Harrison’s Principles of Internal Medicineis the world＇s most trusted clinical medicine text―and a superb resource for learning the art and science of clinical reasoning. Recognized by healthcare professionals worldwide as the leading authority on applied pathophysiology and clinical medicine,Harrison’s Principles of Internal Medicineprovides the informational foundation you need for the best patient care possible. This new edition is fully updated with timely new chapters and essential updates across the spectrum of internal medicine.
Written and edited by the world’s top experts in their respective fields, this landmark guide provides comprehensive, accurate, and essential coverage of the pathogenesis, diagnosis, and treatment of disease.
Harrison’s is world-renowned as the most authoritative source for:
• Clear, concise schemas that facilitate the generation of differential diagnoses to reason efficiently through complex real world clinical cases
• The physiologic and etiologic basis of signs and symptoms, which are covered through a wealth of unsurpassed expert guidance and linked to the disease-specific chapters that follow
• Updated clinical trial results and recommended guidelines
• Excellent and extensive visual support, including radiographs, clinical photos, schematics, and high-quality drawings
• Coverage of both therapeutic approaches and specific treatment regimens
• Practical clinical decision trees and algorithms
• Organ/system-specific sections, with clinically relevant pathophysiology and practical clinical advice on the approach to the patient, strategies towards building a differential diagnosis, outstanding clinical algorithms and diagnostic schema, a wealth of clinical images and diagrams, current clinical guidelines, and general and specific approaches to therapy
Harrison’s remains the most trusted resource in a world influenced by endless sources of medical information. The most timely and comprehensive updates from the world’s top experts are featured in the 21st edition:
• Current coverage of the diagnosis and treatment of diseases, from COVID to dementia to sepsis to multiple sclerosis to lung cancer
• Updated content that reflects new approved therapeutics and new practice-changing guidelines and evidence summaries
• More than 1000 clinical, pathological, and radiographic photographs, diagnostic and therapeutic decision trees, and clear schematics and diagrams describing pathophysiologic processes
• Numerous atlases featuring curated collections of important visual aspects of diagnosis and management
• Updated and time-saving curation and synthesis of established and new medical literature and studies
• Clinically relevant coverage of disease mechanics and pathophysiology, and related therapeutic mechanisms
Contributors............................................................................. xviii
Preface ..................................................................................... xxxix
Harrison’s Related Resources.........................................................xl
PART 1 The Profession of Medicine
1 The Practice of Medicine....................................................1
The Editors
2 Promoting Good Health.....................................................8
Donald M. Lloyd-Jones, Kathleen M. McKibbin
3 Vaccine Opposition and Hesitancy....................................13
Julie A. Bettinger, Hana Mitchell
4 Decision-Making in Clinical Medicine.............................21
Daniel B. Mark, John B. Wong
5 Precision Medicine and Clinical Care................................30
The Editors
6 Screening and Prevention of Disease.................................37
Katrina A. Armstrong, Gary J. Martin
7 Global Diversity of Health System Financing
and Delivery.....................................................................42
Richard B. Saltman
8 The Safety and Quality of Health Care..............................50
David W. Bates
9 Diagnosis: Reducing Errors and Improving Quality..........54
Gordon Schiff
10 Racial and Ethnic Disparities in Health Care.....................59
Lenny López, Joseph R. Betancourt
11 Ethical Issues in Clinical Medicine....................................67
Christine Grady, Bernard Lo
12 Palliative and End-of-Life Care........................................72
Ezekiel J. Emanuel
PART 2 Cardinal Manifestations and
Presentation of Diseases
SECTION 1 Pain
13 Pain: Pathophysiology and Management...........................91
James P. Rathmell, Howard L. Fields
14 Chest Discomfort...........................................................100
David A. Morrow
15 Abdominal Pain..............................................................108
Danny O. Jacobs
16 Headache........................................................................112
Peter J. Goadsby
17 Back and Neck Pain........................................................117
John W. Engstrom
SECTION 2 Alterations in Body Temperature
18 Fever..............................................................................130
Neeraj K. Surana, Charles A. Dinarello, Reuven Porat
19 Fever and Rash...............................................................133
Elaine T. Kaye, Kenneth M. Kaye
20 Fever of Unknown Origin...............................................145
Chantal P. Bleeker-Rovers, Catharina M. Mulders-Manders,
Jos W. M. van der Meer
SECTION 3 Nervous System Dysfunction
21 Syncope..........................................................................152
Roy Freeman
22 Dizziness and Vertigo.....................................................159
Mark F. Walker, Robert B. Daroff
23 Fatigue...........................................................................162
Jeffrey M. Gelfand, Vanja C. Douglas
24 Neurologic Causes of Weakness and Paralysis..................165
Stephen L. Hauser
25 Numbness, Tingling, and Sensory Loss...........................168
Stephen L. Hauser
26 Gait Disorders, Imbalance, and Falls...............................173
Jessica M. Baker
27 Confusion and Delirium.................................................178
S. Andrew Josephson, Bruce L. Miller
28 Coma.............................................................................183
S. Andrew Josephson, Allan H. Ropper, Stephen L. Hauser
29 Dementia........................................................................189
William W. Seeley, Gil D. Rabinovici, Bruce L. Miller
30 Aphasia, Memory Loss, and Other Cognitive
Disorders........................................................................195
M.-Marsel Mesulam
31 Sleep Disorders...............................................................204
Thomas E. Scammell, Clifford B. Saper, Charles A. Czeisler
SECTION 4 Disorders of Eyes, Ears, Nose, and Throat
32 Disorders of the Eye........................................................215
Jonathan C. Horton
33 Disorders of Smell and Taste...........................................232
Richard L. Doty, Steven M. Bromley
34 Disorders of Hearing......................................................238
Anil K. Lalwani
35 Upper Respiratory Symptoms, Including Earache,
Sinus Symptoms, and Sore Throat...................................247
Rachel L. Amdur, Jeffrey A. Linder
36 Oral Manifestations of Disease.......................................256
Samuel C. Durso
SECTION 5 Alterations in Circulatory and
Respiratory Functions
37 Dyspnea.........................................................................263
Rebecca M. Baron
38 Cough............................................................................267
Christopher H. Fanta
39 Hemoptysis....................................................................270
Carolyn M. D’Ambrosio
40 Hypoxia and Cyanosis.....................................................272
Joseph Loscalzo
41 Edema............................................................................275
Joseph Loscalzo
42 Approach to the Patient with a Heart Murmur................278
Patrick T. O’Gara, Joseph Loscalzo
43 Palpitations.....................................................................286
Joseph Loscalzo
SECTION 6 Alterations in Gastrointestinal Function
44 Dysphagia......................................................................287
Ikuo Hirano, Peter J. Kahrilas
45 Nausea, Vomiting, and Indigestion..................................291
William L. Hasler
46 Diarrhea and Constipation..............................................297
Michael Camilleri, Joseph A. Murray
47 Unintentional Weight Loss.............................................309
J. Larry Jameson
48 Gastrointestinal Bleeding................................................311
Loren Laine
49 Jaundice..........................................................................315
Savio John, Daniel S. Pratt
50 Abdominal Swelling and Ascites.....................................321
Lawrence S. Friedman
SECTION 7 Alterations in Renal and Urinary Tract
Function
51 Interstitial Cystitis/Bladder Pain Syndrome.....................325
R. Christopher Doiron, J. Curtis Nickel
52 Azotemia and Urinary Abnormalities..............................331
David B. Mount
53 Fluid and Electrolyte Disturbances.................................338
David B. Mount
54 Hypercalcemia and Hypocalcemia...................................356
Sundeep Khosla
55 Acidosis and Alkalosis.....................................................359
Thomas D. DuBose, Jr.
SECTION 8 Alterations in the Skin
56 Approach to the Patient with a Skin Disorder..................369
Kim B. Yancey, Thomas J. Lawley
57 Eczema, Psoriasis, Cutaneous Infections, Acne,
and Other Common Skin Disorders................................374
Leslie P. Lawley, Justin Cheeley, Robert A. Swerlick
58 Skin Manifestations of Internal Disease..........................383
Jean L. Bolognia, Jonathan S. Leventhal, Irwin M. Braverman
59 Immunologically Mediated Skin Diseases.......................400
Kim B. Yancey, Benjamin F. Chong, Thomas J. Lawley
60 Cutaneous Drug Reactions.............................................407
Robert G. Micheletti, Misha Rosenbach,
Bruce U. Wintroub, Kanade Shinkai
61 Photosensitivity and Other Reactions to Sunlight............417
Alexander G. Marneros, David R. Bickers
SECTION 9 Hematologic Alterations
62 Interpreting Peripheral Blood Smears..............................424
Dan L. Longo
63 Anemia and Polycythemia...............................................431
John W. Adamson, Dan L. Longo
64 Disorders of Granulocytes and Monocytes......................439
Steven M. Holland, John I. Gallin
65 Bleeding and Thrombosis................................................450
Barbara A. Konkle
66 Enlargement of Lymph Nodes and Spleen.......................457
Dan L. Longo
PART 3 Pharmacology
67 Principles of Clinical Pharmacology................................465
Dan M. Roden
68 Pharmacogenomics.........................................................474
Dan M. Roden
PART 4 Oncology and Hematology
SECTION 1 Neoplastic Disorders
69 Approach to the Patient with Cancer...............................481
Dan L. Longo
70 Prevention and Early Detection of Cancer.......................490
Jennifer M. Croswell, Otis W. Brawley,
Barnett S. Kramer
71 Cancer Genetics.............................................................498
Fred Bunz, Bert Vogelstein
72 Cancer Cell Biology........................................................508
Jeffrey W. Clark, Dan L. Longo
73 Principles of Cancer Treatment.......................................529
Edward A. Sausville, Dan L. Longo
74 Infections in Patients with Cancer...................................556
Robert W. Finberg
75 Oncologic Emergencies...................................................565
Rasim Gucalp, Janice P. Dutcher
76 Cancer of the Skin..........................................................578
Brendan D. Curti, John T. Vetto, Sancy A. Leachman
77 Head and Neck Cancer...................................................590
Everett E. Vokes
78 Neoplasms of the Lung...................................................594
Leora Horn, Wade T. Iams
79 Breast Cancer.................................................................611
Daniel F. Hayes, Marc E. Lippman
80 Upper Gastrointestinal Tract Cancers..............................626
David Kelsen
81 Lower Gastrointestinal Cancers......................................636
Robert J. Mayer
82 Tumors of the Liver and Biliary Tree...............................643
Josep M. Llovet
83 Pancreatic Cancer...........................................................657
Daniel D. Von Hoff
84 Gastrointestinal Neuroendocrine Tumors........................663
Matthew H. Kulke
85 Renal Cell Carcinoma.....................................................673
Robert J. Motzer, Martin H. Voss
86 Cancer of the Bladder and Urinary Tract..........................676
Noah M. Hahn
87 Benign and Malignant Diseases of the Prostate................681
Howard I. Scher, James A. Eastham
88 Testicular Cancer............................................................689
David J. Vaughn
89 Gynecologic Malignancies..............................................695
David Spriggs
90 Primary and Metastatic Tumors of the Nervous
System............................................................................701
Lisa M. DeAngelis, Patrick Y. Wen
91 Soft Tissue and Bone Sarcomas and Bone
Metastases......................................................................712
Shreyaskumar R. Patel
92 Carcinoma of Unknown Primary.....................................716
Kanwal Raghav, James L. Abbruzzese, Gauri R. Varadhachary
93 Paraneoplastic Syndromes: Endocrinologic/
Hematologic...................................................................721
J. Larry Jameson, Dan L. Longo
94 Paraneoplastic Neurologic Syndromes and
Autoimmune Encephalitis...............................................728
Josep Dalmau, Myrna R. Rosenfeld, Francesc Graus
95 Cancer Survivorship and the Long-Term Impact
of Cancer and Its Treatment............................................736
Mark Roschewski, Dan L. Longo
SECTION 2 Hematopoietic Disorders
96 Hematopoietic Stem Cells...............................................743
David T. Scadden, Dan L. Longo
97 Iron Deficiency and Other Hypoproliferative
Anemias.........................................................................747
John W. Adamson
98 Disorders of Hemoglobin................................................754
Martin H. Steinberg
99 Megaloblastic Anemias...................................................766
A. Victor Hoffbrand
100 Hemolytic Anemias........................................................776
Lucio Luzzatto, Lucia De Franceschi
101 Anemia Due to Acute Blood Loss...................................791
Dan L. Longo
102 Bone Marrow Failure Syndromes Including
Aplastic Anemia and Myelodysplasia...............................792
Neal S. Young
103 Polycythemia Vera and Other Myeloproliferative
Neoplasms......................................................................802
Jerry L. Spivak
104 Acute Myeloid Leukemia................................................809
William Blum
105 Chronic Myeloid Leukemia.............................................818
Hagop Kantarjian, Elias Jabbour, Jorge Cortes
106 Acute Lymphoid Leukemia.............................................828
Dieter Hoelzer
107 Chronic Lymphocytic Leukemia.....................................834
Jennifer A. Woyach, John C. Byrd
108 Non-Hodgkin’s Lymphoma............................................841
Caron A. Jacobson, Dan L. Longo
109 Hodgkin’s Lymphoma.....................................................852
Caron A. Jacobson, Dan L. Longo
110 Less Common Lymphoid and Myeloid
Malignancies..................................................................855
Ayalew Tefferi, Dan L. Longo
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