(Original PDF) Pathophysiology -

E-Book 6th Edition

Go to download the full and correct content document:
https://ebooksecure.com/product/original-pdf-pathophysiology-e-book-6th-edition/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

(eBook PDF) Understanding Pathophysiology - E-Book 6th

Edition

http://ebooksecure.com/product/ebook-pdf-understanding-
pathophysiology-e-book-6th-edition/

(eBook PDF) Pathophysiology for the Health Professions

- E- Book 6th Edition

http://ebooksecure.com/product/ebook-pdf-pathophysiology-for-the-
health-professions-e-book-6th-edition/

Yen & Jaffe's Reproductive Endocrinology E-Book:

Physiology, Pathophysiology, and Clinical Management
7th

http://ebooksecure.com/product/yen-jaffes-reproductive-
endocrinology-e-book-physiology-pathophysiology-and-clinical-
management-7th/

(eBook PDF) Gordis Epidemiology E-Book 6th Edition

http://ebooksecure.com/product/ebook-pdf-gordis-epidemiology-e-
book-6th-edition/
(Original PDF) Mosby's Fundamentals of Therapeutic
Massage - E-Book 6th Edition

http://ebooksecure.com/product/original-pdf-mosbys-fundamentals-
of-therapeutic-massage-e-book-6th-edition/

Understanding Pathophysiology (Canadian Edition) Sue E.

Huether - eBook PDF

https://ebooksecure.com/download/understanding-pathophysiology-
canadian-edition-ebook-pdf/

(eBook PDF) Mosby's Manual of Diagnostic and Laboratory

Tests - E-Book 6th Edition

http://ebooksecure.com/product/ebook-pdf-mosbys-manual-of-
diagnostic-and-laboratory-tests-e-book-6th-edition/

(Original PDF) Gartsmans Shoulder Arthroscopy E-Book

http://ebooksecure.com/product/original-pdf-gartsmans-shoulder-
arthroscopy-e-book/

Rang & Dale's Pharmacology E-Book - eBook PDF

https://ebooksecure.com/download/rang-dales-pharmacology-e-book-
ebook-pdf/
This page intentionally left blank
 CONTRIBUTORS
Brent A. Banasik, PhD, MA, BS Roberta J. Emerson, PhD, RN Faith Young Peterson, BSN, MSN,
Scientist Associate Professor, Retired MPA, CFNP
Chemistry Washington State University Family Nurse Practitioner
Banasik Consulting College of Nursing Marsing, Idaho
Seattle, Washington Spokane, Washington
Cheryl Rockwell, RN, MSN
Brianne N. Banasik, BS Environmental Linda Felver, PhD, RN Clinical Assistant Professor
Science, MS Marine Resources Associate Professor Nursing Department
Management School of Nursing Indiana University-Purdue University at
Research Associate Oregon Health & Science University Fort Wayne;
Pediatric Vaccinology Portland, Oregon Staff/Clinical Nurse
University of Texas Medical Branch Surgical Trauma Intensive Care Unit
Galveston, Texas Rosemary A. Jadack, PhD, RN Parkview Health Systems
Professor Fort Wayne, Indiana
Jacquelyn L. Banasik, PhD, ARNP Nursing
Associate Professor University of Wisconsin—Eau Claire Samantha Cody Russell, Psychology, MA
College of Nursing Eau Claire, Wisconsin Graduate Student
Washington State University Psychological Sciences
Spokane, Washington Debra A. Jansen, PhD, RN Northern Arizona University
Associate Dean, Professor Flagstaff, Arizona
Robin Y. Beeman, BSN, MSN, PhD College of Nursing and Health Sciences
Chair and Professor University of Wisconsin—Eau Claire Jeffrey S. Sartin, MD
Nursing Eau Claire, Wisconsin Consulting Physician
University of Wisconsin—Eau Claire Infectious Diseases
Eau Claire, Wisconsin Marie L. Kotter, PhD, MS, BS Infectious Disease and Epidemiology
Professor Emeritus Associates;
Cheryl L. Brandt, PhD, RN, ACNS-BC Health Sciences Consulting Physician
Professor Weber State University Infectious Diseases
College of Nursing and Health Sciences Ogden, Utah Nebraska Medicine;
University of Wisconsin—Eau Claire Consulting Physician
Eau Claire, Wisconsin Teresa Grigsby Loftsgaarden, MSN, RN, Infectious Diseases
OCN,ONN-CG CHI Hospitals
Ann Futterman Collier, PhD Oncology Nurse Navigator Omaha, Nebraska
Associate Professor and Chair Regional Cancer Center
Psychological Sciences Sacred Heart Hospital Lorna L. Schumann, PhD
Northern Arizona University Eau Claire, Wisconsin Heritage UGM Women and Children’s
Flagstaff, Arizona Clinic
Joni D. Marsh, BSN, MN Medical Clinic
Lee-Ellen C. Copstead, PhD, RN Advanced Registered Nurse Practitioner Heritage Health
Professor Emerita Medical Oncology Coeur d’Alene, Idaho
Department of Nursing Summit Cancer Centers
College of Nursing and Health Sciences Spokane, Washington Susan G. Trevithick, RN, MS, NE-BC
University of Wisconsin—Eau Claire Compliance Officer
Eau Claire, Wisconsin Benjamin J. Miller, PhD, ARNP, FNP-C, VA Salt Lake City Healthcare System
ACNPC, ENP-C Salt Lake City, Utah
Carol L. Danning, MD Assistant Professor
Staff Rheumatologist Seattle University Marvin Van Every, MD
Rheumatology Department Seattle, Washington Staff Urologist
Gundersen Health Systems Urology Department
La Crosse, Wisconsin Sarah Ogle, DO, MS Gundersen Health Systems
Banner University Medical Center-Phoenix La Crosse, Wisconsin
Michael R. Diestelmeier, MD University of Arizona College of Medicine
Fellow American Academy of Dermatology Phoenix Linda D. Ward, PhD, FNP-C
Dermatologist, Retired Phoenix, Arizona Assistant Professor
Mayo Clinic Health System College of Nursing
Eau Claire, Wisconsin Nirav Patel, MD Washington State University
Assistant Professor, Infectious Diseases and Spokane, Washington
Ruth E. Diestelmeier, RN, MSN Critical Care Medicine
Clinical Instructor Internal Medicine
Department of Nursing Saint Louis University School of Medicine;
University of Wisconsin—Eau Claire Chief Medical Officer
Eau Claire, Wisconsin SSM Health Saint Louis University Hospital;
Infection Control Officer/Director of
Antibiotic Stewardship
SSM Health Saint Louis University Hospital
Saint Louis, Missouri
vii
REVIEWERS
Brianne N. Banasik, MS
Research Associate
Pediatric Vaccinology
University of Texas Medical Branch
Galveston, Texas
Deb Cipali, RN, BSN, MSN, EdD(c)
Des Moines Area Community College
Nursing Lab Coordinator/Adjunct Professor
Ankeny, Iowa
Janie Corbitt, RN, MLS
Milledgville, Georgia
Maria Fleurdeliz Cuyco, BS
Instructor
Preferred College of Nursing
Los Angeles, California
Abimbola Farinde, PhD
Professor
Columbia Southern University
Orange Beach, Alabama
Annette Gunderman, DEd, MSN, RN
Associate Professor of Nursing
Bloomsburg University
Bloomsburg, Pennsylvania
viii
Barbara Hunter, RN, MSN
School of Nursing, Klamath Falls Campus
Oregon Health & Science University
Klamath Falls, Oregon
Sandra L. Kaminski, MS, PA-C
Assistant Professor
Seton Hall University
School of Health and Medical Sciences;
Physician Assistant
VA NJ Healthcare System
Medical Service/Infections Disease
Clark, New Jersey
Steven Krau, PhD, RN, CNE
Associate Professor
Vanderbilt School of Nursing
Nashville, Tennessee
Clarice Perry, MS
Research Associate
Pediatric Vaccinology
University of Texas Medical Branch
Galveston, Texas
Janet Pinkelman, MSN, RNC-Maternal
Newborn Nursing
Professor of Nursing
Owens Community College
Toledo, Ohio
Linda Turchin, RN, MSN, CNE
Associate Professor of Nursing
Fairmont State University
Fairmont, West Virginia
Kim Webb, MN, RN
Adjunct Nursing Instructor
Pioneer Technology Center
Ponca City, Oklahoma
Janice Williams, RN, ACNS-BC, CDE
Professor of Nursing and Program Director
Armstrong McDonald School of Nursing
College of the Ozarks
Point Lookout, Missouri

The pace of scientific discovery in health and medicine continues to
transform our understanding of physiology and disease. To be clinically
relevant and useful to health care students and professionals, a text
must synthesize a vast amount of detailed knowledge into overarching
concepts that can be applied broadly. As in previous editions, the goal
of the sixth edition of Pathophysiology is to include recent and relevant
information on anatomy, biochemistry, cell physiology, genomics, and
pathophysiology while not overwhelming the reader. Attention is given
to major concepts relevant to clinical practice while still providing
enough detail for deep understanding.
ORGANIZATION
Pathophysiology uses a systems approach to content, beginning with a
review of normal anatomy and physiology, followed by pathophysiology
and application of concepts to specific disorders. The text is organized
into 15 units, each of which includes a particular body system or group
of interrelated body systems and the pertinent pathophysiologic concepts
and disorders.
FEATURES
An understanding of normal structure and function of the body is
necessary for any detailed understanding of its abnormalities and
pathophysiology. The first chapter in most units includes a fully
illustrated review of normal physiology. Age-related concepts are
highlighted in boxes titled Geriatric Considerations and Pediatric
Considerations.
Each chapter opens with Key Questions, which are designed to alert
the reader to important conceptual questions that will be discussed in
the chapter. Although the chapters are meant to be read from beginning
to end to develop an understanding of the material, the text also serves
as a reference for looking up specific content. Chapter Outlines are
included at the beginning of each chapter to help the reader locate
specific content. Within every chapter, Key Points are identified at the
end of every major discussion and are presented in short bulleted
lists. These recurring summaries help readers to focus on the main
points.
Nearly 900 illustrations elucidate both normal physiology and
pathophysiologic changes. The entire book is in full color, with color
P R E FA C E
used generously in the illustrations to better explain pathophysiologic
concepts.
A study of pathophysiology requires a new vocabulary, and many
of these terms are defined in a comprehensive Glossary, which appears
at the end of the text. Common prefixes and suffixes as well as root
words are included in the back matter to help with basic understanding
of the language of pathophysiology.
ANCILLARIES
Student Learning Resources on Evolve
The student section of the book’s website hosted on Evolve offers nearly
700 Student Review Questions in a variety of question formats, an Audio
Glossary, Animations to help readers visualize pathophysiologic processes,
Case Studies with questions, and Key Points Review. Visit the Evolve
website at http://evolve.elsevier.com/Banasik/pathophysiology.
Study Guide
Pathophysiology can be a daunting subject for students because of the
large volume of factual material to be learned. The student Study Guide
is designed to help students focus on important pathophysiologic
concepts. Questions to check recall of normal anatomy and physiology
are included for each chapter. A number of activities that help the
student focus on similarities and differences between often-confused
pathologic processes are included. More than 1500 self-assessment test
questions with answers are included to help students check their
understanding and build confidence for examinations. Case studies,
with more than 250 questions including rationales for correct and
incorrect answers, are used to help students begin to apply pathophysi-
ologic concepts to clinical situations.
Instructor Learning Resources on Evolve
The Instructor Learning Resources on Evolve provide a number of
teaching aids for instructors who require the text for their students. The
materials include a Test Bank presented in Exam View with approximately
1200 test items, a Teach for Nurses instructor manual detailing the
resources available to instructors for their lesson planning, a PowerPoint
lecture guide with more than 4000 slides with integrated case studies
and audience response questions to facilitate classroom presentations,
and an Image Collection of more than 900 color images from the text.
ix
AC K N OW L E D G M E N T S
Revising this 6th edition of the text has been possible because of the
tremendous dedication of authors, artists, reviewers, and editors. Sincere
gratitude goes to all who helped with this and previous editions. In
particular, grateful appreciation is extended to all of the contributing
authors who have given exhaustively of their time over many editions
over the decades. Thank you to the many thoughtful experts who gave
their time to read and critique manuscripts and help ensure excellence
in chapter content throughout the text.
Grateful recognition is made to the staff at Elsevier: Kellie White,
Executive Content Strategist; Jennifer Wade, Content Development
Specialist; Jeffrey Patterson, Publishing Service Manager; Carol O’Connell,
Book Production Specialist; Renee Duenow, Book Designer; and
Vikraman Palani, Multimedia Producer.
x
We would like to recognize those who provided a foundation for
the revised text through their contributions to earlier editions: Arnold
A. Asp, Donna Bailey, Barbara Bartz, Linda Belsky-Lohr, Tim Brown,
Carolyn Spenee Cagle, Karen Carlson, Katherina P. Choka, Arnold
Norman Cohen, Cynthia F. Corbett, Lorri Dawson, Leslie Evans, Patricia
Garber, Jane Georges, Karen Groth, Christine M. Henshaw, Carolyn
Hoover, Jo Annalee Irving, Marianne Genge Jagmin, Debby Kaaland,
Naomi Lungstrom, Rick Madison, Anne Roe Mealey, David Mikkelsen,
Carrie Miller, Linda Denise Oakley, Maryann Pranulis, Mark Puhlman,
Edith Randall, Bridget Recker, Cleo Richard, Dawn Rondeau, Mary
Sanguinetti-Baird, Billie Marie Severtsen, Jacqueline Siegel, Gary Smith,
Sheila Smith, Martha Snider, Pam Springer, Angela Starkweather, Patti
Stec, Julie Symes, Lorie Wild, and Debra Winston-Heath.

UNIT I Pathophysiologic Processes
1 Introduction to Pathophysiology, 1
Lee-Ellen C. Copstead
Framework for Pathophysiology, 2
Etiology, 2
Pathogenesis, 2
Clinical Manifestations, 3
Treatment Implications, 3
Concepts of Normality in Health and Disease, 4
Statistical Normality, 4
Individual Factors Influencing Normality, 5
Patterns of Disease in Populations, 6
Concepts of Epidemiology, 6
2 Homeostasis, Allostasis, and Adaptive Responses to
Stressors, 12
Debra A. Jansen and Roberta J. Emerson
Homeostasis and Allostasis, 12
Homeostasis, 12
Allostasis, 13
Stress as a Concept, 13
The General Adaptation Syndrome and
Allostasis, 14
Stressors, Gender and Developmental Influences,
and Risk Factors, 16
Neurohormonal Mediators of Stress and
Adaptation, 17
Catecholamines: Norepinephrine and
Epinephrine, 17
Adrenocortical Steroids: Cortisol and
Aldosterone, 18
Endorphins, Enkephalins, and Immune
Cytokines, 19
Sex Hormones: Estrogen, Testosterone, and
Dehydroepiandrosterone, 19
Growth Hormone, Prolactin, and
Oxytocin, 19
Adaptation, Coping, and Illness, 20
Adaptation, Coping, and Resilience, 20
Allostatic Overload and Illness, 21
UNIT II Cellular Function
3 Cell Structure and Function, 26
Jacquelyn L. Banasik and Brianne N. Banasik
Plasma Membrane, 27
Membrane Structure, 27
Lipid Bilayer, 27
Membrane Proteins, 29
Organization of Cellular Compartments, 30
Cytoskeleton, 30
Nucleus, 30
Endoplasmic Reticulum, 31
Golgi Apparatus, 32
Lysosomes and Peroxisomes, 33
Mitochondria, 34
CONTENTS
Cellular Metabolism, 34
Glycolysis, 36
Citric Acid Cycle, 36
Oxidative Phosphorylation, 36
Functions of the Plasma Membrane, 39
Membrane Transport of Macromolecules, 39
Membrane Transport of Small Molecules, 40
Cellular Membrane Potentials, 45
Intercellular Communication and Growth, 48
Cell Signaling Strategies, 48
Cell Surface Receptor–Mediated Responses, 49
Intracellular Receptor–Mediated Responses, 53
Regulation of Cellular Growth and Proliferation, 54
4 Cell Injury, Aging, and Death, 59
Jacquelyn L. Banasik
Reversible Cell Injury, 59
Hydropic Swelling, 60
Intracellular Accumulations, 60
Cellular Adaptation, 63
Atrophy, 63
Hypertrophy, 63
Hyperplasia, 63
Metaplasia, 63
Dysplasia, 64
Irreversible Cell Injury, 64
Necrosis, 64
Apoptosis, 66
Etiology of Cellular Injury, 68
Ischemia and Hypoxic Injury, 68
Nutritional Injury, 70
Infectious and Immunologic Injury, 70
Chemical Injury, 72
Physical and Mechanical Injury, 72
Cellular Aging, 74
Cellular Basis of Aging, 74
Physiologic Changes of Aging, 75
Somatic Death, 75
5 Genome Structure, Regulation, and Tissue
Differentiation, 77
Jacquelyn L. Banasik
Structure and Function of DNA, 78
Structure of DNA, 78
DNA Replication, 79
Genetic Code, 80
Transcription, 81
Translation, 82
Regulation of the Genome, 84
Transcriptional Controls, 84
Differentiation of Tissues, 86
Cell Diversification and Cell Memory, 86
Mechanisms of Development, 86
Differentiated Tissues, 87
6 Genetic and Developmental Disorders, 94
Linda D. Ward
Principles of Inheritance, 95
DNA Mutation and Repair, 96
xi
xii Contents
GENETIC DISORDERS, 98
Chromosomal Abnormalities, 99
Aberrant Number of Chromosomes, 99
Abnormal Chromosome Structure, 100
Examples of Autosomal Chromosome
Disorders, 100
Examples of Sex Chromosome Disorders, 101
Mendelian Single-Gene Disorders, 102
Autosomal-Dominant Disorders, 103
Autosomal-Recessive Disorders, 104
Sex-Linked (X-Linked) Disorders, 106
Nonmendelian Single-Gene Disorders, 107
Anticipation, 109
Mitochondrial Gene Mutations, 109
Genomic Imprinting, 110
Polygenic and Multifactorial Disorders, 110
Environmentally Induced Congenital
Disorders, 111
Periods of Fetal Vulnerability, 111
Teratogenic Agents, 111
Other Disorders of Infancy, 113
Diagnosis, Counseling, and Gene Therapy, 113
Prenatal Diagnosis and Counseling, 113
Genetic Analysis and Therapy, 114
Recombinant DNA Technology, 114
7 Neoplasia, 117
Jacquelyn L. Banasik
Benign Versus Malignant Growth, 118
Characteristics of Benign and Malignant
Tumors, 118
Tumor Terminology, 118
The Malignant Phenotype, 118
Epidemiology and Cancer Risk Factors, 120
Tobacco Use, 120
Nutrition, 120
Genetic Mechanisms of Cancer, 123
Proto-Oncogenes, 124
Tumor Suppressor Genes, 127
Multistep Nature of Carcinogenesis, 129
Initiation, 129
Promotion, 131
Progression, 131
Metastasis, 132
Patterns of Spread, 132
Angiogenesis, 133
Grading and Staging of Tumors, 134
Effects of Cancer on the Body, 136
Cancer Therapy, 137
Surgery, 137
Radiation Therapy, 138
Drug Therapy, 138
Immunotherapy, 138
Gene and Molecular Therapy, 138
Stem Cell Transplantation, 139
UNIT III Defense
8 Infectious Processes, 141
Brent A. Banasik
Host–Microbe Relationship, 142
The Human Microbiome, 142
Host Characteristics, 142
Pathogen Characteristics, 144
Transmission of Infection, 147
Routes of Transmission, 148
Emerging Infectious Diseases, 148
Weapons of Bioterrorism, 149
Types of Pathogenic Organisms, 149
Bacteria, 149
Viruses, 150
Fungi, 151
Parasites, 152
9 Inflammation and Immunity, 158
Jacquelyn L. Banasik
COMPONENTS OF THE IMMUNE
SYSTEM, 159
Epithelial Barriers, 159
Mononuclear Phagocyte System, 159
Lymphoid System, 160
Primary Lymphoid Organs, 160
Secondary Lymphoid Organs, 161
Leukocytes, 162
Neutrophils, 162
Eosinophils, 163
Basophils and Mast Cells, 164
Monocytes and Macrophages, 164
Dendritic Cells, 165
Lymphocytes, 165
Chemical Mediators of Immune Function, 167
Complement, 167
Kinins, 169
Clotting Factors, 169
Cytokines and Chemokines, 169
INNATE DEFENSES AND INFLAMMATION, 169
Inflammation, 171
Increased Vascular Permeability, 171
Emigration of Leukocytes, 172
Phagocytosis, 172
Chronic Inflammation, 174
Healing, 174
Inflammatory Exudates, 175
Systemic Manifestations of Inflammation, 175
SPECIFIC ADAPTIVE IMMUNITY, 176
Major Histocompatibility Complex, 176
Antigen Presentation by MHC, 176
MHC Class I Presentation, 177
MHC Class II Presentation, 177
Mechanisms of Cell-Mediated Immunity, 178
T Helper Cells (CD4+), 178
Cytotoxic T Cells (CD8+), 181
Mechanisms of Humoral Immunity, 181
Antigen Recognition by B Cells, 181
Antibody Structure, 183
Class Switching and Affinity Maturation, 185
Antibody Functions, 186
Passive and Active Immunity, 187
Passive Immunity, 187
Active Immunity, 187
INTEGRATED FUNCTION AND REGULATION OF
THE IMMUNE SYSTEM, 189
Integrated Response to Microbial Antigen, 189
Integrated Response to Viral Antigen, 191
Regulation of Immune Function, 192

10 Alterations in Immune Function, 194
Faith Young Peterson
EXCESSIVE IMMUNE RESPONSES, 195
Autoimmunity, 195
Genetic Factors, 196
Environmental Triggers, 196
Pharmacotherapies, 197
Hypersensitivity, 198
Type I Hypersensitivity, 199
Type IIa Hypersensitivity, 201
Type IIb Hypersensitivity, 204
Type III Hypersensitivity, 204
Type IV Hypersensitivity, 207
DEFICIENT IMMUNE RESPONSES, 210
Primary Immunodeficiency Disorders, 210
B-Cell and T-Cell Combined Disorders, 210
T-Cell Disorders, 211
B-Cell Disorders, 212
Secondary Immunodeficiency Disorders, 212
11 Malignant Disorders of White Blood Cells, 215
Marie L. Kotter and Jacquelyn L. Banasik
Classification of Hematologic Neoplasms, 215
Etiology of Myeloid and Lymphoid Neoplasms, 216
General Principles of Management, 217
Diagnosis of Hematologic Neoplasms, 217
Principles of Treatment, 218
Prevention and Management of Complications, 219
Myeloid Neoplasms, 221
Chronic Myeloid Leukemia, 221
Acute Myeloid Leukemia, 222
Lymphoid Neoplasms, 223
Chronic Lymphoid Leukemia, 223
Acute Lymphoblastic Leukemia/Lymphoma, 223
Hairy Cell Leukemia, 224
Plasma Cell Myeloma (Multiple Myeloma), 224
Hodgkin Disease, 227
B-Cell, T-Cell, and NK-Cell Lymphoma
(Non-Hodgkin), 229
12 HIV Disease and AIDS, 233
Faith Young Peterson
Epidemiology, 234
History, 234
Types of HIV, 234
Transmission, 236
Prevention of Transmission, 238
Etiology, 239
HIV Structure, 239
HIV Binding and Infection, 239
Pathogenesis, 242
Effect of HIV on Immune Cells at the Cellular
Level, 242
Viral Production and Cell Death, 242
Progression of HIV Infection From Seroconversion
to AIDS, 244
CDC HIV Classification System, 245
Diagnostic Testing, 245
Monitoring the Progression of HIV, 246
Clinical Manifestations, 248
Systemic Manifestations, 248
Gastrointestinal Manifestations, 249
Pulmonary Manifestations, 249
Mucocutaneous Manifestations, 250
Contents xiii
Gynecologic Manifestations, 251
Neurologic Manifestations, 252
Ocular Manifestations, 253
Cardiovascular Manifestations, 253
Manifestations in Other Systems, 253
Manifestations in Children, 254
Treatment, 254
Antiretroviral Therapy Recommendations, 254
Nucleoside Reverse Transcriptase Inhibitors, 255
Nucleotide Reverse Transcriptase Inhibitors, 255
Nonnucleoside Reverse Transcriptase
Inhibitors, 255
Protease Inhibitors, 257
Fusion Inhibitors, 257
CCR5 Inhibitors, 257
Integrase Strand Transfer Inhibitors, 257
Other Treatments and Vaccines, 257
UNIT IV Oxygen Transport, Blood Coagulation,
Blood Flow, and Blood Pressure
13 Alterations in Oxygen Transport, 259
Susan G. Trevithick
Composition of Blood, 260
Organic and Inorganic Components, 261
Cellular Components, 261
Structure and Function of Red Blood Cells, 262
Hematopoiesis, 263
Hemoglobin Synthesis, 265
Nutritional Requirements for Erythropoiesis, 266
Energy and Maintenance of Erythrocytes, 267
Red Cell Production, 267
Red Cell Destruction, 268
Gas Transport and Acid–Base Balance, 268
Oxygen Transport, 268
Carbon Dioxide Transport, 270
Alterations in Oxygen Transport, 270
Anemia, 272
General Effects of Anemia, 272
Anemia Related to Decreased Red Cell
Production, 277
Aplastic Anemia, 277
Anemia of Chronic Renal Failure, 277
Anemia Related to Vitamin B12 (Cobalamin)
or Folate Deficiency, 278
Iron Deficiency Anemia, 279
Anemia Related to Inherited Disorders of the Red
Cell, 279
Thalassemia, 279
Sickle Cell Anemia, 281
Hereditary Spherocytosis, 282
Glucose-6-Phosphate Dehydrogenase
Deficiency, 282
Anemia Related to Extrinsic Red Cell Destruction or
Loss, 284
Hemolytic Disease of the Newborn, 284
Antibody-Mediated Drug Reactions, 284
Acute Blood Loss, 285
Other Extrinsic Abnormalities, 285
Transfusion Therapy, 286
Polycythemia, 286
xiv Contents

Polycythemia Vera, 286 UNIT V Cardiac Function

Secondary Polycythemia, 292
Relative Polycythemia, 293 17 Cardiac Function, 354
14 Alterations in Hemostasis and Blood Coagulation, 298 Jacquelyn L. Banasik
Cheryl Rockwell Cardiovascular Anatomy, 355
The Process of Hemostasis, 298 Heart, 355
Stages of Hemostasis, 298 Circulatory System, 356
Platelets, 299 Cardiac Cycle, 358
Blood Coagulation Factors, 299 Isovolumic Contraction, 359
Fibrin Clot, 299 Ventricular Ejection, 360
Fibrinolysis, 301 Isovolumic Relaxation, 360
Evaluation of Hemostasis and Coagulation, 301 Atrial Events, 360
Clinical Assessment, 301 Aortic and Pulmonary Artery Events, 360
Laboratory Tests, 304 Coronary Circulation, 360
Vascular and Platelet Disorders, 304 Anatomy of the Coronary Vessels, 360
Vascular Disorders, 304 Regulation of Coronary Blood Flow, 361
Platelet Disorders, 306 Cardiac Myocytes, 363
Coagulation Disorders, 308 Myocyte Structure, 363
15 Alterations in Blood Flow, 313 Structure of the Contractile Apparatus, 363
Teresa Grigsby Loftsgaarden Characteristics of Contractile Filaments, 365
Organization of the Circulatory and Lymphatic Molecular Basis of Contraction, 366
Systems, 315 Overview of Contraction, 366
Vessel Structure, 315 Sliding Filament/Cross-Bridge Theory of Muscle
Lymphatic Structure, 317 Contraction, 366
Principles of Flow, 317 Role of Calcium in Muscle Contraction, 367
Hemodynamics of the Circulatory System, 317 Energy of Muscle Relaxation, 367
Control of Flow, 322 Cardiac Energy Metabolism, 368
Control of Blood Flow, 322 Oxygen Utilization, 368
Control of Lymphatic Flow, 323 Substrate Utilization, 369
General Mechanisms That Cause Altered Flow, 323 Cardiac Electrophysiology, 369
Blood Vessels: Obstructions, 323 Cardiac Resting Potential, 369
Blood Vessels: Structural Alterations, 325 Cardiac Action Potential, 369
Lymphatic Vessels, 326 Rhythmicity of Myocardial Cells, 370
Alterations in Arterial Flow, 326 Specialized Conduction System of the Heart, 371
Arteriosclerosis/Atherosclerosis, 326 Autonomic Regulation of Rhythmicity, 372
Thromboangiitis Obliterans (Buerger Disease), 330 Electrocardiography, 372
Raynaud Syndrome, 330 Determinants of Cardiac Output, 374
Aneurysms, 330 Determinants of Heart Rate, 374
Acute Arterial Occlusion, 331 Determinants of Stroke Volume, 375
Alterations in Venous Flow, 332 Cardiac Workload, 376
Valvular Incompetence, 332 Endocrine Function of the Heart, 376
Varicose Veins, 332 Tests of Cardiac Function, 376
Chronic Venous Insufficiency, 333 Electrocardiography, 376
Deep Vein Thrombosis, 333 Magnetic Resonance Imaging and Computed
Alterations in Lymphatic Flow, 333 Tomography, 378
Lymphedema, 333 Echocardiography, 378
16 Alterations in Blood Pressure, 337 Nuclear Cardiography, 379
Benjamin J. Miller Cardiac Catheterization/Coronary
Arterial Blood Pressure, 337 Angiography, 379
Determinants of Systemic Blood Pressure, 337 18 Alterations in Cardiac Function, 382
Measurement of Blood Pressure, 338 Jacquelyn L. Banasik
Mechanisms of Blood Pressure Regulation, 341 Coronary Heart Disease, 383
Short-Term Regulation of Systemic Blood Etiology of Coronary Heart Disease, 383
Pressure, 341 Risk Factors and Mechanisms of Coronary
Long-Term Regulation of Systemic Blood Pressure, 341 Atherosclerosis, 383
Normal Fluctuations in Systemic Blood Pressure, 343 Pathophysiology of Ischemia, 385
Hypertension, 343 Clinical Features and Management of Coronary
Definition and Classification, 343 Syndromes, 388
Primary Hypertension, 344 Endocardial and Valvular Diseases, 394
Secondary Hypertension, 348 Disorders of the Mitral Valve, 394
Hypertensive Emergencies and Urgency, 349 Disorders of the Aortic Valve, 397
Low Blood Pressure, 350 Diseases of the Endocardium, 398

Myocardial Diseases, 399
Myocarditis, 399
Cardiomyopathy, 400
Pericardial Diseases, 402
Pericardial Effusion, 402
Pericarditis, 402
Congenital Heart Diseases, 403
Embryologic Development, 403
Etiology and Incidence of Congenital Heart
Disease, 404
Pathophysiology of Congenital Heart
Disease, 405
Acyanotic Congenital Defects, 406
Cyanotic Congenital Defects, 408
19 Heart Failure and Dysrhythmias: Common Sequelae of
Cardiac Diseases, 411
Benjamin J. Miller and Jacquelyn L. Banasik
Heart Failure, 412
Pathogenesis and Diagnosis, 412
Compensatory Mechanisms, Remodeling,
and Progression, 413
Clinical Manifestations, 417
Class and Stage of Heart Failure, 420
Treatment, 421
Cardiac Dysrhythmias, 421
Dysrhythmia Mechanisms, 421
Dysrhythmia Analysis, 423
Abnormal Rates of Sinus Rhythm, 424
Abnormal Site of Impulse Initiation, 425
Conduction Pathway Disturbances, 428
Treatment, 431
20 Shock, 434
Benjamin J. Miller
Pathogenesis of Shock, 434
Impaired Tissue Oxygenation, 435
Compensatory Mechanisms and Stages of
Shock, 437
Types of Shock, 439
Cardiogenic Shock, 439
Obstructive Shock, 441
Hypovolemic Shock, 442
Distributive Shock, 443
Assessment and Hemodynamic Monitoring, 447
Cardiac Output, 447
Arterial Oxygen Content, 447
Distribution of Blood Flow, 448
Hemodynamic Monitoring, 448
Complications of Shock, 449
Acute Respiratory Distress Syndrome, 449
Disseminated Intravascular Coagulation, 449
Acute Renal Failure, 449
Multiple Organ Dysfunction Syndrome, 449
UNIT VI Respiratory Function
21 Respiratory Function and Alterations in
Gas Exchange, 451
Lorna L. Schumann
Functional Anatomy, 452
Development of the Pulmonary System, 452
Upper Airway Structures, 452
Contents xv
Lower Airway Structures, 453
Pulmonary Circulation, 457
Age-Related Variations, 457
Ventilation, 460
Lung Volumes and Capacities, 460
Dead Space, 460
Minute Ventilation, 460
Alveolar Ventilation/Oxygenation, 461
Mechanics of Breathing, 461
Airway Resistance, 461
Lung Compliance, 462
Distribution of Ventilation, 462
Neurologic Control of Ventilation, 462
Pulmonary Blood Flow, 465
Pulmonary Vasculature, 465
Distribution of Blood Flow, 465
Ventilation–Perfusion Ratios, 465
Hypoxic Vasoconstriction, 466
Diffusion and Transport of Respiratory
Gases, 466
Barriers to Diffusion, 466
Oxygen Transport, 467
Carbon Dioxide Transport, 467
Alterations in Pulmonary Function, 468
Hypoventilation and Hyperventilation, 468
Hypoxemia and Hypoxia, 468
Acute Respiratory Failure, 469
Diagnostic Tests, 471
Pulmonary Function Testing, 471
Bronchial Provocation Tests, 472
Alterations in Pulmonary Vasculature, 472
Pulmonary Hypertension, 472
Pulmonary Venous Thromboembolism, 473
Pulmonary Malignancies, 475
Etiology, 475
Pathogenesis, 475
Clinical Manifestations, 476
Diagnosis, 476
Treatment, 476
22 Obstructive Pulmonary Disorders, 478
Benjamin J. Miller and Lorna L. Schumann
Obstruction From Conditions in the Wall of the
Lumen, 479
Asthma, 479
Acute Bronchitis, 483
Chronic Bronchitis, 485
Obstruction Related to Loss of Lung
Parenchyma, 488
Emphysema, 488
Obstruction of the Airway Lumen, 491
Bronchiectasis, 491
Bronchiolitis, 493
Cystic Fibrosis, 494
Acute Tracheobronchial Obstruction, 495
Epiglottitis, 496
Croup Syndrome, 496
23 Restrictive Pulmonary Disorders, 499
Lorna L. Schumann and Benjamin J. Miller
Lung Parenchyma Disorders, 500
Fibrotic Interstitial Lung Diseases, 500
Atelectatic Disorders, 504
Pleural Space Disorders, 508
xvi Contents
Neuromuscular, Chest Wall, and Obesity
Disorders, 511
Neuromuscular Disorders, 511
Chest Wall Deformities, 511
Disorders of Obesity, 513
Infection or Inflammation of the Lung, 514
UNIT VII F luid, Electrolyte, and Acid-Base
Homeostasis
24 Fluid and Electrolyte Homeostasis and Imbalances, 521
Linda Felver
Body Fluid Homeostasis, 522
Fluid Intake and Absorption, 522
Fluid Distribution, 523
Fluid Excretion, 524
Fluid Loss Through Abnormal Routes, 524
Fluid Imbalances, 525
Extracellular Fluid Volume, 525
Body Fluid Concentration, 526
Both Volume and Concentration, 528
Interstitial Fluid Volume, 528
Principles of Electrolyte Homeostasis, 529
Electrolyte Intake and Absorption, 529
Electrolyte Distribution, 531
Electrolyte Excretion, 531
Electrolyte Loss Through Abnormal Routes, 531
Electrolyte Imbalances, 531
Plasma Potassium, 531
Plasma Calcium, 533
Plasma Magnesium, 534
Plasma Phosphate, 535
25 Acid–Base Homeostasis and Imbalances, 541
Linda Felver
Acid–Base Homeostasis, 541
Buffers, 542
Respiratory Contribution, 542
Renal Contribution, 543
Acid–Base Imbalances, 545
Mixed Acid–Base Imbalances, 549
UNIT VIII Renal and Bladder Function
26 Renal Function, 551
Jacquelyn L. Banasik
Renal Anatomy, 552
Renal Parenchyma, 552
Renal Lymphatics and Innervation, 552
Renal Blood Supply, 553
Overview of Nephron Structure and
Function, 554
Glomerulus, 555
Proximal Convoluted Tubule, 557
Loop of Henle, 558
Distal Convoluted Tubule, 559
Collecting Duct, 559
Regulation of Glomerular Filtration, 560
Physics of Filtration, 560
Factors Affecting Filtration Pressure, 562
Tubuloglomerular Feedback, 563
Effects of Glucose and Amino Acids, 563
Role of Mesangial Cells, 564
Transport Across Renal Tubules, 565
Reabsorption of Glucose, 565
Regulation of Acid–Base Balance, 565
Secretion of Potassium, 566
Regulation of Blood Volume and Osmolality, 567
Antidiuretic Hormone, 567
Aldosterone, Angiotensin II, Natriuretic
Peptides, Urodilatin, Uroguanylin, and
Guanylin, 568
Diuretic Agents, 569
Endocrine Functions, 570
Erythropoietin, 570
Vitamin D, 570
Age-Related Changes in Renal Function, 570
Infant, 570
Adult and Elderly, 570
Tests of Renal Structure and Function, 570
Urine and Blood Studies, 570
Diagnostic Tests, 572
27 Intrarenal Disorders, 575
Jacquelyn L. Banasik and Roberta J. Emerson
Common Manifestations of Kidney Disease, 575
Pain, 575
Abnormal Urinalysis Findings, 576
Other Diagnostic Tests, 576
Congenital Abnormalities, 577
Renal Agenesis and Hypoplasia, 577
Cystic Kidney Diseases, 578
Neoplasms, 579
Infection, 581
Obstruction, 583
Glomerular Disorders (Glomerulopathies), 586
Glomerulonephritis, 587
Nephrotic Syndrome, 589
28 Acute Kidney Injury and Chronic Kidney Disease, 593
Cheryl Rockwell and Robin Y. Beeman
Acute Kidney Injury, 593
Etiology and Pathophysiology, 594
Clinical Presentation of Acute Kidney Injury, 596
Chronic Kidney Disease, 601
Risk Factors, 601
Pathophysiology of Progression of Chronic
Kidney Disease, 602
Stages of Chronic Kidney Disease, 602
Complications of Chronic Kidney Disease, 602
Clinical Management, 604
29 Disorders of the Lower Urinary Tract, 609
Cheryl L. Brandt
Lower Urinary Tract, 609
Functional Anatomy, 609
Physiology of Micturition, 610
Diagnostic Tests, 611
Lower Urinary Tract Symptoms and
Syndromes, 611
Neurogenic Bladder, 614
Congenital Disorders, 615
Neoplasms, 617
Inflammation and Infection, 619
Obstruction, 622
Lower Urinary Tract Calculi, 622
 Contents xvii

UNIT IX Genital and Reproductive Function Cancer of the Female Genital Structures, 679
Disorders of Pregnancy, 681
30 Male Genital and Reproductive Function, 626 Disorders of the Breast, 682
Marvin Van Every Reactive-Inflammatory Breast Disorders, 682
Anatomy, 626 Benign Breast Disorders, 683
Upper Genitourinary Tract, 626 Malignant Disorder of the Breast, 684
Lower Genitourinary Tract, 627 34 Sexually Transmitted Infections, 689
Auxiliary Genital Glands, 628 Rosemary A. Jadack
External Genitalia, 629 Urethritis, Cervicitis, Salpingitis, and Pelvic
Embryology, 632 Inflammatory Disease, 690
Nephric System, 632 Diseases With Systemic Involvement, 691
Vesicourethral Unit, 633 Diseases With Localized Lesions, 694
Gonads, 633 Ulcerative Lesions, 694
Genital Duct System, 633 Nonulcerative Lesions, 694
External Genitalia, 633 Enteric Infections, 695
Male Reproductive Physiology, 633
Hypothalamic-Pituitary-Testicular Axis, 633
Spermatogenesis, 637 UNIT X Gastrointestinal Function
Anatomy of Spermatozoa, 637
Transport of Spermatozoa, 637 35 Gastrointestinal Function, 697
31 Alterations in Male Genital and Reproductive Jeffrey S. Sartin
Function, 641 Structure and Organization of the Gastrointestinal
Marvin Van Every Tract, 698
Disorders of the Penis and Male Urethra, 641 Embryology, 698
Congenital Anomalies, 641 Functional Anatomy, 699
Acquired Disorders, 643 Gastrointestinal Motility, 704
Infectious Disorders, 645 Characteristics of the Intestinal Wall, 704
Neoplastic Disorders, 647 Neural Control, 704
Disorders of the Scrotum and Testes, 647 Hormonal Control, 706
Congenital Disorders, 647 Movement in the Gastrointestinal Tract, 706
Acquired Disorders, 648 Movement of Nutrients, 707
Infectious Disorders, 650 Secretory Function, 712
Neoplastic Disorders, 650 Secretion of Gastrointestinal Juices, 712
Disorders of the Prostate, 651 Gastrointestinal Hormones, 712
32 Female Genital and Reproductive Function, 656 Digestion and Absorption, 712
Rosemary A. Jadack Digestion of Carbohydrates, 713
Reproductive Structures, 656 Digestion of Lipids, 713
Organization of the Female Reproductive Digestion of Proteins, 714
Organs, 656 Absorption, 715
Menstrual Cycle, 659 Gastrointestinal Function Across the Life
Breast, 662 Span, 717
Structure of the Breast, 662 Maturation, 717
Breast Development, 662 Age-Related Changes, 717
Lactation, 663 36 Gastrointestinal Disorders, 720
Pregnancy, 663 Jeffrey S. Sartin
Early Human Development, 663 Manifestations of Gastrointestinal Tract
Implantation, 663 Disorders, 721
Fetal Membranes and Placenta, 663 Dysphagia, 721
Development of the Human Embryo and Fetus, 664 Esophageal Pain, 721
Parturition, 665 Abdominal Pain, 721
Response of the Mother’s Body to Pregnancy, 667 Vomiting, 723
Menopause, 668 Intestinal Gas, 723
33 Alterations in Female Genital and Reproductive Alterations in Bowel Patterns, 723
Function, 671 DISORDERS OF THE MOUTH AND
Rosemary A. Jadack ESOPHAGUS, 724
Menstrual Disorders, 672 Oral Infections, 724
Alterations in Uterine Position and Pelvic Esophageal Disorders, 724
Support, 674 ALTERATIONS IN THE INTEGRITY OF
Inflammation and Infection of the Female THE GASTROINTESTINAL TRACT
Reproductive Tract, 676 WALL, 726
Benign Growths and Aberrant Tissue of the Female Inflammation of the Stomach and
Reproductive Tract, 678 Intestines, 726
xviii Contents
Inflammatory Bowel Disease, 728
Enterocolitis, 731
ALTERATIONS IN MOTILITY OF THE
GASTROINTESTINAL TRACT, 733
Motility Disorders, 733
Disorders of Malabsorption, 735
Mucosal Disorders, 735
Malabsorption Disorders After Surgical
Intervention, 735
NEOPLASMS OF THE GASTROINTESTINAL
TRACT, 737
Esophageal, Gastric, and Small Intestinal
Cancers, 737
Colonic Polyps and Colon Cancer, 738
Psychosocial Aspects of Gastrointestinal
Disorders, 739
Stress of Lifestyle Changes, 739
37 Alterations in Function of the Gallbladder and Exocrine
Pancreas, 742
Jeffrey S. Sartin
Structure and Function of the Pancreaticobiliary
System, 742
Embryology of the Pancreaticobiliary
System, 743
Physiology of Bile, 743
Functional Anatomy of the Pancreas, 744
Disorders of the Gallbladder, 744
Pathophysiology of Cholesterol Gallstone
Formation, 744
Cholelithiasis and Cholecystitis, 745
Disorders of the Pancreas, 748
Pancreatitis, 748
38 Liver Diseases, 754
Jeffrey S. Sartin
Structure and Function of the Liver, 755
General Manifestations of Liver Disease, 755
Hepatocellular Failure, 755
Portal Hypertension, 759
Portal Systemic Encephalopathy, 763
Complications of Advanced Liver
Disease, 764
Disorders of the Liver, 767
Hepatitis, 767
Chronic Hepatitis, 772
Cirrhosis, 773
Alcoholic Liver Disease, 773
Toxic Liver Disorders, 774
Metal Storage Diseases, 774
Toxic Metabolic Agents, 775
Other Structural Liver Conditions, 775
Transplantation, 776
Evaluation of the Transplantation
Patient, 777
Posttransplantation Management, 777
Age-Related Liver Disorders, 778
Liver Diseases and Pediatric Considerations, 778
Abnormal Bilirubin Metabolism in the Neonatal
Period, 778
Infectious and Acquired Hepatitides in
Children, 778
Congenital Liver Disease, 779
Liver Diseases and Geriatric Considerations, 780
UNIT XI E ndocrine Function, Metabolism, and
Nutrition
39 Endocrine Physiology and Mechanisms of
Hypothalamic-Pituitary Regulation, 783
Jacquelyn L. Banasik
Hormone Structure and Action, 784
Chemical Structure of Hormone Classes, 784
Mechanisms of Hormone Action, 784
Hormone Regulation, 786
Hormone Synthesis, Secretion, and
Metabolism, 786
Regulation of Receptor Responses, 787
Hypothalamic-Pituitary Endocrine System, 788
Hormones of the Posterior Pituitary Gland, 788
Hormones of the Hypothalamus and Anterior
Pituitary Gland, 790
Thyroid Hormones, 793
Thyroid Hormone Synthesis and Secretion, 793
Thyroid Action on Target Cells, 793
Steroid Hormones, 794
Steroid Hormone Synthesis and Secretion, 794
Steroid Action on Target Cells, 795
Categories of Endocrine Disease, 797
Hyposecretion, 797
Hypersecretion, 797
Hyporesponsiveness, 797
40 Disorders of Endocrine Function, 799
Jacquelyn L. Banasik
Basic Concepts of Endocrine Disorders, 799
Etiology of Endocrine Disorders, 799
Classification of Endocrine Disorders, 800
Growth Hormone Disorders, 801
Thyroid Hormone Disorders, 803
Adrenocortical Hormone Disorders, 806
Adrenal Medulla Disorder, 810
Parathyroid Gland Disorders, 811
Regulation and Actions of Parathyroid
Hormone, 811
Antidiuretic Hormone Disorders, 812
41 Diabetes Mellitus, 815
Benjamin J. Miller
Regulation of Glucose Metabolism, 816
Hormonal Regulation, 816
Neural Regulation, 817
Exercise, 818
Stress, 818
Glucose Intolerance Disorders, 820
Classification of Glucose Intolerance
Disorders, 820
Prediabetes, 820
Diabetes Mellitus, 821
Screening for Diabetes, 824
Clinical Manifestations and Complications, 825
Acute Hyperglycemia, 825
Diabetic Ketoacidosis, 825
Nonketotic Hyperglycemic Hyperosmolar
Syndrome, 826
Chronic Hyperglycemia, 826
Vascular Complications, 826
Neuropathic Complications, 827
Complications in Pregnancy, 827
 Contents xix

Treatment and Education, 827 Peripheral Nervous System, 863

Nutrition, 828 Cranial Nerves, 863
Obesity and Eating Disorders, 828 Spinal Nerves, 864
Exercise, 829 Autonomic Nervous System, 867
Pharmacologic Agents, 829 NEURONAL STRUCTURE AND FUNCTION, 868
Stress Management, 831 Neurons and Supportive Cells, 868
Assessment of Efficacy, 831 Neurons, 868
Pediatric Considerations, 833 Glia, 868
Goals of Therapy, 834 Neuronal Communication, 872
Acute Complications, 834 Membrane Potentials, 872
Chronic Complications, 834 Synaptic Transmission, 874
Treatment, 834 Neurotransmitters, 875
Geriatric Considerations, 834 Neuronal Circuits, 880
Goals of Therapy, 835 Neural Development, Aging, and Injury, 880
Acute Complications, 835 Development, 880
Chronic Complications, 835 Aging, 881
Treatment, 835 Injury, 881
42 Nutritional and Metabolic Disorders, 838 SENSORY FUNCTION, 882
Brent A. Banasik Sensory Receptors, 882
Metabolic Processes, 838 Sensory Pathways, 883
Anabolism and Catabolism, 839 Somatosensory Cortex, 883
Metabolic Rate, 839 MOTOR FUNCTION, 883
Nutrient Metabolism, 839 Motor Neurons, 884
Carbohydrates, 839 Spinal Reflexes, 884
Lipids, 840 Central Control of Motor Function, 885
Proteins, 841 CONSCIOUSNESS, MEMORY, AND SLEEP, 886
Regulation of Appetite and Nutrient Consciousness and Memory, 886
Metabolism, 841 Sleep, 888
Role of Genetics, Epigenetics, and 44 Acute Disorders of Brain Function, 891
Environment, 841 Joni D. Marsh and Jacquelyn L. Banasik
Hormonal Regulation of Nutrient Intake and Mechanisms of Brain Injury, 892
Appetite, 842 Ischemia and Hypoxia, 892
Hormonal Regulation of Nutrient Storage, Increased Intracranial Pressure, 895
Distribution, and Metabolism, 843 Manifestations of Brain Injury, 900
Obesity and Metabolic Syndrome, 844 Level of Consciousness, 900
Obesity, 844 Glasgow Coma Scale, 900
Metabolic Syndrome, 844 Cranial Nerve Reflexes, 901
Metabolic Responses to Starvation and Physiologic TRAUMATIC BRAIN INJURY, 902
Stress, 844 Epidemiology, 902
Starvation and Protein-Energy Malnutrition, 845 Types of Traumatic Brain Injury, 903
Physiologic Stress, 845 Primary Injury, 903
Nutritional Considerations for Aging and Altered Intracranial Hematomas, 903
Health States, 846 Secondary Injury, 905
Aging, 846 Treatment, 905
Infection, Sepsis, and Fever, 846 CEREBROVASCULAR DISEASE AND
Surgery, 848 STROKE, 905
Trauma, 848 Epidemiology, 906
Burns, 848 Ischemic Stroke, 906
Cancer, 848 Hemorrhagic Stroke, 906
Immobility, 848 Treatment, 906
Stroke Sequelae, 908
Motor and Sensory Deficits, 908
UNIT XII Neural Function Language Deficits, 908
Cognitive Deficits, 908
43 Structure and Function of the Nervous System, 850 CREBRAL ANEURYSM AND ARTERIOVENOUS
Jacquelyn L. Banasik MALFORMATION, 909
STRUCTURAL ORGANIZATION, 851 Cerebral Aneurysm, 909
Central Nervous System, 851 Etiology, 909
Support and Protection of the Central Nervous Pathogenesis and Manifestations, 910
System, 851 Treatment, 910
The Brain, 853 Arteriovenous Malformation, 911
The Spinal Cord, 861 Etiology, 911
xx Contents

Pathogenesis and Manifestations, 911 Transduction, 956

Treatment, 911 Transmission, 956
CENTRAL NERVOUS SYSTEM INFECTIONS, 911 Perception, 958
Meningitis, 911 Modulation, 958
Etiology, 911 TYPES OF PAIN, 960
Pathogenesis and Clinical Manifestations, 911 Acute Pain, 961
Treatment, 911 Headache, 962
Encephalitis, 912 Chronic Pain, 962
Etiology, 912 Fibromyalgia Syndrome, 963
Pathogenesis and Manifestations, 912 Cancer-Related Pain, 964
Treatment, 912 Neuropathic Pain, 964
Brain Abscess, 912 Trigeminal Neuralgia, 965
Etiology, 912 Diabetic Neuropathy, 965
Pathogenesis and Manifestations, 912 Postherpetic Neuralgia, 966
Treatment, 913 Ischemic Pain, 966
45 Chronic Disorders of Neurologic Function, 915 Referred Pain, 966
Joni D. Marsh Physiologic Responses to Pain, 967
Brain and Cerebellar Disorders, 916 Pain in the Young and the Elderly, 967
Seizure Disorder, 916 TREATMENT MODALITIES, 967
Dementia, 918 Pharmacologic and Nonpharmacologic Pain
Parkinson Disease, 920 Management, 967
Cerebral Palsy, 922 Interrupting Peripheral Transmission of Pain, 968
Hydrocephalus, 923 Modulating Pain Transmission at the Spinal
Cerebellar Disorders, 924 Cord, 968
Spinal Cord and Peripheral Nerve Disorders, 925 Altering the Perception and Integration of
Multiple Sclerosis, 925 Pain, 968
Spina Bifida, 927
Amyotrophic Lateral Sclerosis, 928
Spinal Cord Injury, 928 UNIT XIII Neuropsychological Function
Guillain-Barré Syndrome, 931
Bell Palsy, 932 48 Neurobiology of Psychotic Illnesses, 971
46 Alterations in Special Sensory Function, 936 Ann Futterman Collier and Samantha Cody Russell
Joni D. Marsh Schizophrenia, 972
HEARING AND BALANCE, 937 Etiology and Neurobiology, 972
Structure and Function of the Ear, 937 Clinical Manifestations, 976
External Ear, 937 Pharmacologic Treatment, 976
Middle Ear, 937 Nonpharmacologic Treatment, 977
Inner Ear, 937 Major Depressive and Persistent Depressive
Balance, 938 Disorders, 978
General Manifestations of Hearing Impairment, 938 Etiology and Neurobiology, 979
Hearing Impairment Disorders, 939 Clinical Manifestations, 980
Conductive Hearing Impairment, 939 Pharmacologic Treatment, 981
Sensorineural Hearing Impairment, 939 Nonpharmacologic Treatment, 981
Otitis Media, 941 Bipolar Disorder, 982
Interventions for Individuals With Hearing Etiology and Neurobiology, 982
Impairment, 942 Clinical Manifestations, 983
VISION, 942 Pharmacologic Treatment, 983
Structure of the Eye, 942 Nonpharmacologic Treatment, 984
Visual Pathways, 943 Population Considerations, 984
General Manifestations of Visual Impairment, 944 Women and Mental Illness, 984
Disorders of the Eye, 944 Cultural Considerations, 984
Errors of Refraction, 944 Geriatric Considerations, 984
Age-Related Disorders, 945 49 Neurobiology of Nonpsychotic Illnesses, 989
Retinopathy, 947 Ann Futterman Collier and Samantha Cody Russell
Glaucoma, 948 Anxiety Disorders, 989
Visual Field Deficits, 950 Panic Disorder, 990
Interventions for Individuals With Vision Generalized Anxiety Disorder, 991
Impairment, 950 Obsessive-Compulsive Disorder, 992
SMELL AND TASTE, 952 Posttraumatic Stress Disorder, 994
47 Pain, 955 Neurodevelopmental Disorders, 995
Joni D. Marsh Attention-Deficit/Hyperactivity Disorder, 996
Physiology of Pain, 955 Autism Spectrum Disorder, 997

UNIT XIV M
 usculoskeletal Support and
Movement
50 Structure and Function of the Musculoskeletal
System, 1001
Carol L. Danning
Structure and Function of Bone, 1002
Composition, 1002
Functional Properties, 1003
Response to Injury, Stress, and Aging, 1004
Structure and Function of Joints, 1006
Synarthroses, 1007
Diarthroses, 1007
Structure and Function of Articular
Cartilage, 1011
Composition, 1011
Functional Properties, 1011
Response to Injury, Stress, and Aging, 1012
Structure and Function of Tendons and
Ligaments, 1012
Composition, 1012
Functional Properties, 1013
Response to Injury, Stress, and Aging, 1013
Structure and Function of Skeletal Muscle, 1013
Composition, 1014
Mechanics of Muscle Contraction, 1015
Sliding Filament Theory, 1015
Role of Calcium, 1015
Electromechanical Coupling, 1015
Types of Muscle Contraction, 1016
Mechanical Principles, 1017
Response to Movement and Exercise, 1017
51 Alterations in Musculoskeletal Function: Trauma,
Infection, and Disease, 1020
Carol L. Danning
SOFT TISSUE INJURIES, 1021
Inert Soft Tissue Injuries, 1021
Ligament Injuries, 1021
Joint Capsule Injuries, 1022
Internal Joint Derangement, 1023
Injuries to Fasciae and Bursae, 1023
Injuries to Nerves, Nerve Roots, or Dura
Mater, 1023
Contractile Soft Tissue Injuries, 1023
Injury to Tendons, 1023
Muscle and Tendon Strains, 1024
Blunt Trauma, 1024
Compartment Syndrome, 1024
Soft Tissue Healing After Trauma, 1024
BONE INJURIES AND INFECTIONS, 1026
Bone and Joint Trauma, 1026
Types of Bone, 1026
Fracture, 1026
Dislocations and Subluxations, 1030
Infections of the Bone, 1031
Osteomyelitis, 1031
Tuberculosis, 1032
ALTERATIONS IN BONE STRUCTURE AND
MASS, 1032
Bone Structure Disorders, 1032
Scoliosis, 1032
Metabolic Bone Diseases, 1033
Contents xxi
Osteoporosis, 1033
Rickets and Osteomalacia, 1035
Paget Disease, 1035
Bone Tumors, 1036
Benign Tumors, 1036
Malignant Bone Tumors, 1037
DISEASES OF SKELETAL MUSCLE, 1038
Idiopathic Inflammatory Myopathy, 1038
Polymyositis and Dermatomyositis, 1038
Muscular Dystrophy, 1039
Duchenne Muscular Dystrophy, 1039
Becker Muscular Dystrophy, 1039
Facioscapulohumeral Muscular Dystrophy, 1039
Myotonic Dystrophies, 1039
OTHER DISORDERS OF MUSCLE, 1039
Myasthenia Gravis, 1039
Treatment, 1039
Chronic Muscle Pain, 1040
Fibromyalgia Syndrome, 1040
52 Alterations in Musculoskeletal Function: Rheumatic
Disorders, 1042
Carol L. Danning
Local Disorders of Joint Function, 1042
Osteoarthritis, 1042
Infectious Arthritis, 1045
Lyme Disease, 1045
Systemic Disorders of Joint Function, 1046
Immune-Mediated Disorders, 1046
Postinfectious Systemic Disorders, 1052
Joint Dysfunction Secondary to Other Diseases, 1053
Psoriatic Arthritis, 1053
Enteropathic Arthritis, 1053
Neuropathic Osteoarthropathy, 1054
Hemophilic Arthropathy, 1054
Gout, 1054
Adult-Onset Still Disease, 1055
Pediatric Joint Disorders, 1056
Nonarticular Rheumatism, 1056
Hypermobility of Joints, 1056
Juvenile Idiopathic Arthritis, 1056
UNIT XV Integumentary System
53 Alterations in the Integumentary System, 1058
Lee-Ellen C. Copstead, Ruth E. Diestelmeier, and
Michael R. Diestelmeier
Age-Related Changes, 1059
Epidermis, 1060
Dermis and Subcutaneous Tissue, 1060
Appendages, 1061
Evaluation of the Integumentary System, 1061
Primary and Secondary Lesions, 1061
Lesion Descriptors, 1062
Selected Skin Disorders, 1063
Infectious Processes, 1064
Viral Infections, 1064
Fungal Infections, 1065
Bacterial Infections, 1067
Inflammatory Conditions, 1069
Allergic Skin Responses, 1072
Parasitic Infestations, 1075
xxii Contents

Other Disorders of the Dermis, 1076 Risk Factors, 1094

Scleroderma, 1076 Integument Effects, 1094
Sunburn and Photosensitivity, 1077 Depth Classification, 1096
Ulcers, 1078 Extent of Injury, 1097
Altered Cell Growth: Epidermal Proliferation, 1078 Severity Classification, 1097
Pigmentation Alterations, 1080 Acute Management, 1097
Special Characteristics of Dark Skin, 1081 Assessment, 1099
Integumentary Manifestations of Systemic Burn Shock and Acute Resuscitation, 1099
Disease, 1083 Organ Dysfunction, 1101
Skin, 1083 Metabolic Changes, 1102
Hair, 1084 Cellular Changes, 1102
Nails, 1084 Immune Response, 1103
Treatment Implications, 1086 Elements of Burn Injury Survival, 1103
Topical Treatment, 1086 Rehabilitation Phase, 1106
Intralesional Injection, 1086 Electrical Injury, 1107
Selection of a Delivery System, 1087 Incidence and Mortality, 1107
Corticosteroids, 1087 Pathophysiology, 1107
Developmental Considerations, 1087 Management and Complications, 1108
Infancy, 1087 Chemical Injury, 1109
Childhood Skin Disorders, 1088 Management and Complications, 1109
Adolescence and Young Adulthood, 1090 Common Agents and Treatment, 1109
Geriatric Considerations, 1090 Special Populations, 1110
54 Burn Injuries, 1093 Introduction, 1110
Sarah Ogle and Nirav Patel
Thermal Injury, 1094 Glossary, 1114
Etiology, Incidence, and Mortality, 1094 Index, 1143
UNIT I Pathophysiologic Processes
Introduction to Pathophysiology
http://evolve.elsevier.com/Banasik/pathophysiology/
• Review Questions and Answers
• Glossary (with audio pronunciations for selected terms)
• Animations
KEY QUESTIONS
• What is pathophysiology?
• How are etiology and pathogenesis used to predict clinical
manifestations and response to therapy?
• How are normal and abnormal physiologic parameters defined?
CHAPTER OUTLINE
Framework for Pathophysiology, 2
Etiology, 2
Pathogenesis, 2
Clinical Manifestations, 3
Stages and Clinical Course, 3
Treatment Implications, 3
Concepts of Normality in Health and Disease, 4
Statistical Normality, 4
Reliability, Validity, and Predictive Value, 5
Individual Factors Influencing Normality, 5
Cultural Considerations, 5
Pathophysiology derives from the intersection of two older, related
disciplines: pathology (from pathos, suffering) and physiology (from
physis, nature). Pathology is the study and diagnosis of disease through
examination of organs, tissues, cells, and bodily fluids. Physiology is the
study of the mechanical, physical, and biochemical functions of living
organisms. Together, as pathophysiology, the term refers to the study of
abnormalities in physiologic functioning of living beings.
Pathophysiology seeks to reveal physiologic responses of an organism
to disruptions in its internal or external environment. Because humans
exhibit considerable diversity, healthy structure and function are not
precisely the same in any two individuals. However, discovering the
common and expected responses to abnormalities in physiologic func-
tioning is useful, and it allows a general prediction of clinical progression,
identification of possible causes, and selection of interventions that are
1
Lee-Ellen C. Copstead
• Case Studies
• Key Points Review
• What general factors affect the expression of disease in a
particular person?
• What kinds of information about disease can be gained through
understanding concepts of epidemiology?
Age Differences, 6
Gender Differences, 6
Situational Differences, 6
Time Variations, 6
Patterns of Disease in Populations, 6
Concepts of Epidemiology, 6
Endemic, Pandemic, and Epidemic Diseases, 7
Aggregate Factors, 7
Levels of Prevention, 9
most likely to be helpful. Thus pathophysiology is studied in terms of
common, or “classic,” presentations of disorders.
Historically, descriptions of diseases were based on observations of
those individuals who attracted medical attention because they exhibited
abnormal signs or complained of symptoms. Over time, cases with
similar presentations were noted and treatments that had been successful
before were used again. In some cases, similarities among individuals
pointed to possible common causes. With the advent of more sophis-
ticated measurements of physiologic and biochemical function, such
as blood pressure measurements, blood chemistry values, x-ray images,
and DNA analysis, the wide variability in the expression of diseases
and disorders in the population became apparent, as did the opportunity
to discover diseases at earlier stages, before they were clinically obvious.
Screening programs that evaluated large segments of the population
1
Another random document with
no related content on Scribd:
 Fishing Fleet going out, Aberdeen
The herring fishery was prosecuted off the Scottish coast by the
Dutch, long before the Scotch could be induced to take part in it.
Many futile attempts were made to exploit the industry but little came
of them till the nineteenth century. A beginning was made at
Peterhead in 1820 and at Fraserburgh a little earlier. Aberdeen
followed in 1836 but no great development took place till 1870. The
first trawler came on the scene in 1882; to-day there are over 200
local vessels of this type besides many from other ports.
The salmon fishery has long been famous and at one time was
relatively a source of much greater revenue than at present. It still
yields a considerable annual surplus to the Corporation funds, but
has been eclipsed by the growth of other fisheries. The rateable
value of the salmon fishings on the Dee is nearly £19,000; those of
the other salmon rivers—the Don, Ythan and Ugie—being much
less. The fish are caught by fixed engines in the sea—stake-nets
and bag-nets—set within a statutory radius of the river mouth, and
by sweep- or drag-nets in the tidal reaches of the rivers. A good
many fish are caught by rod and line throughout the whole course of
the rivers but angling is not the commercial side of salmon-fishing.
 15. Shipping and Trade.
Aberdeenshire has practically but three ports—Fraserburgh,
Peterhead and Aberdeen. The herring fishing with its concomitant
activities absorbs the energies of the two former so far as shipping is
concerned, but Aberdeen having to serve a larger and wider area
than these two northern burghs has developed a range of docks of
considerable extent and importance. During the last forty years the
Harbour Commissioners have spent £3,000,000 in improving the
harbour, increasing the wharfage, adding break-waters, diverting the
course of the Dee, deepening the entrance channel, forming a
graving dock and so forth. Still, in spite of these outlays, Aberdeen,
which has been a port for centuries, has hardly grown in shipping
proportionately to its growth in other respects. The reason is that,
except fish, granite and agricultural products, the city has nothing of
much moment to export.
 At the docks, Aberdeen
Exclusive of fishing vessels the tonnage of home and foreign going
vessels was in 1882, 587,173; in 1909 it had advanced to over a
million, hardly doubling itself in 27 years. While its imports have gone
up from 522,544 tons in 1882 to 1,165,060 in 1909, the exports have
made only a very slight advance. The chief export is herrings, and
last year nearly 100,000 tons of these, salted and packed in barrels,
were sent by sea. The fresh fish are dispatched by rail. Stones in the
form of granite, either polished for monumental purposes or in setts
and kerbs for paving, account for 50,000 tons. The remainder (of
210,554 tons) is made up by oats, barley, oatmeal, paper, preserved
provisions, whisky, manures, flax and cotton fabrics, woollen cloth,
cattle and horses, butter and eggs, salmon and pine-wood.
The trade is mostly a coasting trade and more an import than an
export one. Coal is the chief article of import, 600,000 tons being
discharged in a year. Besides coal, esparto grass, wood-pulp and
rags for paper-making, foreign granite in the rough state sent to be
polished, flour, maize, linseed, the horns of cattle used for comb-
making, and the salt used in fish-curing, are the chief materials
landed on the Aberdeen quays. Aberdeen being the distributing
centre for the county, and all the railway routes focussing in it, the
coal and the building materials not produced in the district, such as
lime, slate and cement, all pass this way, while the tea and sugar,
the tobacco and other articles of daily use, also arrive mostly by the
harbour.
There are regular lines of steamers between Aberdeen and the
following ports: London, Newcastle, Hull, Liverpool, Glasgow and
Leith, as also with continental towns such as Hamburg, Rotterdam
and Christiania.
 16. History of the County.
Standing remote from the centre of the country, Aberdeenshire has
not been fated to figure largely in general history. The story of its
own evolution from poverty to prosperity is an interesting one, but it
is only now and again that the county is involved in the main current
of the history of Scotland.
If the Romans ever visited it, which is highly doubtful, they left no
convincing evidence of their stay. Of positive Roman influence no
indication has survived, and no conquest of the district can have
taken place. The only records of the early inhabitants of the district—
usually called Picts—are the Eirde houses, the lake dwellings or
crannogs, the hill forts or duns, the “Druidical” circles and standing
stones and the flint arrow-heads, all of which will be dealt with in a
later chapter.
Christianity had reached the south of Scotland before the Romans
left early in the fifth century. The first missionary who crossed the
Mounth was St Ternan, whose name survives at Banchory-Ternan on
the Dee, the place of his death. St Kentigern or St Mungo, the patron
saint of Glasgow, had a church dedicated to him at Glengairn. St
Kentigern belonged to the sixth century, and was therefore a
contemporary of St Columba, who christianised Aberdeenshire from
Iona. In this way two great currents met in the north-east. Columba
accompanied by his disciple Drostan first appeared at Aberdour on
the northern coast. From Aberdour he passed on through Buchan,
and having established the Monastery of Deer and left Drostan in
charge, moved on to other fields of labour. His name survives in the
fishing village of St Combs. He is the tutelar saint of Belhelvie, and
the churches of New Machar and Daviot were dedicated to him.
These facts indicate the mode in which Pictland was brought under
the influence of Christianity.
The next historical item worthy of mention is the ravages of the
Scandinavian Vikings. The descents on the coast of these sea-
rovers were directed against the monastic communities, which had
gathered some wealth. The Aberdeenshire coast, having few inlets
convenient for the entry of their long boats, was to a large extent
exempt from their raids, but in 1012 an expedition under Cnut, son of
Swegen, the king of Denmark, landed at Cruden Bay.
Another fact of interest is the death of Macbeth, who for seventeen
years had by the help of Thorfinn, the Scandinavian (whose name
may be seen in the Deeside town of Torphins), usurped the kingship
of Scotland. Malcolm Canmore led an army against him in 1057, and
gradually driving him north, beyond the Mounth, overtook him at
Lumphanan. There Macbeth was slain. A Macbeth’s stone is said to
mark the place where he received his death-wound, and Macbeth’s
Cairn is marked by a clump of trees in the midst of cultivated land.
The farm called Cairnbethie retains the echo of his name. Kincardine
O’Neil, where Malcolm awaited the result of the conflict, commands
the ford of the Dee on the ancient route of travel from south to north
across the Cairn-o-Mounth.
Malcolm shortly after passed through Aberdeenshire at the head of
an expedition against the Celtic population which had supported
Macbeth. The Norman Conquest, nine years thereafter, was the
occasion of Anglo-Saxon settlements in the county. The court of
Malcolm and Queen Margaret became a centre of Anglo-Saxon
influence. The old Gaelic language gave way before the new
Teutonic speech. The Celtic population made various attempts to
recover the power that was fast slipping from their hands. Malcolm
headed a second expedition to Aberdeenshire in 1078, and on that
occasion granted the lands of Monymusk and Keig to the church of
St Andrews. He is said to have had a hunting-seat in the forest of
Mar, and the ruined castle of Kindrochit in the village of Braemar is
associated with this fact.
The earliest mention of Aberdeen is in a charter of Alexander I,
granting to the monks of Scone a dwelling in each of the principal
towns—one of which is Aberdeen. A stream of Anglo-Saxons,
Flemings and Scandinavians had been gradually flowing towards the
settlement at the mouth of the Dee, where they pursued their
handicrafts and established trade with other ports. William the Lion
frequently visited the town and ultimately built a royal residence,
which after a time was gifted to the Trinity or Red Friars for a
monastery. The bishopric of Aberdeen dates from 1150.
Edward I of England in 1296 at the head of a large army paid these
northern parts a visit. He entered the county by the road leading from
Glenbervie to Durris, whence he proceeded to Aberdeen, exacting
homage from the burghers during his five days’ stay. From Aberdeen
he went to Kintore and Fyvie and on to Speyside, returning by the
Cabrach, Kildrummy, Kincardine O’Neil and the Cairn-o-Mounth.
The next year Wallace, in his patriotic efforts to clear the country
from English domination, surprised Edward’s garrison at Aberdeen,
but unable to effect anything, hastily withdrew from the
neighbourhood. Edward was back in Aberdeen in 1303 and paid
another visit to Kildrummy Castle, then in the possession of Bruce.
Then Bruce, having fled from the English court and assassinated the
Red Comyn at Dumfries, was crowned at Scone and the long
struggle for national independence began in earnest. In 1307 he
came to Aberdeen, which was favourable to his cause. At Barra, not
far from Inverurie and Old Meldrum, his forces met those of the Earl
of Buchan (John Comyn) and defeated them (1308). It was not a
great battle in itself, but its consequences were important. It marked
the turn of the tide in the national cause. The Buchan district, in
which the battle took place, had long been identified with the
powerful family of the Comyns; and after his victory at Barra, Bruce
devastated the district with relentless fury. This “harrying of Buchan,”
as it has been called, is referred to by Barbour as an event
bemoaned for more than fifty years. The family of the Comyns was
crushed, and their influence, which had been liberal and considerate
to the native race of Celts, came to an end. The whole of the north-
east turned to Bruce’s support, and in a short time all Edward’s
garrisons disappeared. This upheaval created a fresh partition of the
lands of Aberdeenshire. New families such as the Hays, the Frasers,
the Gordons and the Irvines, were rewarded for faithful service by
grants of land. The re-settlement of the county from non-Celtic
sources accentuated the Teutonic element in the county. After
Bannockburn, Bruce rewarded Aberdeen itself for its support by
granting to the burgesses the burgh as well as the forest of Stocket.
The great event of the fifteenth century was the Battle of Harlaw,
which took place in 1411 at no great distance from the site of the
Battle of Barra. It was really a conflict between Celt and Saxon, and
was a despairing effort on the part of the dispossessed native
population to re-establish themselves in the Lowlands. The
Highlanders were led by Donald of the Isles, who gathering the
clansmen of the northern Hebrides, Ross and Lochaber, and
sweeping through Moray and Strathbogie, arrived at the Garioch on
his way to Aberdeen. The burghers placed themselves under the
leadership of the Earl of Mar (Alexander Stewart, son of the Wolf of
Badenoch), a soldier who had seen much service in various parts of
the world. The provost of the city, Robert Davidson, led forth a body
of his fellow-citizens and joined Mar’s forces at Inverurie, within three
miles of the Highlanders’ camp. The two forces were unequally
matched—Donald having 10,000 men and Mar only a tenth of that
number, but of these many were mail-clad knights on horseback and
armed with spears. It was a fiercely contested battle and lasted till
the darkness of a July night. The slaughter on both sides was great,
but the tide of barbarism was driven back. The Highlanders retreated
whence they came and the county of Aberdeen was saved from the
imminent peril of a Celtic recrudescence. This is the only really
memorable battle associated with Aberdeenshire soil. Its “red” field,
on which so many prominent citizens shed their life-blood (Provost
Davidson and Sir Alexander Irvine of Drum being of the number),
was long remembered as a dreary and costly victory.
Another battle of much less significance was that of Corrichie, fought
in Queen Mary’s reign in 1562 on the eastern slope of the Hill of
Fare, not far from Banchory. It was a contest between James
Stewart (the Regent Murray, and half-brother of the Queen) and the
Earl of Huntly. Huntly was defeated and slain, and his son, Sir John
Gordon, who was taken prisoner, was afterwards executed at
Aberdeen. Queen Mary, it is said, was a spectator both of the battle
and of the execution.
In the seventeenth century, at the beginning of the Covenanting
“troubles,” Aberdeenshire gained a certain notoriety as being the
place where the sword was first drawn. In 1639 the Covenanters
mustered at Turriff under Montrose, to the number of 800. The
Royalist party under the Earl of Huntly, to the number of 2000 but
poorly armed, marched to the town with the intention of preventing
the Covenanters from meeting, but they were already in possession,
and when Huntly’s party saw how matters stood, they passed on, the
two forces surveying each other at close quarters without hostile act
or word. This bloodless affair is known as the first Raid of Turriff. A
few weeks later a somewhat similar encounter took place, when the
Covenanters, completely surprised, fled without striking a blow. The
loss on either side was trifling, still some blood was actually shed,
and the Trot of Turriff, as it was called, became the first incident in a
long line of mighty events.
Montrose, both when he was leading on the side of the Covenant,
and later when he became a Royalist leader, paid several visits to
Aberdeen, which, although supporting the Royalist cause, suffered
exactions from both parties. In 1644 Montrose made a forcible entry
of the town, which resulted in the death of 150 Covenanters, and in
the plundering of the city. Later on, after his victory over Argyll at
Inverlochy, Montrose gained a success for the Royalist cause at
Alford (1645).
In 1650, after the execution of Charles I, his son Charles II landed at
Speymouth, and on his way south to be crowned at Scone, visited
Aberdeen, where he was received with every manifestation of loyalty
and goodwill. The next year General Monk paid the town a visit, and
left an English garrison, which remained till 1659. The Restoration
was hailed with rejoicing: the Revolution with dislike. Yet at the
Rebellion of 1715 scant enthusiasm was roused for the cause of the
Pretender, who himself passed through the city on his way from
Peterhead to Fetteresso. In the thirty years that passed before the
second Jacobite Rebellion, public sentiment had grown more
favourable to the reigning House. The ’45 therefore received little
support in Aberdeenshire. A few of the old county families threw in
their lot with the Prince, but the general body of the people were
averse to taking arms. The Duke of Cumberland, on his way north to
meet Prince Charlie at Culloden, remained with his army six weeks
in the city; when he started on his northward march through Old
Meldrum, Turriff and Banff, he left a garrison of 200 men in Robert
Gordon’s Hospital, lately built but not yet opened. After Culloden
small pickets of troops were stationed in the Highland districts of the
county, to suppress the practice of cattle-lifting. Braemar Castle and
Corgarff Castle in the upper reaches of the Dee and the Don still
bear evidence of their use as garrison forts. The problem of dealing
with the inhabitants of the higher glens, where agriculture was
useless, and where the habits of the people prompted to raiding and
to rebellion, was solved by enlisting the young men in the British
Army. The Black Watch (42nd) as reorganised (1758) and a regiment
of Gordon Highlanders (1759) were largely recruited from West
Aberdeenshire, and this happy solution closed the military history of
the district.
 17. Antiquities—Circles, Sculptured Stones,
Crannogs, Forts.
Aberdeenshire is particularly rich in stone-circles. No fewer than 175
of them have been recorded as existing in the district. Unfortunately
many of them entirely disappeared when the sites were turned to
agricultural uses; others have been mutilated, and owing to the
removal of some of the stones, stand incomplete; a few have been
untouched, and from these we may judge what the others were like.
One of the best preserved is that at Parkhouse, a mile south-west of
the Abbey of Deer. A circle of great blocks of stone, irregular and of
unequal height, some standing erect, some evidently fallen down, is
the general feature. Sometimes inside the circle, but more usually in
the circumference of the circle itself, there is one conspicuously
larger stone, in a recumbent position. This it has been usual to call
the rostrum or altar stone. It is well marked at Parkhouse, being 14
feet 9 inches long, 5 feet 9 inches high, and estimated to weigh 20
tons. The so-called rostrum is usually on the south side of the circle
and the stones facing it on the north are of smaller size.
 White Cow Wood Cairn Circle; View from the S.W.
From _Proceedings of the Society of Antiquaries of Scotland_,
1903-4
 Palaeolithic Flint Implement
(From Kent’s Cavern, Torquay.)
Neolithic Celt of Greenstone
(From Bridlington, Yorks.)

The size of the circles varies, the largest being over 60 feet in
diameter, the smaller ones less than 30. Parkhouse measures 50
feet. They are found all over the county, in the valley of the Dee, in
the valley of the Don at Alford, Inverurie and Dyce, as well as in
Auchterless, Methlick, Crimond and Lonmay. The recumbent stone is
invariably a feature of the larger circles. One of the largest is in the
circle at Old Keig in Alford—a huge monolith computed to be 30 tons
in weight. Other good examples are at Auchquorthies, Fetternear
and at Balquhain near Inveramsay.
In the smaller and simpler circles, there is no recumbent stone, and
the blocks are of more uniform height.
What the circles were used for is still a matter of dispute. They have
for long been called “Druidical” circles, and the received opinion was
that they were places of worship, the recumbent stone being the
altar. But there is no certitude in this view; and, indeed, the fact that
several exist at no great distance from each other (more than a
dozen are located in Deer) would seem to be adverse to it. They
were certainly used as places of burying, and some antiquarians
hold that they were the burying grounds of the people of the Bronze
Age. A later theory is that they were intended to be astronomical
clocks to a people who knew nothing of the length of the year, and
who had no almanacs to guide them in the matter of the seasons.
The stone-circles, however, still remain an unsolved problem.
 Stone at Logie, in the Garioch (4 feet high)
From Anderson’s Scot. in Early Ch. Times, 2nd Series

Besides the circles, Aberdeenshire has another class of

archaeological remains, called sculptured stones. These are of three
kinds: (1) those with incised symbols only, (2) those with in addition
Celtic ornament carved in relief, and (3) monuments with Celtic
ornament in relief and no symbols. The first class is the only one
largely represented in Aberdeenshire and a good many
representatives are in existence. The symbols most commonly seen
are the crescent and sceptre, the spectacles, the mirror and comb,
and the so-called “elephant” symbol, a representation of a beast with
long jaws, a crest and scroll feet. Another is the serpent symbol.
What the symbols signify is still a mystery, but the fact that the
stones with symbolism are unusually common in what was known as
Northern Pictland seems to point to their being indigenous to that
area. Out of 124 stones in the first class Aberdeenshire has 42. It
would seem as if the county had been the focus where the
symbolism originated. The richness of the locality round Kintore and
Inverurie in symbol stones is taken to indicate that region as the
centre from which they radiated.
Another form of archaeological remains found in the county is the
Eirde or Earth-Houses. These are subterranean dwellings dug out of
the ground and walled with unhewn, unmortared stones, each stone
overlapping the one below until they meet at the top which is
crowned with a larger flag-stone, or sometimes with wood. The
probability is that in conjunction with the underground chambers
there were huts above ground, which, being composed of wood,
have now entirely disappeared. At many points in these earth-
houses traces of fire and charcoal are to be seen, stones blackened
by fire and layers of black ashes. In one at Loch Kinnord a piece of
the upper stone of a quern as well as an angular piece of iron was
found. It may be inferred that the inhabitants, whoever they were,
were agriculturists, and that the period of occupation lasted down to
the Iron Age. Specimens of these houses, which usually go by the
local name of Picts’ houses, are found in the neighbourhood of Loch
Kinnord on Deeside, at Castle Newe on the Don, and at Parkhouse,
not far from the circle already referred to.
 “PICTS” OR “EIRDE HOUSE” AT MIGVIE
ABERDEENSHIRE
From Proceedings of the Society of Antiquaries of Scotland,
Vol. V. 1865

The common notion of the purpose of these underground dwellings

was that they were meant for hiding-places in which the inhabitants
took refuge when unable to resist their enemies in the open, but if,
as has now been discovered, they were associated with wooden
erections above ground, they could not have served this purpose.
On the surface beside them were other houses, cattlefolds and other
enclosures; once an enemy was in possession of these, he could
hardly miss the earth-houses. Moreover, the inhabitants, if
discovered, were in a trap from which there was no escape. It is
more probable that the dwellings were adjuncts of some unknown
kind to the huts on the surface. The fact that pottery and bronze
armlets have been unearthed from these underground caverns
proves that the earth-dwellers had reached a certain advancement in
civilisation. They reared domestic animals, wove cloth and sewed it,
and manufactured pottery. They used iron for cutting weapons and
bronze for ornament, and must have possessed a wonderfully high
standard of taste and manual skill.
Along with the earth-houses at Kinnord are found crannogs or lake-
dwellings. Artificial islands were created in the loch by forming a raft
of logs, upon which layers of stones and other logs were deposited.
As fresh materials were added the raft gradually sank till it rested on
the bottom. The sides were afterwards strengthened with the
addition of stones and beams. In this way was formed what is called
the Prison Island on Loch Kinnord. In all probability the other island
in the same loch, the Castle Island, may also be artificial, although it
has usually been regarded as natural. Crannogs in pairs—one large
and the other small—occur in several lochs.

Loch Kinnord

A number of hill-forts, more or less disintegrated, are traceable in the

higher ground in the vicinity of Lochs Kinnord and Davan. These
show concentric lines of circumvallation, with stronger fortifications at
various points. Vitrified forts, where the stones have been run
together by the application of heat, are found at Dunnideer near
Insch, and on the conical summit of Tap o’ Noth near Rhynie. The
Barmekin at Dunecht encloses an area of more than two acres, and
consists of five concentric walls, three of earth-works and two of
stone.
Numerous cairns, barrows or tumuli exist all over the county, at
Aberdour on the coast, at Birse, Bourtie, Rhynie, Turriff, and
elsewhere. Human remains have been found in most of these; and
as a rule flint arrow-heads and other implements are also associated
with them.