The Nature of Disease: Pathology for the Health Professions_1 doc

 


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Acquisitions Editor: David B. Troy
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Copyright © 2007 Lippincott Williams & Wilkins

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Printed in the United States of America

Librar y of Congress Cataloging-in-Publication Data
McConnell, Thomas H.
The nature of disease : pathology for the health professions / Thomas H. McConnell.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-5317-3 (alk. paper) 1. Pathology—Textbooks. I. Title.
[DNLM: 1. Pathology. QZ 4 M4789n 2007]
RB111.M21 2007
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2006027273

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This book is dedicated to:
Hazel and T.H.
for
gifts
Marianne
for
unconditional love
Anne, Allen, Lea, and Jim
for
keeping the faith
Helen
for
pure devotion
Jack, Margot, Andrew, Conner, JuJu, Kate, and Missa
for hope
Charles Ashworth
for
generosity
Vernie Stembridge
for

showing me the way
Adam, Clint, and Jason
for
renewal
Mark and Peggy
for
good example
William Marsh Rice, founder of Rice University
and
the citizens of Texas
for
a rigorous and free education


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Preface
The Nature of Disease is a short textbook of pathology,
but it took a long time to write. Each sentence has been
crafted for a particular audience: students studying for a
degree in the health professions.
This text’s aim is twofold:
• To present basic normal anatomy and physiology and
contrast them with the essential pathology and
pathophysiology of the most common and important
human diseases.
• To make the material enjoyable and easy to read.

Classroom Vetted
This textbook literally grew out of a classroom. When I
joined the academic community after a career in private
practice, the classroom was an alien place to me. I puzzled over the fact that the students I taught, who were of
the very highest quality, still had trouble grasping the
topics. I began to pay more critical attention to the textbooks I had selected for them, and I quickly learned the
student perspective of most pathology texts: they are
difficult to read.
Most pathology books are compilations written by
multiple authors, each with a certain writing style and
with differing views about the relative importance of
things. The style is generally stilted and formal—the
text doesn’t flow, and the reading is bare of enjoyment.
If I had a hard time with these texts, what about the students?
And so I concluded to write an outline of pathology
for them—a simple bullet list of important statements
written in declarative sentences that I was sure were

clear and easy to understand. This proved a success, but
the students wanted more. The demand grew, and my
simple outline soon became a self-published, spiralbound manual. After three editions of this manual, I realized I had the makings of a textbook in my hands. The
result is The Nature of Disease.

Approach
Having spent much of my professional life communicating with physicians buried in a blizzard of paper, I

know that brevity, manner, and style are the essence of
written communication. The Nature of Disease adopts a
deliberately casual, narrative style that served me well
in medical practice. It makes reading easier, holds the
reader’s attention, and enhances understanding and recall of important points without sacrificing scientific
relevance.
The Nature of Disease focuses on answering the most
important questions that students and patients have
about every disease: what?, why?, where?, and how? It
does so by concentrating on the nuts and bolts of human
pathology: the causes and the mechanisms of disease, its
progress, and its outcome. The science is flavored with
a bit of humor to offer a break from the scientific drill.
Along the way, the text uses a number of devices to
deepen understanding, retain interest, and enhance
recall:
• Much of the molecular and microscopic detail typically
found in similar textbooks has been eliminated. Each
chapter focuses on the essentials necessary to build a
broad, fundamental understanding, with supporting
detail where relevant.
• Clinical examples from daily life are integrated throughout to explain basic concepts. For example, fever blisters (cold sores, herpesvirus infection) illustrate the

pathology of virus infections. Placing disease in a realistic, familiar context enhances recall and develops
insight.
• Key points and concepts are reiterated where appropriate. Rather than assume that the reader recalls the details, the text errs (judiciously) on the side of restating the obvious. Experience shows that students
benefit from the redundancy.
• New terms are boldfaced and defined at their first use in
the narrative. This practice alerts the reader to the importance of the new term, which is defined in the
same sentence or the one immediately following.
• Selected important points are italicized for emphasis.
For example, in Chapter 11, Diseases of Blood Cells
and Blood Coagulation, the following italicized sentence emphasizes the threat of colon cancer: Iron deficiency anemia in a man or postmenopausal woman is
to be considered bleeding from gastrointestinal cancer
until proven otherwise.
vii


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Preface

• The narrative is sprinkled with quotations—serious,
whimsical, or humorous—to humanize the material
and make the subject matter more memorable. For example, Chapter 13, Diseases of the Heart, begins with

a line from singer Tim McGraw’s tune, “Where the
Green Grass Grows”: “. . . another supper from a sack,
a ninety-nine cent heart attack . . . .” This snippet of
lyric speaks volumes about the American diet and
heart disease, and students invariably enjoy and remember it.
• The History of Medicine boxes further humanize the
narrative by presenting historical anecdotes that put in
its historical perspective. For example, in Chapter 10,
Disorders of Daily Life and Diet, the box titled
“French Food, Fast Food, Fat Food” discusses the
history of restaurants, the development of fast food
in America, and the rise of obesity. The “History of
Medicine” box is my favorite feature.

Organization
Although this textbook is unique in many ways, it is organized in a familiar fashion: it presents general aspects
of pathology first, with the pathology of organ systems
following.
Part 1, General Pathology, opens with a chapter titled
The Nature of Disease, which discusses the actual nature
of disease—that is, the intimate relationship between
form and function in both health and sickness. This
chapter also emphasizes the difference between the disease itself and the signs and symptoms it produces. The
failure of health care professionals and their patients to
appreciate this distinction accounts for a great deal of
medical misdirection and misunderstanding.
The remainder of Part 1 consists of a series of chapters that deal with pathologic forces that can affect any
part of the body: the life and death of cells, inflammation and repair, disorders of fluid balance and blood
flow, neoplasia, genetic and pediatric diseases, infectious disease, diseases of diet, workplace and environment, and diseases of the immune system.
Part 1 establishes the foundation, and Part 2,

Diseases of Organ Systems, expands understanding by
discussing diseases of particular organs and organ systems. Along the way the narrative is stitched together
with liberal use of cross-references. In early chapters
they are used to steer the reader to more detailed discussion in later chapters. In later chapters they are used
to recall earlier discussion of basic concepts. For example, in Chapter 21, Diseases of the Female Genital Tract
and Breast, the discussion of dysplasia of the cervix calls
on the reader to understand the concept of metaplasia,

which was defined and discussed initially in Chapter 2.
The cross-reference is presented in the following sentence: “However, during puberty the ectocervix is transformed by metaplasia (Chapter 2) from flat squamous
cells into tall, columnar glandular cells.”

Art Program
No textbook of human pathology can succeed without
an excellent art program. Both photographs and line
drawings are necessary for a thorough understanding of
the subject. Line art simplifies the structures and concepts depicted by distilling them to their basic, most
easily recognizable forms, while photographs show
anatomic structures as they appear in real life. The
Nature of Disease is richly illustrated with both.
More than 600 full-color figures augment the discussions in this book. In keeping with the core notion that
anatomic form and function go hand in hand in health
and disease, this text contains more pathologic gross
photographs of patients and organs than comparable
texts do. Each photograph has been chosen to illustrate
a critical point and is intended to speak for itself. The
guiding principle in developing medical line art is that
good art should be understandable at a glance, or with
minimal study. The high-quality line drawings in this
book have been designed both to be esthetically pleasing and to guide the reader’s thought without needing to

read a lengthy description.

Chapter Features: A Guided Tour
Think of reading this textbook as a road trip through
unfamiliar territory: there is a lot to see, and the driver
(reader) needs a roadmap, a short list of the most important things to see, and reference material to study in
detail. Each chapter contains a set of consistent chapter
opener features; narrative content with supporting features such as sidebar boxes, tables, and figures; and endof-chapter features to promote retention and comprehension.
CHAPTER OPENER FEATURES

The chapter opener contains several features to help to
orient and prepare the reader for the material that
follows:
• A brief overview of the chapter content provides a
thumbnail sketch of what to expect.
• A chapter outline of major headings and subheadings
serves as a large-scale atlas of the material ahead.


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Preface

• Learning Objectives instruct the reader about the

most important learning tasks on a trip through the
chapter.
• Key Terms and Concepts acquaint the reader with the
most important “must see and understand” points of
interest on the trip.
CHAPTER FEATURES

The features in the body of each chapter are designed to
meet the specific needs of health professions students.
Every feature has been carefully crafted to hone critical
thinking skills and judgment, build clinical proficiency,
and promote comprehension and retention of the material.
Fundamentals

The following features present core concepts that form
the foundation of a thorough understanding of pathology. They focus on the essential science necessary to understand each topic.
• Back to Basics is a special narrative overview of normal anatomy and physiology, which appears in two
chapters in Part 1 (Chapter 5, Disorders of Fluid
Balance and Blood Flow, and Chapter 8, Diseases of
the Immune System) and at the beginning of all
chapters in Part 2. Back to Basics has its own special
design to distinguish it from the rest of the chapter,
with its text set against a lightly shaded background.
This feature not only serves as a refresher of relevant
material from students’ previous coursework but also
provides a basis for comparing and contrasting the
abnormal anatomy and function that characterize
every disease. For example, it is impossible to understand immune disease without understanding the
nature of B and T cells and their role in normal immunity; the Back to Basics section in Chapter 8 offers
the reader a quick tour of normal immune function

before moving on to immune disease.
• Basics in Brief boxes expand on the Back to Basics
feature and carry a similar design to indicate their relatedness. These boxes offer snippets of basic concepts where specific discussion within a chapter calls
for it. For example, in Chapter 13, Diseases of the
Heart, it is not possible to understand congential
heart disease without acquaintance with fetal circulation. At the opening of the discussion of congenital
heart disease, a Basics in Brief box offers a detailed illustration and discussion of fetal blood flow.
• Major Determinants of Disease is a box that occurs in
most chapters in Part 1 and in all chapters in Part 2.
It consists of a bulleted list of key “rules” that determine why disease occurs and unfolds the way it does.

ix

Each point is brief and written to be remembered.
For example, in Chapter 14, Diseases of the
Respiratory System, one of the major determinants of
disease is: Smoking is a major cause of lung disease.
•
Key Points boxes reiterate important points that
warrant special emphasis. For example, in Chapter
15, Diseases of the Gastrointestinal Tract, one of
these boxes reminds the reader: The colon is host to
more neoplasms than any other organ in the body.
Clinical Applications

The following features have a practical, real-world focus
that teaches students how to apply their learning in
clinical situations. They are specifically designed to promote the development of sound clinical judgment and
prepare the student to function effectively in his or her
chosen health profession.

•

The Clinical Side boxes feature information of
several different kinds:
• Clinical techniques in the diagnosis and management of disease. For example, in Chapter 21,
Diseases of the Female Genital Tract and Breast,
the box explains the use of the Pap smear in the
detection of lesions of the cervix, especially dysplasia and cancer.
• Therapies as a natural outgrowth of an understanding of basic anatomy and pathophysiology.
For example in Chapter 5, Disorders of Fluid
Balance and Blood Flow, a box entitled Salt Water
Therapy—a discussion of intravenous fluid therapy—is presented in conjunction with a discussion of body water and fluid compartments and
how they change with disease.
• Lifestyle changes and other activities to prevent
disease. For example, Chapter 13, Diseases of the
Heart, contains a box titled “Lifestyle and
Ischemic Heart Disease,” which discusses lifestyle
habits that cause ischemic heart disease and the
changes in lifestyle that will help prevent it.
• The Clinical Side boxes are woven throughout the
text and echo relevant basic sciences themes in every
instance; they are an integral part of the teaching narrative.
•
Lab Tools feature boxes offer information on
common laboratory procedures and results. For
example, a box in Chapter 7, Developmental,
Genetic, and Pediatric Disease, discusses Laboratory
Diagnosis in Genetic Disease in simple terms that students can easily grasp.
•
Case Studies, which appear at the end of every

chapter just before the chapter review material,


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Preface

are built from the details of an actual patient’s experience. For consistency, each case is organized
around the same set of headings. The headings themselves follow the sequence in which events typically
unfold in a real-world health care setting:
• Topics: Lists the major disease and problems presented by the patient.
• Setting: Describes the hospital, clinic, office, and
the reader’s imagined role in the case.
• Clinical History: Tells the patient’s story.
• Physical Examination and Other Data: Gives the
scientific facts.
• Clinical Course: Describes what happens.
• Discussion: Analyzes the case, with a focus on
cause, effect, and outcome.
• Points to Remember: Lists the lessons learned.
• The Road Not Taken—An Alternative Scenario: Because most of the cases are derived from autopsy
material, I have added a twist to some of them,

which imagines a better outcome for the patient
had the case unfolded in a different way. For example, in Chapter 12, Diseases of Blood Vessels,
the case is that of a man found dead from a stroke
in his office. The alternative scenario imagines the
patient behaving differently—losing weight, taking his blood pressure medicine regularly, exercising, and watching his diet—and living happily ever
after.
CHAPTER REVIEW FEATURES

At the end of each chapter are two features that reinforce learning by providing an opportunity to review the
material and assess understanding:
• The Objectives Recap is a brief narrative explanation
of the salient points relating to each chapter objective. More than just a simple chapter outline or bulleted summary of key points, this feature provides a
narrative overview of the main points that are directly related to each of the chapter objectives.
• Typical Test Questions stimulate recall and give the
reader a sense of the kinds of questions to expect on
an exam.
OTHER TEXT FEATURES

Several other unique features of this book offer quick
access to key information.

• The Guide to Case Studies in the front matter lists the
titles of cases at the end of every chapter and the topics that each case centers around: diseases, disorders,
testing, and other relevant clinical information.
Classroom and informal discussions reveal that students enjoy case studies more and learn more from
them than from any other aspect of my course, and
this guide helps them refer to them easily and
quickly.
• The Index of Case Studies in the back matter provides
another means of accessing useful clinical information in the case studies. It consists of an alphabetical

list of the diseases and other topics from the case
studies, cross-referenced by case study and text page
number.
• The end-of-text Glossary contains short definitions
of important terms and topics. It includes only terms
that are unfamiliar and not easily recalled, that rely
especially on precise definition, or that are often misunderstood. These are primarily descriptive terms
from the chapters, where all new terms are boldfaced
and defined on first encounter. In this respect our
glossary is like most, but with a twist: ours includes
few disorders or diseases. These are best studied via
detailed discussion rather than short definition.

Summary
I trust you will learn by reading my book. But more than
that, I hope you will enjoy reading it. I have spent a
great deal of time and energy on the latter in the hope
that it will improve the former. For example, I have
larded the narrative with medical history anecdotes that
I hope will entertain and will give disease a human face,
and I have salted it with quotations that may add a note
of melancholy or humor to the topic.
So, here it is; judge for yourself. And after you have
judged, I want you to tell me what you think. This is no
idle invitation—please send your comments, suggestions, praise, or criticism to me in care of the publisher at:
Lippincott Williams and Wilkins
351 West Camden Street
Baltimore, MD 21201-2436
Thomas H. McConnell, MD, FCAP
Dallas, Texas, April 15, 2006

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xi

Additional Learning Resources

STUDENT CD INCLUDES:

• 250 practice quiz questions to test knowledge and skills
• Animations to reinforce visual learning

INSTRUCTOR’S RESOURCE CD INCLUDES:

•
•
•
•

PowerPoint slides with accompanying lecture notes
Image bank of figures from the text

Answers to end-of-chapter review questions in the text
Test generator with more than 2,000 questions

Everything you need to develop, administer, and present your course!

All of these essential teaching tools are also available on the text’s companion website:
/>

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User’s Guide
This User’s Guide introduces you to the features
and tools of The Nature of Disease. Each feature
is specifically designed to enhance your learning experience, preparing you for a successful career
as a health professional.

Chapter Opener Features
Each chapter begins with a two-page chapter opener
that previews chapter contents and provides a framework for learning. These features are also handy tools
to use when reviewing for tests.

Chapter Overview. Gives a thumbnail
sketch of what’s covered in the chapter.

Chapter Outline. Serves as a “roadmap” to
the material ahead.

Learning Objectives. Preview the most important learning tasks on a trip through the
chapter.

Key Terms and Concepts. List the most important terms and concepts in the chapter.
These terms appear in bold type the first time
they are used. The Glossary also contains a selection of the most important terms and their
definitions.

Highlights of this text:
• Focuses on the essential pathology and pathophysiology of the most common and important human
diseases.
• Presents the basic normal anatomy and physiology
of each body system, then contrasts them with the
system in disease.
• Provides the conceptual knowledge you’ll need as a
health professional and teaches you how to apply it
in clinical settings.


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User’s Guide

xiii

Chapter Features
The following features appear throughout the body
of the chapter. They’re designed to hone critical thinking skills and judgment, build clinical proficiency, and
promote comprehension and retention of the material.
They also provide a fun and interesting human perspective on some of the concepts!
FUNDAMENTALS

These features provide an overview, review, or other
concise summary of fundamental concepts in
anatomy, physiology, and pathology.

“History of Medicine” boxes. Put disease
in the context of human history—fun and interesting facts help you remember the
disease content!

“Back to Basics” section. Previews/reviews
the normal anatomy and physiology of each
body system. Its shaded background sets it
off from the chapter’s pathology content—
helping you find it fast when you need to review!

“Key Points” boxes. Repeat the most important points from the narrative,
reinforcing learning.

“Basics in Brief” boxes. Feature tidbits of
normal anatomy and physiology review, just

where you need them!


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User’s Guide

CLINICAL APPLICATIONS

The hands-on content in these features helps you apply your learning in real-world clinical settings.

“The Clinical Side” boxes. Focus on clinical
techniques in diagnosing and managing
disease, treatment therapies, and disease
prevention.

“Lab Tools” boxes. Explain common
laboratory procedures and results.

“Major Determinants of Disease”
boxes. List the key “rules” that determine
why disease occurs and unfolds the way

it does.

Case Studies. Actual cases at the end of
every chapter are built from the details of a
real patient’s illness. The consistent heading
structure in every case helps you find the information you need at a glance!

The Road Not Taken. An alternative
scenario that imagines how the course of
disease might have unfolded differently, with a
better outcome for the patient, if certain factors had been changed. (Included in
select case studies.)


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User’s Guide

CHAPTER REVIEW FEATURES

These features help you review chapter content and
test yourself before exams.

Objectives Recap. A brief explanation of

the chapter’s main points related to each
chapter objective.

Typical Test Questions. Give you a
sense of the kinds of questions to expect on
an exam.

Index of Case Studies
The table below is a quick-reference key to the common diseases and disorders discussed in the case studies that appear at the end of each chapter. It is arranged alphabetically by disorder, with cross-references to the case studies
that contain information about the condition.
Disease/Disorder

Related Case Study

AIDS
Amniotic fluid embolism
Angina pectoris

Case 8-1, “I’m afraid I have AIDS.”
Case 5-1, “She’s gone.”
Case 10-1, “My chest feels funny.”

173
83
229

Barrett metaplasia of the esophagus
Blood glucose testing
Bronchopneumonia

Case 2-1, “This heartburn is killing me.”
Case 1-2, How High Is Up?
Case 9-1, “I knew she was sick when she didn’t want a cigarette.”

31
12
201

Cancer of the cervix
Carcinoma of the breast
Carcinoma of the colon
Cholelithiasis
Chronic obstructive pulmonary disease
Chronic salpingitis
Cigarette smoking, effects of

Case 21-1, “I can’t get pregnant.”
Case 21-2, “I have a lump in my breast.”
Case 15-1, “I’m in great shape.”
Case 17-1, “He drinks; I don’t.”
Case 14-1, Cigarette Asthma
Case 21-1, “I can’t get pregnant.”
Case 9-1, “I knew she was sick when she didn’t want a cigarette.”
Case 14-1, Cigarette Asthma
Case 11-1, “I’m tired and short of breath all the time.”

576
578
384
443

349
576
201
349
266

Dysplasia

Case 4-1, “You’d think I’d know better.”
Case 1-2, How High Is Up?
Case 2-1, “This heartburn is killing me.”

62
12
31

Fibromyalgia

Case 22-1, “The doctor told me I was being poisoned.”

609

Glaucoma
Glomerulonephritis, acute

Case 25-1, “I’m having a different kind of migraine.”
Case 19-1, “His water looks like Coca-Cola.”

700
506

Hepatitis C infection
Hostility, patient
Hypertension
Hypothyroidism

Case 16-1, “I didn’t give it a second thought.”
Case 3-1, “My doctor thinks I’m crazy.”
Case 12-1, A man found dead in his office
Case 18-1, “I’m running out of gas.”

418
48
288
475

Infant small for gestational age
Infertility
Influenza
Intestinal bleeding
Iron deficiency anemia

Case 7-1, “I thought it would go away.”
Case 21-1, “I can’t get pregnant.”
Case 9-1, “I knew she was sick when she didn’t want a cigarette.”
Case 11-1, “I’m tired and short of breath all the time.”
Case 11-1, “I’m tired and short of breath all the time.”

140
576

201
266
266

Lung cancer

Case 6-1, “I have a chest cold that won’t go away.”

106

Melanoma, malignant
Meningitis, acute
Metabolic syndrome
Metaplasia
Myocardial infarction, acute

Case 24-1, “She fries easier than bacon.”
Case 1-1, A Diagnosis Missed and a Diagnosis Made
Case 10-1, “My chest feels funny.”
Case 2-1, “This heartburn is killing me.”
Case 13-1, “He’s been having a lot of heartburn lately.”

672
11
229
31
319

Colon cancer
Diabetes mellitus

Glossary

This glossary is intended to serve as a quick reference to
many of the most important words and phrases commonly encountered in the study of pathology. It does
not include all of the boldfaced terms in the text but instead focuses on terms that are often misunderstood or
unfamiliar. It also includes some terms that are not
boldfaced in the text, especially ones that may be unfamiliar. Definitions of boldfaced terms not included here
can be located by referring to the comprehensive main
index at the end of this book.

abnormal A measurement or observation not falling

into the usual range
abortion Interruption of pregnancy before 20 weeks or

500 grams fetal weight
abrasion Injury to skin that scrapes away epidermis
acetylcholine A neurotransmitter; a molecule released at

the ends of nerve fibers that carries the nerve signal
across the synapse to cause action on the other side
achalasia Painful esophageal muscle spasms
acid-fast stain A laboratory dye to stain tuberculosis

bacilli for diagnosis
acidosis Blood pH that is lower (more acid) than normal
ACTH See adrenocorticotrophic hormone
actin One of the two contractile proteins in muscle cells

(the other: myosin)
acute A condition that arises rapidly, lasts a short time,

Page

Other Useful Features
The Nature of Disease contains several other unique
features that offer quick access to key information.

Index of Case Studies. An alphabetical list
of diseases and other clinical topics from the
case studies. Cross-referenced by case study
and text page number for quick access!
723

adrenocorticotrophic hormone (ACTH) The hormone re-

leased by the pituitary that stimulates the adrenal
cortex to produce and release cortisol and other hormones
aerobic Requiring oxygen for metabolism
afferent arteriole The arteriole bringing blood into the
glomerulus
agammaglobulinemia Absence of plasma gamma globulins; an immunodeficiency
agent An infective bacterium, virus, prion, or other object that causes infectious disease
agglutinin Naturally occurring blood group antibodies;
anti-A and anti-B
agranulocytosis Marked decrease in the number of
blood granulocytes
AIDS Acquired immunodeficiency syndrome
albumin The most abundant blood protein, made by the

liver; accounts for most plasma osmotic pressure
aldosterone An adrenocortical hormone that stimulates
kidney retention of sodium and water, thereby increasing vascular volume and cardiac output; also
stimulates kidney excretion of potassium
alkalosis Blood pH that is higher (more alkaline) than
normal
allele One gene of a pair that controls a given trait; one
allele inherited from the father, one from the mother
allergen A substance capable of causing an allergic reaction

Glossary. Contains definitions of the
most important terms and topics discussed in
the text.

xv


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Acknowledgments
There was a time when I paid little attention to
Acknowledgments pages in books. That was then; this is
now, and I have an unimagined appreciation for the contributions of people whose name is not on the cover.
This textbook is largely an accident that would not

have occurred but for a chain of unlikely events that led
me into academia after a career as a practicing pathologist. It began in June 1997 when I answered the phone
to hear the voice of Lynn Little, a former employee I’d
not heard from in years. He was calling in his capacity as
Chairman of the Medical Laboratory Sciences department in the UT Southwestern Allied Health Sciences
School. Lynn asked if I would be interested in teaching
the required pathology course for health professions
students. Being somewhat at loose ends at the time, and
having narrowly chosen private practice over academia
30 years earlier, I leapt at the chance.
Almost immediately, I began to worry if I would be
accepted in the Department of Pathology or by the
Chairman, Errol Friedberg, whom I scarcely knew and
who had succeeded my mentor, Vernie Stembridge. To
their everlasting credit, Errol and his colleagues graciously accepted me in my teaching role and encouraged
this project in every way.
Then came the task of assembling course materials.
Beni Stewart, chief guru in the photography lab, guided
me through a huge collection of images and in short order helped me assemble the rudiments of a course. In
the succeeding years I have called on her time and again
as those images began to find their way into this book.
Once I began creating my first outline of pathology
for students, pathology residents Reade Quinton and
Trey Martin agreed to help by taking new photographs.
When the outline grew into a compact textbook, I took
the raw project to a pathology department colleague,
Jim Richardson, a master teacher, for his advice. His patient, detailed notes on that early manuscript set me on
the correct course.
As word spread and other programs began using my
materials, I soon found myself in the business of selfpublishing. This proved to be so time-consuming that I

decided to mail copies of my ring-bound textbook and
companion CD to about two dozen editors. A copy
landed on John Goucher’s desk at Lippincott Williams
and Wilkins. It was my lucky day. Several other publishers were interested, but it didn’t take long for John

and Lippincott to rise to the top of the heap by virtue of
plainly evident professionalism.
Then came the formal editorial process, completely
new to me, which has proven to be one of the best educational experiences in a lifetime of learning. I fancied
myself good with words until I got into the hands of professional editors. It’s especially hard on someone with an
ego as big as mine, especially about language and literature, to have my carefully crafted sentences disassembled
with surgical precision and denuded of excess. David
Troy, senior acquisition editor who succeeded John
Goucher, oversaw our collective effort. Dana Knighten,
senior development editor, presided over the editorial
development process with admirable maturity borne of
long experience. She answered technical and procedural
questions, listened patiently to my rants about politically
correct language, kept me on schedule, and offered
sound advice and new ideas. Lonnie Christiansen edited
the raw manuscript. Her consistent grammatical and
structural insights were invaluable. Lastly, Bev
Shackelford, copy editor, did far more than merely clean
up and coordinate: she spotted critical shortcomings,
and her knowledge of medicine, history, grammar, and
literary style added gloss to the final product.
Jim McCulley, Chairman of Ophthalmology at UT
Southwestern, and his staff furnished many of the photographs of eye disease. A note of thanks is also due to several physician friends in the private sector, each of whom
brings an academic mindset to the private practice of
medicine. Alan Menter, dermatologist and athlete, allowed me to troll through his collection of dermatology

photographs, which constitute the bulk of images in the
chapter on skin disease. Bob Kramer, a long-time friend
and pediatrician colleague, critiqued the text from his
unique perspective. Dee Dockery, radiologist and philosopher, assisted by providing some useful radiographs.
Finally, Sean Hussey, chief pathology resident at UT
Southwestern and Parkland Memorial Hospital, agreed to
help me with this project. As the project grew, he not only
provided some wonderful photographs, but he also read
chapters for scientific accuracy and currency. Sean has a
way with words, too, and his editorial advice has been invaluable.
Thomas H. McConnell, MD, FCAP
Dallas, Texas


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Reviewers
We gratefully acknowledge the generous contributions
of the reviewers whose names appear in the list that follows. These instructors were kind enough to read the
proposal or the manuscript, or in some cases both, and
make thoughtful suggestions for improvement. Their
comments determined much of the direction for this
text and helped us shape the content to meet the specific
needs of health professions students. We hope they will

be pleased with the results of their hard work.
Karen Bawel, PhD
University of Southern Indiana
Evansville, Indiana
Carie Braun, PhD
College of St. Benedict/St. John’s University
St. Joseph, Minnesota; Collegeville, Minnesota
Patricia Brewer
University of Texas Health Science Center at San
Antonio
San Antonio, Texas
Bridget Calhoun, MHP, PA-C
Duquesne University
Pittsburgh, Pennsylvania

Linda Ludovico, MS
Tyler Junior College
Tyler, Texas
Kathryn Robinson, MS
University of Texas Health Sciences Center at San
Antonio
San Antonio, Texas
Barbara Sawyer
Texas Tech University Health Sciences Center
Lubbock, Texas
Margaret Schmidt, EdD, CLS
Duke University
Durham, North Carolina
Terry Powell, BS
Shoreline Community College

Shoreline, Washington
Henry Wormser, PhD
Wayne State University
Detroit, Michigan

xvii


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Contents
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii
Additional Learning Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
User’s Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xii

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvi
Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii
Guide to Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxvi

PART 1

GENERAL PATHOLOGY

1
2
3
4
5
6
7
8
9
10

The Nature of Disease: How to Think about Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Cell Injury, Adaptation, and Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Inflammation: The Reaction to Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Repair: Recovery from Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Disorders of Fluid Balance and Blood Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Developmental, Genetic, and Pediatric Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Diseases of the Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144
Infectious Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176
Disorders of Daily Life and Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205

PART 2

DISEASES OF ORGAN SYSTEMS

11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Diseases of Blood Cells and Blood Coagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .234
Diseases of Blood Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .270
Diseases of the Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292
Diseases of the Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .324
Diseases of the Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .354
Diseases of the Liver and Biliary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .389
Diseases of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .422
Diseases of Endocrine Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .448
Diseases of the Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .479
Diseases of the Lower Urinary Tract and Male Genitalia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .509

Diseases of the Female Genital Tract and Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .536
Diseases of Bones, Joints, and Skeletal Muscle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .581
Diseases of the Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .612
Diseases of the Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .648
Diseases of the Eye and Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .677
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .704
Index of Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .723
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .725

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Chronic Inflammation / 44
The Pathogenesis of Chronic Inflammation / 44
The Anatomic Characteristics of Chronic Inflammation / 45
The Consequences of Chronic Inflammation / 45
Distant Effects of Inflammation / 46
Lymphangitis, Lymphadenitis, and
Lymphadenopathy / 46
Systemic Effects of Inflammation / 46
The Inflammatory Response to Infection / 46

Dedication / v
Preface / vii
Additional Learning Resources / xi
User’s Guide / xii
Acknowledgments / xvi
Reviewers / xvii
Guide to Case Studies / xxvi

PART 1 GENERAL PATHOLOGY
1

The Nature of Disease: How to Think about
Illness / 2
The Nature of Disease / 3
Bodily Structure and Function in Disease / 5
Healthy Is Not the Same as Normal; Sick Is Not the Same as
Abnormal / 6
Defining Normal / 6
The Extent of Abnormality / 8
Test Sensitivity and Specificity / 8
The Usefulness of Tests in Diagnosis / 8
The Effect of Disease Prevalence on Test
Usefulness / 10
Initial Tests and Follow-up Tests / 10
Disease and Diagnosis / 11

2

3

xx

Cell Injury, Adaptation, and Death / 14
Back to Basics / 15
The Origins of Cells and the Organization of
Tissues / 15
The Nucleus / 16
The Cytoplasm / 17
The Cell Membrane / 20
The Cell Cycle / 20
Cellular Communication / 23
Biologic Aging / 24
Cell Injury and Disease / 24
Mild Cell Injury / 26
Intracellular Accumulations / 26
Adaptations of Cell Growth and Differentiation / 28
Severe Cell Injury and Cell Death / 29
Inflammation: The Reaction to Injury / 34
The Inflammatory Response to Injury / 35
The Cellular Response in Inflammation / 36
The Vascular Response in Inflammation / 39
Molecular Mediators of Inflammation / 40
Acute Inflammation / 41
The Pathogenesis of Acute Inflammation / 41
The Anatomic Characteristics of Acute
Inflammation / 42
The Consequences of Acute Inflammation / 43

4

Repair: Recovery from Injury / 51
Definitions / 52
Replacement of Injured Cells / 52
The Importance of Tissue Structure / 55
The Control of Cell Reproduction and Tissue
Growth / 56
Wound Healing and Fibrous Repair / 56
Cell Migration into the Wound / 57
The Growth of New Blood Vessels / 57
Scar Development / 57
Healing by First Intention / 58
Healing by Second Intention / 59
Abnormal Wound Healing / 61
Host Factors Interfering with Wound Healing / 61
Pathologic Wound Healing / 61
Overview of Injury, Inflammation, and Repair / 62

5

Disorders of Fluid Balance and Blood Flow / 65
Back to Basics / 66
Blood Pressure / 66
Osmotic Pressure / 67
The Circulation of Blood and Lymph / 68
The Anatomy of Blood Vessels and Lymphatics / 69
Body Water and Fluid Compartments / 69
Edema / 72
Low-protein Edema / 73
High-protein Edema / 74

Clinical Aspects of Edema / 74
Hyperemia and Congestion / 74
Hemorrhage, Thrombosis, and Embolism / 75
Hemorrhage / 75
Thrombosis / 76
Embolism / 79
Blood Flow Obstruction / 80
Infarction / 80
The Development of an Infarct / 81
The Collapse of Circulation: Shock / 81
Types of Shock / 81
Stages of Shock / 82


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6

7

Neoplasms / 86
The Language of Neoplasia / 87

Types of Neoplasms / 89
The Molecular and Genetic Basis of Neoplasia / 90
Mutations / 90
Cell Growth Control Genes / 90
DNA Repair / 91
The Causes of Cancer / 91
The Structure of Neoplasms / 92
The Gross Anatomy of Neoplasms / 92
The Microscopic Anatomy of Neoplasms / 93
Premalignant States and Conditions / 94
The Biology of Neoplastic Growth / 95
The Differentiation of Tumor Cells / 95
Clones of Cells / 96
The Speed of Tumor Growth / 96
The Nourishment of Tumors / 97
Tumor Cell Variation / 98
The Spread of Neoplasms / 98
The Immune Defense Against Neoplasia / 99
The Epidemiology of Cancer / 100
The Clinical Picture of Cancer / 101
Clinical and Laboratory Assessment of Neoplasms / 101
Clinical History / 101
Obtaining Tissues and Cells for Diagnosis / 102
Grading and Staging of Malignancies / 103
Early Detection of Cancer / 105
Tumor Markers / 106

Hemolytic Disease of the Newborn
(Erythroblastosis Fetalis) / 137
Cystic Fibrosis / 138

Tumors and Tumor-like Conditions of Children / 139

8

Diseases of the Immune System / 144
Back to Basics / 145
Nonimmune Defense Mechanisms / 145
The Normal Immune System / 147
Immunity in Blood Transfusion / 152
Classification of Immune Disease / 153
Mechanisms of Immune Reaction / 153
Type 1 Immune Reaction: Immediate
Hypersensitivity / 154
Type 2 Immune Reaction: Cytotoxic
Hypersensitivity / 154
Type 3 Immune Reaction: Immune-complex Hypersensitivity / 154
Type 4 Immune Reaction: Cellular (Delayed) Hypersensitivity / 158
Hypersensitivity Disease / 159
Allergic Disease / 159
Autoimmune Disease / 159
Immunity in Organ and Tissue Transplantation / 164
Immunity in Blood Transfusion / 165
Amyloidosis / 167
Immunodeficiency Diseases / 167
Inherited Immunodeficiency Diseases / 167
Acquired Immunodeficiency Syndrome (AIDS) / 168
Malignancies of Immune Cells / 172

9

Infectious Disease / 176
Back to Basics / 177
Infection / 182
Contagion / 184
The Spread of Organisms in Tissue / 185
Mechanisms of Microbiologic Injury / 186
The Inflammatory Response to Infection / 186
Infections of Organ Systems / 186
Respiratory Infections / 186
Gastrointestinal Infections / 188
Genitourinary Infections / 189
Skin Infections / 191
Infections by Pyogenic Bacteria / 191
Infections by Clostridium Organisms and Other Necrotizing
Agents / 193
Opportunistic and AIDS-related Infections / 193
Tropical, Vector-borne, and Parasite Infections / 194
Vector-borne Infections / 195
Parasitic Infections / 195
The Natural Course of an Infection / 197
Signs and Symptoms of Infection / 199
Laboratory Tools / 199

10

Disorders of Daily Life and Diet / 205

Developmental, Genetic, and Pediatric Disease / 110
Section 1: Developmental Abnormalities / 111
Embryologic Development / 112

Congenital Malformations / 114
Congenital Deformations / 115
Section 2: Genetic Disorders / 116
Mutations / 118
The Broad Influence of Genetics in Disease / 118
Disease of Single Genes (Monogenic Disorders) / 119
Disease Caused by Defective Dominant Autosomal
Genes / 120
Disease Caused by Defective Recessive Autosomal
Genes / 121
Disease Caused by Defective Genes on Sex Chromosomes / 122
Clinical Expression of Single-Gene Defects / 122
Cytogenetic Diseases / 125
Disease Associated with Abnormal Numbers of Autosomes / 126
Disease Associated with Abnormal Numbers of Sex
Chromosomes / 129
Genetic Diagnosis / 130
Section 3: Pediatric Diseases / 132
Perinatal and Neonatal Disease / 132
Intrauterine Growth Restriction / 134
Prematurity / 134
Birth Injury / 136
Fetal and Newborn Infections / 136
Infections in Children / 136
Sudden Infant Death Syndrome (SIDS) / 137

xxi

Injury Resulting from Trauma / 207
Injury Resulting from Extremes of Temperature / 208

Thermal Burns / 208
Cold Injury / 209
Heat Cramps, Heat Exhaustion, and Heat
Stroke / 209


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Pollution and Occupational Disease / 210
Exposure to Toxic Materials / 211
Chemicals / 211
Adverse Reactions to Therapeutic Drugs / 213
Radiation / 215
Inhalant Lung Disease / 215
Tobacco, Alcohol, and Drugs / 216
Cigarette Smoking / 216
Alcohol Abuse / 217
Drug Abuse / 219
Nutritional Disease / 221
Malnutrition / 221

Obesity / 222
The Metabolic Syndrome / 227

The Pathologic Anatomy of Atherosclerosis / 280
Clinical Manifestations of Atherosclerosis / 281
Hypertension / 282
Types of Hypertension / 283
Pathogenesis of Hypertension / 283
The Pathology of Hypertension / 283
Clinical Aspects of Hypertension / 284
Aneurysms and Dissections / 285
Vasculitis / 286
Raynaud Phenomenon / 286
Diseases of Veins / 287
Tumors of Blood and Lymphatic Vessels / 287

13

Back to Basics / 293
The Normal Heart / 293
The Coronary Circulation / 294
The Cardiac Cycle / 295
Arrhythmias / 297
Congestive Heart Failure / 298
Pathophysiology / 298
Etiology / 300
Clinical Features / 300
Ischemic Heart Disease (Coronary Artery Disease) / 302
Epidemiology of Ischemic Heart Disease / 302
Causes of Coronary Ischemia / 303

Angina Pectoris / 304
Myocardial Infarction / 304
Chronic Myocardial Ischemia / 307
Sudden Cardiac Death / 308
Hypertensive Heart Disease / 309
Valvular Heart Disease / 309
Rheumatic Heart Disease / 309
Calcific Aortic Stenosis / 310
Myxomatous Degeneration of the Mitral Valve / 312
Endocarditis / 312
Nonbacterial Thrombotic Endocarditis / 312
Infective Endocarditis / 313
Primary Myocardial Diseases / 314
Myocarditis / 314
Cardiomyopathies / 314
Congenital Heart Disease / 315
Malformations With Shunts / 315
Malformations With Obstruction to Flow / 318
Pericardial Disease / 319

PART 2 DISEASES OF ORGAN SYSTEMS
11

Diseases of Blood Cells and Blood Coagulation / 234
Section 1: Diseases of Blood Cells / 235
Back to Basics / 235
Normal Blood Production (Hematopoiesis) / 236
Cell Compartments and Life Span / 236
Laboratory Assessment of Blood Cells / 237
Too Little Hemoglobin (Anemia) / 240

The Anemia of Hemorrhage / 240
Anemia of Red Cell Destruction
(Hemolytic Anemias) / 241
Anemia of Insufficient Red Cell Production / 245
Too Many Red Cells—Polycythemia / 248
Too Few White Cells—Leukopenia and
Agranulocytosis / 249
Too Many White Cells—Benign and Malignant Disorders of
Leukocytes / 249
Peripheral Leukocyte Responses to Infection or
Injury / 250
Lymph Node Response to Injury or Infection / 251
Lymphoid Neoplasms / 252
Myeloid Neoplasms / 257
Disorders of the Spleen and Thymus / 260
Section 2: Bleeding Disorders / 260
Back to Basics / 260
Bleeding Disorders / 263
Vascular or Platelet Deficiency / 264
Coagulation Factor Deficiency / 264
Disseminated Intravascular Coagulation (DIC) / 265
Thrombotic Disorders / 266

12

Diseases of Blood Vessels / 270
Back to Basics / 271
The Normal Vascular System / 271
Regulation of Blood Pressure / 273
Lipid Classification and Metabolism / 275

Desirable Plasma Lipid Concentrations / 275
Nomenclature of Blood Vessel Disease / 277
Atherosclerosis / 277
The Causes and Consequences of
Atherosclerosis / 277
The Pathogenesis of Atherosclerosis / 278
Risk Factors for Atherosclerosis / 279

Diseases of the Heart / 292

14

Diseases of the Respiratory System / 324
Back to Basics / 325
The Normal Respiratory Tract / 325
Lung Volume, Air Flow, and Gas Exchange / 328
Diseases of the Upper Respiratory Tract / 330
Atelectasis (Collapse) / 330
Obstructive Lung Disease / 331
Asthma / 331
Chronic Obstructive Pulmonary Disease (COPD) / 332
Restrictive Lung Disease / 335
Interstitial Fibrosis without Granulomatous Inflammation / 336
Interstitial Fibrosis with Granulomatous
Inflammation / 336


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Hepatitis C Virus (HCV) Infection / 406
Hepatitis D Virus (HDV) Infection / 406
Hepatitis E virus (HEV) Infection / 406
The Anatomic Pathology of Hepatitis /407
Autoimmune Hepatitis / 407
Liver Abscess / 408
Toxic Liver Injury / 408
Alcoholic Liver Disease / 408
Fatty Liver / 409
Alcoholic Hepatitis / 410
Alcoholic Cirrhosis / 410
Inherited Metabolic and Pediatric Liver Disease / 410
Hemochromatosis / 410
Wilson Disease / 412
Hereditary Alpha-1 Antitrypsin Deficiency / 412
Neonatal Cholestasis, Biliary Atresia, and
Hepatitis / 412
Reye syndrome / 412
Disease of Intrahepatic Bile Ducts / 413
Primary Biliary Cirrhosis / 413
Primary Sclerosing Cholangitis / 413
Circulatory Disorders / 413
Tumors of the Liver / 414

Primary Carcinomas of the Liver / 414
Cholangiocarcinoma / 415
Diseases of the Gallbladder and Extrahepatic Bile
Ducts / 415
Diseases of the Gallbladder / 415
Diseases of Extrahepatic Bile Ducts / 417

Vascular and Circulatory Lung Disease / 336
Pulmonary Edema / 337
Pulmonary Thromboembolism / 337
Pulmonary Hypertension / 337
Adult Respiratory Distress Syndrome / 338
Pulmonary Infections / 339
Pneumonia / 339
Lung Abscess / 341
Pulmonary Tuberculosis / 341
Pulmonary Fungus Infections (Deep Mycoses) / 345
Other Lung Infections / 346
Lung Neoplasms / 347
Bronchogenic Carcinoma / 347
Bronchial Carcinoid Tumor / 349
Diseases of the Pleura / 349

15

Diseases of the Gastrointestinal Tract / 354
Back to Basics / 355
The Mouth and Esophagus / 358
The Stomach / 358
The Small Intestine / 358

The Large Bowel / 359
Intestinal Bacteria / 359
Intestinal Bleeding / 359
Intestinal Obstruction and Ileus / 361
Diseases of the Oral Cavity / 361
Diseases of Salivary Glands / 365
Diseases of the Esophagus / 365
Diseases of the Stomach / 367
Gastritis / 367
Gastric and Duodenal Ulcers / 367
Carcinoma of the Stomach / 369
Nonneoplastic Diseases of the Small Bowel and Large
Bowel / 369
Congenital Anomalies / 369
Vascular Diseases / 370
Diarrheal Diseases / 371
Malabsorption Syndromes / 374
Inflammatory Bowel Disease / 374
Colonic Diverticulosis and Other Conditions / 377
Peritonitis / 379
Neoplasms of the Large and Small Bowel / 379
Nonneoplastic Polyps / 380
Neoplastic Polyps (Adenomas) / 380
Carcinoma of the Colon / 381
Diseases of the Appendix / 384

16

Diseases of the Liver and Biliary Tract / 389
Back to Basics / 390

Liver Anatomy / 392
Liver Function / 392
The Liver Response to Injury / 394
Anatomic Patterns of Liver Injury / 394
Functional Patterns of Liver Injury / 394
Cirrhosis / 397
Anatomic Types of Cirrhosis / 398
The Pathophysiology of Cirrhosis / 398
Clinical Features of Cirrhosis / 398
Viral Hepatitis / 401
Clinicopathologic Syndromes / 402
Hepatitis A Virus (HAV) Infection / 402
Hepatitis B Virus (HBV) Infection / 404

17

Diseases of the Pancreas / 422
Back to Basics / 423
The Digestive (Exocrine) Pancreas / 423
The Hormonal (Endocrine) Pancreas / 424
Diseases of the Digestive (Exocrine) Pancreas / 427
Pancreatitis / 427
Carcinoma of the Pancreas / 431
Diseases of the Hormonal (Endocrine) Pancreas / 433
Diabetes Mellitus / 433
Pancreatic Endocrine Neoplasms / 442

18

Diseases of Endocrine Glands / 448

Back to Basics / 449
Homeostasis / 449
The Pituitary Gland / 450
The Thyroid Gland / 452
The Parathyroid Glands / 453
The Adrenal Glands / 454
Diseases of the Pituitary Gland / 455
Diseases Affecting the Anterior Pituitary / 455
Disease of the Posterior Pituitary / 458
Diseases of the Thyroid Gland / 459
Overactivity of the Thyroid Gland
(Hyperthyroidism) / 459
Underactivity of the Thyroid Gland
(Hypothyroidism) / 462
Goiter / 463
Thyroiditis / 463
Neoplasms of the Thyroid Gland / 464
Diseases of the Parathyroid Glands / 465
Overactivity of the Parathyroid Glands (Hyperparathyroidism) / 465

xxiii