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Cell Injury, Cell Death, and Adaptations

Introduction to Pathology The field of pathology is dedicated to understanding the causes of disease and the changes in cells, tissues, and organs that are associated with development of disease. Thus, pathology provides the scientific foundation for the practice of medicine. There are two important terms that students will encounter throughout their study of pathology and medicine: Etiology is the origin of a disease, including the…

The Eye

Although this chapter comes at the end of the book, it is not an afterthought. Vision is a major quality-of-life issue. Before the public awareness of acquired immunodeficiency syndrome (AIDS) and Alzheimer disease, the most feared disease among Americans was cancer, and the second most feared disease was blindness. So great is the fear of blindness that even today, people often tell their physicians, “Doctor, I'd…

The Central Nervous System

The principal functional unit of the central nervous system (CNS) is the neuron . Neurons of different types and in different locations have distinct properties, including diverse functional roles, patterns of synaptic connections, neurotransmitters used, and metabolic requirements, which vary with electrical activity. A set of neurons, not necessarily clustered together in a region of the brain, may thus show selective vulnerability to particular insults because…

Peripheral Nerves and Skeletal Muscles

Neuromuscular diseases are a complex group of disorders that typically present with weakness, muscle pain, or sensory deficits and may be inherited or acquired. They can be grouped according to anatomy, disease course, and pathogenesis. Physicians keep all these characteristics in mind when evaluating a patient with neuromuscular symptoms. This chapter uses an anatomic approach, grouping neuromuscular disorders into those that preferentially affect the peripheral nerves,…

Bones, Joints, and Soft Tissue Tumors

Bone Basic Structure and Function of Bone The adult human skeleton is composed of 206 bones that account for ~12% of body weight. Bone functions include mechanical support, force transmission, internal organ protection, and mineral homeostasis, and it also serves as the major site of hematopoiesis during postnatal life. Bone consists of extracellular matrix and several cell types. Matrix The extracellular component of bone, the matrix,…

The Skin

The Skin: More Than a Mechanical Barrier More than a century and a half ago, the noted pathologist Rudolph Virchow described the skin as a mere protective covering for more delicate and functionally sophisticated internal viscera. Subsequently, the skin was viewed as a necessary but rather uninteresting barrier to fluid loss and mechanical injury. Over the last several decades, however, the skin has come to be…

The Endocrine System

The endocrine system consists of a highly integrated and widely distributed group of organs, called glands, that orchestrate a state of metabolic equilibrium among the various organs of the body. Signaling by secreted molecules can be classified into three types—autocrine, paracrine, or endocrine—on the basis of the distance over which the signal acts. In endocrine signaling, the secreted molecules, also known as hormones, act on target…

The Breast

The breast is distinguished from other organs by three important characteristics. First, its major function is to provide for the nutritional support and survival of another individual, the infant. Second, it undergoes dynamic structural changes throughout life: expansion of the lobular system after menarche; periodic remodeling during adulthood, especially during and after pregnancy; and ultimately involution and regression. Finally, as symbols of femininity, breasts have social,…

The Female Genital Tract

A brief review of the development and anatomy of the female genital tract is fundamental to understanding the diseases that affect this complex organ system. Normal development of the female genital tract proceeds through a series of tightly choreographed events involving the primordial germ cells, the müllerian (paramesonephric) ducts, the wolffian (mesonephric) ducts, and the urogenital sinus ( Fig. 22.1 ). Germ cells arise in the…

The Lower Urinary Tract and Male Genital System

The Lower Urinary Tract The renal pelves, ureters, urinary bladder, and urethra (except the terminal portion) are lined by a special form of transitional epithelium called urothelium . Urothelium is composed of five to six layers of cells with oval nuclei, often with linear nuclear grooves, and a surface layer consisting of large, flattened “umbrella cells” with abundant cytoplasm. This epithelium rests on a well-developed basement…

The Kidney

What is a human but an ingenious machine designed to turn, with “infinite artfulness, the red wine of Shiraz into urine?” So said the storyteller in Isak Dinesen's Seven Gothic Tales . More accurately but less poetically, human kidneys serve to convert more than 1700 L of blood per day into about 1 L of a highly concentrated fluid called urine . In so doing, the kidney excretes…

The Pancreas

The adult pancreas is a transversely oriented retroperitoneal organ extending from the C-loop of the duodenum to the hilum of the spleen ( Fig. 19.1A ). Although the organ gets its name from the Greek pankreas (“all flesh”), it is in fact a complex lobulated organ with distinct exocrine and endocrine components. Open full size image Figure 19.1 Pancreatic ductal anatomy. (A) Normal ductal anatomy. (B)…

Liver and Gallbladder

The Liver and Bile Ducts The normal adult liver weighs 1400 to 1600 g. It has a dual blood supply, with the portal vein providing 60% to 70% of hepatic blood flow and the hepatic artery supplying the remaining 30% to 40%. The portal vein and the hepatic artery enter the inferior aspect of the liver through the hilum, or porta hepatis. Within the liver, the branches…

The Gastrointestinal Tract

The gastrointestinal (GI) tract is a hollow tube extending from the oral cavity to the anus that consists of anatomically distinct segments including the esophagus, stomach, small intestine, colon, rectum, and anus. Each of these segments has unique, complementary, and highly integrated functions, which together serve to regulate the intake, processing, and absorption of ingested nutrients and the disposal of waste products. The regional variations in…

Head and Neck

Diseases of the head and neck range from the common cold to uncommon neoplasms of the ear and nose. The examples discussed in the following sections are organized based on the primary anatomic site at which they occur, that is, oral cavity, upper airways (including the nose, pharynx, larynx, and nasal sinuses), ears, neck, and salivary glands. Oral Cavity Diseases of Teeth and Supporting Structures Caries…

The Lung

The lungs are ingeniously constructed to carry out their cardinal function, the exchange of gases between inspired air and blood. Developmentally, the respiratory system is an outgrowth from the ventral wall of the foregut. The midline trachea develops two lateral outpocketings, the lung buds, which eventually divide into branches called lobar bronchi, three on the right and two on the left, thus giving rise to three…

Red Blood Cell and Bleeding Disorders

In this chapter, we will first consider diseases of red cells. By far, the most common and important are the anemias, red cell deficiency states that usually have a nonneoplastic basis. We will then complete our review of blood diseases by discussing the major bleeding disorders and complications of blood transfusion. Anemias Anemia is defined as a reduction of the total circulating red cell mass below…

Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus

The components of the hematopoietic system have been traditionally divided into the myeloid tissues, which include the bone marrow and the cells derived from it (e.g., red cells, platelets, granulocytes, and monocytes), and the lymphoid tissues, consisting of the thymus, lymph nodes, and spleen. It is important to recognize, however, that this subdivision is artificial with respect to both the normal physiology of hematopoietic cells and…

The Heart

The human heart is a remarkably efficient, durable, and reliable pump, propelling more than 7500 L of blood through the body each day, and beating more than 40 million times a year—the wellspring for tissue oxygenation, nutrition, and waste removal. In utero, the heart and vasculature are the first fully functional organ system (at roughly 8 weeks of gestation). Without a vascular supply and a beating heart,…

Blood Vessels

Vascular pathology is responsible for more morbidity and mortality than any other category of human disease. Although the most clinically significant lesions involve arteries, venous disorders are not inconsequential. Two principal mechanisms underlie vascular disease: Narrowing (stenosis) or complete obstruction of vessel lumens, either progressively (e.g., by atherosclerosis) or precipitously (e.g., by thrombosis or embolism) Weakening of vessel walls, leading to dilation or rupture To better…