LECTURE NOTES Undergraduate Nursing Students Pathophysiology Fuad Ibrahim (MD) Mengistu Welday (M.Sc.N., B.Sc.N) Haramaya University In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education July 2008 Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. ©2008 by Fuad Ibrahim, Mengistu Welday All rights reserved. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. PREFACE This pathophysiology lecture note will serve as a theoretical guideline for undergraduate nurse and other health sciences students. Pathophysiology is the study of the disturbance of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting from a disease or abnormal syndrome or condition that may not qualify to be called a disease. An alternate definition is "the study of the biological and physical manifestations of disease as they correlate with the underlying abnormalities and physiological disturbances. This lecture-note will provide a summarized basis for the students by expanding the student’s knowledge in the sciences how alteration in structure (Anatomy) and function (Physiology) disrupt the human body as a whole. It is written for undergraduate students in nursing and other health oriented disciplines as prerequisite course for certain courses. i The under standing of disease process is continually being updated and clarified by research. In this text of pathophysiology, every attempt has been made to provide the most current available information in simplified and well- explained ways. ii ACKNOWLEDGEMENT First of all we would like to thank The Carter Center EPHTI, Addis Abeba for the continual and unreserved support in solving the shortage of teaching/learning materials in the higher teaching institutions of Ethiopia. We especially thank the national reviewers Mr. Asrat Demisie (Addis abeba University) and Dr. Mesele Bezabih (Jimma University) for their intensive and meticulouse review of this lecture note. We extend our sincere thanks to our colleagues Dr. Musa Husien and Mr. Biftu Geda from Haramaya University Faculty of Health Sciences for their invaluable comments in reviewing the lecture note. Our heart felt thanks also goes to interinstitutional reviewers Mr. Birara Tadeg, (University of Gonder), Mr. Alemayohu Bayray (Mekelle University), Wezam Tesfay (Defence College of Health Sciences) and Mr. Mewael Fikru (Hawassa University) for their constructive comments. iii Finally, we wish to express our sincere thanks to Mr. Akililu Mulugeta whose support and encouragement made this lecture note possible. iv TABLE OF CONTENTS Titles Pages Preface ................................................................................i Acknowledgment ...............................................................iii Table of Contents ...............................................................v List of tables ......................................................................ix List of figures ......................................................................x List of Abbreviation ............................................................xi Chapter One: Alteration in cell function and growth .........1 1.1 Cell injury and cellular adaptive changes .........1 1.2 Neoplasm .......................................................12 Chapter Two: Alteration in body defense .........................22 2.1 Body defense mechanisms against injury ......23 2.1.1 Skin and mucus membrane .............23 2.1.2 Mononuclear phagocyte system .......23 2.1.3 Inflammatory response ....................26 2.1.4 Immunological defense mechanism .61 2.1.4A) Hypersensitivity reaction ........61 2.1.4B) Immunodeficiency diseases .. 66 - Human immunodeficiency virus 68 Chapter Three: Alteration in tissue oxygenation .............80 v 3.1 Congestive heart failure ..................................81 3.1.4 Classification of heart failure ............89 3.2 Obstructive diseases of blood vessels ............95 3.3 Lung diseases ................................................98 3.3.1 Restrictive lung diseases .................99 3.3.2 Obstructive lung diseases .............110 3.3.2.1 Acute obstructive lung disease ....111 3.3.2.2 Chronic obstructive lung disease (COPD) .......................................111 Chapter Four: Alteration in distribution of body fluids ...126 4.1 Regulation of interstitial fluid volume ...........127 4.2 Edema ...........................................................127 4.3 Nephrotic syndrome ......................................134 4.4 Cirrhosis of liver ............................................137 Chapter Five: Alterations in gastrointestinal function ....143 5.1 Peptic ulcer disease ......................................143 5.2 Intestinal obstruction .....................................149 Chapter Six: Alteration in endocrine function ................156 6.1 Review of endocrine function ........................157 6.2 General aspects of altered endocrine function 159 6.2.1 Primary and secondary endocrine disorders .................................................160 vi 6.3 Alterations in endocrine control of growth and metabolism ....................................................161 6.4 Disorders of the anterior pituitary gland ........162 6.4.1 Growth hormone excess ................162 6.4.2 Hypofunction of pituitary gland .......167 6.5 Disorders associated with ADH .....................169 6.5.1. Syndrome of inappropriate secretion of ADH .........................................................170 6.6. A;teratopms om tjurpod fimctopm ...............173 6.6.1 Hypothyroidism ...............................176 6.6.2. Hyperthyroidism .............................180 6.7. Disorders of Adrenal cortical function ...........183 6.7.1. Congenital Adrenal hyperplasia ....183 6.7.2. Adrenal insufficiency ....................184 6.7.3. Glucocorticoid hormone excess ...187 Chapter Seven: Alteration in genitourinary function .....191 7.1. Abnormal uterine bleeding (AUB) ...............192 7.2. Pelvic inflammatory disease .......................197 7.3. Obstructive Uropathy ..................................199 Chapter Eight: Alteration in neuronal function, intracranial mass effect and meningitis ..................208 8.1 Alterations in cerebral volume and ressure (ICP) ..............................................................209 8.1.1 Compensatory mechanisms for raised vii ICP .................................................210 8.1.2 Manifestation of raised ICP ...........212 8.2 Head injury ...................................................218 Chapter Nine: Genetic and metabolic disorder ...........225 9.1 Genetic and chromosomal disorder ..............225 9.1.1 Single gene disorders ....................225 9.1.2 Disorder of autosomal inheritance .227 9.1.3 Disorder of sex-linked inheritance ..229 9.1.4 Chromosomal disorder ...................232 LIST OF TABLE Title page viii Table 1.1: Comparison of malignant and benign tumors .15 Table 2.1: Location and names of macrophages ..............25 Table 2.2: Mediators of inflammation ...............................32 Table 2.3: Types of inflammatory exudates .....................33 Table 2.4: Local manifestation of inflammation ................35 Table 2.5: Stage of febrile responses ..............................39 Table 2.6: Regeneration ability of different types of Tissues ............................................................42 Table 2.7: Phases in Primary Intention healing ...............44 Table 6.1: Manifestations of Hypothyroid and hyperthyroid state .............................................................173 Table 7.1: Types of renal stone based on its chemical composition ..................................................203 LIST OF FIGURES Title Page Figure 1.1: Types of cellular adaptive changes .................8 ix Figure 2.1: Vascular response in inflammation ................28 Figure 2.2: Structure of HIV cell .......................................70 Figure 2.3: Mechanism of HIV entry and replication ........73 Figure 3.1: Effects of angiotensin II in congestive heart Failure ............................................................86 Figure 7.1: Causes of AUB and its effects ......................195 Figure 8.1: Types of brain edema and its effect .............216 x LIST OF ABBREVIATIONS ACTH Adreno cortico trophic hormone ADH Anti diuretic hormone AIDS Acquired immuno deficiency