Porth's Pathophysiology Concepts of Altered Health States
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unit i concepts of health and disease 1
1 Concepts of Health and Disease 2
CONCEPTS OF HEALTH AND DISEASE 2 Health 3 Disease 3
HEALTH AND DISEASE IN POPULATIONS 7 Epidemiology and Patterns of Disease 7 Determination of Risk Factors 8 Natural History 8 Preventing Disease 9 Evidence-Based Practice and Practice Guidelines 9
2 Concepts of Altered Health in Children 12
GROWTH AND DEVELOPMENT 13 Prenatal Growth and Development 14 Birth Weight and Gestational Age 15 INFANCY 17
Growth and Development 17 Health Problems of the Neonate 21 Health Problems of the Infant 27 EARLY CHILDHOOD 29 Growth and Development 29 Common Health Problems 30 MIDDLE TO LATE CHILDHOOD 30 Growth and Development 30 Common Health Problems 31 ADOLESCENCE 33 Growth and Development 33 Common Health Problems 35
3 Concepts of Altered Health in Older Adults 40
THE OLDER ADULT AND THEORIES OF AGING 40
Who Are Older Adults? 40
Theories of Aging 42
PHYSIOLOGIC CHANGES OF AGING 43
Integumentary Changes 43
Stature and Musculoskeletal Function 45
Cardiovascular Function 45
Respiratory Function 46
Neurologic Function 46
Special Sensory Function 46
Immune Function 47
Gastrointestinal Function 48
Renal Function 48
Genitourinary Function 49
FUNCTIONAL PROBLEMS ASSOCIATED WITH
AGING 49
Functional Assessment 50 Urinary Incontinence 51 Instability and Falls 52 Sensory Impairment 53 Depression 53 Dementia 55 Delirium 56
DRUG THERAPY IN THE OLDER ADULT 57 Factors Contributing to Adverse Drug Reactions 58
Strategies to Enhance Therapeutic Effects and Prevent Harm 58
unit ii cell function and growth 63
4 Cell and Tissue Characteristics 64
FUNCTIONAL COMPONENTS OF THE CELL 64 Protoplasm 65 The Nucleus 66
The Cytoplasm and Its Organelles 66 The Cytoskeleton 70 The Cell (Plasma) Membrane 72 INTEGRATION OF CELL FUNCTION AND REPLICATION 73 Cell Communication 73 Cell Receptors 74 The Cell Cycle and Cell Division 76 Cell Metabolism and Energy Sources 77 MOVEMENT ACROSS THE CELL MEMBRANE AND MEMBRANE POTENTIALS 81 Movement of Substances across the Cell Membrane 81 Membrane Potentials 83 BODY TISSUES 87 Cell Differentiation 88 Embryonic Origin of Tissue Types 88 Epithelial Tissue 88 Connective or Supportive Tissue 93 Muscle Tissue 94 Nervous Tissue 97 Extracellular Tissue Components 98
5 Cellular Adaptation, Injury, and Death 101
CELLULAR ADAPTATION 101 Atrophy 102 Hypertrophy 103 Hyperplasia 103 Metaplasia 104 Dysplasia 104
Intracellular Accumulations 104 Pathologic Calcifications 105 CELL INJURY AND DEATH 106 Causes of Cell Injury 107 Mechanisms of Cell Injury 110 Reversible Cell Injury and Cell Death 112 Cellular Aging 115
6 Genetic Control of Cell Function and Inheritance 118
GENETIC CONTROL OF CELL FUNCTION 119
DNA Structure and Function 119
From Genes to Proteins 122
CHROMOSOMES 127
Cell Division 127
Chromosome Structure 128
PATTERNS OF INHERITANCE 130
Definitions 130
Genetic Imprinting 131
Mendel’s Laws 132
Pedigree 132
GENE TECHNOLOGY 133
Genetic Mapping 133
Recombinant DNA Technology 134
RNA Interference Technology 136
7 Genetic and Congenital Disorders 138
GENETIC AND CHROMOSOMAL DISORDERS 138 Single-Gene Disorders 139 Multifactorial Inheritance Disorders 144 Chromosomal Disorders 145 Mitochondrial Gene Disorders 150 DISORDERS DUE TO ENVIRONMENTAL INFLUENCES 151 Period of Vulnerability 151 Teratogenic Agents 151 Folic Acid Deficiency 154 DIAGNOSIS AND COUNSELING 155 Genetic Assessment 155 Prenatal Screening and Diagnosis 155
8 Neoplasia 160
CONCEPTS OF CELL DIFFERENTIATION AND
GROWTH 161
The Cell Cycle 161
Cell Proliferation 162
Cell Differentiation 164
CHARACTERISTICS OF BENIGN AND
MALIGNANT NEOPLASMS 166
Terminology 166
Benign Neoplasms 168
Malignant Neoplasms 168
ETIOLOGY OF CANCER 174
Genetic and Molecular Basis of Cancer 174
Host and Environmental Factors 179
CLINICAL MANIFESTATIONS 183
Tissue Integrity 183
Systemic Manifestations 183
Paraneoplastic Syndromes 185
SCREENING, DIAGNOSIS, AND
TREATMENT 186
Screening 186
Diagnostic Methods 187
Cancer Treatment 189
CHILDHOOD CANCERS 195
Incidence and Types 195
Biology of Childhood Cancers 196
Diagnosis and Treatment 196
unit iii disorders of integrative function 201
9 Stress and Adaptation 202
HOMEOSTASIS 203
Constancy of the Internal Environment 203 Control Systems 203 Feedback Systems 204 STRESS AND ADAPTATION 204 The Stress Response 205 Coping and Adaptation to Stress 209 DISORDERS OF THE STRESS RESPONSE 212 Effects of Acute Stress 212 Effects of Chronic Stress 212 Posttraumatic Stress Disorder 212 Treatment and Research of Stress Disorders 213
10 Alterations in Temperature Regulation 216
BODY TEMPERATURE REGULATION 216 Mechanisms of Heat Production 219 Mechanisms of Heat Loss 219 INCREASED BODY TEMPERATURE 220 Fever 220 Hyperthermia 224
DECREASED BODY TEMPERATURE 226 Hypothermia 227
11 Activity Tolerance and Fatigue 230
EXERCISE AND ACTIVITY TOLERANCE 230 Types of Exercise 231
Physiologic and Psychological Responses of Exercise 232
Assessment of Activity and Exercise Tolerance 236
Exercise and Activity Tolerance in Older Adults 237
ACTIVITY INTOLERANCE AND FATIGUE 238 Mechanisms of Fatigue 238 Acute Physical Fatigue 239 Chronic Fatigue 239 BED REST AND IMMOBILITY 243 Physiologic Effects of Bed Rest 243 Time Course of Physiologic Responses 247 Psychosocial Responses 247 Management of People Who Are Immobile or on Bed Rest 247
unit iv infection, inflammation, AND immunity 251
12 Mechanisms of Infectious Disease 252
INFECTIOUS DISEASES 252
Terminology 252
Agents of Infectious Disease 254
MECHANISMS OF INFECTION 261
Epidemiology of Infectious Diseases 262
Portal of Entry 262
Source 263
Symptomatology 263
Disease Course 263
Site of Infection 264
Virulence Factors 265
DIAGNOSIS AND TREATMENT OF INFECTIOUS DISEASES 267 Diagnosis 267 Treatment 270
BIOTERRORISM AND EMERGING GLOBAL INFECTIOUS DISEASES 273 Bioterrorism 273 Global Infectious Diseases 274
13 Innate and Adaptive Immunity 276
THE IMMUNE RESPONSE 276 Cytokines and Their Role in Immunity 277 INNATE IMMUNITY 282 Epithelial Barriers 282 Cells of Innate Immunity 283 Pathogen Recognition 284 Soluble Mediators of Innate Immunity 286 The Complement System 287 ADAPTIVE IMMUNITY 288 Antigens 288
Cells of Adaptive Immunity 291 B Lymphocytes and Humoral Immunity 294 T Lymphocytes and Cellular Immunity 297 Lymphoid Organs 300 Active versus Passive Immunity 302 Regulation of the Adaptive Immune Response 302
DEVELOPMENTAL ASPECTS OF THE IMMUNE SYSTEM 303
Transfer of Immunity from Mother to Infant 303
Immune Response in the Older Adult 304
14 Inflammation, Tissue Repair, and Wound Healing 306
THE INFLAMMATORY RESPONSE 306
Acute Inflammation 307
Chronic Inflammation 317
Systemic Manifestations of Inflammation 317
TISSUE REPAIR AND WOUND HEALING 319
Tissue Repair 319
Wound Healing 322
15 Disorders of the Immune Response 329
IMMUNODEFICIENCY DISORDERS 329 Humoral (B Cell) Immunodeficiencies 332 Cell-Mediated (T Cell) Immunodeficiencies 334 Combined T-Cell and B-Cell Immunodeficiencies 336 Disorders of the Complement System 337 Disorders of Phagocytosis 338 Stem Cell Transplantation 340 HYPERSENSITIVITY DISORDERS 341 Type I, Immediate Hypersensitivity Disorders 341
Type II, Antibody-Mediated Disorders 345 Type III, Immune Complex-Mediated Disorders 346
Type IV, Cell-Mediated Hypersensitivity Disorders 347 Latex Allergy 349 TRANSPLANTATION IMMUNOPATHOLOGY 350 Mechanisms Involved in Transplant Rejection 351
AUTOIMMUNE DISEASE 353 Immunologic Tolerance 353 Mechanisms of Autoimmune Disease 355 Diagnosis and Treatment of Autoimmune Disease 356
16 Acquired Immunodeficiency Syndrome 361
THE AIDS EPIDEMIC AND TRANSMISSION OF HIV INFECTION 361 Emergence of AIDS 362 Transmission of HIV Infection 362 PATHOPHYSIOLOGY AND CLINICAL COURSE 363
Molecular and Biologic Features of HIV 363 Classification and Phases of HIV Infection 366 Clinical Course 367 PREVENTION, DIAGNOSIS, AND TREATMENT 373 Prevention 374 Diagnostic Methods 374 Treatment 375
HIV INFECTION IN PREGNANCY AND IN INFANTS AND CHILDREN 376 Preventing Perinatal HIV Transmission 377 Diagnosis of HIV Infection in Children 377 Clinical Presentation of HIV Infection in Children 377
unit v disorders of neural function 381
17 Organization and Control of Neural Function 382
NERVOUS TISSUE CELLS 382 Neurons 383
Neuroglial Cells 384
Metabolic Requirements of Nervous Tissue 386
NEUROPHYSIOLOGY 387
Action Potentials 387
Synaptic Transmission 388
Messenger Molecules 390
DEVELOPMENTAL ORGANIZATION OF THE
NERVOUS SYSTEM 391
Embryonic Development 392
Segmental Organization 394
STRUCTURE AND FUNCTION OF THE SPINAL
CORD AND BRAIN 400
Spinal Cord 400
The Brain 403
THE AUTONOMIC NERVOUS SYSTEM 413 Autonomic Efferent Pathways 414 Sympathetic Nervous System 414 Parasympathetic Nervous System 416 Central Integrative Pathways 417 Autonomic Neurotransmission 417
18 Somatosensory Function, Pain, and Headache 422
ORGANIZATION AND CONTROL OF SOMATOSENSORY FUNCTION 423 Sensory Systems 423 Sensory Modalities 427 Clinical Assessment of Somatosensory Function 429 PAIN 430 Pain Theories 431
Pain Mechanisms and Pathways 431
Pain Threshold and Tolerance 435
Types of Pain 435
Assessment of Pain 438
Management of Pain 439
ALTERATIONS IN PAIN SENSITIVITY AND
SPECIAL TYPES OF PAIN 442
Alterations in Pain Sensitivity 442
Special Types of Pain 443
HEADACHE AND ASSOCIATED PAIN 445
Headache 445
Migraine Headache 445
Cluster Headache 446
Tension-Type Headache 447
Chronic Daily Headache 447
Temporomandibular Joint Pain 448
PAIN IN CHILDREN AND OLDER ADULTS 448
Pain in Children 448
Pain in Older Adults 449
19 Disorders of Motor Function 452
ORGANIZATION AND CONTROL OF MOTOR
FUNCTION 453
Organization of Movement 453
The Motor Unit 455
Spinal Reflexes 455
Motor Pathways 457
Assessment of Motor Function 457
DISORDERS OF THE MOTOR UNIT 461
Skeletal Muscle Disorders 461
Disorders of the Neuromuscular Junction 463
Lower Motor Neuron Disorders 465
Peripheral Nerve Disorders 465
DISORDERS OF THE CEREBELLUM AND BASAL
GANGLIA 470
Disorders of the Cerebellum 470 Disorders of the Basal Ganglia 471 UPPER MOTOR NEURON DISORDERS 475 Amyotrophic Lateral Sclerosis 476 Multiple Sclerosis 476 Vertebral and Spinal Cord Injury 479
