Part 2 book “Pathophysiology - A practical approach” has contents: Gastrointestinal function, endocrine function, neural function, musculoskeletal function, integumentary function, sensory function, normal lab values, root words and combining forms.
© Steve Gschmeissner/Science Photo Library/Getty C HAPTER Gastrointestinal Function L E A R N I N G O B J E C T I V E S • Discuss normal gastrointestinal anatomy and physiology • Describe and compare congenital defects of the gastrointestinal system • Compare and contrast disorders of the upper gastrointestinal system K E Y • Describe and compare disorders of the gallbladder, liver, and pancreas • Compare and contrast disorders of the lower gastrointestinal system • Describe and compare cancers of the gastrointestinal system T E R M S achlorhydria acute gastritis appendicitis appendix ascites aspiration atrophic gastritis bile cecum celiac disease cholecystitis cholelithiasis chronic gastritis chyme cirrhosis cleft lip cleft palate colon colorectal cancer constipation Crohn’s disease Curling’s ulcer Cushing’s ulcer defecation diarrhea diverticula diverticular disease diverticulitis diverticulosis duodenal ulcer dysphagia emesis esophageal cancer esophagus feces frank blood gallbladder gastric cancer gastric ulcer gastritis gastroenteritis gastroesophageal reflux disease (GERD) hematemesis hepatic artery hepatitis hepatobiliary system hiatal hernia infantile hypertrophic pyloric stenosis (IHPS) inflammatory bowel disease (IBD) intestinal obstruction irritable bowel syndrome (IBS) jaundice large intestine liver liver cancer lower esophageal sphincter (LES) mastication melena mesentery mucosa mucus muscle layer nausea occult blood oral cancer pancreas pancreatic cancer pancreatitis paralytic ileus parietal peritoneum layer peptic ulcer disease (PUD) 260 Chapter 9 Gastrointestinal Function peristalsis peritoneal cavity peritoneum peritonitis portal hypertension rugae serosa small intestine stomach stress ulcer portal vein pyloric sphincter pyloric stenosis rectum retching T he gastrointestinal (GI) system, or digestive system, consists of structures responsible for consumption, digestion, and elimination of food (FIGURE 9-1) These processes provide the essential nutrients, water, and electrolytes required for the body’s physiologic activities Structures of the GI system include an alimentary canal through which food is passed and accessory organs that aid digestion (FIGURE 9-2) The alimentary canal includes the oral cavity, pharynx, esophagus, stomach, small intestine, large intestine, and anus The accessory organs include the salivary glands, liver, gallbladder, bile ducts, and pancreas Disorders of the GI system can result in nutritional deficits and metabolic imbalances These conditions vary from mild (e.g., constipation) to life threatening (e.g., pancreatitis) in severity, and often present as vague, nonspecific manifestations that reflect a disruption in the system’s normal functioning Anatomy and Physiology The GI tract is divided into upper and lower divisions, which will be further discussed in upcoming sections Additionally, the liver, gallbladder, and pancreas are collectively referred to as the hepatobiliary system because of their close proximity to each other and their complementary functions The walls Mouth Salivary gland cavity Esophagus Pancreas Storage Food enters Digestion submucosa layer ulcerative colitis visceral peritoneum layer vomiting vomitus of the GI tract have four layers (FIGURE 9-3) The mucosa is the innermost layer that produces mucus Mucus facilitates movement of the GI contents and protects the GI tissue from the extreme pH conditions of the GI tract (the stomach’s pH is in the range of 1–2) necessary for digestion The epithelial mucosa cells have a high turnover rate because of erosion associated with food passage and the highly acidic environment The submucosa layer consists of connective tissue that includes blood vessels, nerves, lymphatics, and secretory glands The muscle layer includes circular and longitudinal smooth muscle layers This layer contracts in a wavelike motion to propel food through the GI tract, an action called peristalsis The serosa is the outer layer of the wall The peritoneum is the large serous membrane that lines the abdominal cavity The outer parietal peritoneum layer covers the abdominal wall as well as the top of the bladder and uterus The inner visceral peritoneum layer encases the abdominal organs This doublewalled membrane is similar to the pericardial sac (see the Cardiovascular Function chapter) and the pleural membrane (see the Respiratory Function chapter) The peritoneal cavity is the space between these two layers; it contains serous fluid to decrease friction and facilitate movement The mesentery is a double-layer peritoneum containing blood vessels and nerves Small intestine Digestion and absorption Large intestine Undigested materials released Digestion ends and water absorption continues Anus Stomach Gallbladder (bile storage) FIGURE 9-1 Functions of the gastrointestinal system Liver Cecum Anatomy and Physiology Parotid duct Parotid gland Gastroesophageal sphincter Masseter muscle Submandibular duct Sublingual gland Tongue Ileum of small intestine Liver Large intestine Cecum Pharynx Esophagus Submandibular gland Ascending portion of large intestine Stomach Oral cavity Duodenum of small intestine Small intestine Pyloric sphincter Pancreas Appendix Gallbladder Duodenum of small intestine Transverse colon Ascending colon Descending colon Ileum of small intestine Appendix Sigmoid colon Rectum Anus FIGURE 9-2 The structures of the gastrointestinal system that supplies the intestinal wall It supports the intestines while allowing flexibility to accommodate peristalsis and varying content volumes Upper Gastrointestinal Tract The upper GI tract includes the oral cavity, pharynx, esophagus, and stomach (Figure 9-2) Food usually enters the GI tract through the mouth (consumption), where chemical and mechanical digestion begins Issues with the mouth or swallowing can create a need to bypass the mouth and esophagus and introduce the food or a food supplement directly into the stomach or small intestine Chewing, or mastication, pulverizes the food into small pieces, and saliva from the salivary glands moistens and further breaks down the food (TABLE 9-1) Saliva contains 261 262 Chapter 9 Gastrointestinal Function Esophagus Cardiac sphincter Pyloric sphincter Cardiac portion of stomach Longitudinal Lesser curvature Circular Oblique Smooth muscle layers Duodenum Greater curvature Pyloric portion of stomach FIGURE 9-3 The layers of the gastrointestinal tract Photo: © Donna Beer Stolz, PhD, Center for Biologic Imaging, University of Pittsburgh Medical School enzymes and antibodies that can kill or neutralize bacteria The smell, taste, feel, and thought of food trigger saliva secretion Healthy teeth and gums play a key role in maintaining adequate nutrition The tongue pushes the semisolid food mass to the back of the throat, where it is swallowed (FIGURE 9-4) Food passing the trigeminal and glossopharyngeal nerves initiates the swallowing reflex These nerves relay information to the swallowing center in the medulla; the swallowing center then coordinates the movement of the food from the mouth through the esophagus to the stomach with cranial nerves V, IX, X, and XII This orchestrated movement prevents food from entering the nearby trachea and lungs (a phenomenon called aspiration) The esophagus has muscular rings to move the food toward the stomach (FIGURE 9-5) As the food nears the stomach, the lower esophageal sphincter (LES) relaxes to allow the food to enter the stomach The LES also prevents the stomach contents from refluxing into the esophagus The stomach is an expandable food and liquid reservoir When it is empty, the stomach wall shrinks, forming wrinkles called rugae (FIGURE 9-6) As the stomach fills, the rugae unfold and the wall stretches to accommodate a volume up to to liters Inside the stomach, hydrochloric acid and enzymes (Table 9-1) further chemically digest the food, and peristaltic churning further mechanically digests the food This new food mixture is referred to as chyme The highly acidic nature of chyme aids in digestion and destroys bacteria The epithelial cells of the stomach’s inner lining are densely packed together to prevent damage to the tissues through contact with the acidic stomach contents For additional protection, numerous glands are located in the stomach that coat the inner lining with a Anatomy and Physiology TABLE 9-1 Digestive Juices and Actions Source Type Action Salivary glands Bicarbonate Salivary lipase Moistens food Digests fat Stomach Hydrochloric acid Pepsin Gastric lipase Intrinsic factor Mucus Digests protein Kills bacteria Digests protein Digests fat aids in absorption of vitamin B12 in the small intestine Protects stomach lining Liver Bile acids Cholesterol Phospholipids Immunoglobulins Dissolves fats Excreted in bile aids in absorption of fats acts as antibodies Pancreas Bicarbonate Protects digestive enzymes Neutralizes acid Carries enzymes Digests starch and glycogen Digests fats Digests protein Water amylase Lipases Proteases thick layer of mucus Nutrients are not absorbed in the stomach; instead, the food is simply prepared for absorption However, alcohol is absorbed in the stomach Chyme leaves the stomach through the pyloric sphincter in small (1–3 mL), intermittent amounts As it passes through the pyloric sphincter into the duodenum, liver and pancreatic secretions (Table 9-1) are added to continue the digestion process Much like the LES, the pyloric sphincter prevents reflux of bile from the small intestines into the stomach Liver The liver is an organ that is a hub of activity This large organ performs as many as 500 different functions Some of the liver’s primary roles are vital for homeostasis and include the following: • Metabolize carbohydrates, protein, and fats • Synthesize glucose, protein (albumin), cholesterol, triglycerides, and clotting factors • Store glucose (glycogen), fats (lipids), and micronutrients (e.g., iron, copper, and vitamin B12) and release them when needed • Detoxify the blood of potentially harmful chemicals (e.g., alcohol, nicotine, and medications) • Maintain intravascular fluid volume through the production of circulating proteins (see the Fluid, Electrolyte, and Acid–Base Homeostasis chapter) • Metabolize medications to prepare them for excretion • Produce bile (necessary for emulsification of fat and fat-soluble vitamins) • Inactivate and prepare hormones for excretion • Remove damaged or old erythrocytes from blood to recycle iron and protein • Serve as a blood reservoir (stores approximately 450 mL of blood that can be used when needed) • Convert fatty acids to ketones A tough membrane (Glisson’s capsule) protects this crucial organ The liver has a dual blood supply The hepatic artery carries oxygenated blood from the general circulation to the liver at a rate of approximately 300 mL per minute to nourish the liver The portal vein carries partially deoxygenated blood from the stomach, pancreas, and spleen, as well as from the small and large intestines, to the liver at a rate of approximately 1,000 mL per minute so that the liver can process nutrients and digestion by-products The liver is one of the body’s few organs that can regenerate As much as 75% of the liver tissue can be lost or removed, yet the remaining liver tissue can slowly regenerate into a whole liver again This regeneration occurs primarily due to certain liver cells (hepatocytes) that act as stem cells A single hepatocyte can divide into two daughter cells During regeneration, steps 263 264 Chapter 9 Gastrointestinal Function Nasal cavity Soft palate Blocked nasal passage Bolus Pharynx Epiglottis Larynx The bolus enters the pharynx and the soft palate closes the nasal cavity Trachea (windpipe) Esophagus The larynx rises up to meet the epiglottis The bolus presses on the epiglottis and bends it downward, closing the opening to the windpipe The bolus enters the esophagus FIGURE 9-4 Swallowing should be taken to protect the liver from damage (e.g., avoiding hepatotoxic medications and substances) In addition to providing regeneration capabilities, the hepatocytes produce bile and perform most of the liver’s other activities The hepatocytes constantly produce bile at a rate of approximately 600–1,200 mL per day Bile is a green or yellowish liquid that contains water, bile salts (formed from cholesterol), conjugated Anatomy and Physiology Ringlike peristaltic contraction sweeping down the esophagus A Circular muscles contract, constricting passageway and pushing food down Relaxed muscles Longitudinal muscles contract, shortening passageway ahead of food Food Sphincter remains closed Relaxed muscles Stomach Sphincter opens, allowing food to enter stomach B FIGURE 9-5 Peristalsis (a) Peristaltic contractions in the esophagus propel food into the stomach (b) When food reaches the stomach, the gastroesophageal sphincter opens, allowing food to enter bilirubin, cholesterol, and electrolytes (including bicarbonate) Bile salts are necessary to emulsify fats and fat-soluble vitamins (A, D, E, and K) so that they can be absorbed in the small intestine The distal ileum reabsorbs most of the bile and returns it to the liver through the portal vein for recycling The bicarbonate ions in the bile neutralize the acidic gastric contents so that the intestinal and pancreatic enzymes can perform their functions The bile flows from the liver through a duct system to either the gallbladder for storage or on to the duodenum The gallbladder is a small (usually no larger than a golf ball), saclike organ located on the under-surface of the liver that serves as a reservoir for bile In addition to storing the bile, the gallbladder concentrates it by removing water The presence of chyme in the small intestine triggers the gallbladder to contract, releasing bile into yet another duct system, where it travels to the small intestine If the gallbladder requires surgical removal, the bile constantly flows directly from the liver to the small intestine 265 266 Chapter 9 Gastrointestinal Function © David M Martin, MD/Science Source these substances to the duodenum to join the chyme The endocrine functions (see the Endocrine Function chapter) include producing hormones (insulin and glycogen) to help regulate blood glucose, thereby maintaining homeostasis Lower Gastrointestinal Tract The lower GI tract comprises the small intestine (duodenum, jejunum, and ileum), large intestine (cecum, colon, and rectum), and anus (Figure 9-2) The small intestine is the longest section of the GI tract (approximately 20 feet long in adults) This length allows for adequate nutrient absorption as the small intestine continues the digestion process In the small intestine, the enzymes that have been secreted into the GI tract break the large food molecules into smaller molecules, which are then absorbed These smaller molecules are transported to the circulatory and lymphatic system Muscular rings slowly move the food mixture through the small intestine using a peristaltic wave motion The wall of the small intestine contains numerous circular folds (plicae circulars) covered with villi and microvilli (FIGURE 9-7) These projections increase the surface area available for absorption of nutrients Each villus contains capillaries, nerves, FIGURE 9-6 Rugae of the stomach Pancreas The pancreas is an organ that is nestled underneath the stomach and liver It has exocrine and endocrine functions The exocrine functions include producing enzymes, electrolytes (e.g., bicarbonate ions), and water necessary for digestion (Table 9-1) A duct system carries Nutrients Villi Absorptive cell Lacteal Blood capillary A FIGURE 9-7 Villi of the small intestines Photo: © Donna Beer Stolz, PhD, Center for Biologic Imaging, University of Pittsburgh Medical School B and lymphatic vessels that play key roles in this absorption The small intestine also contains cells that secrete fluid to neutralize pH and enzymes to facilitate digestion Much like the stomach, the small intestine produces a large amount of protective mucus After making its long journey through the small intestine, the chyme ultimately reaches the large intestine (in approximately 3–5 hours) The large intestine is approximately feet long and does not contain villi The small intestine ends in a pouch called the cecum The appendix is also attached to the cecum This small, wormlike structure seemingly has no function, but does have plenty of potential to cause harm The colon makes up most of the large intestine Unlike the coiled small intestine, the colon has three relatively straight sections—termed the ascending, transverse, and descending colon The mixture entering the colon from the small intestine includes water, unabsorbed food molecules, indigestible food remnants (e.g., cellulose), and electrolytes (sodium and potassium) The colon absorbs 90% of the water and electrolytes, and Escherichia coli feed off the undigested or unabsorbed food remnants E coli organisms constitute a large population of bacteria normally found in the GI tract These bacteria synthesize several key vitamins (e.g., vitamins B12, B1, B2, and K) that are later absorbed by the large intestine As the chyme moves through the colon, it changes into feces Feces contain the remaining undigested or unabsorbed remnants along with bacteria (one-third of the feces) Feces also introduce mucus (approximately 300 mL daily) to aid in bowel movements, even in times of decreased dietary intake Because the feces are more dense than the contents in the small intestines, the colon’s muscular rings must be thicker to propel the feces until they reach the rectum (this usually takes approximately 18 hours) The rectum serves as a reservoir to store the feces Much like the bladder (see the Reproductive Function chapter), the rectum expands when feces enter this area, stimulating the stretch receptors in the rectal wall These receptors send an impulse through the spinal cord to elicit the defecation reflex During defecation, the internal and external anal sphincters relax and the rectum contracts to expel the feces Defecation is consciously controlled (except in Anatomy and Physiology infants) and may require assistance from abdominal muscles Defecation control requires both appropriate muscular and nervous function The urge to defecate can be delayed up to a point, but the longer the feces remain in the large intestine, the more water from them will be absorbed, making the feces more difficult to expel In addition to the nerves that control defecation, the sympathetic and parasympathetic nervous systems innervate the GI tract Activation of the sympathetic nervous system slows digestive activity, whereas activation of the parasympathetic nervous system increases digestive activity Gastrointestinal Changes Associated with Aging The GI system undergoes a few, usually minor, changes with aging The stomach lining may shrink and become inflamed, leading to atrophic gastritis Stomach acid production can decrease (achlorhydria), occasionally because of atrophic gastritis Achlorhydria can cause vitamin B12 deficiency and slow digestion Changes in the liver associated with age include reduced blood flow, delayed drug clearance, and a diminished capacity to regenerate damaged liver cells Additionally, changes in the metabo lism and absorption of lactose, calcium, and iron can occur In particular, the small intestine absorbs less calcium with advancing age, so increased calcium intake is needed to prevent bone mineral loss and osteoporosis The production of some enzymes, such as lactase (which aids in the digestion of lactose, a sugar found in dairy products), declines with age Peristalsis also decreases with age, increasing the risk of constipation Learning Points T he GI tract is another system in the body that is much like basic household plumbing Normally, food enters the tubular system and moves in one direction until the waste products are expelled Peristaltic movement keeps the system flowing in the right direction, but conditions can sometimes slow, cease, or reverse this movement Problems can occur when food moves too rapidly or too slowly through the system Much like household plumbing, the whole system backs up and overall health can be significantly impacted if an occlusion occurs If the system is backing up, intake should cease until functioning returns Remember, what goes in must come out! 267 268 CHaPtER Gastrointestinal Function U N D E R S TA N D I N G C O N D I T I O N S T H AT A F FECT THE GASTROI NTE STI NAL S YST EM W hen considering alterations in the GI system, organizing them based on their basic underlying pathophysiology can increase understanding These concepts are based on the two major underlying pathological issues—altered nutrition and impaired elimination Conditions that alter nutritional status include issues with consuming (e.g., cleft lip), digesting (e.g., pancreatitis), and absorbing (e.g., celiac disease) food Regardless of the cause of the altered nutrition, the end result is similar—inadequate nutritional states in which individuals may be underweight and vitamin deficient Conditions impairing elimination generally focus on constipation and diarrhea These issues may be either the primary condition or a symptom of another condition Additionally, conditions that cause altered nutrition may cause issues with elimination Disorders of the Upper Gastrointestinal Tract Disorders of the upper GI tract generally cause issues with nutrition and range in severity from mild to life threatening These disorders can be congenital (e.g., cleft lip/palate or pyloric stenosis) or acquired (e.g., peptic ulcers) Depending on their severity, most of these disorders can be resolved or managed with minimal residual effects Congenital Defects develop between the fourth and ninth weeks of gestation and are multifactorial in origin Such defects have been associated with genetic mutations, maternal diabetes, drugs (e.g., anticonvulsants), toxins, viruses, vitamin deficiencies, and cigarette smoking Clefts are most frequent in children of Native American, Hispanic, and Asian descent, whereas African American children are the least likely to have a cleft Males are twice as likely as females to have a cleft lip Females, however, are twice as likely as males to have a cleft palate A cleft lip and palate can affect the appearance of an individual’s face and may lead to feeding issues, speech problems, ear infections (otitis media), and hearing problems The conditions may vary in severity from a small notch in the lip to a complete groove that runs into the roof of the mouth and nose (FIGURE 9-8) These defects may occur either separately or together Cleft lip may appear unilaterally or bilaterally (on either side of the midline of the upper lip) This defect results from failure of the maxillary processes and nasal elevations or upper lip to fuse during development Cleft palate results from failure of the hard and soft palates to fuse in development, creating an opening between the oral and nasal cavities In addition to lip and palate deformities, teeth and nose malformations may be present Feeding problems result from Cleft Lip and Palate Cleft lip and cleft palate are relatively common congenital defects of the mouth and face that are apparent at birth The Centers for Disease Control and Prevention (CDC, 2015a) estimates that cleft palate without cleft lip occurs in every 2,650 births in the United States, and cleft lip with or without cleft palate occurs in every 4,440 births These conditions usually Courtesy of Leonard V Crowley, MD, Century College Congenital defects of the digestive system often affect the upper GI tract These congenital disorders are common and not usually life threatening, but they may cause nutritional and self-image issues FIGURE 9-8 Cleft lip and palate 508 Glossary urethra Tube that empties the urinary bladder urge incontinence A sudden, intense urge to urinate, followed by an involuntary loss of urine uric acid A metabolism by-product managed by the kidneys that is a result of the breakdown of nucleotides, the building blocks of DNA urinary incontinence Involuntary loss of urine urinary tract infection (UTI) Infection of the urinary tract that often ascends from the urinary meatus It is typically caused by Escherichia coli and occurs more frequently in females urination The voluntary contraction of the bladder and relaxation of the external sphincter, forcing urine out through the urethra urticaria Raised erythematous skin lesions that are a result of a type I hypersensitivity reaction Also called hives uterine prolapse The descent of the uterus or cervix into the vagina uterus A hollow, pear-shaped organ held in place by the broad, round, and uterosacral ligaments utricle A division of the inner ear that detects motion and position vagina A hollow, tunnel-like structure that extends from the cervix to the external genitalia varicocele A dilated vein in the spermatic cord varicose vein A dilated, tortuous, engorged vein that develops because of improper venous valve function The most common location in which varicose veins occur is the legs, but they can be found in the esophagus (esophageal varices) and the rectum (hemorrhoids) Also called varicosity vas deferens Part of the male duct system that carries sperm out of the testes vascular birthmark Birthmark that consists of blood vessels that have not formed correctly; therefore, these birthmarks are generally red vein A blood vessel that carries blood back to the heart ventilation The transportation of air from the atmosphere to the lungs and out again ventilation/perfusion ratio A measurement used to assess the efficacy and adequacy of ventilation and perfusion Also called VQ ratio ventral root A root formed from approximately 6–8 ventral rootlets The roots combine to form the spinal nerve ventricle A hollow area In the brain, ventricles are interconnected, and cerebrospinal fluid fills and flows freely between them In the heart, they are pumping chambers venule A blood vessel that is larger than a capillary Venules merge together to form veins verruca (plural: verrucae) A viral infection caused by any of a number of the human papillomaviruses Verrucae can develop at any age and often resolve spontaneously They can be transmitted through direct skin contact between people or within the same person vertebral canal Part of the central nervous system through which the spinal cord extends to the second lumbar vertebra vertigo An illusion of motion People experiencing vertigo have a sensation that they or the room is spinning or moving vesicle A blister vestibular apparatus Part of the inner ear that includes the semicircular canals and the vestibule vestibule A bony chamber positioned between the cochlea and semicircular canals of the ear The vestibule houses receptors that respond to body position and movement The area of the vagina that contains the urethral and vaginal opening viral pneumonia A form of pneumonia that is usually mild and heals without intervention, but that can lead to a virulent bacterial pneumonia visceral pain One of two types of pain the body perceives It results from noxious stimuli to internal organs and may include expansion and hypoxia Visceral pain is usually vague and diffuse It may even be sensed on body surfaces at distant locations from the originating organ visceral peritoneum layer The inner layer of the peritoneum that encases the abdominal organs vital capacity The sum of the tidal volume and reserves in the lungs vitiligo A rare condition characterized by small patchy areas of hypopigmentation Vitiligo occurs when the cells that produce melanin die or no longer form melanin, leading to slowly enlarging white patches of irregular shapes on the skin vitreous humor A clear, gelatinous material that fills the posterior chamber of the eye volatile acid Acid that can be excreted via the lungs volatile gas Gas that can be excreted via the lungs vomiting The involuntary or voluntary forceful ejection of chyme from the stomach up through the esophagus and out of the mouth It is a common event that often results from a wide range of conditions Also called emesis vomitus The stomach contents ejected beyond the mouth during vomiting von Willebrand’s disease A common bleeding disorder caused by a defect or deficiency of a blood clotting protein, called von Willebrand factor vulva The structures of external female genitalia These structures include the mons pubis, the labia majora, the labia minora, the clitoris, and the vestibule water intoxication Fluid excess that occurs in the intracellular space welt A raised erythematous skin lesion wet gangrene Type of gangrene that occurs with liquefaction necrosis Extensive damage from bacteria and white blood cells combine to produce a liquid wound white matter Bundles of myelinated nerves Wilms’ tumor A rare kidney cancer that primarily affects children Also called nephroblastoma xenogenic Type of transplant in which tissue is used from a different species yellow marrow Bone marrow that begins to form during adolescence and is present in most bones by adulthood Yellow marrow can be reactivated to produce blood cells under certain circumstances Zika virus disease Condition resulting from an infection of the Zika virus, a member of the virus family Flaviviridae The virus spreads mostly by the bite of an infected Aedes species mosquito, but it can also be transmitted from mother to fetus and through sexual contact zygote A fertilized egg Index Note: Page numbers followed by f and t indicate material in figures and tables, respectively A ABGs See arterial blood gases abrasions, 431f absence seizure, 362, 363f accessory glands, 219 achlorhydria, 267 acid–base balance, 175–183 ABGs, 182–183 buffers, 176–177 case study, 167, 184 compensation, 178 metabolic acidosis, 178–180, 180f metabolic alkalosis, 180 mixed disorders, 182, 182f pH regulation, 176, 176f renal regulation, 177 respiratory acidosis, 181 respiratory alkalosis, 181–182 respiratory regulation, 177 acid–base imbalances, 143, 176, 177, 178t acidosis, 157 See also arterial blood gases acne vulgaris, 434–435, 434f acoustic neuroma, 460 acquired (secondary) immunodeficiency, 44 acquired defenses, 37–40 acquired immunity, 38, 40t acquired immunodeficiency syndrome (AIDS), 45–48, 47t dementia complex, 373 acromegaly, 311, 312f actin myofilaments, 384 action potential, 327, 330f active acquired immunity, 38, 40t active infection phase, 139 active transport, 5, 7f acute bronchitis, 133–134 acute disease, xvii acute flares/attack, 407 acute gastritis, 274 acute heart failure, 91 See also heart failure acute lung injury (ALI), 154 acute lymphoblastic leukemia (ALL), 58 acute myeloid leukemia (AML), 58 acute pancreatitis, 282–284, 283f acute renal failure (ARF), 208–209 acute respiratory distress syndrome (ARDS), 154–156, 154f, 155f, 282 acute respiratory failure (ARF), 156–157 acute tissue rejections, 42 acute urinary incontinence, 196 AD See Alzheimer’s disease adaptation, adaptive defenses, 37–40 cellular immunity, 37–38, 39f humoral immunity, 38–40, 39f Addison’s disease, 321–323 adenocarcinoma, 204 adenosine triphosphate (ATP), ADH See antidiuretic hormone adrenal cortex, 309 adrenal glands, 309 disorders, 320–323 adrenal medulla, 320 adult-onset DM, 315 afferent arteriole, 190 afferent nerves, 338 afferent tracts, 335 afterload, 77, 86, 87 age-related changes ear, 450–451 eyes, 450 skin, 421–422 Age-Related Eye Disease study formula, 457 aging, sensory conditions associated with, 449–451 AIDS See acquired immunodeficiency syndrome air-conduction, 118–121, 119f air flow measurement, 126f alarm stage, 32 albinism, 419–421, 420f aldosterone, 77, 164, 167, 309 on kidney, 192f ALI See acute lung injury alkalosis See also arterial blood gases (ABGs) metabolic, 180 respiratory, 181–182 ALL See acute lymphoblastic leukemia alleles, 22, 63 allergic contact dermatitis, 423 allergic rhinitis, 423 allogeneic transplants, 41 alpha cells, 306 ALS See amyotrophic lateral sclerosis altered immune response, 40 alveolar macrophages, 122f alveoli, 118–122 gas exchange, 121 Alzheimer’s disease (AD), 370–372, 371f amblyopia, 459 amenorrhea, 233 amines, 305 amino acids, 191, 305 AML See acute myeloid leukemia ammonia, 191 amphiarthroses, 383 ampulla, 219 amylin, 306 amyotrophic lateral sclerosis (ALS), 367–370, 367f anaphase, anaphylactic shock, 112, 425 anaplasia, 15 anasarca, 164, 207 anemia, 59–65 aplastic, 62–63 causes, 17 hemolytic, 63–65 iron-deficiency, 59–60, 60f mean corpuscular volume changes with, 60f pernicious, 60–62, 62f sickle cell, 63–64, 63f, 64t 509 510 Index aneurysm, 94, 94f angina, 100 anion gap, 179, 180f anions, 167 ankylosing spondylitis, 408–409, 408f ankylosis, 404 anotia, 449, 450f anteflexed, 222 anterior chamber, 445 anterior dislocation, 394f antiangiogenesis, treatment for macular degeneration, 457 antibodies, 38 antibody-producing cells, 38 antidiuretic hormone (ADH), 77, 164 effects, 192f antigens, 34 antiretroviral therapy, 46 antivascular endothelial growth factor therapy, 457 antiviral medications, 135 aorta, 74 aortic defects, 24 aortic valve, 74 aplastic anemia, 62–63 apocrine glands, 416 apoptosis, 11 appendicitis, 288–289, 289f appendicular skeleton, 378 appendix, 267 aqueous humor, 445 arachnoid layer, 326 ARDS See acute respiratory distress syndrome areola, 226 areolar gland, 226 ARF See acute renal failure; acute respiratory failure arrhythmias, 76 arterial blood gases (ABGs), 179t, 182 interpretation, 182–183, 182t arteries, 73, 78 arterioles, 78 arthritis, 404t psoriatic, 426 ascending fibers, 335 ascending testicle, 228 ascites, 280 aspiration, 262 aspiration pneumonia, 137 asthma, 141–144, 142f action plan, 144f severity, 143t astigmatism, 420 atelectasis, 147, 156, 157f atherosclerosis, 96–98 complications, 98f development, 99f athlete’s foot See tinea pedis atopic dermatitis, 423–424, 423f atopic march theory, 423 ATP See adenosine triphosphate atresia, 83, 449 atria, 73 atrial natriuretic peptide, 164, 191 atrioventricular (AV) node, 74 atrophic gastritis, 267 atrophy, auras, 362 auricle, 445 autoimmune disorders, 42–45 See also specific disorders autoimmune thyroiditis, 317 autologous transplants, 42 automaticity, 74 automatisms, 362 autonomic hyperreflexia, 357 autonomic nervous system, 338–339, 341f autonomic receptors, 342t autoregulation, 353 autosomal dominant disorders, 22–25 autosomal dominant polycystic kidney disease, 206 autosomal recessive disorders, 25–26 autosomes, 22 AV node See atrioventricular node avascular necrosis, 393 axial skeleton, 378 axons, 327 azotemia, 208 B B cells, 37, 55 Babinski’s sign, 62 bacillus Calmette-Guérin (BCG) vaccination, 141 bacterial infections See also specific infections secondary, 128, 130 sexually transmitted, 243–246 bacterial pneumonia, 137, 137t bacterial sexually transmitted infections, 243–246 baroreceptors, 77 Bartholin’s glands, 225 basal cell carcinoma, 436 basal ganglia, 334 basilar skull fracture, 350 BCG vaccination See bacillus Calmette-Guérin vaccination Bence Jones proteins, 59 benign prostatic hyperplasia (BPH), 204–205 benign tumors, 15f, 15–16, 15t beta-amyloid peptide, 370 beta cells, 306 bicarbonate–carbonic acid system, 176–177 bile, 264–265 birthmarks, 417–419 bisphosphates, 319–320 blackheads, 434 bladder, 188 cancer, 203–204 dysfunction, 196–197 exstrophy, 226, 227f function, 188–189 blebs, 151 blindness, 420 blocked sinus, 130f blood, 52 See also circulatory system case study, 61–62, 68 cells, 52t clotting, 53, 53f disorders See also specific disorders platelets, 65–68 red blood cells, 59–65 white blood cells, 53–59 pressure, role of kidneys, 77–78, 77f transfusion reactions, 41 vessels, 73, 78, 78f blood flow through heart, 75f renal, 77 blue bloaters, 146 body defenses See also immunity AIDS, 45–48, 47t autoimmune disorders, 42–45 immunity, 33 adaptive defenses, 37–40 altered immune response, 40 immune system components, 35t innate defenses, 36–37 stress, 32–33, 32f transplant reactions, 41–42 body lice, 430 body movements, 386f boils, 427 bone marrow, 52, 65, 380 biopsy, 55 bones, 378 anatomy and physiology, 378–388, 383f classifications, 380f shaft, 381f structural elements, 382t tumors, 411–412 bovine spongiform encephalopathy, 372 Bowman’s capsule, 189 BPH See benign prostatic hyperplasia brain, 326, 327f injuries, 349–357 regions, 332f, 334f tumors, 373, 373f brain stem, 333, 460 breast cancer, 253–254, 254f breasts, disorders, 239–240 breathing, 121, 124, 125f, 131, 132 acts of, 118 phases, 123 Bristol Stool Chart, 285, 285f bronchi, 120 bronchioles, 120 bronchiolitis, 136 bronchitis acute, 133–134 chronic, 144–146 bronchogenic carcinoma, 149 bronchopneumonia, 137 buffers, 176–177 bundle branches, 74 bundle of His, 74 burns, 431–434 C cachexia, 17 CAD See coronary artery disease café au lait spots, 418–419, 418f calcimimetics, 319 calcitonin, 172, 173, 306, 319 calcium, 172–174, 306, 309 calculi, 199–200 callus, 392 calyces, 188, 200 cancer, 13 See also carcinoma; neoplasms breast, 253–254, 254f carcinogenesis, 14 case study, 23 cervical, 254–255, 254f colorectal, 299–300 endometrial, 255–256 esophageal, 297–298 in eyes, 458 gastric, 298 gastrointestinal (GI) system, 297–300 genetic disorders, 21–29 liver, 298–299, 298f lung, 148–150, 149f neoplasm, 14–21 nervous system, 373 oral, 297, 297f ovarian, 256 pancreatic, 299 penile, 252, 252f prostate, 252–253 reproductive system, 251–256 screening guidelines, 18t staging, 57 testicular, 253 warning signs, 16 candidiasis, 241–242 capillaries, 73, 78 lymphs, 79 carbon dioxide, 118, 125 carbuncles, 427 carcinogenesis, 14 carcinoma See also cancer basal cell, 436 Index renal cell, 203, 203f squamous cell, 204 transitional cell, 203 cardiac markers, 106t cardiac muscle, 384 cells, 74 cardiac output, 77 cardiac tamponade, 80, 81f cardiogenic shock, 80, 112 cardiomyopathy, 85–87, 85f cardiovascular disease hypertension See hypertension shock See shock cardiovascular system anatomy and physiology, 72–79 case study, 83, 114–115 structural alterations cardiomyopathy, 85–87, 85f congenital heart defects, 91, 93 electrical alterations, 87 heart failure, 87–91 infective endocarditis, 81–82, 82f myocarditis, 82 pericarditis, 80–81 valvular disorders, 83, 84t carotid arteries, 74 cartilage, 383 caseous necrosis, 11, 13f cataract, 456, 456f cations, 167 caucasians, 146 cauda equina, 334 cauda equina syndrome, 357 cecum, 267 celiac blood panel, 291 celiac disease/celiac sprue, 291–292, 291f cell(s) adaptation and damage, 9–13, 10f, 12f basic function, 2–9 differentiation, 8–9 energy production, 7–8 exchanging material, 2–6 replication, 8–9 case study, 23 neoplasm, 14–21 organelles, 5t response to tonicity, 164f selectively permeable, 2, 6f cell membrane, cellular immunity, 37–38, 39f cellulitis, 428, 428f central nervous system (CNS), 326–336 central vertigo, 460 cerebellum, 334, 460 cerebral aneurysm, 361–362, 361f cerebral contusion, 349 cerebral cortex, 332, 334, 334f cerebral edema, 165, 168 cerebral palsy (CP), 345–346 511 cerebral vascular accident (CVA), 360–361, 360f cerebrospinal fluid (CSF), 326 cerebrum, 332, 332f lobes, 333f cervical cancer, 254–255, 254f cervix, 223 chancres, 245, 246f Chédiak-Higashi syndrome, 420 chemical inflammatory mediator, 155 chemoreceptors, 77, 124, 440 chemotherapy, 17 Cheyne-Stokes respiration, 354 chickenpox (varicella), 429 chlamydia, 244, 244f chloride, 169–170 cholecystitis, 276 cholelithiasis, 201, 276–277, 276f location, 277f types, 277t cholesterol, 95 chondrosarcoma, 411–412 chordee, 228 choroid, 443 chromosomal disorders, 27–29 chromosomes, 8, 22 chronic bronchitis, 144–146 chronic disease, xvii chronic gastritis, 274 chronic heart failure, 91 See also heart failure chronic kidney disease (CKD), 209–210, 212 complications, 211–212t chronic lymphoid leukemia (CLL), 58 chronic myeloid leukemia (CML), 58 chronic obstructive pulmonary disease (COPD), 144, 145f chronic overdistension, 195 chronic tissue rejection, 42 chronotropic effect, 77 Chvostek’s sign, 174, 174f chylomicrons, 95 chyme, 262, 265, 272 cigarette smoking, 121, 144, 148 cilia, 121 ciliary body, 443 circulatory system, 73, 78f See also blood cirrhosis, 278–282, 280f CJD See Creutzfeldt-Jakob disease CKD See chronic kidney disease cleft lip, 27, 27f, 268–269, 268f cleft palate, 27, 27f, 268–269, 268f clitoris, 225 CLL See chronic lymphoid leukemia closed-angle (acute) glaucoma, 454 closed fractures, 392 closed traumatic brain injury, 349, 350f, 351f clotting cascades, 53, 54f 512 Index CNS See central nervous system coagulative necrosis, 11, 13f cochlea, 445 cross section of, 448f colicky pain, 200 colon, 267 colorectal cancer, 299–300 comminuted fracture, 392 comminuted skull fracture, 350 communicating hydrocephalus, 341–343 community-acquired pneumonia, 138 compact bone, 378 compartment syndrome, 393 compensatory mechanisms, xvii, 112 complement proteins, 37 complete fractures, 392 complications, xviii compound skull fracture, 350 compression fracture, 392 concussion, 349 conduction system, 74–75, 75f, 76f conductive hearing loss, 450 conductivity, 74 condylomata acuminata, 250 cones (photoreceptors), 444 congenital cataracts, 449 congenital defects, xvi, 21 congenital disorders See genetic disorders congenital glaucoma, 455 congenital hearing loss, 449 congenital heart defects, 91, 93 congenital megacolon, 287 conjunctiva, 445 conjunctivitis, 451, 451f constipation, 286–297 appendicitis, 288–289, 289f celiac disease, 291–292, 291f diverticular disease, 295–297, 296f IBD, 292–294 intestinal obstruction, 286–288, 287f, 288f peritonitis, 289–290, 290f constrictive pericarditis, 80 contact dermatitis, 422–423, 423f contrecoup, 350 convalescence, xviii COPD See chronic obstructive pulmonary disease cornea, 443 corneal abrasions, 453 coronary artery disease (CAD), 99–101 risk factors, 100t corpus luteum, 222 cortex, 309 cortisol, 32, 33, 309 coughing, 146 coup, 350 Cowper’s glands, 219 CP See cerebral palsy cranial nerve VIII, 446 cranial nerves, 329, 331f crenation, crepitus, 393 Creutzfeldt-Jakob disease (CJD), 372–373, 372f Crohn’s disease, 292–293, 292f croup, 133 cryopexy, 459 crypt, 293 cryptorchidism, 228–229, 229f CSF See cerebrospinal fluid curative, 20 Curling’s ulcers, 275 Cushing’s disease, 320–321, 321f, 322f Cushing’s reflex, 353 Cushing’s syndrome, 311, 320–321, 321f, 322f Cushing’s triad, 353 Cushing’s ulcers, 275 CVA See cerebral vascular accident cystic fibrosis, 146–148 cystitis, 198 cystocele, 236, 236f cytoplasm, 2, 4f cytotoxic cells, 38 D deamination, 191 debridement, 393 decerebrate response, 355f decorticate response, 355f decubitus ulcers, 421 deep vein thrombosis (DVT), 103f defecation, 267 degenerative joint disease, xvi, 403 dehydration, 166 delta cells, 306 dementia, 370–373 dendrites, 327 deoxyribonucleic acid (DNA), 22, 191 depolarization, 75, 167, 329 depressed fractures, 392 depressed skull fracture, 350 dermatitis, 423 dermatome, 338 dermis, 416 descending fibers, 335 detrusor hyperreflexia, 195 detrusor muscle areflexia, 195 developmental diseases, definition of, xvi diabetes insipidus, 166, 168, 310 diabetes mellitus (DM), 166, 282, 312–315, 314t diabetic ketoacidosis, 179, 180, 313 diabetic retinopathy, 461 diagnosis/identification, disease, xviii diaphragm, 123 diaphyses, 378 diarrhea, 284–286 diastole, 77 diastolic dysfunction, 91 DIC See disseminated intravascular coagulation diencephalon, 333 dietary cholesterol, 95 differentiation, diffusion, dilated cardiomyopathy, 85, 85f diplopia, 453 disease definition of, xvi development of, xvii–xviii disease-modifying antirheumatic drugs (DMARDs), 44 dislocation, 393–395 disorders See also specific disorder cancers, 436–437 chronic, 434–436 congenital, 417–421 infectious, 427–431 inflammatory, 422–427 melanin, 419–421 traumatic, 431–434 dissecting aneurysm, 94 disseminated intravascular coagulation (DIC), 66–67, 67f, 282 distributive shock, 112 diverticula, 295, 296f diverticular disease, 295–297, 296f diverticulitis, 296 diverticulosis, 296 dizziness, 460 DM See diabetes mellitus DNA See deoxyribonucleic acid dominant, 22 dorsal root, 336 ganglion, 339f Down syndrome, 28, 28f dromotropic effect, 77 drowsiness, 206 drug-induced asthma, 143 dry gangrene, 11, 13f dry macular degeneration, 456–457 duct system, 219 duodenal ulcers, 275 dura mater, 326 DVT See deep vein thrombosis Dwarfism, 310, 311f dyslipidemia, 95–96 dysmenorrhea, 233 dysphagia, 269–271, 270f dysplasia, 11 dysrhythmias, 76 causes, 87 types, 88–89f E ear(s), 445 anatomy and physiology, 445–448, 445f age-related changes, 450–451 disorders chronic sensory, 457–458 congenital, 449 infectious/inflammatory, 452–453 miscellaneous sensory organ conditions, 460 sensory conditions associated with aging, 450–451 structures and functions of, 446t transmission of sound through, 447f traumatic sensory, 453 eardrum, 445 EBV See Epstein-Barr virus eccrine glands, 416 eclampsia, 111 ectopic pregnancy, 222 ectopic testes, 228 eczema, 423–424 ED See erectile dysfunction edema, 79, 164 anasarca, 165 cerebral, 165, 168 periorbital, 165 peripheral, 165 pitting, 165, 165f edrophonium, 369 effector cells, 38 efferent arteriole, 190 efferent nerves, 338 efferent tracts, 335 ejaculation, 217 ejaculatory duct, 219 EKG See electrocardiogram elastic fibers, 146 in lung, 124 electrical alterations, 87 electrocardiogram (EKG) characteristic features, 75–76 hypokalemic effects, 172f ischemia and infarction patterns, 107f electrolyte, balance, 167–175 calcium, 172–174 chloride, 169–170 magnesium, 175 normal serum values, 167t phosphorus, 174–175 potassium, 170–172 sodium, 167–169 electroretinogram, 459 embolisms, 81 embolus, 101 embryo, 224f emesis, 271 Index emphysema, 146 encapsulated nerve endings, 440, 441f encephalitis, 347–348 end-stage renal disease, 206 endocarditis, infective, 81–82, 82f endocardium, 74 endocrine system, 304, 304f, 306 adrenal glands, 309 case study, 322, 323 diabetes mellitus, 312–315, 314t disorders adrenal gland, 320–323 parathyroid, 319–320 pituitary gland, 310–312 thyroid, 315–319 pancreas, 306, 308f parathyroid glands, 306–307 pituitary gland, 306, 307f, 308t thyroid gland, 306, 309f endocrinopathies, 229 endocytosis, endometrial cancer, 255–256 endometriosis, 237–238, 237f endometrium, 222 endomysium, 385 endothelial cells, 37 endotracheal intubation, 138, 139 energy production, 7–8 enuresis, 194 enzymes, See also specific enzymes epidemics, xviii epidemiology, xviii epidermis, 416, 417f, 422 epididymis, 218 epididymitis, 241 epidural hematomas, 355 epiglottis, 120, 131–132 epiglottitis, 131–132 epilepsy, 362 epinephrine, 309, 425 epiphyses, 378 epispadias, 226–227, 227f epithalamus, 333 epsilon cells, 306 Epstein-Barr virus (EBV), 55 erectile dysfunction (ED), 230 erythema, 423 erythematous skin lesions (welts), 424–425 erythroblastosis fetalis, 41, 63 erythrocyte, 52 See also red blood cells erythrodermic lesions, 426 erythropoietin, 191 Escherichia coli, 197, 267 esophageal cancer, 297–298 esophageal varices, 281, 281f esophagus, 262 essential hypertension, 109 etiology, xvii eustachian tube, 446 513 Ewing’s sarcoma, 412 exacerbation, xvii excitability, 74 exercise-induced asthma, 142 exhalation, 123, 124 exhaustion phase, 33 exocytosis, exophthalmos, 318, 318f expiration, 123 expiratory reserve volume, 124 exsanguination, 94 exstrophy–epispadias complex (EEC), 226 external ear canal, 445 external genitalia, 225, 226f extracellular anion, 169 extracellular fluid, 162, 167 extrinsic asthma, 142 eye(s), 420 anatomy and physiology, 443–445, 443f age-related changes, 450 cancers, 458 disorders chronic sensory, 454–457 congenital sensory, 449 infectious/inflammatory sensory, 451–452 miscellaneous sensory organ conditions, 458–460 sensory cancers, 458 sensory conditions associated with aging, 450 traumatic sensory, 453–454 structures and functions of, 443t F facilitated diffusion, factor VIII concentrates, 66 fallopian tubes, 222 familial dyslipidemia, 95 farsightedness, 420 fascia, 385 fat embolism, 393 fat necrosis, 11, 13f fatty acid derivatives, 305 fatty streaks, 97 feces, 267 female reproductive system anatomy and physiology, 219–226, 220f external genitalia, 225, 226f fallopian tubes, 222 mammary glands, 225–226 ovaries, 220–222, 222f uterus, 222–225 vagina, 225 fever, 37 fibrillin-1, 24 514 Index fibrocystic breast disease, 239–240 fibromyalgia, 410–411 fibrous plaque, 97 fight-or-flight response, 32 first-degree burn, 432, 433f flat bones, 378 flexor reflex, 335 flora, 416 flu, 134–136 fluid balance, 162–167, 163f fluid deficit, 166–167 fluid excess, 164–166 fluid movement, 162–164 fluid volume deficit, 166 fluid volume excess, 165 FMR1 gene, 27 focal seizures, 362, 363f focal vitiligo, 421 follicle-stimulating hormone (FSH), 221, 223–224 follicles, 306 folliculitis, 427 foramen magnum, 334 forced expiratory volume in second, 124 forced vital capacity, 124 foreskin, 217 fracture, 391–393, 391f, 392f fragile X syndrome, 26–27, 26f frank blood, 285 freckles, 420 free radicals, 12 frontal lobe, 332 FSH See follicle-stimulating hormone full thickness burns, 432, 433f fully compensated, 183 functional blindness, 420 functional cyst, 239 functional incontinence, 195 fungal-related pneumonias, 138 furuncles, 427 fusiform aneurysm, 94 G gallbladder, 265 gallstones See cholelithiasis gangrene, 11 gas exchange in lungs, 123 respiratory, 118–123 gas gangrene, 12, 14f gastric cancer, 298 gastric ulcers, 275 gastritis, 274–275 gastroenteritis, 274 gastroesophageal reflux disease (GERD), 273–274, 274f gastrointestinal (GI) system anatomy and physiology, 260–267 liver, 263–265 lower tract, 266–267 upper tract, 261–263 cancers, 297–300 case study, 283, 301 changes associated with aging, 267 constipation, 286–297 disorders liver, 277–282 lower tract, 284–286 pancreas, 282–284 upper tract, 268–277 functions, 260f layers, 262f structures, 261f general adaptation syndrome, 32, 33f alarm stage, 32 resistance stage, 32–33 generalized seizures, 362 generalized vitiligo, 421 genes, 22 genetic disorders, xvi, 21–29 autosomal dominant, 22–25 autosomal recessive, 25–26 chromosomal disorders, 27–29 cryptorchidism, 228–229, 229f epispadias, 226–227, 227f hypospadias, 228, 228f and inheritance, 22t multifactorial disorders, 27 patterns of inheritance, 22 sex-linked, 26–27 genital herpes, 247–249, 250f genital warts, 250, 250f on penis, 251f on vagina, 251f genitalia, 218f, 221f external female, 225, 226f GERD See gastroesophageal reflux disease gestation, 219 gestational diabetes, 315 GFR See glomerular filtration rate GH See growth hormone Ghon complexes, 139, 141f ghrelin, 306 GI system See gastrointestinal system gigantism, 311, 311f Glasgow Coma Scale, 352, 352f glaucoma, 454 closed-angle (acute), 454 congenital, 455 open-angle (chronic), 454 secondary, 455–456 types of, 455f glomerular filtration rate (GFR), 190 glomerulonephritis, 206–207 glomerulus, 189, 206 glucagon, 306 glucocorticoids, 309, 321 glucose, gluten-sensitive enteropathy See celiac disease goiter, 316, 317f gonadocorticoids, 309 gonorrhea, 244–245, 245f Gordon’s syndrome, 170 gout, 191, 406–408, 407f grading system, 18 graft-versus-host rejection, 42 granulocyte colony-stimulating factor, 55 Graves’ disease, 318 gray matter, 340 greenstick fracture, 392 gross total incontinence, 195 growth hormone (GH), 305, 311 Guillain-Barré syndrome, 42, 135, 348 guttate, 426 gyri, 332 H Haemophilus influenzae, 131, 452 Haemophilus influenzae type B (Hib), 131, 133 hair, 416, 420 See also integumentary system hairy nevi, 419 Hashimoto’s thyroiditis, 317 HD See Huntington’s disease HDLs See high-density lipoproteins head lice, 430 health, definition of, xvi hearing loss, 450 heart See also under cardiac anatomy and physiology, 73–74, 73f blood flow through, 75f valves, 74f heart failure, 87–91 course, 90f left-sided, 91, 92f, 93t right-sided, 91, 92f, 93t Helicobacter pylori, 274 helper cells, 38 hemangiomas, 418, 418f hematemesis, 272 hematocrit, 53, 59 hematomas, 355–357, 356f hematopoiesis, 52 hematopoietic growth factors, 55 hematuria, 203, 206 hemoglobin, 53, 59 hemoglobin S, 63 hemoglobin system, 177 hemolysis, 63 hemolytic anemia, 63–65 hemolytic uremic syndrome, 209 hemophilia A, 65 hemorrhagic strokes, 360 hepatectomy, 299 hepatic artery, 263 hepatitis, 278 hepatobiliary system, 260 hereditary, definition of, xvi Hering-Breuer reflex, 124 Hermansky-Pudlak syndrome, 420 herniated intervertebral disk, 397–398, 397f herniation, 354, 354f herpes simplex type 1, 428, 451 herpes simplex virus (HSV), 247, 249f, 428 herpes zoster, 428–429, 429f heterophile antibody test, 55 heterozygous, 22 alleles, 63 HEXA gene, 26 hexosaminidase A, 26 hiatal hernia, 272–273, 273f Hib See Haemophilus influenzae type B high-density lipoproteins (HDLs), 95, 97t HIV See human immunodeficiency virus hives, 424–425 HMG-CoA reductase inhibitors, 96 Hodgkin’s lymphoma, 56–58, 57f homeostasis, xvi–xvii homozygous, 22 allele, 63 hormone therapy, 21 hormones antidiuretic, 192f endocrine, 305f nontropic, 306 parathyroid, 172 sex, 309 tropic, 305–306 host-versus-graft rejection, 42 HPVs See human papilloma viruses HSV See herpes simplex virus human immunodeficiency virus (HIV), 45, 47t human papilloma viruses (HPVs), 250, 429 humoral immunity, 38–40, 39f hunchback, 388 Huntington’s disease (HD), 369–370, 369f hyaline cartilage, 383 hydrocele, 231, 232f hydrocephalus, 341–343, 342f, 343f hydrochloric acid, 36 hydronephrosis, 200–202, 201f hydrostatic pressure, 164 hygiene hypothesis, 142 hymens, 225, 225f hyperacute tissue rejections, 42 hyperaldosteronism, 165 hypercalcemia, 59, 172–173 hypercapnia, 144 hyperchloremia, 169–170 Index hyperglycemia, 313 hyperkalemia, 170–171 hyperlipidemia, 95 hypermagnesemia, 175 hypernatremia, 168 hyperparathyroidism, 319 hyperphosphatemia, 174–175 hyperpituitarism, 311–312 hyperplasia, 11 hyperprolactinemia, 311 hypersensitivity, 40–41, 41t reactions, 424–425 hypertension, 107–112 development, 109f JNC guideline management algorithm, 110f hyperthyroidism, 312, 318–319 hypertonic solutions, 163 hypertrophic cardiomyopathy, 85f, 86 hypertrophy, 11 hypervolemia, 164 hypocalcemia, 173–174 hypochloremia, 170 hypocoagulopathy, 67 hypodermis, 416 hypodipsia, 164 hypoglycemia, 313 hypokalemia, 171–172, 172f hypomagnesemia, 175 hyponatremia, 168–169 hypoparathyroidism, 319–320 hypophosphatemia, 175 hypopituitarism, 310–311 hypospadias, 228, 228f hypotension, 77 hypothalamic–pituitary axis, 306 hypothalamus, 306, 333 hypothermia, 432 hypothyroidism, 316–318 hypotonic solutions, 163 hypovolemia, 166, 432 hypovolemic shock, 112 hypoxia, 64, 144, 157 hypoxic drive, 127f I iatrogenic diseases, xvii IBD See inflammatory bowel disease IBS See irritable bowel syndrome idiopathic thrombocytopenic purpura (ITP), 67–68 idiopathy, xvii immovable joints, 384f immune system, 48–49 immunity, 33–34 adaptive defenses, 37–40 altered immune response, 40 case study, 43 hypersensitivity reactions, 424–425 immune system components, 35t 515 immunodeficiency, 44–45 innate defenses, 36–37 immunodeficiency, 44–45 immunoreactive trypsinogen (IRT), 148 immunosuppressive therapy, 42 immunotherapy, 21 impacted fractures, 392 impetigo, 427, 427f impregnation, 219 incomplete fractures, 392 incontinence, urinary, 194–196 increased intracranial pressure, 352–355, 354f incus, 445 infantile hypertrophic pyloric stenosis (IHPP) See pyloric stenosis infarction, 100 infectious disorder, 128–141 lower respiratory tract, 136–141 upper respiratory tract, 128–136 infectious mononucleosis, 55–56 infectious rhinitis, 128–130, 129f diagnosis, 130 and influenza, 135t infective endocarditis, 81–82, 82f inferior vena cava, 74 infertility, 229–230 disorders of testes and scrotum, 230–233 ED, 230 hydrocele, 231, 232f phimosis, 230–231 priapism, 231 spermatocele, 231–232, 232f testicular torsion, 233, 234f varicocele, 232, 233f inflammatory bowel disease (IBD), 292–294, 295t inflammatory diseases, definition of, xvi inflammatory response, 36–37, 36f, 131, 145 influenza, 134–136 infectious rhinitis and, 135t inhalation, 123 inheritance patterns, 22 initiation, 14 innate defenses, 36–37 barriers, 36 complement proteins, 37 inflammatory response, 36–37, 36f interferons, 37, 38f pyrogens, 37 innate immunity, 34 inner ear, 445, 446t inotropic effect, 77 insidious, xvii inspiration, 123 inspiratory reserve volume, 124 insulin, 306 insulin-dependent DM, 314–315 516 Index integumentary system age-related changes, 421–422 anatomy and physiology, 416–417, 416f, 417f case study, 437 interferons, 37, 38f interneurons, 338 interstitial fluid, 162 interstitial pneumonia, 137 intestinal obstruction, 286–288, 287f, 288f intracellular fluid, 162 intracerebral hematomas, 356 intractable pain, 442 intraocular cancers, 458 intrarenal conditions, 209 intravascular fluid, 162 intrinsic asthma, 142 inverse psoriatic lesions, 426 iris, 444, 445 iron-deficiency anemia, 59–60, 60f iron-rich foods, 60 irregular bones, 379 irritable bowel syndrome (IBS), 294, 295t ischemia, 11, 64 ischemic/low-flow priaprism, 231 ischemic strokes, 360, 361 islets of Langerhans, 306 isotonic solutions, 163 isthmus, 306 ITP See idiopathic thrombocytopenic purpura J jaundice, 281 joint capsule, 383 joints, 383 juvenile-onset DM, 314–315 K karyotype, 22 keratin, 416 keratitis, 451–452, 451f ketoacidosis, 179, 180 kidney See also under renal; urinary system aldosterone on, 192f anatomy and physiology, 188, 188f chloride excretion, 169 glomerulus, 191f nephrons, 190f renin–angiotensin–aldosterone system, 77, 190 stones, 199 killer cells, 38 Klinefelter’s syndrome, 29, 29f Krebs cycle, kyphosis, 388–390, 389f L labia majora, 225 labia minora, 225 lacerations, 431f lacrimal ducts, 445 lacrimal glands, 445 lactation, 219 lamellae, 381 Langhans layer, 246 large intestine, 267 laryngitis, 132 laryngotracheobronchitis, 132–133 See also bronchitis larynx, 120 laser surgery, 459 treatment for macular degeneration, 457 latent herpes genitalis, 248 latent syphilis, 246 lazy eye See amblyopia LDLs See low-density lipoproteins left atrium, 74 left-sided heart failure, 91, 92f, 93t left ventricle, 74 Legionnaires’ disease, 138 leiomyomas, 238, 238f lens, 445 lentigines, 420 lentigos, 422, 422f LES See lower esophageal sphincter leukemias, 58 leukocyte, 52 See also white blood cells leukocytopenia, 53 leukocytosis, 53 leukopenia, 17 LH See luteinizing hormone lice infestation, 430 ligaments, 383 limbic system, 334–335, 335f linear skull fracture, 350 lipid bilayer, lipids, 95 in blood, 96f liquefaction necrosis, 11, 13f liver, 263–265, 263t anatomy and physiology cholesterol production, 95 cancer, 298–299, 298f disorders, 277–282 lobar pneumonia, 137 lobes, 332 cerebrum, 333f local adaptation syndrome, 33 local inflammatory reaction, 33 long bones, 378 longitudinal fissure, 332 lordosis, 389, 389f Lou Gehrig’s disease, 367–370 louse, 430f low-density lipoproteins (LDLs), 95, 97t lower esophageal sphincter (LES), 262 lower respiratory tract infections, 136–141 lung cancer, 148–150, 149f lungs, 74 See also under pulmonary anatomy and physiology, 118–127 gas exchange in, 123 stretch receptors, 124 luteinizing hormone (LH), 221, 223–224 lymph, 79 lymphatic system, 73, 79, 79f lymphedema, 105, 105f lymphocytes, 56, 139 lymphokines, 38 lymphomas, 56–58 lysis, lysozyme, 36 M macrophages, 37, 40–41, 139 macular degeneration, 456–457 macular stains, 418, 418f mad cow disease, 372 magnesium, 175 maladaptive coping strategies, 33 male reproductive system accessory glands, 219 anatomy and physiology, 216–219, 216t, 217f duct system, 219 penis, 216–217, 218f scrotum, 217–218 testes, 218–219 malignant hypertension, 111 malignant tumors, 15f, 15–16, 15t malleus, 445 malnutrition, 282, 284 mammary glands, 225–226 female, 221f manifestations, definition of, xvii Marfan syndrome, 24, 24f master gland, 306 mastication, 261 mastitis, 240, 240f matrix, 381 MD See muscular dystrophy meatus, 217 mechanoreceptors, 440 medulla, 309, 334 megaloblastic anemia, 60 meiosis, 8, 9f melanin disorders, 416 melanoma, 419, 436 melena, 285 membrane-attack complex, 37 memory cells, 38 Meniere’s disease, 457–458 meninges, 326 meningitis, 347 meningocele, 344, 344f meningoencephalitis, 428 menopause, 224 menorrhagia, 234 menstrual cycle, 223, 223f menstrual disorders, 233–235 menstruation, 223 merocrine glands, 416 mesentery, 260 metabolic acidosis, 178–180, 180f metabolic alkalosis, 180 metabolic syndrome, xvi, 315 metabolic wastes, 193t metaphase, metaplasia, 11 metastasis, 16f, 17t metastasize, 14 metrorrhagia, 234 MI See myocardial infarction microcephaly, 348, 349f microfibrils, 24 microtia, 449, 450f micturition, 189 See also urinary system midbrain, 334 middle ear, 445, 446t Middle East respiratory syndrome, 138 mild presbyopia, 461 mineralocorticoids, 309 minute respiratory volume, 124 mite infestation, 430 mitosis, 8, 9f mitral valve, 74 mixed acid–base disorders, 182, 182f mixed dysfunction, 91 mixed incontinence, 195 moles, 419, 420 mongolian spots, 419, 419f monosomy X, 28–29 Monospot test, 56 Monro-Kellie hypothesis, 353, 353f mons pubis, 225 morbidity, xviii mortality, xviii motor nerves, 338 MS See multiple sclerosis mucosa, 260 mucous membranes, 36 mucous trap, 120 mucus, 120, 260 multifactorial disorders, 27 multiple myeloma, 58–59 multiple sclerosis (MS), 365–366, 365f muscle fiber, 384 muscle layer, 260 muscles, 384–388 muscular dystrophy (MD), 409–410 musculoskeletal systems anatomy and physiology bones, 378–384 muscles, 384–388 bone tumors, 411–412 case study, 394, 412 Index congenital musculoskeletal disorders kyphosis, 388–390, 389f lordosis, 389, 389f scoliosis, 389–390, 389f fibromyalgia, 410–411 inflammatory joint disorders ankylosing spondylitis, 408–409, 408f gout, 406–408, 407f OA, 403–404, 403f rheumatoid arthritis, 404–406, 405f metabolic bone disorders osteomalacia, 400–401 osteoporosis, 398–400, 398f, 399f Paget’s disease, 401–403, 402f rickets, 400–401, 401f muscular dystrophy, 409–410 traumatic musculoskeletal disorders dislocation, 393–395, 394f fracture, 391–393, 391f, 392f herniated intervertebral disk, 397–398 sprains, 395–396 strains, 396–397 myasthenia gravis, 368–369 myasthenic crisis, 368 Mycobacterium tuberculosis, 139 Mycoplasma pneumoniae, 138 myelin sheath, 327 myelinated nerves, 327, 328f myelomeningocele, 344, 344f myocardial infarction (MI), 105–107, 105f, 106f, 108f myocarditis, 82 myocardium, 73, 82 myoclonic seizures, 363, 364f myofibrils, 384 myofilaments, 384 myometrium, 222 myopia, 24 myosin myofilaments, 384 myxedema, 318 N nails, 416, 426, 429–430 See also integumentary system nausea, 272 nearsightedness, 420 necrosis, 11 caseous, 11, 13f coagulative, 11, 13f fat, 11, 13f liquefaction, 11, 13f necrotizing fasciitis, 428, 428f negative feedback system, xvii, 305, 306, 309 Neisseria gonorrhoeae, 244 neoplasms, 14–21 See also cancer benign tumors, 15f, 15–16, 15t 517 clinical manifestations, 16–18 diagnosis, 18–21 malignant tumors, 15f, 15–16, 15t prognosis, 21 neoplastic diseases, definition of, xvi nephritic syndrome, 207f, 208 nephroblastoma, 202 nephrolithiasis, 199–200 nephrons, 189 components and its function, 190t kidney, 190f nephrosis, 166 nephrotic syndrome, 166, 207–208, 207f nerve(s), 336 impulses, 123 nervous system, 326 ALS, 367–370 anatomy and physiology, parasympathetic, 77 autonomic, 338–339 cancers, 373 case study, 345, 361, 374 chronic degenerative disorders, 365–367 CNS, 326–336 congenital neurologic disorders, 341–346 cerebral palsy, 345–346 hydrocephalus, 341–343, 342f, 343f spina bifid, 344–345, 344f dementia, 370–373 HSV, 249f infectious neurologic disorders, 346–349 encephalitis, 347–348 meningitis, 347 Zika virus disease, 348–349 PNS, 336–338 seizure disorders, 362–364 traumatic neurologic disorders, 349–359 brain injuries, 349–359 SCIs, 357–359 vascular neurologic disorders, 359–362 cerebral aneurysm, 361–362, 361f CVA, 360–361, 360f TIA, 359–360 neurodermatitis, 423 neurofibromatosis, 25, 25f, 419 neurofibromin, 25 neurogenic bladder, 196 neurogenic shock, 112, 357 neuroglia, 326 neuromelanin, 340 neurons, 327, 328f neuropathic pain, 442–443 neurotransmitters, 329, 329f neutropenia, 54–55 neutrophils, 54, 55f 518 Index nipple, 226 nits, 430f nociceptors, 440 nocturia, 206 nocturnal asthma, 142 nocturnal enuresis, 194 nodes of Ranvier, 327 nodular lymphocyte predominance Hodgkin’s disease, 56 non-Hodgkin’s lymphoma, 58 non-small-cell carcinoma, 149, 150t noncommunicating hydrocephalus, 341–342 noninsulin-dependent DM, 315 nonischemic/high-flow priaprism, 231 nontropic hormones, 306 nonvolatile acids, 176 norepinephrine, 309 normal flora, 416 normal lab values, 463–466 normal respiratory control, 127f nosocomial pneumonia, 138 nucleotides, 22 nucleus, 2, 4f nurse’s bladder, 195 nystagmus, 420, 449 O OA See osteoarthritis oat-cell carcinoma, 149 oblique fracture, 392 obstructive hydrocephalus, 341–342 occipital lobe, 333 occult blood, 285 occupational asthma, 143 ocular albinism type 1, 420 oculocutaneous albinism, 420 oligomenorrhea, 234 oliguria, 208 oncogenes, 15 oogenesis, 219, 220 open-angle (chronic) glaucoma, 454 open fractures, 392, 392f open spina bifida, 344 open traumatic brain injury, 349, 351f opportunistic infections, 44 optic nerve, 444 oral cancer, 297, 297f organ of Corti, 446 organelles, cell, 5t organized depolarization, 74 orgasm, 219 osmolarity, 164 osmosis, 3, 162 osmotic diuresis, 166 osmotic pressure, 3, 162, 163f ossicles, 445 osteoarthritis (OA), 403–404, 403f osteoblasts, 379 osteochondroma, 411 osteoclasts, 381 osteocyte, 381 osteomalacia, 400–401 osteomyelitis, 393 osteonecrosis, 393 osteopenia, 399 osteoporosis, 398–400, 398f, 399f osteosarcoma, 411, 412f otitis externa, 452–453 otitis media, 452 otosclerosis, 457 outer ear, 445, 446t oval window, 445 ovarian cancer, 256 ovarian cysts, 239 ovaries, 220–222, 222f disorders, 239 overactive bladder, 195 overflow incontinence, 195 ovulation, 219 oxygen diffusion, 123f oxygen therapy, 81, 101 oxyhemoglobin dissociation curve, 124f P P waves, 75–76 pacemaker, 74 Paget’s disease, 401–403, 402f pain, 421, 440 colicky, 200 intractable, 442 neuropathic, 442–443 phantom, 442 referred, 442 somatic, 442 visceral, 442 pain threshold, 440 pain tolerance, 440 palivizumab, 136 palliative, 20 pancreas, 263t, 266, 306, 308f pancreatic cancer, 284, 299 pancreatic polypeptide, 306 pancreatitis, 282–284 pancytopenia, 62 pandemic, xviii panhypopituitarism, 310 paralysis, 357 paralytic ileuses, 287 paraneoplastic syndrome, 149, 203 paraphimosis, 230 paraplegia, 357 parasitic infections, 429–431 parasympathetic nervous system (PNS), 77, 339 parathyroid glands, 306 disorders, 319–320 parathyroid hormone (PTH), 172, 306 parietal lobe, 333 parietal peritoneum layer, 260 Parkinson’s disease, 366–367, 366f partial seizures, 362 partial thickness burns, 432, 433f partially compensated, 183 parturition, 219 passive acquired immunity, 40 patent ductus arteriosus, 93 pathogenesis, xvii pathologic fractures, 392 pathophysiology, concepts of, xvi pediculosis, 430–431 pelvic inflammatory disease (PID), 242–243 penile cancer, 252, 252f penis, 216–217, 218f genital warts on, 251f peptic ulcer disease (PUD), 275–276, 275f perfusion, 121 pericardial effusion, 80 pericardial sac, 73 pericarditis, 80–81 pericardium, 73 perimetrium, 223 perimysium, 385 periorbital edema, 165 periosteum, 379 peripheral edema, 165 peripheral nerves, 338 peripheral nervous system (PNS), 326, 336–338 peripheral vascular disease (PVD), 98–99 peripheral vascular resistance (PVR), 77 peripheral vertigo, 460 peristalsis, 260, 265f peritoneal cavity, 260 peritoneum, 260 peritonitis, 289–290, 290f pernicious anemia, 60–62, 62f perspiration, 422 pH regulation, 176, 176f phagocytosis, 6, 37 phantom pain, 442 pharynx, 120 phenotype, 22 phenylalanine, 25 phenylketonuria (PKU), 25–26 pheochromocytoma, 320 phimosis, 230–231 phosphate system, 177 phosphates, 320 phosphorus, 174–175 photodynamic therapy for macular degeneration, 457 photophobia, 420 photoreceptors, 440 pia mater, 326 PID See pelvic inflammatory disease pigmentation, 420 pigmented birthmarks, 418–419 PIH See pregnancy-induced hypertension pink eye See conjunctivitis pink puffers, 146 pinna, 445 pinocytosis, pituitary gland, 306, 307f, 308t disorders, 310–312 PKD See polycystic kidney disease PKU See phenylketonuria placenta, 222, 224f plaque, 426 plasma, 52, 58 plasma membrane, plasmin, 53 platelets, 52 disorders, 65–68 pleural effusion, 150–151, 151f pleurisy, 151 plexus, 338 PMDD See premenstrual dysphoric syndrome PMS See premenstrual syndrome pneumatic retinopexy, 459 Pneumocystis carinii pneumonia, 138 Pneumocystis jiroveci pneumonia, 138 pneumonia, 136–141 aspiration, 137 community-acquired, 138 interstitial, 137 lobar, 137 nosocomial, 138 prevention strategies, 139 types, 137t viral and bacterial, 137, 137t pneumothorax, 151–153, 152f PNS See peripheral nervous system polycystic kidney disease (PKD), 205–206, 205f polycystic ovary syndrome, 239 polycythemia vera, 65 polydipsia, 313 polymenorrhea, 234 polypeptide, 305, 306 polyphagia, 313 polysomy X, 29 polyuria, 173, 313 pons, 334 port-wine stains, 418, 418f portal hypertension, 279 portal vein, 263 positive feedback system, xvii, 305 positive TB skin test, 141, 141f posterior chamber, 445 postictal period, 364 postrenal conditions, 209 postsynaptic cell membrane, 327 potassium, 170–172 Potter facies, 206 Index PP cells, 306 predisposing factor, xvii pregnancy-induced hypertension (PIH), 111 preload, 77 premenstrual dysphoric syndrome (PMDD), 235 premenstrual syndrome (PMS), 235 prerenal conditions, 208–209 presbycusis, 450 presbyopia, 450 presynaptic terminal, 327 prevention, xviii priapism, 231 primary deficit, 44 primary herpes genitalis, 248 primary hypertension, 109 primary syphilis, 245–246, 246f primary TB infection, 139 prodrome, 247 prognosis, xviii, 21 programmed cell death, 11 progression, 14 progressive stage, 112 prolactin, 226 proliferation, promotion, 14 prophase, prophylactic, 20 prostaglandins, 305 prostate cancer, 252–253 prostate gland, 204, 219 prostatic stromal cell proliferation, 204 prostatitis, 240–241 protein, 305 protein system, 177 protoplasm, protozoan sexually transmitted infections, 250–251 pruritus, 423, 429 pseudocyst/abscess, 284 psoriasis, 425–427, 425f, 426f psoriatic arthritis, 426 PTH See parathyroid hormone pubic lice, 430 PUD See peptic ulcer disease pulled muscles, 396 pulmonary arteries, 74 pulmonary circulation, 73 pulmonary embolism, 104f pulmonary function test, 124 pulmonary gas exchange, 73f pulmonary veins, 74 pulmonic valve, 74 pulse pressure, 77 pupil, 444 Purkinje network of fibers, 74 pus, 54 pustular lesions, 426 PVD See peripheral vascular disease 519 PVR See peripheral vascular resistance pyelonephritis, 198–199 pyloric sphincter, 263 pyloric stenosis, 269 pyloromyotomy, 269 pyrogens, 37 Q QRS complex, 76 quadriplegia, 357 R RA See rheumatoid arthritis Raynaud’s disease, 98, 100f recessive alleles, 22 rectocele, 236 rectum, 267 recurrent herpes genitalis, 248 red blood cells, 52 disorders, 59–65 red marrow, 380 Reed-Sternberg cells, 56–58, 56f referred pain, 442, 442f reflex incontinence, 195 reflux nephropathy, 200 regulator cells, 38 regurgitation, 83 remission, xvii, 21 renal artery, 188 renal blood flow, 77 renal calculi, 199f types, 199t renal capsule, 188 renal cell carcinoma, 203, 203f renal cortex, 188 renal failure, 208–212, 282 renal function tests, 193t renal hilum, 188 renal pelvis, 188 renal regulation, 177 renal sinus, 188 renin–angiotensin–aldosterone system, 77, 190 replication, 8–9 repolarization, 76, 167 reproductive system anatomy and physiology, 216–226 cancers, 251–256 case study, 256 disorders breasts, 239–240 congenital See genetic disorders menstrual, 233–235 ovaries, 239 pelvic support, 236 uterus, 236–238 female See female reproductive system 520 Index infertility issues, 229–230 disorders of testes and scrotum, 230–233 ED, 230 hydrocele, 231, 232f phimosis, 230–231 priapism, 231 spermatocele, 231–232, 232f testicular torsion, 233, 234f varicocele, 232, 233f male See male reproductive system miscellaneous infections, 240–243 candidiasis, 241–242 epididymitis, 241 PID, 242–243 prostatitis, 240–241 STIs, 243–251 bacterial, 243–246 protozoan, 250–251 viral, 246–250 residual volume, 124 resistance stage, 32–33 respiratory acidosis, 157, 181 respiratory alkalosis, 181–182 respiratory failure, 357 respiratory regulation, 177 respiratory syncytial virus (RSV), 136 respiratory system anatomy and physiology, 118–127, 119f, 119t case study, 158–159 conditions affect, 127 infectious disorder, 128–141 ventilation, alterations in ARDS, 154–156, 154f, 155f asthma, 141–144, 142f, 143t, 144f chronic bronchitis, 144–146 COPD, 144, 145f cystic fibrosis, 146–148 emphysema, 146 lung cancer, 148–150, 149f and perfusion, 156–157 pleural effusion, 150–151, 151f pneumothorax, 151–153, 152f resting potential, 327 restrictive cardiomyopathy, 85f, 86 retching, 272 retention, 195 reticular activation system, 334, 335f reticular formation, 334 retina, 444, 444f retinal detachment, 459–460 retinoblastoma, 458 retractile testicle, 228 retroflexed, 222 rheumatoid arthritis (RA), 404–406, 405f rhinitis, 423 rhinophyma, 435 rhinosinusitis, 130–131 Rho[D] immune globulin (RhoGAM), 41 rickets, 400–401, 401f right atrium, 74 right-sided heart failure, 91, 92f, 93t right ventricle, 74 ringworm See tinea corporis rods, 444 Rome III criteria, 294, 296t root words and combining forms, 467–480 rootlets, 336 rosacea, 435–436, 435f RSV See respiratory syncytial virus Ruffini’s corpuscle, 441f rugae, 262, 266f S SA node See sinoatrial node saccular aneurysm, 94 saccule, 446 salivary glands, 263t sarcomeres, 384 SARS See severe acute respiratory syndrome scabies, 430, 430f Scheuermann’s disease, 388 Schwann cells, 327 sciatica, 398 SCIs See spinal cord injuries sclera, 443 scleral buckle, 459 scoliosis, 389–390, 389f scrotum, 217–218 seasonal flu vaccinations, 135 sebaceous glands, 416, 422 sebum, 416, 422 second-degree burns, 432, 433f secondary (acquired) immunodeficiency, 44 secondary glaucoma, 455–456 secondary hypertension, 109 secondary infection phase, 140 secondary syphilis, 246, 246f secondary TB infection, 139 segmental vitiligo, 421 seizures, 362 absence, 362, 363f disorders, 362–364 generalized, 362 myoclonic, 363, 364f tonic-clonic, 363, 364f selectively permeable, 2, 6f Selye, Hans, 32 semen, 219 semicircular canals, 446 seminal vesicles, 219 semipermeable membranes, 162 sense receptors, 440 senses See also specific sense affecting, 449 chronic sensory disorders, 454–458 congenital sensory disorders, 449 infectious and inflammatory sensory disorders, 451–453 miscellaneous sensory organ conditions, 458–460 sensory conditions associated with aging, 449–451 traumatic sensory disorders, 453–454 anatomy and physiology, 440–448 case study, 454, 461 sense receptors, 440, 441f summary of, 440t sensorineural hearing loss, 450 sensory nerves, 338 sensory pathway, 441f septal defects, 93 septic shock, 112 serosa, 260 sesamoid bones, 379 severe acute respiratory syndrome (SARS), 138 sex chromosomes, 22 sex-linked disorders, 26–27 sexually transmitted diseases (STDs) See sexually transmitted infections sexually transmitted infections (STIs), 243–251 bacterial, 243–246 protozoan, 250–251 viral, 246–250 shedding herpes genitalis, 248 shock, 112–113, 282 anaphylactic, 425 preventing, 434 progression, 113f spinal, 357 short bones, 378 shoulder, anterior dislocation, 394f SIADH See syndrome of inappropriate antidiuretic hormone sickle cell anemia, 63–64, 63f, 64t signs, definition of, xvii simple fracture, 391 sinoatrial (SA) node, 74 sinus blocked, 130f transillumination, 131f sinusitis, 130–131 skeletal muscles, 384, 385f striated pattern, 388f structure, 387f skeleton, 378, 379f Skene’s glands, 225 skin, 36, 416, 416f See also integumentary system skin cancers, 436–437, 436f skin tags, 422, 422f skip lesions, 292 SLE See systemic lupus erythematosus small-cell carcinoma, 149, 150t small intestine, 266, 266f smegma, 217 smoking, 149 smooth muscles, 384 SNS See sympathetic nervous system SOAP BRIAN MD, 44 sodium, 167–169 solutes, 162 somatic pain, 442 somatostatin, 306 sperm, 218 spermatic cord, 219 spermatocele, 231–232, 232f spermatogenesis, 216 spina bifida, 344–345, 344f spina bifida occulta, 344, 344f spinal cord, 327f, 334, 336f herniated intervertebral disk, 397f nerve tracts, 337f spinal cord injuries (SCIs), 357–359, 358f spinal nerve innervation, 338f spinal reflex arcs, 335, 337f spinal shock, 357 spiral fracture, 392 spongy bone, 378 spontaneous pneumothorax, 153 sprains, 395–396 grading system, 395t, 396f squamous cell carcinoma, 204, 436 stable angina pectoris, 100 stapes, 445 Staphylococcus aureus, 81, 83 Staphylococcus enterococcus, 81 status asthmaticus, 143 status epilepticus, 362 STDs See sexually transmitted diseases steeple sign, 133f stem cells, 52 stenosis, 83 steroids, 305 STIs See sexually transmitted infections stomach, 262, 263t, 266f strabismus, 420, 459, 459f strain, 396–397 muscle tissue, 396f strawberry birthmarks, 418 Streptococcus pneumoniae, 131, 452 Streptococcus viridans, 81 stress effects, 34f physiological response to, 32f response, 32–33 stress fractures, 392 stress incontinence, 195 Index stress ulcers, 275 stretch receptors in lung, 124 stroke volume, 77 strokes, 95, 97, 360–361, 360f subarachnoid hemorrhage, 356 subdural hematomas, 356 submucosa layer, 260 substantia nigra, 340 subthalamus, 333 sulci, 332 superficial burn, 432, 433f superior vena cava, 74 suppressor cells, 38 surfactant, 122, 146 surgery, 153, 456 sutures, 383, 384f swallowing, 264f swayback, 389 sweat glands, 147, 416, 422 swimmer’s ear See otitis externa sympathetic nervous system (SNS), 339 fight-or-flight response, 32 symptoms, definition of, xvii Synagis, 136 synapses, 327 synaptic cleft, 327, 329f synarthrose, 383 syndrome, definition of, xviii syndrome of inappropriate antidiuretic hormone (SIADH), 311 syngenic transplants, 42 synovial fluid, 383, 383f uric acid crystals, 406f synovial joints, 383 syphilis, 245–247, 246f systemic circulation, 73 systemic lupus erythematosus (SLE), 42–44 manifestations, 43t systole, 77 systolic dysfunction, 91 T T3, 306 T4, 306 T cells, 37 T lymphocytes, 426, 427 T wave, 76 Tay-Sachs disease, 26 TB See tuberculosis TBI See traumatic brain injury teacher’s bladder, 195 telangiectasia, 435 telophase, temporal lobe, 333 tendons, 384 tension pneumothorax, 153, 153f teratogens, 27 terminal boutons, 327 tertiary syphilis, 246 521 testes, 218–219 testicular cancer, 253 testicular torsion, 233, 234f testosterone, 219 tetralogy of Fallot, 93 thalamus, 333 thalassemia, 64–65 thermoreceptors, 440 third-degree burns, 432, 433f third spacing, 164, 290 thirst mechanism, 164 thrombi, 101–102, 101t thromboangiitis obliterans, 98, 99f thrombocytes, 52 thrombocytopenia, 17, 65 thrombocytosis, 65 thromboplastin, 53 thrombotic thrombocytopenic purpura (TTP), 68 thrombus, 101 thymus, 38 thyroid crisis, 318 thyroid gland, 306, 309f disorders, 315–319 thyroid-stimulating hormone (TSH), 306 thyrotoxicosis, 318 TIA See transient ischemic attack tidal volume, 124 tinea, 429–430, 430f tinea capitis, 429 tinea corporis, 429 tinea pedis, 429 tinea unguium, 429 tinnitus, 460 tissue ischemia, 64 tissue rejections, 42 TNM staging, 20, 21f tonic-clonic seizures, 363, 364f tonicity, 162, 164f tophi, 407 trachea, 120 bifurcation, 120f transcellular compartment, 162, 164 transcellular fluid, 162 transfusion reactions, 41 transient incontinence, 194 transient ischemic attack (TIA), 359–360 transillumination hydrocele, 232f sinus, 131f transitional cell carcinoma, 203 transplant reactions, 42 transverse fracture, 392 traumatic brain injury (TBI), 349 traumatic pneumothorax, 153 treatment, xviii Treponema pallidum, 245, 245f Trichomonas vaginalis, 250 trichomoniasis, 250–251, 251f 522 Index tricuspid valve, 74 triglycerides, 95 trisomy 21, 28 tropic hormones, 305–306 Trousseau’s sign, 174, 174f TSH See thyroid-stimulating hormone TTP See thrombotic thrombocytopenic purpura tuberculosis (TB), 139–141, 140f positive skin test, 141, 141f tuberous sclerosis, 420 tumor, 14 cell markers, 19–20t tunica adventitia, 78 tunica intima, 78 tunica media, 78 Turner’s syndrome, 28–29, 28f tympanic membrane, 445 tympanostomy tubes, 452, 453f type albinism, 419 type diabetes, 314–315, 315t type albinism, 419 type diabetes, 315, 315t type A influenza, 134 type B influenza, 134 type C influenza, 134 type I hypersensitivity, 40 type I (IgE mediated) hypersensitivity reactions, 424–425 type II hypersensitivity, 40–41 type III hypersensitivity, 41 type IV hypersensitivity, 41 U ulcer, 422 ulcerative colitis, 293–294 uncal (uncinate) herniation, 354, 354f uncompensated, 183 unstable angina, 100 upper respiratory tract, 118f infections disorder, 128–141 urea, 191 uremia, 206 ureters, 188 urethra, 189 and prostate gland, 204f urge incontinence, 195 uric acid, 191 crystals, synovial fluid, 406f urinary incontinence, 194–196 urinary output, 164 urinary system anatomy and physiology, 188, 188f case study, 208, 213 components and functions, 189t disorders BPH, 204–205 cancer, 202–204 congenital, 197 cystitis, 198 inflammatory, 206–208 neurogenic bladder, 196–197 PKD, 205–206 pyelonephritis, 198–199 renal failure, 208–212 urinary tract obstructions, 199–202 urination, 194–196 UTIs, 197–198 urinary tract infections (UTIs), 197–198 urinary tract obstructions, 199–202 urination, 189, 189f urine, 163, 191, 197, 199 urticaria, 424–425, 424f uterine prolapse, 236 uterus disorders, 236–238 female reproductive system, 222–225 UTIs See urinary tract infections utricle, 446 V vagina, 225 genital warts on, 251f valvular disorders, 83, 84t, 93 See also specific disorder valvular regurgitation, 83, 84t valvular stenosis, 83, 84t VAP See ventilator-associated pneumonia varicella (chickenpox), 429 varicella-zoster virus, 429–430 varicocele, 232, 233f varicose veins, 102–104, 104f vas deferens, 219 vascular birthmarks, 417–418 vasoconstriction, 37 vasodilation, 37 veins, 73, 78 ventilation, 121 ventilation/perfusion (VQ) ratio, 121 ventilator-associated pneumonia (VAP), 138 ventral root, 336 ventricles, 73, 74, 326 venules, 78 verrucae (warts), 429, 429f vertebral canal, 334 vertigo, 460 very-low-density lipoproteins, 95 vesicles, 423 vestibular apparatus, 446, 448f vestibule, 225, 446 vestibulocochlear nerve, 446 viral hepatitis, 278, 279t viral infections, 132, 134, 136 viral pneumonia, 137, 137t viral rhinitis, 128–130 viral sexually transmitted infections, 246–250 Virchow’s triad, 101, 102f visceral pain, 442 visceral peritoneum layer, 260 vision changes, 420 vital capacity, 124 vitamin B12, 60 vitamin C, 60 vitamin D, 172, 191 vitamin K, 172 vitiligo, 421, 421f vitrectomy, 459–460 vitreous humor, 445 vocal cords, 120f volatile acid, 176 volatile gas, 176 vomiting, 271–272 reflex, 271f vomitus, 272 von Willebrand’s disease, 66 VQ ratio, 121 vulva, 225 W Waardenburg’s syndrome, 420 warts, 429 water balance, 164, 167, 169 water elimination, 165 water intoxication, 165, 166 wear-and-tear arthritis, 403 welts, 424–425 wet gangrene, 11–12, 13f wet macular degeneration, 457 Whipple procedure, 299 white blood cells, 37, 52 disorders, 53–59 movement, 54f white matter, 327 whiteheads, 434 Wilms’ tumor, 202–203, 202f wounds types, 431–432f X X-linked recessive bleeding disorder, 65 xenogenic transplants, 42 Y yellow marrow, 380 Z Zika virus disease, 348–349 zygote, 222 ... congenital defects Risk factors associated with hiatal hernias include advancing age and smoking Small hiatal hernias may go undetected and rarely cause problems Large hiatal hernias can cause chyme... increases Anatomy and Physiology NORMAL HIATAL HERNIA Esophagus Esophagus Stomach Weak diaphragm Diaphragm Stomach © Scott Camazine/Science Source FIGURE 9-1 1 Hiatal hernia gastrointestinal... physical examination, abdominal X-ray, gallbladder ultrasound, abdominal computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography