Understanding Pathophysiology

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
Pathophysiology
Clinical manifestations
EVALUATION and TREATMENT
Inflammatory disorders of the gastrointestinal tract
Ulcerative colitis
Pathophysiology
Clinical manifestations
Crohn’s disease
Pathophysiology
Clinical manifestations
Evaluation and treatment of inflammatory bowel disease
Irritable bowel syndrome
Pathophysiology
Clinical manifestations
Evaluation and treatment
Diverticular disease
Pathophysiology
Clinical manifestations
Evaluation and treatment
Appendicitis
Pathophysiology
Clinical manifestations
Evaluation and treatment
Gastritis
Peptic ulcer disease
Gastric ulcers
Pathophysiology
Clinical manifestations
Duodenal ulcers
Pathophysiology
Clinical manifestations
Stress ulcers
Evaluation and treatment of peptic ulcer disease
Nutritional disorders
Lactose intolerance
Pathophysiology
Clinical manifestations
Evaluation and treatment
Coeliac disease
Pathophysiology
Clinical manifestations
Evaluation and treatment
Malnutrition
Starvation
Obesity
Disorders of motility
Gastro-oesophageal reflux and GORD
Pathophysiology
Clinical manifestations
Evaluation and treatment
Faecal incontinence
Structural abnormalities of the gastrointestinal tract
Hiatal hernia
Pathophysiology
Clinical manifestations
Evaluation and treatment
Intestinal obstruction
Clinical manifestations of gastrointestinal tract alterations
Vomiting
Pathophysiology
Clinical manifestations
Treatment
Nausea
Constipation
Pathophysiology
Clinical manifestations
Evaluation and treatment
Diarrhoea
Pathophysiology
Clinical manifestations
Evaluation and treatment
Dysphagia
Clinical manifestations
Evaluation and treatment
Anorexia
Gastrointestinal bleeding
Disorders of the hepatobiliary system and pancreas
Hepatic disorders
Inflammatory processes of the liver
Non-alcoholic liver disease
Alcoholic liver disease
Pathophysiology of non-alcoholic and alcoholic liver disease
Clinical manifestations of non-alcoholic and alcoholic liver disease
EVALUATION and TREATMENT of non-alcoholic and alcoholic liver disease
Viral hepatitis
Pathophysiology
Clinical manifestations
Evaluation and treatment
Hepatic cancer
Pathophysiology
Clinical manifestations
Evaluation and treatment
Clinical manifestations of hepatobiliary alterations
Portal hypertension
Pathophysiology
Clinical manifestations
Evaluation and treatment
Ascites
Pathophysiology
Clinical manifestations
Evaluation and treatment
Hepatic encephalopathy
Pathophysiology
Clinical manifestations
Evaluation and treatment
Jaundice
Pathophysiology
Clinical manifestations
Evaluation and treatment
Biliary disorders
Cholelithiasis
Pathophysiology
Clinical manifestations
Evaluation and treatment
Cholecystitis
Pancreatic disorders
Pancreatitis
Acute pancreatitis
Pathophysiology
Clinical manifestations
Evaluation and treatment
Chronic pancreatitis
Pancreatic cancer
Pathophysiology
Clinical manifestations
Evaluation and treatment
Review questions
28 The structure and function of the urinary system
Chapter outline
Key terms
Introduction
The structure of the kidneys
External anatomy
Internal anatomy
The nephrons
The glomerular filtration membrane
Blood supply to the kidneys and nephrons
The juxtaglomerular apparatus
The function of the kidneys
Urine formation
Glomerular filtration
Tubular reabsorption
The proximal convoluted tubule
The loop of henle
The distal convoluted tubule and collecting duct
Tubular secretion
Urine concentration
Antidiuretic hormone
Aldosterone
Atrial natriuretic peptide
Diuretics as a factor in urine flow
Renal hormones
Urodilatin
Vitamin D
Erythropoietin
Glomerular filtration rate
Intrinsic control
Extrinsic control
Sympathetic nervous system control
The renin-angiotensin- aldosterone system
Urine
Acidification of urine
Measures of renal function
Urinalysis
Urea
Creatinine
Urinary structures
The ureters
The bladder
The urethra
Micturition
Review questions
29 Fluids and electrolytes, acids and bases
Chapter outline
Key terms
Introduction
Fluid balance
The distribution of body fluids
Water intake and output
Water movement between the plasma and interstitial fluid
Water movement between the interstitial fluid and intracellular fluid
Alterations in water movement
Oedema
Pathophysiology
Clinical manifestations
Evaluation and treatment
Fluid spacing
Water balance
Electrolyte balance
Sodium, chloride and potassium balance
Sodium
Chloride
Potassium
Alterations in sodium, chloride and water balance
Isotonic alterations
Hypovolaemia
Hypervolaemia
Hypertonic alterations
Hypernatraemia
Pathophysiology
Clinical manifestations
Evaluation and treatment
Water deficit
Pathophysiology
Clinical manifestations
Evaluation and treatment
Hypotonic alterations
Hyponatraemia
Pathophysiology
Clinical manifestations
Evaluation and treatment
Water excess
Pathophysiology
Clinical manifestations
Evaluation and treatment
Alterations in potassium balance
Hypokalaemia
Pathophysiology
Clinical manifestations
Evaluation and treatment
Hyperkalaemia
Pathophysiology
Clinical manifestations
Evaluation and treatment
Calcium, phosphate and magnesium
Calcium
Hypercalcaemia
Hypocalcaemia
Phosphate
Hypophosphataemia
Magnesium
Hypomagnesaemia
Acid–base balance
Acid and pH
Buffer systems
Protein buffering
Carbonic acid–bicarbonate buffering
Respiratory buffering
Renal buffering
Acid–base imbalances
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Review questions
30 Alterations of renal and urinary tract function across the life span
Chapter outline
Key terms
Introduction
Urinary tract obstruction
Upper urinary tract obstruction
Kidney stones
Pathophysiology
Clinical manifestations
Evaluation and treatment
Lower urinary tract obstruction
Neurogenic bladder
Overactive bladder syndrome
Obstructions to urine flow
Evaluation and treatment
Urinary tract infection
Causes of urinary tract infection
Types of urinary tract infection
Acute cystitis
Pathophysiology
Clinical manifestations
Evaluation and treatment
Painful bladder syndrome/interstitial cystitis
Acute pyelonephritis
Pathophysiology
Clinical manifestations
Evaluation and treatment
Chronic pyelonephritis
Pathophysiology
Clinical manifestations
Evaluation and treatment
Glomerular disorders
Glomerulonephritis
Types of glomerulonephritis
Acute glomerulonephritis
Chronic glomerulonephritis
Pathophysiology of glomerulonephritis
Clinical manifestations of glomerulonephritis
Evaluation and treatment of glomerulonephritis
Nephrotic syndrome
Pathophysiology
Clinical manifestations
Evaluation and treatment
Chronic kidney disease
Stages of chronic kidney disease
Pathophysiology
Clinical manifestations
Creatinine and urea clearance
Fluid and electrolyte balance
Calcium, phosphate, and bone
Protein, carbohydrate, and fat metabolism
Musculoskeletal system
Cardiovascular system
Pulmonary system
Haematological system
Immune system
Neurological system
Digestive system
Endocrine and reproductive systems
Integumentary system
Evaluation and treatment
Acute kidney injury
Pathophysiology
Clinical manifestations
Evaluation and treatment
Tumours
Renal tumours
Pathogenesis
Clinical manifestations
Evaluation and treatment
Bladder tumours
Pathogenesis
Clinical manifestations
Evaluation and treatment
Review questions
31 The structure and function of the reproductive systems
Chapter outline
Key terms
Introduction
The structure and function of the male reproductive system
External structures
Testes
Penis
Internal structures
Spermatic ducts
Accessory glands
The structure and function of the female reproductive system
External structures
Internal structures
Vagina
Uterus, cervix and uterine tubes
Ovaries
Breast structure
Puberty in males and females
The effects of testosterone in males
The effects of oestrogen and progesterone in females
Gametogenesis
General principles
Meiosis
Spermatogenesis
Oogenesis
The ovarian cycle
The uterine (menstrual) cycle
Ovarian and uterine cycle timing
Male and female sexual responses
The female sexual response
The male sexual response
Conception, gestation and parturition
Fertilisation
Implantation
The development and function of the placenta
Fetal placental circulation
Maternal placental circulation
Transfer (exchange) across the placenta
The embryonic sac
The origin, composition and significance of amniotic fluid
The mother’s adaptations to pregnancy
Weight gain
Endocrine changes
Changes in reproductive and other organs during gestation
Uterus
Cervix
Breasts
Respiratory changes
Cardiovascular changes
Water and electrolytes
Nutrition and metabolism
Fetal development
Development of the reproductive systems in utero
The immune system of the fetus
The neonate
Changes in the cardiovascular system at birth
Changes in the respiratory system at birth
Changes in liver function at birth
Review questions
32 Alterations of the reproductive systems across the life span
Chapter outline
Key terms
Introduction
Classification of reproductive system alterations
Growths
The endocrine system
The reproductive system
Cancer
Cancers of the female reproductive system
Breast cancer
Risk factors
Reproductive factors
Hormonal factors
Environmental factors
Familial factors
Pathogenesis
Clinical manifestations
Evaluation and treatment
Cervical cancer
Ovarian cancer
Cancers of the male reproductive system
Prostate cancer
Risk factors
Diet
Hormones
Chronic inflammation
Familial factors
Pathogenesis
Clinical manifestations
Evaluation and treatment
Testicular cancer
Pathophysiology
Clinical manifestations
Evaluation and treatment
Disorders of the female reproductive system
Benign growths and proliferative conditions
Benign ovarian cysts
Endometrial polyps
Leiomyomas
Pathophysiology
Clinical manifestations
Evaluation and treatment
Adenomyosis
Endometriosis
Polycystic ovary syndrome
Pathophysiology
Clinical manifestations
Evaluation and treatment
Hormonal and menstrual alterations
Dysmenorrhoea
Amenorrhoea
Abnormal uterine bleeding
Premenstrual syndrome
Pathophysiology
Clinical manifestations
Evaluation and treatment
Infection and inflammation
Pelvic inflammatory disease
Vaginitis
Cervicitis
Vulvitis
Bartholinitis
Pelvic relaxation disorders
Reproductive and sexual dysfunction
Disorders of the male reproductive system
Disorders of the urethra
Urethritis
Urethral strictures
Disorders of the penis
Phimosis and paraphimosis
Peyronie’s disease
Priapism
Disorders of the scrotum, testis and epididymis
Disorders of the scrotum
Cryptorchidism
Torsion of the testis
Orchitis
Impairment of sperm production and quality
Epididymitis
Disorders of the prostate gland
Benign prostatic hyperplasia
Prostatitis
Bacterial prostatitis
Non-bacterial prostatitis
Sexual dysfunction
Disorders of the breast
Disorders of the female breast
Disorders of the male breast
Fertility
Control of fertility
Surgical sterilisation
Barrier methods
Hormonal methods
Other methods of contraception
The failure of contraception
Impaired fertility
Assisted reproductive technologies
Major sexually transmitted infections
Gonorrhoea
Syphilis
Chlamydia trachomatis
Herpes simplex virus
Human papillomavirus
Human immunodeficiency virus
Other infections
Review questions
Bacterial sources
33 Introduction to contemporary health issues
Chapter outline
Introduction
Australia and New Zealand: demographics
Current population
Population projections
Ageing
Hospitalisations
Mortality
Chronic diseases
Mental health
Indigenous health
Contemporary lifestyle
Stress
Dietary factors
Physical activity
Obesity
Health promotion initiatives
Review questions
34 Stress and chronic disease
Chapter outline
Key terms
Introduction
The general adaptation syndrome
Stressors
Physical stress
Psychological stress
Contemporary stressors
The detection of stress
The alarm stage
The resistance stage
The exhaustion stage
Physiological processes of the stress response
The sympathetic nervous system
The hypothalamic–pituitary–adrenal axis
Physiological effects of the stress response
Increased cardiac output and breathing rate
Elevated blood pressure
Increased blood glucose and lipid levels
Altered immune response
Stress and the innate defences
Stress and the adaptive defences
Immune system signalling to the hypothalamus
A delicate balance
Suppression of pain
Effects of cortisol used as a therapeutic agent
Benefits of the stress response
Health alterations with chronic stress
Stress, inflammation and chronic disease
Modulation of the stress response
Psychological influences on stress
Personality characteristics and stress
Sex hormone influences on stress
Strategies for coping with stress
Physical activity
Stress and sleep
Hormonal fluctuations with circadian rhythm
Sleep and circadian regulation of stress hormones
Cortisol and sleep
Sleep, stress and immunity
Shift work and disease
Review questions
35 Obesity
Chapter outline
Key terms
Introduction
The progression to overweight and obesity
Evaluation of body size
Body mass index
Waist circumference
Body composition
Obesity
The extent of the issue
Risk factors for the development of obesity
Steady state weight
Lifestyle factors
Unhealthy diet
Physical inactivity
Stress
Smoking
Socioeconomic factors
Genetic factors
Metabolic disorders
Pathophysiology
Adipose cells
Control of appetite
Health complications associated with obesity
Cardiovascular disease
Type 2 diabetes
Cancer
Respiratory disorders
Gallbladder and liver disease
Osteoarthritis
Mortality
Management of obesity
Dietary factors
Physical activity
Pharmacological agents
Surgical treatment
Complications of weight loss
Metabolic syndrome
Evaluation of metabolic syndrome
Chronic complications associated with metabolic syndrome
Coronary heart disease
Type 2 diabetes
Treatment of metabolic syndrome
Review questions
36 Type 2 diabetes
Chapter outline
Key terms
Introduction
Diabetes mellitus
The extent of the issue
Diagnosis of diabetes
Clinical manifestations of diabetes
Pathophysiology
Insulin resistance
Beta cell destruction
Risk factors for the development of type 2 diabetes
Obesity
Understanding the relationship between obesity and diabetes
Pre-diabetes
Metabolic syndrome
Physical inactivity
Unhealthy diet
Tobacco smoking
Genetic factors
Management of diabetes
Glucose lowering oral therapies
Insulin
Complications of pharmacological insulin treatments
Monitoring blood glucose control
Acute complications of diabetes
Hypoglycaemia
Hyperglycaemia
Diabetic ketoacidosis
Hyperglycaemic hyperosmolar state
Chronic complications of diabetes
Mechanisms of microvascular disease and macrovascular disease
Cardiovascular disease
Stroke
Visual disturbances
Kidney damage
Liver disease
Nervous system alterations
Infection
Lower limb disease and amputation
Mortality
Review questions
37 Cancer
Chapter outline
Key terms
Introduction
Cancer is a chronic disease
Cancer characteristics and terminology
What is cancer?
Carcinogenesis
Cancer names
The genetic basis of cancer
Types of gene mutations in cancer
Alteration of progrowth and antigrowth signals — epigenetics
Oncogenes, tumour-suppressor genes and DNA repair genes
Genetics and cancer risk in families
Cancer growth rates
Cancer growth, spread and metastasis
Cancer, immunity, inflammation and infection
Cancer and the immune system
Chronic inflammation
Viral causes of cancer
Bacterial causes of cancer
Gene–environment interaction
Factors that increase the risk of cancer
Cigarette smoking
Dietary factors
Obesity
Alcohol consumption
Ultraviolet radiation
Occupational hazards
Air pollution
Ionising radiation
Electromagnetic fields
Cancer prevention
Physical activity
Dietary factors
Diagnosis and evaluation of cancer
Tumour markers
Evaluation
Clinical staging
Clinical manifestations of cancer and cancer treatments
Infection, anaemia and thrombocytopenia
Pain
Fatigue
Cachexia
Paraneoplastic syndromes
Cancer treatments
Chemotherapy
Hormone therapy
Immunotherapy
Gene therapy
Radiation
Surgery
Complementary and alternative medicines
Adverse effects of cancer treatments
Gastrointestinal tract
Bone marrow
Hair and skin
Reproductive tract
Cancers of greatest significance in Australia and New Zealand
The incidence and mortality rates of specific cancers
Breast and prostate cancers
Colorectal cancer
Melanoma
Lung cancer
The role of cancer screening
Cervical cancer
Breast cancer
Colorectal cancer
Melanoma
Prostate cancer
Cancer across the life span
Review questions
38 Genes, genetic diseases and the environment
Chapter outline
Key terms
Introduction
Studying genetic disease
Studying populations
Studying families
Genetic disorders
Chromosomal disorders
Non-disjunction of autosomes
Non-disjunction of sex chromosomes
Single gene disorders
Autosomal dominant disorders
Autosomal recessive disorders
Sex-linked disorders
Fragile X syndrome
Multifactorial inheritance
Conditions arising from genetic and environmental factors
Congenital abnormalities
Neural tube defects
Fetal alcohol syndrome
Cardiovascular disease
Coronary heart disease
Hypertension
Obesity
Metabolic syndrome
Diabetes mellitus
Mental illness
Drug and alcohol addiction
Cancers
The relative importance of genetic and environmental contributions to disease
The prevention of disease
Genetic screening
The future of disease prevention and treatment
Review questions
39 Neurobiology of mental illness
Chapter outline
Key terms
Introduction
The epidemiology of mental illness in Australia and New Zealand
Genetics and mental illness
Neurotransmitters
Classification systems
Anxiety disorders
Pathophysiology of anxiety
Pathophysiology of obsessive-compulsive disorder
Pathophysiology of posttraumatic stress disorder
Evaluation and treatment
Mood disorders
Signs and symptoms of mood disorders
Mania (or the milder form, hypomania)
Major depression
Pathophysiology
Genetic factors and the gene–environment interaction
Neurochemical factors, hormonal systems, circadian rhythms and environmental factors
Gender differences
Evaluation and treatment
Bipolar disorder
Pathophysiology
Genetic influences
Other biological influences
Evaluation and treatment
Schizophrenia
Pathophysiology
Genetics
Environment and genetic interactions
Neurodevelopment and neuroanatomy
Clinical manifestations
Evaluation and treatment
Substance use
The pathophysiology of reward and addiction
Drug intoxication
Drug withdrawal
Clinical manifestations
Stimulants
Depressants
Opioids
Cannabis
Evaluation and treatment
Eating disorders
Pathophysiology
Evaluation and treatment
Personality disorders
Pathophysiology
Evaluation and treatment
Review questions
40 Indigenous health issues in Australia
Chapter outline
Key terms
Introduction
The Indigenous Australian population
Indigenous health
Mortality
Infant mortality
Morbidity
Fertility
Birth rates
Conditions affecting the wellbeing of Indigenous Australians
Cardiovascular disease
Coronary heart disease
Stroke
Rheumatic heart disease
Diabetes mellitus
Cancer
Chronic kidney disease
Respiratory diseases
Mental health, social and emotional wellbeing
Dementia
Infection
Eye problems
Common threads — factors contributing to health problems
Injuries
Smoking
Alcohol misuse
Social determinants of Indigenous health
Education
Employment
Housing
Closing the Gap
Review questions
41 Maori health in Aotearoa New Zealand
Chapter outline
Key terms
Introduction
The New Zealand Maori population
Distribution
Maori health
Mortality
Infant mortality
Morbidity
Fertility
Conditions affecting the wellbeing of Maori
Cardiovascular disease
Coronary heart disease
Stroke
Rheumatic fever
Diabetes mellitus
Chronic kidney disease
Cancer
Asthma
Mental illness
Infection
Oral health
Factors contributing to health problems
Injuries
Smoking
Alcohol misuse
Social determinants of Maori health
Poverty
Education
Income and employment
Housing
Review questions
Appendix A Normal reference laboratory values
Appendix B Prefixes, suffixes and root words commonly used in health sciences
Image and text credits
Chapter 1
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Chapter 33
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Chapter 36
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Chapter 37
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Chapter 39
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Chapter 41
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