Preface

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, physicians' assistant 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 120 commonly encountered diseases. Nurses, nurse-practitioners, physicians' assistants and other allied health practitioners have found that its concise format and broad scope facilitate their understanding of these basic disease entries.

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 Studies Questions and Answers are also available on the Internet, at www.accessmedicine.com, an online version of McGraw-Hill's many medical textbooks.

In preparation for this seventh edition, the editors and authors reviewed the entire book. There have been many revisions aimed at updating information, improving clarity, and eliminating minor errors. References have also been updated, with emphasis on valuable reviews. “Checkpoints,” collections of review questions, which continue to appear throughout the chapters, have been revised.

Examples of New Content Found in This Edition

• Expanded sections on recent advances in whole genome sequencing approaches

• Update on the molecular biology of cells of the immune system and inflammatory mediators

• Update on role of thrombopoietin in thrombopoiesis

• Substantial revision of coagulation factors and the coagulation system, including a new figure summarizing the coagulation cascade

• Update on pathogenesis of immune-mediated and heparin-induced thrombocytopenia

• Revised sections on the pathogenesis of psoriasis, erythema multiforme and bullous pemphigoid

• Revised sections on the pathophysiology of idiopathic pulmonary fibrosis and pulmonary edema

• Updated section on endothelin physiology and pathophysiology

• Revised sections on adaptive and innate immunity of the gastrointestinal tract

• Revised sections on pathophysiology of Helicobacter pylori, atrophic gastritis and inflammatory bowel disease

• New detailed section on commensal microbes of the small intestine

• Updated section on pancreatic development and associated congenital disorders

• Revised sections on the pathophysiology of autoimmune, acute and chronic pancreatitis together with associated complications

• Updated section on the pathophysiology and management of pancreatic cancer

• New introduction to the chapter on renal disease

• Revised sections on hormonal control of sodium reabsorption, potassium excretion, and acid/base metabolism

• Updated sections on pathophysiology of renal diseases

• Addition of discussion on role of RANK and RANK-L in bone biology

• Revised section on roles of PTH versus PTHrP in calcium homeostasis

• Updated section on vitamin D physiology

• Revised section on medullary thyroid carcinoma

• Updated roles of glucagon and GLP-1 in the endocrine pancreas

• Updated sections on obesity, insulin resistance and metabolic syndrome

• New information on mutations in various genes shown to predispose to the development of pheochromocytoma and paraganglioma

• Revised information about complications of liver disease such as hepatorenal syndrome, hepatic encephalopathy, and hepatopulmonary syndrome

• Updated section on the mechanism of action of thyroid hormones

• Revised section on the pathophysiology of subclinical thyroid disease

• Revised information on the diagnosis of suspected Cushing syndrome and suspected adrenal insufficiency, on the different forms of genetic primary aldosteronism, and on congenital adrenal hyperplasia

• Updated section on primary ovarian failure

• Updated section on the role of kisspeptins in puberty and the genetics of hypogonadism

Pathophysiology of Disease Flashcards

Another new development with the book's seventh edition is the simultaneous publication of a set of 120 Pathophysiology of Disease Flashcards, useful study aids for students and other readers. These Pathophysiology of Disease Flashcards were developed by Yeong Kwok, MD, of the University of Michigan, in collaboration with Drs. McPhee and Hammer. The Flashcards incorporate clinical “Cases” with several “Questions,” each of which is followed by bulleted “Answers.” The “Questions” derive from the text's unanswered review “Checkpoints” and the Flashcards “Answers” have been drawn from the relevant text material and are printed upside down so as to encourage the user to think through the answers after reading the questions. Note that these questions and answers do not duplicate the Case Studies Questions and Answers already found in the textbook itself.

With this seventh edition, Gary Hammer, MD, PhD at the University of Michigan has assumed the role of “lead” title page editor, and Stephen McPhee, MD at the University of California, San Francisco has moved to “second in command.”

With this seventh edition, too, the authorship of several chapters has evolved and transitioned—the editors wish to welcome aboard the following new contributors and thank the following past contributors who are now departing the book:

• Catherine Lomen-Hoerth, MD, PhD, has taken over the current revision of Chapter 7: Nervous System Disorders; we would like to thank Robert O. Messing, MD, for the original development of this chapter and his revisions for the first 5 editions and assistance with the 6^th edition

• Melissa M. Meier, MD, has joined Timothy H. McCalmont, MD, (both at the University of California at San Francisco) in producing the revision of Chapter 8: Diseases of the Skin

• Mark Chesnutt, MD, at the University of Oregon has joined Thomas J. Prendergast, MD, as co-author for Chapter 9: Pulmonary Disease; we would like to acknowledge Stephen J. Ruoss, MD, for his role in co-authoring the original chapter with Dr. Prendergast and for his revisions for the next 5 editions; and we thank Eric J. Seeley, MD for his assistance with the 6^th edition

• Mandana Khalili, MD, MAS, now working with Blaire Burman, MD, produced the current revision of Chapter 14: Liver Disease; and we thank Tung T. Nguyen, MD, for his work on previous editions, and Charles Liao, MD for his assistance with the 6^th edition

• Christopher J. Sonnenday, MD, produced the current revision of Chapter 15: Disorders of the Exocrine Pancreas; and the editors thank Diane M. Simeone, MD, for her assistance with the 6^th edition

• Rachel L. Perlman, MD, and Michael Heung, MD, MS, will serve as the new lead co-authors of Chapter 16: Renal Disease with Joachim H. Ix, MD, and they will henceforth take over the chapter from him; we are grateful to Benjamin D. Parker, MD, for his work on the 6^th edition

• Erika B. Johnston-MacAnanny, MD, has joined Robert N. Taylor, MD, PhD, (both at Wake Forest University), in revising Chapter 22: Disorders of the Female Reproductive Tract; we thank Karen J. Purcell, MD, PhD, for her work on previous editions

  and

• Yeong Kwok, MD, at the University of Michigan, has taken over the revisions and additions of the Case Studies Questions and Answers for each chapter; the editors thank Eva M. Aagaard, MD, and Jonathan D. Fuchs, MD, MPH, for their work on each of the previous editions.

With these transitions, the content of one-third of the book has benefited from new contributors' viewpoint and input.

As mentioned, each chapter ends with a collection of Case Studies. These clinical problems give students 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 seventh edition, an additional 9 Case Studies with Questions have been added by Yeong Kwok, MD, bringing the total number to 120, or one for each of the clinical entities discussed in the book's 24 chapters. As before, detailed analyses of the cases appear in Chapter 25: Case Study Answers; Dr. Kwok has added Answers to the new Case Studies and updated the existing answers to reflect the changes made by chapter authors in their revisions.

Finally, the seventh edition of Pathophysiology of Disease: An Introduction to Clinical Medicine has more than two dozen new illustrations in its attractive four-color design and layout.

With publication of this seventh edition, the editors want to extend special thanks, not only to the contributors old and new, but also to the students and colleagues who have offered helpful comments and criticisms for each of the previous editions. The authors and editors continue to welcome comments and recommendations for future editions, in writing or via electronic mail. The editors' and authors' institutional and e-mail addresses are given in the Authors section.