Understanding Pathophysiology - ANZ adaptation

Written by Judy Craft and Christopher Gordon, Understanding Pathophysiology 3e remains Australia and New Zealand’s leading pathophysiology text for nursing and allied health students. Updated to include the most current scientific and clinical case material across the life span, complex subject manner is presented in an approachable and easy-to-understand format. Beginning with essential concepts, the text examines the normal structure and function of each body system, followed by the alterations to that system caused by disease. Conditions particularly relevant to children and to the ageing are described in separate sections in each chapter to demonstrate disease processes across the life span. Strong ANZ pathophysiological focus — with disease and disorder profiles specific to the region explained in greater detail and with an epidemiological focus Expert editors, clinicians, researchers and academic writers Recent developments in evidence-based practice for diseases and disorders incorporated throughout Evolve Student Resources: eBook on VitalSource Animations Glossary References Evolve Instructor Resources: Answer Guides to in-print features Focus on Learning, Case Studies and Review Questions Image collection Instructor’s Manual PowerPoints References Test Bank NEW chapter on diabetes to highlight the prevalence of the disease in Australia and New Zealand Expanded obesity chapter to reflect the chronic health complications and comorbidities New concept maps designed to stand out and pull together key chapter concepts and processes Updated Focus on Learning, Case Studies and Chapter Review Questions Now includes an eBook with all print purchases Understanding Pathophysiology ANZ Copyright Page About the Authors Australian and New Zealand Contributors US Contributors Reviewers Preface Organisation of content The Australian and New Zealand context Concept maps: a unique feature of the text Acknowledgments Text Features 1 Introduction to clinical science Chapter outline Key terms Introduction Essential pathophysiology Pathophysiology and clinical manifestations Disorders and diseases The onset of disease Population-level indicators of disease Age groups within the population Evaluation and treatment Essential anatomy Anatomical position Body sections and planes Anatomical directional terminology Body cavities and quadrants Health science terminology Essential physiology The hierarchy from microscopic to whole body level Organ systems Essential chemistry Elements Ions and electrolytes Molecules and compounds Water Acids and bases Acidosis and alkalosis Chemical reactions Energy Molecules of life Proteins Lipids Carbohydrates Nucleic acids Essential physics Pressure within an enclosed area of the body Pressure from the atmosphere Review questions 2 Homeostasis Chapter outline Key terms Introduction Homeostasis The cellular environment Homeostasis at the cellular and local level Homeostasis at the body level Regulation of homeostasis Disturbances of homeostasis lead to pathophysiology Review questions 3 Cellular structure and function Chapter outline Key terms Introduction Cellular structure and function Cellular components The organelles The nucleus The ribosomes Endoplasmic reticulum The Golgi apparatus Lysosomes Peroxisomes Mitochondria The cytoskeleton The cytoplasm The cell membrane Lipids Proteins Cellular receptors and communication Membrane transport Movement of water and solutes Passive transport Filtration Simple diffusion Facilitated diffusion Osmosis Active transport Endocytosis and exocytosis Cellular metabolism The role of ATP Tissues Types of tissues Epithelial tissue Connective tissue Muscle tissue Nervous tissue Review questions 4 Altered cellular function Chapter outline Key terms Introduction Causes of cellular injury Hypoxia Chemical agents Physical agents Infectious agents Genetic causes Mechanisms of cellular injury Hypoxic injury The impact of oxygen and oxygen-derived free radicals Alteration to calcium homeostasis Cellular adaptation Atrophy Hypertrophy Hyperplasia Metaplasia Dysplasia Reversible and irreversible cell injury Reversible cell injury Irreversible cell injury Apoptosis Necrosis Death Review questions 5 Genes Chapter outline Key terms Introduction The nucleus Cell proliferation The cell cycle Control of cell division DNA, RNA and proteins: heredity at the molecular level Chemical composition of DNA From genes to proteins Elements of genetics Genes, alleles and mutations Phenotype and genotype Dominance and recessiveness Inheritance of traits Autosomal and X-linked inheritance Codominance and multiple alleles Newborn screening Review questions 6 The structure and function of the neurological system Chapter outline Key terms Introduction Organisation of the nervous system Cells of the nervous system Neurons The structure of neurons The function of neurons Neuroglia Nerve injury and regeneration The nerve impulse Membrane potentials Resting membrane potential Action potential Synapses Neurotransmitters Myelin The central nervous system The brain The cerebral hemispheres The cerebral cortex Cerebral tracts Basal nuclei The limbic system The diencephalon The brainstem The sleep process The importance of sleep Control of the sleep–wake cycle The cerebellum The spinal cord Reflexes Sensory pathways Motor pathways Protective structures of the central nervous system The cranium and vertebral column The meninges The dura mater The arachnoid The pia mater Cerebrospinal fluid and the ventricular system The blood–brain barrier Blood supply of the central nervous system Blood supply to the brain Blood supply to the spinal cord The peripheral nervous system The autonomic nervous system Anatomy of the sympathetic nervous system Anatomy of the parasympathetic nervous system Neurotransmitters and receptors Neurotransmitters and receptors of the sympathetic nervous system Neurotransmitters and receptors of the parasympathetic nervous system Physiology of the autonomic nervous system Sympathetic nervous system: functions Parasympathetic nervous system: functions Sensory function Somatosensory function Touch Temperature Chemical Proprioception Vision Hearing Olfaction and taste Alterations of sensory function Visual dysfunction Alterations in ocular movements Alterations in visual acuity Alterations in refraction Alterations in colour vision Neurological disorders causing visual dysfunction External eye structure disorders Auditory dysfunction Conductive hearing loss Sensorineural hearing loss Ménière’s disease Ear infections Olfactory and taste dysfunction Review questions 7 Pain Chapter outline Key terms Introduction The definition of pain Types of pain Nociceptive pain Neuropathic pain Psychogenic pain Pain terminology The physiology of pain Nociceptors Cutaneous nociceptors High threshold mechanoreceptors Polymodal nociceptors Musculoskeletal and visceral nociceptors Spinothalamic tract neurons Thalamocortical neurons Cortical representation of pain Neuromodulation of pain Clinical manifestations of pain Evaluation and treatment Pathophysiology of pain Peripheral neuropathic pain Central pain syndromes Review questions 8 Concepts of neurological dysfunction Chapter outline Key terms Introduction Alterations in cerebral homeostasis Cerebral haemodynamics Intracranial pressure Cerebral oedema Pathophysiology Clinical manifestations Evaluation and treatment Hydrocephalus Pathophysiology Clinical manifestations Evaluation and treatment Alterations in cognitive function Alterations in arousal Pathophysiology Clinical manifestations and evaluation Level of consciousness Breathing pattern Pupillary changes Oculomotor responses Motor responses Vomiting Post-coma unresponsiveness Brain death Seizures Pathophysiology Types of seizure disorders Evaluation and treatment Cognitive disorders Acute confusional states Pathophysiology Clinical manifestations Evaluation and treatment Dementia Pathophysiology Clinical manifestations Evaluation and treatment Depression Alterations in motor function Alterations in muscle tone Hypotonia Hypertonia Alterations in movement Review questions 9 Alterations of neurological function across the life span Chapter outline Key terms Introduction Cerebrovascular disorders Stroke Ischaemic strokes Thrombotic stroke Embolic stroke Haemorrhagic stroke Clinical manifestations Ischaemic stroke Haemorrhagic stroke Evaluation and treatment The longer-term consequences of stroke Cerebral aneurysm Pathophysiology Classification Clinical manifestations Evaluation and treatment Vascular malformation Pathophysiology Clinical manifestations Evaluation and treatment Headache and migraine Headache Migraine Trauma to the central nervous system Brain trauma Pathophysiology Focal brain injury Diffuse brain injury Clinical manifestations Focal brain injury Diffuse brain injury Evaluation and treatment Spinal cord trauma Pathophysiology Clinical manifestations Evaluation and treatment Degenerative disorders of the central nervous system Alzheimer’s disease Pathophysiology Clinical manifestations Evaluation and treatment Parkinson’s disease Pathophysiology Clinical manifestations Evaluation and treatment Huntington’s disease Pathophysiology Clinical manifestations Evaluation and treatment Multiple sclerosis Pathophysiology Clinical manifestations Evaluation and treatment Motor neuron disease Pathophysiology Clinical manifestations Evaluation and treatment Peripheral nervous system and neuromuscular junction disorders Guillain-Barré syndrome Pathophysiology Clinical manifestations Treatment Myasthenia gravis Pathophysiology Clinical manifestations Evaluation and treatment Infection and inflammation of the central nervous system Meningitis Pathophysiology Clinical manifestations Evaluation and treatment Encephalitis Pathophysiology Clinical manifestations Evaluation and treatment Abscesses Pathophysiology Clinical manifestations Evaluation and treatment Tumours of the nervous system Cranial tumours Primary intracerebral tumours Astrocytomas Oligodendrogliomas Ependymomas Primary extracerebral tumours Meningiomas Nerve sheath tumours Secondary (metastatic) brain carcinomas Review questions 10 The structure and function of the endocrine system Chapter outline Key terms Introduction Mechanisms of hormonal regulation Regulation of hormone release Mechanisms of hormone action Hormone receptors Protein-based hormones Steroid-based hormones The structure and function of the endocrine glands The hypothalamic–pituitary system The anterior pituitary Growth hormone Function of growth hormone Regulation of growth hormone secretion Other anterior pituitary hormones The posterior pituitary Antidiuretic hormone Function of antidiuretic hormone Regulation of antidiuretic hormone secretion The thyroid and parathyroid glands The thyroid gland Thyroid hormone Function of thyroid hormone Regulation of thyroid hormone secretion Calcitonin The parathyroid glands Parathyroid hormone Function of parathyroid hormone Regulation of parathyroid hormone secretion Homeostasis of blood calcium levels The pancreas Insulin Function of insulin Regulation of insulin secretion Glucagon Function of glucagon Regulation of glucagon secretion Homeostasis of blood glucose levels The adrenal glands The adrenal cortex Cortisol Functions of cortisol Regulation of cortisol secretion Aldosterone Functions of aldosterone Regulation of aldosterone secretion Oestrogens and androgens The adrenal medulla Adrenaline and noradrenaline Function of adrenaline and noradrenaline Regulation of adrenaline and noradrenaline secretion Neuroendocrine response to stressors The pineal gland The thymus gland The testes and ovaries Review questions 11 Alterations of endocrine function across the life span Chapter outline Key terms Introduction Mechanisms of hormonal alterations Alterations of pituitary function Syndrome of inappropriate antidiuretic hormone secretion Pathophysiology Clinical manifestations Evaluation and treatment Diabetes insipidus Pathophysiology Clinical manifestations Evaluation and treatment Alterations of adrenal function Hyperaldosteronism Pathophysiology Clinical manifestations Evaluation and treatment Hypercortisolism Pathophysiology Clinical manifestations Evaluation and treatment Hypoadrenalism Pathophysiology Clinical manifestations Evaluation and treatment Alterations of pancreatic function Type 1 diabetes mellitus Pathophysiology Clinical manifestations Evaluation and treatment Diabetes in pregnancy Alterations of thyroid function Hyperthyroidism Graves’ disease Hyperthyroidism resulting from nodular thyroid disease Hyperthyroidism resulting from thyroiditis Clinical manifestations Evaluation and treatment Thyrotoxic crisis Hypothyroidism Primary hypothyroidism Pathophysiology Clinical manifestations Evaluation and treatment Thyroid disease and pregnancy Hyperthyroidism Hypothyroidism Alterations of parathyroid function Hyperparathyroidism Pathophysiology Clinical manifestations Evaluation and treatment Hypoparathyroidism Pathophysiology Clinical manifestations Evaluation and treatment Review questions 12 The structure and function of the immune system Chapter outline Key terms Introduction Human defence mechanisms Innate immunity Epithelial barriers Cellular components Phagocytes Natural killer cells Chemical mediators Cytokines Interferons Adaptive immunity Antigens Cells of the immune system Lymphocytes B lymphocytes T lymphocytes Antigen-presenting cells Humoral and cell-mediated immunity Humoral immune response Antibodies Antigen binding The function of antibodies Direct effects Indirect effects IgE B cell antigen receptor Cell-mediated immune response T cell recognition of a target cell T cell receptor complex Antigen presentation molecules CD molecules T lymphocyte function Cytotoxic T lymphocytes Other cells that kill abnormal cells Regulatory T lymphocytes Helper T lymphocytes Induction of the immune response Review questions 13 Inflammation and fever Chapter outline Key terms Introduction Acute inflammation Cellular components of inflammation Mast cells and basophils Neutrophils Monocytes and macrophages Eosinophils Platelets Phagocytosis Inflammatory mediators Histamine Chemotactic factors Leukotrienes Nitric oxide Prostaglandins Platelet-activating factor Cytokines Interleukins Tumour necrosis factor-alpha Plasma protein systems The complement system The coagulation system The kinin system Plasma protein system interactions Chronic inflammation Clinical manifestations of inflammation Fever Body temperature Thermoregulation Body temperature abnormalities Hyperthermia Hypothermia The pathogenesis of fever The benefits of fever Clinical patterns of fever Wound healing The reconstructive phase The maturation phase Dysfunctional wound healing Dysfunction during the inflammatory response Dysfunction during the reconstructive phase Impaired collagen production Impaired epithelialisation Wound disruption Impaired contraction Review questions 14 Infection Chapter outline Key terms Introduction Infection rates Definitions Microorganisms Normal flora Pathogens Classes of microorganisms Bacteria Viruses Fungi Methods of infection Clinical manifestations of infection Detection and treatment of microorganisms Antimicrobials Vaccines Infections Common infections The common cold Helicobacter pylori infection Urinary tract infection Infection control and healthcare-acquired infections Antimicrobial resistance Review questions 15 Alterations of immune function across the life span Chapter outline Key terms Introduction Hypersensitivity reactions Type I: IgE-mediated hypersensitivity reactions Mechanisms of IgE-mediated hypersensitivity Clinical manifestations Evaluation and treatment Anaphylaxis Type II: tissue-specific hypersensitivity reactions Type III: immune complex–mediated hypersensitivity reactions Type IV: cell-mediated hypersensitivity reactions Transplantation Transplantation rejection Blood transfusion reactions The ABO blood group system The Rhesus system The universal donor Autoimmune diseases The breakdown of tolerance Systemic lupus erythematosus Immune deficiencies Primary immune deficiencies Secondary immune deficiencies Acquired immunodeficiency syndrome Epidemiology Pathogenesis Clinical manifestations Treatment and prevention Review questions 16 The structure and function of the haematological system Chapter outline Key terms Introduction Components of the haematological system The composition of blood Plasma and plasma proteins Plasma versus serum Cellular components of blood Erythrocytes Leucocytes Granulocytes Agranulocytes Platelets Lymphoid organs The spleen Lymph nodes The mononuclear phagocyte system The development of blood cells Haematopoiesis Bone marrow Cellular differentiation The development of erythrocytes Haemoglobin production Nutritional requirements for erythropoiesis Iron cycle Normal destruction of aged erythrocytes The development of leucocytes The development of platelets The mechanisms of haemostasis The function of platelets and blood vessels The function of clotting factors Natural substances that limit coagulation and platelet plug formation Clot retraction and fibrinolysis Review questions 17 Alterations of haematological function across the life span Chapter outline Key terms Introduction Alterations of erythrocyte function Anaemia Classification of anaemia General clinical manifestations of anaemia Anaemia due to insufficient erythrocyte production Iron deficiency anaemia Pathophysiology Clinical manifestations Evaluation and treatment Folate deficiency anaemia Clinical manifestations Evaluation and treatment Pernicious anaemia Clinical manifestations Evaluation and treatment Aplastic anaemia Renal anaemia Anaemia due to excessive erythrocyte loss Post-haemorrhagic anaemia Malarial anaemia Inherited blood disorders Haemolytic disease of the newborn Myeloproliferative red cell disorders Alterations of platelets and coagulation Platelet disorders Thrombocytopenia Pathophysiology Heparin-induced thrombocytopenia syndrome Clinical manifestations Evaluation and treatment Alterations of platelet function Disorders of coagulation Haemophilia Clinical manifestations Evaluation and treatment Impaired haemostasis Vitamin K deficiency Liver disease Thromboembolic disorders Disseminated intravascular coagulation Pathophysiology Clinical manifestations Evaluation and treatment Haemostasis therapy Alterations of leucocytes Alterations of leucocyte count Granulocyte and monocyte alterations Infectious mononucleosis Clinical manifestations Evaluation and treatment Alterations of leucocyte function Leukaemia Pathophysiology Acute leukaemia Clinical manifestations Evaluation and treatment Chronic leukaemia Pathophysiology and clinical manifestations Evaluation and treatment Alterations of lymphoid function Lymphadenopathy Malignant lymphomas Non-Hodgkin’s lymphomas Pathophysiology Clinical manifestations Evaluation and treatment Hodgkin’s lymphoma Pathophysiology Clinical manifestations Evaluation and treatment Multiple myeloma Pathophysiology Clinical manifestations Evaluation and treatment Review questions 18 The structure and function of the integumentary system Chapter outline Key terms Introduction The structure of the skin Layers of the skin The epidermis The dermis The dermal–epidermal junction Skin colour Appendages of the skin Hair Nails Sweat glands Eccrine sweat glands Apocrine sweat glands Sebaceous glands The function of the integumentary system Protection Physical barrier Chemical barrier Biological barrier Regulation of body temperature Cutaneous sensation Production of vitamin D Excretion Review questions 19 Alterations of the integumentary system across the life span Chapter outline Key terms Introduction Skin lesions Skin cancer Basal cell carcinoma Squamous cell carcinoma Solar (acitinic) keratosis Squamous cell carcinoma in situ (Bowen’s disease) Melanoma Pathophysiology Clinical manifestations Evaluation and treatment Inflammatory disorders of the skin Dermatitis Irritant contact dermatitis Allergic contact dermatitis Latex allergy Atopic dermatitis Pathophysiology Clinical manifestations Evaluation and treatment Seborrhoeic dermatitis Acne vulgaris Acne rosacea Cutaneous lupus erythematosus Papulosquamous disorders Infections of the integumentary system Bacterial infections Folliculitis Furuncles and carbuncles Cellulitis Staphylococcal scalded skin syndrome Paronychia Viral infections Herpes simplex virus Herpes zoster and varicella Warts Molluscum contagiosum Fungal infections Tinea infections Candidiasis Parasitic infestations Scabies Pediculosis Ticks Traumatic conditions of the integumentary system Pressure injuries Pathophysiology Clinical manifestations Evaluation and treatment Skin tears Burns Pathophysiology Clinical manifestations Evaluation and treatment Vascular disorders Cutaneous vasculitis Scleroderma Port-wine stain Review questions 20 The structure and function of the musculoskeletal system Chapter outline Key terms Introduction The structure and function of bones Elements of bone tissue Bone cells Osteoblasts Osteoclasts Osteocytes Bone matrix Collagen fibres Proteoglycans Glycoproteins Bone minerals Types of bone tissue Characteristics of bone Maintenance of bone integrity Remodelling Repair The structure and function of joints Fibrous joints Cartilaginous joints Synovial joints Joint capsule Synovial membrane Joint cavity Synovial fluid Articular cartilage Intraarticular menisci The movement of synovial joints The structure and function of skeletal muscles Whole muscle Motor unit Sensory receptors Muscle fibres Myofibrils, sarcomeres and myofilaments Non-protein constituents of muscle Components of muscle function Neuromuscular junction Muscle contraction at the molecular level Muscle metabolism Muscle mechanics Types of muscle contraction The movement of muscle groups The effect of training on muscle The clinical relevance of skeletal muscle Review questions 21 Alterations of musculoskeletal function across the life span Chapter outline Key terms Introduction Musculoskeletal injuries Skeletal trauma Fractures Classification of fractures Pathophysiology Clinical manifestations Evaluation and treatment Dislocation and subluxation Pathophysiology Clinical manifestations Evaluation and treatment Support structures Sprains and strains of tendons and ligaments Pathophysiology Clinical manifestations Evaluation and treatment Tendonitis, epicondylitis and bursitis Pathophysiology Clinical manifestations Evaluation and treatment Muscle strains Post-exercise muscle soreness Myoglobinuria Pathophysiology Clinical manifestations Evaluation and treatment Disorders of bone and joints Metabolic bone disease Osteoporosis Pathophysiology Clinical manifestations Evaluation and treatment Paget’s disease Pathophysiology Clinical manifestations Evaluation and treatment Disorders of joints Inflammatory joint disease Rheumatoid arthritis Pathophysiology Clinical manifestations Evaluation and treatment Ankylosing spondylitis Pathophysiology Clinical manifestations Evaluation and treatment Gout Pathophysiology Clinical manifestations Treatment Osteoarthritis Pathophysiology Clinical manifestations Evaluation and treatment Infectious bone disease Osteomyelitis Pathophysiology Clinical manifestations Evaluation and treatment Disorders of skeletal muscle Contractures Stress-induced muscle tension Disuse atrophy Fibromyalgia Pathophysiology Clinical manifestations Evaluation and treatment Integrative conditions related to the musculoskeletal system Lower back pain Pathophysiology Evaluation and treatment Bone pain Myasthenia gravis Review questions 22 The structure and function of the cardiovascular and lymphatic systems Chapter outline Key terms Introduction The circulatory system The structure of the heart The size and location of the heart The heart wall Heart chambers and great vessels Valves of the heart Heart sounds Blood flow during the cardiac cycle The coronary circulation Coronary arteries Collateral arteries Coronary capillaries Coronary veins and lymphatic vessels Structures that control heart function Myocardial cells Myocardial excitation–contraction coupling Myocardial relaxation Myocardial metabolism The cardiac conduction system Action potentials of the cardiac conduction system Cardiac innervation The electrocardiogram Factors affecting cardiac performance Preload Afterload Myocardial contractility Heart rate Pulse The physiology of cardiovascular control Cardiovascular control centres in the brain Neural reflexes Atrial receptors Hormones and biochemicals The systemic circulation Blood vessels Arteries Capillaries Endothelium Veins Blood pressure and blood flow Factors affecting blood flow Pressure and resistance Blood vessel radius Blood vessel length Viscosity Total resistance Neural control of total peripheral resistance Laminar versus turbulent flow Vascular compliance Regulation of blood pressure Arterial pressure Baroreceptors Arterial chemoreceptors Hormones Venous pressure Regulation of the coronary circulation Autoregulation The lymphatic system Lymphatic capillaries Lymphatic vessels and ducts Lymph nodes Review questions 23 Alterations of cardiovascular function across the life span Chapter outline Key terms Introduction Alterations of blood flow and pressure Hypertension Factors associated with primary hypertension Primary hypertension Secondary hypertension Isolated systolic hypertension Complicated hypertension Clinical manifestations Evaluation and treatment Orthostatic hypotension Arteriosclerosis Atherosclerosis Pathophysiology Clinical manifestations Evaluation and treatment Coronary heart disease The development of coronary heart disease Dyslipidaemia and atherosclerosis-promoting diet Hypertension Cigarette smoking Diabetes mellitus and insulin resistance Obesity and sedentary lifestyle Myocardial ischaemia Pathophysiology Clinical manifestations Angina Evaluation and treatment The acute coronary syndromes Unstable angina Acute myocardial infarction Pathophysiology Cellular death Structural and functional changes Repair Clinical manifestations Evaluation and treatment Treatment Aneurysm Thrombus formation Embolism Peripheral artery disease Alterations to veins Venous thromboembolus Varicose veins Alterations of the heart wall Disorders of the pericardium Acute pericarditis Pericardial effusion Disorders of the myocardium: the cardiomyopathies Disorders of the endocardium Valvular dysfunction Stenosis Aortic stenosis Mitral stenosis Regurgitation Aortic regurgitation Mitral regurgitation Tricuspid regurgitation Rheumatic heart disease Pathophysiology Clinical manifestations Evaluation and treatment Infective endocarditis Pathophysiology Clinical manifestations Evaluation and treatment Alterations of cardiac conduction Arrhythmias Heart failure Left heart failure Systolic heart failure Diastolic heart failure Right heart failure Shock Impairment of cellular metabolism Impairment of oxygen use Impairment of glucose use Types of shock Cardiogenic shock Hypovolaemic shock Neurogenic shock Anaphylactic shock Septic shock Clinical manifestations of shock Treatment for shock Multiple organ dysfunction syndrome Pathophysiology Clinical manifestations Evaluation and treatment Review questions 24 The structure and function of the pulmonary system Chapter outline Key terms Introduction The structure of the pulmonary system The conducting zone The respiratory zone The pulmonary and bronchial circulation The chest wall and pleura The function of the pulmonary system The mechanics of breathing Major and accessory muscles Alveolar surface tension Elastic properties of the lung and chest wall Airway resistance The work of breathing Ventilation Control of ventilation Neural control Mechanical control Chemical control Gas transport Gas pressure Distribution of ventilation and perfusion Oxygen transport Diffusion across the alveolar–capillary membrane Determinants of arterial oxygenation The oxygen–haemoglobin dissociation curve Carbon dioxide transport Review questions 25 Alterations of pulmonary function across the life span Chapter outline Key terms Introduction Disorders of the pulmonary system Obstructive airway diseases Asthma Pathophysiology Clinical manifestations Evaluation and treatment Chronic obstructive pulmonary disease Chronic bronchitis Pathophysiology Emphysema Pathophysiology Clinical manifestations of COPD Evaluation and management of COPD Cystic fibrosis Pathophysiology Clinical manifestations Evaluation and treatment Bronchiectasis Restrictive airway diseases Acute respiratory distress syndrome Pathophysiology Clinical manifestations Evaluation and treatment Inhalation disorders Exposure to toxic gases Pneumoconiosis Infections of the pulmonary system Pneumonia Pathophysiology Clinical manifestations Evaluation and treatment Tuberculosis Pathophysiology Clinical manifestations Evaluation and treatment Acute bronchitis Influenza Pathophysiology Clinical manifestations Evaluation and treatment Lung cancer Types of lung cancer Non-small cell carcinoma Small cell carcinoma Pathophysiology Clinical manifestations Evaluation and treatment Obstructive sleep apnoea Pathophysiology Clinical manifestations Evaluation and treatment Alterations of pulmonary blood flow and pressure Pulmonary embolism Pathophysiology Clinical manifestations Evaluation and treatment Cor pulmonale Pathophysiology Clinical manifestations Evaluation and treatment Clinical manifestations of pulmonary alterations Conditions caused by pulmonary alterations Pulmonary oedema Hypoxaemia Hypercapnia Acute respiratory failure Atelectasis Pneumothorax Pleural effusion Empyema Aspiration Signs and symptoms of pulmonary alterations Dyspnoea Cough Hypoventilation and hyperventilation Abnormal breathing patterns Haemoptysis Cyanosis Review questions 26 The structure and function of the digestive system Chapter outline Key terms Introduction An overview of the digestive system The gastrointestinal tract and accessory organs Layers of the gastrointestinal tract Neural control of the digestive system Motility Splanchnic blood flow The main nutrients The mouth, pharynx and oesophagus Anatomy and physiology of the mouth, pharynx and oesophagus Salivation Swallowing Digestion in the mouth, pharynx and oesophagus The stomach Anatomy and physiology of the stomach Gastric motility Gastric secretion Acid Pepsin Mucus Phases of gastric secretion Digestion in the stomach Absorption from the stomach The small intestine Anatomy and physiology of the small intestine Intestinal motility Digestion in the small intestine Absorption from the small intestine Accessory organs of digestion The liver Secretion of bile Vascular and haematological functions Metabolism of nutrients Fats Proteins Carbohydrates Storage of minerals and vitamins Metabolism of bilirubin Metabolic detoxification Liver immunity The gallbladder The pancreas The large intestine Anatomy and physiology of the large intestine Intestinal bacteria Defecation reflex Digestion in the large intestine Absorption in the large intestine Fluid movements in the digestive system The gastrointestinal tract and immunity An overview of nutrition Review questions 27 Alterations of digestive function across the life span Chapter outline Key terms Introduction Disorders of the gastrointestinal tract Cancers of the gastrointestinal tract Colorectal cancer Pathophysiology Clinical manifestations Evaluation and treatment Oesophageal cancer Pathophysiology Clinical manifestations EVALUATION and TREATMENT Gastric cancer Pathophy