Applied Pathophysiology

1 Introduction to
P athophysiology 1
Introduction 1
Defi ning P athophysiology 2
Understanding P athophysiology 2
P athogenesis 2
Etiology 2
Clinical Manifestations 2
Diagnosis and Treatment 3
Applying P athophysiology 4
Individual Health 4
Population Health 5
Disease Prevention 5
Evidence-Based Practice 6
Functional Concepts of Altered Health 6
2 Altered Cells and
T issues 9
Introduction 9
Module 1: Review of Cellular Structure and
Function 10
Cellular Components 10
Plasma (Cell) Membrane 10
Cytoplasm and Organelles 11
Cytoskeleton 12
Cellular Function 12
Cellular Mechanisms of Transportation 12
P assive Transport 12
Active Transport 13
Ingestion 13
Secretion 14
Respiration 14
Communication 15
Reproduction 15
Module 2: Cellular Adaptation and
Response to Stress 15
Atrophy 16
Hypertrophy 17
Hyperplasia 17
Metaplasia 17
Dysplasia 18
Module 3: Cellular Injury and Death 19
Mechanisms of Cell Death 19
Apoptosis 19
Necrosis 19
Causes of Cell Injury and Death 20
Module 4: Clinical Models 21
Cerebral Atrophy 21
P athophysiology 21
Clinical Manifestations 22
Diagnosis 22
Treatment 23
Cardiac Hypertrophy 23
P athophysiology 23
Clinical Manifestations 24
Diagnosis 24
Treatment 25
Acromegaly 25
P athophysiology 26
Clinical Manifestations 26
Diagnosis 28
Treatment 28
Cervical Metaplasia and Dysplasia 29
P athophysiology 29
Clinical Manifestations 29
Diagnosis 29
Screening T ests 29
Diagnostic T ests 32
Treatment 32
Environmental T oxin Injury and
Cardiovascular Disease 32
P athophysiology 32
Clinical Manifestations 33
Diagnosis 33
Treatment 33
CONTENTS 3 Inflammation and Tissue
Repair 36
Introduction 36
Review of Body Defense Mechanisms 37
Module 1: Acute Inflammation 38
Vascular Response 38
Inflammatory Mediators Within Cells 39
Inflammatory Mediators Within White Blood Cells 39
Inflammatory Mediators Within Platelets 40
Inflammatory Mediators Within Endothelial or
Injured Tissue Cells 40
Inflammatory Mediators Within Plasma 40
Cellular Response 41
General Manifestations 42
Treatment 42
Resolution of Acute Inflammation 43
Module 2: Healing and Tissue Repair 44
Sealing the Wound 44
Clearing the Debris 44
Restoring Structural Integrity 45
Restoring Functional Integrity 46
Conditions That Promote Wound Healing 47
Healing by Intention 50
Complications of Healing and Tissue Repair 50
Module 3: Chronic Inflammation 51
Cells of Chronic Inflammation 51
Granuloma Formation 51
General Manifestations 51
Treatment 52
Module 4: Applied Pathophysiology Clinical
Models 52
Sinusitis 52
Functions of the Sinuses 53
Acute Sinusitis 53
Pathophysiology 53
Clinical Manifestations 53
Diagnostic Criteria 54
Treatment 54
Chronic Sinusitis 54
Pathophysiology 54
Clinical Manifestations 55
Diagnostic Criteria 55
Treatment 55
Skin and Burn Injuries 55
Burns 55
Pathophysiology 55
Clinical Manifestations 58
Diagnostic Criteria 58
Treatment 58
Arthritis 59
Functions of Synovial Joints 59
Rheumatoid Arthritis 60
Pathophysiology 60
Clinical Manifestations 61
Diagnostic Criteria 61
Treatment 62
Gastritis 62
Functions of the Stomach 62
Acute Gastritis 62
Pathophysiology 63
Clinical Manifestations 63
Diagnostic Criteria 63
Treatment 63
Chronic Gastritis: Infection 63
Pathophysiology 63
Clinical Manifestations 64
Diagnostic Criteria 64
Treatment 64
Chronic Gastritis: Autoimmune 64
Pathophysiology 64
Clinical Manifestations 64
Diagnostic Criteria 64
Treatment 64
Pancreatitis 64
Functions of the Pancreas 64
Acute Pancreatitis 65
Pathophysiology 65
Clinical Manifestations 65
Diagnostic Criteria 65
Treatment 65
Chronic Pancreatitis 66
Pathophysiology 66
Clinical Manifestations 66
Diagnostic Criteria 66
Treatment 67
Inflammatory Bowel Disease 67
Functions of the Small Intestine 67
Crohn Disease 67
Pathophysiology 67
Clinical Manifestations 68
Diagnostic Criteria 68
Treatment 68Ulcerative Colitis 69
Pathophysiology 69
Clinical Manifestations 69
Diagnostic Criteria 70
Treatment 70
4 Altered Immunity 74
Introduction 74
Module 1: Review of Immune Function 75
Cellular Components of Immunity 76
Immune Cell Origin 76
Lymphoid Progenitor Cells 76
Myeloid Progenitor Cells 77
Lymphatics 78
Immune Processes 79
Innate Immunity 79
Adaptive Immunity 79
Humoral Immunity 80
Cell-Mediated Immunity 81
Module 2: Process of Altering Immune
Function 83
Host Defense Failure 83
Hypersensitivity 84
Type I or Immediate Hypersensitivity Reaction 85
Type II Antibody-mediated Reactions 86
Type III Immune Complex–mediated Reaction 87
Type IV Cell-mediated Hypersensitivity
Reaction 88
Autoimmunity 88
Alloimmunity 90
Graft Rejection 90
Graft Versus Host Disease 91
Module 3: Immune Response
Manipulation 91
Treatment of Maladaptive Immune
Responses 91
Immune Response in Disease Management 92
Immune Response in the Prevention of
Disease 92
Module 4: Clinical Models 93
Immune Maladaptation: AIDS 93
Pathophysiology 93
Clinical Manifestations 93
Diagnostic Criteria 94
Treatment 95
Immune Maladaptation: Anaphylactic
Pathophysiology 95
Clinical Manifestations 95
Diagnostic Criteria 97
Treatment 97
Immune Maladaptation: Systemic Lupus
Erythematosus 97
Pathophysiology 98
Clinical Manifestations 98
Diagnostic Criteria 98
Treatment 99
Immune Maladaptation: Rh
Isoimmunization 99
Pathophysiology 99
Clinical Manifestations 100
Diagnostic Criteria 100
Treatment 101
5 Infection 105
Introduction 105
Module 1: Microbes 107
Pathogens 107
Types of Pathogens 108
Bacteria 108
Viruses 110
Rickettsiae, Mycoplasmas, and Chlamydiae 113
Fungi 114
Protozoa 115
Module 2: Communicable Disease 115
Reservoir 115
Portal of Exit 116
Mode of Transmission 116
Portal of Entry 117
Host Factors 117
Module 3: Acute Infection and
Complications 117
Complications of Infection 118
Clinical Manifestations 119
Laboratory and Diagnostic Tests 119
Treatment Modalities 119
Module 4: Clinical Models 120
Influenza 120
Pathophysiology 120
Clinical Manifestations 121
Diagnostic Criteria 121Hepatitis 121
The Function of the Liver 121
Viral Hepatitis 122
Pathophysiology 123
Clinical Manifestations 124
Diagnostic Criteria 124
Treatment 125
Tuberculosis 125
Pathophysiology 125
Clinical Manifestations 126
Diagnostic Criteria 127
Treatment 127
Urinary Tract Infection 127
Pathophysiology 127
Clinical Manifestations 128
Diagnostic Criteria 128
Treatment 128
Pyelonephritis 128
Function of the Kidneys 128
Acute Pyelonephritis 128
Pathophysiology 128
Clinical Manifestations 129
Diagnostic Criteria 129
Treatment 129
Meningitis 129
Function of the Meninges 129
Bacterial Meningitis 129
Pathophysiology 129
Clinical Manifestations 131
Diagnostic Criteria 131
Treatment 131
Tinea 132
Pathophysiology 132
Clinical Manifestations 132
Diagnostic Criteria 132
Treatment 132
Malaria 133
Pathophysiology 133
Clinical Manifestations 133
Diagnostic Criteria 133
Treatment 133
6 Genetic and Developmental
Disorders 137
Introduction 137
Deoxyribonucleic Acid 139
Genes 139
Chromosomes 141
Chromosomal Replication 142
Module 2: Inheritance of Genetic
Disorders 143
Transmission and Expression of Genetic
Traits 143
Inheritance of Single Gene Disorders 144
Genetic Mutations 145
Autosomal Dominant Disorders 145
Autosomal Recessive Disorders 147
Sex-Linked Disorders 147
Mitochondrial Diseases 147
Inheritance of Polygenic Disorders 148
Inheritance of Chromosomal Alterations 149
Alterations in Chromosomal Number 149
Alterations in Chromosomal Structure 150
Epigenetic Inheritance 150
Module 3: Developmental Disorders 151
Congenital Disorders 151
Developmental Origins of Adult Disease 152
Module 4: Management of Genetic and
Developmental Disorders 153
Screening and Diagnosis 153
Prenatal Screening and Diagnosis 153
Postnatal Screening and Diagnosis 154
Treatment Strategies 154
Module 5: Clinical Models 154
Autosomal Dominant Genetic Disorder:
Huntington Disease 155
Pathophysiology 155
Clinical Manifestations 155
Diagnostic Criteria 156
Treatment 156
Autosomal Recessive Disorder: Sickle Cell
Disease 156
Pathophysiology 156
Clinical Manifestations 157
Diagnostic Criteria 157
Treatment 158
Mitochondrial Disease 158
Pathophysiology 158
Clinical Manifestations 158
Diagnosis 159Alteration in Autosome Chromosome Number:
Down Syndrome 159
Pathophysiology 159
Clinical Manifestations 160
Diagnostic Criteria 160
Treatment 161
Alteration in Sex Chromosome Number: Turner
Syndrome and Klinefelter Syndrome 161
Pathophysiology 161
Clinical Manifestations 161
Diagnostic Criteria 162
Treatment 162
Sex-Linked Genetic Disorder: Fragile X
Syndrome (FXS) 163
Pathophysiology 163
Clinical Manifestations 164
Diagnostic Criteria 164
Treatment 164
Epigenetic Inheritance: Beckwith–
Wiedemann Syndrome 164
Pathophysiology 164
Clinical Manifestations 165
Diagnostic Criteria 165
Treatment 165
Developmental Maladaptation: Neural Tube
Defects 165
Pathophysiology 165
Clinical Manifestations 166
Diagnostic Testing 166
Treatment 166
7 Altered Cellular
Proliferation and
Differentiation 171
Introduction 171
Module 1: The Impact of Cancer on the Cell 172
Altered Cellular Proliferation and
Differentiation 172
Carcinogenesis 173
Genetic Mutations 173
Oncogenes 174
Tumor Suppressor Genes 175
Role of Gene Variants and Epigenetics 175
Carcinogens 175
Radiation 176
Hormones 177
Chemicals 177
Tobacco 177
Microbes 177
Initiation–Promotion–Progression Theory 177
Module 2: The Impact of Cancer on Tissues,
Organs, and Organ Systems 178
Benign Versus Malignant 179
Cancer Spread 180
Cancer Nomenclature 181
Cancer Classifications 181
Cancer Prognosis 182
General Manifestations 182
Diagnostic Tests 184
Cancer Treatment 184
Cancer Prevention 184
Children and Cancer 186
Module 3: Clinical Models 186
Lung Cancer 186
Pathophysiology 186
Clinical Manifestations 187
Diagnostic Criteria 187
Treatment 187
Colon Cancer 187
Pathophysiology 188
Clinical Manifestations 189
Diagnostic Criteria 189
Treatment 189
Brain Cancer 190
Pathophysiology 190
Clinical Manifestations 191
Diagnostic Criteria 191
Treatment 191
Leukemia 191
Acute Leukemias 191
Pathophysiology 192
Clinical Manifestations 192
Diagnostic Criteria 192
Treatment 192
Chronic Lymphocytic and Myelogenous
Leukemias 192
Pathophysiology 193
Clinical Manifestations 193
Diagnostic Criteria 193
Treatment 193
Lymphomas 193
Hodgkin Lymphoma 193Pathophysiology 194
Clinical Manifestations 194
Diagnostic Criteria 194
Treatment 194
Non-Hodgkin Lymphoma 195
Pathophysiology 195
Clinical Manifestations 195
Diagnostic Criteria 195
Treatment 195
8 Altered Fluid and
Electrolyte Balance 199
Introduction 199
Module 1: Electrolyte Imbalance 200
Electrolyte Transport 200
Altered Electrolyte Balance 201
Altered Sodium Balance 201
Hyponatremia 201
Hypernatremia 201
Altered Potassium Balance 201
Hypokalemia 201
Hyperkalemia 201
Altered Chloride Balance 202
Hypochloremia 202
Hyperchloremia 202
Altered Calcium Balance 202
Hypocalcemia 202
Hypercalcemia 202
Altered Magnesium Balance 202
Hypomagnesemia 202
Hypermagnesemia 203
Altered Phosphate Balance 203
Hypophosphatemia 204
Hyperphosphatemia 204
Module 2: Fluid Imbalance 204
Fluid Balance 204
Fluid Transport 204
Fluid Regulation 205
Mechanisms to Promote Fluid Intake 207
Mechanisms to Promote Fluid Excretion 207
Tonicity 208
Altered Fluid Balance 209
Water Content 209
Hypovolemia 209
Hemorrhage 210
Dehydration 210
Hypervolemia 210
Edema 212
Module 3: Clinical Models 213
Altered Fluid Balance: Cirrhosis 213
Pathophysiology 213
Clinical Manifestations 213
Diagnostic Criteria 213
Treatment 214
Altered Sodium Balance: Dehydration 215
Pathophysiology 215
Clinical Manifestations 215
Diagnostic Criteria 216
Treatment 216
Altered Calcium Balance:
Hypoparathyroidism 216
Pathophysiology 216
Clinical Manifestations 217
Diagnostic Criteria 217
Treatment 217
9 Altered Acid–Base
Balance 220
Introduction 220
Module 1: Acid–Base Imbalance 221
Regulation of Acid and Base 221
Buffer Systems 222
Plasma Buffer Systems 222
Respiratory Buffer System 223
Renal Buffer System 223
Altered Acid–Base Balance 224
Metabolic Acidosis 224
Metabolic Alkalosis 224
Module 2: Clinical Models 225
Altered Acid–Base Balance: Highly Active
Antiretroviral Therapy (HAART)-Associated
Acidosis 225
Pathophysiology 225
Clinical Manifestations 225
Diagnostic Criteria 226
Treatment 226
Altered Acid–Base Balance: Renal
Tubulopathy 226
Pathophysiology 226
Clinical Manifestations 227
Diagnostic Criteria 227
Treatment 227
Altered Acid–Base Balance: Metabolic Pathophysiology 228
Clinical Manifestations 228
Diagnostic Criteria 228
Treatment 228
10 Altered Neural
Function 231
Introduction 231
Module 1: Alterations in Nerve Impulse
Conduction 232
Neurons 233
Supporting Cells 233
Neurotransmission 234
Communication Between Neurons 234
Processes of Neural Injury 236
Developmental Considerations 236
Module 2: Alterations in Central Nervous
System Function 236
Central Nervous System Organization 237
Brain 237
Spinal Cord 238
Protective Structures of the CNS 240
Neurocirculatory System 240
Cerebrovascular Circulation 240
Blood–Brain Barrier 240
Cerebrospinal Fluid 240
CNS Cellular Injury 241
Mechanisms of Injury to the Cns 241
Traumatic CNS Injury 241
Ischemic CNS Injury 243
Excitation injury 243
CNS pressure injury 244
Module 3: Alterations in Peripheral Nervous
System Function 246
Peripheral Nervous System
Organization 246
Somatic Nervous System 247
Autonomic Nervous System 247
Sympathetic Nervous System 248
Parasympathetic Nervous System 249
Reflex Arcs 250
Peripheral Nervous System Cellular Injury 250
Mechanisms of Injury to the Peripheral Nervous
System 250
Traumatic Peripheral Nerve Injury 250
Peripheral Nervous System Motor
Dysfunction 251
Module 4: Clinical Models 252
Cerebral Palsy 252
Pathophysiology 253
Clinical Manifestations 253
Diagnostic Criteria 254
Treatment 255
Multiple Sclerosis 255
Pathophysiology 255
Clinical Manifestations 256
Diagnostic Criteria 256
Treatment 257
Hydrocephalus 257
Pathophysiology 257
Clinical Manifestations 258
Diagnostic Criteria 259
Treatment 259
Incomplete Spinal Cord Transection 259
Pathophysiology 259
Clinical Manifestations 259
Diagnostic Criteria 261
Treatment 261
Parkinson Disease 262
Pathophysiology 262
Clinical Manifestations 263
Diagnosis 263
Treatment 264
11 Altered Mood, Attention,
and Behavior 268
Introduction 268
Module 1: Regulation of Mood, Attention, and
Behavior 269
Regulation of Mood 269
Regulation of Attention 270
Behavior Regulation 272
Module 2: Alterations in Mood, Attention, and
Behavior 272
Alterations in Brain Structure and Function 272
Recognizing Alterations in Mood, Attention,
and Behavior 272
Treating Alterations in Mood, Attention, and
Behavior 272
Module 3: Clinical Models 273Pathophysiology 275
Clinical Manifestations 275
Diagnostic Criteria 275
Treatment 275
Posttraumatic Stress Disorder 275
Pathophysiology 275
Clinical Manifestations 276
Diagnostic Criteria 276
Treatment 277
Major Depressive Disorder 277
Pathophysiology 277
Clinical Manifestations 278
Diagnostic Criteria 279
Treatment 279
Bipolar Affective Disorder 279
Pathophysiology 279
Clinical Manifestations 280
Diagnostic Criteria 280
Treatment 280
Attention-Deficit Hyperactivity Disorder 280
Pathophysiology 280
Clinical Manifestations 281
Diagnostic Criteria 281
Treatment 281
Autism Spectrum Disorders 281
Pathophysiology 281
Clinical Manifestations 282
Diagnostic Criteria 283
Treatment 283
Schizophrenia 283
Pathophysiology 283
Clinical Manifestations 283
Diagnostic Criteria 284
Treatment 284
12 Altered Somatic
and Special Sensory
Function 288
Introduction 288
Module 1: Pain 289
Somatosensory System 289
Somatosensory Neuronal Organization 290
Somatosensory Neurotransmission 291
Dorsal Root Ganglia Fibers 291
Dermatome Innervation 291
Somatosensory Modalities 291
Stimulus Discrimination 291
Tactile Stimulation 292
Thermal Sensation 292
Position Sensation 292
Pain 292
Characterization of Pain 292
Conduction of Pain Sensation 292
Pattern Theory 293
Specificity Theory 293
Gate Control Theory 294
Intensity Theory 294
Neuromatrix Theory of Pain 294
Manifestations and Evaluation of Pain 295
Treatment of Pain 295
Module 2: Alterations in Vision 297
Visual Structures and Function 297
Control of Eye Movement 298
Protective Eye Structures 298
External Structures 298
Tears 299
Aqueous Humor 299
Alterations in Visual Function 300
Errors in Refraction 300
Alterations in Eye Movement 300
Alterations in Protective Eye Structures 301
Manifestations and Evaluation of Alterations in
Vision 301
Treatment of Alterations in Vision 302
Module 3: Alterations in Hearing and
Balance 302
Structural Components of the Ear 302
External Ear 302
Middle Ear 303
Internal Ear 304
Hearing Processes 304
Balance Processes 304
Alterations in Hearing and Balance 304
Disorders of the External Ear 305
Alteration in Middle Ear Function 305
Alteration in Internal Ear Function 305
Manifestations and Evaluation of Alterations in
Hearing 306
Hearing Evaluation 306
Evaluation of the Middle Ear 306
Evaluation of the Internal Ear 306
Treatment of Alterations in Hearing 307Taste 307
Smell 307
Module 4: Clinical Models 308
Fibromyalgia 308
Pathophysiology 308
Clinical Manifestations 308
Diagnostic Criteria 309
Treatment 309
Migraine Headache 310
Pathophysiology 310
Clinical Manifestations 310
Diagnostic Criteria 310
Treatment 311
Otitis Media 311
Pathophysiology 311
Clinical Manifestations 311
Diagnostic Criteria 312
Treatment 312
Ménière Disease 312
Pathophysiology 312
Clinical Manifestations 313
Diagnostic Criteria 313
Treatment 313
Macular Degeneration 313
Pathophysiology 313
Clinical Manifestations 314
Diagnostic Criteria 314
Treatment 314
Glaucoma 314
Pathophysiology 315
Clinical Manifestations 315
Diagnostic Criteria 316
Treatment 316
Retinopathy of Prematurity 316
Pathophysiology 316
Clinical Manifestations 317
Diagnosis 317
Treatment 317
13 Altered Hormonal and
Metabolic Regulation 321
Introduction 321
Module 1: Function and Regulation of
Hormones 322
Integrating Endocrine, Neural, and Defense
Mechanisms in the Body 322
The Hypothalamic–Pituitary Axis 324
Feedback Mechanisms 325
Hormone Secretion, Metabolism, and
Elimination 327
Receptor Binding 327
Mediating Cell-to-Cell Communication 328
Module 2: The Stress Response 328
Neurologic Response to Stress 328
Hormonal Response to Stress 328
General Adaptation Syndrome 330
Module 3: Altered Hormone Function 331
Damage to the Hypothalamic–Pituitary
Axis 331
Damage to Endocrine Glands 331
Damage to Cell Receptors 331
Damage to Feedback Mechanisms 332
Damage to Metabolism and Elimination
Mechanisms 332
General Manifestations of Altered Hormone
Function 332
Diagnosing and Treating Altered Hormone
Function 332
Module 4: Clinical Models 333
Syndrome of Inappropriate Antidiuretic
Hormone Secretion 333
Pathophysiology 334
Clinical Manifestations 334
Diagnostic Criteria 334
Treatment 334
Diabetes Insipidus 334
Pathophysiology 334
Clinical Manifestations 335
Diagnostic Criteria 335
Treatment 335
Hyperthyroidism 335
Pathophysiology 336
Clinical Manifestations 336
Diagnostic Criteria 336
Treatment 337
Hypothyroidism 337
Pathophysiology 337
Clinical Manifestations 337
Diagnostic Criteria 338
Treatment 338
Cushing Syndrome 338
Pathophysiology 339Diagnostic Criteria 340
Treatment 340
Addison Disease 340
Pathophysiology 340
Clinical Manifestations 340
Diagnostic Criteria 341
Treatment 341
14 Altered Reproductive
Function 345
Introduction 345
Module 1: Regulation of Reproduction 346
Female Reproductive Hormone Function 346
Male Reproductive Hormone Function 350
Module 2: Altered Reproductive Function 352
General Manifestations of Altered
Reproductive Function 352
Diagnosing and Treating Altered
Reproductive Function 353
Module 3: Clinical Models 354
Pelvic Inflammatory Disease 354
Pathophysiology 355
Clinical Manifestations 355
Diagnostic Criteria 355
Treatment 355
Polycystic Ovarian Syndrome 356
Pathophysiology 356
Clinical Manifestations 357
Diagnostic Criteria 357
Treatment 357
Ovarian Cancer 357
Pathophysiology 357
Clinical Manifestations 358
Diagnostic Criteria 359
Treatment 359
Menopause 359
Pathophysiology 359
Clinical Manifestations 359
Diagnostic Criteria 360
Treatment 360
Erectile Dysfunction 361
Pathophysiology 361
Clinical Manifestations 362
Diagnostic Criteria 362
Treatment 362
Pathophysiology 362
Clinical Manifestations 362
Diagnostic Criteria 363
Treatment 363
Prostate Cancer 363
Pathophysiology 363
Clinical Manifestations 364
Diagnostic Criteria 364
Treatment 366
Testicular Cancer 366
Pathophysiology 366
Clinical Manifestations 367
Diagnostic Criteria 367
Treatment 367
15 Altered Ventilation and
Diffusion 371
Introduction 371
Module 1: Pulmonary Structure and
Function 372
Ventilation 372
Inspiration 374
Expiration 374
Measurement of Ventilation 374
Diffusion 375
Partial Pressure 375
Oxygen Diffusion and Transport 375
Carbon Dioxide Diffusion and Transport 376
Diffusing Capacity 376
Module 2: Impaired Ventilation 377
Impaired Ventilation–Perfusion Matching 378
Impaired Diffusion 378
The Effects of Impaired Ventilation and
Diffusion 379
Hypoxemia and Hypoxia 379
Hypercapnia 379
General Manifestations of Impaired Ventilation and
Diffusion 380
Laboratory and Diagnostic Tests 383
Treating Impaired Ventilation and Diffusion 383
Module 3: Clinical Models 384
Pneumonia 384
Pathophysiology 384
Clinical Manifestations 386
Diagnostic Criteria 386Chronic Obstructive Pulmonary Disease 387
Emphysema 387
Pathophysiology 387
Clinical Manifestations 388
Diagnostic Criteria 389
Treatment 389
Chronic Bronchitis 389
Pathophysiology 389
Clinical Manifestations 389
Diagnostic Criteria 390
Treatment 390
Asthma 390
Pathophysiology 391
Clinical Manifestations 391
Diagnostic Criteria 391
Treatment 393
Cystic Fibrosis 394
Pathophysiology 394
Clinical Manifestations 395
Diagnostic Criteria 395
Treatment 396
Acute Respiratory Distress Syndrome 396
Pathophysiology 396
Clinical Manifestations 396
Diagnostic Criteria 396
Treatment 398
16 Altered Perfusion 402
Introduction 402
Module 1: Perfusion 403
From Ventilation to Perfusion 404
Circulation 404
Pulmonary Circulation 405
Systemic Circulation 405
Coronary Circulation 405
Movement of Blood Through the
Circulation 405
Cardiac Cycle 406
Conduction of Impulses 408
Cardiac Output 409
Blood Pressure 409
Neural Control of Blood Pressure and
Cardiovascular Adaptation 410
Module 2: Altered Perfusion 412
Ventilation–Perfusion Mismatching 412
Impaired Circulation 412
Excessive Perfusion Demands 417
General Manifestations of Altered
Perfusion 417
Diagnosing and Treating Altered
Perfusion 417
Module 3: Clinical Models 418
Hypertension 419
Pathophysiology 419
Clinical Manifestations 420
Diagnostic Criteria 420
Treatment 420
Shock 421
Pathophysiology 421
Clinical Manifestations 422
Diagnostic Criteria 422
Treatment 423
Myocardial Infarction 423
Pathophysiology 423
Clinical Manifestations 425
Diagnostic Criteria 425
Treatment 425
Heart Failure 426
Pathophysiology 426
Left Heart Failure 426
Right Heart Failure 427
Clinical Manifestations 429
Diagnostic Criteria 430
Treatment 430
Stroke 430
Pathophysiology 430
Clinical Manifestations 431
Diagnostic Criteria 431
Treatment 431
Disseminated Intravascular Coagulation 431
Pathophysiology 432
Clinical Manifestations 432
Diagnostic Criteria 432
Treatment 432
17 Altered Nutrition 436
Introduction 436
Module 1: Nutrition 437
Water 437
Macronutrients: Proteins, Lipids, and
Carbohydrates 438Nutritional Intake Requirements 443
Intake and Storage of Nutrients 443
Digestion 444
Absorption 448
Glucose and Fructose Absorption 448
Amino Acid and Small Peptide
Absorption 449
Fatty Acid and Glycerol Absorption 449
Module 2: Altered Nutrition 450
Inherited Metabolic Disorders 450
Undernutrition 451
Vitamin and Mineral Deficiencies 451
Protein Energy Malnutrition 451
Overnutrition 454
Malabsorption 455
Food Allergy 455
General Manifestations of Altered Nutrition 456
Diagnostic Tests and Treatments Related to Altered
Nutrition 456
Module 3: Clinical Models 456
Iron-Deficiency Anemia 456
Pathophysiology 457
Clinical Manifestations 457
Diagnostic Criteria 457
Treatment 458
Anorexia Nervosa 458
Pathophysiology 458
Clinical Manifestations 459
Diagnostic Criteria 459
Treatment 459
Celiac Disease (Gluten-Sensitive
Enteropathy) 460
Pathophysiology 460
Clinical Manifestations 460
Diagnostic Criteria 461
Treatment 461
Phenylketonuria 461
Pathophysiology 461
Clinical Manifestations 461
Diagnostic Criteria 461
Treatment 461
Obesity 462
Pathophysiology 462
Clinical Manifestations 463
Diagnostic Criteria 463
Treatment 463
18 Altered Elimination 468
Introduction 468
Module 1: Altered Urinary Elimination 469
Urine Production Process 469
Urine Production 469
Urine Removal 471
Urine Characteristics 472
Urine Analysis 473
Altered Urinary Elimination 474
Processes of Altered Urinary
Elimination 474
Alteration in Urinary Motility 474
Alteration in Urinary Neuromuscular
Function 474
Alteration in Urinary Perfusion 475
Alteration in Urinary Patency 475
General Manifestations of Altered Urinary
Elimination 476
Diagnosis of Conditions of the Renal and
Urinary Systems 476
Treatment of Altered Urinary Elimination 477
Module 2: Alteration in Stool
Elimination 478
Processes of Stool Elimination 478
Stool Elimination Process 478
Stool Production 478
Stool Evacuation 479
Stool Characteristics 480
Stool Analysis 481
Altered Bowel Elimination 481
Processes of Altered Bowel Elimination 481
Alteration in Bowel Motility 481
Alteration in Bowel Neuromuscular Function 481
Alteration in Bowel Perfusion 482
Alteration in Bowel Patency 482
General Manifestations of Altered Bowel
Elimination 483
Diagnosis of Bowel Conditions 484
Treatment of Altered Bowel Elimination 485
Module 3: Clinical Models 485
Urolithiasis 486
Pathophysiology 486
Clinical Manifestations 486
Diagnostic Criteria 486
Treatment 487Pathophysiology 488
Clinical Manifestations 488
Diagnostic Criteria 488
Treatment 489
Polycystic Kidney Disease 489
Pathophysiology 489
Diagnostic Criteria 490
Treatment 491
Diverticular Disease 492
Pathophysiology 492
Clinical Manifestations 494
Diagnostic Criteria 494
Treatment 494
Functional Fecal Incontinence 494
Pathophysiology 495
Clinical Manifestations 495
Diagnostic Criteria 495
Treatment 495
19 Degenerative Changes in
Aging 499
Introduction 499
Module 1: Theories of Aging 500
Theories of Aging 500
Developmental Theories 500
Module 2: General Manifestations of
Aging 501
Stochastic Theories 501
Cellular Changes in Aging 502
Aging and Appearance 502
Fluid and Electrolyte Balance 502
Immune Response 503
Age-Related Proliferative Changes 503
Neurologic Function 503
Mobility 504
Perfusion and Ventilation 505
Metabolic Processes 505
Nutrition and Elimination 507
Module 3: Managing Degenerative Changes in
Older People 507
Module 4: Clinical Models 508
Progeria (Hutchinson-Gilford Progeria
Syndrome) 508
Clinical Manifestations 508
Diagnosis 509
Treatment 509
Osteoporosis 509
Pathophysiology 509
Clinical Manifestations 510
Diagnosis 510
Treatment 511
Alzheimer Disease 511
Pathophysiology 511
Clinical Manifestations 513
Diagnosis 515
Treatment 515
20 Integrated
Pathophysiologic
Concepts 518
Introduction 518
Glucose, Insulin, Energy, and the
Pancreas 519
Diabetes Mellitus 520
Insulin Deficit: Type 1 Diabetes Mellitus 520
Pathophysiology 520
Clinical Manifestations 521
Diagnostic Criteria 521
Treatment 521
Insulin Resistance and Reduction: Type 2 Diabetes
Mellitus 523
Pathophysiology 524
Clinical Manifestations 524
Diagnostic Criteria 525
Treatment 525
Gestational Diabetes Mellitus 526
Acute Complications of Diabetes Mellitus 526
Hypoglycemia 526
Diabetic Ketoacidosis 528
Hyperglycemic Hyperosmolar Nonketotic
Syndrome 529
The Somogyi Effect and Dawn Phenomenon 529
Chronic Complications of Diabetes Mellitus 529
Microvascular Complications 530
Macrovascular Complications 531
Neuropathies 531
Infection 531
Glossary 535