Study Guide for Understanding Pathophysiology This page intentionally left blank Study Guide for Understanding Pathophysiology Sue E. Huether, MSN, PhD Professor Emeritus College of Nursing University of Utah Salt Lake City, Utah Kathryn L. McCance, MSN, PhD Professor College of Nursing University of Utah Salt Lake City, Utah Section Editors Valentina L. Brashers, MD Professor Nursing and Attending Physician in Internal Medicine University of Virginia Health System Charlottesville, Virginia Neal S. Rote, PhD Academic Vice-Chair and Director of Research Department of Obstetrics and Gynecology University Hospitals of Cleveland; Professor of Reproductive Biology and Pathology Case School of Medicine Case Western Reserve University Cleveland, Ohio Prepared by Clayton F. Parkinson, PhD Professor Emeritus College of Health Sciences Weber State University Ogden, Utah 3251 Riverport Lane St. Louis, Missouri 63043 STUDY GUIDE FOR UNDERSTANDING PATHOPHYSIOLOGY, ISBN: 978-0-323-08489-5 5TH EDITION Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of 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: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability 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. Vice President and Publisher: Loren S. Wilson Senior Editor: Sandra Clark Senior Developmental Editor: Charlene Ketchum Editorial Assistant: Brooke Kannady Publishing Services Managers: Jeffrey Patterson and Hemamalini Rajendrababu Senior Project Managers: Jeanne Genz and Srikumar Narayanan Designer: Paula Catalano Multimedia Producer: Lisa Godoski Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 Reviewers Mandi Counters, RN, MSN, CNRN Assistant Professor Nursing Department Mercy College of Health Sciences Des Moines, Iowa Bradley R Harrell, DNP, ACNP-BC, CCRN Assistant Professor of Nursing School of Nursing Union University-Germantown Germantown, Tennessee Jane Cross Norman, Ph.D., R.N., CNE Professor of Nursing MSN Program Director Tennessee State University Nashville, Tennessee Marylou Virginia Robinson, PhD, FNP-C Assistant Professor College of Nursing University of Colorado Aurora, Colorado v Reviewers This page intentionally left blank Preface The study of pathophysiology is complex, ever expanding, and challenging. It requires correlations between normal and abnormal anatomy and physiology as well as the processes resulting in the manifestations of disease. This Study Guide is designed for students as an adjunct to Understanding Pathophysiology, fifth edition, by Sue E. Huether and Kathryn L. McCance. It is intended to facilitate an understanding of the consequences of pathologic proc- esses on the structure and function of the human body. The Study Guide contains 40 chapters, each following the organization of the textbook. The Guide’s chapters have two different formats—one for normal anatomy and physiology and another for anatomic and physiologic alterations. For the normal anatomy and physiology chapters, it is assumed that the student possesses foundational knowledge of anatomy and physiology; therefore, no supplemental narrative is provided. n These chapters have foundational objectives that direct review of the information, principles, and concepts that are essential for understanding the specific diseases that follow in the next chapter. Chapters five and six depart from the usual normal anatomy and physiology chapter’s format. This departure is because inflammation and immunity con- cepts are frequently referenced throughout the following text and study guide chapters. n Each chapter has a practice examination to give students an opportunity to assess their understanding of normality. The chapters on alterations direct the learner’s study of abnormal anatomy and physiology. n These chapters include 1) foundational objectives for review and 2) learning objectives for study with narrative, charts, and tables. n Each chapter has a practice examination requiring factual and conceptual knowledge related to disease mechanisms. n Each chapter includes one or two case studies linking fact and concept to reality that require analysis and applica- tion. The objectives for all chapters are referenced to corresponding pages in the fifth edition of Understanding Pathophysiology. Huether and McCance’s philosophy that students need to grasp basic laws and principles to understand how alterations occur led them to develop an understandable and conceptually integrated textbook. I enjoyed working with Mosby, particularly with Charlene Kechum and Jeanne Genz. All of Mosby’s staff ensured that my efforts were developed into a creative, professional, and pleasing style for student learners. I wish to dedicate my efforts during the preparation of this Study Guide to students who inspired me to search for a better way to convey information to them. Clayton F. Parkinson vii Preface This page intentionally left blank Contents PART ONE BASIC CONCEPTS OF PATHOPHYSIOLOGY Unit 1 The Cell 1. Cellular Biology, 1 2. Genes and Genetic Diseases, 5 3. Altered Cellular and Tissue Biology, 11 4. Fluids and Electrolytes, Acids and Bases, 17 Unit 2 Mechanisms of Self-Defense 5. Innate Immunity: Inflammation and Wound Healing, 25 6. Third Line of Defense: Adaptive Immunity, 33 7. Infection and Defects in Mechanisms of Defense, 39 8. Stress and Disease, 47 Unit 3 Cellular Proliferation: Cancer 9. Biology, Clinical Manifestations, and Treatment of Cancer, 53 10. Cancer Epidemiology, 63 11. Cancer in Children, 69 PART TWO BODY SYSTEMS AND DISEASES Unit 4 The Neurologic System 12. Structure and Function of the Neurologic System, 73 13. Pain, Temperature, Sleep, and Sensory Function, 77 14. Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function, 85 15. Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction, 95 16. Alterations of Neurologic Function in Children, 107 Unit 5 The Endocrine System 17. Mechanisms of Hormonal Regulation, 113 18. Alterations of Hormonal Regulation, 117 Unit 6 The Hematologic System 19. Structure and Function of the Hematologic System, 131 20. Alterations of Hematologic Function, 135 21. Alterations of Hematologic Function in Children, 147 Unit 7 The Cardiovascular and Lymphatic Systems 22. Structure and Function of the Cardiovascular and Lymphatic Systems, 153 23. Alterations of Cardiovascular Function, 157 24. Alterations of Cardiovascular Function in Children, 177 Unit 8 The Pulmonary System 25. Structure and Function of the Pulmonary System, 183 26. Alterations of Pulmonary Function, 187 27. Alterations of Pulmonary Function in Children, 199 ix Contents Unit 9 The Renal and Urologic Systems 28. Structure and Function of the Renal and Urologic Systems, 205 29. Alterations of Renal and Urinary Tract Function, 209 30. Alterations of Renal and Urinary Tract Function in Children, 219 Unit 10 The Reproductive Systems 31. Structure and Function of the Reproductive Systems, 225 32. Alterations of the Reproductive Systems, Including Sexually Transmitted Infections, 229 Unit 11 The Digestive System 33. Structure and Function of the Digestive System, 243 34. Alterations of Digestive Function, 247 35. Alterations of Digestive Function in Children, 261 Unit 12 The Musculoskeletal and Integumentary Systems 36. Structure and Function of the Musculoskeletal System, 267 37. Alterations of Musculoskeletal Function, 271 38. Alterations of Musculoskeletal Function in Children, 285 39. Structure, Function, and Disorders of the Integument, 291