Pathophysiologic Processes

Pathophysiologic Processes


UNIT I Pathophysiologic Processes

1 Introduction to Pathophysiology, 1

2 Homeostasis, Allostasis, and Adaptive Responses to Stressors, 12

UNIT II Cellular Function

3 Cell Structure and Function, 26

4 Cell Injury, Aging, and Death, 59

5 Genome Structure, Regulation, and Tissue Differentiation, 77

6 Genetic and Developmental Disorders, 94

7 Neoplasia, 117

UNIT III Defense

8 Infectious Processes, 141

9 Inflammation and Immunity, 158

10 Alterations in Immune Function, 194

11 Malignant Disorders of White Blood Cells, 215

12 HIV Disease and AIDS, 233

UNIT IV Oxygen Transport, Blood Coagulation, Blood Flow, and Blood Pressure

13 Alterations in Oxygen Transport, 259

14 Alterations in Hemostasis and Blood Coagulation, 298

15 Alterations in Blood Flow, 313

16 Alterations in Blood Pressure, 337

UNIT V Cardiac Function

17 Cardiac Function, 354

18 Alterations in Cardiac Function, 382

19 Heart Failure and Dysrhythmias: Common Sequelae of Cardiac Diseases, 411

20 Shock, 434

UNIT VI Respiratory Function

21 Respiratory Function and Alterations in Gas Exchange, 451

22 Obstructive Pulmonary Disorders, 478

23 Restrictive Pulmonary Disorders, 499

UNIT VII Fluid, Electrolyte, and Acid-Base Homeostasis

24 Fluid and Electrolyte Homeostasis and Imbalances, 521

25 Acid–Base Homeostasis and Imbalances, 541

UNIT VIII Renal and Bladder Function

26 Renal Function, 551

27 Intrarenal Disorders, 575

28 Acute Kidney Injury and Chronic Kidney Disease, 593

29 Disorders of the Lower Urinary Tract, 609

UNIT IX Genital and Reproductive Function

30 Male Genital and Reproductive Function, 626

31 Alterations in Male Genital and Reproductive Function, 641

32 Female Genital and Reproductive Function, 656

33 Alterations in Female Genital and Reproductive Function, 671

34 Sexually Transmitted Infections, 689

UNIT X Gastrointestinal Function

35 Gastrointestinal Function, 697

36 Gastrointestinal Disorders, 720

37 Alterations in Function of the Gallbladder and Exocrine Pancreas, 742

38 Liver Diseases, 754

UNIT XI Endocrine Function, Metabolism, and Nutrition

39 Endocrine Physiology and Mechanisms of Hypothalamic-Pituitary Regulation, 783

40 Disorders of Endocrine Function, 799

41 Diabetes Mellitus, 815

42 Nutritional and Metabolic Disorders, 838

UNIT XII Neural Function

43 Structure and Function of the Nervous System, 850

44 Acute Disorders of Brain Function, 891

45 Chronic Disorders of Neurologic Function, 915

46 Alterations in Special Sensory Function, 936

47 Pain, 955

UNIT XIII Neuropsychological Function

48 Neurobiology of Psychotic Illnesses, 971

49 Neurobiology of Nonpsychotic Illnesses, 989

UNIT XIV Musculoskeletal Support and Movement

50 Structure and Function of the Musculoskeletal System, 1001

51 Alterations in Musculoskeletal Function: Trauma, Infection, and Disease, 1020

52 Alterations in Musculoskeletal Function: Rheumatic Disorders, 1042

UNIT XV Integumentary System

53 Alterations in the Integumentary System, 1058

54 Burn Injuries, 1093

Evolve Student Resources for Banasik: Pathophysiology, 6th Edition, include the following:

• Animations.

• Review questions with rationales.

• Key Points.

• Glossary with audio pronunciations.

• Answers to key questions.

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JACQUELYN L. BANASIK, PhD, ARNP Associate Professor College of Nursing

Washington State University Spokane, Washington

LEE-ELLEN C. COPSTEAD, PhD, RN Professor Emerita

Department of Nursing College of Nursing and Health Sciences

University of Wisconsin—Eau Claire Eau Claire, Wisconsin

3251 Riverport Lane St. Louis, Missouri 63043


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Loved ones, past and present,

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Brent A. Banasik, PhD, MA, BS Scientist Chemistry Banasik Consulting Seattle, Washington

Brianne N. Banasik, BS Environmental Science, MS Marine Resources Management

Research Associate Pediatric Vaccinology University of Texas Medical Branch Galveston, Texas

Jacquelyn L. Banasik, PhD, ARNP Associate Professor College of Nursing Washington State University Spokane, Washington

Robin Y. Beeman, BSN, MSN, PhD Chair and Professor Nursing University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Cheryl L. Brandt, PhD, RN, ACNS-BC Professor College of Nursing and Health Sciences University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Ann Futterman Collier, PhD Associate Professor and Chair Psychological Sciences Northern Arizona University Flagstaff, Arizona

Lee-Ellen C. Copstead, PhD, RN Professor Emerita Department of Nursing College of Nursing and Health Sciences University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Carol L. Danning, MD Staff Rheumatologist Rheumatology Department Gundersen Health Systems La Crosse, Wisconsin

Michael R. Diestelmeier, MD Fellow American Academy of Dermatology Dermatologist, Retired Mayo Clinic Health System Eau Claire, Wisconsin

Ruth E. Diestelmeier, RN, MSN Clinical Instructor Department of Nursing University of Wisconsin—Eau Claire Eau Claire, Wisconsin


Roberta J. Emerson, PhD, RN Associate Professor, Retired Washington State University College of Nursing Spokane, Washington

Linda Felver, PhD, RN Associate Professor School of Nursing Oregon Health & Science University Portland, Oregon

Rosemary A. Jadack, PhD, RN Professor Nursing University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Debra A. Jansen, PhD, RN Associate Dean, Professor College of Nursing and Health Sciences University of Wisconsin—Eau Claire Eau Claire, Wisconsin

Marie L. Kotter, PhD, MS, BS Professor Emeritus Health Sciences Weber State University Ogden, Utah

Teresa Grigsby Loftsgaarden, MSN, RN, OCN,ONN-CG

Oncology Nurse Navigator Regional Cancer Center Sacred Heart Hospital Eau Claire, Wisconsin

Joni D. Marsh, BSN, MN Advanced Registered Nurse Practitioner Medical Oncology Summit Cancer Centers Spokane, Washington

Benjamin J. Miller, PhD, ARNP, FNP-C, ACNPC, ENP-C

Assistant Professor Seattle University Seattle, Washington

Sarah Ogle, DO, MS Banner University Medical Center-Phoenix University of Arizona College of Medicine

Phoenix Phoenix, Arizona

Nirav Patel, MD Assistant Professor, Infectious Diseases and

Critical Care Medicine Internal Medicine Saint Louis University School of Medicine; Chief Medical Officer SSM Health Saint Louis University Hospital; Infection Control Officer/Director of

Antibiotic Stewardship SSM Health Saint Louis University Hospital Saint Louis, Missouri

Faith Young Peterson, BSN, MSN, MPA, CFNP

Family Nurse Practitioner Marsing, Idaho

Cheryl Rockwell, RN, MSN Clinical Assistant Professor Nursing Department Indiana University-Purdue University at

Fort Wayne; Staff/Clinical Nurse Surgical Trauma Intensive Care Unit Parkview Health Systems Fort Wayne, Indiana

Samantha Cody Russell, Psychology, MA Graduate Student Psychological Sciences Northern Arizona University Flagstaff, Arizona

Jeffrey S. Sartin, MD Consulting Physician Infectious Diseases Infectious Disease and Epidemiology

Associates; Consulting Physician Infectious Diseases Nebraska Medicine; Consulting Physician Infectious Diseases CHI Hospitals Omaha, Nebraska

Lorna L. Schumann, PhD Heritage UGM Women and Children’s

Clinic Medical Clinic Heritage Health Coeur d’Alene, Idaho

Susan G. Trevithick, RN, MS, NE-BC Compliance Officer VA Salt Lake City Healthcare System Salt Lake City, Utah

Marvin Van Every, MD Staff Urologist Urology Department Gundersen Health Systems La Crosse, Wisconsin

Linda D. Ward, PhD, FNP-C Assistant Professor College of Nursing Washington State University Spokane, Washington


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

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

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

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.



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.

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.


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