Fundamentals of Applied Pathophysiology 2nd edition by Muralitharan Nair Ian Peate 9781118502372 111850237X

1 Cell and body tissue physiology

Contents

Key words

Test your prior knowledge

Learning outcomes

Introduction

Anatomy of the cell

Figure 1.1 Simplified structure of a cell.

The cell membrane

Figure 1.2 The cell membrane.

Functions

Figure 1.3 Endocytosis.

Transport across the cell membrane

Figure 1.4 Osmosis.

Figure 1.5 Osmosis and movement of solute.

Cytoplasm

Role of cytoplasm

Nucleus

Figure 1.12 Types of cells.

Mitosis and meiosis

Mitosis

Prophase

Figure 1.6 Prophase.

Metaphase

Figure 1.7 Metaphase.

Anaphase

Figure 1.8 Anaphase.

Telophase

Figure 1.9 Telophase.

Cell cycle

Figure 1.10 Cell cycle.

Meiosis

Table 1.1 Stages of meiosis.

First meiotic stage

Prophase I

Metaphase I

Anaphase I

Telophase I

Second meiotic stage

Fusion of the gametes

The organelles

Endoplasmic reticulum

Figure 1.11 Endoplasmic reticulum (ER).

Golgi apparatus

Lysosomes

Peroxisomes

Mitochondria (single = mitochondrion)

Cytoskeleton

Microfilaments

Microtubules

Intermediate filaments

Centrioles, cilia and flagella

Centrioles

Cilia and flagella

Types of cells

Tissues

Epithelial tissue

Figure 1.13 Simple epithelium.

Figure 1.14 Stratified epithelium.

Figure 1.15 Epithelial cells classified according to shape.

Glandular epithelium

Connective tissue

Bone

Cartilage

Dense connective tissue

Loose connective tissue

Areolar tissue

Adipose tissue

Reticular connective tissue

Blood

Muscle tissue

Skeletal muscle

Cardiac muscle

Smooth muscle

Figure 1.16 Peristalsis.

Nervous tissue

Tissue repair

Conclusion

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Activities

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Glossary of terms

References

2 Cancer

Contents

Key words

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Learning outcomes

Introduction

Biology of cancer

Figure 2.1 Apoptosis (Cell Migration Lab, University of Reading, https://www.reading.ac.uk/cellmigration/apoptosis.htm).

Figure 2.2 Molecular biology model (after King, 2000).

Figure 2.3 Clinical model (after King, 2000).

Causes of cancer

Genes

Environmental factors

Radiation

Smoking

Diet

Alcohol

Sexual and reproductive behaviour

Environmental pollution

Occupation

Hormones

Oral contraceptives

Male hormones

Viruses

Staging of cancers

Figure 2.4 Common sites and symptoms of cancer metastasis.

Signs and symptoms of cancer

Treatment of cancer

Drug therapy

Side effects

Radiation therapy

Immunotherapy

Surgical removal

Hormonal therapy

Photodynamic therapy

Gene therapy

Prevention of cancer

Examples of cancers

Acute lymphoblastic leukaemia

Case study

Treatment and prognosis

Lung cancer

Case study

Breast cancer

Figure 2.5 Diagram of breast showing lobules and ducts.

Figure 2.6 Symptoms of breast cancer.

Conclusion

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Activities

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Further resources

BMC Cancer

British Cancer Journal

Cancer Research UK

Cancer Symptoms

Inside Cancer

Glossary of terms

References

3 Inflammation, immune response and healing

Contents

Key words

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Learning outcomes

Introduction

Infectious micro-organisms

Spread of infection

Droplet spread

Air currents (airborne transmission)

Aerosol transmission

Water transmission

Contact transmission

Soil

Inoculation

Faecal-oral route

Vector transmission

Contaminated intermediates

Case study

Types of infectious micro-organisms

Bacteria

Figure 3.1 Shapes of bacteria.

Cocci

Bacilli

Spiral

Bacterial reproduction

Figure 3.2 Bacterial reproduction – simple fission.

Viruses

Infection of host cells

Figure 3.3 Viral replication.

Fungi

Figure 3.4 Typical fungi shapes. (a) Cryptococcus neoformans, (b) Candida albicans, (c) Microsporum canis, (d) Histoplasma capsulatum, (e) Epidermophyton floccosum, (f) Trichophyton mentagrophytes, (g) Aspergillus fumigatus, (h) ringworm infection of the hair.

Protozoa

Rickettsiae, chlamydiae and mycoplasmas

Rickettsiae

Chlamydiae

Mycoplasmas

Helminths

Transmission

Case study

The immune system

Organs, cells and proteins of the immune system

The lymphatic system

Figure 3.5 The lymphatic system.

Lymphoid tissue

Figure 3.6 Lymph node.

Other lymphoid organs

Types of immunity

Non-specific immunity

Physical barriers

Mechanical barriers

Chemical barriers

Blood cells

Phagocytic cells

Figure 3.7 Phagocytosis.

Mediator cells

Specific immunity

Immune problems

Inflammatory response

Figure 3.8 The inflammatory process.

Summary of inflammation

Conclusion

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Further resources

AVERT

CELLS alive!

National Resource for Infection Control (NRIC)

The Biology Project

The Department of Health (DH)

HIV tutorial (University of Utah)

Department of Health – E. coli outbreak

Glossary of terms

References

4 Shock

Contents

Key words

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Learning outcomes

Introduction

Case study

Types of shock

Table 4.1 Types of shock and common causative factors (Docherty and Hall, 2002).

Hypovolaemic shock

Figure 4.1 Hypovolaemic shock.

Cardiogenic and obstructive shock

Distributive shock

Figure 4.2 Distributive shock.

Case study

Anaphylactic shock

Septic shock

Neurogenic (vasogenic) shock

Pathophysiology of shock

Table 4.2 A summary of the clinical presentation of different types of shock.

Stages of shock

Stage 1: Compensatory (non-progressive) stage of shock

Neural compensatory mechanisms

Hormonal compensatory mechanisms

Figure 4.3 Renin–angiotensin mechanism.

Chemical compensatory mechanisms

Stage 2: Progressive (decompensated) stage of shock

Stage 3: Irreversible (refractory) stage of shock

Table 4.3 Physiological changes that occur at each stage of shock (adapted from Sole et al., 2008).

Care of the patient in shock

Pharmacological management of shock

Table 4.4 Common drugs used to manage shock (adapted from Sole et al., 2008).

Table 4.5 Additional management of shock according to type.

Conclusion

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Further resources

Resuscitation Council (UK)

NHS Clinical Knowledge Summaries

Trauma and shock factsheet

Toxic shock syndrome

Food Allergy & Anaphylaxis Network (FAAN)

British Society for Allergy and Clinical Immunology

Glossary of terms

References

5 The heart and associated disorders

Contents

Key words

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Learning outcomes

Introduction

Location of the heart

Figure 5.1 Location of the heart.

Structures of the heart

Figure 5.2 The cardiac muscle.

Chambers of the heart

Figure 5.3 The chambers and the valves of the heart.

Valves of the heart

Vessels of the heart

Figure 5.4 The vessels of the heart.

Table 5.1 Summary of the vessels and their functions.

Blood flow through the heart

Figure 5.5 Blood flow through the heart. The arrows indicate the direction of blood flow.

Conducting systems of the heart

Figure 5.6 The conducting system of the heart.

The SA node

The AV node

Bundle of His

Right and left bundle branches

Purkinje fibres

Nerve supply of the heart

Figure 5.7 The cardioregulatory centre.

Diseases of the heart

Learning outcomes

Case study

Myocardial infarction

Figure 5.8 Myocardial infarction.

Aetiology

Investigations

Pathophysiology

Signs and symptoms

Care and management

Pharmacological and non-pharmacological treatment

Heart failure/congestive heart failure

Case study

Aetiology

Pathophysiology

Investigations

Pathophysiology of right heart failure

Signs and symptoms of right heart failure

Pathophysiology of left heart failure

Left heart failure (backward effects)

Left heart failure (forward effects)

Signs and symptoms of left heart failure

Care and management

Pharmacological and non-pharmacological treatment

Cardiogenic shock

Aetiology

Investigations

Pathophysiology

Figure 5.9 Vicious cycle of cardiogenic shock.

Signs and symptoms

Care and management

Pharmacological interventions

Angina

Investigations

Pathophysiology

Figure 5.10 Blockage of the coronary arteries.

Types of angina

Signs and symptoms

Care and management

Non-pharmacological interventions

Pharmacological interventions

Conclusion

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Further resources

Online nutritional information and facts

NHS Choices

BUPA

National Institute for Health and Clinical Excellence (NICE)

Department of Health – Policy, guidance and publications for NHS and social care professionals

Glossary of terms

References

6 The vascular system and associated disorders

Contents

Key words

Test your prior knowledge

Learning outcomes

Introduction

Figure 6.1 Blood flow.

Overview of blood vessels

Structure of the blood vessels

Figure 6.2 Structures of an artery and a vein.

Arteries

Figure 6.3 Elastic recoil of the aorta.

Figure 6.4 Capillaries.

Capillaries

Venules

Veins

Figure 6.5 Bicuspid valves of a vein.

Blood pressure

Factors that can affect blood pressure

Diseases of the blood vessels

Case study

Atherosclerosis/arteriosclerosis

Aetiology

Investigations

Pathophysiology of atherosclerosis

Figure 6.6 Atheroma build-up in an artery.

Table 6.1 Effects of atherosclerosis on different sites.

Signs and symptoms of atherosclerosis

Care and management

Pharmacological interventions for atherosclerosis

Hypertension

Note

Aetiology

Investigations

Common presenting symptoms

Pathophysiology

Primary hypertension

Secondary hypertension

Malignant hypertension

Isolated systolic hypertension

Non-pharmacological interventions

Pharmacological interventions

Aneurysm

Figure 6.7 (a) A dissecting aneurysm; (b) a fusiform aneurysm; and (c) a saccular aneurysm.

Aetiology

Investigations

Symptoms

Care and management

Figure 6.8 Dacron graft for an abdominal aortic aneurysm. Synthetic graft used for surgery. Reproduced with permission from Vascutek.

Pharmacological interventions

Case study

Peripheral vascular disease

Aetiology

Investigations

Arterial insufficiency

Pathophysiology

Table 6.2 Comparison between an arterial and venous insufficiency.

Signs and symptoms

Care and management

Figure 6.9 Dacron graft for peripheral vascular disease. Synthetic graft used for surgery. Reproduced with permission from Vascutek.

Pharmacological interventions

Venous insufficiency/varicose veins

Figure 6.10 Varicose veins.

Figure 6.11 Calf-muscle pump.

Veins affected with varicosity

Figure 6.12 Veins of the leg susceptible to varicosity.

Signs and symptoms

Complications

Figure 6.13 (a) Venous ulcer; (b) venous eczema; and (c) lipodermatosclerois.

Care and management

Deep vein thrombosis

Figure 6.14 Formation of thrombosis.

Aetiology

Pathophysiology

Figure 6.15 Formation of a platelet plug.

Figure 6.16 Formation of a clot.

Signs and symptoms

Care and management

Pharmacological interventions

Conclusion

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Further resources

Patient UK

Scottish Intercollegiate Guidelines (SIGN)

National Institute for Health and Clinical Excellence (NICE)

Department of Health (DH)

British Hypertension Society

British Heart Foundation

Glossary of terms

References

7 The blood and associated disorders

Contents

Key words

Test your prior knowledge

Learning outcomes

Introduction

Figure 7.1 Components of blood.

Composition of blood

Figure 7.2 Cells of the blood.

Properties of blood

Functions of blood

Transportation

Regulation

Protection

Plasma

Water in plasma

Plasma proteins

Albumin

Globulins

Fibrinogen

Plasma electrolytes

Gases

Nutrients and waste products of metabolism

Formed elements of blood

Red blood cells

Figure 7.3 Red blood cell.

Haemoglobin

Figure 7.4 Haemoglobin molecule.

Formation of red blood cells

Figure 7.5 Formation of blood cells.

Transport of respiratory gases

Destruction of red blood cells

Figure 7.6 Haemolysis of red blood cells.

White blood cells

Neutrophils

Eosinophils

Basophils

Monocytes

Lymphocytes

Platelets

Haemostasis

Vasoconstriction

Platelet aggregation

Coagulation

Table 7.1 Blood clotting factors.

Blood groups

Figure 7.7 ABO blood groups.

Table 7.2 Blood groups.

Rhesus factor

Diseases of the blood

Learning outcomes

Case study

Anaemia

Microcytic anaemia

Iron deficiency anaemia

Aetiology

Investigations

Pathophysiology

Signs and symptoms

Care and management

Pharmacological interventions

Macrocytic anaemia

Aetiology

Folate deficiency

Aetiology

Symptoms

Vitamin B12 deficiency

Aetiology

Symptoms

Care and management of macrocytic anaemia

Normocytic anaemia

Aplastic anaemia

Aetiology

Pathophysiology

Symptoms

Care and management

Pharmacological interventions

Haemolytic anaemia

Aetiology

Pathophysiology

Signs and symptoms

Care and management

Sickle cell anaemia

Figure 7.8 Sickled red blood cell.

Pathophysiology

Figure 7.9 Sickle cell in microcirculation.

Symptoms

Care and management

Leukaemia

Case study

Aetiology

Pathophysiology

Symptoms

Care and management

Pharmacological and non-pharmacological interventions

Thrombocytopenia

Aetiology

Pathophysiology

Signs and symptoms

Care and management

Pharmacological and non-pharmacological interventions

Conclusion

Test your knowledge

Activities

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Further resources

Contact a Family

National Institute for Health and Clinical Excellence (NICE) – Treatment for chronic myeloid leukaemia

National Institute for Health and Clinical Excellence (NICE) – Treatment of anaemia in patients with chronic kidney disease

Sheffield NHS

Biomedical Central

National Heart, Lung and Blood Institute

Glossary of terms

References

8 The renal system and associated disorders

Contents

Key words