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BASICS OF
PATHOPHYSIOLOGY I
Jassin M. Jouria, MD
Dr. Jassin M. Jouria is a medical doctor, professor
of academic medicine, and medical author. He
graduated from Ross University School of Medicine
and has completed his clinical clerkship training in
various teaching hospitals throughout New York,
including King’s County Hospital Center and
Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board
exams, and has served as a test prep tutor and instructor for Kaplan. He has developed
several medical courses and curricula for a variety of educational institutions. Dr. Jouria has
also served on multiple levels in the academic field including faculty member and
Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several
continuing education organizations covering multiple basic medical sciences. He has also
developed several continuing medical education courses covering various topics in clinical
medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson
Memorial Hospital’s Department of Surgery to develop an e-module training series for
trauma patient management. Dr. Jouria is currently authoring an academic textbook on
Human Anatomy & Physiology.
Abstract
Pathophysiology, the study of disease function and processes, enables
medical professionals to understand diagnosis, treatment, and management
options to achieve a best-case scenario for their patients. Recognizing
disease and disorder manifestations will assist nurses and nurse practitioners
with early diagnosis to improve patient outcomes. This course provides a
brief overview of pathophysiology principles, including a cellular biology
review, before delving in-depth into the pathophysiology of disorders
affecting the cardiovascular, circulatory, pulmonary, gastrointestinal,
reproductive, urinary, renal, and musculoskeletal systems, in addition to
fluid, electrolyte, and acid/base imbalance disorders.
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Continuing Nursing Education Course Planners
William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster,
Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner
Policy Statement
This activity has been planned and implemented in accordance with the
policies of NurseCe4Less.com and the continuing nursing education
requirements of the American Nurses Credentialing Center's Commission on
Accreditation for registered nurses. It is the policy of NurseCe4Less.com to
ensure objectivity, transparency, and best practice in clinical education for
all continuing nursing education (CNE) activities.
Continuing Education Credit Designation
This educational activity is credited for 2.5 hours. Nurses may only claim
credit commensurate with the credit awarded for completion of this course
activity.
Statement of Learning Need
Nurses at all levels of professional development need an enhanced
understanding of pathophysiology in order to understand patient treatment
and care for certain medical conditions.
Course Purpose
To provide nursing professionals with knowledge of the basic principles of
pathophysiology and associated medical conditions.
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Target Audience
Advanced Practice Registered Nurses and Registered Nurses
(Interdisciplinary Health Team Members, including Vocational Nurses and
Medical Assistants may obtain a Certificate of Completion)
Course Author & Planning Team Conflict of Interest Disclosures
Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA,
Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures
Acknowledgement of Commercial Support
There is no commercial support for this course.
Activity Review Information
Reviewed by Susan DePasquale, MSN, FPMHNP-BC
Release Date: 2/15/2016
Termination Date: 4/9/2018
Please take time to complete a self-assessment of knowledge, on
page 4, sample questions before reading the article.
Opportunity to complete a self-assessment of knowledge learned
will be provided at the end of the course.
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1. Which of the following is the name for the process by which the
cell produces energy through the breakdown of complex
molecules?
a. Catabolism
b. Replication
c. Synthesis
d. Anabolism
2. Which of the following is NOT one of the chemicals that DNA is
comprised of?
a. Adenine
b. Thymine
c. Bromine
d. Cytosine
3. This branch of pathology is the study of chemical and
biochemical mechanisms of the body in relation to disease.
a. Anatomical Pathology
b. Chemical Pathology
c. Biological Pathology
d. Immunology
4. Which of the following is NOT one of the classifications for
kidney infections:
a. Complex
b. Uncomplicated
c. Complicated
d. Chronic
5. The body is comprised of _______________ percent fluids.
a. 12 – 18
b. 24 – 30
c. 52 - 60
d. 72 - 80
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Introduction
Pathophysiology, the study of disease function and processes, enables
medical professionals to understand diagnosis, treatment, and management
options to achieve a best-case scenario for their patients. The ultimate goal
of pathophysiology is to be able to answer the following questions:1

What is the cause or causes of the disease, and why the disease is
developing?

What are the mechanisms responsible for disease onset, progression,
and recovery?

What are the mechanisms responsible for development of symptoms
and signs of disease?
Recognizing disease and disorder manifestations will assist nurses and nurse
practitioners with early diagnosis to improve patient outcomes. This course
provides a brief overview of pathophysiology principles, including a cellular
biology review, before delving in-depth into the pathophysiology of disorders
affecting the cardiovascular, circulatory, pulmonary, gastrointestinal,
reproductive, urinary, renal, and musculoskeletal systems, in addition to
fluid, electrolyte, and acid or base imbalance disorders.
Cellular Biology Review
Cells are the basic building blocks of all living things. Humans are
multicellular, meaning that they are comprised of more than one cell. In
fact, the human body contains approximately 100,000,000,000,000 cells.2
The cells are supported and sustained by the body’s organ systems.3
There are a number of specialized cells in the body, which perform different
functions. For example, some cells combine together to create tissue and
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organs, while other cells carry out the body’s functions. In total, there are
approximately 200 specialized cells within the body carrying out these
special functions.4
The following table provides information on each of the types of specialized
cells:5
Cell Type
Nerve Cells
Function
Also called Neurons, these cells are in the nervous system and
function to process and transmit information (it is hypothesized).
They are the core components of the brain, spinal cord and peripheral
nerves. They use chemical synapses that can evoke electrical signals,
called action potentials, to relay signals throughout the body.
Epithelial
Functions of epithelial cells include secretion, absorption, protection,
cells
transcellular transport, sensation detection, and selective
permeability. Epithelium lines both the outside (skin) and the inside
cavities and lumen of bodies.
Exocrine
These cells secrete products through ducts, such as mucus, sweat, or
cells
digestive enzymes. The products of these cells go directly to the
target organ through the ducts. For example, the bile from the gall
bladder is carried directly into the duodenum via the bile duct.
Endocrine
These cells are similar to exocrine cells, but secrete their products
cells
directly into the bloodstream instead of through a duct. Endocrine
cells are found throughout the body but are concentrated in
hormone-secreting glands such as the pituitary. The products of the
endocrine cells go throughout the body in the blood stream but act
on specific organs by receptors on the cells of the target organs. For
example, the hormone estrogen acts specifically on the uterus and
breasts of females because there are estrogen receptors in the cells
of these target organs.
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Blood Cells
The most common types of blood cells are: red blood cells
(erythrocytes). The main function of red blood cells is to collect
oxygen in the lungs and deliver it through the blood to the body
tissues. Gas exchange is carried out by simple diffusion.
White Blood
Leukocytes are produced in the bone marrow and help the body to
Cells
fight infectious disease and foreign objects in the immune system.
(leukocytes)
White cells are found in the circulatory system, lymphatic system,
spleen, and other body tissues.
Although cells will differ in their structure and function, they all have similar
needs and a similar structural organization.
Cellular Function
Cellular function can be broken into four distinct categories, each of which is
essential to the development and maintenance of the cells and the body as a
whole. The following table provides information on each of the categories of
cellular function:
Function
Description
Growth and
Cell growth occurs as the result of functional cell metabolism, which is
metabolism
the process that occurs when cells create nutrient molecules. There
are two components of metabolism:4

Catabolism – the cell produces energy through the breakdown
of complex molecules.

Anabolism – The cell constructs complex molecules by using
energy and reducing its power. These molecules are used for
other biological processes.
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Replication
Cell division occurs when the mother cell, which is a single cell, divides
into two individual cells. These newly formed cells are called daughter
cells. Cell division (replication) is what enables growth within the
organism.2
Protein
The synthesis of protein is necessary for the maintenance of cellular
synthesis
activities. The protein synthesis process utilizes DNA and RNA amino
acids to form new protein molecules through a two-step process:3

Transcription

Translation
Movement or
Human cells are capable of moving during specific cellular processes,
motility
including immune responses and cancer mastitis. Cellular movement
occurs in three steps:3

Protrusion of the leading edge of the cell

Adhesion of the leading edge and de-adhesion at the cell body
and rear

Cytoskeletal contraction that pulls the cell forward
Genes and Genetic Disorders
Deoxyribonucleic acid (DNA) is comprised of four primary chemicals:

Adenine

Thymine

Cytosine

Guanine
These chemicals bind together to create genetic patterns within the cell. The
DNA, which contains the genetic material, binds together to form
chromosomes. Typically, a cell contains 23 pairs of chromosomes. When
cells replicate, the genetic material is transferred to the new cells.6
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Genetic disorders occur when an individual experiences a mutation in one or
more genes. These mutations can occur at conception, or they can occur at
some point during the individual’s lifetime.7 When mutations occur during an
individual’s lifetime, they are typically caused by the aging of cells or
exposure to external factors such as chemicals or radiation.8 In many
instances, these mutations will be repaired by the cells and will cause no
damage. However, in some instances, these mutations cannot be repaired.
In these instances, the patient will experience adverse effects such as illness
or disability.9
When a gene mutation occurs at conception, the mutation becomes part of
the individual’s genetic make up. In these instances, the mutation cannot be
repaired by the cell.10
There are more than 4000 diseases that can be caused by gene mutations.
When an individual experiences a mutation in a dominant gene, he or she
will typically experience the condition and/or symptoms associated with the
mutation.11
Examples of common conditions caused by dominant gene mutations
include:12

Achondroplasia

Marfan syndrome

Huntington disease
When an individual experiences a mutation in a recessive gene, he or she
will not typically develop the condition associated with the mutation. The
individual will be a carrier of the mutation, but will not develop the condition
because one of the two genes in the pair will still be healthy.13 However, if
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an individual receives mutated genes from both the X chromosome and the
Y chromosome, he or she will develop the condition associated with the
recessive gene.6 Examples of common conditions caused by mutated
recessive genes include:10

Cystic fibrosis

Sickle cell anemia

Tay-Sachs disease
Pathology And Physiology Medicine
Pathology is the branch of medicine that studies changes in the structure
and function of the tissues and organs that either cause disease or are
caused by disease. Pathologists focus on the basic nature of disease and
attempt to understand how disease affects, and is affected, by the body.
Through the examination of blood, bodily fluids, and tissue, pathologists
identify the causes and severity of an illness and the impact it is having on
the patient. The results from a pathologist’s analysis are used to develop a
treatment plan for the patient.14 Pathologists will study disease using the
following parts of the body:15

Whole bodies

Organs

Tissues

Bodily fluids
The above list provides information regarding the parts of the body that are
studied. However, pathology is also broken into a number of categories
based on how the body is studied and what parts of the body are studied.
The categories are defined as specialty areas and a description of each is
provided in the table below:16
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Specialty
Definition
Anatomical
Anatomical Pathology is the microscopic study of organs and tissues to
Pathology
determine the causes and effects of particular diseases. Specialist
pathologists, Anatomical Pathologists, examine tissue to aid in the
diagnosis of disease and the determination of a treatment plan.
Chemical
Chemical Pathology is the study of chemical and biochemical mechanisms
Pathology
of the body in relation to disease. A chemical pathology department
within a hospital provides a link between medicine and the basic sciences
employing analytical and interpretative skills to aid the clinician in the
prevention, diagnosis and treatment of disease.
In many diseases there are significant changes in the chemical
composition of body fluids. Testing is aimed at detecting these changes
quantitatively compared to results from Healthy People.
Cytogenetics
This involves the analysis of abnormalities at a chromosomal level.
Techniques have been developed using high-powered microscopes, which
are used to look at the number and structure of chromosomes so that
genetic conditions such as Downs Syndrome can be diagnosed.
Hematology
Hematology is the study of diseases that affect blood. Investigations that
take place in the Hematology laboratory include:
Immunology

Routine hematological testing

Clotting and bleeding studies

Transfusion services
Clinical Immunology is concerned with the diagnosis and management of
diseases arising from abnormal immune responses. In broad terms, these
abnormalities may be the result of either under-activity
(immunodeficiency) or over-activity (autoimmunity and allergy) of the
immune system.
Microbiology
Microbiology deals with isolation and identification of infectious agents
such as bacteria, viruses, fungi and parasites that cause disease.
Molecular
Molecular pathology is a term commonly used to encompass all forms of
Pathology
diagnostic DNA and RNA tests (also referred to as nucleic acid tests).
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Physiology is the branch of medicine that focuses on the functions of the
body. Specifically, physiologists are concerned with how the organs and the
systems of the body function in both normal situations and abnormal
situations. Physiologists focus on four aspects of function:8

Physical

Mechanical

Biochemical

Bioelectric
Circulatory Disease
Coagulation Disorders
Coagulation disorders occur when the body is unable to control blood
clotting. When an individual has a coagulation disorder, he or she is at risk
of hemorrhaging or developing thrombosis.17 Hemorrhaging occurs when the
patient is unable to produce significant clotting to sustain basic blood flow.
Thrombosis occurs when a patient has too much clotting agent present.18
Coagulation disorders can be caused by a variety of factors, the most
common being:19

Vitamin K deficiency

Liver disease

Disseminated intravascular coagulation

Development of circulating anticoagulants
Individuals may inherit the disorder, or it can be acquired or develop at
some point in the individual’s life. The most common hemorrhagic condition
is hemophilia, which is a hereditary disease. The most common form of
thrombophilia is Factor V Leiden Mutation.17
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Vascular Disorders
A vascular disorder is any disease that affects the blood vessels (arteries,
lymphatics, veins). There are a number of vascular disorders.
Disorders of the veins and arteries20

Carotid Artery Disease:
The carotid arteries in the neck that deliver blood to the brain can
become blocked by a buildup of plaque. This can cause a variety of
symptoms and lead to a stroke.

Mesenteric Artery Disease:
The blood flow to the intestine (belly area) can be blocked by
atherosclerosis. This blockage can lead to malnutrition, weight loss,
even death if left untreated.

Renal Artery Disease:
A blockage of the renal (kidney) arteries can lead to poor kidney
function and high blood pressure.

Peripheral Artery Disease:
Deposits of plaque on the walls of the arteries that take the blood to
the legs and arms can lead to the hardening of the arteries and can
cause leg pain.

Venous Disease:
Veins can become inflamed, dilated and blocked, particularly those in
the legs.
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
Stroke:
A stroke occurs when a blood vessel (artery) that supplies blood to the
brain bursts or is blocked by a blood clot. Within minutes, the nerve
cells in that area of the brain are damaged, and they die within a few
hours.

Varicose Veins:
Varicose veins are twisted, enlarged veins near the surface of the skin.
They most commonly develop in the legs and ankles.

Venous Skin Ulcer:
A venous skin ulcer, also called a stasis leg ulcer, is a shallow wound
that develops when the leg veins do not move blood back toward the
heart normally.
Thrombosis and Emboli
Thrombosis is caused by an obstruction in the veins or arteries.21 There are
two types of thrombosis, depending on where the obstruction is located.
Venous thrombosis is an obstruction that occurs in a vein, while arterial
thrombosis is an obstruction that occurs in an artery.22,23 Thrombi, which are
the clots that form, remain in one region of the body without traveling
through the bloodstream.24
An embolism occurs when a blood clot forms in an artery or vein, and then
breaks free from the region and travels to a new location in the body.25 Once
the clot breaks free, it can cause a blockage to different regions of the body
and it has the potential to cause significant damage to the region.26 There
are a number of different types of embolism:25
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
Brain embolism - a clot that can prevent blood flow to the brain and
can cause an ischemic stroke

Retinal embolism - small clots that can block blood flow to the retina of
the eye and can cause sudden blindness in an eye

Amniotic embolism - amniotic fluid during pregnancy that can form
clots and reach the lungs, resulting in pulmonary amniotic embolism

Air embolism - air bubbles that form clots in the arteries and block
blood flow, often seen in scuba divers rising to the surface too quickly

Thromboembolism - a blood clot (thrombus) that breaks free to form
an embolus, capable of causing a heart attack

Cholesterol embolism - cholesterol from plaques in a blood vessel
break free and form a blockage

Fat embolism - fat droplets enter the blood stream and block blood
flow, usually a side-effect of certain surgeries or bone fractures

Septic embolism - embolism infected with bacteria containing pus

Foreign body embolism - any other small particle or object that enters
the circulatory system and manages to block the flow of blood.
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Cardiovascular Disease
Congenital Heart Disease
Congenital heart disease is a form of heart disease that is caused by
abnormalities that form in the cardiovascular system prior to birth.27 The
abnormalities occur while the fetus is developing and can cause significant
problems. The symptoms of congenital heart disease may be present at
birth, or they may develop over time. In some instances, the individual will
never show signs of the disease.28
In most instances, the cause of the disorder is unknown. However, there are
a number of factors that may contribute to the development of congenital
heart disease:29

Genetic or chromosomal abnormalities in the child, such as Down
syndrome

Taking certain medications or alcohol or drug abuse during pregnancy

Maternal viral infection, such as rubella (German measles) in the first
trimester of pregnancy

A parent or sibling with congenital heart disease.
Valvular Disorders
There are a number of different valve disorders ranging in severity from mild
to severe. While there are many different types of valvular disorders, they
all produce similar symptoms, which include:30

Dizziness

Shortness of breath

Fatigue

Irregular pulse
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Valve disorders are broken into the categories of stenosis (narrowing),
pulmonary valve stenosis, prolapse (slipping out of place), and regurgitation
(backward flow), as described in the table below.31
Type
Description
Stenosis
The narrowing of heart valves is known as stenosis. When the opening
(narrowing)
narrows, the heart cannot push the required amount of blood through
the valve. Stenosis makes the heart work harder to pump the same
volume of blood and may also lead to an increase in the size of the
heart muscle. Enlargement of the heart muscle may lead to serious
complications.
Pulmonary
Pulmonary valve stenosis is a narrowing or obstruction that partly or
valve
completely blocks the flow of blood. Obstructions can occur in heart
stenosis
valves, arteries or veins. This condition results in the narrowing of the
pulmonary valve (which lets blood flow from the right lower chamber of
the heart to the lungs). As a result, the right lower chamber (right
ventricle) must pump harder than normal to overcome the obstruction.
This may cause stress on, and enlargement of, the right ventricle.
Prolapse
In valve prolapse, the valve flaps do not close smoothly or evenly.
(slipping out
Instead, they collapse backwards into the heart chamber they are
of place)
supposed to be sealing off. This sometimes makes a clicking noise and
allows a small amount of blood to leak backward through the valve.
This group of conditions may be called mitral valve prolapse, clickmurmur syndrome, Barlow's syndrome, balloon mitral valve and floppy
valve syndrome.
Regurgitation
Regurgitation occurs when a heart valve doesn't close securely. This
(backward
condition reduces the heart's pumping efficiency. When the heart
flow)
contracts, blood is pumped forward in the proper direction and is also
forced backwards through the damaged valve. This not only limits the
heart's ability to supply the body with blood, but may also cause lung
problems.
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Coronary Heart Disease
Coronary heart disease occurs when plaque builds up in the coronary
arteries, thereby causing blockages. The blockages prevent adequate flow of
blood to the heart.32 When this occurs, the heart does not receive the
appropriate amount of oxygen or the nutrients necessary for proper
function.33 In many instances, the disorder will not produce immediate
symptoms.
Most patients who have coronary heart disease will experience symptoms
and complications during times of increased stress and exertion, when the
oxygen supply to the heart is further reduced.34 In some instances, the
patient may develop a blood clot that will block the blood supply to the
heart, thereby resulting in a myocardial infarction.32 In other instances, the
blood clot will block a vessel to the brain, which can cause an ischemic
stroke. In some situations, the clot in the brain may burst, which will cause
a hemorrhagic stroke.34
Congestive Heart Failure
Congestive heart failure occurs when the pumping power of the heart has
been reduced and the blood moves through the circulatory system at a
slower rate. When this occurs, the amount of pressure in the heart increases
and the heart is unable to pump an appropriate amount of oxygen and
nutrients to adequately meet the needs of the body.35
In some instances, the chambers of the heart will become stiff and
thickened, or they may stretch to hold more blood. In either instance, the
muscle walls will eventually weaken and will not be able to pump
efficiently.36 In response, the kidneys will send a signal for the body to retain
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fluid and salt in different regions of the body, such as the arms, legs, lungs
and other organs.37
Pulmonary Disease
Respiratory Diseases
Respiratory disease is a term that is used to describe a number of different
conditions that affect the organs and tissues involved in respiration, which
include:38

Upper respiratory tract

Trachea

Bronchi

Bronchioles

Alveoli

Pleura

Pleural cavity

Nerves and muscles involved in respiration
Respiratory diseases can be mild, moderate or severe and include conditions
such as colds and viruses, as well as bacterial pneumonia and lung cancer.39
The following is a list of the most common respiratory diseases:38

Inflammatory lung disease

Obstructive lung diseases

Chronic obstructive pulmonary disease (COPD)

Restrictive lung diseases

Respiratory tract infections

Upper respiratory tract infection

Lower respiratory tract infection

Malignant tumors
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
The major histological types of respiratory system cancer are:
o Small cell lung cancer
o Non-small cell lung cancer
o Adenocarcinoma of the lung
o Squamous cell carcinoma of the lung
o Large cell lung carcinoma
o Other lung cancers (carcinoid, Kaposi’s sarcoma, melanoma)
o Lymphoma
o Head and neck cancer
o Pleural Mesothelioma, almost always caused by exposure to
asbestos dust
o Benign tumors

Pulmonary hematoma

Congenital malformations such as pulmonary sequestration and
congenital cystic adenomatoid malformation (CCAM).

Pleural cavity diseases

Pulmonary vascular disease

Neonatal diseases
Bronchial Disorders and Diseases
Bronchial disorders occur when the airways become inflamed or damaged.40
There are a number of different bronchial disorders, ranging in severity from
mild to severe.
Bronchitis is the most common bronchial disorder. It occurs when the tubes
become inflamed and can be acute or chronic.41 In addition to bronchitis, the
following conditions are also included in the category of bronchial disorders
and diseases:40
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
Bronchiectasis:
A condition in which damage to the airways causes them to widen and
become flabby and scarred

Exercise-induced bronchospasm:
Occurs when the airways shrink while an individual is exercising

Bronchiolitis:
An inflammation of the small airways that branch off from the bronchi

Bronchopulmonary dysplasia:
A condition that affects infants
Restrictive Pulmonary Diseases
Restrictive pulmonary diseases are characterized by a reduction in the total
lung capacity. They occur as the result of a number of conditions, such as:42

Alteration in lung parenchyma

Disease of the pleura

Disease of the chest wall

Disease of the neuromuscular apparatus
Gastrointestinal Disease
Hepatic Disorders
Hepatic disorders are any disease that affects the liver. There are a number
of hepatic disorders that can range in severity and duration. However, while
there are a number of diseases that affect the liver, it is typically less prone
to diseases than other organs due to the nature of the organ. It is able to
regenerate itself through the repair and replacement of injured tissue.43 In
addition, the liver is comprised of a number of cell units that all perform the
same duties. If one part of the liver suffers damage, the remaining cells will
maintain the functions of the injured area. These defense mechanisms limit
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the number and type of disorders that can affect the liver.44 The most
common liver disorders include:44

Hepatitis

Cirrhosis

Liver tumors

Liver abscess
Gallbladder Disorders
There are a number of different gallbladder disorders that can develop,
ranging in severity from mild to severe. Depending on the cause of the
disorder, the patient may need extensive treatment. The following is a list of
the most common gallbladder disorders:45

Gallstones (cholelithiasis)

Cholecystitis

Gallbladder cancer

Gallstone pancreatitis
Gastric Disorders
Gastric disorders are defined as any disease or disorder that occurs in the
stomach. Many of the disorders affecting the stomach are mild to moderate
and can be treated without long-term ramifications. However, there are
some gastric disorders that cause long term complications, even when
treated. Gastric disorders can be caused by a variety of factors, including
exposure to bacteria, perforation, inflammation, poor motility, and cancerous
cell growth.
The specific needs of the patient will depend on the type of disorder he or
she has.46 The following is a list of the most common gastric disorders:47
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
Gastritis

Gastroenteritis

Gastric ulceration

Abnormalities

Gastric cancer
Intestinal Disorders
Intestinal disorders are defined as any conditions that affect the large
intestine, small intestine or bowels. These conditions are typically caused by
infections, autoimmune disorders, and physiological states.48 Intestinal
disorders can be either acute or chronic, and will range in severity from mild
to severe. Most intestinal disorders will cause changes in stool (constipation
or diarrhea, and/or the presence of blood), vomiting, and abdominal
discomfort.49 In acute disorders, the cause is often impaction or obstruction,
or an infectious agent. These conditions can be treated and often resolve
quickly.50
Chronic disorders are typically caused by malabsorption, autoimmune
conditions, structural changes in the intestines, or lifestyle choices.51 Most
chronic disorders can be treated and minimized, but they will not be
resolved.49 The following is a list of the most common intestinal disorders:52

Angiodysplasia of the colon

Appendicitis

Bowel twist

Chronic functional abdominal pain

Celiac disease

Colitis

Colorectal cancer

Constipation
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
Crohn's disease

Diarrhea

Diverticular disease

Enteroviruses

Gastroenteritis

Hirschsprung's disease (aganglionosis)

Ileitis (inflammation of the ileum)

Ileus (blockage of the intestines)

Intussusception

Irritable bowel syndrome (IBS)

Polyp

Pseudomembranous colitis

Ulcerative colitis and toxic megacolon
Reproductive System Disease
Male Reproductive System Disorders
The male reproductive system is a complex system, which makes it prone to
a variety of disorders. The male reproductive system is comprised of the
following organs:53

Testicles

Epididymis

Vas deferens

Seminal vesicles

Prostrate gland

Urethra

Penis
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There are a number of conditions that affect the organs that comprise the
male reproductive system. They can range in severity from mild to severe,
and some will impact a patient’s fertility.54 These conditions will produce a
range of symptoms, depending on the area affected. Typically symptoms
range from mild to severe pain, difficulty urinating, impotence, discharge,
and swelling.55 The most common male reproductive disorders include:53

Tumors

Lack of testicular descent

Hydrocele

Infection and inflammation of the epididymis

Varicocele

Inflammation and development of small calculi

Benign overgrowth of prostrate gland

Prostrate cancer

Inflammation of the urethra

Inflammation (balanitis) or narrowing (phimosis) of the foreskin

Growths and ulcers

Sexually transmitted infections

Disorders of erectile capability
Female Reproductive System Disorders
The female reproductive system is also quite complex and prone to a
number of disorders. The female reproductive system is comprised of the
following components:56

Ovaries

Fallopian tubes

Uterus

Cervix

Vagina
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
Vulva
There are a number of conditions that affect the organs that comprise the
female reproductive system. They can range in severity from mild to severe,
and some will impact the patient’s fertility. These conditions will produce a
range of symptoms, depending on the area affected. Typically symptoms
range from mild to severe pain, difficulty urinating, discharge, delayed or
discontinued menstruation, abnormal menstruation, infertility and swelling.55
The most common female reproductive disorders include:56

Failure of the ovaries to form normally

Destruction of the ovaries

Neoplastic enlargement of the ovary

Ovarian tumors

Endometriosis

Inflammation of the fallopian tubes

Ectopic pregnancy

Benign tumors of the myometrium (fibroids)

Hormonal abnormalities

Infection of the endocervical glands with gonococcus or chlamydia
trachomatis agent

Cervical cancer

Developmental abnormalities of the vagina

Inflammation of the lining of the vagina

Atrophy or shrinkage of the vagina and mucosa secondary to estrogen
deprivation

Weakened vaginal support

Vaginismus

Infection of the female external genitalia
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Pregnancy and Prenatal Disorders
Pregnancy disorders can affect both the pregnant woman and the fetus, or
they can affect one or the other. In some instances, the condition will
primarily affect the mother, but will pose a risk to the fetus if untreated, and
vice versa.57 The following is a list of the most common pregnancy and
prenatal disorders:
Maternal Problems

Hyperemesis gravidarum

Diabetes Mellitus, Type I

Gestational Diabetes

Thyroid Disease

Hyperparathyroidism

Pelvic girdle pain (PGP)

Severe hypertensive states:
o Preeclampsia = gestational hypertension, proteinuria (>300
mg), and edema. Severe preeclampsia involves a blood pressure
over 160/110 (with additional signs)
o Eclampsia = seizures in a preeclamptic patient
o HELLP syndrome = Hemolytic anemia, Elevated liver enzymes
and low platelet count
o Acute fatty liver of pregnancy is sometimes included in the
preeclamptic spectrum.

Deep vein thrombosis

Anemia

Pituitary Adenomas
Fetal Problems58-60

Ectopic pregnancy (implantation of the embryo outside the uterus)
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
Placental abruption (separation of the placenta from the uterus)

Monochorionic Multiples

Twin-to-twin transfusion syndrome

Monoamniotic multiples

Umbilical cord compression

Prenatal infection
Urinary And Renal System Disease
Urinary and renal system disease affects a number of individuals and range
in severity from minor infections to complete kidney failure. The most
common forms of urinary and renal disease include:61,62

Kidney stones

Urinary incontinence

Benign hyperplasia

Interstitial cystitis

Urinary tract infection

Polycystic kidney disease

End-stage renal disease
Infections
The most common form of urinary and renal disorders is infections. These
infections can affect any part of the urinary or renal system and can range in
severity from mild to severe.
Urinary Tract Infections
Most urinary tract infections are caused by Escherichia coli (E. coli) bacteria,
which normally live in the colon. Women are more prone to urinary tract
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infections than men.63 The following is a list of the most common forms of
urinary tract infection:61

Urethritis

Cystitis

Pyelonephritis
Kidney Infections
Kidney infections can be caused by a variety of conditions and bacteria, and
will range in severity from mild to severe.64 There are three classifications
for kidney infections:

Uncomplicated

Complicated

Chronic
Of the three classifications, complicated kidney infection is the most severe
and typically involves abscess formation, enlarged kidney, or gas in the
kidney.65 A chronic infection is less severe than other forms of kidney
infection, but it typically lasts longer than other infections, and is often
recurring.64
Bacteria cause kidney infections. The most common forms of bacteria
associated with kidney infections include:66

Escherichia coli (E. coli) (accounts for 80% of infections)

Klebsiella

Proteus

Pseudomonas

Enterococcus

Staphylococcus saprophyticus
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Cysts and Tumors
Cysts and tumors can form in many areas of the urinary and renal system.
Cysts are quite common and can cause complications depending on their
location and size. In some instances, a cyst may resolve by itself. However,
many patients will require surgery to remove a cyst or cysts.67 Tumors can
be benign or malignant and typically require treatment. Tumors will not
resolve on their own.68
The causes of cysts and tumors vary depending on the area affected and the
type of cyst or tumor that has developed. In some instances, the patient will
only develop one cyst or tumor. However, some patients will develop
multiple cysts or tumors in the same region or throughout the urinary and
renal system.69,70
Renal Failure
Renal failure is a severe complication that occurs as the result of extensive
damage to the kidneys. The onset of renal failure may be sudden, or it can
develop over time. Acute renal failure occurs suddenly, typically caused
immediate damage to the kidneys through injury or infection.71 Chronic renal
failure typically develops over a prolonged period and is often the result of
long-term damage to the kidneys.72
Patients with renal failure will display an elevated level of blood creatinine,
which is excreted from the damaged muscle tissue. Patients will also
experience passing of proteins and blood in the urine and abnormal fluid and
electrolyte levels, abnormal blood acid levels, and abnormal mineral levels.73
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Musculoskeletal Disease
Arthritis
Arthritis is an inflammatory joint disorder that can affect one or more joints
throughout the body. There are more than 100 forms of arthritis that affect
individuals. These different forms of arthritis affect the body differently, and
they range in severity from mild to severe.74 The most common forms of
arthritis include:75

Osteoarthritis

Rheumatoid arthritis

Psoriatic arthritis

Septic arthritis

Autoimmune disorders
Arthritis causes pain in the joints, which is a result of the following factors:76

Inflammation that occurs around the joint

Damage to the joint from disease

Daily wear and tear of joint muscle strains caused by forceful
movements against stiff painful joints

Fatigue
Fractures
A fracture is an area of the bone that is broken. However, there are different
types and severity levels of fractures. Depending on the cause and the
impact, a patient may experience any level and type of fracture.
There are two categories of fractures: closed fractures and compound
fractures.77 A closed fracture is one in which there is a clean break to the
bone. With this type of fracture, there is no damage to the surrounding
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tissue and the bone does not tear through the skin.78 A compound fracture is
more complex. With this type of fracture, the surrounding tissue and skin
can be damaged, resulting in significant bruising. A compound fracture may
also involve the bone tearing through the skin.79 Within these two categories
of fractures, there are many different types. The areas they affect, the
damage they inflict, and the cause of the fracture define these fracture
types.
Types of Fractures:80

Avulsion fracture

Comminuted fracture

Compression (crush) fracture

Fracture dislocation

Greenstick fracture

Hairline fracture

Impacted fracture

Longitudinal fracture

Oblique fracture

Pathological fracture

Spiral fracture

Stress fracture

Torus (buckle) fracture

Transverse fracture
Atrophy and Dystrophy
Spinal muscular atrophy is a disorder that affects the region of the nervous
system that is responsible for controlling voluntary muscle movement. The
disorder is genetic and cannot be repaired.81 While the disorder affects the
nervous system, its primary impact is on the muscles. When the nerves are
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unable to transmit the appropriate signals to the muscles, the muscles do
not perform properly, which leads to shrinkage. This is directly caused by
the loss of the nerve cells that transmit the information.82
Spinal muscular atrophy is present at birth. However, many individuals will
not display signs of the disorder until their later childhood or teenage years.
The age of onset is directly correlated to the degree in which motor function
will be impaired. Early onset atrophy has a greater impact on motor
function, while late onset has a reduced impact.83
Muscular dystrophy is a term used to describe approximately thirty different
genetic diseases. While the diseases differ in terms of age of onset, whom
they affect, and which muscles they affect, all of the diseases cause some
level of muscle weakness and muscle loss.84 In addition, all forms of the
disorder are degenerative, with the loss of the ability to walk as a common
outcome. The major types of muscular dystrophy are:85

Becker

Congenital

Distal

Duchenne

Emery-Dreifuss

Facioscapulohumeral

Limb–girdle

Myotonic

Oculopharyngeal
Abnormal Bone Formations
Abnormal bone formations can occur throughout the body and are the result
of a number of different factors, including:79
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
Genetic conditions (such as fibrodysplasia ossificans progressiva and
progressive osseous heteroplasia)

Surgical procedures (including total hip replacement and elbow
fracture and forearm fracture surgery)

Brain or spinal cord injury (traumatic brain injury and spinal cord
injury)

Sports injuries (myositis ossificans)

Fractures
In some instances, the bone formations will occur in regions such as the
muscles, ligaments, or other soft tissue. This type of abnormal bone
formation is called heterotopic ossification, and it is common in the above
situations.86 Other abnormal formations will occur in bony regions. The most
common type of abnormal bone formation is the bone spur.87
Fluid, Electrolyte, And Acid/Base Imbalance Disorders
Fluid Imbalance
The body is comprised of approximately 52% - 60% fluids (male to females,
respectively).88 Therefore, an increase or reduction in body fluids can have a
significant impact on an individual. Hypovolemia is a loss of fluid and
hypervolemia is an overload of fluid.89 Fluid imbalance can be caused by any
of the factors listed below due to fluid loss or gain.88
Fluid Loss:

Diarrhea

Vomiting

Sweating/fever

Hemorrhage
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
Diuretics

Excessive urination
Fluid Gain:

Congestive cardiac failure

Renal failure

High sodium intake

Cirrhosis of the liver

Over infusion of intravenous fluids
Electrolyte Imbalance
An electrolyte imbalance can be caused by a variety of factors and will range
in severity. The most common forms of electrolyte imbalance occur due to
an altered level of magnesium, sodium, potassium, or calcium.90 The most
common causes of electrolyte imbalance include:89

Kidney disease

Vomiting for prolonged periods

Severe dehydration

Heatwaves (a report found that the number of cases of electrolyte
imbalances increases significantly during heatwaves)

Acid/base (pH) imbalance (acid and alkaline balance in the body is
disproportionate)

Congestive heart failure

Cancer treatment

Some drugs, such as diuretics or ACE inhibitors.

Bulimia (eating and purging meals, an eating disorder)

Severe and persistent vomiting and nausea during pregnancy
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Acid-Base Imbalance
An acid-base imbalance occurs when the normal levels of acids and bases
deviate from the appropriate range. Acidosis is the excess of acid, while
alkalosis is the excess of bases.91 Many different processes can cause an
acid-base imbalance, and the level of abnormality will range in severity
depending on the cause. Individuals can experience a simple acid-base
disorder, or they may experience a mixed disorder.
Acid-base imbalance disorders are classified depending on the derangement
that the patient experiences.92 The most common causes of acid gain and
acid loss are listed below.91
Sources of acid gain include:

Retention of carbon dioxide

Production of nonvolatile acids from the metabolism of proteins and
other organic molecules

Loss of bicarbonate in feces or urine

Intake of acids or acid precursors
Sources of acid loss include:

Use of hydrogen ions in the metabolism of various organic anions

Loss of acid in the vomitus or urine

Gastric aspiration in hospital

Severe diarrhea
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Summary
Pathophysiology is the study of disease function and processes. It enables
healthcare professionals to understand diagnosis, treatment, and
management options to achieve a best-case scenario for patients.
Recognizing disease and disorder manifestations will assist nurses and nurse
practitioners with early diagnosis to improve patient outcomes. This course
provided a brief overview of pathophysiology principles, including a cellular
biology review, before delving in-depth into the pathophysiology of disease
processes and disorders affecting the cardiovascular, circulatory, pulmonary,
gastrointestinal, reproductive, urinary, renal, and musculoskeletal systems,
in addition to fluid, electrolyte, and acid-base imbalance disorders.
Please take time to help NurseCe4Less.com course planners evaluate
the nursing knowledge needs met by completing the self-assessment
of Knowledge Questions after reading the article, and providing
feedback in the online course evaluation.
Completing the study questions is optional and is NOT a course
requirement.
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1.
Which of the following is the name for the process by which the
cell produces energy through the breakdown of complex
molecules?
a. Catabolism
b. Replication
c. Synthesis
d. Anabolism
2.
Which of the following is NOT one of the chemicals that DNA is
comprised of?
a. Adenine
b. Thymine
c. Bromine
d. Cytosine
3.
This branch of pathology is the study of chemical and
biochemical mechanisms of the body in relation to disease.
a. Anatomical Pathology
b. Chemical Pathology
c. Biological Pathology
d. Immunology
4.
Which of the following is NOT one of the classifications for
kidney infections:
a. Complex
b. Uncomplicated
c. Complicated
d. Chronic
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5.
The body is comprised of _____________________ percent
fluids.
a. 12 – 18
b. 24 – 30
c. 52 - 60
d. 72 – 80
6.
Genetic disorders occur when an individual experiences a
mutation in one or more genes
a. at conception
b. associated with gender
c. at some point during a lifetime
d. *Answers a and c above
7.
The most common forms of electrolyte imbalance occur due to
an altered level of the following EXCEPT:
a. Magnesium
b. Sodium,
c. Potassium
d. *Phosphorus
8.
True or False. HELLP syndrome is an acronym for Hemolytic anemia,
Elevated Liver enzymes and Low Platelet count.
a. *True
b. False
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9.
Abnormal bone formation is called ______________________.
a. trophic calcification
b. *heterotopic ossification
c. heterotropic calcification
d. none of the above
10. ___________________ is the most common bronchial disorder.
a. pneumonia
b. asthma
c. *bronchitis
d. fluid congestion
11. A number of different cells in the body perform different functions.
There are approximately _____ specialized cells within the body.
a. *200
b. 100
c. 300
d. 500
12. Most urinary tract infections are caused by __________________.
a. Pseudomonas
b. *E. Coli
c. Staph
d. None of the above
13. Spinal muscular atrophy is a disorder that affects the region of the
_______________________.
a. *nervous system
b. skeletal system
c. spinal and muscular system
d. skeletal and spinal system
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14. Patients with renal failure will display an elevated level of blood
creatinine, which is excreted from _________________
a. the kidneys
b. *damaged muscle tissue
c. renal tubules
d. answers a and c above
15. The mesenteric artery involves blood flow to the:
a. *intestine
b. kidneys
c. lungs
d. liver
16. Valve disorders are broken into categories that include
a. stenosis (narrowing)
b. prolapse (slipping out of place)
c. regurgitation (backward flow)
d. *all of the above
17. The most common form of urinary and renal disorders is __________.
a. calculi
b. *infections
c. genetic
d. incontinence
18. True or False. A most common female reproductive disorder does NOT
include hormonal abnormalities.
a. True
b. *False
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19. The most common gastric disorders may include:
a. Gastritis
b. Gastric ulceration
c. Gastric cancer
d. *All of the above
20. Preeclampsia involves the following factors:
a. gestational hypotension
b. proteinuria (>300 mg)
c. edema
d. *answers b and c above
CORRECT ANSWERS:
1.
a
11. a
2.
c
12. b
3.
b
13. a
4.
a
5.
c
6.
d
7.
d
18. b
8.
a
19. d
9.
b
20. d
14. b
15. a
16. d
17. b
10. c
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The reference section of in-text citations include published works intended as
helpful material for further reading. Unpublished works and personal
communications are not included in this section, although may appear within
the study text.
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Dolbec K, Mick NW. Congenital Heart Disease. Emerg. Med. Clin. North
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