Campbell's Pathophysiology Notes

Description

Acknowledgements Introduction Chapter 1 Nature and Aetiology of Disease Basic Terms Causes of disease Endogenous aetiology Genetic disorders Autosomal dominant disorders Autosomal recessive disorders Sex linked diseases Genetic predispositions Implications of genetic knowledge Chromosomal disorders Exogenous aetiology Infections Chemical toxins Physical agents Nutritional factors Degenerative disorders Abnormal immunity Neoplasm Psychosomatic factors Psychiatric disorders Iatrogenic disease Idiopathic disease Multifactorial aetiology Congenital disorders Teratogenesis Drugs Intrauterine infections Radiation Nutrition Health care and disease aetiology Prophylaxis Identifying disease Clinical features History taking Pathological investigations Other investigations Differential diagnosis Acute and chronic disease Fulminant disease Complications Lesion Disease evolution Relapse, remission and exacerbation Convalescence Terminal disease and palliative care Prognosis Epidemiology Incidence and prevalence Correlation studies Screening for disease Chapter 2 Neoplasia Aetiology of Cancer Neoplasms and mutations Chemical carcinogens Tobacco smoke as a carcinogen Direct and indirect carcinogens Initiation and promotion Free radicals Radiation DNA repair Genetic factors Cancer prevention Never use tobacco Limit alcohol intake Eat enough antioxidants to neutralise free radicals Combat and prevent obesity Be physically active Avoid too much ultraviolet radiation Avoid carcinogens Sarcoma Bone marrow derived cells Other categories of malignancies Hypertrophy and hyperplasia Benign and malignant neoplasms Characteristics of malignant neoplasms Characteristics of benign neoplasms Metaplastic tissue Invasion and metastasis Carcinoma in situ Primary and secondary tumours Loss of cell to cell adhesion Metastasis of malignant cells Cancer staging Cancer grading Tumour markers Paraneoplastic syndromes Early warning signs of cancer Indigestion or difficulty in swallowing Diagnosis of malignancy Principles of cancer management Local excision Chemotherapy Radiotherapy Endocrine related treatment Immunotherapy Palliative treatment Chapter 3 Infectious Disease Introduction to infection Infection is a global problem Infection and immunity Types of human / microbe relationships Pathogenic microorganisms Opportunistic microorganisms Local and systemic infection Epidemiology Modes of transmission Vectors Fomites Cross-infection Vertical and horizontal transmission Health-care and community acquired infections Common sites of HAIs Zoonoses Portal of entry Ingestion Inhalation Penetration Blood-borne spread Direct contact Infectious agents Viruses Bacteria Colonization or infection Gram-positive or negative Bacterial resistance Timing of treatment Other infectious agents Fungi Mycoplasma Helminths Arthropods Protozoa Chlamydiae, rickettsiae, ehrlichieae and coxiella Prions Diagnosis of infection Koch’s postulates Clinical diagnosis Evolution of an infection Chapter 4 Disorders of Immunity Human immunodeficiency virus infection Epidemiology HIV/AIDS is a new disease HI virus Disease transmission Sexual spread Mother to child spread Blood borne spread Clinical features Clinical phases in HIV infection Incubation Seroconversion phase Latent or asymptomatic infectious phase ARC and AIDS phases Clinical presentations in HIV infection Candida Pneumocystis carinii pneumonia (PCP) Cryptococcal meningitis Other possible forms of OI Malignancies Management principles in HIV Highly active antiretroviral therapy (HAART) HIV and pregnancy HIV and you Preventing opportunistic infections (OIs) Prevention of HIV Hypersensitivity (allergic and autoimmune) disorders Hypersensitivity verses immunological tolerance Allergies Antibodies Autoimmunity Types of hypersensitivity reaction Type I (immediate allergic) hypersensitivity reactions Clinical features in type I hypersensitivity reactions Diagnosis Management principles Atopy Healthy dirt Type II hypersensitivity Chapter 5 Disorders of Arteries Physiology Pathophysiology Atherosclerosis Causes of atheroma Elevated plasma cholesterol High density and low density lipoprotein particles Harmful diets Protective diets Alcohol Smoking Diabetes mellitus Hypertension Physical activity Gender Psychosocial factors Age Obesity Risk factors are synergistic Complications of atheroma Ischaemia Aerobic and anaerobic metabolism Thrombosis Disorders of vascular endothelium Sluggish or abnormal blood flow Increased blood coagulability Embolism Pathophysiology Forms of emboli Aneurysm Dissecting aneurysm Berry aneurysms Collateral circulation Disorders caused by disrupted arterial circulation and inadequate tissue perfusion Gangrene Prevention Coronary heart and cerebrovascular disease Peripheral vascular disease (PVD) Clinical features Ankle: Brachial Pressure Index (ABPI) Treatment Acute limb ischaemia Raynaud’s disease Chapter 6 Disorders of Veins Deep venous thrombosis (DVT) Physiology Risk factors Pathophysiology Anatomy Clinical features Prevention of DVT Treatment principles Pulmonary embolism Pathophysiology Clinical features Management principles Chronic venous insufficiency and hypertension Physiology Causes of varicose veins Complications of varicose veins Venous leg ulcers Classification of leg ulcers Aetiology of venous ulcers Clinical features Treatments Oesophageal varices Haemorrhoids Aetiology Clinical features Treatments Chapter 7 Shock Introduction Factors affecting blood pressure Venous return Physiological response when blood pressure falls Neurological response Endocrine system response Clinical features of shock Arterial vasoconstriction Venous vasoconstriction Tachycardia Clammy Thirst Respiratory effects Coronary and cerebral circulation Effects on other body tissues Renal effects Stages of shock Compensated shock Progressive shock Irreversible shock The Golden Hour Clinical forms of shock Myocardial infarction Severe heart valve dysfunction Cardiomyopathy Hypovolaemic shock Haemorrhage Burns Oedema Dehydration Tachycardia and hypovolaemia Management principles in hypovolaemia Oral rehydration therapy Intravenous fluid replacement Obstructive shock Uncomplicated sepsis, severe sepsis and septic shock Uncomplicated sepsis Severe sepsis Septic shock Vasodilation as part of the problem Management principles in severe sepsis and septic shock Anaphylactic shock Clinical features Management principles in anaphylaxis Spinal shock Vasovagal (neurogenic) syncope Shock and children Chapter 8 Haemorrhage Damage to blood vessels Arterial haemorrhage Venous haemorrhage Capillary haemorrhage Forms of haemorrhage Primary haemorrhage Management principles in primary haemorrhage Use of pressure Tourniquets Prevent hypothermia Patient position Reactionary haemorrhage Secondary haemorrhage Presentations of haemorrhage External haemorrhage Internal haemorrhage Management principles in internal haemorrhage Blood in vomit Blood in faeces Blood in urine Blood in sputum Bleeding from bony injury Site of haemorrhage Haematoma Thyroid related haematoma Intracranial haematoma Pressure on a nerve Cardiac tamponade Effects of haemorrhage Blood volumes Acute haemorrhage Class I haemorrhage Class II haemorrhage Class III haemorrhage Class IV haemorrhage Chronic haemorrhage Discussion of treatment principles in haemorrhage Restoration of blood volume following haemorrhage Background physiology Physiological compensations after haemorrhage Haemorrhage, haematocrit and haemoglobin concentrations Red blood cell replacement after haemorrhage Disorders of blood clotting Chapter 9 Cardiac Disorders The electrocardiogram (ECG) Coronary heart disease (CHD) Stable angina pectoris Clinical features Treatment principles Uncommon forms of angina Variant angina Syndrome X Acute coronary syndrome (ACS) Pathophysiology in acute coronary syndrome Unstable angina Myocardial infarction (MI) Pathophysiology Clinical features ECG changes in STEMI Cardiac markers Complications following MI Dysrhythmias Conduction disorders Acute left ventricular failure Cardiogenic shock Pericarditis Ventricular rupture Ventricular aneurysm Mural thrombosis Infarct of a papillary muscle Management principles in MI Cardiac failure Aetiology Pathophysiology Left and right ventricular failure Clinical features of LVF Treatment principles in cardiac failure Pulmonary heart disease Acute pulmonary heart disease (acute cor pulmonale) Pathophysiology Clinical features Treatment principles Chronic pulmonary heart disease (chronic cor pulmonale) Background physiology Clinical features Management principles Cardiac arrest Diagnosis Ventricular fibrillation (VF) Ventricular tachycardia (VT) Pulseless electrical activity (PEA) Asystole Treatment of cardiac arrest Chapter 10 Hypertension Introduction Normal physiology Neuronal regulation of BP Renal regulation of BP Definition of hypertension Aetiology and prevention of essential hypertension Genetic factors Congenital factors Race Obesity Alcohol Sodium and potassium Physical inactivity Metabolic (insulin resistance) syndrome Smoking Psychological stress Other factors Acquired or secondary hypertension Hypertension and pregnancy Clinical features of hypertension ‘White coat’ hypertension Pathological changes and long term complications of hypertension Atherosclerosis Lesions in smaller arterial vessels Cerebrovascular disease Coronary and peripheral arterial disease Left ventricular hypertrophy (LVH) and cardiac failure Renal damage Retinal damage Conclusion Treatment principles Orthostatic or postural hypotension Chapter 11 Respiratory Disorders Bronchial asthma Aetiology Pathophysiology Clinical features Treatment principles Acute severe asthma Chronic asthma Acute bronchitis Pneumonia Aetiology Types of pneumonia Pathophysiology Pneumonia and age Clinical features Treatment principles Chronic obstructive pulmonary disease (COPD) Aetiology Chronic bronchitis Pathophysiology Clinical features Emphysema Pathophysiology Clinical features Chronic bronchitis and emphysema Treatment of COPD Risks of oxygen therapy in carbon dioxide retainers Tuberculosis (TB) Aetiology Post-primary tuberculosis Prevention Treatment Bronchial carcinoma Aetiology Pathophysiology Clinical features Management principles Cystic fibrosis (CF) Aetiology Pathophysiology Clinical features Treatment principles Common acute respiratory infections The common cold Sinusitis Influenza Chapter 12 Hypoxia Introduction Oxygen physiology Oxygen is essential Hypoxic injury Oxygen transport from air to mitochondria Classification of hypoxia Extrinsic hypoxia Altitude Lack of oxygen in the air Problems causing hypoventilation Airway obstruction Pulmonary hypoxia Lung collapse Anaemic hypoxia Stagnant hypoxia Venous-to-arterial shunts Response of the body to hypoxia Oxygen flux Cardiovascular compensatory response Respiratory compensatory response Increase in red cell numbers response Other clinical features of hypoxia Cyanosis Central nervous system effects Hypoxia and cerebral oedema Hypoxic damage to other organs Treatment of hypoxia Aspects of oxygen therapy Aim of oxygen therapy Oxygen flow rates Warming and humidification Mechanical ventilation Oxygen toxicity Safety aspects of oxygen therapy Pulse oximetry Oxygen saturation Background physiology How oximetry works Recording sites Anaemic and histotic hypoxia Carboxyhaemoglobin Pigments on the nails or skin Alarm settings Chapter 13 Nervous System Disorders Motor neurone disease Pathophysiology Clinical features Treatment Multiple sclerosis (MS) Aetiology Pathophysiology Diagnosis Clinical presentations Clinical features Treatment Epilepsy Aetiology Pathophysiology Seizure threshold Classification of epilepsy Partial seizures Generalised absence seizures Generalised tonic-clonic seizures Status epilepticus Treatment principles in epilepsy Guillain-Barré syndrome Aetiology Pathophysiology Clinical features Treatment principles Aetiology Transmission Pathophysiology Clinical features Clinical features in bacterial meningitis Clinical features in other forms of meningitis Management principles Prevention Prion disease Pathophysiology Clinical features Transmission Alzheimer’s disease (AD) Aetiology of Alzheimer’s disease Clinical features Pathophysiology Other causes of dementia Aetiology Pathophysiology Clinical features Treatment principles Parkinsonian syndromes Thromboembolic pathophysiology Extracranial emboli Disease in intracerebral arteries Haemorrhagic pathophysiology Aetiology and Prevention Clinical features of stroke Prognosis Management principles Transient ischaemic attack (TIA) Subarachnoid haemorrhage Chapter 14 Head Injuries Brain Injuries Focal brain injuries Diffuse brain injury and concussion Secondary brain injury Extracranial secondary brain injury Hypoxia Increased carbon dioxide Cerebral hypoperfusion Intracranial secondary brain injury Extradural (epidural) haematoma Subdural haematoma Intracerebral haematoma Raised ICP Space occupying lesions (SOLs) Coning Infection Chapter 15 Endocrine Disorders Endocrine disorders Thyroid disorders Goitre Hypothyroidism Aetiology of hypothyroidism Pathophysiology and clinical features in hypothyroidism Treatment principles Hyperthyroidism Aetiology of Graves’ disease Clinical features in Graves’ disease Clinical features of hyperthyroidism Treatment principles Thyroid neoplasia Disorders of the adrenal gland Addison’s disease Cushing’s syndrome Disorder of the adrenal medulla Chapter 16 Diabetes Mellitus Diabetes Diabetes mellitus Background physiology Insulin Insulin and glucose Insulin and proteins Insulin receptors Glucose physiology Pathophysiology Types of diabetes mellitus (DM) Type 1 Type 2 Secondary diabetes Diabetes as a complication of pregnancy Type 1 diabetes mellitus Aetiology Pathophysiology Presentation in type 1 diabetes mellitus Classic triad Polyuria and glucosuria Thirst Weight loss Ketosis Diagnosis Type 2 diabetes mellitus Aetiology Pathophysiology Presentation Metabolic syndrome Maturity onset diabetes of the young (MODY) Long term complications Macrovascular disease Microvascular complications Renal failure (diabetic nephropathy) Blindness Congestive cardiac failure Predisposition to infections Foot and leg problems Hypoglycaemia Causes Clinical features Treatment principles in hypoglycaemia General principles of diabetes management Diet General life-style Type 2 DM Type 1 DM Chapter 17 Disorders of the Blood Anaemia Clinical features Aetiology Iron deficiency anaemia Aetiology Pathophysiology Clinical features Treatment Megaloblastic anaemia Pernicious anaemia Aetiology Pathophysiology Clinical features Treatment Aplastic anaemia Aetiology Pathophysiology Clinical features Treatment principles Haemolytic anaemias Pathophysiology Hereditary spherocytosis G6PD deficiency Thalassaemia Mechanical haemolytic anaemia Haemolytic disease of the newborn Sickle cell disease Pathophysiology Clinical features Epidemiology Treatment principles Other forms of anaemia Sideroblastic anaemia Anaemia in renal disease Anaemia of chronic disease Cigarette smoking Polycythaemia Thrombocytopenia Pathophysiology Clinical features Treatment principles Haemophilia Other causes of impaired coagulation Liver disease Vitamin K deficiency Disseminated intravascular coagulation Alterations in white cell numbers Lymphocytes Neutrophils Eosinophils Basophils Monocytes Leukaemia Aetiology Background physiology Pathophysiology Clinical features in acute leukaemias Chronic myeloid leukaemia (CML) Chronic lymphocytic leukaemia (CLL) Management principles Chapter 18 Gastrointestinal Disorders Useful terms and concepts The abdomen Dysphagia Nausea Vomiting Diarrhoea Steatorrhoea Haematemesis and melaena Dyspepsia Constipation Ascites The mouth Dental caries Periodontitis Conditions affecting the oesophagus Gastro-oesophageal reflux disease (GORD) Cancer of the oesophagus Gastritis Acute gastritis Chronic gastritis Peptic ulcer disease Aetiology Clinical features Complications Treatment of peptic ulcers Stress ulcers Helicobacter pylori infection Eradication therapy Gastric cancer Aetiology Clinical features Treatments Inflammatory bowel disease (IBD) Crohn’s disease Ulcerative colitis Diverticular disease Aetiology Pathophysiology Clinical features Complications Cancer of the colon and rectum Aetiology Pathophysiology Spread Clinical features Treatment Acute peritonitis Peritoneum Causes Pathophysiology Clinical features of peritonitis Principles of treatment Aetiology Pathophysiology Clinical features Complications Acute intestinal obstruction Aetiology Causes of intraluminal obstruction Causes of mural obstruction Causes of extramural obstruction Paralytic ileus Pathophysiology in intestinal obstruction Clinical features Principles of treatment in obstruction Chapter 19 Disorders of the Liver Jaundice Physiology Classification of jaundice Prehepatic jaundice Hepatic (or hepatocellular) jaundice Post hepatic (cholestatic) jaundice Clinical features of jaundice Treatment principles in jaundice Liver tumours Primary liver tumours Metastatic liver tumours Clinical features in viral hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Alcohol Alcohol and the liver Alcoholic hepatitis Pathophysiology Complications of cirrhosis and liver failure Jaundice Portal hypertension Oesophageal varices Ascites Hepatic encephalopathy Hypersplenism Haemorrhage Hepatorenal syndrome Hepatopulmonary syndrome Hypoproteinaemia Endocrine complications Fetor hepaticus Chapter 20 Disorders of the Gall Bladder and Bile Ducts Gallstones Aetiology of gallstones Clinical features Complications of gall stones Management of symptomatic gallstones Pathophysiology of biliary colic Clinical features of biliary colic Treatment of biliary colic Acute cholecystitis Chronic cholecystitis Acute cholangitis Treatment principles in acute cholangitis Cancer of the gall bladder Chapter 21 Disorders of the Pancreas Background physiology Aetiology Pathophysiology Clinical features Treatment principles in severe acute pancreatitis Aetiology Pathophysiology Clinical features Treatment Carcinoma of the pancreas Aetiology Pathophysiology Treatment Insulinomas Chapter 22 Genitourinary Disorders Aetiology Secondary prevention Pathophysiology and clinical features Management Aetiology Pathophysiology Clinical features Management Carcinoma of the prostate Aetiology Pathophysiology Clinical features Screening and management Aetiological factors Pathophysiology Screening Management Aetiology Clinical features in UTI Diagnosis Treatment of UTI Presentation Pathophysiology Management Chapter 23 Renal Disorders Acute Renal Failure (ARF) Acute prerenal failure Oliguria Renal hypoperfusion Acute intrinsic renal failure Acute tubular necrosis (ATN) Other intrinsic causes of ARF Acute postrenal failure Evolution of acute renal failure Onset Oliguria Recovery phase Management of acute renal failure Fluid retention Pulmonary oedema Electrolyte balance Diet Dialysis and haemofiltration Drugs Chronic Renal Failure (CRF) Aetiology Evolution of chronic renal failure Diminished renal reserve Renal insufficiency Renal failure End stage renal disease Clinical features in chronic renal failure (CRF) Management in chronic renal failure Blood pressure control Cardiovascular disease Glycaemic control Fluid and electrolyte control Diet Infections Renal replacement therapy Renal transplantation Glomerulonephritic (nephritic) syndrome Pathophysiology Immune complex mediated glomerular inflammation Anti-GBM (glomerular basement membrane) antibody-mediated causes General clinical presentations in nephritic disease Glomerulonephritis Clinical features in glomerulonephritis Proliferative glomerulonephritis Crescentic proliferative glomerulonephritis Acute post-streptococcal glomerulonephritis Clinical features and prognosis Treatment principles Membranous glomerulonephritis IgA nephropathy Goodpasture’s syndrome Focal segmental glomerulosclerosis (FSGS) Minimal-change glomerular lesion Aetiology Pathophysiology Treatment principles Nephrotic syndrome Aetiology Pathophysiology Investigations Management principles Malignant renal tumours Aetiology Pathophysiology Clinical features Treatment and prognosis Chapter 24 Alteration in Body Temperature Pyrexia Cause of fevers Fever increases immune function Stages of a fever Fever management in adults Fever management in children Early detection of infection Heat illness Heat cramps Heat stroke Aetiology Clinical features Management Heat exhaustion Aetiology Clinical features Management Acclimatization to heat Hypothermia Causes of hypothermia Assessment Clinical features Management of hypothermia Principles in rewarming management Temperature observations after surgery or trauma Health and the weather Chapter 25 Wounds and Healing Liver Kidneys Lungs Muscle Nervous system Contusion Abrasion Avulsion Laceration Incised wound Puncture wounds Strains Sprains Priorities in wound management Systemic stabilisation Haemostasis Disadvantages associated with secondary intention Delayed primary closure Wound healing by regeneration and/or repair Stages in wound healing Inflammatory phase Destructive phase Proliferation phase Remodelling phase Hypertrophic and keloid scars Factors which may delay wound healing Infection Poor hygiene Local blood supply Oedema Carbohydrates Fats Vitamins Minerals Psychological Stress Delayed inflammatory response Age effects Poorly managed or unrecognised diabetes mellitus Chapter 26 Fractures Introduction Open and closed fractures Causes; traumatic, pathological and stress fractures Descriptions of fractures Clinical features of fractures Dislocation injuries Healing in bones Haematoma formation Cellular proliferation Callus formation Ossification Remodelling Treatment principles Reduction Immobilisation Chapter 27 Burns Aetiology Pathophysiology Superficial burns Partial thickness burns Superficial partial-thickness burns Deep partial-thickness burns Full thickness burns Body surface area involvement Complications and management principles of burns Hypovolaemia Electrolyte disturbance Protein loss Pain Acute oedema Smoke inhalation Renal involvement Stress ulcers Increased nutritional requirements Hypothermia Wound infection Scarring and joint contractures Chapter 28 Pain The value of pain Inability to feel pain Components of pain Sensory component Affective component Autonomic component Motor component Descriptions of pain Acute and chronic pain Superficial or deep pain Pain threshold Pain tolerance Pain perception at the peripheral level Nociceptors Nociception Local a naesthetics Aspirin Basic care Sharp and dull pain Fast and slow pain neurones Pain transmission into and up the spinal cord Spinothalamic tract Pain processing in the brain stem, thalamus and sensory cortex Fast pain fibres Slow pain fibres Common causes of acute pain Inflammation Hypoxia and ischaemia Spasm Irritation of internal membranes Pain from the skin Neuropathic pain Common causes of chronic pain Untreated pathology Untreatable pathologies Musculoskeletal Cancer pain Stages of cancer pain Other presentations of pain Referred Phantom pain Clinical features of pain Acute pain Chronic pain Assessment of pain Age and pain Pain inhibition physiology Central descending inhibition of pain Observations about descending inhibition Clinical applications of descending inhibition Clinical applications of ascending inhibition Placebo effect Treat or remove the cause of pain whenever possible