespread acceptance of our textbook, Pathophysiology: children , pregnant women , and older adults .
Concepts of Altered Health States,has led to requests for an es- Some of the most popular features found in the sixth edition
sentials version that can be used by students who do not need ofPathophysiology: Concepts of Altered Health Stateshave been
the extensive breadth or detail of content provided in the larger retained in this Essentialsversion:
book. In preparing the essentials version, we have reorganized
content, attempted to eliminate nonessential information, and ■ List of suffixes and prefixes
developed or modified illustrations in an effort to produce a ■ Tables of Normal Laboratory Values
comprehensive text that is accurate, up-to-date, and appealing ■ Glossary
to the reader. Great care also was taken to integrate text and ■ Key Concept Boxes and Summary Boxes, which help the
design in a manner that will aid the reader’s exploration. reader retain and use information by showing how indi-
Although the chapters are authored by a variety of experts, there vidual facts come together to form a larger conceptual unit
is a unified voice and a consistent level of readability.
Additional features that are new to the Essentialsversion include:
As a nurse-physiologist, my major emphasis in the prepara-
tion of the essentials version, as with current and previous edi- ■ Review Questions at the end of each chapter
tions of Pathophysiology: Concepts of Altered Health States, has ■ An appendix of Website Resources, to encourage readers
been to relate normal body functioning to the physiologic to investigate areas of individual interest and update
changes that participate in disease production and occur as a knowledge in a world of ever-changing information.
result of disease, as well as the body’s remarkable ability to
compensate for these changes. The beauty of a physiologic ap-
STUDENT AND
proach is that it integrates all of the aspects of the individual
INSTRUCTOR RESOURCES
cells and organs of the human body into a total functional
whole that can be used to explain both the physical and psy-
chological aspects of altered health. Indeed, it has been my goal A variety of ancillary materials have been developed to support
to share the beauty of the human body and to emphasize that students and instructors alike.
in disease as in health, there is more “going right” in the body
than is “going wrong.” This book is an extension of my career Resources for Students
and, as such, of my philosophy. It is my hope that readers will
■ A back-of-the-book CD-ROM.This free CD-ROM con-
learn to appreciate the marvelous potential of the body, incor-
tains multiple-choice questions for review and anima-
porating this belief into their own philosophy and ultimately
tions of selected pathophysiologic processes.
sharing it with their clients.
■ Study Guide to Accompany Porth’s Essentials of Pathophysio-
In the preparation of Essentials of Pathophysiology: Concepts of
logy: Concepts of Altered Health States,by Kathleen Schmidt
Altered Health States,every attempt has been made to develop a
Prezbindowski. This study guide, available for purchase,
text that is current, accurate, and well organized. The content
reinforces the information in the text using a variety of
has been arranged so that concepts build on one another.
question styles, including multiple choice, fill-in-the-
Words are defined as content is presented. Concepts from phys-
blank, matching, short answer, and figure completion
iology, biochemistry, physics, and other sciences are reviewed
exercises.
as deemed appropriate. Common health problems, including
the special needs of children and older adults, are addressed.
Resources for Instructors
Although intended as a course textbook, Essentials of Pathophy-
siology: Concepts of Altered Health Statesis also intended to serve ■ Instructor’s Resource CD-ROM to Accompany Essentials of
as a reference book that students can take with them and use in Pathophysiology: Concepts of Altered Health States,by Patricia
their practice once the course is finished. S. Bowne. This CD-ROM contains the following:
The use of full color in the design and illustrations offers ■ AnInstructor’s Manualwith lecture outlines and teach-
visual appeal and enhances conceptual learning, linking text ing suggestions, plus printable worksheets for student
content to illustration content. Icons identify content related to assignments
xi
xii Preface
■ ATest Bank,containing approximately 1100 multiple- The writing of this book has been a meaningful endeavor for
choice questions the authors. It was accomplished through an extensive review
■ AnImage Bank,containing approximately 300 images of the literature and through the use of critiques provided by
from the text in formats suitable for printing, project- students, faculty, and content specialists. As this vast amount
ing, and incorporating into web sites of information was processed, inaccuracies or omissions may
■ PowerPointpresentations with incorporated images. have occurred. Readers are encouraged to contact us about such
errors. Such feedback is essential to the continual development
Resources for Students and Instructors of the book.
Visit the Porth: Essentials of Pathophysiology: Concepts of Altered CMP
Health StatesConnection siteat http://connection.LWW.com/
go/porth.
Reviewers
Kevin Branch, BHSc.PHC, ACP Marguerite J. Murphy, RN, MS
Coordinator, Paramedic Programs and Pre-Service Assistant Professor
Firefighter Education and Training Program School of Nursing
Cambrian College Medical College of Georgia
Sudbury, Ontario, Canada Barnesville, Georgia
Deborah A. Hallingstad, MSN, RN, OCN Gila Strauch, BSc, MSc, MEd, PhD
Nursing Faculty Director, Department of Education
Chippewa Valley Technical College ICT Schools
Eau Claire, Wisconsin Toronto, Ontario, Canada
ix
Contributors
Diane Book, MD Kathleen E. Gunta, RN, MSN, ONC
Assistant Professor, Neurology Clinical Nurse Specialist, Orthopaedics
Medical College of Wisconsin St. Luke’s Medical Center
Milwaukee, Wisconsin Milwaukee, Wisconsin
(Chapter 37) (Chapters 42, 43)
Edward W. Carroll, MS, PhD Safak Guven, MD, FACP, FACE
Clinical Assistant Professor Assistant Professor, Obesity/Metabolic Syndrome
Department of Biomedical Sciences, Clinic Director
College of Health Sciences Medical College of Wisconsin
Marquette University Milwaukee, Wisconsin
Milwaukee, Wisconsin (Chapters 30, 31, 32)
(Chapters 1, 3, 36, 40)
Candace Hennessy, RN, PhD
Kathryn Ann Caudell, RN, PhD Vice President, Patient Care Services
St. Michaels Hospital
Clinical Research and Education Manager
Milwaukee, Wisconsin
Amgen-Oncology Professional Services
(Chapter 18)
Edgewood, New Mexico
(Chapters 5, 11)
Julie A. Kuenzi, RN, MSN, CDE, BC-ADM
Diabetes Care Center Manager
Robin Curtis, PhD
Diabetes Nurse Specialist
Professor, Retired
Froedtert Hospital and Medical College of Wisconsin
Department of Cellular Biology, Neurobiology,
Milwaukee, Wisconsin
and Anatomy
(Chapters 30, 31, 32)
The Medical College of Wisconsin
Milwaukee, Wisconsin
Mary Pat Kunert, RN, PhD
(Chapter 38)
Associate Professor
School of Nursing
Elizabeth C. Devine, RN, PhD, FAAN
Marquette University
Professor, School of Nursing
Milwaukee, Wisconsin
University of Wisconsin- Milwaukee
(Chapter 7)
Milwaukee, Wisconsin
(Chapter 39) Glenn Matfin, BSc (Hons), MB ChB, DGM, MFPM,
MRCP(UK), FACE, FACP
Susan A. Fontana, RN, PhD, CS-FNPNET
Medical Director and Vice President
Certified Family Nurse Practitioner Medical Research and Development
Associate Professor, School of Nursing Inverness Medical Innovations
University of Wisconsin-Milwaukee USA and Unipath, UK
Milwaukee, Wisconsin (Chapters 30, 31, 32)
(Chapter 40)
Patricia McCowen Mehring, RNC, MSN, OGNP
Kathryn J. Gaspard, PhD Department of Obstetrics and Gynecology
Clinical Associate Professor, School of Nursing Division of Reproductive Medicine
University of Wisconsin-Milwaukee Medical College of Wisconsin
Milwaukee, Wisconsin Milwaukee, Wisconsin
(Chapters 11, 12, 13) (Chapters 34, 35)
vii
viii Contributors
Joan Pleuss, MS, RD, CDE Cynthia V. Sommer, PhD, MT (ASCP)
Bionutrition Research Manager Associate Professor Emerita, Department of Biological
General Clinical Research Center Sciences
Medical College of Wisconsin University of Wisconsin-Milwaukee
Milwaukee, Wisconsin Milwaukee, Wisconsin
(Chapter 29) (Chapters 8, 9)
Debra Ann Bancroft Rizzo, RN, MSN, FNP-C Kathleen A. Sweeney, RN, BSN, ACRN
Rheumatology Nurse Practitioner Women’s Statewide Outreach Coordinator
Rheumatic Disease Center Wisconsin HIV Primary Care Support Network
Milwaukee, Wisconsin Medical College of Wisconsin
(Chapter 43) Milwaukee, Wisconsin
(Chapter 10)
Gladys Simandl, RN, PhD
Professor
Columbia College of Nursing
Milwaukee, Wisconsin
(Chapter 44)
Contents
UNIT ONE UNIT TWO
Mechanisms of Disease Alterations in Body Defenses
1 Cell Structure and Function 1 7 Stress and Adaptation 121
Edward W. Carroll Mary Pat Kunert
Functional Components of the Cell 2 Homeostasis 122
Cell Metabolism and Energy Sources 7 Stress 123
Cell Membrane Transport, Signal Transduction, Disorders of the Stress Response 128
and Generation of Membrane Potentials 9
8 The Immune Response 134
Body Tissues 14
Cynthia V. Sommer
2 Tissue Adaptation and Injury 24 The Immune System 134
Developmental Aspects of the Immune System 148
Cellular Adaptation 24
Cell Injury and Death 27 9 Inflammation, Tissue Repair,
and Fever 150
3 Genetic Control of Cell Function 36
Cynthia V. Sommer, Carol M. Porth
Edward W. Carroll The Inflammatory Response 150
Genetic Control of Cell Function 36
Tissue Repair and Wound Healing 157
Chromosomes 41
Temperature Regulation and Fever 161
Patterns of Inheritance 44
Gene Mapping and Technology 46 10 Alterations in the
Immune Response 168
4 Genetic and Congenital Disorders 50
Carol M. Porth, Kathleen Sweeney
Genetic and Chromosomal Disorders 50 Allergic and Hypersensitivity Disorders 168
Disorders Due to Environmental Influences 58 Transplantation Immunopathology 174
Autoimmune Disorders 175
5 Alterations in Cell Growth Immunodeficiency Disorders 178
and Replication: Neoplasia 64
UNIT THREE
Kathryn Ann Caudell
Concepts of Cell Growth 64 Alterations in the Hematologic System
Characteristics of Benign
and Malignant Neoplasms 67 11 Alterations in White Blood Cells 191
Carcinogenesis and Causes of Cancer 72
Kathryn Ann Caudell, Kathryn J. Gaspard
Clinical Features 77 Hematopoietic and Lymphoid Tissue 191
Childhood Cancers 81 Non-neoplastic Disorders of White Blood Cells 194
Neoplastic Disorders of Hematopoietic
6 Alterations in Fluids, Electrolytes,
and Lymphoid Origin 197
and Acid-Base Balance 84
12 Alterations in Hemostasis
Composition and Compartmental Distribution
of Body Fluids 84 and Blood Coagulation 205
Sodium and Water Balance 90 Kathryn J. Gaspard
Potassium Balance 99 Mechanisms of Hemostasis 205
Calcium and Magnesium Balance 103 Hypercoagulability States 209
Acid-Base Balance 108 Bleeding Disorders 210
xix
xx Contents
13 Alterations in Red Blood Cells 216 21 Alterations in Respiratory Function:
Kathryn J. Gaspard Disorders of Gas Exchange 376
The Red Blood Cell 216 Disorders of Lung Inflation 376
Anemia 220 Obstructive Airway Disorders 380
Polycythemia 227 Interstitial Lung Diseases 390
Age-Related Changes in Red Blood Cells 227 Pulmonary Vascular Disorders 392
Respiratory Failure 395
UNIT FOUR
Alterations in the Cardiovascular System UNIT SIX
Alterations in the Urinary System
14 Structure and Function of
the Cardiovascular System 231 22 Control of Kidney Function 401
Organization of the Circulatory System 232 Kidney Structure and Function 402
Principles of Blood Flow 233 Tests of Renal Function 412
The Heart as a Pump 236
Blood Vessels and the Peripheral Circulation 246 23 Alterations in Renal Function 415
Neural Control of Circulatory Function 251 Congenital and Hereditary Disorders of the Kidney 415
Obstructive Disorders 417
15 Alterations in Blood Flow 254 Urinary Tract Infections 421
Disorders of the Arterial Circulation 254 Disorders of Glomerular Function 425
Disorders of the Venous Circulation 266 Tubulointerstitial Disorders 429
Disorders of Blood Flow Caused by Neoplasms 430
Extravascular Forces 269
24 Renal Failure 433
16 Alterations in Blood Pressure 274 Acute Renal Failure 433
Control of Blood Pressure 274 Chronic Renal Failure 436
Hypertension 279 Renal Failure in Children and Elderly Persons 443
Orthostatic Hypotension 287
25 Alterations in Urine Elimination 446
17 Alterations in Cardiac Function 291 Control of Urine Elimination 446
Disorders of the Pericardium 291 Alterations in Bladder Function 449
Coronary Heart Disease 294 Cancer of the Bladder 456
Myocardial and Endocardial Disease 302
Valvular Heart Disease 308
UNIT SEVEN
Heart Disease in Infants and Children 312
Alterations in the
18 Heart Failure and Circulatory Shock 320 Gastrointestinal System
Candace Hennessy, Carol M. Porth
Heart Failure 320 26 Structure and Function of
Circulatory Failure (Shock) 330 the Gastrointestinal System 459
Heart Failure in Children and the Elderly 336
Structure and Organization of
the Gastrointestinal Tract 460
UNIT FIVE Innervation and Motility 463
Alterations in the Respiratory System Hormonal and Secretory Function 466
Digestion and Absorption 468
Anorexia, Nausea, and Vomiting 471
19 Structure and Function of
the Respiratory System 339 27 Alterations in Gastrointestinal
Structural Organization of the Respiratory System 340 Function 473
Exchange of Gases Between the Atmosphere
Disorders of the Esophagus 473
and the Lungs 344
Disorders of the Stomach 476
Exchange and Transport of Gases 351
Disorders of the Small and Large Intestines 480
Control of Breathing 356
20 Alterations in Respiratory Function:
Infectious Disorders and Neoplasia 359
Respiratory Tract Infections 359
Cancer of the Lung 367
Respiratory Disorders in Infants and Children 369
Contents xxi
28 Alterations in Hepatobiliary 35 Sexually Transmitted Diseases 627
Function 494 Patricia McCowen Mehring
The Liver and Hepatobiliary System 494 Infections of the External Genitalia 627
Disorders of the Liver 500 Vaginal Infections 630
Disorders of the Gallbladder and Extrahepatic Vaginal-Urogenital-Systemic Infections 632
Bile Ducts 510
Disorders of the Exocrine Pancreas 513 UNIT TEN
Alterations in the Nervous System
29 Alterations in Body Nutrition 517
Joan Pleuss
36 Organization and Control of
Regulation of Food Intake and Energy Metabolism 517
Overnutrition and Obesity 521 the Nervous System 637
Undernutrition 524 Edward W. Carroll, Robin L. Curtis
Nervous Tissue Cells 637
Nerve Cell Communication 641
UNIT EIGHT
Development and Organization of
Alterations in the Endocrine System
the Nervous System 644
The Spinal Cord and Brain 651
30 Organization and Control of The Autonomic Nervous System 660
the Endocrine System 529
37 Alterations in Brain Function 667
Glenn Matfin, Safak Guven, Julie A. Kuenzi
The Endocrine System 529 Diane Book
Brain Injury 668
31 Alterations in Pituitary, Thyroid, Cerebrovascular Disease 679
Parathyroid, and Adrenal Function 538 Infections and Neoplasms 685
Seizure Disorders 688
Glenn Matfin, Safak Guven, Julie A. Kuenzi
Dementias 691
General Aspects of Altered Endocrine Function 538
Pituitary and Growth Hormone Disorders 539
38 Alterations in Neuromuscular
Thyroid Disorders 545
Parathyroid Hormone Disorders 551 Function 696
Disorders of Adrenal Cortical Function 552 Carol M. Porth, Robin L. Curtis
The Organization and Control of Motor Function 696
32 Diabetes Mellitus 560 Skeletal Muscle and Peripheral Nerve Disorders 702
Safak Guven, Julie A. Kuenzi, Glenn Matfin Basal Ganglia and Cerebellum Disorders 709
Energy Metabolism 560 Upper and Lower Motoneuron Disorders 713
Diabetes Mellitus 565 Spinal Cord Injury 716
39 Pain 725
UNIT NINE
Elizabeth C. Devine
Alterations in the Male and Female
Organization and Control of
Reproductive Systems
Somatosensory Function 725
Pain 731
33 Alterations in the Male Alterations in Pain Sensitivity and Special Types
Reproductive System 581 of Pain 739
Headache 741
Physiologic Basis of Male Reproductive Function 581
Pain in Children and Older Adults 744
Disorders of the Penis, the Scrotum and Testes,
and the Prostate 587
40 Alterations in Special Sensory
Disorders in Childhood and Aging Changes 597
Function 747
34 Alterations in the Female Edward W. Carroll, Susan A. Fontana
Reproductive System 602 The Eye and Disorders of Vision 747
The Ear and Disorders of Auditory Function 763
Patricia McCowen Mehring
The Vestibular System and Maintenance
Structure and Function of the Female
of Equilibrium 772
Reproductive System 602
Disorders of the Female Reproductive Organs 607
Menstrual Disorders 619
Disorders of the Breast 622
xxii Contents
44 Alterations in Skin Function
UNIT ELEVEN
Alterations in the Skeletal and Integrity 835
and Integumentary Systems Gladys Simandl
Structure of the Skin 835
Manifestations of Skin Disorders 839
41 Structure and Function of Skin Damage Caused by Ultraviolet Radiation 841
the Skeletal System 779 Primary Disorders of the Skin 842
Characteristics of Skeletal Tissue 779 Nevi and Skin Cancers 853
Skeletal Structures 785 Age-Related Skin Manifestations 857
42 Alterations in the Skeletal System:
Trauma, Infection, and Glossary 863
Developmental Disorders 789
APPENDIX A: Lab Values 873
Kathleen E. Gunta
Injury and Trauma of Musculoskeletal Structures 789
Bone Infections 799 APPENDIX B: Weblinks 875
Neoplasms 802
Index 879
Disorders of Skeletal Growth and Development
in Children 805
43 Alterations in the Skeletal System:
Metabolic and Rheumatoid
Disorders 814
Debra Bancroft Rizzo, Kathleen E. Gunta
Metabolic Bone Disease 814
Rheumatic Disorders 820
Rheumatic Diseases in Children and the Elderly 832
UNIT
One
Mechanisms
of Disease
CHAPTER
1
Cell Structure and Function
Signal Transduction and Cell Communication
Functional Components of the Cell
Cell Membrane Receptors
The Nucleus
Messenger-Mediated Control of Nuclear Function
The Cytoplasm and Its Organelles
Membrane Potentials
Ribosomes
Electrical Potentials
Endoplasmic Reticulum
Action Potentials
Golgi Complex
Body Tissues
Lysosomes and Peroxisomes
Cell Differentiation
Mitochondria
Embryonic Origin of Tissue Types
The Cytoskeleton
Epithelial Tissue
Microtubules
Simple Epithelium
Microfilaments
Stratified and Pseudostratified Epithelium
The Cell Membrane
Glandular Epithelium
Cell Metabolism and Energy Sources
Connective or Supportive Tissues
Anaerobic Metabolism
Loose Connective Tissue
Aerobic Metabolism
Dense Connective Tissue
Cell Membrane Transport, Signal Transduction,
Muscle Tissue
and Generation of Membrane Potentials
Skeletal Muscle
Movement Across the Cell Membrane
Smooth Muscle
Passive Movement
Cell Junctions and Cell-to-Cell Adhesion
Active Transport and Cotransport
Endocytosis and Exocytosis
Ion Channels
The cell is the smallest functional unit that an organism
can be divided into and retain the characteristics neces-
sary for life. Cells with similar embryonic origin or func-
tion are often organized into larger functional units called tis-
sues.These tissues in turn combine to form the various body
structures and organs. Although the cells of different tissues
1