Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, uyieiied or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal m«^niqmijarin»Mi
The authors, editors, and publisher have anted every effort to ensure that drug selection and dosage set forth in this text are in accordance with die current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, die reader is urged to check the package insert for each drug for any changB in Indications and dosagft and for added warnings and precautions. Ibis is paxticulariy Important when the recommended agent la a new or infrequently employed drug.
Preface vi
Acknowledgments viii
1. CELLULAR REACTION TO INJURY 1
Adaptation to Environmental Stress 1
Hypoxic Cell Injury 3
Free Radic. Injury 4
Chemical Cell Injury 4
Necrosis 5
Apoptosis 6
Reversible Cellular Changes and Accumulations 8
Disorders Characterized by Abnormalities of Protein Folding 11
Review Test 12
2. INFLAMMATION 17
Introduction 17
Acute Inflammation 17
Chronic Inflammation 24
Tissue Repair 26
Review Test 28
3. HEMODYNAMIC DYSFUNCTION 33
Hemorrhage 33
Hyperemia 33
Infarction 34
Thrombosis 34
Embolism 39
Edema 40
Shock 41
Review Test 43
4 GENETIC DISORDERS 48
Chromosomal Disorders 48
Modes of Inheritance of Monogenic Disorders 52
Mendelian Disorders 53
Balanced Polymorphism 60
Polygenic and Multifactorial Disorders 60
Disorders of Sexual Differentiation 61
Review Test 67
5. IMMUNE DYSFUNCTION 67
Cells of the Immune System 67
Cytokines 68
Complement System 68
Human Leukocyte Antigen System 69
Innate versus Acquired Immunity 69
Mechanisms of Immune Injury 69
Transplantation Immunology 72
Immunodeficiency Diseases 73
Autoimmunity 76
Connective Tissue (Collagen) Diseases 77
Amyloidosis 80
Review Test 82
6. NEOPLASIA 87
General Considerations 87
Classification and Nomenclature of TUmors 87
Properties of Neoplasms 89
Carcinogenesis and Etiology 92
Other Neoplastic Disorders with Known DNA Defects 97
Grading and Staging 98
Review Test 99
7. ENVIRONMENTAL PATHOLOGY 103
Physical Injury 103
Chemical Abuse 105
Chemical Injuries 107
Adverse Effects of Therapeutic Drugs 108
Review Test 119
8. NUTRITIONAL DISORDERS 114
Malnutrition 114
Vitamins 114
Obesity 118
Review Test 119
9. VASCULAR SYSTEM 123
Arterial Disorders 123
Venous Disorders 127
TVunors of Bloodvessels 127
Vasculitis Syndromes (Vasculitides) 128
Functional Vascular Disorders 130
Hypertension 130
Review Test 133
10. THE HEART 137
Ischemic Heart Disease (IHD) 137
Rheumatic Fever 139
Other Forms of Endocarditis 141
Valvular Heart Disease 142
Congenital Heart Disease 143
Diseases of the Myocardium 145
E iseases of the Pericardium 146
Tumors of the Heart 147
Congestive Heart Failure 147
Hypertrophy of the Heart 148
Review Test 150
11. ANEMIA 155
General Concepts 155
Acute Posthemorrhagic Anemia 155
Iron Deficiency Anemia 155
Megaloblastic Anemias 157
Anemia of Chronic Disease 159
Aplastic Anemia 159
Myelophthisic Anemia 160
Hemolytic Anemias 160
Review Test 167
12. NEOPLASTIC AND PROLIFERATIVE DISORDERS OF THE HEMATOPOIETIC AND LYMPHOID SYSTEMS 172
Leukemia 172
Myeloproliferative Diseases 175
Non- Neoplastic Lymphoid Proliferations 177
Plasma Cell Disorders 177
Lymphoid Neoplasms 179
Review Test 186
13. HEMORRHAGIC DISORDERS 192
L Disorders of Primary Hemostasis 192
Disorders of Secondary Hemostasis 194
Combined Primary and Secondary Hemostatic Defects 195
Review Test 197
14. RESPIRATORY SYSTEM 201
Disorders of the Upper Respiratory TVact 201
Rimors of the Upper Respiratory TVact 201
Chronic Obstructive Pulmonary Disease (COPD) 202
Restrictive Pulmonary Disease 205
Pulmonary Vascular Disease 210
Pulmonary Infection 211
Miscellaneous Disorders of the Lungs 215
Cancers of the Lung 215
Review Test 219
15. GASTROINTESTINAL TRACT 225
Diseases of the Mouth and Jaw 225
Diseases of the Salivary Glands 226
Diseases of die Esophagus 228
Diseases of the Stomach 230
Diseases of the Small Intestine 232
Diseases of the Colon 236
Diseases of the Appendix 240
Review Test 241
16. LIVER, GALLBLADDER, AND EXOCRINE PANCREAS 247
Diseases of the liver 247
Diseases of die Gallbladder 255
Diseases of the Exocrine Pancreas 256
Review lest 298
17. KIDNEY AND URINARY TRACT 264
Congenital Anomalies of the Urinary Itact 264
Glomerular Diseases 264
Urinary TVact Obstruction 269
Infection of the Urinary Ttact and Kidney 270
Tubular and Interstitial Disorders of the Kidney 270
Diffuse Cortical Necrosis 272
Nephrocalcinosis 272
Urolithiasis 273
Cystic Diseases of the Kidney 273
Renal Failure 274
Nonrenal Causes of Azotemia 274
Tumors of the Kidney, Urinary Ttact, and Bladder 275
Review Test 278
18. MALE REPRODUCTIVE SYSTEM 287
Diseases of the Penis 287
Diseases of the Testes 288
Diseases of the Prostate 291
Review Test 293
19. FEMALE REPRODUCTIVE SYSTEM AND BREAST 297
Uva and Vagina 297
Uterine Cervix 300
Uterine Corpus 301
Fallopian Ttibes 303
Ovaries 304
Disorders of Pregnancy 308
Breast 310
Review Test 313
20. ENDOCRINE SYSTEM 320
Pituitary 320
Thyroid Gland 322
Parathyroid Glands 327
Adrenal Glands 328
Endocrine Pancreas 331
Multiple Endocrine Neoplasia (MEN) Syndromes 334
Review Test 335
21. SKIN 342
Terminology Relating to Skin Diseases 342
Inflammatory and Vesicular Lesions 342
Disorders of Pigmentation 344
Disorders of Viral Origin 345
Miscellaneous Skin Disorders 345
Skin Malignancies 347
Review Test 349
22. MUSCULOSKELETAL SYSTEM 353
Diseases of Skeletal Muscle 353
Diseases of Bone 355
Diseases of Joints 361
Soft Tissue Ttimors 364
Review Test 366
23. NERVOUS SYSTEM 371
Congenital Disorders 371
Cerebrovascular Disease 372
Head Injuries 373
Infections 374
Demyelinating Diseases 378
Degenerative Diseases 379
Tumors 383
Ocular Disorders 385
Review Test 387
24. INTERPRETATION OF DIAGNOSTIC TESTS: LABORATORY STATISTICS 392
General Considerations 392
Sensitivity and Specificity 392
Positive and Negative Predictive Values 393
Variation 394
Review Test 395