Chat with us, powered by LiveChat Using the video from Episode 4 on Mr. Jones, answer two of the following prompts: Please identify each prompt you answer by number. Prompt 1: How many patients are suffe - Wridemy Essaydoers

Using the video from Episode 4 on Mr. Jones, answer two of the following prompts: Please identify each prompt you answer by number. Prompt 1: How many patients are suffe


# Using the video from Episode 4 on Mr. Jones, answer two of the following prompts: Please identify each prompt you answer by number.

Prompt 1: How many patients are suffering from COPD in the United States? Do COPD sufferers die of respiratory causes or other causes? (Be sure to cite the data.)

Prompt 2: What two separate diseases are the main COPD diseases? Give background on each disease.

Prompt 3: How does COPD correlate with left ventricular pressure and primary heart failure?

Prompt 4: What are the three types of bronchodilators, and how do they function to alleviate the symptoms of COPD? What are other possible treatments for COPD?

Prompt 5: Through which mechanism does bronchiolitis cause the destruction of alveoli? Is emphysema genetic? Can environmental factors increase the risk of emphysema? Why or why not? 

Prompt 6: Is lung transplantation a solution for emphysema? Can new technology be useful in the treatment of emphysema? Why or why not? 

# Please correlate your responses to Mr. Jones’s case. Content in this case scenario incorporates topics from Chapter 22. 


UNIT I Pathophysiologic Processes

1 Introduction to Pathophysiology, 1

2 Homeostasis, Allostasis, and Adaptive Responses to Stressors, 12

UNIT II Cellular Function

3 Cell Structure and Function, 26

4 Cell Injury, Aging, and Death, 59

5 Genome Structure, Regulation, and Tissue Differentiation, 77

6 Genetic and Developmental Disorders, 94

7 Neoplasia, 117

UNIT III Defense

8 Infectious Processes, 141

9 Inflammation and Immunity, 158

10 Alterations in Immune Function, 194

11 Malignant Disorders of White Blood Cells, 215

12 HIV Disease and AIDS, 233

UNIT IV Oxygen Transport, Blood Coagulation, Blood Flow, and Blood Pressure

13 Alterations in Oxygen Transport, 259

14 Alterations in Hemostasis and Blood Coagulation, 298

15 Alterations in Blood Flow, 313

16 Alterations in Blood Pressure, 337

UNIT V Cardiac Function

17 Cardiac Function, 354

18 Alterations in Cardiac Function, 382

19 Heart Failure and Dysrhythmias: Common Sequelae of Cardiac Diseases, 411

20 Shock, 434

UNIT VI Respiratory Function

21 Respiratory Function and Alterations in Gas Exchange, 451

22 Obstructive Pulmonary Disorders, 478

23 Restrictive Pulmonary Disorders, 499

UNIT VII Fluid, Electrolyte, and Acid-Base Homeostasis

24 Fluid and Electrolyte Homeostasis and Imbalances, 521

25 Acid–Base Homeostasis and Imbalances, 541

UNIT VIII Renal and Bladder Function

26 Renal Function, 551

27 Intrarenal Disorders, 575

28 Acute Kidney Injury and Chronic Kidney Disease, 593

29 Disorders of the Lower Urinary Tract, 609

UNIT IX Genital and Reproductive Function

30 Male Genital and Reproductive Function, 626

31 Alterations in Male Genital and Reproductive Function, 641

32 Female Genital and Reproductive Function, 656

33 Alterations in Female Genital and Reproductive Function, 671

34 Sexually Transmitted Infections, 689

UNIT X Gastrointestinal Function

35 Gastrointestinal Function, 697

36 Gastrointestinal Disorders, 720

37 Alterations in Function of the Gallbladder and Exocrine Pancreas, 742

38 Liver Diseases, 754

UNIT XI Endocrine Function, Metabolism, and Nutrition

39 Endocrine Physiology and Mechanisms of Hypothalamic-Pituitary Regulation, 783

40 Disorders of Endocrine Function, 799

41 Diabetes Mellitus, 815

42 Nutritional and Metabolic Disorders, 838

UNIT XII Neural Function

43 Structure and Function of the Nervous System, 850

44 Acute Disorders of Brain Function, 891

45 Chronic Disorders of Neurologic Function, 915

46 Alterations in Special Sensory Function, 936

47 Pain, 955

UNIT XIII Neuropsychological Function

48 Neurobiology of Psychotic Illnesses, 971

49 Neurobiology of Nonpsychotic Illnesses, 989

UNIT XIV Musculoskeletal Support and Movement

50 Structure and Function of the Musculoskeletal System, 1001

51 Alterations in Musculoskeletal Function: Trauma, Infection, and Disease, 1020

52 Alterations in Musculoskeletal Function: Rheumatic Disorders, 1042

UNIT XV Integumentary System

53 Alterations in the Integumentary System, 1058

54 Burn Injuries, 1093

Evolve Student Resources for Banasik: Pathophysiology, 6th Edition, include the following:

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• Glossary with audio pronunciations.

• Answers to key questions.

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JACQUELYN L. BANASIK, PhD, ARNP Associate Professor College of Nursing

Washington State University Spokane, Washington

LEE-ELLEN C. COPSTEAD, PhD, RN Professor Emerita

Department of Nursing College of Nursing and Health Sciences

University of Wisconsin—Eau Claire Eau Claire, Wisconsin

3251 Riverport Lane St. Louis, Missouri 63043


Copyright © 2019 by Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).


Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous editions copyrighted 2013, 2010, 2005, 2000, and 1995.

International Standard Book Number: 978-0-323-35481-3

Executive Content Strategist: Kellie White Content Development Specialist: Jennifer Wade Publishing Service Manager: Jeffrey Patterson Book Production Specialist: Carol O’Connell Book Designer: Renee Duenow

Printed in Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1


Loved ones, past and present,

who give meaning to the work.


This page intentionally left blank


Brent A. Banasik, PhD, MA, BS Scientist Chemistry Banasik Consulting Seattle, Washington

Brianne N. Banasik, BS Environmental Science, MS Marine Resources Management

Research Associate Pediatric Vaccinology University of Texas Medical Branch Galveston, Texas

Jacquelyn L. Banasik, PhD, ARNP Associate Professor College of Nursing Washington State University Spokane, Washington

Robin Y. Beeman, BSN, MSN, PhD Chair and Professor Nursing University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Cheryl L. Brandt, PhD, RN, ACNS-BC Professor College of Nursing and Health Sciences University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Ann Futterman Collier, PhD Associate Professor and Chair Psychological Sciences Northern Arizona University Flagstaff, Arizona

Lee-Ellen C. Copstead, PhD, RN Professor Emerita Department of Nursing College of Nursing and Health Sciences University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Carol L. Danning, MD Staff Rheumatologist Rheumatology Department Gundersen Health Systems La Crosse, Wisconsin

Michael R. Diestelmeier, MD Fellow American Academy of Dermatology Dermatologist, Retired Mayo Clinic Health System Eau Claire, Wisconsin

Ruth E. Diestelmeier, RN, MSN Clinical Instructor Department of Nursing University of Wisconsin—Eau Claire Eau Claire, Wisconsin


Roberta J. Emerson, PhD, RN Associate Professor, Retired Washington State University College of Nursing Spokane, Washington

Linda Felver, PhD, RN Associate Professor School of Nursing Oregon Health & Science University Portland, Oregon

Rosemary A. Jadack, PhD, RN Professor Nursing University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Debra A. Jansen, PhD, RN Associate Dean, Professor College of Nursing and Health Sciences University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Marie L. Kotter, PhD, MS, BS Professor Emeritus Health Sciences Weber State University Ogden, Utah

Teresa Grigsby Loftsgaarden, MSN, RN, OCN,ONN-CG

Oncology Nurse Navigator Regional Cancer Center Sacred Heart Hospital Eau Claire, Wisconsin

Joni D. Marsh, BSN, MN Advanced Registered Nurse Practitioner Medical Oncology Summit Cancer Centers Spokane, Washington

Benjamin J. Miller, PhD, ARNP, FNP-C, ACNPC, ENP-C

Assistant Professor Seattle University Seattle, Washington

Sarah Ogle, DO, MS Banner University Medical Center-Phoenix University of Arizona College of Medicine

Phoenix Phoenix, Arizona

Nirav Patel, MD Assistant Professor, Infectious Diseases and

Critical Care Medicine Internal Medicine Saint Louis University School of Medicine; Chief Medical Officer SSM Health Saint Louis University Hospital; Infection Control Officer/Director of

Antibiotic Stewardship SSM Health Saint Louis University Hospital Saint Louis, Missouri

Faith Young Peterson, BSN, MSN, MPA, CFNP

Family Nurse Practitioner Marsing, Idaho

Cheryl Rockwell, RN, MSN Clinical Assistant Professor Nursing Department Indiana University-Purdue University at

Fort Wayne; Staff/Clinical Nurse Surgical Trauma Intensive Care Unit Parkview Health Systems Fort Wayne, Indiana

Samantha Cody Russell, Psychology, MA Graduate Student Psychological Sciences Northern Arizona University Flagstaff, Arizona

Jeffrey S. Sartin, MD Consulting Physician Infectious Diseases Infectious Disease and Epidemiology

Associates; Consulting Physician Infectious Diseases Nebraska Medicine; Consulting Physician Infectious Diseases CHI Hospitals Omaha, Nebraska

Lorna L. Schumann, PhD Heritage UGM Women and Children’s

Clinic Medical Clinic Heritage Health Coeur d’Alene, Idaho

Susan G. Trevithick, RN, MS, NE-BC Compliance Officer VA Salt Lake City Healthcare System Salt Lake City, Utah

Marvin Van Every, MD Staff Urologist Urology Department Gundersen Health Systems La Crosse, Wisconsin

Linda D. Ward, PhD, FNP-C Assistant Professor College of Nursing Washington State University Spokane, Washington


Brianne N. Banasik, MS Research Associate Pediatric Vaccinology University of Texas Medical Branch Galveston, Texas

Deb Cipali, RN, BSN, MSN, EdD(c) Des Moines Area Community College Nursing Lab Coordinator/Adjunct Professor Ankeny, Iowa

Janie Corbitt, RN, MLS Milledgville, Georgia

Maria Fleurdeliz Cuyco, BS Instructor Preferred College of Nursing Los Angeles, California

Abimbola Farinde, PhD Professor Columbia Southern University Orange Beach, Alabama

Annette Gunderman, DEd, MSN, RN Associate Professor of Nursing Bloomsburg University Bloomsburg, Pennsylvania

Barbara Hunter, RN, MSN School of Nursing, Klamath Falls Campus Oregon Health & Science University Klamath Falls, Oregon

Sandra L. Kaminski, MS, PA-C Assistant Professor Seton Hall University School of Health and Medical Sciences; Physician Assistant VA NJ Healthcare System Medical Service/Infections Disease Clark, New Jersey

Steven Krau, PhD, RN, CNE Associate Professor Vanderbilt School of Nursing Nashville, Tennessee

Clarice Perry, MS Research Associate Pediatric Vaccinology University of Texas Medical Branch Galveston, Texas


Janet Pinkelman, MSN, RNC-Maternal Newborn Nursing

Professor of Nursing Owens Community College Toledo, Ohio

Linda Turchin, RN, MSN, CNE Associate Professor of Nursing Fairmont State University Fairmont, West Virginia

Kim Webb, MN, RN Adjunct Nursing Instructor Pioneer Technology Center Ponca City, Oklahoma

Janice Williams, RN, ACNS-BC, CDE Professor of Nursing and Program Director Armstrong McDonald School of Nursing College of the Ozarks Point Lookout, Missouri


The pace of scientific discovery in health and medicine continues to transform our understanding of physiology and disease. To be clinically relevant and useful to health care students and professionals, a text must synthesize a vast amount of detailed knowledge into overarching concepts that can be applied broadly. As in previous editions, the goal of the sixth edition of Pathophysiology is to include recent and relevant information on anatomy, biochemistry, cell physiology, genomics, and pathophysiology while not overwhelming the reader. Attention is given to major concepts relevant to clinical practice while still providing enough detail for deep understanding.

ORGANIZATION Pathophysiology uses a systems approach to content, beginning with a review of normal anatomy and physiology, followed by pathophysiology and application of concepts to specific disorders. The text is organized into 15 units, each of which includes a particular body system or group of interrelated body systems and the pertinent pathophysiologic concepts and disorders.

FEATURES An understanding of normal structure and function of the body is necessary for any detailed understanding of its abnormalities and pathophysiology. The first chapter in most units includes a fully illustrated review of normal physiology. Age-related concepts are highlighted in boxes titled Geriatric Considerations and Pediatric Considerations.

Each chapter opens with Key Questions, which are designed to alert the reader to important conceptual questions that will be discussed in the chapter. Although the chapters are meant to be read from beginning to end to develop an understanding of the material, the text also serves as a reference for looking up specific content. Chapter Outlines are included at the beginning of each chapter to help the reader locate specific content. Within every chapter, Key Points are identified at the end of every major discussion and are presented in short bulleted lists. These recurring summaries help readers to focus on the main points.

Nearly 900 illustrations elucidate both normal physiology and pathophysiologic changes. The entire book is in full color, with color

used generously in the illustrations to better explain pathophysiologic concepts.

A study of pathophysiology requires a new vocabulary, and many of these terms are defined in a comprehensive Glossary, which appears at the end of the text. Common prefixes and suffixes as well as root words are included in the back matter to help with basic understanding of the language of pathophysiology.

ANCILLARIES Student Learning Resources on Evolve The student section of the book’s website hosted on Evolve offers nearly 700 Student Review Questions in a variety of question formats, an Audio Glossary, Animations to help readers visualize pathophysiologic processes, Case Studies with questions, and Key Points Review. Visit the Evolve website at

Study Guide Pathophysiology can be a daunting subject for students because of the large volume of factual material to be learned. The student Study Guide is designed to help students focus on important pathophysiologic concepts. Questions to check recall of normal anatomy and physiology are included for each chapter. A number of activities that help the student focus on similarities and differences between often-confused pathologic processes are included. More than 1500 self-assessment test questions with answers are included to help students check their understanding and build confidence for examinations. Case studies, with more than 250 questions including rationales for correct and incorrect answers, are used to help students begin to apply pathophysi- ologic concepts to clinical situations.

Instructor Learning Resources on Evolve The Instructor Learning Resources on Evolve provide a number of teaching aids for instructors who require the text for their students. The materials include a Test Bank presented in Exam View with approximately 1200 test items, a Teach for Nurses instructor manual detailing the resources available to instructors for their lesson planning, a PowerPoint lecture guide with more than 4000 slides with integrated case studies and audience response questions to facilitate classroom presentations, and an Image Collection of more than 900 color images from the text.



Revising this 6th edition of the text has been possible because of the tremendous dedication of authors, artists, reviewers, and editors. Sincere gratitude goes to all who helped with this and previous editions. In particular, grateful appreciation is extended to all of the contributing authors who have given exhaustively of their time over many editions over the decades. Thank you to the many thoughtful experts who gave their time to read and critique manuscripts and help ensure excellence in chapter content throughout the text.

Grateful recognition is made to the staff at Elsevier: Kellie White, Executive Content Strategist; Jennifer Wade, Content Development Specialist; Jeffrey Patterson, Publishing Service Manager; Carol O’Connell, Book Production Specialist; Renee Duenow, Book Designer; and Vikraman Palani, Multimedia Producer.

We would like to recognize those who provided a foundation for the revised text through their contributions to earlier editions: Arnold A. Asp, Donna Bailey, Barbara Bartz, Linda Belsky-Lohr, Tim Brown, Carolyn Spenee Cagle, Karen Carlson, Katherina P. Choka, Arnold Norman Cohen, Cynthia F. Corbett, Lorri Dawson, Leslie Evans, Patricia Garber, Jane Georges, Karen Groth, Christine M. Henshaw, Carolyn Hoover, Jo Annalee Irving, Marianne Genge Jagmin, Debby Kaaland, Naomi Lungstrom, Rick Madison, Anne Roe Mealey, David Mikkelsen, Carrie Miller, Linda Denise Oakley, Maryann Pranulis, Mark Puhlman, Edith Randall, Bridget Recker, Cleo Richard, Dawn Rondeau, Mary Sanguinetti-Baird, Billie Marie Severtsen, Jacqueline Siegel, Gary Smith, Sheila Smith, Martha Snider, Pam Springer, Angela Starkweather, Patti Stec, Julie Symes, Lorie Wild, and Debra Winston-Heath.




UNIT I Pathophysiologic Processes

1 Introduction to Pathophysiology, 1 Lee-Ellen C. Copstead

Framework for Pathophysiology, 2 Etiology, 2 Pathogenesis, 2 Clinical Manifestations, 3 Treatment Implications, 3

Concepts of Normality in Health and Disease, 4 Statistical Normality, 4 Individual Factors Influencing Normality, 5

Patterns of Disease in Populations, 6 Concepts of Epidemiology, 6

2 Homeostasis, Allostasis, and Adaptive Responses to Stressors, 12 Debra A. Jansen and Roberta J. Emerson

Homeostasis and Allostasis, 12 Homeostasis, 12 Allostasis, 13

Stress as a Concept, 13 The General Adaptation Syndrome and

Allostasis, 14 Stressors, Gender and Developmental Influences,

and Risk Factors, 16 Neurohormonal Mediators of Stress and

Adaptation, 17 Catecholamines: Norepinephrine and

Epinephrine, 17 Adrenocortical Steroids: Cortisol and

Aldosterone, 18 Endorphins, Enkephalins, and Immune

Cytokines, 19 Sex Hormones: Estrogen, Testosterone, and

Dehydroepiandrosterone, 19 Growth Hormone, Prolactin, and

Oxytocin, 19 Adaptation, Coping, and Illness, 20

Adaptation, Coping, and Resilience, 20 Allostatic Overload and Illness, 21

UNIT II Cellular Function

3 Cell Structure and Function, 26 Jacquelyn L. Banasik and Brianne N. Banasik

Plasma Membrane, 27 Membrane Structure, 27 Lipid Bilayer, 27 Membrane Proteins, 29

Organization of Cellular Compartments, 30 Cytoskeleton, 30 Nucleus, 30 Endoplasmic Reticulum, 31 Golgi Apparatus, 32 Lysosomes and Peroxisomes, 33 Mitochondria, 34

Cellular Metabolism, 34 Glycolysis, 36 Citric Acid Cycle, 36 Oxidative Phosphorylation, 36

Functions of the Plasma Membrane, 39 Membrane Transport of Macromolecules, 39 Membrane Transport of Small Molecules, 40 Cellular Membrane Potentials, 45

Intercellular Communication and Growth, 48 Cell Signaling Strategies, 48 Cell Surface Receptor–Mediated Responses, 49 Intracellular Receptor–Mediated Responses, 53 Regulation of Cellular Growth and Proliferation, 54

4 Cell Injury, Aging, and Death, 59 Jacquelyn L. Banasik

Reversible Cell Injury, 59 Hydropic Swelling, 60 Intracellular Accumulations, 60

Cellular Adaptation, 63 Atrophy, 63 Hypertrophy, 63 Hyperplasia, 63 Metaplasia, 63 Dysplasia, 64

Irreversible Cell Injury, 64 Necrosis, 64 Apoptosis, 66

Etiology of Cellular Injury, 68 Ischemia and Hypoxic Injury, 68 Nutritional Injury, 70 Infectious and Immunologic Injury, 70 Chemical Injury, 72 Physical and Mechanical Injury, 72

Cellular Aging, 74 Cellular Basis of Aging, 74 Physiologic Changes of Aging, 75

Somatic Death, 75 5 Genome Structure, Regulation, and Tissue

Differentiation, 77 Jacquelyn L. Banasik

Structure and Function of DNA, 78 Structure of DNA, 78 DNA Replication, 79 Genetic Code, 80 Transcription, 81 Translation, 82

Regulation of the Genome, 84 Transcriptional Controls, 84

Differentiation of Tissues, 86 Cell Diversification and Cell Memory, 86 Mechanisms of Development, 86 Differentiated Tissues, 87

6 Genetic and Developmental Disorders, 94 Linda D. Ward

Principles of Inheritance, 95 DNA Mutation and Repair, 96

xii CoNTeNTs

GENETIC DISORDERS, 98 Chromosomal Abnormalities, 99

Aberrant Number of Chromosomes, 99 Abnormal Chromosome Structure, 100 Examples of Autosomal Chromosome

Disorders, 100 Examples of Sex Chromosome Disorders, 101

Mendelian Single-Gene Disorders, 102 Autosomal-Dominant Disorders, 103 Autosomal-Recessive Disorders, 104 Sex-Linked (X-Linked) Disorders, 106

Nonmendelian Single-Gene Disorders, 107 Anticipation, 109 Mitochondrial Gene Mutations, 109 Genomic Imprinting, 110

Polygenic and Multifactorial Disorders, 110 Environmentally Induced Congenital

Disorders, 111 Periods of Fetal Vulnerability, 111 Teratogenic Agents, 111 Other Disorders of Infancy, 113

Diagnosis, Counseling, and Gene Therapy, 113 Prenatal Diagnosis and Counseling, 113 Genetic Analysis and Therapy, 114 Recombinant DNA Technology, 114

7 Neoplasia, 117 Jacquelyn L. Banasik

Benign Versus Malignant Growth, 118 Characteristics of Benign and Malignant

Tumors, 118 Tumor Terminology, 118 The Malignant Phenotype, 118

Epidemiology and Cancer Risk Factors, 120 Tobacco Use, 120 Nutrition, 120

Genetic Mechanisms of Cancer, 123 Proto-Oncogenes, 124 Tumor Suppressor Genes, 127

Multistep Nature of Carcinogenesis, 129 Initiation, 129 Promotion, 131 Progression, 131

Metastasis, 132 Patterns of Spread, 132 Angiogenesis, 133 Grading and Staging of Tumors, 134

Effects of Cancer on the Body, 136 Cancer Therapy, 137

Surgery, 137 Radiation Therapy, 138 Drug Therapy, 138 Immunotherapy, 138 Gene and Molecular Therapy, 138 Stem Cell Transplantation, 139

UNIT III Defense

8 Infectious Processes, 141 Brent A. Banasik

Host–Microbe Relationship, 142 The Human Microbiome, 142

Host Characteristics, 142 Pathogen Characteristics, 144

Transmission of Infection, 147 Routes of Transmission, 148 Emerging Infectious Diseases, 148 Weapons of Bioterrorism, 149

Types of Pathogenic Organisms, 149 Bacteria, 149 Viruses, 150 Fungi, 151 Parasites, 152

9 Inflammation and Immunity, 158 Jacquelyn L. Banasik


Epithelial Barriers, 159 Mononuclear Phagocyte System, 159 Lymphoid System, 160

Primary Lymphoid Organs, 160 Secondary Lymphoid Organs, 161

Leukocytes, 162 Neutrophils, 162 Eosinophils, 163 Basophils and Mast Cells, 164 Monocytes and Macrophages, 164 Dendritic Cells, 165 Lymphocytes, 165

Chemical Mediators of Immune Function, 167 Complement, 167 Kinins, 169 Clotting Factors, 169 Cytokines and Chemokines, 169


Increased Vascular Permeability, 171 Emigration of Leukocytes, 172 Phagocytosis, 172 Chronic Inflammation, 174

Healing, 174 Inflammatory Exudates, 175 Systemic Manifestations of Inflammation, 175 SPECIFIC ADAPTIVE IMMUNITY, 176 Major Histocompatibility Complex, 176 Antigen Presentation by MHC, 176

MHC Class I Presentation, 177 MHC Class II Presentation, 177

Mechanisms of Cell-Mediated Immunity, 178 T Helper Cells (CD4+), 178 Cytotoxic T Cells (CD8+), 181

Mechanisms of Humoral Immunity, 181 Antigen Recognition by B Cells, 181

Antibody Structure, 183 Class Switching and Affinity Maturation, 185 Antibody Functions, 186

Passive and Active Immunity, 187 Passive Immunity, 187 Active Immunity, 187


Integrated Response to Microbial Antigen, 189 Integrated Response to Viral Antigen, 191 Regulation of Immune Function, 192

CoNTeNTs xiii

10 Alterations in Immune Function, 194 Faith Young Peterson


Genetic Factors, 196 Environmental Triggers, 196 Pharmacotherapies, 197

Hypersensitivity, 198 Type I Hypersensitivity, 199 Type IIa Hypersensitivity, 201 Type IIb Hypersensitivity, 204 Type III Hypersensitivity, 204 Type IV Hypersensitivity, 207

DEFICIENT IMMUNE RESPONSES, 210 Primary Immunodeficiency Disorders, 210

B-Cell and T-Cell Combined Disorders, 210 T-Cell Disorders, 211 B-Cell Disorders, 212

Secondary Immunodeficiency Disorders, 212 11 Malignant Disorders of White Blood Cells, 215

Marie L. Kotter and Jacquelyn L. Banasik Classification of Hematologic Neoplasms, 215 Etiology of Myeloid and Lymphoid Neoplasms, 216 General Principles of Management, 217

Diagnosis of Hematologic Neoplasms, 217 Principles of Treatment, 218 Prevention and Management of Complications, 219

Myeloid Neoplasms, 221 Chronic Myeloid Leukemia, 221 Acute Myeloid Leukemia, 222

Lymphoid Neoplasms, 223 Chronic Lymphoid Leukemia, 223 Acute Lymphoblastic Leukemia/Lymphoma, 223 Hairy Cell Leukemia, 224 Plasma Cell Myeloma (Multiple Myeloma), 224 Hodgkin Disease, 227 B-Cell, T-Cell, and NK-Cell Lymphoma

(Non-Hodgkin), 229 12 HIV Disease and AIDS, 233

Faith Young Peterson Epidemiology, 234

History, 234 Types of HIV, 234 Transmission, 236 Prevention of Transmission, 238

Etiology, 239 HIV Structure, 239 HIV Binding and Infection, 239

Pathogenesis, 242 Effect of HIV on Immune Cells at the Cellular

Level, 242 Viral Production and Cell Death, 242 Progression of HIV Infection From Seroconversion

to AIDS, 244 CDC HIV Classification System, 245

Diagnostic Testing, 245 Monitoring the Progression of HIV, 246 Clinical Manifestations, 248

Systemic Manifestations, 248 Gastrointestinal Manifestations, 249 Pulmonary Manifestations, 249 Mucocutaneous Manifestations, 250

Gynecologic Manifestations, 251 Neurologic Manifestations, 252 Ocular Manifestations, 253 Cardiovascular Manifestations, 253 Manifestations in Other Systems, 253 Manifestations in Children, 254

Treatment, 254 Antiretroviral Therapy Recommendations, 254 Nucleoside Reverse Transcriptase Inhibitors, 255 Nucleotide Reverse Transcriptase Inhibitors, 255 Nonnucleoside Reverse Transcriptase

Inhibitors, 255 Protease Inhibitors, 257 Fusion Inhibitors, 257 CCR5 Inhibitors, 257 Integrase Strand Transfer Inhibitors, 257 Other Treatments and Vaccines, 257

UNIT IV Oxygen Transport, Blood Coagulation, Blood Flow, and Blood Pressure

13 Alterations in Oxygen Transport, 259 Susan G. Trevithick

Composition of Blood, 260 Organic and Inorganic Components, 261 Cellular Components, 261

Structure and Function of Red Blood Cells, 262 Hematopoiesis, 263 Hemoglobin Synthesis, 265 Nutritional Requirements for Erythropoiesis, 266 Energy and Maintenance of Erythrocytes, 267 Red Cell Production, 267 Red Cell Destruction, 268

Gas Transport and Acid–Base Balance, 268 Oxygen Transport, 268 Carbon Dioxide Transport, 270 Alterations in Oxygen Transport, 270

Anemia, 272 General Effects of Anemia, 272

Anemia Related to Decreased Red Cell Production, 277 Aplastic Anemia, 277 Anemia of Chronic Renal Failure, 277 Anemia Related to Vitamin B12 (Cobalamin)

or Folate Deficiency, 278 Iron Deficiency Anemia, 279

Anemia Related to Inherited Disorders of the Red Cell, 279 Thalassemia, 279 Sickle Cell Anemia, 281 Hereditary Spherocytosis, 282 Glucose-6-Phosphate Dehydrogenase

Deficiency, 282 Anemia Related to Extrinsic Red Cell Destruction or

Loss, 284 Hemolytic Disease of the Newborn, 284 Antibody-Mediated Drug Reactions, 284 Acute Blood Loss, 285 Other Extrinsic Abnormalities, 285

Transfusion Therapy, 286 Polycythemia, 286

xiv CoNTeNTs

Polycythemia Vera, 286 Secondary Polycythemia, 292 Relative Polycythemia, 293

14 Alterations in Hemostasis and Blood Coagulation, 298 Cheryl Rockwell

The Process of Hemostasis, 298 Stages of Hemostasis, 298 Platelets, 299 Blood Coagulation Factors, 299 Fibrin Clot, 299 Fibrinolysis, 301

Evaluation of Hemostasis and Coagulation, 301 Clinical Assessment, 301 Laboratory Tests, 304

Vascular and Platelet Disorders, 304 Vascular Disorders, 304 Platelet Disorders, 306

Coagulation Disorders, 308 15 Alterations in Blood Flow, 313

Teresa Grigsby Loftsgaarden Organization of the Circulatory and Lymphatic

Systems, 315 Vessel Structure, 315 Lymphatic Structure, 317

Principles of Flow, 317 Hemodynamics of the Circulatory System, 317

Control of Flow, 322 Control of Blood Flow, 322 Control of Lymphatic Flow, 323

General Mechanisms That Cause Altered Flow, 323 Blood Vessels: Obstructions, 323 Blood Vessels: Structural Alterations, 325 Lymphatic Vessels, 326

Alterations in Arterial Flow, 326 Arteriosclerosis/Atherosclerosis, 326 Thromboangiitis Obliterans (Buerger Disease), 330 Raynaud Syndrome, 330 Aneurysms, 330 Acute Arterial Occlusion, 331

Alterations in Venous Flow, 332 Valvular Incompetence, 332 Varicose Veins, 332 Chronic Venous Insufficiency, 333 Deep Vein Thrombosis, 3

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