FIFTH EDITION. Human. Introduction to. Michael N. Hart, MD. Agnes G. Loeffler, MD, PhD

Transcription

1 FIFTH EDITION Human Introduction to Disease Pathophysiology for Health Professionals Michael N. Hart, MD Professor and Chair, Department of Pathology University of Wisconsin Madison Agnes G. Loeffler, MD, PhD Assistant Professor, Department of Pathology University of Wisconsin Madison..

2 World Headquarters Jones & Bartlett Learning 40 Tall Pine Drive Sudbury, MA Jones & Bartlett Learning Canada 6339 Ormindale Way Mississauga, Ontario L5V 1J2 Canada Jones & Bartlett Learning International Barb House, Barb Mews London W6 7PA United Kingdom Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call , fax , or visit our website, Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an to Copyright 2012 by Jones & Bartlett Learning, LLC All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information NOT FOR storage SALE and retrieval OR DISTRIBUTION system, without written permission from the copyright owner. The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures Jones described. & Bartlett Treatments Learning, and side effects LLC described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. Production Credits Publisher: David D. Cella Associate Editor: Maro Gartside Production Director: Amy Rose Senior Production Editor: Renée Sekerak Production Assistant: Sean Coombs Marketing Manager: Grace Richards Manufacturing and Inventory Control Supervisor: Amy Bacus Associate Photo Researcher: Jessica Elias Composition: DataStream Content Solutions, LLC Cover Design: Kristin E. Parker Cover Image: Elena Ray/ShutterStock, Inc. Printing and Binding: Webcrafters, Inc. Cover Printing: Webcrafters, Inc. Library of Congress Cataloging-in-Publication Data Hart, Michael Noel, Introduction to human Jones disease: pathophysiology & Bartlett for Learning, health professionals LLC / Michael N. Hart, Agnes G. Loeffler. 5th ed. p. ; cm. Rev. ed. of: Introduction to human disease / Thomas H. Kent, Michael Noel Hart. 4th ed. c1998. Includes bibliographical references and index. ISBN-13: ISBN-10: Pathology. 2. Allied health personnel. I. Loeffler, Agnes Gertrud, II. Kent, Thomas H. (Thomas Hugh), Introduction to human disease. III. Title. [DNLM: NOT FOR 1. Pathology. SALE QZ OR 4] DISTRIBUTION RB111.K dc Printed in the United States

3 Dedication Amy Treece MD Momen M. Wahidi MD Momen M. Wahidi MD Scott L. Shofer MD, PhD Amy Treece Jones MD & Bartlett Learning, LLC Scott L. Shofer MD, PhD Amy Treece MD This book is dedicated to students beginning their career in the allied health sciences. iii..

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5 Brief Contents SECTION I An Overview 1 NOT FOR SALE Chapter OR DISTRIBUTION 1 Introduction to Pathology 3 Chapter 2 Most Frequent and Significant Diseases 11 Chapter 3 Diagnostic Resources 19 SECTION II Basic Disease Processes 29 Chapter 4 Injury, Inflammation, and Repair 31 Chapter NOT FOR 5 SALE Hyperplasias OR DISTRIBUTION and Neoplasms 51 Chapter 6 Cancer 63 Chapter 7 Genetic and Developmental Diseases 73 NOT FOR SALE SECTION OR DISTRIBUTION III Major Organ-Related Diseases NOT FOR 89 SALE OR DISTRIBUTION Chapter 8 Vascular System 91 Chapter 9 Heart 109 Chapter 10 Hematopoietic System 125 Chapter 11 Bleeding and Clotting Disorders 141 Chapter Jones 12 & Bartlett Lung Learning, 153 LLC Chapter 13 Oral Region, Upper Respiratory Tract, and Ear 177 Chapter 14 Gastrointestinal Tract 191 Jones & Bartlett Chapter Learning, 15 Liver, LLC Gallbladder, and Pancreas Jones 215& Bartlett Learning, LLC Chapter 16 Kidney, Lower Urinary Tract, and Male Genital Organs v

6 vi Brief Contents Chapter 17 Female Genital Organs 259 NOT FOR SALE Chapter OR DISTRIBUTION 18 Breast 283 Chapter 19 Skin 295 Chapter 20 Eye 313 Chapter 21 NOT Bones FOR and SALE Joints OR 323 DISTRIBUTION Chapter 22 Skeletal Muscle and Peripheral Nerve 343 Chapter 23 Central Nervous System 351 Chapter NOT FOR 24 SALE Mental OR Illness DISTRIBUTION 367 Chapter 25 Endocrine System 377 SECTION IV Multiple Organ System Diseases 395 Chapter 26 Infectious Diseases 397 Chapter 27 Immunologic Diseases 421 Chapter 28 Physical Jones Injury & Bartlett 437 Learning, LLC Chapter 29 NOT Chemical FOR Injury SALE 445 OR DISTRIBUTION Chapter 30 Nutritional Disorders and Alcoholism 451..

7 Contents Preface xi Preface to the First Edition xiii NOT FOR SALE Acknowledgments OR DISTRIBUTION xv Reviewers xvii Chapter 3 Diagnostic Resources 19 Approach to Patient Care 20 Jones & Bartlett Screening Learning, 21LLC NOT FOR SALE OR Diagnostic DISTRIBUTION Tests and Procedures 21 Practice Questions 27 SECTION I An Overview Jones & Bartlett 1 Learning, LLC SECTION II Jones Chapter & Bartlett 6 Cancer Learning, 63LLC NOT FOR SALE OR Frequency DISTRIBUTION and Significance 64 Basic Disease Processes NOT 29 FOR SALE OR DISTRIBUT Chapter 1 Introduction to Pathology 3 Chapter 4 Injury, Inflammation, and Jones & Bartlett Disease Learning, 4 LLC Jones Repair & Bartlett 31 Learning, LLC NOT FOR SALE Pathology OR DISTRIBUTION 4 NOT FOR Review SALE of Structure OR DISTRIBUTION and Manifestations of Function 32 Disease 5 Structural Diseases 6 Events Following Injury 34 Injury 35 Functional Diseases 6 Inflammation 39 Causes of Disease 7 Repair 46 The Care of Patients 7 Practice Questions 49 Obstacles to Patient Care 8 Chapter 5 Hyperplasias and The Structure of the Neoplasms 51 Book Jones 9 & Bartlett Learning, LLC Practice NOT FOR Questions SALE 10OR DISTRIBUTION Function NOT 52 FOR SALE OR DISTRIBUT Chapter 2 Most Frequent and Significant Diseases 11 Significance of Hyperplasias and Neoplasms 55 Classification of Jones & Bartlett Causes of Learning, Death (Mortality) LLC 11 NOT FOR SALE Causes OR and DISTRIBUTION Measures of Disability Jones Neoplasms & Bartlett 55Learning, LLC NOT FOR Natural SALE History OR of Hyperplasia DISTRIBUTION and Cancer 59 Practice Questions 61 (Morbidity) 13 Frequency of Acute Diseases 15 Frequency of Chronic Diseases 15 Aging 15 Practice Questions 16.. vii

8 viii Contents Etiology 65 Chapter 11 Bleeding and Clotting Local and Systemic Disorders 141 Manifestations 67 Diagnosis 69 Function 142 Prognosis 69 Treatment 71 Problems 145 Practice Jones Questions & Bartlett 72 Learning, LLC Symptoms, Signs, Jones and & Tests Bartlett 146Learning, LL Specific Diseases NOT FOR 147SALE OR DISTRIBUT Chapter 7 Genetic and Developmental Practice Questions 152 Diseases 73 Chapter 12 Lung 153 Function 74 Jones Review & Bartlett of Structure Learning, and LLC Definitions 76 NOT FOR Function SALE 154 OR DISTRIBUTION Frequency and Significance of Developmental Abnormalities 77 Problems 155 Symptoms, Signs, and Tests 81 Symptoms, Signs, and Tests 157 Specific Diseases 82 Specific Diseases 158 Jones & Bartlett Learning, Practice LLC Questions 87 Organ Failure 175 Practice Questions 176 SECTION III Major Organ-Related Diseases 89 Chapter 13 Oral Region, Upper Respiratory Tract, and Chapter 8 Vascular System 91 Function 92 Jones & Bartlett Problems Learning, 93 LLC NOT FOR SALE Symptoms, OR DISTRIBUTION Signs, and Tests 94 Specific Diseases 95 Organ Failure 107 Practice Questions 108 Ear 177 Function 178 Problems 179 Jones Symptoms, & Bartlett Signs, Learning, and Tests 179 LLC NOT FOR Specific SALE Diseases OR DISTRIBUTION 180 Organ Failure 188 Practice Questions 189 Jones & Chapter Bartlett Learning, 9 Heart LLC 109 Jones Chapter & Bartlett 14 Gastrointestinal Learning, LLCTract 191 NOT FOR SALE OR Review DISTRIBUTION of Structure and Function 110 Function 192 Problems 111 Problems 194 Symptoms, Signs, and Tests 112 Symptoms, Signs, and Tests 195 Specific Diseases 114 Specific Diseases Jones 197 & Bartlett Learning, LL Organ Failure 122 Organ Failure NOT 213 FOR SALE OR DISTRIBUT Practice Questions 123 Practice Questions 214 Chapter 10 Hematopoietic System 125 Chapter 15 Liver, Gallbladder, and Jones & Bartlett Review of Learning, Structure and LLC Jones Pancreas & Bartlett 215Learning, LLC NOT FOR SALE Function OR DISTRIBUTION 126 NOT FOR Review SALE of Structure OR DISTRIBUTION and Function 216 Problems 128 Symptoms, Signs, and Tests 128 Problems 218 Specific Diseases 130 Jones & Bartlett Symptoms, Learning, Signs, LLCand Organ Failure 139 Tests 219 Practice Questions 139 Specific Diseases 220..

9 Contents ix Organ Failure 228 Chapter 21 Bones and Joints 323 Practice Questions 231 Function 324 Chapter 16 Kidney, Lower Urinary Tract, and Male Genital Organs 233 Problems 326 Symptoms, Signs, and Tests 327 Function Jones 234 & Bartlett Learning, LLC Specific Diseases Jones 327 & Bartlett Learning, LL Most NOT Frequent FOR SALE and Serious OR DISTRIBUTION Organ Failure NOT 340 FOR SALE OR DISTRIBUT Problems 237 Practice Questions 340 Symptoms, Signs, and Tests 238 Specific Diseases 240 Chapter 22 Skeletal Muscle and Peripheral Jones & Bartlett Organ Failure Learning, 255 LLC Practice Questions 256 Nerve 343 Chapter 17 Female Genital Organs 259 Function 343 Function 260 Problems 345 Jones & Bartlett Symptoms, Learning, Signs, LLCand Tests 345 Problems 262 Symptoms, Signs, and Tests 263 Specific Diseases 265 NOT FOR SALE OR Specific DISTRIBUTION Diseases 346 Organ Failure 350 Practice Questions 350 Organ Failure 280 Practice Jones Questions & Bartlett 281 Learning, LLC Chapter 23 Central Nervous System NOT 351 FOR SALE OR DISTRIBUT Chapter 18 Breast 283 Function 352 Function 284 Jones Problems & Bartlett 353Learning, LLC Problems 285 NOT FOR SALE Symptoms, Signs, and Tests 353 Symptoms, OR DISTRIBUTION Signs, and Tests 285 Specific Diseases 354 Specific Diseases 287 Organ Failure 365 Practice Questions 293 Practice Questions 366 Jones & Chapter Bartlett Learning, 19 Skin LLC 295 NOT Chapter FOR SALE 24 OR Mental DISTRIBUTION Illness 367 Function 296 Nature of Mental Illness 368 Problems 297 Problems 368 Symptoms, Signs, and Tests 298 Symptoms, Signs, Jones and & Tests Bartlett 369Learning, LL Specific Diseases 299 Specific Diseases NOT FOR 369SALE OR DISTRIBUT Organ Failure 312 Practice Questions 375 Practice Questions 312 Chapter 20 Eye 313 Chapter 25 Endocrine System 377 Jones & Bartlett Review of Learning, Structure and LLC NOT FOR SALE Function OR DISTRIBUTION 314 Problems 314 Symptoms, Signs, and Tests 315 Jones Review & Bartlett of Structure Learning, and LLC NOT FOR Function SALE 378 OR DISTRIBUTION Problems 379 Symptoms, Signs, and Tests 380 Specific Diseases 316 Specific Diseases 380 Organ Failure 321 Organ Failure 392 Practice Questions 321 Practice Questions 393..

10 x Contents Mechanical Injuries 438 Jones & SECTION Bartlett Learning, IV Multiple LLCOrgan System Thermal Injury 441 Diseases 395 Radiation Injury 443 Practice Questions 444 Chapter 26 Infectious Diseases 397 Chapter 29 Chemical Injury 445 Infection Jones and & the Bartlett Body s Defense Learning, LLC Modes of Chemical Jones Injury & Bartlett 445 Learning, LL Mechanisms 399 Most Frequent NOT and FOR Serious SALE OR DISTRIBUT Problems 446 Problems 400 Symptoms, Signs, and Tests 447 Symptoms, Signs, and Tests 401 Specific Diseases 448 Specific Diseases 402 Jones & Bartlett Practice Questions 450 Practice Questions Learning, 419 LLC Chapter NOT 30 FOR Nutritional SALE Disorders OR DISTRIBUTION and Chapter 27 Immunologic Diseases 421 Alcoholism 451 Review of Function 451 Function 422 Jones & Bartlett Learning, Classification LLC of Immunologic Jones & Bartlett Learning, Problems 452 LLC Diseases 424 Problems 426 Symptoms, Signs, and Tests 426 Specific Diseases 428 Glossary 457 Practice Jones Questions & Bartlett 434 Learning, LLC Index 493 Chapter 28 Physical Injury 437 Problems 438 Symptoms, Signs, and Tests 453 Specific Diseases 453 Practice Questions 456..

11 Preface The scope and purpose of Introduction to Human practice. The basic format of the book, which has made Disease has not changed since it was first published Learning, 31 years ago, LLC and the intentions expressed Jones retained, & Bartlett with the exception Learning, that we LLC now provide a com- it so popular through the first four editions, has been Jones & Bartlett NOT FOR SALE in the preface OR DISTRIBUTION to the First Edition are just as applicable NOT prehensive FOR SALE list of OR learning DISTRIBUTION objectives at the beginning of to the Fifth. Introduction to Human Disease introduces each chapter and a set of practice questions at the end of the basic principles of disease to allied health professions students. The intent of the book is to provide a physiology instructors for content, accuracy, and pre- each chapter. Each chapter has been critiqued by patho- text that covers all aspects of human disease with minimal requirements for prerequisite Jones & knowledge. Bartlett Learning, Over the LLC for each successive edition, we have Jones added & more Bartlett clinical Learning, LL sentation. Based on reviewers and readers suggestions course of the past four NOT editions, FOR SALE we have OR noticed DISTRIBUTION that information, including general NOT and FOR specific SALE treatments OR DISTRIBUT lay people and medical students, overwhelmed by the for diseases. Consequently, although Introduction to volumes of detailed, technical information delivered to Human Disease remains primarily a pathology text, the them in print and, increasingly, on the Internet, turn to clinical information provides a more circumspect foundation for the reader. the book for a basic outline of how the health profession approaches Jones particular & Bartlett diseases, Learning, or where a LLC specific disease NOT fits into FOR the SALE medical OR nosological DISTRIBUTION scheme. While we vides fundamental NOT FOR vocabulary SALE and OR concepts, DISTRIBUTION a broad The text is divided Jones into & Bartlett four sections. Learning, Section I LLC pro- are happy that they derive benefit from the discussions analysis of the most common and significant diseases, of diseases laid forth in this text, the intended readership is students wishing to pursue a career in nursing, nosis. Section II provides a framework for the basic and a discussion of the tools and processes of diag- pharmacy, dentistry, physical or occupational therapy, types of human disease: reactions to injury, neoplasia, genetically & Bartlett determined Learning, disease, LLCand intrauterine Jones & nutrition Bartlett or Learning, other allied LLC health professions fields, who Jones require a broad understanding of disease epidemiology, injury. In Section III, each chapter discusses diseases cause, diagnosis and treatment, and a basic grounding of a particular organ system. We review the anatomy in the specialized medical lexicon. and physiology of that organ, provide an overview of We have been pleased by the continual use of the First, the most frequent and important diseases encountered, discuss diagnostic techniques (symptoms, Second, Th i r d, and Fourth Editions by instructors who teach pathology courses Jones to a wide & variety Bartlett of allied Learning, health LLC signs, laboratory tests, and radiological Jones & and Bartlett clinical Learning, LL professions students. We think that all health professions students have a need for a common vocabulary and sequences of failure of the organ to function. Section procedures), profile the diseases, and discuss the con- a broad-based understanding of human disease. Thus, we IV presents diseases that tend to affect multiple organs define terms as clearly and specifically as possible and and that share causative mechanisms within each attempt to describe all of the most common and important diseases Jones of & humans, Bartlett including Learning, mental LLC illnesses. In tions, external Jones injury by & physical Bartlett and Learning, chemical agents, LLC group. Topics included are infections, immune reac- fact, NOT a special FOR effort SALE is made OR via DISTRIBUTION the text s format to make and disorders NOT caused FOR by SALE nutritional OR deprivations DISTRIBUTION and the reader aware of the most frequent and significant diseases in each organ category. to learn after diseases of the organs have been stud- excesses. We have found that these chapters are easier In the Fifth Edition, all of the illustrations have ied. They can, however, be inserted earlier in a course been converted to color, new illustrations have been without any prerequisites other than Sections I and II. Jones & added, Bartlett and Learning, the content has LLC been considerably updated Jones We & hope Bartlett that the text Learning, continues LLC to be of use to students NOT FOR SALE to reflect OR the DISTRIBUTION current state of medical knowledge and NOT embarking FOR SALE on a OR career DISTRIBUTION in the allied health professions... xi

12 xii Preface The sheer volume of medical knowledge can appear this book, students should be well on their way to gaining Jones & overwhelming, Bartlett Learning, and the technical LLC vocabulary used can Jones the basic & Bartlett foundation Learning, they need for LLC a rewarding and exciting FOR career SALE in medicine. OR DISTRIBUTION NOT FOR SALE seem like OR a foreign DISTRIBUTION language to students at the beginning NOT of their studies. By reading and studying the content of..

13 Preface to the First Edition This text includes the knowledge that we believe offered to the medical student. The text has four general the various health science students should have in content areas: Jones & Bartlett common Learning, to facilitate LLC further learning in their area Jones 1. & Chapters Bartlett 1 Learning, through 3 provide LLC an overview of NOT FOR SALE of specialization OR DISTRIBUTION and effective interaction as members of NOT FOR human SALE disease OR DISTRIBUTION in terms of general vocabulary, the healthcare team. Each student should go beyond this overall frequency and significance of disease, text in areas of special interest or need, and some may and diagnostic approach including laboratory choose to omit some of the chapters. resources. The need for this text at the University of Iowa grew 2. Chapters 4 through 6 cover the basic pathologic out of our experience Jones in developing & Bartlett and teaching Learning, a LLC processes common to most Jones diseases: & Bartlett inflamma- degeneration-necrosis, NOT FOR repair, SALE growth OR dis-distribut physical therapy, and dental students. We anticipate that turbances, and developmental disorders. Learning, LL pathology course for NOT pharmacy, FOR SALE physicians OR assistants, DISTRIBUTIONtion, this text will be suitable to the needs of other health science students, including nurses. Based on experience as organ system. In our experience, teaching disease 3. Chapters 7 through 23 cover diseases by organ or well as analysis of the needs of these students, we concluded Jones that the & text Bartlett content Learning, should be significantly LLC difeases has Jones the advantage & Bartlett of encountering Learning, the LLC com- by organs before discussion of multisystem disferent NOT from FOR that offered SALE in OR texts DISTRIBUTION oriented toward medical mon NOT diseases FOR of the SALE heart and OR other DISTRIBUTION major organs students. For example, we designed this text to be more early in the course. Within each organ-system clinically oriented than a typical medical student s text chapter, material is presented in a standardized because most health science students will not have further courses in the general aspects of medicine. We chose frequent and serious problems, major manifesta- sequence: review of structure and function, most Jones & to Bartlett emphasize Learning, common laboratory LLC tests, frequency of Jones & tions, Bartlett specific Learning, diseases (under LLCthe categories of disease, and mental illness and deemphasize histologic developmental abnormalities, inflammatory and detail. degenerative diseases, and growth disturbances), In making a blueprint for the text we carefully considered material to be included under four categories: 4. Chapters 24 through 31 discuss multisystem dis- and organ failure. (1) the vocabulary for each chapter was determined by eases and disease processes, including infections, consensus among the authors Jones from & Bartlett a list of vocabulary Learning, LLC immunologic disorders, Jones physical & and Bartlett chemical Learning, LL expected of medical students; (2) the diseases to be covered were selected on the basis of their frequency and erosclerosis, diabetes mellitus, nutritional disor- injury, bleeding and clotting, hypertension, ath- significance or as representative examples; (3) a list of ders, alcoholism, and cancer. diagnostic resources and laboratory tests was selected The order of teaching these topics can easily be altered for each content area; and (4) for each organ, we included and many could be inserted at an earlier stage in a course. a discussion Jones of & the Bartlett general effects Learning, of failure LLC of that organ. In our experience, Jones multisystem & Bartlett diseases Learning, have been easier LLC In NOT addition, FOR we have SALE included OR DISTRIBUTION a brief review of the most for the students NOT to FOR learn after SALE the diseases OR DISTRIBUTION of each system important aspects of anatomy and physiology in most of have been learned, and they provide a nice overview to the chapters. end the course. In line with our goal of providing a survey or introduction to human disease rather than emphasizing the educational objectives, we have chosen not to include Although the text was written on the basis of detailed Jones & discipline Bartlett of Learning, pathology, we LLC also decided to depart from Jones the objectives & Bartlett as such Learning, the text, LLC but rather to provide NOT FOR SALE the classic OR sequence DISTRIBUTION of general and systemic pathology NOT the FOR student SALE a content OR DISTRIBUTION outline at the beginning of each.. xiii

14 xiv Preface to the First Edition chapter and review questions based on the objectives needs information beyond the scope of this text, we recommend & Bartlett more comprehensive Learning, pathology LLC texts or major Jones & at Bartlett the end of Learning, the chapter. LLC We highly recommend that Jones NOT FOR SALE instructors OR provide DISTRIBUTION problem-solving exercises as supplemental learning exercises so that the student s knowledge Suggestions for improvement and criticisms of this NOT textbooks FOR SALE of internal OR medicine. DISTRIBUTION level can be expanded beyond that of recall to problem text will be welcomed by the authors. solving and analysis. For the student who desires or..

15 Acknowledgments Foremost, we want to acknowledge the contributions of Thomas Kent, MD, who was the senior author of Introduction to Human Disease through the first four editions. Thomas Kent was a leading medical educator for many OR DISTRIBUTION years. He was cofounder of the Group for NOT FOR SALE Research in Pathology Education (GRIPE), a consortium that shares pathology education materials amongst over 75 medical schools. In 1975, Thomas Kent was having students at the University of Iowa College of Medicine text with high quality, color photographs. We would like take tests on the computer, a further example of his to thank the following individuals who contributed significantly to the Fifth Edition NOT of this FOR textbook SALE by review- OR DISTRIBUT prescience in education. NOT Dr. FOR Kent SALE is now OR retired DISTRIBUTION from pathology teaching, but the success of the first four editions of this text is in no small measure the result of his Agni, Daniel Albert, Richard Antaya, Luis Brandi, Alan ing chapters, contributing illustrations, or both: Rashmi vision in creating the style and format of the text, plus Bridges, Darya Buehler, Robert Corliss, Kirkland Davis, his insistence that the content must be directed to an Charles Ford, John Frey, Andreas Friedl, Michael Fritsch, understanding of the most common and important diseases. NOT We FOR strive to SALE carry forward OR DISTRIBUTION his vision into the Fifth Edition. In June of 2008, we received a letter from Kristine Johnson of Jones and Bartlett Publishers (now Jones & Bartlett Learning). She had received a note from a person been extremely pleased with the help we have received along the way from Kristine Johnson, Maro Gartside, Renée Sekerak, Jessica Elias, and the other members of the editorial, marketing, and production team. NOT FOR Bringing SALE this OR text up DISTRIBUTION to date required the concerted effort of numerous colleagues. Not only did the text have to be revised, sometimes substantially, to reflect progress in medical knowledge, but we also wanted to enhance the Molly Gurney, Josephine Harter, Michael Hartman, Eleanor Knopp, NOT FOR Catherine SALE Leith, OR Bradley DISTRIBUTION Maxfield, Patrick McBride, Fern Murdoch, Kenneth Noonan, Terry Oberley, Scott Perlman, Myron Pozniak, Gordana Raca, Shahriar Salamat, Lonie Salkowski, Suzanne Selvaggi, Donald Schalk, Lynette Scott, Carol Spiegel, Jones & who Bartlett was extremely Learning, sad LLC to see Introduction to Human Jones Jose Torrealba, & Bartlett Patrick Learning, Turski, LLC Art Walaszek, Stacy NOT FOR SALE Disease OR leave DISTRIBUTION the shelves after the Fourth Edition. Ms. NOT Walz, FOR Eliot SALE Williams, OR DISTRIBUTION Donald Yandow, David Yang, and Johnson asked if we would consider revising the book as Weixiong Zhong. its content area was consistent with the intended audience for Jones & Bartlett Learning. Thus began our rela- Rasmusson, who provided excellent secretarial support Special thanks are also due to Joan Miller and Korise tionship with Jones & Bartlett Learning, and we have during the revision process. xv..

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17 Reviewers Barbara Murray Fenner, PhD Norwich University Suni A. Susko, BSMT(ASCP)SH Hematology/Coagulation Supervisor Altoona Regional Health System Hematology/Coagulation Instructor NOT FOR Altoona SALE Hospital OR School DISTRIBUTION of Medical Technology and Clinical Laboratory Science NOT FOR SALE Sara OR Parker, DISTRIBUTION BHS-RRT, NPS Clinical Instructor School of Health Professions University of Missouri Heather A. Vitko, RN, BSN Instructor of Nursing Jennifer L. Pitchford, PTA, BS Saint Francis University Instructor Jefferson Community and Technical College PTA Program xvii..

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