The power of Osmosis.

Water diffusion through a semipermeable membrane. Influenced by solute concentration and water's flow to dilute it, to work against osmosis, which our cells do constantly, requires energy from ATP.

Amblyomma Americanum

This tick is the vector in the Rickettsial disease, Ehrlichiosis

Erythema Chronicum Migrans

The classic rash of Lyme Disease

Rocky Mountain Spotted Fever

Rickettsia rickettsii infection. A severe tick bourne illness

Common Skin Lesions. Elevated Plaque

Urine

Characteristics of Urine. (From Bonewit-West K: Clinical procedures for medical assistants, 8e, St Louis, Saunders, 2011.)

You're getting on my nerves!

Light micrograph of neurons in a smear of the spinal cord. The neurons in this slide show characteristic cell bodies and multiple cell processes. (Dennis Strete.)

Scurvy

Scurvy. In scurvy, lack of vitamin C impairs the normal maintenance of collagen-containing connective tissues, causing bleeding and ulceration of the skin, gums, and other tissues, as these lesions on the skin show. (From Morgan SL and Weinsier: Fundamentals of clinical nutrition, ed 2, St Louis, 1998, Mosby.)

Common Skin Lesions. Depressed. Ulcer

Common Skin Lesions. Depressed. Atrophy

Hypertension, High Blood Pressure

Classification of hypertension. This chart is adapted from the National High Blood Pressure Education Program. After age 50, the systolic pressure becomes more significant than diastolic pressure in assessing high blood pressure and associated risk of cardiovascular and renal disease.

vCJD

Photomicrograph of a slice of brain from an individual with Variant Creutzfeldt-Jakob disease (vCJD). Arrows show where abnormal, tangled proteins have built up in the brain tissue. Later in the disease, these areas will develop open spaces in the brain. (From Travis J: Drugs counter mad cow agent in cells, Science News 160(7):100, 2001, © Fred Cohen.)

Common Skin Lesions. Elevated Papule

Nodular manifestation.

Pneumothorax

Pneumothorax. Air in the pleural space may accumulate when the visceral pleura ruptures and air from the lung rushes out or when atmospheric air rushes in through a wound in the chest wall and parietal pleura. In either case, the lung collapses and normal respiration is impaired. If blood accumulates in the pleural space, the condition is called hemothorax.

Strawberry Hemangioma

Strawberry hemangioma. (From Habif TP: Clinical dermatology, ed 4, St Louis, 2004, Mosby.)

Herpes Zoster

Herpes zoster (shingles). Photograph of a 13-year-old boy with eruptions involving dermatome T4 (see Figure 10-24). (From Habif TP: Clinical dermatology, ed 2, St Louis, 1990, Mosby.)

Respiratory Epithelium

Respiratory mucosa lining the trachea. A layer of mucus covers the hairlike cilia.

The Autonomic Nervous System

Innervation of the major target organs by the autonomic nervous system. The sympathetic pathways are highlighted with orange, and the parasympathetic pathways are highlighted with green.

Acne

Acne. (From Callen JP, Paller AS, Greer KE et al: Color atlas of dermatology, ed 2, Philadelphia, 2000, Saunders.)

Conjunctivitis

Acute bacterial conjunctivitis. Notice the discharge of mucous pus characteristic of this highly contagious infection of the conjunctiva. (From Newell FW: Ophthalmology: principles and concepts, ed 8, St Louis, 1996, Mosby.)

Dysrythmia

Dysrhythmia. Examples of different types of dysrhythmia are shown as they would appear in an electrocardiogram (ECG strip recording). (From Aehlert B: ACLS quick review study cards, ed 2, St Louis, 2004, Mosby.)

Cardiac Transplantation

Heart transplant. Human heart prepared for transplantation into a patient. (Courtesy Patricia Kane, Indiana University Medical School.)

The Integument

Microscopic view of the skin. The epidermis, shown in longitudinal section, is raised at one corner to reveal the ridges in the dermis.

The EEG

Electroencephalography. A, Photograph of a person with voltage-sensitive electrodes attached to his skull. Information from these electrodes is used to produce a graphic recording of brain activity—an electroencephalogram (EEG). B, An EEG tracing showing activity in four different places in the brain (obtained from four sets of electrodes). Compare the moderate chaotic activity identified as normal with the explosive activity that occurs during a seizure. (From Chipps EM, Clanin NJ, Campbell VG: Neurologic disorders, St Louis, 1992, Mosby.)

Common Skin Lesions. Depressed. Athlete’s foot

Tinea Pedis

The Urinary System

Urinary system. A, Anterior view of urinary organs. B, Surface markings of the kidneys, eleventh and twelfth ribs, spinous processes of L1 to L4, and lower edge of pleura viewed from behind. C, Horizontal (transverse) section of the abdomen showing the retroperitoneal position of the kidneys. D, Colorized x-ray film of the urinary organs. (B, From Abrahams P, Hutchings RT, Marks SC: McMinn’s color atlas of human anatomy, ed 5, St Louis, 2003, Mosby.)

The Respiratory Entrance

Sagittal section of the head and neck. The nasal septum has been removed, exposing the right lateral wall of the nasal cavity so that the nasal conchae can be seen. Note also the divisions of the pharynx and the position of the tonsils

Tonsilitis

Tonsillitis. Enlarged palatine tonsils can be seen nearly meeting at the midline of the pharynx. (From Zitelli BJ, Davis HW: Atlas of pediatric physical diagnosis, ed 4, Philadelphia, 2002, Mosby.)

Common Skin Lesions. Depressed. Scratch

Cartilage

Cartilage. Photomicrograph showing the chondrocytes located in lacunae and distributed throughout the gel-like matrix. (Dennis Strete.)

Common Skin Lesions. Depressed. Striae

X-ray image of the left knee

The Electroencephalogram

What seizures look like on an EEG.

Obstructive Pulmonary Disease

Major obstructive pulmonary disorders.

Coronary Arteriogram

This angiogram of the coronary arteries shows a narrowing (arrow) of the channel in the anterior ventricular (left anterior descending or LAD) artery of the heart. Narrowing of this artery is sometimes called the “widow maker” because when it becomes infl amed and blocked by a blood clot, a massive heart attack and sudden death may result—often occurring in men in their 50s. (From Goldman L, Ausiello D: Cecil textbook of medicine, ed 23, Philadelphia, 2008, Saunders.)

The Mouth

Mouth cavity and tongue. A, Mouth cavity showing hard and soft palates, tongue surface, and uvula. B, Undersurface of tongue showing frenulum, sublingual gland, and opening of sublingual duct. C, Photograph shows an abnormally short lingual frenulum, which may result in faulty speech. D, Papillae with taste buds located on the lateral surfaces. (C, From Zitelli BJ, McIntire SC, and Nowalk AJ: Atlas of pediatric physical diagnosis, ed 6, Philadelphia, 2012, Mosby. D, Dennis Strete.)

Common Skin Lesions. Depressed. Fissure

Skin Cancers

Examples of skin cancer lesions. (A, From Goldman L and Schafer AI: Goldman’s Cecil Medicine, ed 24, Philadelphia, 2012, Saunders. B, From Noble J and Greene HL: Textbook of primary care medicine, St Louis, ed 3, Mosby, 2001. C, From Townsend C, Beauchamp RD, Evers BM, Mattox K: Sabiston textbook of surgery, ed 18, Philadelphia, 2008, Saunders. D, From Rakel R: Textbook of family medicine, ed 7, Philadelphia, 2007, Saunders. )

Fetal Circulation

Fetal circulation in the normal fetus.

Mastoiditis

Mastoiditis. Note the redness and swelling over the mastoid process of the temporal bone behind the left ear. (Courtesy Dr. N. Blevins, New England Medical Center, Boston.)

Vascular and Inflammatory Disease

Vascular and inflammatory skin disorders. (A, From Potter P, Perry A: Fundamentals of nursing, ed 7, St Louis, 2009, Mosby. B, From Habif TP: Clinical dermatology, ed 4, St Louis, 2004, Mosby. C, From Habif TP: Clinical dermatology, ed 5, St Louis, 2010, Mosby. D, From Kumar V, Abbas A, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Saunders.)

Hyperthyroidism

Hyperthyroidism. Note the prominent, protruding eyes (exophthalmos) of this woman with Graves disease. (From Seidel NM, Ball JW, Dains JE, Benedict GW: Mosby’s guide to physical examination, ed 4, St. Louis, 1999.)

Atherosclerosis

Partial blockage of an artery in atherosclerosis. Atherosclerotic plaque develops from the deposition of fats and other substances in the wall of the artery. The inset is a photograph showing a cross section of an artery partially blocked by plaque.

Nails

Structure of nails. A, Posterior view of fingernail. B, Sagittal section of fingernail and associated structures.

The Rule of Nines

The rule of nines. Dividing the body into 11 areas of 9% each helps in estimating the amount of skin surface burned in an adult.

Vitiligo

A pigmentation disorder

Layers of the small intestine

Layers of the small intestine. The four layers include the mucosa, submucosa, muscularis, and serosa.

Fungi

Examples of pathogenic fungi. Electron micrographs and drawings. A, Scanning electron micrograph of yeast cells. Yeasts commonly infect the urinary and reproductive tracts.

Shaken Baby Syndrome

Shaken baby syndrome. Ophthalmoscope view shows multiple hemorrhages of the retina typical of this type of child abuse. (Courtesy Stephen Ludwig, MD. Children’s Hospital of Philadelphia. In Zitelli, Davis: Atlas of pediatric physical diagnosis, ed 6, Mosby, 2012, St Louis.)

Otitis Media

Acute otitis media. The tympanic membrane is red, thickened, and bulging. (From Kliegman RM, Behrman RE, Jenson HB, Stanton BF: Nelson textbook of pediatrics, ed 18, Philadelphia, 2007, Saunders.)

Amoebae

Naegleria fowlerii. N. fowlerii is an emerging pathogen in the southern United States. It is an amoeba found in warm, fresh-water ponds, lakes, streams, and warm springs. The organism enters the body by swimming up the nose and invading the brain through the thin ethmoid bone. It causes a fatal central nervous system infection called primary amoebic meningoencephalitis. (From Schuster FL, Visvesvara GS: Free-living amoebae as opportunistic and non-opportunistic pathogens of humans and animals, Int J Parasitol 34(9): 1001-1027, 2004.)

Common Skin Lesions. Depressed. Excoriation

Varicose Veins

Varicose veins. A, Veins near the surface of the body—especially in the legs—may bulge and cause venous valves to leak. B, Photograph showing varicose veins on the surface of the leg.

Esophagitis

Esophageal inflammation. Chronic inflammation of the esophagus is characteristic of GERD (gastroesophageal reflux disease). Arrows show reddened, inflamed areas about midway along esophagus. This damage is caused by the frequent “splashing back” of acids from the stomach. (Copyright Kevin Patton, Lion Den Inc, Weldon Spring, MO.)

Hypothyroidism

Myxedema. This condition results from hyposecretion of the thyroid gland during the adult years. Note the edema around the eyes and the facial puffiness.

Decubitous Ulcer

Common Skin Lesions. Depressed. Bedsore or pressure sore

Insulin and Glucagon

Pancreas. Location and structure of the pancreas (cut open). Inset shows a pancreatic islet (of Langerhans) in cross section, showing the glucagon-producing alpha cells and insulin-producing beta cells. Notice the many exocrine cells surrounding the endocrine pancreatic islet.

Erythroblastosis Fetalis

Erythroblastosis fetalis. A, Rh-positive blood cells enter the mother’s bloodstream during delivery of an Rh-positive baby. If not treated, the mother’s body will produce anti-Rh antibodies. B, A later pregnancy involving an Rh-negative baby is normal because there are no Rh antigens in the baby’s blood. C, A later pregnancy involving an Rh-positive baby may result in erythroblastosis fetalis. Anti-Rh antibodies enter the baby’s blood supply and cause agglutination of RBCs that have the Rh antigen.

The Complement Cascade

Effect of the complement cascade. A, Complement molecules activated by antibodies form doughnut-shaped complexes in a bacterium’s plasma membrane. B, Holes in the complement complex allow sodium (Na+) and then water (H2O) to diffuse into the bacterium. C, After enough water has entered, the swollen bacterium bursts.

Common Skin Lesions. Elevated Crust

Scab formation

The extrinsic clotting cascade initiates this.

Herpes Zoster

The Shingles

Common Skin Lesions. Elevated Vesicle

Warts

Papular expression of the papilloma virus.

Plaque raising skin infection.

Wheal

Wheal and flare of urticaria.

Skeletal muscle

Skeletal muscle. Photomicrograph showing the striations of the muscle cell fibers in longitudinal section. (Dennis Strete.)

Burns

Classification of burns by depth of injury. First- and second-degree burns are classified as partial-thickness burns and third- and fourth-degree burns as full-thickness burns.

Coagulation, aka Clotting

Blood clotting. The extremely complex clotting mechanism, called the Coagulation Cascade can be distilled into three basic steps: (1) release of clotting factors from both injured tissue cells and sticky platelets at the injury site (which form a temporary platelet plug); (2) series of chemical reactions that eventually result in the formation of thrombin; and (3) formation of fibrin and trapping of red blood cells to form a clot.

Artery and Vein

Artery and vein. Schematic drawings of an artery and a vein show comparative thicknesses of the three layers: the outer layer or tunica externa, the muscle layer or tunica media, and the tunica intima made of endothelium. Note that the muscle and outer layers are much thinner in veins than in arteries and that veins have valves.

Blood

Blood. Photomicrograph of a human blood smear. This smear shows a white blood cell surrounded by a number of smaller red blood cells. The liquid matrix of this tissue is also called plasma. (From Gartner LP, Hiatt JL: Color textbook of histology, ed 3, Philadelphia, 2007, Saunders.)

Fine Needle Biopsy or Aspiration (FNA) of the Kidney

Needle biopsy of kidney. Computed tomography (CT) image of biopsy needle (arrow) inserted into left kidney to remove tissue. K, Kidney. (From Schmidbauer J, Remzi M, Memsaradeghi M et al: Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses, Eur Urol 53(5):1003-1012, 2008.)

Bladder Cancer

Imaging of bladder cancer. A, Cystoscope in male bladder. B, Cystoscopic view of a cancerous growth (a transitional cell carcinoma) on the bladder wall. (B, Courtesy of B. Bracken, MD, Cincinnati, Ohio. IN Weiss MA, Mills SE: Atlas of genitourinary tract disorders, Philadelphia, 1988, J.B. Lippincott/Gower Medical Publishing.)

Kidney Stones

Renal calculi. Coronal (frontal) section of kidney, partially cut and opened like a book, showing a large stone (arrow) in the renal pelvis. (Courtesy of Dr. E. Mosher, Brigham and Women’s Hospital, Boston, MA. IN Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Elsevier.)

Vertabral fracture repair

An illustration of torn ligaments in the knee.

Wow! this was what happened to Tom Brady, quarterback for the New England Patriots, in 2008. With his left knee planted in terminal extension, and a laterally and anteriorly placed vector, he lost his cruciates, medial collateral ligament, and what is not illustrated, his medial meniscus was also torn, ending his season.

Bone fracture and inherent repair.

Bone fracture and repair. After a fracture (A), there is bleeding and inflammation around the affected area (B). Special tissue forms a bony framework called a callus (C) that stabilizes the bone until the repair is complete (D).

Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL). Appearance of B lymphocytes in acute lymphocytic leukemia. A disease which likes to hunt down our children (Courtesy of Dr. Robert W McKenna, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX. IN Kumar V et al: Robbins basic pathology, ed 9, Philadelphia, 2013, Saunders.)

Phagocytosis

Phagocytosis. This series of scanning electron micrographs shows the progressive steps in phagocytosis of damaged red blood cells (RBCs) by a macrophage. A, RBCs (R) attach to the macrophage (M). B, Plasma membrane of the macrophage begins to enclose the RBC. C, The RBCs are almost totally ingested by the macrophage. (Courtesy Emma Shelton.)

Squamous

Stratified squamous epithelium. A, Photomicrograph. Note the many layers of cells and flattened (squamous) nucleated cells in the outer layer. B, Sketch of the photomicrograph. (A, From Gartner LP, Hiatt JL: Color textbook of histology, ed 3, Philadelphia, 2007, Saunders. B, Barbara Cousins.)

Electroencephalography. A, Photograph of a person with voltage-sensitive electrodes attached to his skull. Information from these electrodes is used to produce a graphic recording of brain activity—an electroencephalogram (EEG). B, An EEG tracing showing activity in four different places in the brain (obtained from four sets of electrodes). Compare the moderate chaotic activity identified as normal with the explosive activity that occurs during a seizure.

Computerized Tomography scans of a normal brain and a brain affected by Alzheimer Disease

Alzheimer disease (AD). The CT scan on the left shows a horizontal section of a normal brain. In the CT scan on the right, however, you can see the dark patches in the cerebral cortex that show damage to brain tissue typical of AD. (James King-Holmes and Science Photo Library.)

Sites of intramuscular injection.

A. Deltoid. B. Gluteus Medius.

Stress responses induced by high concentrations of glucocorticoids in blood.

Epitheliae

Classification of epithelial tissues. The tissues are classified according to the shape and arrangement of cells. (Barbara Cousins.)

Malnutrition

Protein-calorie malnutrition (PCM). A, Marasmus results from starvation. B, Kwashiorkor results from a diet sufficient in calories but deficient in protein. Note the abdominal bloating typical in kwashiorkor. (A, Courtesy Dr. Jonathan Spector, Boston, MA. IN Zitelli BJ, McIntire SC, Nowalk AJ: Zitelli and Davis’ atlas of pediatric physical diagnosis, ed 6, Philadelphia, 2012, Mosby. B, From Zitelli BJ, McIntire SC, Nowalk AJ: Zitelli and Davis’ atlas of pediatric physical diagnosis, ed 6, Philadelphia, 2012, Mosby.)

Cleft Palate

Congenital defects of the mouth. A, Bilateral cleft lip in an infant. B, Cleft palate. (A, From Wilson SF, Giddens JF: Health assessment for nursing practice, ed 2, St Louis, 2001, Mosby. B, From Greig JD, Garden OJ: Color atlas of surgical diagnosis, London, 1996, Times Mirror International Publishers.)

Emphysema

Emphysema. The effects of emphysema can be seen in these scanning electron micrographs of lung tissue. A, Normal lung with many small alveoli. B, Lung tissue affected by emphysema. Notice that the alveoli have merged into larger air spaces, reducing the surface area for gas exchange. (Courtesy Andrew P. Evan, Indiana University School of Medicine.)

Raynaud's Phenomenon

Raynaud's phenomenon is an exaggeration of vasomotor responses to cold or emotional stress. More specifically, it is a hyperactivation of the sympathetic nervous system causing extreme vasoconstriction of the peripheral blood vessels, leading to tissue hypoxia. Chronic, recurrent cases of Raynaud phenomenon can result in atrophy of the skin, subcutaneous tissues, and muscle. In rare cases it can cause ulceration and ischemic gangrene.

The Gall Bladder

The gallbladder and bile ducts. Obstruction of the hepatic or common bile duct by stone or spasm blocks the exit of bile from the liver, where it is formed, and prevents bile from being ejected into the duodenum (choledocholithiasis). The drawing shows gallstone locations: in the gallbladder (a), blocking the cystic duct (b), in the common bile duct (c), and blocking both the pancreatic duct and the common bile duct (d). Inset shows an x-ray of the gallbladder and the ducts that carry bile taken during a specialized procedure called an endoscopic cholangiography. Inset: 1, Common bile duct; 2, common hepatic duct; 3, cystic duct; 4, gallbladder; 5, left hepatic duct; 6, liver shadow with tributaries of hepatic ducts; 7, right hepatic duct. (From Abrahams PH, Boon JM, Spratt JD, et al: McMinn’s color atlas of human anatomy, ed 6, Edinburgh, 2008, Mosby.)

Kaposis Sarcoma

Interferon treatment. A, Cancerous skin tumors of Kaposi sarcoma (KS). B, After treatment with alpha interferon, the KS tumors have been reduced. (National Cancer Institute.)

The Abdomen

Horizontal (transverse) section of the abdomen. The photograph of a cadaver section shows the relative position of some of the major digestive organs of the abdomen. Such a view is typical in imaging methods such as computed tomography (CT) scanning and magnetic resonance imaging (MRI). (From Vidic B, Suarez RF: Photographic atlas of the human body, St Louis, 1984, Mosby.)

The Alveolus

The gas-exchange structures of the lung. Each alveolus is continually ventilated with fresh air. The inset shows a magnified view of the respiratory membrane composed of the alveolar wall (surfactant, epithelial cells, and basement membrane), interstitial fluid, and the wall of a pulmonary capillary (basement membrane and endothelial cells). The gases, CO2 (carbon dioxide) and O2 (oxygen), diffuse across the respiratory membrane.

The Kidney

Gross structure of the kidney. A, Coronal section of the kidney in an artist’s rendering. B, Photo of coronal section of a preserved human kidney. (B, From Abrahams P, Marks S, Hutchings R: McMinn’s color atlas of human anatomy, ed 6, Philadelphia, 2008, Mosby.)

Color Vision Screens

Color vision screening figures. A, People with normal color vision can see 74 in this mosaic; people with red-green color blindness cannot. B, This mosaic is used to classify the type of red-green color blindness a patient has. If the patient sees only the 2, the red-sensitive cones are abnormal. If only the 4 is seen, the green-sensitive cones are abnormal. (From Ishihara’s tests for colour deficiency, Tokyo, Japan, 1973, Kanehara Trading Co, Copyright Isshinkai Foundation.)

Late onset Growth Hormone overproduction can cause Acromegaly. Pituitary Adenomas can cause this.

Acromegaly. Notice the large head, exaggerated projection of the lower jaw, and protrusion of the ridge above the eye orbits. (From Forbes CD and Jackson WF: Color atlas and text of clinical medicine, ed 3, Edinburgh, 2003, Mosby.)

The Stomach

Stomach. A portion of the anterior wall has been cut away to reveal the three muscle layers of the stomach wall. Notice that the mucosa lining the stomach forms folds called rugae.

Smooth muscle

Smooth muscle. Photomicrograph, longitudinal section. Note the central placement of nuclei in the spindle-shaped smooth muscle fibers. (Dennis Strete.)

The Formed Elements of Blood

Components of blood. Approximate values for the components of blood in a normal adult.

Let's slice it.

Photomicrograph of the skin. Many dead cells of the stratum corneum have flaked off from the surface of the epidermis. Note that the epidermis is very cellular. The dermis has fewer cells and more connective tissue. (Ed Reschke.)

Alterations in cell growth and reproduction. (From Stevens A, Lowe J: Pathology, ed 2, St Louis, 2000, Mosby.)

Chronic Myelogenous Leukemia

Chronic myeloid leukemia (CML). Severe granulocytic leukocytosis typical of CML. (From Hoffbrand AV, Pettit JE: Clinical haematology illustrated, Edinburgh/London, 1987, Churchill Livingstone/Gower Medical Publisher.)

Sty, aka, Hordeolum

Sty. The arrow points to swelling caused by infection of an eyelash follicle. (From Palay DA, Krachmer JH: Ophthalmology for the primary care physician, St Louis, 1997, Mosby.)

Vitiligo

Vitiligo. Note the patchy loss of pigment on the forehead. (Courtesy James A Ischen, MD, Baylor College of Medicine.)

Nomal and Osteoporotic Bone

Comparison of normal and osteoporotic spongy bone. Scanning electron micrograph (SEM) of, A, normal bone and, B, bone with osteoporosis. Note the loss of trabeculae and appearance of enlarged pores in the osteoporotic bone. (From Dempster DW et al: A simple method for correlative light and scanning electron microscopy of human iliac crest bone bipsies, J Bone Miner Res 1:15, 1986.)

Cushing Syndrome

Cushing syndrome. This condition results from hypersecretion of glucocorticoid hormone by a tumor of the middle zone of the adrenal cortex. A, Photo taken when patient was first diagnosed with Cushing syndrome. B, Taken 4 months after treatment. (Courtesy Gower Medical Publishers.)

Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL). Peripheral blood smear showing large numbers of diseased B lymphocytes. (Courtesy Dr. JV Melo.)

Dental Implants

Dental implant. A permanent dental prosthesis will be affixed to the anchor after bone grows and healing has occurred. (From Christensen GJ: A consumer’s guide to dentistry, ed 2, St Louis, 2002, Mosby.)

Pneumonia

Types of pneumonia. A, Bronchopneumonia. B, Lobar pneumonia. (From Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Elsevier.)

The Blood Brain Barrier.

Lymphatic Metastasis

Lymphatic metastasis. This cluster of cancer cells moving through a lymphatic vessel may eventually start another cancerous tumor in another part of the body. (From Stevens A, Lowe JS, Young B: Wheater’s basic histopathology, ed 4, Edinburgh, 2002, Churchill Livingstone.)

Fat cells.

Adipose tissue. Photomicrograph showing the large storage spaces for fat inside the adipose tissue cells. (Dennis Strete.)

Clotting

Red and white blood cells (WBCs) entrapped in a fibrin (yellow) mesh during clot formation (WBCs are blue). (Copyright Dennis Kunkel Microscopy, Inc.)

The Sickle Cell

Sickle cell. A sickle-shaped red blood cell typical of sickle cell anemia. (From Bevelander G, Ramalay JA: Essentials of histology, ed 8, St Louis, 1979, Mosby.)

Baloon Angioplasty, PTCA

Balloon angioplasty. A, A catheter is inserted into the vessel until it reaches the affected region. B, A probe with a metal tip is pushed out the end of the catheter into the blocked region of the vessel. C, The balloon is inflated, pushing the walls of the vessel outward. Sometimes metal coils or tubes (stents) are inserted to keep the vessel open.

The Hematocrit, one of our oldest blood tests.

Hematocrit (Hct) test. Note the buffy coat located between the packed RBCs and the plasma. A, Normal blood with the typical percent of RBCs. B, Anemia (a low percent of RBCs). C, Polycythemia (a high percent of RBCs). D, Centrifuge that spins tubes of blood, causing RBCs to become densely packed into the bottom of the tubes. (A-C From Bevelander G, Ramalay JA: Essentials of histology, ed 8, St Louis, 1979, Mosby. D, From Zakus SM: Clinical procedures for medical assistants, ed 3, St Louis, 1995, Mosby.)

SLE, Systemic Lupus Erythematosis

Lupus erythematosus. A red “butterfly” rash on the face is sometimes seen in cases of systemic lupus erythematosus (SLE). (From Habif TP: Clinical dermatology: a color guide to diagnosis and therapy, ed 3, St Louis, 1996, Mosby.)

Antibodies

Antibody function. Antibodies produce humoral immunity by binding to specific antigens to form antigen-antibody complexes. These complexes produce a variety of changes that inactivate or kill threatening cells.

Location of nephrons

Location of nephrons. Magnified wedge cut from the tissue of a kidney shows an example of a cortical nephron and a juxtamedullary nephron.

Bone.

Bone tissue. Photomicrograph of dried, ground bone. A wheel-like structural unit of bone, known as an osteon (Haversian system), is apparent in this section. (Dennis Strete.)

Contact Dermatitis

Contact dermatitis. Dermatitis, or skin inflammation, can result from contact with allergens—substances that trigger allergic responses in hypersensitive individuals. (From Cerio R, Jackson WF: Colour atlas of allergic skin disorders, London, 1992, Mosby-Wolfe.)

Mitral Stenosis

Mitral valve stenosis. Stenosed valves are valves that are narrower than normal, slowing blood flow from a heart chamber. Compare this valve with the normal valve shown in Figure 14-3, A. (From Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Elsevier.)

Skin Grafting

Skin graft. Illustration shows a skin graft covering a severe burn to the hand. Multiple slits allow the grafted piece of skin to stretch over a larger area than would otherwise be possible. (Hockenberry-Wilson: Wong’s nursing care of infants and children, ed 9, St Louis, 2013, Mosby.)

Skin Infections

Skin infections. (A, From Emond RTD, Welsby PD, Rowland HAK: Colour atlas of infectious diseases, ed 3, London, 1995, Mosby. B, From Habif TP: Clinical dermatology, ed 4, St Louis, 2004, Mosby. C,D, Courtesy Jaime A Tschen, MD, Department of Dermatology, Baylor College of Medicine, Houston, TX.)

The Pituitary, aka The Hypophysis

Pituitary hormones. Principal anterior and posterior pituitary hormones and their target organs.

Bone Cancer

Tumors of bone and cartilage (surgical specimens sectioned longitudinally). A, Osteosarcoma of distal femur. The tumor has broken out of the medullary cavity and is growing on the surface of the bone. B, Chondrosarcoma of proximal humerus. Note the glistening appearance of the hyaline cartilage tumor in the medullary cavity. (Damjanov I, Linder J, Anderson WAD: Anderson’s pathology, ed 10, St Louis, 1996, Mosby.)

Cardiac muscle

Cardiac muscle. Photomicrograph showing the branched, lightly striated fibers. The darker bands, called intercalated disks, which are characteristic of cardiac muscle, are easily identified in this tissue section. (Ed Reschke.)

The Salivary Glands

Location of the salivary glands. A, The salivary glands and their associated ducts. B, Photo shows the inflamed opening of the parotid duct into the mouth of a patient with mumps. C, Mumps (paramyxovirus) inflammation and swelling of the parotid gland in a child. (B, From Emond RTD, Welsby PD, Rowland HAK: Colour atlas of infectious diseases, ed 4, Edinburgh, 2003, Mosby. C, Courtesy GDW McKendrick. IN Zitelli BJ, Davis HW: Atlas of pediatric physical diagnosis, ed 5, Philadelphia, 2007, Mosby.)

Mononucleosis

Atypical lymphocyte seen in patient with infectious mononucleosis. The cell on the left is a typical small lymphocyte with its nucleus almost filling the cell. The larger atypical lymphocyte on the right has much more cytoplasm and a larger nucleus. (From Kumar V: Robbins basic pathology, ed 9, Philadelphia, 2013, Saunders.)

Fibrous connective tissue.

Dense fibrous connective tissue. Photomicrograph of tissue. Note the multiple bundles of collagenous fibers in parallel and wave-form arrangements. Collagen is white in living tissue but is stained pink here to make it visible. (Dennis Strete.)

The Trachea

Cross section of the trachea. Shown in a posterior view. Inset on right shows where the section was cut. The scanning electron micrograph shows the tip of one of the C-shaped cartilage rings

MVP, Mitral Valve Prolapse

Mitral valve prolapse. The normal mitral valve (upper left) prevents backflow of blood from the left ventricle into the left atrium during ventricular systole (contraction). The prolapsed mitral valve (right) permits leakage because the valve flaps billow backward, parting slightly. The photo inset shows the ballooning (arrow) of the mitral valve into the atrium. (Insert, Courtesy of William D Edwards, MD, Mayo Clinic, Rochester, MN. IN Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Elsevier.)

Tumor Imaging

Medical images of tumors. A, A mammogram showing carcinoma of a breast duct. B, CT scan of the brain showing a tumor in the left hemisphere. C, MR image of the brain showing a tumor in the left hemisphere. D, Sonogram showing a transverse view of an abdominal tumor. IVC, inferior vena cava; L, liver; M, mass; RK, right kidney. (A, From LeTreut AL: Mammography, St Louis, 1991, Mosby. B, From Williams AL, Haughton VM: Cranial computed tomography, St Louis, 1985, Mosby. C, From Runge VM: Enhanced magnetic resonance imaging, St Louis, 1989, Mosby. D, From Hagen-Ansert SL: Textbook of diagnostic ultrasonography, ed 6, St Louis, 2006, Mosby.)

Arthroscopy of the knee

A common reality for American football players.

The Last Small Pox Patient

The last smallpox patient. Ali Maow Maalin of Somalia contracted the last known naturally occurring case of smallpox in 1977. Successful disease prevention techniques completely eradicated natural outbreaks of this disease that once killed millions worldwide and dramatically affected human history. The World Health Organization (WHO) considers naturally occurring cases to be eradicated; thus the vaccine for smallpox is no longer required in the United States. Unfortunately, the potential of smallpox being used as a biological weapon remains a threat. (Centers for Disease Control and Prevention, Atlanta, GA.)

The Carpal Tunnel

The median nerve and muscles that flex the fingers pass through a concavity called the carpal tunnel.

Heart Action

Heart action. A, During atrial systole (contraction), cardiac muscle in the atrial wall contracts, forcing blood through the atrioventricular (AV) valves and into the ventricles. Bottom illustration shows superior view of all four valves, with semilunar (SL) valves closed and AV valves open. B, During ventricular systole that follows, the AV valves close, and blood is forced out of the ventricles through the semilunar valves and into the arteries. Bottom illustration shows superior view of SL valves open and AV valves closed.

Calcium Regulation

Regulation of blood calcium levels. Calcitonin and parathyroid hormones have antagonistic (opposite) effects on calcium concentration in the blood. Both are negative feedback effects because they reverse a trend away from normal blood calcium levels.

Hair

Hair follicle. Structure of a hair follicle and its relationship to nearby structures.

Hiatal Hernia

Hiatal hernia. Note herniated portion of stomach pushed through diaphragm. LES, Lower esophageal sphincter.

Membranes

Types of body membranes. A, Epithelial membranes, including cutaneous membrane (skin), serous membranes (parietal and visceral pleura and peritoneum), and mucous membranes. B, Connective tissue membranes, including synovial membranes.

Goiter

Goiter. The enlarged thyroid gland appears as a swelling of the neck. This condition results from a low dietary intake of iodine. (From Swartz MH: Textbook of physical examination, ed 6, Philadelphia, 2010, Saunders.)

The Urinary Bladder

Urinary bladder. Male bladder cut to show the interior. In the male, a large prostate gland surrounds the urethra as it exits from the bladder. The glands associated with the male reproductive system are further discussed in Chapter 23.

Strabismus

Strabismus. This child exhibits convergent left eye strabismus. (Seidel H et al: Mosby’s guide to physical examination, ed 3, St Louis, 2002, Mosby.)

Metastasis

Metastasis. Abnormal cells from malignant tumors fall away from the original neoplasm and travel along lymphatic vessels, through which they can enter and exit easily. Malignant cells also can travel through the bloodstream and burrow through a blood vessel wall to invade other tissues. (Rolin Graphics.

Hydronephrosis. This is the source of the pain usually described as similar to the pain of natal labor with kidney stones.

Hydronephrosis. Note the dramatic enlargement of the renal pelvis and calyces caused by blockage and “backing up” of urine. (From Kumar V, Abbas A, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Saunders.)

Keloid (Proud Flesh)

Keloid. Keloids are thick scars that form in the lower layer of the skin in predisposed individuals. (From Callen JP, Paller AS, Greer KE et al: Color atlas of dermatology, Philadelphia, 1993, Saunders.)

Rickets, a disease which is now rare in North America.

Rickets. Bowing of legs in this toddler is due to poorly mineralized bones. (From Kumar V: Robbins basic pathology, ed 9, Philadelphia, 2013, Saunders.)

The EKG, aka ECG, aka The Electrocardiogram

Events represented by the electrocardiogram (ECG). It is nearly impossible to illustrate the invisible, dynamic events of heart conduction in a few cartoon panels or “snapshots,” but the sketches here give you an idea of what is happening in the heart as an ECG is recorded.

Capillaries

Capillaries. Capillaries are microscopic, thin-walled vessels that form networks joining arterioles to venules. Smooth muscles wrapping around the entrances to capillaries (precapillary sphincters) act as valves that control local blood flow.

The Colon, aka The Large Intestine

Divisions of the large intestine. A, Artist’s drawing of the large intestine. B, X-ray of large intestine and terminal ileum filled with barium contrast material (barium enema). C, X-ray of a barium enema showing diverticulosis (arrowheads). D, Acute appendicitis. Appendix is gangrenous and showing signs of ischemia and putrefaction. (B, From Abrahams PH, Boon JM, Spratt JD, et al: McMinn’s color atlas of human anatomy, ed 6, Edinburgh, 2008, Mosby. C, From Heuman DM, Mills AS, McGuire HH: Gastroenterology, Philadelphia, 1997, Saunders. D, From Zitelli BJ, Davis HW: Atlas of pediatric physical diagnosis, ed 3, Philadelphia, 1997, Mosby.)

Effects of Cor Pulmonale

Cor pulmonale. When pulmonary blood backs up into the right side of the heart during right heart failure, it may stretch the right ventricle. Note in this photograph how large the right ventricle is in comparison with the left ventricle. (From Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Elsevier.)

Diversity Of Viruses

Diversity of pathogenic viruses. Some viruses are relatively large; others are extremely tiny. A human hair would be 8 meters (over 26 feet) thick if drawn at the same scale as the particles depicted here. (Barbara Cousins.)

Pulmonary Embolus

Pulmonary embolism. An embolus (clot fragment) that formed in the leg but broke away and lodged in a branch of the pulmonary artery within the lung. Arrowhead shows the embolus blocking the artery, thus drastically reducing gas exchange in the affected lung. (From Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2010, Elsevier.)

Neurofibromatosis

Multiple neurofibromatosis. This photo shows multiple tumors of Schwann cells in the nerves of the skin that are characteristic of this inherited condition. (From Feldman M, Friedman L, Brandt L: Sleisenger & Fordtran’s gastrointestinal and liver disease, ed 8, Philadelphia, 2006, Saunders.)

Multiple Myeloma

Multiple myeloma. A, X-ray film of skull showing “honeycomb” or “punched-out” bone defects caused by diseased antibody from plasma cells. B, Malignant plasma cell. Vacuoles, known as "Foam Cells"(arrowheads) contain defective antibodies. (From Kumar V: Robbins basic pathology, ed 9, Philadelphia, 2013, Saunders.)

Muscle Strain

Muscle strain. Severe strain of the biceps brachii muscle. When a muscle is severely strained, it may break in two pieces, causing a visible gap in muscle tissue under the skin. Notice how the broken ends of the muscle reflexively contract (spasm) to form a knot of tissue. (Photo, Courtesy Rob Williams. IN Booher JM, Thibodeau GA: Athletic injury assessment, ed 2, St Louis, 1989, Mosby.)

Prion

Prion. A, This pathogenic protein particle is the cause of variant Creutzfeldt-Jakob disease (vCJD), a degenerative, fatal condition of the brain.

Diabetes Mellitis

Diabetes mellitus. The signs and symptoms of this disorder (highlighted in yellow) all result from decreased insulin effects.

Normal variations in nail structure. A, Longitudinal ridges in light-skinned people are common. B, Pigmented bands are a normal finding in dark-skinned individuals. (A, From Habif T: Clinical dermatology, ed 3, St Louis, 1996, Mosby. B, From Habif TP: Clinical dermatology, ed 4, St Louis, 2004, Mosby.)

Osteomyelitis

Osteomyelitis. Segment of femur from a patient with chronic osteomyelitis. (From Kumar V: Robbins basic pathology, ed 9, Philadelphia, 2013, Saunders.)

EKG Continued

Cont’d. Events represented by the electrocardiogram (ECG). It is nearly impossible to illustrate the invisible, dynamic events of heart conduction in a few cartoon panels or “snapshots,” but the sketches here give you an idea of what is happening in the heart as an ECG is recorded.

The Lymph Node

Lymph node. A, Structure of a lymph node. B, Diagram of a skin section in which an infection surrounds a hair follicle. The yellow areas represent dead and dying cells (pus). The black dots around the yellow areas represent bacteria. Bacteria entering the lymph node via the afferent lymphatics are filtered out.

Pagets Disease of The Bone, because of the large trebecular caverns

Abnormal nail structure. A, Onycholysis. Separation of nail from the nail bed begins at the free edge. B, Nail pitting. A common finding in persons with psoriasis. (From Habif T: Clinical dermatology, ed 3, St Louis, 1996, Mosby.)

Positron Emission Tomography images of the Occipital Lobe in the Brain

What the PET scanner sees when we see.

Homeostasis

Model of homeostatic balance. Movement of the parameter in question, away from the ideal normal value, is depicted as normal fluctuations. Sometimes a physiological disturbance pushes the body beyond its capacity to maintain homeostasis and into the abnormal range for a given physiological parameter. Disturbances in the extreme may result in death.

Spinal Curvatures.

Abnormal spinal curvatures. A, Lordosis. B, Kyphosis. C, Scoliosis. D, An x-ray showing pronounced scoliosis and E, an x-ray of an 11-year-old girl after corrective surgery for scoliosis. (D, From Barkauskas V, Baumann L, Stoltenberg-Allen K, Darling-Fisher C: Health and physical assessment, ed 2, St Louis, 1998, Mosby. E, Courtesy Nancy Lynch.)

Somatotropin, aka Growth Hormone

Growth hormone abnormalities. A, The 22-year-old man on the left with gigantism is much taller than his identical twin on the right. (Courtesy Robert F Gagel, MD, and Ian McCutcheon, MD, University of Texas M.D. Anderson Cancer Center, Houston, Texas. IN Black JM, Hawks JH: Medical-surgical nursing: clinical management for positive outcomes, ed 8, St Louis, 2009, Mosby.)

The Pacemaker

Artificial pacemaker. This x-ray photograph shows the stimulus generator in the subcutaneous tissue of the chest wall. Thin, flexible wires extend through veins to the heart, where timed electrical impulses stimulate the myocardium. (From Libby P, Bonow RO, Mann DL, Zipes DP: Braunwald’s heart disease: a textbook of cardiovascular medicine, ed 8, Philadelphia, 2008, Saunders.)

Cerebral Palsy

Cerebral palsy (CP). This patient requires crutches to walk because abnormal tension (spasticity) in muscles prevents normal walking movements. (From Zitelli BJ, Davis HW: Atlas of pediatric physical diagnosis, ed 5, Philadelphia, 2007, Mosby.)

Lymphangitis

Lymphangitis. This condition is characterized by inflamed lymphatic vessels that appear as red streaks (highlighted by arrows) radiating from the source of infection. (From Zitelli B, McIntire SC, and Nowalk AJ: Atlas of pediatric physical diagnosis, ed 6, Philadelphia, 2012, Mosby.)

Leukocytes

Leukocytes in human blood smears. Each light micrograph shows a different type of stained WBC surrounded by several smaller RBCs. (Dennis Strete.)

Human Immune Virus

HIV. The human immunodeficiency virus, or HIV (blue in this electron micrograph), which is released from infected white blood cells, soon spreads over neighboring cells, infecting them in turn. The individual viruses are very small; more than 200 million would fit on the period at the end of this sentence. (Centers for Disease Control and Prevention, Atlanta, GA.)

The Human Pelvis

Comparison of the male and female pelvis. Notice the narrower width of the male pelvis, giving it a more funnel-like shape than the female pelvis.

Elephantiasis

Elephantiasis. Lymphedema caused by prolonged infestation by Filaria worms produces elephant-like limbs. (From Goldstein B, editor: Practical dermatology, ed 2, St Louis, 1997, Mosby.)

Virilization

Results of a virilizing tumor. This young girl has a virilizing tumor of the inner zone of the adrenal cortex. The tumor secretes androgens, thereby producing masculinizing effects that resemble the secondary sex characteristics of men

Arthritis

Types of arthritis. A, Osteoarthritis. Note the presence of nodes in the proximal interphalangeal joints (Bouchard nodes) and distal interphalangeal joints (Heberden nodes). B, Rheumatoid arthritis. Note the marked ulnar deviation of the wrists. C, Gouty arthritis. Note tophi (stones) containing sodium urate crystals. (From Swartz MH: Textbook of physical diagnosis, ed 6, Philadelphia, 2010, Saunders.)

Parkinsonism

Parkinsonism. Parkinsonism is a syndrome typically found in individuals with Parkinson disease (PD). The signs include (but are not limited to) rigidity and trembling of the head and extremities, a forward tilt of the trunk, and a shuffling gait with short steps and reduced arm swinging.

GERD

Gastroesophageal reflux disease (GERD). Reflux of gastric acid up into the esophagus, causing irritation of the lining of the esophagus.

The Lymphatic System

Lymph drainage. The right lymphatic duct drains lymph from the upper right quarter of the body into the right subclavian vein at its junction of the internal jugular vein. The thoracic duct drains lymph from the rest of the body into the left subclavian vein at its junction with the internal jugular vein.

Cataract

Cataract. Notice the cloudiness of the left eye. (From Swartz MH: Textbook of physical diagnosis, ed 6, Philadelphia, 2010, Saunders.)

The Coronary Circulation occurs in Diastole.

Coronary arteries. A, Diagram showing the major coronary arteries (anterior view). Clinicians often refer to the interventricular arteries as descending arteries. Thus a cardiologist would refer to the left anterior descending (LAD) artery and an anatomist would refer to the same vessel as the anterior interventricular branch or artery. B, The unusual placement of the coronary artery opening behind the leaflets of the aortic valve allows the coronary arteries to fill during ventricular relaxation.

Columns

Pseudostratified columnar epithelium. A, Photomicrograph. The arrangement of nuclei makes this specimen seem stratified, but it is not because each cell reaches the basement membrane, thus forming just one layer. B, Sketch of the micrograph. Note the presence of goblet cells and cilia. (Dennis Strete.)

Osteogenisis Imperfecta

Osteogenesis imperfecta. Treatment of femurs. These x-ray films show the progression of treatment in the same individual with “brittle bone disease.” A telescoping medullary rod is inserted and expanded while the individual grows. A, Shows original x-ray film; B, same individual with the rods in place; C, x-ray film of the same person 4 years later. (From Canale ST: Campbell’s operative orthopaedics, ed 9, St Louis, 1998, Mosby.)

X-ray image of a "Total Hip Replacement".

Neoplasms

Types of neoplasms. A, Benign neoplasms (tumors) are usually encapsulated and grow slowly. B, Malignant neoplasms or cancers are not encapsulated. They grow rapidly, extending into surrounding tissues. Some cells metastasize, that is, they fall away from the original tumor and form tumors in other parts of the body. (Rolin Graphics.)

Common Skin Lesions. Elevated. Pustule

Acne

Common Skin Lesions Elevated

Inflammation

Typical inflammatory response to a mechanical injury. A, A splinter damages tissue and carries bacteria into the body. Blood vessels dilate and begin leaking fluids, causing swelling and redness. B, White blood cells are attracted to the injury site and begin to consume bacteria and damaged tissue cells. A fibrous capsule separates the injury site from surrounding tissue.

Skin Repair

Skin repair. A minor skin injury is followed by blood clotting and self-repair of the damaged epidermis and dermis. Thickened fibrous tissue produced during dermal repair may cause formation of a scar.

The Tooth

Longitudinal section of a tooth. A molar is sectioned here to show its bony socket and details of its three main parts: crown, neck, and root. Enamel (over the crown) and cementum (over the neck and root) surround the dentin layer. The pulp contains nerves and blood vessels.

Bone Fractures

Bone fractures. A, Open. B, Closed. C, Incomplete and complete. D, Linear, transverse, and oblique.

The Sinuses

The paranasal sinuses. A, Lateral view of the position of the sinuses in adults. B, The anterior view shows the anatomical relationship of the paranasal sinuses to each other and to the nasal cavity.

The Larynx

The larynx. A, Sagittal section of the larynx. B, Superior view of the larynx. C, Photograph of the larynx taken with an endoscope (optical device) inserted through the mouth and pharynx to the epiglottis. (C, Custom Medical Stock Photo, Chicago, IL.)

The Lungs and Pleura

Lungs and pleura. The inset shows where the body was cut to show this transverse section of the thorax. A serous membrane lines the thoracic wall (parietal pleura) and then folds inward near the bronchi to cover the lung (visceral pleura). The intrapleural space contains a small amount of serous pleural fluid.

Pulmonary Ventilation

Pulmonary ventilation volumes. The chart in A shows a tracing like that produced with a spirometer. The diagram in B shows the pulmonary volumes as relative proportions of an inflated balloon (see Figure 17-13). During normal, quiet breathing, about 500 ml of air is moved into and out of the respiratory tract, an amount called the tidal volume. During forceful breathing (like that during and after heavy exercise), an extra 3300 ml can be inspired (the inspiratory reserve volume), and an extra 1000 ml or so can be expired (the expiratory reserve volume). The largest volume of air that can be moved in and out during ventilation is called the vital capacity. Air that remains in the respiratory tract after a forceful expiration is called the residual volume.

Disorders of the mouth and teeth

Disorders of the mouth and teeth. A, Snuff dipper’s pouch. This individual has developed leukoplakia in the area between cheek and gum used for placement of chewing tobacco. B, Squamous cell carcinoma of lip. Excessive long-term exposure to ultraviolet light (UV) such as in sunlight increases the risk of skin cancer. C, Dental caries. These permanent defects, or cavities, are filled with decayed dental tissues. (A, From Regezi JA, Sciubba JJ, Pogrel MA: Atlas of oral and maxillofacial pathology, Philadelphia, 2000, Saunders. B, From Callen JP, Paller AS, Greer KE et al: Color atlas of dermatology, ed 2, Philadelphia, 2000, WB Saunders. C, From Grundy JR, Jones JG: A color atlas of clinical operative dentistry: crowns and bridges, ed 2, London, 1993, Mosby-Wolfe.)

Gastropathies

Disorders of the stomach. A, Gastric ulcer. B, H. pylori (black particles) infecting the stomach mucosa. (B, From Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 7, Philadelphia, 2005, Elsevier.)

The Small Intestine

The small intestine. A, Note the four tissue coats or layers and the presence of villi and microvilli, which increase the area available for absorption. B, X-ray study. C, Laparoscopic view. (B, From Weir J, Abrahams PH, Spratt JD, and Salkowski LR: Imaging atlas of human anatomy, ed 4, Mosby Elsevier Ltd, 2011. C, From Abrahams PH, Boon JM, Spratt JD, et al: McMinn’s color atlas of human anatomy, ed 6, Edinburgh, 2008, Mosby.)

Gallstones

Gallstones. A, Inflamed gallbladder filled with yellow cholesterol gallstones. B, View of the gallbladder before removal using a laparoscope (viewing tube) inserted into the abdomen during surgery. (Courtesy Thompson JM, Wilson SF: Health assessment for nursing practice, St Louis 1996, Mosby.)

Cirrhosis of the Liver

Liver damage. A, Alcoholic cirrhosis where liver surface is hard and covered with nodules that look like pebbles. B, Varicose veins (varices) of the esophagus caused by reduction of blood flow through liver with cirrhosis. (From Kumar V, Abbas AK, Fausto N: Robbins and Cotran pathologic basis of disease, ed 6

The Renal Corpuscle

Renal corpuscle. A, Schematic showing relationship of glomerulus to the Bowman capsule (together called the renal corpuscle) and adjacent structures. B, Scanning electron micrograph showing several glomeruli and their associated blood vessels. (Courtesy Andrew P. Evan, Indiana University School of Medicine.)

The Nephron

The nephron unit. Cross sections from different segments of the renal tubule are shown. The differences in appearance in tubular cells seen in a cross section reflect the differing functions of each nephron segment.

The Ureter

Ureter cross section. Note the many folds of the mucous lining (transitional epithelium) that permit stretching as urine passes through the tube. A thick muscular layer of smooth muscle helps “pump” urine toward the bladder. On its outer surface the ureter is covered by a tough fibrous connective tissue coat. (From Kerr J: Atlas of functional histology, London, 1999, Mosby.)

Formation of Urine

Formation of urine. Diagram shows examples of steps in urine formation in successive parts of a nephron: filtration, reabsorption, and secretion.

Polycystic Kidney Disease

Polycystic kidney disease. A, External view shows characteristic cysts. B, Lateral view of a kidney partially cut along a frontal plane and then opened like a book to view the cysts inside the kidney. (From Kumar V, Abbas AK, Fausto N, Mitchell RN: Robbin’s basic pathology, ed 7, Philadelphia, 2007, Saunders.)

Renal Failure

The three stages of chronic renal failure. Stage 1: As nephrons are lost (indicated by decreasing GFR), the remaining healthy nephrons compensate—keeping BUN values within the normal range. Stage 2: As more than 75% of kidney function is lost, BUN levels begin to climb. Stage 3: Uremia (elevated BUN) results from mas