Pathology

353 Pages·2012·16.71 MB·English

by  Philip Xiu

Pathology
First, second and third edition
authors:
Bethan Goodman Jones
Daniel J O’Connor
Atul Anand
CommissioningEditor:JeremyBowes
DevelopmentEditor:EwanHalley
ProjectManager:AndrewRiley
Designer/DesignDirection:StewartLarking
IllustrationManager:JenniferRose
IconIllustrations:GeoParkin
4
th Edition
CRASH COURSE
SERIES EDITOR
Dan Horton-Szar
BSc(Hons), MBBS(Hons), MRCGP
NorthgateMedicalPractice
Canterbury
Kent, UK
FACULTY ADVISOR
Sebastian Lucas
BA, BM BCh(Oxon),FRCP,FRCPath
Department of Histopathology
King’sCollege London School of Medicine
London,UK
Pathology
Philip Xiu
BA (Cantab) Hons
Medical Student
University of Cambridge
Cambridge, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
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Firstedition1999
Secondedition2002
Thirdedition2007
Fourthedition2012
ISBN9780723436195
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Series editor foreword
TheCrashCourseserieswasfirstpublishedin1997andnow,15yearson,weare
stillgoingstrong.Medicineneverstandsstill,andtheworkofkeepingthisseries
relevantfortoday’sstudentsisanongoingprocess.Thesefourtheditionsbuild
onthesuccessoftheprevioustitlesandincorporatenewandrevisedmaterial,to
keeptheseriesup-to-datewithcurrentguidelinesforbestpractice,andrecent
developmentsinmedicalresearchandpharmacology.
Wealwayslistentofeedbackfromourreaders,throughfocusgroupsandstudent
reviewsoftheCrashCoursetitles.Forthefourtheditionswehavecompletely
re-writtenourself-assessmentmaterialtokeepupwithtoday’s‘single-bestanswer’
and‘extendedmatchingquestion’formats.Theartworkandlayoutofthetitles
hasalsobeenlargelyre-workedtomakeiteasierontheeyeduringlongsessionsof
revision.
Despitefullyrevisingthebookswitheachedition,weholdfasttotheprincipleson
whichwefirstdevelopedtheseries.CrashCoursewillalwaysbringyouallthe
informationyouneedtoreviseincompact,manageablevolumesthatintegrate
basicmedicalscienceandclinicalpractice.Thebooksstillmaintainthebalance
betweenclarityandconciseness,andprovidesufficientdepthforthoseaimingat
distinction.Theauthorsaremedicalstudentsandjuniordoctorswhohaverecent
experienceoftheexamsyouarenowfacing,andtheaccuracyofthematerialis
checkedbyateamoffacultyadvisorsfromacrosstheUK.
Iwishyouallthebestforyourfuturecareers!
Dr Dan Horton-Szar
v
Prefaces
Author
Mypredecessor,ProfRosemaryWalkerdidanexcellentjobinsteeringthis
incrediblycomprehensiveshorttextthroughseveraleditions,providingaverygood
backgroundtoallaspectsofpathologyandtheirrelevancetoclinicalmedicine.
ReflectingthisAdvisor’sspecialinterest,thetexthasbeenfurtherrevisedand
updatedinseveralareaswherethereisprogress,confusionandcomplexity:
pregnancy-associateddiseases,sicklecelldisease,HIVandAIDS,leprosy,systemic
sepsis,andinfectiousdiseasesingeneral.Theclassicalareasofcancerand
circulatorydiseaseshavealsobeendiscretelyamendedtoreflectcurrentthinking
whereitmatters.Ifallmedicalstudentsknewmostofwhatisinthistext,withits
appropriateorganisationofknowledge,teacherscouldsleepmoreeasilyandthe
qualityofdiagnosticproblem-solvingamongyoungdoctorswouldbesignificantly
improved.Itwillcertainlyhelpyouinallaspectsofyourmedicalcourse.Special
thanksandacknowledgementshouldalsogotoPhilipXiuforhisworkonthe
newedition.
Philip Xiu
Faculty advisor
Mypredecessor,ProfRosemaryWalkerdidanexcellentjobinsteeringthis
incrediblycomprehensiveshorttextthroughseveraleditions,providingaverygood
backgroundtoallaspectsofpathologyandtheirrelevancetoclinicalmedicine.
ReflectingthisAdvisor’sspecialinterest,thetexthasbeenfurtherrevisedand
updatedinseveralareaswherethereisprogress,confusionandcomplexity:
pregnancy-associateddiseases,sicklecelldisease,HIVandAIDS,leprosy,systemic
sepsis,andinfectiousdiseasesingeneral.Theclassicalareasofcancerand
circulatorydiseaseshavealsobeendiscretelyamendedtoreflectcurrentthinking
whereitmatters.Ifallmedicalstudentsknewmostofwhatisinthistext,withits
appropriateorganisationofknowledge,teacherscouldsleepmoreeasilyandthe
qualityofdiagnosticproblem-solvingamongyoungdoctorswouldbesignificantly
improved.Itwillcertainlyhelpyouinallaspectsofyourmedicalcourse.Special
thanksandacknowledgementshouldalsogotoPhilipXiuforhisworkonthenew
edition.
Sebastian Lucas
vi
Acknowledgements
Iwouldliketothankeveryonewhohashelpedduringthewritingofthisbook.Iam
gratefultothenumerousfriendswhoprovidedmoralsupportandacceptedhaving
ideasthrownatthem.ParticularmentionsmustgotoKentYip,AdamYoung,Kevin
McCarthy,KariSchaitel,OscarBennett,TomClare,SaurabhSingh,BenPierceand
SarahMason.
FinallyIwishtothanktheveryhelpfulpeopleinvolvedintheproductionofthis
book,bothinEdinburghandOxford.
Figure Acknowledgements
Figs3.3,3.4,3.6,3.7,6.21,7.18,11.2and13.23andFig.5.15areadaptedwith
permissionfromGeneralandSystematicPathology,5thEdition,editedbyJCE
Underwood.ChurchillLivingstone,Edinburgh,2009.
Figs5.6and5.8areadaptedwithpermissionfromAnderson’sPathology,
10thedition,editedbyIDamjanovandJLinder.Mosby,St.Louis,1996.
Fig.10.2andFigs5.11and7.8areadaptedwithpermissionfrommedicshandbook.
com,2011.
Fig.6.16isadaptedwithpermissionfromRobbinsandCotran,PathologicBasisof
Disease,7thedition,editedbyVKumar,AAbbas,andNFausto.ElsevierSaunders,
Philadelphia,2005.
Fig.8.20isadaptedwithpermissionfromClinicalMedicine,7thedition,editedby
PKumarandMClark.,Elsevier,London,2009.
Fig.8.37isadaptedwithpermissionfromPrinciplesandPracticeofSurgery,
3rdedition,editedbyAPMForrest,DCCarterandIBMacleod.Churchill
Livingstone,Edinburgh,1995.
Fig.8.40 isadaptedwithpermissionfromLectureNotesinGeneralSurgery,
12thedn,byHEllis,Wiley-Blackwell,2010.
Fig.11.14isadaptedwithpermissionfromLectureNotesonUrology,5thedition,
byJBlandy.BlackwellScientific,Oxford,1998.
Fig.13.4isadaptedwithpermissionfromLectureNotesinPaediatrics,8thEdition,
bySNewell.Wiley-Blackwell,2010.
Fig.13.14isadaptedwithpermissionfromEssentialHaematology,5thedition,by
AVHoffbrandandJEPettit.Wiley-Blackwell,Oxford,2006.
Figs13.30and13.31areadaptedwithpermissionfromPathologyIllustrated,
6thedition,byRReidandFRoberts.ChurchillLivingstone,Edinburgh,2005.
vii
Dedication
ToMum,DadandJane
viii
Contents
Serieseditorforeword . . . . . . . . . . . . . . . v Atherosclerosis,hypertensionand
thrombosis . . . . . . . . . . . . . . . 60
Prefaces . . . . . . . . . . . . . . . . . . . . . . vi
Ischaemicheartdiseaseandheartfailure. . 68
Acknowledgements. . . . . . . . . . . . . . . . . vii
Disordersoftheheartvalves . . . . . . . 72
Dedication . . . . . . . . . . . . . . . . . . . . viii
Diseasesofthemyocardium . . . . . . . 76
Part I: Principles of pathology
Diseasesofthepericardium. . . . . . . . 77
1. Introductiontopathology . . . . . . . . . 1 Aneurysms . . . . . . . . . . . . . . . 79
Diseases. . . . . . . . . . . . . . . . . . 1 Inflammatoryandneoplasticvascular
disease. . . . . . . . . . . . . . . . . 81
Pathology . . . . . . . . . . . . . . . . . 1
Diseasesoftheveinsandlymphatics . . . 84
Howpathologyiscoveredinthisbook . . . 2
2. Inflammation,repairandcelldeath. . . . . 3 7. Pathologyoftherespiratorysystem. . . . 87
Inflammation . . . . . . . . . . . . . . . 3 Disordersoftheupperrespiratorytract . . 87
Acuteinflammation . . . . . . . . . . . . 3 Disordersofthelungs . . . . . . . . . . 89
Chemicalmediatorsofinflammation. . . . . 5 Infectionsofthelungs . . . . . . . . . . 98
Chronicinflammation . . . . . . . . . . . 8 Neoplasticdiseasesofthelungs. . . . . .104
Celldeath. . . . . . . . . . . . . . . . 10 Diseasesofvascularorigin . . . . . . . .108
Diseasesofiatrogenicorigin . . . . . . .111
3. Cancer . . . . . . . . . . . . . . . . . 15
Disordersofthepleura . . . . . . . . . .111
Definitionsandnomenclature. . . . . . . 15
Molecularbasisofcancer. . . . . . . . . 18
8. Pathologyofthegastrointestinal
Tumourgrowthandspread. . . . . . . . 19 system . . . . . . . . . . . . . . . . . 115
Carcinogenicagents . . . . . . . . . . . 22 Disordersoftheuppergastrointestinal
Hostdefencesagainstcancer . . . . . . . 24 tract . . . . . . . . . . . . . . . . . .115
Clinicalcancerpathology. . . . . . . . . 25 Disordersofthestomach. . . . . . . . .119
Generalaspectsofhepaticdamage . . . .124
4. Infectiousdisease . . . . . . . . . . . . 27
Disordersoftheliverandbiliarytract . . .129
Generalprinciplesofinfection. . . . . . . 27
Disordersoftheexocrinepancreas . . . .140
Categoriesofinfectiousagent. . . . . . . 28
Disordersoftheintestine. . . . . . . . .142
Mechanismsofpathogenicity. . . . . . . 32
Disordersoftheperitoneum . . . . . . .156
Sepsis. . . . . . . . . . . . . . . . . . 35
Inflammatoryresponsestoinfection. . . . 36 9. Pathologyofthekidneyandurinary
Part II: Systemic pathology tract . . . . . . . . . . . . . . . . . .159
Abnormalitiesofkidneystructure . . . . .159
5. Pathologyofthenervoussystem . . . . . 37
Diseasesoftheglomerulus . . . . . . . .161
Disordersofthecentralnervoussystem . . 37
Glomerularlesionsinsystemicdisease . . .168
Disordersoftheperipheralnervoussystem. 50
Diseasesofthetubulesandinterstitium . .169
Disordersoftheautonomicnervoussystem 53
Diseasesoftherenalbloodvessels . . . .171
6. Pathologyofthecardiovascularsystem . . 55 Neoplasticdiseaseofthekidney. . . . . .174
Congenitalabnormalitiesoftheheart . . . 55 Disordersoftheurinarytract . . . . . . .175
ix