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10952-00b_FMrev.qxd 6/25/08 6:01 PM Page xii This page intentionally left blank. 10952-00b_FMrev.qxd 6/25/08 6:01 PM Page i PATHOPHYSIOLOGY Concepts of Altered Health States EIGHTH EDITION Carol Mattson Porth, RN, MSN, PhD (Physiology) Professor Emerita College of Nursing University of Wisconsin—Milwaukee Milwaukee, Wisconsin Glenn Matfin, BSc (Hons), MB ChB, DGM, FFPM, FACE, FACP, FRCP Clinical Associate Professor of Medicine, Department of Endocrinology School of Medicine New York University New York, New York 10952-00c_CIP-InterONLY.qxd 6/25/08 2:22 PM Page iv Senior Acquisitions Editor:Hilarie Surrena Senior Managing Editor:Helen Kogut Editorial Assistant:Brandi Spade Senior Production Editor:Debra Schiff Director of Nursing Production:Helen Ewan Senior Managing Editor/Production:Erika Kors Senior Designer:Joan Wendt Senior Designer, Illustration:Brett MacNaughton Manufacturing Coordinator:Karin Duffield Indexer:Cassar Technical Services Compositor:Circle Graphics 8th Edition Copyright ©2009 Wolters Kluwer Health |Lippincott Williams & Wilkins. Copyright ©2005, 2002 by Lippincott Williams & Wilkins. Copyright ©1998 by Lippincott-Raven Publishers. Copyright ©1994 by J.B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmit- ted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information stor- age and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia PA 19106, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China ISBN 10: 0-7817-6616-8 ISBN 13: 978-16054-7390-1 Not authorized for sale in North America. Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice. LWW.COM 10952-00b_FMrev.qxd 6/25/08 6:01 PM Page iii This book is dedicated to My family: Rick, Susan, Tom, Cody, and Noah —CAROLMATTSONPORTH To my wife Marcia and my parents, Enid and Sid I also dedicate it to my mentor, Professor Harold Adelman, Tampa, Florida —GLENNMATFIN 10952-00b_FMrev.qxd 6/25/08 6:01 PM Page iv Consultants Kathryn J. Gaspard, PhD Clinical Associate Professor Emerita College of Nursing University of Wisconsin—Milwaukee Milwaukee, Wisconsin Kim Litwack, RN, PhD, FAAN, APNP Associate Professor College of Nursing University of Wisconsin—Milwaukee Milwaukee, Wisconsin iv 10952-00b_FMrev.qxd 6/25/08 6:01 PM Page v Contributors Judith A. Aberg, MD Jason Faulhaber, MD, Fellow Principal Investigator, AIDS Clinical Trials Unit Division of Infectious Diseases and Immunology Director of HIV, Bellevue Hospital Center New York University School of Medicine Associate Professor of Medicine New York, New York New York University School of Medicine (Chapter 20) (Chapter 20) Susan A. Fontana, PhD, APRN-BC Toni Balistrieri, RN, MSN, CCNS Associate Professor and Family Nurse Practitioner Clinical Nurse Specialist, Critical Care College of Nursing Zablocki Veterans Affairs Medical Center University of Wisconsin-Milwaukee Milwaukee, Wisconsin Milwaukee, Wisconsin (Chapter 24) (Chapter 55) Anna Barkman, RN, BN, MN Kathryn J. Gaspard, PhD Mount Royal College Clinical Associate Professor Emerita School of Nursing College of Nursing Faculty of Health & Community Studies University of Wisconsin-Milwaukee Calgary, Alberta, Canada Milwaukee, Wisconsin (Chapter 26) (Chapters 12, 13, 14) Diane S. Book, MD Kathleen E. Gunta, MSN, RN, OCNS-C Assistant Professor of Neurology Clinical Nurse Specialist Medical College of Wisconsin Aurora St. Luke’s Medical Center Milwaukee, Wisconsin Milwaukee, Wisconsin (Chapter 51) (Chapters 57, 58) Edward W. Carroll, MS, PhD Safak Guven, MD, MBA, FACE, FACP Clinical Assistant Professor Las Vegas, Nevada Department of Biomedical Sciences, College of Health Sciences (Chapter 42) Marquette University Milwaukee, Wisconsin Serena W. Hung, MD (Chapters 4, 6, 48, 54) Assistant Professor, Department of Neurology Medical College of Wisconsin Robin Curtis, PhD Milwaukee, Wisconsin Professor, Retired (Chapter 50) Department of Cellular Biology, Neurobiology, and Anatomy Medical College of Wisconsin Scott A. Jens, OD, FAAO Milwaukee, Wisconsin Doctor of Optometry (Chapters 48, 54) Isthmus Eye Care, SC Middleton, Wisconsin W. Michael Dunne Jr., PhD (Chapter 54) Professor of Pathology, Immunology, and Molecular Microbiology Washington University School of Medicine Mary Kay Jiricka, RN, MSN, CCRN, APN-BC Medical Director of Microbiology Staff Nurse, Cardiac Intensive Care Unit Barnes-Jewish Hospital Aurora St. Luke’s Medical Center St. Louis, Missouri Milwaukee, Wisconsin (Chapter 16) (Chapter 11) v 10952-00b_FMrev.qxd 6/25/08 6:01 PM Page vi vi Contributors Julie A. Kuenzi, RN, MSN, CDE Sandra Kawczynski Pasch, RN, MS, MA Manager–Diabetes and Endocrine Center Assistant Professor Froedtert Hospital and Medical College of Wisconsin Columbia College of Nursing Milwaukee, Wisconsin Milwaukee, Wisconsin (Chapter 42) (Chapter 53) Mary Pat Kunert, RN, PhD Janice Kuiper Pikna, RN, MSN, CS Associate Professor Clinical Nurse Specialist–Gerontology College of Nursing Froedtert Hospital University of Wisconsin-Milwaukee Milwaukee, Wisconsin Milwaukee, Wisconsin (Chapter 3) (Chapters 9, 10) Joan Pleuss, RD, MS, CDE, CD Nathan A. Ledeboer, PhD Program Manager/Bionutrition Core Assistant Professor of Pathology General Clinical Research Center (GCRC) Medical College of Wisconsin Medical College of Wisconsin Director, Clinical Microbiology Milwaukee, Wisconsin DynaCare Laboratories (Chapter 39) Milwaukee, Wisconsin (Chapter 16) Charlotte Pooler, RN, BScN, MN, PhD (Nursing), CNCC(C), CNC(C) Kim Litwack, RN, PhD, FAAN, APNP Director, Baccalaureate Nursing Program Associate Professor Faculty of Health and Community Studies College of Nursing Grant MacEwan College University of Wisconsin-Milwaukee Edmonton, Alberta, Canada Milwaukee, Wisconsin (Chapters 26, 29) (Chapters 27, 32, 49) Debra Bancroft Rizzo, RN, MSN, FNP-C Judy Wright Lott, RNC, DSN, FAAN Nurse Practitioner Dean and Professor of Nursing Rheumatic Disease Center Louise Herrington School of Nursing Glendale, Wisconsin Baylor University (Chapter 59) Waco, Texas (Chapter 2) Gladys Simandl, RN, PhD Professor Patricia McCowen Mehring, RNC, MSN, WHNP Columbia College of Nursing Nurse Practitioner, Department of OB-GYN Milwaukee, Wisconsin Medical College of Wisconsin (Chapters 60, 61) Milwaukee, Wisconsin (Chapters 45, 46, 47) Cynthia Sommer, PhD, MT (ASCP) Associate Professor Emerita, Department of Biological Sciences Carrie J. Merkle, RN, PhD, FAAN University of Wisconsin-Milwaukee Associate Professor Milwaukee, Wisconsin College of Nursing (Chapters 17, 18) University of Arizona Tucson, Arizona Jill Winters, RN, PhD (Chapters 5, 8) Director of Research and Scholarship; Associate Professor Marquette University College of Nursing Kathleen Mussatto, RN, PhD(C) Milwaukee, Wisconsin Research Manager (Chapter 25) Herma Heart Center Children’s Hospital of Wisconsin Milwaukee, Wisconsin (Chapter 24) 10952-00b_FMrev.qxd 6/25/08 6:01 PM Page vii Reviewers Sally Aboelela, PhD Jackie Carnegie, PhD, MEd Jamie Flower, RN, MS Assistant Professor Assistant Professor, Department of Cellular Assistant Professor Columbia University and Molecular Medicine University of Arkansas-Fort Smith New York, New York University of Ottawa Fort Smith, Arkansas Ottawa, Ontario, Canada Joann Acierno, RN, BSN, MSN Joyce S. Fontana, RN, PhD Assistant Professor Margaret Christensen, RN, PhD Assistant Professor of Nursing Clarkson College Associate Professor St. Joseph College-W. Hartford Omaha, Nebraska Northeastern University West Hartford, Connecticut Boston, Massachusetts Karen Bailey, RN, MSN, BC-FNP Dorothy Ann Fraser, MSN, FNP-C Assistant Professor; Family Nurse Elizabeth Cohn, RN, NP, ACNP, DNSc Lecturer Practitioner Assistant Professor University of California-Davis Marshall University; Valley Health Adelphi University Davis, California Huntington, West Virginia Garden City, New York Susan K. Frazier, RN, PhD Joseph Balatbat, MD Christine Colella, MSN, CS, CNP Associate Professor Vice President of Academic Affairs Associate Professor of Clinical Nursing; University of Kentucky Sanford-Brown Institute NYC Adult Nurse Practitioner Lexington, Kentucky New York, New York University of Cincinnati Cincinnati, Ohio Laura M. Freidhoff, MD Susan Blakey, RN, MS Assistant Professor Assistant Professor Cathleen A. Collins, RN, MSN Michigan State University College Georgia Baptist College of Nursing Assistant Professor of Nursing Atlanta, Georgia Texas Tech University Lansing, Michigan Lubbock, Texas Carey Bosold, RN, MSN, APN, FNP Louise Glover, RN, BA, A-EMCA Assistant Professor David Derrico, RN, MSN Professor and Coordinator Arkansas Tech University Assistant Clinical Professor College Boreal Russellville, Arkansas University of Florida Sudbury, Ontario, Canada Gainesville, Florida Donna Bowles, RN, MSN, EdD James Hampton, PhD Associate Professor of Nursing Dare Domico, RN, DSN Professor Indiana University Southeast Professor Medical College of Ohio New Albany, Indiana Mercer University-Atlanta Toledo, Ohio Atlanta, Georgia Carolyn M. Burger, RN, MSN, BC, AOCN Sharon R. Haymaker, PhD, CRNP Associate Professor Crystal Donlevy, EdD Associate Professor Miami University Middletown Professor Bloomsburg University Middletown, Ohio Cincinnati State Technical Bloomsburg, Pennsylvania and Community College Wanda Emberley Burke, RN, BN, Cincinnati, Ohio Judy Hembd, RN, MSN MEd, PCNP Assistant Professor Faculty (Nurse Practitioner Program) Margaret Fink, RN, EdD, BC Montana State University Northern Centre for Nursing Studies Assistant Professor Havre, Montana St. John’s, Newfoundland and Labrador, Dominican University of California Canada San Rafael, California Lori Hendrickx, RN, EdD, CCRN Associate Professor Connie Lorette Calvin, CRNA, ARNP, Cindy Fitzgerald, RN, PhD(c), ARNP South Dakota State University MS, Doctoral Fellow Assistant Professor and Coordinator, Brookings, South Dakota Associate Clinical Coordinator Family Nurse Practitioner Program Northeastern University Gonzaga University Boston, Massachusetts Spokane, Washington vii 10952-00b_FMrev.qxd 6/25/08 6:01 PM Page viii viii Reviewers Leslie Higgins, PhD, APRN, BC Brian Kipp, PhD Eve Main, ARNP Associate Professor and Director, Assistant Professor Assistant Professor Graduate Nursing Program Grand Valley State University Western Kentucky University Belmont University Allendale, Michigan Bowling Green, Kentucky Nashville, Tennessee Lori Knight, CCHRA(c) Maria E. Main, MSN, ARNP, MSN Lisa Hight, EdD Instructor, Health Information Assistant Professor Associate Professor, Biology Management Program Western Kentucky University Baptist Memorial College of Health Sciences SIAST Wascana Campus Bowling Green, Kentucky Memphis, Tennessee Regina, Saskatchewan, Canada Brenda Mason, MSN, APRN, FNP-BC Kathleen J. Holbrook, BS Therese M. Lahnstein, RN, MSN, CCRN Assistant Professor of Nursing Vice President and Director Assistant Professor Alderson-Broadus College Andrews and Holbrook Training Corporation Columbus State University Philippi, West Virginia Latham, New York Columbus, Georgia Timothy Maze, PhD Patricia C. Hunt, DO, MHA Brigitte Lalonde, ACP Assistant Professor Adjunct Professor Coordinator/Professor Lander University Pace University La Cite Collegiale Greenwood, South Carolina New York, New York Ottawa, Ontario, Canada Sharon McCleave, BS, MEd Joanne Itano, RN, PhD, OCN Gemme Langor, BN, Med Professor Interim Vice Chancellor; Director of Professor Seneca College Academic Plan and Policy Centre for Nursing Studies Toronto, Ontario, Canada University of Hawaii St. John’s, Newfoundland and Labrador, Honolulu, Hawaii Canada Leigh Ann McInnis, PhD, APRN, BC, FNP Frances Jackson, RN, PhD Ramona Lazenby, EdD, CRNP Instructor Associate Professor of Nursing Assistant Dean and Associate Professor Belmont University Oakland University of Nursing Nashville, Tennessee Rochester, Michigan Auburn University-Montgomery Montgomery, Alabama Rhonda M. McLain, RN, DSN Nadine T. James, RN, BSN, MSN, PhD Assistant Professor Assistant Professor Edna Johnson Lewis, MS, RN, CCRN, CS Clayton College and State University University of Southern Mississippi Clinical Assistant Professor Atlanta, Georgia Hattiesburg, Mississippi Downstate Medical Center, College of Nursing Thomas McNeilis, PhD, DO Judy Jezierski, RN, MSN Brooklyn, New York Associate Professor, Biology Chair, Department of Nursing Dixie State College Saint Joseph’s College Linda Linc, RN, PhD, CNS St. George, Utah West Hartford, Connecticut Professor University of Akron James A. Metcalf, PhD Ritamarie John, DrNP, CPNP Akron, Ohio Professor PNP/NNP Program Director George Mason University Columbia University School of Nursing Anne Lincoln, DVM Fairfax, Virginia New York, New York Associate Professor, Biology North Country Community College Anita Mills, RN, MSN Brenda P. Johnson, RN, PhD Saranac Lake, New York 4th Semester Lead Faculty Associate Professor Butler County Community College-El Dorado Southeast Missouri State University Suzanne E. Lindley, PhD, MS El Dorado, Kansas Cape Girardeau, Missouri Associate Professor, Biology Limestone College Robert Moldenhauer, MS Jennifer Johnson, MSN Gaffney, South Carolina Professor Assistant Professor, Department of Nursing St. Clair County Community College University of NC-Pembroke Wendy B. Loren, MS, LMT Port Huron, Michigan Pembroke, North Carolina Faculty Lane Community College Donna Moralejo, RN, PhD Eugene, Oregon Memorial University School of Nursing St. John’s, New Foundland and Labrador, Canada

Description:

This is the Eighth Edition of the comprehensive and well-respected text and reference of pathophysiology. As a nurse-physiologist, Carol Porth uniquely emphasizes "concepts" of altered health states, as opposed to factual descriptions of diseases and disorders. This conceptual model integrates the d