Anatomie et physiologie normales et pathologiques

Front cover
Ross and Wilson Anatomy and Physiology in Health and Illness
Copyright page
Table of Contents
Evolve page
Preface
Acknowledgements
	Authors’ Acknowledgements
	Publisher’s Acknowledgements
Common prefixes, suffixes and roots
Key
1 The body and its constituents
	1 Introduction to the human body
		Animations
		Levels of structural complexity
		The internal environment  and homeostasis
			Homeostasis
				Control systems
					Negative feedback mechanisms (Fig. 1.4)
					Positive feedback mechanisms
			Homeostatic imbalance
		Survival needs of the body
			Communication
				Transport systems
					Blood (Ch. 4)
						Plasma.
						Blood cells.
					Cardiovascular system (Ch. 5)
						Blood vessels.
						Heart.
					Lymphatic system (Ch. 6)
				Internal communication
					Nervous system (Ch. 7)
					Endocrine system (Ch. 9)
				Communication with  the external environment
					Special senses (Ch. 8)
					Verbal communication
					Non-verbal communication
			Intake of raw materials and  elimination of waste
				Intake of oxygen
				Ingestion of nutrients (eating)
					Digestion
						Alimentary canal.
						Accessory organs.
					Metabolism
				Elimination of wastes
					Carbon dioxide
					Urine
					Faeces
			Protection and survival
				Protection against the  external environment
				Defence against infection
					Non-specific defence mechanisms
					Specific defence mechanisms
				Movement
				Survival of the species
					Transmission of inherited characteristics
					Reproduction (Ch. 18)
		Introduction to ageing
		Introduction to the study  of illness
			Aetiology
			Pathogenesis
				Inflammation.
				Tumours.
				Abnormal immune mechanisms.
				Thrombosis, embolism and infarction.
				Degeneration.
				Metabolic abnormalities.
				Genetic abnormalities.
		Further reading
	2 Introduction to the chemistry of life
		Animations
		Atoms, molecules  and compounds
			Atomic structure
			Atomic number and atomic weight
				Isotopes.
			Molecules and compounds
				Covalent and ionic bonds.
					Covalent bonds
					Ionic bonds
			Electrolytes
			Measurement of substances in body fluids
			Acids, bases and pH
				The pH scale
				pH values of body fluids
				Buffers
				Acidosis and alkalosis
		Important biological molecules
			Carbohydrates
			Amino acids and proteins
			Lipids
			Nucleotides
				Nucleic acids
				Adenosine triphosphate (ATP)
			Enzymes
		Movement of substances within body fluids
			Diffusion
			Osmosis
		Body fluids
			Extracellular fluid
			Intracellular fluid
	3 The cells, tissues and organisation of the body
		Animations
		The cell: structure and functions
			Plasma membrane
				Membrane proteins
			Organelles  3.1
				Nucleus
				Mitochondria
				Ribosomes
				Endoplasmic reticulum (ER)
				Golgi apparatus
				Lysosomes
				Cytoskeleton
					Microfilaments.
					Microtubules.
					Centrosome.
					Cell extensions.
			The cell cycle
				Interphase
				Mitosis (Figs 3.8 and 3.9)  3.2
					Prophase.
					Metaphase.
					Anaphase.
					Telophase.
			Transport of substances across  cell membranes
				Passive transport
					Diffusion
					Facilitated diffusion
					Osmosis
				Active transport  3.5
					The sodium–potassium pump
					Bulk transport (Fig. 3.11)
		Tissues
			Epithelial tissue (Fig. 3.12)
				Simple epithelium
					Squamous (pavement) epithelium
					Cuboidal epithelium
					Columnar epithelium
				Stratified epithelia
					Stratified squamous epithelium (Fig. 3.13)
						Keratinised stratified epithelium.
						Non-keratinised stratified epithelium.
					Transitional epithelium (Fig. 3.15)
			Connective tissue
				Cells in connective tissue
					Fibroblasts.
					Fat cells.
					Macrophages.
					Leukocytes.
					Mast cells.
				Loose (areolar) connective tissue (Fig. 3.18)
				Adipose tissue (Fig. 3.19)
					White adipose tissue.
					Brown adipose tissue.
				Reticular tissue (Fig. 3.20)
				Dense connective tissue
					Fibrous tissue (Fig. 3.21A)
					Elastic tissue (Fig. 3.21B)
				Blood
				Cartilage
					Hyaline cartilage (Fig. 3.22A)
					Fibrocartilage (Fig. 3.22B)
					Elastic fibrocartilage (Fig. 3.22C)
				Bone
			Muscle tissue
				Skeletal muscle (Fig. 3.23)
				Smooth muscle (Fig. 3.24)
				Cardiac muscle (Fig. 3.25)
			Nervous tissue
			Tissue regeneration
			Membranes
				Epithelial membranes
					Mucous membrane  3.6
					Serous membrane  3.7
				Synovial membrane  3.8
			Glands
		Organisation of the body
			Anatomical terms
				The anatomical position.
				Directional terms.
				Regional terms.
				Body planes (Fig. 3.29)
					Median plane.
					Coronal plane.
					Transverse plane.
				Anatomical reference icons used  in this book
			The skeleton
				Axial skeleton
					Skull
						Functions
					Vertebral column  3.9
						Functions
					Thoracic cage
						Functions
				Appendicular skeleton
					The shoulder girdles and upper limbs.
					The pelvic girdle and lower limbs.
					Functions
			Cavities of the body
				Cranial cavity
				Thoracic cavity
					Contents of the thoracic cavity
				Abdominal cavity  3.10
					Contents
				Pelvic cavity
					Contents
		Changes in cell size and number
			Cell death
				Apoptosis
				Necrosis
			Neoplasms or tumours
				Causes of neoplasms
					Carcinogens
						Chemical carcinogens
						Ionising radiation
						Oncogenic viruses
						Host factors
				Growth of tumours
					Cell differentiation
					Encapsulation and spread of tumours
						Local spread
						Body cavities spread
						Lymphatic spread
						Blood spread
				Effects of tumours
					Pressure effects
					Hormonal effects
					Cachexia
				Causes of death in malignant disease
					Infection
					Organ failure
					Carcinomatosis
					Haemorrhage
2 Communication
	4 The blood
		Animations
		Plasma
			Plasma proteins
				Albumins.
				Globulins.
				Clotting factors.
			Electrolytes
			Nutrients
			Waste products
			Hormones (see Ch. 9)
			Gases
		Cellular content of blood  4.1
			Erythrocytes (red blood cells)  4.2
				Life span and function of erythrocytes
					Haemoglobin
					Oxygen transport
						Low pH
						Low oxygen levels (hypoxia)
						Temperature
					Control of erythropoiesis
					Destruction of erythrocytes
				Blood groups  4.3
					The ABO system
					The Rhesus system  4.4
			Leukocytes (white blood cells)  4.5
				Granulocytes (polymorphonuclear leukocytes)
					Neutrophils
					Eosinophils
					Basophils
				Agranulocytes
					Monocytes
						The monocyte–macrophage system.
					Lymphocytes
			Platelets (thrombocytes)  4.6
				Haemostasis
					1. Vasoconstriction.
					2. Platelet plug formation.
					3. Coagulation (blood clotting).
					4. Fibrinolysis.
					Control of coagulation
		Erythrocyte disorders
			Anaemias
				Iron deficiency anaemia
					Deficient intake
					High requirements
					Malabsorption
				Vitamin B12/folic acid  deficiency anaemias
					Vitamin B12 deficiency anaemia
						Pernicious anaemia
						Dietary deficiency of vitamin B12
						Other causes of vitamin B12 deficiency
						Complications of vitamin B12 deficiency anaemia
					Folic acid deficiency anaemia
				Aplastic anaemia
				Haemolytic anaemias
					Congenital haemolytic anaemias
						Sickle cell anaemia
							Complications.
						Thalassaemia
						Haemolytic disease of the newborn
				Acquired haemolytic anaemias
					Chemical agents
					Autoimmunity
					Blood transfusion reactions
			Polycythaemia
				Relative increase in erythrocyte count
				True increase in erythrocyte count
					Physiological.
					Pathological.
		Leukocyte disorders
			Leukopenia
				Granulocytopenia (neutropenia)
			Leukocytosis
			Leukaemia
				Causes of leukaemia
					Ionising radiation.
					Chemicals.
					Genetic factors.
				Types of leukaemia
					Acute leukaemias
						Acute myeloblastic leukaemia (AML).
						Acute lymphoblastic leukaemia (ALL).
					Chronic leukaemias
						Chronic myeloid leukaemia (CML).
						Chronic lymphocytic leukaemia (CLL).
		Haemorrhagic diseases
			Thrombocytopenia
				Reduced platelet production
				Increased platelet destruction
					Autoimmune thrombocytopenic purpura.
			Vitamin K deficiency
				Haemorrhagic disease of the newborn
				Deficiency in adults
			Disseminated intravascular  coagulation (DIC)
			Congenital disorders
				The haemophilias
				von Willebrand disease
	5 The cardiovascular system
		Animations
		Blood vessels
			Arteries and arterioles
				Anastomoses and end-arteries
			Capillaries and sinusoids
				Capillary refill time
			Veins and venules
			Blood supply
			Control of blood vessel diameter
				Blood vessel diameter and blood flow
				Local regulation of blood flow
			Capillary exchange
				Exchange of gases
				Exchange of other substances
					Capillary fluid dynamics
		Heart
			Position   5.2
				Organs associated with the heart (Fig. 5.10)
			Structure
				The heart wall
					Pericardium
					Myocardium
						Fibrous tissue in the heart.
					Endocardium
				Interior of the heart   5.3, 5.4
			Flow of blood through the heart  (Fig. 5.14)   5.5
			Blood supply to the heart (the coronary circulation)   5.6
				Arterial supply (Fig. 5.17).
				Venous drainage.
			Conducting system of the heart  (Fig. 5.18)   5.7
				Sinoatrial node (SA node)
				Atrioventricular node (AV node)
					Atrioventricular bundle (AV bundle or  bundle of His)
				Nerve supply to the heart
				Factors affecting heart rate
			The cardiac cycle
				Stages of the cardiac cycle
					Heart sounds
				Electrical changes in the heart   5.8
			Cardiac output
				Stroke volume
					Arterial blood pressure.
					Blood volume.
				Venous return
					The position of the body.
					Muscular contraction.
					The respiratory pump.
				Heart rate
					Autonomic nervous system.
					Circulating chemicals.
					Position.
					Exercise.
					Emotional states.
					Gender.
					Age.
					Temperature.
					Baroreceptor reflex.
		Blood pressure
			Systolic and diastolic pressures.
			Elasticity of arterial walls.
			Factors determining blood pressure
				Cardiac output
				Peripheral or arteriolar resistance
				Autoregulation
			Control of blood pressure (BP)
				Short-term blood pressure regulation
					Baroreceptors
					Chemoreceptors
					Higher centres in the brain
				Long-term blood pressure regulation
				Pressure in the pulmonary circulation
		Pulse
			Factors affecting the pulse   5.9
		Circulation of the blood
			Pulmonary circulation   5.10
			Systemic or general circulation
				Major blood vessels
					Aorta (Fig. 5.28)
						Thoracic aorta (Fig. 5.28)
							Ascending aorta.
							Arch of the aorta.
							Descending aorta in the thorax.
						Abdominal aorta (Fig. 5.28)
					Venae cavae (Fig. 5.29)
						Superior vena cava
						Inferior vena cava
				Circulation in the head and neck
					Arterial supply
						Carotid arteries.
						External carotid artery (Fig. 5.30).
						Internal carotid artery.
						Circulus arteriosus (circle of Willis [Fig. 5.31]).
					Venous return
				Circulation in the upper limb
					Arterial supply
						The subclavian arteries.
					Venous return
				Circulation in the thorax
					Arterial supply
					Venous return
				Circulation in the abdomen
					Arterial supply
						Paired branches.
						Unpaired branches.
					Venous return
					Portal circulation   5.11
						Portal vein.
					Circulation in the pelvis and lower limb
						Arterial supply
							Common iliac arteries.
						Venous return
							Deep veins.
							Superficial veins (Fig. 5.44).
		Summary of the main  blood vessels
		Fetal circulation
			Features of the fetal circulation   5.12
				Placenta
					Structure
					Functions
						Exchange of nutrients and wastes.
						Protection of the fetus.
						Maintenance of pregnancy.
							Human chorionic gonadotrophin (hCG).
							Progesterone and oestrogen.
				Fetal adaptations (Fig. 5.47A)
					Ductus venosus.
					Ductus arteriosus.
					Foramen ovale.
			Changes at birth (Fig. 5.47B)
		Ageing and the  cardiovascular system
			Ageing and the heart
			Ageing and blood vessels
		Shock
			Hypovolaemic shock
			Cardiogenic shock
			Septic shock (bacteraemic, endotoxic)
			Neurogenic shock
			Anaphylactic shock
			Physiological changes during shock
				Compensated shock
				Uncompensated shock
		Thrombosis and embolism
			Thrombosis
				Slow blood flow.
				Damage to the blood vessel intima.
				Increased blood coagulability.
			Embolism
				Pulmonary embolism.
			Infarction and ischaemia
		Blood vessel pathology
			Atheroma
				Pathological changes
				Causes of atheroma
				Effects of atheroma   5.13
					Narrowing of an artery
					Occlusion of an artery
				Complications of atheroma
					Thrombosis and infarction (p. 120)
					Haemorrhage
					Aneurysm
			Arteriosclerosis
			Aneurysms
				Types of aneurysm
			Venous thrombosis
				Superficial thrombophlebitis
				Deep vein thrombosis (DVT)
			Varicosed veins
				Sites and effects of varicose veins
					Varicose veins of the legs
					Haemorrhoids
					Scrotal varicocele
					Oesophageal varices
			Tumours of blood and lymph vessels
				Angiomas
					Haemangiomas.
						Capillary haemangiomas.
		Oedema
			Sites of oedema
			Causes of oedema
				Increased venous hydrostatic (blood) pressure
				Decreased plasma osmotic pressure
				Impaired lymphatic drainage
				Increased small-vessel permeability
			Effusions and ascites
				Pleural effusion.
				Ascites.
		Diseases of the heart
			Heart (cardiac) failure
				Compensatory mechanisms in heart failure
					Acute heart failure
					Chronic heart failure
				Right-sided (congestive cardiac) failure
					Resistance to blood flow through the lungs.
					Weakness of the myocardium.
				Left-sided (left ventricular) failure
			Disorders of heart valves   5.14
				Stenosis
				Incompetence
			Ischaemic heart disease
				Angina pectoris
				Myocardial infarction
					Complications
			Rheumatic heart disease
				Acute rheumatic heart disease.
				Chronic rheumatic heart disease.
			Infective endocarditis
				Bacteraemia
				Depressed immune response
				Heart abnormalities
			Cardiac arrhythmias
				Sinus bradycardia.
				Sinus tachycardia.
				Asystole
				Fibrillation
				Heart block
			Congenital abnormalities
				Patent ductus arteriosus
				Atrial septal defect
				Coarctation of the aorta
				Fallot’s tetralogy
		Disorders of blood pressure
			Hypertension
				Essential hypertension
					Risk factors.
				Malignant (accelerated) hypertension
				Secondary hypertension
				Effects and complications of hypertension
					Heart.
					Brain.
					Kidneys.
					Blood vessels.
				Pulmonary hypertension
			Hypotension
	6 The lymphatic system
		Animations
		Functions of the lymphatic system
			Tissue drainage
			Absorption in the small intestine (Ch. 12)
			Immunity (Ch. 15)
		Lymph and lymph vessels
			Lymph
			Lymph capillaries
			Larger lymph vessels
				Thoracic duct
				Right lymphatic duct
		Lymphatic organs and tissues
			Lymph nodes  6.3
				Structure
				Functions
					Filtering and phagocytosis
					Proliferation of lymphocytes
			Spleen  6.4
				Organs associated with the spleen
				Structure (Fig. 6.8)
				Functions
					Phagocytosis
					Storage of blood
					Immune response
					Erythropoiesis
			Thymus gland  6.5
				Organs associated with the thymus
				Structure
				Function
			Mucosa-associated lymphoid  tissue (MALT)
				Tonsils.
				Aggregated lymphoid follicles (Peyer’s patches).
		Lymph vessel pathology
			Spread of disease
				Malignant disease
				Infection
					Lymphangitis.
			Lymphatic obstruction
				Tumours
				Surgery
		Diseases of lymph nodes
			Lymphadenitis
				Infectious mononucleosis (glandular fever)
				Other diseases
			Lymphomas
				Hodgkin’s disease
				Non-Hodgkin’s lymphoma (NHL)
		Disorders of the spleen
			Splenomegaly
				Infections
					Chronic infections.
				Circulatory disorders
				Blood disease
				Tumours
		Diseases of the thymus gland
	7 The nervous system
		Animations
		Cells and tissues of the  nervous system
			Neurones (Fig. 7.2)  7.2
				Cell bodies
				Axons and dendrites
					Axons
						Structure of an axon.
							Myelinated neurones
							Unmyelinated neurones
					Dendrites
				The nerve impulse (action potential)  7.3
				The synapse and neurotransmitters  7.4
				Nerves
					Sensory or afferent nerves
						Sensory receptors
							Somatic, cutaneous or common senses.
							Proprioceptor senses.
							Special senses.
							Autonomic afferent nerves.
					Motor or efferent nerves
					Mixed nerves
				Neuroglia
					Astrocytes
					Oligodendrocytes
					Ependymal cells
					Microglia
				Response of nervous tissue to injury
					Peripheral nerve regeneration (Fig. 7.13)
					Neuroglial damage
						Astrocytes.
						Oligodendrocytes.
						Microglia.
		Central nervous system
			The meninges and cerebrospinal fluid (CSF)
				The meninges (Fig. 7.14)
					Dura mater
					Arachnoid mater
					Pia mater
				Ventricles of the brain and  the cerebrospinal fluid  7.5
					The lateral ventricles
					The third ventricle
					The fourth ventricle
					Cerebrospinal fluid (CSF)
						Functions of cerebrospinal fluid
			Brain
				Blood supply and venous drainage
				Cerebrum
					Cerebral tracts and basal ganglia (Fig. 7.19)
					Basal ganglia
					Functions of the cerebral cortex
					Functional areas of the cerebral cortex  (Fig. 7.20)
						Motor areas of the cerebral cortex
							The primary motor area.
							Motor speech (Broca’s) area.
						Sensory areas of the cerebral cortex
							The somatosensory area.
							The auditory (hearing) area.
							The olfactory (smell) area.
							The taste area.
							The visual area.
						Association areas
							The premotor area.
							The prefrontal area.
							Sensory speech (Wernicke’s) area.
							The parieto-occipitotemporal area
				Diencephalon (see Fig. 7.17)
					Thalamus
					Hypothalamus
				Brain stem (Fig. 7.17)
					Midbrain
					Pons
					Medulla oblongata
						Decussation (crossing) of the pyramids.
						Sensory decussation.
						The cardiovascular centre (CVC).
						The respiratory centre.
						Reflex centres.
					Reticular formation
						Functions
				Cerebellum
					Functions
			Spinal cord
				Grey matter
					Posterior columns of grey matter
					Anterior columns of grey matter
				White matter
					Sensory nerve tracts in the spinal cord
					Motor nerve tracts in the spinal cord
						Voluntary muscle movement
							The upper motor neurone.
							The lower motor neurone.
						Involuntary muscle movement
							Upper motor neurones.
							Spinal reflexes.
							Stretch reflexes.
							Autonomic reflexes.
		Peripheral nervous system
			Spinal nerves
				Nerve roots (Fig. 7.31)
				Branches
				Plexuses
					Cervical plexus (Fig. 7.33)
					Brachial plexus
						Lumbar plexus (Figs 7.37–7.39)
						Sacral plexus (Figs 7.37–7.39)
						Coccygeal plexus (Fig. 7.37)
			Thoracic nerves
			Cranial nerves (Fig. 7.40)  7.10
				I. Olfactory nerves (sensory)
				II. Optic nerves (sensory)
				III. Oculomotor nerves (motor)
				IV. Trochlear nerves (motor)
				V. Trigeminal nerves (mixed)
				VI. Abducens nerves (motor)
				VII. Facial nerves (mixed)
				VIII. Vestibulocochlear (auditory) nerves (sensory)
				IX. Glossopharyngeal nerves (mixed)
				X. Vagus nerves (mixed) (Fig. 7.42)
				XI. Accessory nerves (motor)
				XII. Hypoglossal nerves (motor)
			Autonomic nervous  system  7.11, 7.12, 7.13
				Sympathetic nervous system
					The preganglionic neurone.
					The postganglionic neurone.
					Sympathetic ganglia
						The lateral chains of sympathetic ganglia.
						Prevertebral ganglia.
				Parasympathetic nervous system
					The preganglionic neurone.
					The postganglionic neurone.
				Functions of the autonomic  nervous system
				Effects of autonomic stimulation
					Cardiovascular system
						Sympathetic stimulation
						Parasympathetic stimulation
					Respiratory system
						Sympathetic stimulation.
						Parasympathetic stimulation.
					Digestive and urinary systems
						Sympathetic stimulation
						Parasympathetic stimulation
					Eye
						Sympathetic stimulation.
						Parasympathetic stimulation.
					Skin
						Sympathetic stimulation
				Afferent impulses from viscera
					Visceral pain
					Referred pain (Fig. 7.45)
		Effect of ageing on the  nervous system
		Disorders of the brain
			Increased intracranial pressure
				Effects of increased ICP
					Displacement of the brain
					Obstruction of the flow of cerebrospinal fluid
					Vascular damage
					Neural damage
					Bone changes
				Cerebral oedema
				Hydrocephalus
			Head injuries
				Acceleration–deceleration injuries
				Complications of head injury
					Traumatic intracranial haemorrhage
						Extradural haemorrhage.
						Acute subdural haemorrhage.
						Chronic subdural haemorrhage.
						Intracerebral haemorrhage and cerebral oedema.
					Meningitis
					Post-traumatic epilepsy
					Vegetative states
			Cerebral hypoxia
			Stroke
				Cerebral infarction  7.17
				Spontaneous intracranial haemorrhage
					Intracerebral haemorrhage.
					Subarachnoid haemorrhage.
			Dementia
				Alzheimer disease
				Huntington disease
				Secondary dementias
			Parkinson disease  7.18
			Effects of poisons on the brain
		Infections of the central  nervous system
			Bacterial infections
				Bacterial meningitis
			Viral infections
				Viral meningitis
				Viral encephalitis
				Herpes zoster (shingles)
				Poliomyelitis
				Rabies
				Human immunodeficiency virus (HIV)
				Creutzfeldt–Jakob disease
				Myalgic encephalitis (ME)
		Demyelinating diseases
			Multiple sclerosis (MS)
				Effects of multiple sclerosis
			Acute disseminated encephalomyelitis
		Diseases of the spinal cord
			Motor neurones
				Upper motor neurone (UMN) lesions
				Lower motor neurone (LMN) lesions
				Motor neurone disease
			Mixed motor and sensory conditions
				Subacute combined degeneration of  the spinal cord
				Compression of the spinal cord and  nerve roots
					Prolapsed intervertebral disc (Fig. 7.49)
					Syringomyelia
		Diseases of peripheral nerves
			Peripheral neuropathy
				Polyneuropathy
				Mononeuropathy
			Guillain–Barré syndrome
			Bell’s palsy
		Developmental abnormalities of the nervous system
			Spina bifida
				Occult spina bifida
				Meningocele
				Meningomyelocele
			Hydrocephalus
		Tumours of the nervous system
			Slow-growing tumours
			Rapidly growing tumours
			Specific tumours
			Metastases in the brain
	8 The special senses
		Animations
		Hearing and the ear
			Structure
				Outer ear
					The auricle (pinna)
					External acoustic meatus (auditory canal)
				Middle ear (tympanic cavity)
					Auditory ossicles (Fig. 8.3)
						The malleus.
						The incus.
						The stapes.
				Inner ear (Fig. 8.4)
					The bony labyrinth.
					The membranous labyrinth.
					The vestibule
					The semicircular canals
					The cochlea
			Physiology of hearing  8.1
		Balance and the ear
			The semicircular canals and vestibule (Fig. 8.4)
			Physiology of balance
		Sight and the eye
			Structure (Fig. 8.8)
				Sclera and cornea
				Choroid (Figs 8.8 and 8.9)
					Ciliary body
					Iris
					Lens (Fig. 8.10)
				Retina
				Blood supply to the eye
				Interior of the eye
				Optic nerves (second cranial nerves) (Fig. 8.13)
					Optic chiasma
					Optic tracts
			Physiology of sight  8.2
				The electromagnetic spectrum
				Refraction of the light rays
					Focusing of an image on the retina
					Lens
				Size of the pupils
				Accommodation
					Near vision
						Constriction of the pupils.
						Convergence (movement of the eyeballs).
						Changing the refractory power of the lens.
					Distant vision
				Functions of the retina
					Colour blindness.
					Dark adaptation.
				Binocular vision  8.3
			Extraocular muscles of the eye
				Nerve supply to the muscles of the eye
			Accessory organs of the eye
				Eyebrows
				Eyelids (palpebrae)
					Conjunctiva
					Eyelid margins
					Functions
				Lacrimal apparatus (Fig. 8.22)
					Functions
		Sense of smell
			Olfactory nerves (first cranial nerves)
			Physiology of smell
				Adaptation.
		Sense of taste
			Physiology of taste
		The effect of ageing on  the special senses
			Presbycusis
			Vision
				Presbyopia
				Cataracts
		Disorders of the ear
			Hearing loss
				Conductive hearing impairment
					Otosclerosis.
					Serous otitis media.
				Sensorineural hearing impairment
					Ménière’s disease.
					Presbycusis.
			Ear infections
				External otitis
				Acute otitis media
				Chronic otitis media
			Labyrinthitis
			Motion sickness
		Disorders of the eye
			Inflammatory conditions
				Stye
				Blepharitis
				Conjunctivitis
					Infection.
					Neonatal conjunctivitis.
					Allergic conjunctivitis.
				Trachoma
				Corneal ulcer
			Glaucoma
				Primary glaucomas
					Primary open-angle glaucoma (POAG).
					Acute closed-angle glaucoma.
					Chronic closed-angle glaucoma.
			Strabismus (squint, cross-eye)
			Presbyopia
			Cataract
			Retinopathies
				Vascular retinopathies
				Diabetic retinopathy
				Retinopathy of prematurity (ROP)
			Retinal detachment
			Retinitis pigmentosa
			Tumours
				Choroidal malignant melanoma
				Retinoblastoma
		Refractive errors of the eye
	9 The endocrine system
		Animations
		Overview of hormone action
		Pituitary gland and hypothalamus
			Blood supply
				Arterial blood.
				Venous drainage.
			The influence of the hypothalamus  on the pituitary gland
			Anterior pituitary
				Growth hormone (GH)
				Thyroid stimulating hormone (TSH)
				Adrenocorticotrophic hormone  (ACTH, corticotrophin)
				Prolactin
				Gonadotrophins
					In both sexes.
					In females.
					In males.
			Posterior pituitary
				Oxytocin
				Antidiuretic hormone (ADH, vasopressin)
		Thyroid gland (Fig. 9.7)
			Thyroxine and tri-iodothyronine
			Calcitonin
		Parathyroid glands
			Function
		Adrenal glands
			Adrenal cortex
				Glucocorticoids
				Mineralocorticoids (aldosterone)
					Renin–angiotensin–aldosterone system.
				Sex hormones
			Adrenal medulla  9.3
				Adrenaline (epinephrine) and  noradrenaline (norepinephrine)
			Response to stress
		Pancreatic islets
			Insulin
			Glucagon
			Somatostatin (GHRIH)
		Pineal gland
			Melatonin
		Organs with secondary  endocrine functions
		Local hormones
			Histamine
			Serotonin (5-hydroxytryptamine, 5-HT)
			Prostaglandins (PGs)
		The effects of ageing on endocrine function
			Adrenal cortex
			Pancreatic islets
		Disorders of the pituitary gland
			Hypersecretion of anterior  pituitary hormones
				Gigantism and acromegaly
					Gigantism.
					Acromegaly.
				Hyperprolactinaemia
			Hyposecretion of anterior  pituitary hormones
				Ischaemic necrosis
				Pituitary dwarfism (Lorain–Lévi syndrome)
				Fröhlich’s syndrome
			Disorders of the posterior pituitary
				Diabetes insipidus
		Disorders of the thyroid gland
			Hyperthyroidism
				Graves’ disease
					Exophthalmos.
				Toxic nodular goitre
			Hypothyroidism
				Autoimmune thyroiditis.
					Congenital hypothyroidism.
			Simple goitre  9.4
			Tumours of the thyroid gland
				Benign tumours
		Disorders of the  parathyroid glands
			Hyperparathyroidism
			Hypoparathyroidism
				Tetany
				Hypocalcaemia
		Disorders of the adrenal cortex
			Hypersecretion of glucocorticoids (Cushing’s syndrome)
			Hyposecretion of glucocorticoids
			Hypersecretion of mineralocorticoids
			Hyposecretion of mineralocorticoids
			Chronic adrenocortical insufficiency (Addison’s disease)
				Acute adrenocortical insufficiency  (Addisonian crisis)
		Disorders of the adrenal medulla
			Tumours
				Phaeochromocytoma
				Neuroblastoma
		Disorders of the pancreatic islets
			Diabetes mellitus (DM)
				Type 1 diabetes mellitus
				Type 2 diabetes mellitus
				Pathophysiology of DM
					Raised plasma glucose level
					Glycosuria and polyuria
					Weight loss
					Ketosis and ketoacidosis
				Acute complications of  diabetes mellitus
					Diabetic ketoacidosis
					Hypoglycaemic coma
				Long-term complications of  diabetes mellitus
					Cardiovascular disturbances
						Diabetic macroangiopathy.
						Diabetic microangiopathy.
					Infection
					Renal failure
					Visual impairment and blindness
					Diabetic foot
3 Intake of raw materials and elimination of waste
	10 The respiratory system
		Animations
		Nose and nasal cavity
			Position and structure
				Lining of the nasal cavity  10.3
				Openings into the nasal cavity
			Respiratory function of the nose
				Warming.
				Filtering and cleaning.
				Humidification.
			The sense of smell
		Pharynx
			Position
				Structures associated with the pharynx
					The nasopharynx
					The oropharynx
					The laryngopharynx
			Structure
				Mucous membrane lining
				Submucosa
				Smooth muscle
				Blood and nerve supply
			Functions
				Passageway for air and food
				Warming and humidifying
				Hearing
				Protection
				Speech
		Larynx
			Position
				Structures associated with the larynx
			Structure
				Cartilages
					The thyroid cartilage (Figs 10.5 and 10.6).
					The cricoid cartilage (Fig. 10.7).
					The arytenoid cartilages.
					The epiglottis (Figs 10.4–10.6 and 10.8).
				Blood and nerve supply
				Interior of the larynx (Fig. 10.8)
			Functions
				Production of sound.
				Speech.
				Protection of the lower respiratory tract.
				Passageway for air.
				Humidifying, filtering and warming.
		Trachea
			Position
				Structures associated with the trachea  (Fig. 10.10)
			Structure
				Blood and nerve supply, lymph drainage
			Functions
				Support and patency.
				Mucociliary escalator.
				Cough reflex.
				Warming, humidifying and filtering.
		Lungs
			Position and gross structure (Fig. 10.13)
				The apex
				The base
				The costal surface
				The medial surface
			Pleura and pleural cavity
				The visceral pleura
				The parietal pleura
				The pleural cavity
			Interior of the lungs
				Pulmonary blood supply (Fig. 10.16)
			Bronchi and bronchioles
				The right bronchus.
				The left bronchus.
				Structure  10.4
					Structural changes in the bronchial passages
						Cartilage.
						Smooth muscle.
						Epithelial lining.
					Blood and nerve supply, lymph drainage
				Functions
					Control of air entry.
			Respiratory bronchioles  and alveoli  10.5
				Structure
					Nerve supply to bronchioles
				Functions
					External respiration.
					Defence against infection.
					Warming and humidifying.
		Respiration
			Breathing (pulmonary ventilation).
			Exchange of gases.
			Breathing
				Muscles of breathing
					Intercostal muscles
						The external intercostal muscles
						The internal intercostal muscles
					Diaphragm  10.7
					Accessory muscles of respiration (Fig. 10.22A)
				Cycle of breathing  10.8
					Inspiration
					Expiration
				Physiological variables affecting breathing
					Elasticity.
					Compliance.
					Airway resistance.
				Lung volumes and capacities (Fig. 10.23)
					Tidal volume (TV).
					Inspiratory reserve volume (IRV).
					Inspiratory capacity (IC).
					Functional residual capacity (FRC).
					Expiratory reserve volume (ERV).
					Residual volume (RV).
					Vital capacity (VC).
					Total lung capacity (TLC).
					Alveolar ventilation.
			Exchange of gases
				Composition of air
					Alveolar air
				Diffusion of gases
				External respiration (Fig. 10.24A)  10.9
				Internal respiration (Fig. 10.24B)  10.10
				Transport of gases in the bloodstream
					Oxygen
					Carbon dioxide
				Regulation of air and blood flow  in the lung
			Control of respiration
				The respiratory centre
				Chemoreceptors
					Central chemoreceptors.
					Peripheral chemoreceptors.
				Exercise and respiration
				Other factors that influence respiration
		Ageing and the respiratory system
		Disorders of the upper respiratory tract
			Infectious and inflammatory disorders
				Common cold and influenza
				Sinusitis
				Tonsillitis
				Pharyngitis, laryngitis and tracheitis
				Diphtheria
				Hay fever (allergic rhinitis)
		Obstructive lung disorders
			Bronchitis
				Acute bronchitis
				Chronic bronchitis
					Increased size and number of mucus glands.
					Oedema and other inflammatory changes.
					Reduction in number and function of ciliated cells.
					Fibrosis of the airways.
					Breathlessness (dyspnoea).
			Emphysema (Figs 10.28, 10.29)
				Pulmonary emphysema
					Panacinar emphysema
					Centrilobular emphysema
				Interstitial emphysema
			Asthma (Fig. 10.30)
				Atopic (childhood onset, extrinsic) asthma
				Non-atopic (adult onset, intrinsic) asthma
			Bronchiectasis
			Cystic fibrosis (mucoviscidosis)
		Restrictive disorders
			Pneumoconioses
				Coal worker’s pneumoconiosis
				Silicosis
				Asbestosis
				Extrinsic allergic alveolitis
			Pulmonary toxins
				Paraquat.
				Drugs.
				High concentration oxygen therapy.
		Lung infections
			Pneumonia (Fig. 10.31)
				Impaired coughing.
				Damage to the epithelial lining of the tract.
				Impaired alveolar phagocytosis.
				Hospitalisation.
				Other factors.
				Causative organisms
				Lobar pneumonia (Fig. 10.31A)
				Bronchopneumonia (Fig. 10.31B)
			Lung abscess
				Sources of infection
				Outcomes
			Tuberculosis (TB)
				Pulmonary tuberculosis
					Primary tuberculosis
					Secondary TB
				Non-pulmonary TB
					Miliary TB
					Lymph node TB
					Joint and bone TB
					Other affected tissues
		Lung tumours
			Bronchial carcinoma
				Spread of bronchial carcinoma
					Local spread.
					Lymphatic spread.
					Blood spread.
			Pleural mesothelioma
		Lung collapse (Fig. 10.32)
			Obstruction of an airway  (absorption collapse, Fig. 10.32A)
			Impaired surfactant function
			Pressure collapse
				Pneumothorax
					Spontaneous pneumothorax.
					Traumatic pneumothorax.
					Tension pneumothorax (Fig. 10.33).
				Haemothorax
				Pleural effusion
			Alveolar hypoventilation
	11 Introduction to nutrition
		The balanced diet
			Bread, rice, potatoes, pasta
			Fruit and vegetables
			Milk and dairy foods
			Meat, fish, eggs, beans
			Foods and drinks high in fat and/or sugar
			Additional recommendations
			Groups of people with specific  dietary requirements
		Nutrients
			Carbohydrates
				Monosaccharides
				Disaccharides
				Polysaccharides
				Functions of digestible carbohydrates
			Proteins (nitrogenous foods)
				Amino acids (see Fig. 2.8)
				Nitrogen balance
				Biological value of protein
				Functions of proteins
			Fats
				Fats (triglycerides)
				Cholesterol
				Functions of fats
			Vitamins
				Fat-soluble vitamins
					Vitamin A (retinol)
					Vitamin D
					Vitamin E
					Vitamin K
				Water-soluble vitamins
					Vitamin B complex
						Vitamin B1 (thiamin).
						Vitamin B2 (riboflavin).
						Vitamin B3 (niacin).
						Vitamin B6 (pyridoxine).
						Vitamin B12 (cobalamin).
						Folic acid (folate).
						Pantothenic acid.
						Biotin.
					Vitamin C (ascorbic acid)
			Minerals, trace elements and water
				Minerals and trace elements
					Calcium
					Phosphate
					Sodium
					Potassium
					Iron
					Iodine
				Water
					Functions of water
		Non-starch polysaccharide (NSP)
			Functions of NSP (dietary fibre)
		Nutrition and ageing
			Nutritional disorders in older adults
				Malnutrition
				Obesity
				Vitamin deficiency
				Constipation
		Disorders of nutrition
			Protein-energy malnutrition (PEM)
				Kwashiorkor
				Marasmus
			Malabsorption
			Obesity
		Conditions with  dietary implications
		Further reading
	12 The digestive system
		Animations
		Ingestion.
		Propulsion.
		Digestion.
		Absorption.
		Elimination.
		Organs of the digestive system (Fig. 12.1)
			Alimentary canal
			Accessory organs
		Basic structure of the alimentary canal (Fig. 12.2)
			Adventitia or serosa
				Peritoneum
			Muscle layer
			Submucosa
			Mucosa
				Mucous membrane
			Nerve supply
				The parasympathetic supply.
				The sympathetic supply.
		Mouth (Fig. 12.7)
			Tongue
				Blood supply
				Nerve supply
				Functions of the tongue
			Teeth
				Functions of the teeth
				Structure of a tooth (Fig. 12.12)
					Blood supply
					Nerve supply
		Salivary glands (Fig. 12.13)
			Parotid glands
			Submandibular glands
			Sublingual glands
			Structure of the salivary glands
				Blood supply
				Composition of saliva
			Secretion of saliva
			Functions of saliva
				Chemical digestion of polysaccharides
				Lubrication of food
				Cleaning and lubricating the mouth
				Non-specific defence
				Taste
		Pharynx
			Blood supply
			Nerve supply
		Oesophagus (Fig. 12.14)
			Structure of the oesophagus
				Blood supply
					Arterial.
					Venous drainage.
			Functions of the mouth, pharynx  and oesophagus
				Formation of a bolus
				Swallowing (deglutition) (Fig. 12.16)
					1. Oral stage.
					2. Pharyngeal stage.
					3. Oesophageal stage.
		Stomach
			Organs associated with the stomach  (Fig. 12.17)
			Structure of the stomach (Fig. 12.18)
				Walls of the stomach
					Muscle layer.
					Mucosa.
					Blood supply.
			Gastric juice and functions of  the stomach
				Gastric juice
					Functions of gastric juice
					Secretion of gastric juice
						1. Cephalic phase.
						2. Gastric phase.
						3. Intestinal phase.
				Functions of the stomach
		Small intestine (Figs 12.23 and 12.24)
			Duodenum.
			Jejunum.
			Ileum.
			Structure of the small intestine
				Peritoneum
				Mucosa
				Blood supply
			Intestinal juice
			Functions of the small intestine
			Chemical digestion in  the small intestine
				Pancreatic juice
					Functions
						Digestion of proteins.
						Digestion of carbohydrates.
						Digestion of fats.
					Control of secretion
				Bile
					Functions
					Release from the gall bladder
				Intestinal secretions
					Chemical digestion associated with enterocytes
					Control of secretion
			Absorption of nutrients (Fig. 12.27)
		Large intestine, rectum and  anal canal
			The caecum
			The colon
				The ascending colon.
				The transverse colon.
				The descending colon.
				The sigmoid colon.
			The rectum
			The anal canal
			Structure
				Blood supply
			Functions of the large intestine,  rectum and anal canal
				Absorption
				Microbial activity
				Mass movement
				Defaecation
					Constituents of faeces.
		Pancreas (Fig. 12.32)
			The exocrine pancreas
			The endocrine pancreas
			Blood supply
		Liver
			Organs associated with the liver
				The portal fissure
				Blood supply (see Figs 5.38 and 5.40)
			Structure
			Functions of the liver
				Carbohydrate metabolism
				Fat metabolism
				Protein metabolism
					Deamination of amino acids.
					Transamination.
					Synthesis of plasma proteins.
				Breakdown of erythrocytes and defence  against microbes
				Detoxification of drugs and toxic substances
				Inactivation of hormones
				Production of heat
				Secretion of bile
				Storage
				Composition of bile
					Functions of bile
						Fat digestion.
						Excretion of bilirubin.
		Biliary tract
			Bile ducts (Fig. 12.38)  12.12
				Structure
			Gall bladder
				Structure
					Peritoneum.
					Muscle layer.
					Mucous membrane.
					Blood supply
				Functions of the gall bladder
		Summary of digestion and absorption of nutrients
		Metabolism
			Catabolism.
			Anabolism.
			Metabolic pathways
			Energy
			Energy balance
			Metabolic rate  12.13
			Central metabolic pathways
			Carbohydrate metabolism
				Carbohydrate and energy release (Fig. 12.40)
					Aerobic respiration (catabolism).
					Anaerobic catabolism.
					Fate of the end products of carbohydrate metabolism
						Lactic acid.
						Carbon dioxide.
						Metabolic water.
			Protein metabolism
				Amino acid pool (Fig. 12.41)
					Sources of amino acids
						Exogenous.
						Endogenous.
					Loss of amino acids
						Deamination.
						Excretion.
				Amino acids and energy release (see Fig. 12.44)
			Fat metabolism (Fig. 12.43)
				Fatty acids and energy release
				Glycerol and energy release (Fig. 12.44)
		Effects of ageing on  the digestive system
		Diseases of the mouth
			Inflammatory and infectious conditions
				Thrush (oral candidiasis)
				Gingivitis
				Recurrent aphthous ulceration
				Viral infections
					Acute herpetic gingivostomatitis.
					Secondary or recurrent herpes lesions (cold sores).
			Tumours of the mouth
				Squamous cell carcinoma
			Congenital disorders
				Cleft palate and cleft lip (harelip)
			Dental caries
		Diseases of the pharynx
		Diseases of salivary glands
			Mumps
			Tumours of the salivary glands
				Salivary adenoma
				Carcinoma
		Diseases of the oesophagus
			Oesophageal varices (Fig. 12.46)
			Inflammatory and infectious conditions
				Acute oesophagitis
				Gastro-oesophageal reflux disease (GORD)
				Barrett’s oesophagus
			Achalasia
			Tumours of the oesophagus
				Malignant tumours
			Congenital abnormalities
		Diseases of the stomach
			Gastritis
				Acute gastritis
				Chronic gastritis
					Helicobacter-associated gastritis.
					Autoimmune chronic gastritis.
			Peptic ulcer disease
				Blood supply.
				Secretion of mucus.
				Epithelial cell replacement.
				Acute peptic ulcers
				Chronic peptic ulcers
					Complications of peptic ulcers
						Haemorrhage
						Perforation
						Anaemia
						Gastric outflow obstruction
						Malignancy
			Tumours of the stomach
				Malignant tumours
			Congenital pyloric stenosis
		Diseases of the intestines
			Appendicitis
				Complications of appendicitis
					Peritonitis.
					Abscess formation.
					Adhesions.
			Gastrointestinal infections
				Typhoid and paratyphoid (enteric) fever
				Other Salmonella infections
				Escherichia coli (E. coli) food poisoning
				Staphylococcal food poisoning
				Clostridium perfringens food poisoning
				Antibiotic-associated diarrhoea
				Campylobacter food poisoning
				Cholera
				Dysentery
					Bacillary dysentery.
					Amoebiasis (amoebic dysentery).
				Viral gastroenteritis
					Rotavirus.
					Norovirus.
			Inflammatory bowel disease (IBD)
				Crohn’s disease
				Ulcerative colitis
			Diverticular disease
			Tumours of the small and  large intestines
				Benign tumours
				Colorectal cancer
			Hernias
				Sites of hernias (Fig. 12.51A)
					Inguinal hernia.
					Femoral hernia.
					Umbilical hernia.
					Incisional hernia.
					Hiatus hernia.
						Rolling hiatus hernia
						Sliding hiatus hernia
					Peritoneal hernia.
					Congenital diaphragmatic hernia.
			Volvulus
			Intussusception
			Intestinal obstruction
				Mechanical causes
				Neurological causes of obstruction
				Vascular causes of obstruction
				Effects of intestinal obstruction
			Malabsorption
				Coeliac disease
				Tropical sprue
		Diseases of the pancreas
			Pancreatitis
				Acute pancreatitis
				Chronic pancreatitis
			Cystic fibrosis (see p. 266)
			Tumours of the pancreas
				Malignant tumours
		Diseases of the liver
			Acute hepatitis
				Viral hepatitis
					Hepatitis A
					Hepatitis B
						Hepatitis D.
					Hepatitis C
				Toxic substances
				Circulatory disturbances
			Chronic hepatitis
			Cirrhosis of the liver
			Liver failure
				Hepatic encephalopathy
				Blood coagulation defects
				Oliguria and renal failure
				Oedema and ascites
				Jaundice
			Tumours of the liver
				Malignant tumours
		Diseases of the gall bladder  and bile ducts
			Gallstones (cholelithiasis)
			Cholecystitis
				Acute cholecystitis
				Chronic cholecystitis
			Cholangitis
			Tumours of the biliary tract
				Malignant tumours
			Jaundice
				Types of jaundice
					Pre-hepatic jaundice
					Intra-hepatic jaundice
					Post-hepatic jaundice
	13 The urinary system
		Animations
		Kidneys
			Organs associated with the kidneys  (Figs 13.1 and 13.2)
				Right kidney
				Left kidney
			Gross structure of the kidney  13.2
			Microscopic structure of the kidney   13.3
				The nephron (Fig. 13.4)
			Functions of the kidney
				Formation of urine
					Filtration (Fig. 13.10)  13.4, 13.5
						Autoregulation.
					Selective reabsorption (Fig. 13.11)  13.6
						Hormones that influence selective  reabsorption  13.7
							Parathyroid hormone.
							Antidiuretic hormone, ADH.
							Aldosterone.
							Atrial natriuretic peptide, ANP.
					Tubular secretion (Fig. 13.11)  13.8
					Summary of urine formation
					Composition of urine
				Water balance and urine output
				Electrolyte balance
					Sodium and potassium balance
						Renin–angiotensin–aldosterone system. (Fig. 13.13)
						ANP.
					Calcium balance
				pH balance  13.9
		Ureters
			Structure  13.10
			Function
		Urinary bladder
			Organs associated with the bladder
			Structure (Fig. 13.20)  13.11
		Urethra
		Micturition
		The effects of ageing of  the urinary system
		Diseases of the kidneys
			Glomerulonephritis (GN)
				Effects of glomerulonephritis
					Haematuria.
					Asymptomatic proteinuria.
					Acute nephritis.
					Nephrotic syndrome.
					Chronic renal failure.
			Nephrotic syndrome
			Diabetic nephropathy
			Hypertension and the kidneys
				Secondary hypertension
				Malignant hypertension
			Acute pyelonephritis
				Ascending infection.
				Blood-borne infection.
				Pathophysiology
			Reflux nephropathy
			Renal failure
				Acute renal failure
					Acute tubular necrosis (ATN)
				Chronic renal failure
					Polyuria.
					Acidosis.
					Electrolyte imbalance.
					Anaemia.
					Hypertension.
					End-stage renal failure
			Renal calculi  13.13
				Small calculi  13.14
				Large calculi (staghorn calculus)
			Congenital abnormalities of  the kidneys
				Misplaced (ectopic) kidney
				Polycystic disease
					Autosomal dominant polycystic kidney disease (ADPKD).
			Tumours of the kidney
				Malignant tumours
					Renal adenocarcinoma
					Nephroblastoma (Wilms’ tumour)
		Diseases of the renal pelvis, ureters, bladder and urethra
			Obstruction to the outflow of urine
				Hydronephrosis  13.15
					Complete sustained obstruction
					Partial or intermittent obstruction
				Spinal lesions
			Urinary tract infections (UTIs)
				Ureteritis
				Cystitis
					Predisposing factors.
				Urethritis
			Tumours of the bladder
				Transitional cell carcinomas
				Solid tumours
			Urinary incontinence
				Stress incontinence
				Urge incontinence
				Overflow incontinence
4 Protection and survival
	14 The skin
		Animation
		The skin
			Structure of the skin
				Epidermis
				Dermis (Fig. 14.2)
					Blood and lymph vessels.
					Sensory nerve endings.
					Sweat glands
					Hairs
						Arrector pili (Fig. 14.2).
						Sebaceous glands (Fig. 14.2).
					Nails (Fig. 14.6)
			Functions of the skin
				Protection
				Regulation of body temperature
					Heat production
					Heat loss
						Mechanisms of heat loss (Fig. 14.7).
					Control of body temperature
						Activity of the sweat glands.
						Regulation of blood flow through the skin.
					Fever
					Hypothermia
				Formation of vitamin D
				Cutaneous sensation
				Absorption
				Excretion
			Wound healing
				Conditions required for wound healing
					Systemic factors.
					Local factors.
				Primary healing (healing by first intention)
					Inflammation.
					Proliferation.
					Maturation.
				Secondary healing (healing by second intention)
					Inflammation.
					Proliferation.
					Maturation.
				Fibrosis (scar formation)
					Adhesions.
					Fibrosis of infarcts.
					Tissue shrinkage.
				Complications of wound healing
					Infection.
		Effects of ageing on the skin
		Disorders of the skin
			Infections
				Viral infections
					Human papilloma virus (HPV)
					Herpes viruses
				Bacterial infections
					Impetigo
					Cellulitis
				Fungal infections (mycoses)
					Ringworm and tinea pedis
			Non-infective inflammatory conditions
				Dermatitis (eczema)
				Psoriasis
				Acne vulgaris
			Pressure ulcers
				Predisposing factors
			Burns
				Complications of burns
					Dehydration and hypovolaemia.
					Shock.
					Hypothermia.
					Infection.
					Renal failure.
					Contractures.
			Malignant tumours
				Basal cell carcinoma
				Malignant melanoma
				Kaposi’s sarcoma
	15 Resistance and immunity
		Animations
		Non-specific defence mechanisms.
		Specific defence mechanisms.
		Non-specific defence mechanisms
			Defence at body surfaces
			Phagocytosis  15.1
			Natural antimicrobial substances
				Hydrochloric acid.
				Lysozyme.
				Antibodies.
				Saliva.
				Interferons.
				Complement  15.2.
			The inflammatory response  15.3
				Causes of inflammation
				Acute inflammation
					Increased blood flow
					Increased tissue fluid formation
					Migration of leukocytes
						Chemotaxis.
					Increased temperature
					Pain
					Suppuration (pus formation)
					Outcomes of acute inflammation
						Resolution.
						Development of chronic inflammation.
				Chronic inflammation
			Immunological surveillance
		Immunity
			Specificity.
			Memory.
			Tolerance.
			Lymphocytes
				T-cells
				B-cells
			Cell-mediated immunity  15.4
				Cytotoxic T-cells
				Helper T-cells
				Suppressor T-cells
				Memory T-cells
			Antibody-mediated  (humoral) immunity  15.5
				Plasma cells
				Memory B-cells
			Acquired immunity
				The primary response.
				The secondary response.
				Active naturally acquired immunity
				Active artificially acquired immunity
				Passive naturally acquired immunity
				Passive artificially acquired immunity
			Summary of the immune response to  a bacterial infection
		Ageing and immunity
		Abnormal immune function
			Hypersensitivity (allergy)  15.7
				Type I, anaphylactic hypersensitivity
				Type II, cytotoxic hypersensitivity
				Type III, immune-complex-mediated hypersensitivity
				Type IV, delayed type hypersensitivity
			Autoimmune disease
			Immunodeficiency
				Acquired immune deficiency syndrome (AIDS)
					Stages of HIV infection.
	16 The musculoskeletal system
		Animations
		Bone
			Functions of bones
			Types of bones
				Long bones.
				Short, irregular, flat and sesamoid bones.
			Bone structure
				Long bones
					Blood and nerve supply
				Short, irregular, flat and sesamoid bones
			Microscopic structure of bone
				Bone cells
					Osteoblasts
					Osteocytes
					Osteoclasts
				Compact (cortical) bone
				Spongy (cancellous, trabecular) bone
			Development of bone tissue  16.1
				Development of long bones
				Hormonal regulation of bone growth
				Exercise and bone
				Diet and bone
			Bone markings
			Healing of bone  16.2
				Factors that delay healing of fractures
					Tissue fragments between bone ends.
					Deficient blood supply.
					Poor alignment of bone ends.
					Continued mobility of bone ends.
					Miscellaneous.
				Complications of fractures
					Infection (osteomyelitis, p. 432).
					Fat embolism.
		Axial skeleton
			Skull (Figs 16.10 and 16.11)
				Sinuses
				Cranium
					Frontal bone
					Parietal bones
					Temporal bones (Fig. 16.12)
					Occipital bone (Fig. 16.13)
					Sphenoid bone (Fig. 16.14)
					Ethmoid bone (Fig. 16.15)
				Face
					Zygomatic (cheek) bones
					Maxilla (upper jaw bone)
					Nasal bones
					Lacrimal bones
					Vomer
					Palatine bones
					Inferior conchae
					Mandible (lower jaw bone, Fig. 16.17)
					Hyoid bone
				Fontanelles of the skull (Fig. 16.18)
				Functions of the skull
			Vertebral column (Fig. 16.19)  16.3
				Characteristics of a typical  vertebra (Fig. 16.20)
					The body.
					The vertebral (neural) arch.
				Region-specific vertebral characteristics
					Cervical vertebrae (Fig. 16.21)
					Thoracic vertebrae (Fig. 16.23)
					Lumbar vertebrae (Fig. 16.20)
					Sacrum (Fig. 16.24)
					Coccyx (Fig. 16.24)
				Features of the vertebral column
					Intervertebral discs
					Intervertebral foramina
					Ligaments of the vertebral column (Fig. 16.25)
					Curves of the vertebral column (Fig. 16.27)
					Movement of the vertebral column
				Functions of the vertebral column
			Thoracic cage (Fig. 16.28)
				Sternum (breast bone, Fig. 16.29)
				Ribs
		Appendicular skeleton
			Shoulder girdle and upper limb
				Shoulder girdle
					Clavicle (collar bone, Fig. 16.31)
					Scapula (shoulder blade, Fig. 16.32)
				The upper limb
					Humerus (Fig. 16.33)
					Ulna and radius (Fig. 16.34)
					Carpal (wrist) bones (Fig. 16.35)
					Metacarpal bones (bones of the hand)
					Phalanges (finger bones)
			Pelvic girdle and lower limb
				The pelvic girdle
					Innominate (hip) bones (Fig. 16.36)
					The pelvis (Fig. 16.37)
						Differences between male and female pelves (Fig. 16.38).
				The lower limb
					Femur (thigh bone, Fig. 16.39)
					Tibia (shin bone, Fig. 16.40)
					Fibula (Fig. 16.40)
					Patella (knee cap)
					Tarsal (ankle) bones (Fig. 16.41)
					Metatarsals (bones of the foot, Fig. 16.41)
					Phalanges (toe bones, Fig. 16.41)
						Arches of the foot.
							Posterior tibialis muscle
							Short muscles of the foot
							Plantar calcaneonavicular ligament (‘spring’ ligament)
							Plantar ligaments and interosseous membranes
		Joints
			Fibrous joints
			Cartilaginous joints
			Synovial joints
				Characteristics of a synovial joint
					Articular or hyaline cartilage
					Capsule or capsular ligament
					Synovial membrane
						Synovial fluid.
					Other intracapsular structures
					Extracapsular structures
					Nerve and blood supply
				Movements at synovial joints
				Types of synovial joint
					Ball and socket joints
					Hinge joints
					Gliding joints
					Pivot joints
					Condyloid joints
					Saddle joints
			Main synovial joints of  the limbs   16.4
				Shoulder joint (Fig. 16.47)
					Muscles and movements (see Fig. 16.65)
				Elbow joint (Fig. 16.48)
					Muscles and movements (see Fig. 16.65)
				Proximal and distal radioulnar joints
					Muscles and movements (see Fig. 16.65)
				Wrist joint (Fig. 16.49)
					Muscles and movements (see Fig. 16.65)
				Joints of the hands and fingers
				Hip joint (Fig. 16.51)
					Muscles and movements (see Fig. 16.66)
				Knee joint (Fig. 16.52)
					Muscles and movements (see Fig. 16.66)
				Ankle joint (Fig. 16.53)
					Muscles and movements (see Fig. 16.66)
				Joints of the feet and toes
		Skeletal muscle
			Organisation of skeletal  muscle (Fig. 16.54)
				Skeletal muscle cells (fibres)
					Structure
						Actin, myosin and sarcomeres.
					Contraction
			The neuromuscular junction  16.6
				Motor units
			Action of skeletal muscle
				Muscle tone
				Muscle fatigue
				Muscle recovery
				Factors affecting skeletal muscle performance
				The action of skeletal muscles
					Isometric and isotonic contraction  16.7
				Muscle terminology
			Principal skeletal muscles
				Muscles of the face and neck (Fig. 16.58)
					Muscles of the face
						Occipitofrontalis (unpaired).
						Levator palpebrae superioris.
						Orbicularis oculi.
						Buccinator.
						Orbicularis oris (unpaired).
						Masseter.
						Temporalis.
						Pterygoid.
					Muscles of the neck
						Sternocleidomastoid.
						Trapezius.
				Muscles of the trunk
					Muscles of the back
						Latissimus dorsi.
						Teres major.
						Quadratus lumborum.
						Sacrospinalis (erector spinae).
					Muscles of the abdominal wall
						Rectus abdominis.
						External oblique.
						Internal oblique.
						Transversus abdominis.
					Inguinal canal
					Muscles of the thorax
				Muscles of the pelvic floor (Fig. 16.64)
					Levator ani.
					Coccygeus.
				Muscles of the shoulder and  upper limb (Fig. 16.65)
					Deltoid.
					Pectoralis major.
					Coracobrachialis.
					Biceps.
					Brachialis.
					Triceps.
					Brachioradialis.
					Pronator quadratus.
					Pronator teres.
					Supinator.
					Flexor carpi radialis.
					Flexor carpi ulnaris.
					Extensor carpi radialis longus and brevis.
					Extensor carpi ulnaris.
					Palmaris longus.
					Extensor digitorum.
					Muscles that control finger movements.
				Muscles of the hip and  lower limb (Fig. 16.66)
					Psoas.
					Iliacus.
					Quadriceps femoris.
					Obturators.
					Gluteals.
					Sartorius.
					Adductor group.
					Hamstrings.
					Gastrocnemius.
					Anterior tibialis.
					Soleus.
		Ageing and the musculoskeletal system
		Diseases of bone
			Osteoporosis
			Paget’s disease
			Rickets and osteomalacia
			Osteomyelitis
			Developmental abnormalities of bone
				Achondroplasia
				Osteogenesis imperfecta  (‘brittle bone syndrome’)
			Tumours of bone
				Benign tumours
				Malignant tumours
					Metastatic tumours
					Primary tumours
		Disorders of joints
			Inflammatory joint disease (arthritis)
				Rheumatoid arthritis  (RA, rheumatoid disease)
				Other types of polyarthritis
					Ankylosing spondylitis.
					Psoriatic arthritis.
					Reiter’s syndrome (polyarthritis with urethritis and conjunctivitis).
					Rheumatic fever.
				Infective arthritis
			Osteoarthritis (osteoarthrosis, OA)
			Traumatic injury to joints
				Sprains, strains and dislocations
				Penetrating injuries
			Gout
			Connective tissue diseases
			Carpal tunnel syndrome
		Diseases of muscle
			Myasthenia gravis
			Muscular dystrophies
				Duchenne muscular dystrophy
				Facioscapulohumeral dystrophy
				Myotonic dystrophy
			Rotator cuff injury
	17 Introduction to genetics
		Animations
		Chromosomes, genes and DNA
			Chromosomes
			Genes
			DNA
				The genetic code
				Mitochondrial DNA
			Mutation
		Protein synthesis
			Messenger ribonucleic acid (mRNA)
				Transcription  17.4
				Translation  17.5
				Gene expression
		Cell division
			DNA replication
			Mitosis
			Meiosis
				First meiotic division
				Second meiotic division
		The genetic basis of inheritance
			Autosomal inheritance
				Punnett squares  17.8
				Co-dominance
			Sex-linked inheritance  17.9
		Ageing and genetics
			Ageing and DNA
				Cell senescence (ageing).
		Genetic basis of disease
			Cancer
			Inherited disease
				Gene mutations
					Phenylketonuria
					Mitochondrial abnormalities
				Chromosomal abnormalities
					Down syndrome
					Cri-du-chat syndrome
					Abnormalities of the sex chromosomes
						Turner syndrome.
						Klinefelter syndrome.
	18 The reproductive systems
		Animations
		Female reproductive system
			External genitalia (vulva)  18.1
				Labia majora
				Labia minora
				Clitoris
				Vestibular glands  18.2
				Blood supply, lymph drainage and nerve supply
					Arterial supply.
					Venous drainage.
					Lymph drainage.
					Nerve supply.
				Perineum
			Internal genitalia
				Vagina  18.3
					Hymen.
					Structure of the vagina
						Blood supply, lymph drainage and nerve supply
							Arterial supply.
							Venous drainage.
							Lymph drainage.
							Nerve supply.
					Functions of the vagina
				Uterus
					Fundus.
					Body.
					Cervix (‘neck’ of the uterus).
					Structure
						Perimetrium.
						Myometrium.
						Endometrium.
						Blood supply, lymph drainage and nerve supply
							Arterial supply.
							Venous drainage.
							Lymph drainage.
							Nerve supply.
					Supporting structures
						Broad ligaments.
						Round ligaments.
						Uterosacral ligaments.
						Transverse cervical (cardinal) ligaments.
						Pubocervical fascia.
					Functions of the uterus
				Uterine tubes
					Structure
					Functions
				Ovaries  18.4
					Structure
						Medulla.
						Cortex.
						Blood supply, lymph drainage and nerve supply
							Arterial supply.
							Venous drainage.
							Lymph drainage.
							Nerve supply.
					Functions
				Puberty in the female
				The reproductive cycle
					Menstrual phase
					Proliferative phase
					Secretory phase
				Menopause
			Breasts  18.7
				Structure
					The nipple.
					Blood supply, lymph drainage and nerve supply
						Arterial supply.
						Venous drainage.
						Lymph drainage.
						Nerve supply.
				Functions
		Male reproductive system
			Scrotum
			Testes 18.8
				Tunica vaginalis.
				Tunica albuginea.
				Tunica vasculosa.
				Structure
				Functions
				Spermatic cords
					Blood supply, lymph drainage and nerve supply
						Arterial supply.
						Venous drainage.
						Lymph drainage.
						Nerve supply.
					The deferent duct
			Seminal vesicles  18.10
				Functions
			Ejaculatory ducts
			Prostate gland
				Functions
			Urethra and penis  18.11
				Urethra
				Penis  18.12
			Ejaculation
			Puberty in the male
		Human development
			Nourishment during intrauterine growth.
			The first 3 months
			Later pregnancy
		Ageing and the reproductive systems
			Ageing and reproduction in the female
			Ageing and reproduction in the male
		Sexually transmitted infections
			Chlamydia
			Gonorrhoea
			Syphilis
			Trichomonas vaginalis
			Candidiasis
			Acquired immune deficiency syndrome (AIDS) and hepatitis B infection
			Genital herpes
		Diseases of the female reproductive system
			Pelvic inflammatory disease (PID)
			Disorders of the uterus
				Cervical carcinoma
				Disorders of the endometrium
					Endometriosis
					Endometrial hyperplasia
					Endometrial carcinoma
				Disorders of the myometrium
					Adenomyosis
					Leiomyoma (fibroid, myoma)
			Disorders of the uterine tubes  and ovaries
				Acute salpingitis
				Ectopic pregnancy
				Ovarian tumours
					Metastatic ovarian tumours
			Female infertility
			Disorders of the breast
				Mastitis (inflammation of the breast)
				Tumours of the breast
					Benign tumours
					Malignant tumours
		Diseases of the male reproductive system
			Infections of the penis
			Infections of the urethra
			Epididymis and testes
				Infections
					Specific epididymitis.
					Orchitis (inflammation of the testis).
				Undescended testis (cryptorchidism)
				Hydrocele
				Testicular tumours
			Prostate gland
				Infections
				Benign prostatic enlargement
				Malignant prostatic tumours
			Breast
				Gynaecomastia
				Malignant tumours
			Male infertility
Glossary
Normal values
	Metric measures, units and SI symbols
	Hydrogen ion concentration (pH)
	Some normal plasma levels in adults
		Arterial blood gases
		Blood pressure
		Heart rate
		Respiration rate
		Blood count
		Diet
		Urine
		Body temperatures
		Cerebrospinal fluid pressure
		Intraocular pressure
Bibliography
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y
	Z