Pathophysiology of Disease: An Introduction to Clinical Medicine 8E

Book Preface

Goal and Audience

The goal of Pathophysiology of Disease: An Introduction to Clinical Medicine, as outlined in the introductory chapter (Chapter 1), is to introduce students to clinical medicine by reviewing the pathophysiologic basis of the symptoms and signs of various common diseases.
The book has proved useful as a text for both Pathophysiology and Introduction to Clinical Medicine courses in medical schools, and it has been popular in similar courses in nursing schools, physician assistants’ training programs, and other allied health programs. It is valuable to students early in their medical school years by highlighting the clinical relevance of their basic science courses, and in preparation for their USMLE Step 1 examinations. The book is also helpful to students engaged in their internal medicine and surgery clerkships, and to house officers as an up-to-date summary of relevant physiology and a source of key references. Practitioners (both general internists and specialists who provide generalist care) will find it beneficial as a refresher text, designed to update their knowledge of the mechanisms underlying 132 commonly encountered diseases and disorders. Nurses, nurse-practitioners, physician assistants, and other allied health practitioners have found that its concise format and broad scope facilitate their understanding of these basic disease entities.
Pathophysiology of Disease has been widely adopted in the United States, Canada, and the United Kingdom, and it has been translated into Spanish, Italian, Chinese, Japanese, Greek, and Turkish. Both the text and its Case Study Questions and Answers are also available online at
accessmedicine.mhmedical.com, the online version of McGraw-Hill’s many medical textbooks (search under “Books, Library, Basic Science” for
“Pathophysiology,” listed alphabetically).

New Features for This Edition

In preparation for this eighth edition, the editors and authors reviewed the entire book. There have been many text revisions aimed at updating information, improving clarity, and eliminating minor errors. With emphasis on recent pertinent reviews, references have been entirely updated, as have figures and tables. “Checkpoints,” collections of review questions, continue to appear throughout the chapters and have been revised.

Examples of Substantive New Content Found in This Eighth Edition

• Update on components and physiology of normal immunity
• Most recent surveillance case definition for HIV infection
• Explication of the concepts of innate immunity and pathogen-associated molecular patterns
• Totally revised chapter on neoplasia, including 19 new figures and 4 new tables
• New figure illustrating iron transport and regulation in the duodenal enterocyte
• New chapter section on urticaria (perivascular dermatitis)
• New chapter section on various forms of spinocerebellar ataxia
• Clarification in text and figures of regional alterations in the overall distribution of ventilation and perfusion referred to as mismatch, including concepts of anatomic versus alveolar (wasted ventilation) dead space and right-to-left shunt
• Update on genetic factors implicated in asthma risk, as well as allergic versus nonallergic asthma
• Newly rewritten section on idiopathic pulmonary fibrosis as a prototypic restrictive (interstitial) lung disease
• Extensive revision of sections on pulmonary edema, adult respiratory distress syndrome (ARDS), and pulmonary venous thromboembolism
• Expanded material on paragangliomas
• New figures on mechanisms leading to nonalcoholic fatty liver disease and to hepatic steatosis
• New table summarizing adverse prognostic signs in acute pancreatitis derived from the Acute Pancreatitis Classification Working Group’s 2012 classification, a revision of the Atlanta international consensus classification and definitions of acute pancreatitis
• New table summarizing genetic syndromes associated with pancreatic cancer

• New table summarizing the prevalence of various causes of end-stage renal disease for U.S. Medicare recipients in the 2016 U.S. Renal Data System
• Revised flowchart summarizing the pathogenesis of bone diseases in chronic kidney disease
• Updated information on familial hypocalcuric hypercalcemia, malignant hypercalcemia, autosomal dominant hypocalcemia, and the autoimmune polyendocrine failure syndromes
• The American Diabetes Association’s new diagnosis and etiologic classification of diabetes mellitus
• New figure illustrating the amino acid sequence and covalent structure of human proinsulin
• New schematic diagram of glucose-stimulated insulin release from the pancreatic β cell
• New figure showing how pancreatic islet cell secretions of glucagon (from α cells) and insulin (from β cells), which are reciprocally regulated by glucose, play key roles in maintaining glucose homeostasis
• Diagram demonstrating stages in the development of type 1 diabetes mellitus with the appearance of β-cell autoantibodies, followed by dysglycemia, insulinopenia, and then frank hyperglycemia
• Review of mechanisms of the newest classes of pharmacologic agents approved for type 2 diabetes mellitus
• New figure illustrating modifiable cardiovascular risk factors in individuals with diabetes
• New figure illustrating the control of energy homeostasis by arcuate nucleus neurons, both stimulatory and inhibitory neurons with regard to food intake
• Updated information on fine-needle aspiration biopsy of thyroid nodules
• Update on thyroid disorders in pregnancy
• New schematic drawing of the sequence of changes that occur in the alveolar secretory units and duct system of the female breast before, during, and after pregnancy and lactation
• Update of indicators of mild to moderate versus severe preeclampsia-eclampsia
• Incorporation of new International Federation of Gynecology and Obstetrics classification system for pathogenesis of abnormal uterine bleeding
• Update to pathogenesis and pathophysiology of inflammatory myopathies and rheumatoid arthritis
• New chapter section on spondyloarthropathies, including ankylosing spondylitis, reactive arthritis, inflammatory bowel disease–associated arthritis, and psoriatic arthritis

• Updated references throughout the text, including articles mainly from 2015, 2016, and 2017
• Revised and updated figure citations throughout the text

Case Study Questions and Answers

Each chapter ends with a collection of Case Studies. These clinical problems give readers an opportunity to test their understanding of the pathophysiology of each clinical entity discussed and to apply their knowledge to exemplar clinical situations. In this eighth edition, Yeong S. Kwok, MD, of the University of Michigan, has added an additional 12 Case Studies with questions, bringing the total number to 132, or one for each of the clinical entities discussed in the book’s 24 chapters. New Case Study topics include:

• Down syndrome as a result of a balanced robertsonian translocation
• Chronic granulomatous disease
• Malignant hypercalcemia
• Cerebellar ataxia
• Urticaria
• Ulcerative colitis
• Type 1 diabetes mellitus
• Subclinical hypothyroidism
• Subclinical hyperthyroidism
• Amenorrhea caused by polycystic ovary syndrome
• Abnormal vaginal bleeding as a result of endometrial cancer
• Spondyloarthropathy as a result of ankylosing spondylitis
As before, detailed analyses of the Cases appear in Chapter 25: Case Study Answers. There, Dr. Kwok has updated the Answers to the existing 120 Case Study Questions to reflect the changes made by chapter authors in their revisions, and he has added Answers to the Questions for the 12 new Case Studies.