Berne & Levy Physiology

Cover
Berne & Levy Physiology
Copyright
Dedication
Section Authors
Preface
Note to Instructors
Contents
1 - Principles of Cell and Membrane Function
	Overview of Eukaryotic Cells
		The Plasma Membrane
			Structure and Composition
				Membrane Lipids
				Membrane Proteins
			Membrane Transport
			Membrane Transport Proteins
				Water Channels
				Ion Channels
				Solute Carriers
				Adenosine Triphosphate–Dependent Transporters
	Vesicular Transport
		Basic Principles of Solute and Water Transport
		Diffusion
	Electrochemical Gradient
		Active and Passive Transport
	Osmosis and Osmotic Pressure
		Osmolarity Versus Osmolality
		Tonicity
		Oncotic Pressure
		Specific Gravity
	Key Points
2 - Homeostasis: Volume and Composition of Body Fluid Compartments
	.
	Concept of Steady-State Balance
	Volumes and Composition of Body Fluid Compartments
		Definition and Volumes of Body Fluid Compartments
		Movement of Water Between Body Fluid Compartments
			Example 1: Addition of Isotonic Sodium Chloride to the Extracellular Fluid
			Example 2: Addition of Hypotonic Sodium Chloride to the Extracellular Fluid
			Example 3: Addition of Hypertonic Sodium Chloride to the Extracellular Fluid
		Composition of Body Fluid Compartments
	Maintenance of Cellular Homeostasis
		Ionic Composition of Cells
		Membrane Potential
		Regulation of Cell Volume
			Isotonic Cell Volume Regulation
			Nonisotonic Cell Volume Regulation
	Principles of Epithelial Transport
		Epithelial Structure
		Vectorial Transport
		Transepithelial Water Movement
		Regulation of Epithelial Transport
	Key Concepts
3 - Signal Transduction, Membrane Receptors, Second Messengers, and Regulation of Gene Expression
	Cell-to-Cell Communication
	Receptors
	Receptors and Signal Transduction Pathways
		Ligand-Gated Ion Channel Signal Transduction Pathways
		G Protein–Coupled Signal Transduction Pathways
		Protein Phosphatases and Phosphodiesterases Counteract the Activation of Cyclic Nucleotide Kinases
		Enzyme Receptor–Linked Signal Transduction Pathways
			Guanylyl Cyclase Receptors
			Threonine/Serine Kinase Receptors
			Tyrosine Kinase Receptors
			Tyrosine Kinase–Associated Receptors
	Regulation of Gene Expression by Signal Transduction Pathways
		Nuclear Receptor Signal Transduction Pathways
		Cell-Surface Signal Transduction Pathways Control Gene Expression
	Key Points
4 - The Nervous System: Introduction to Cells and Systems
	Cellular Components of the Nervous System
		Neurons
			Axonal Transport
		Glia
	The Peripheral Nervous System
	The Central Nervous System
		Regional Anatomy of the CNS
		Cerebrospinal Fluid
		The Blood-Brain Barrier
	Nervous Tissue Reactions to Injury
		Degeneration
		Regeneration
	Key Points
5 - Generation and Conduction of Action Potentials
	Membrane Potentials
		Observations on Membrane Potentials
		The Passive Response
		The Local Response
	Suprathreshold Response: The Action Potential
		Ionic Basis of Action Potentials
		Ion Channels and Gates
		The Characteristics of the Na+ and K+ Channels Explain the Conductance Changes During the Action Potential
		Accommodation
		Refractory Periods
	Conduction of Action Potentials
		Action Potential Propagation
		Action Potential Conduction Velocity Is Correlated With Axon Diameter
		Myelination Greatly Increases Conduction Velocity
		Functional Consequences of Myelination
		Sensory Transduction
		Receptive Fields
		Coding of Information by Action Potentials
		Sensory Coding
	Key Points
6 - Synaptic Transmission
	Electrical Synapses
	Chemical Synapses
		Calcium Entry Is the Signal for Transmitter Release
		Synaptic Vesicles and the Quantal Nature of Transmitter Release
		Molecular Apparatus Underlying Vesicular Release
		Synaptic Vesicles Are Recycled
		Postsynaptic Potentials
	Synaptic Integration
	Modulation of Synaptic Activity
		Paired-Pulse Facilitation
		Post-tetanic Potentiation
		Synaptic Depression
		Presynaptic Receptors Can Modulate Transmitter Release
		Long-Term Changes in Synaptic Strength
	Neurotransmitters
		Small-Molecule Neurotransmitters
			Acetylcholine
			Amino Acids
			Biogenic Amines
			Purines
		Peptides
			Opioid Peptides
			Substance P
			Endocannabinoids
		Gas Neurotransmitters
	Neurotransmitter Receptors
		Acetylcholine Receptors
		Inhibitory Amino Acid Receptors: GABA and Glycine
		Excitatory Amino Acid Receptors: Glutamate
		Purine (ATP) Receptors
		Biogenic Amine Receptors: Serotonin, Dopamine, Noradrenaline, Adrenaline, Histamine
		Neuropeptide Receptors
		Cannabinoid Receptors
		Gas Neurotransmitter Receptors
	Key Points
7 - The Somatosensory System
	Subdivisions of the Somatosensory System
	Discriminatory Touch and Proprioception
		Innervation of the Skin
			Low-Threshold Mechanoreceptors
			Receptive Field Properties
		Innervation of the Body
		Innervation of the Face
		Central Somatosensory Pathways for Discriminatory Touch and Proprioception
			Dorsal Column–Medial Lemniscus Pathway
			Trigeminal Pathway for Fine-Touch Sensation From the Face
			Spinocerebellar and Proprioceptive Pathways
	Thalamic and Cortical Somatosensory Areas
		Thalamus
		Somatosensory Cortex
			Effects of Lesions of the Somatosensory Cortex
	Pain and Temperature Sensation
		Nociceptors and Primary Afferents
			Spinal Cord Gray Matter and Trigeminal Nucleus
		Central Pain Pathways
			Effects of Interruption of the Spinothalamic Tract and Lesions of the Thalamus on Somatosensory Sensation
		Neuropathic Pain
	Transduction in the Somatosensory System
		Mechanotransduction
		Thermal Transduction
		Modulation of the Transduction Process
	Centrifugal Control of Somatosensation
	Key Points
8 - The Special Senses
	The Visual System
		Structure of the Eye
		Retina
			Layers of the Retina
			Structure of Photoreceptors: Rods and Cones
			Regional Variations in the Retina
			Visual Transduction
			Visual Adaptation
				Light Adaptation
				Dark Adaptation
			Color Vision
			Retinal Circuitry
			Contrasts in Rod and Cone Pathway Functions
			Synaptic Interactions and Receptive Field Organization
			P, M, and W Cells
		The Visual Pathway
			Lateral Geniculate Nucleus
			Striate Cortex
		Extrastriate Visual Cortex
		Other Visual Pathways
	The Auditory and Vestibular Systems
		Audition
			Sound
			The Ear
				External Ear
				Middle Ear
				Inner Ear
			Sound Transduction
			Cochlear Nerve Fibers
				Characteristic Frequencies
				Encoding
			Central Auditory Pathway
			Functional Organization of the Central Auditory System
				Receptive Fields and Tonotopic Maps
				Binaural Interactions
				Cortical Organization
		The Vestibular System
			The Vestibular Apparatus
				Structure of the Vestibular Labyrinth
				Innervation of Sensory Epithelia of the Vestibular Apparatus
			Vestibular Transduction
				Semicircular Canals
				Otolith Organs
			Central Vestibular Pathways
	The Chemical Senses
		Taste
			Taste Receptors
			Distribution and Innervation of Taste Buds
			Central Taste Pathways
		Olfaction
			Olfactory Receptors
			Central Pathways
	Key Points
9 - Organization of Motor Function
	Principles of Spinal Cord Organization
		Somatic Motor Neurons
			α Motor Neurons
			γ Motor Neurons
		Topographic Organization of Motor Neurons in the Ventral Horn
		Spinal Reflexes
			The Myotatic or Stretch Reflex
				Structure of the Muscle Spindle
				Muscle Spindles Detect Changes in Muscle Length
				γ Motor Neurons Adjust the Sensitivity of the Spindle
				The Phasic (or Ia) Stretch Reflex
				The Tonic Stretch Reflex
			Inverse Myotatic or Group Ib Reflex
			Flexion Reflexes and Locomotion
		Determining Spinal Cord Organization Through the Use of Reflexes
	Descending Motor Pathways
		Classification of Descending Motor Pathways
		The Lateral System
			Lateral Corticospinal and Corticobulbar Tracts
			Rubrospinal Tract
		The Medial System
			Pontine and Medullary Reticulospinal Tracts
			Lateral and Medial Vestibulospinal Tracts
			The Tectospinal Tract
		Monoaminergic Pathways
		Motor Deficits Caused by Lesions of Descending Motor Pathways
		The Decerebrate Preparation
	Brainstem Control of Posture and Movement
		Postural Reflexes
		Brainstem Control of Locomotion
	Motor Control by the Cerebral Cortex
		Cortical Motor Areas
		Somatotopic Organization of Cortical Motor Areas
			Primary Motor Cortex
			Supplementary Motor Area
			Premotor Area
			Cingulate Motor Areas
		Connections of the Cortical Motor Areas
		Activity of Motor Cortex Neurons
		Activity in Other Cortical Motor Areas
	Motor Control by the Cerebellum
		Overview of the Role of the Cerebellum in Motor Control
		Behavioral Consequences of Cerebellar Damage
		Cerebellar Organization
		Cerebellar Cortex
			Afferent Systems
			Cellular Elements and Efferent Fibers of the Cerebellar Cortex
			Microcircuitry of the Cerebellar Cortex
		Cerebellar Nuclei
		Activity of Purkinje Cells in the Cerebellar Cortex in the Context of Motor Coordination
	Motor Control by the Basal Ganglia
		Organization of the Basal Ganglia and Related Nuclei
		Connections and Operation of the Basal Ganglia
			Direct Pathway
			Indirect Pathway
		Actions of Neurons in the Pars Compacta of the Substantia Nigra on the Striatum
		Subdivision of the Striatum Into Striosomes and Matrix
		Role of the Basal Ganglia in Motor Control
	Eye Movement
		Types of Eye Movement
			Vestibulo-ocular Reflex
			Optokinetic Reflex
			Saccades
			Smooth Pursuit
			Nystagmus
			Vergence
		Neural Circuitry and Activity Underlying Eye Movement
			Motor Neurons of the Extraocular Muscles
			Circuits Underlying the Vestibulo-ocular Reflex
			Circuits Underlying the Optokinetic Reflex
			Circuits Underlying Saccades
			Circuits Underlying Smooth Pursuit
			Circuits Underlying Vergence
	Key Points
10 - Integrative Functions of the Nervous System
	The Cerebral Cortex
		The Neocortex
			Neuronal Cell Types in the Neocortex
			Cytoarchitecture of Cortical Layers
			Cortical Afferent and Efferent Fibers
			Regional Variations in Neocortical Structure
		Archicortex and Paleocortex
		Functions of the Lobes of the Cerebral Cortex
			Frontal Lobe
			Parietal Lobe
			Occipital Lobe
			Temporal Lobe
		The Electrical Activity of the Cortex
		Evoked Potentials
		Sleep-Wake Cycle
		Cerebral Dominance and Language
		Interhemispheric Communication and the Corpus Callosum
		Learning and Memory
			Long-Term Potentiation
			Memory
			Neural Plasticity
	Key Points
11 - The Autonomic Nervous System and Its Central Control
	Organization of the Autonomic Nervous System
		The Sympathetic Nervous System
		The Parasympathetic Nervous System
		Visceral Afferent Fibers
		The Enteric Nervous System
	Autonomic Ganglia
	Neurotransmitters
		Neurotransmitters in Autonomic Ganglia
		Neurotransmitters Between Postganglionic Neurons and Autonomic Effectors
			Sympathetic Postganglionic Neurons
			Parasympathetic Postganglionic Neurons
	Central Control of Autonomic Function
		Examples of Autonomic Control of Particular Organs
			Pupil
			Urinary Bladder
		Autonomic Centers in the Brain
			The Hypothalamus and Preoptic Area
			Temperature Regulation
			Regulation of Feeding and Body Weight
			Regulation of Water Intake
			Other Autonomic Control Structures
		Neural Influences on the Immune System
	Key Points
12 - Skeletal Muscle Physiology
	Skeletal Muscle Physiology
	Organization of Skeletal Muscle
	Control of Skeletal Muscle Activity
		Motor Nerves and Motor Units
		Excitation-Contraction Coupling
		Actin-Myosin Interaction: Cross-Bridge Formation
		Cross-Bridge Cycling: Sarcomere Shortening
	Skeletal Muscle Types
	Modulation of the Force of Contraction
		Recruitment
		Tetany
	Modulation of Force by Reflex Arcs
		Stretch Reflex
		Golgi Tendon Organ
	Skeletal Muscle Tone
	Energy Sources During Contraction
		Adenosine Triphosphate
		Creatine Phosphate
		Carbohydrates
		Fatty Acids and Triglycerides
	Oxygen Debt
	Fatigue
	Growth and Development
	Denervation, Reinnervation, and Cross-Innervation
	Response to Exercise
	Delayed-Onset Muscle Soreness
	Biophysical Properties of Skeletal Muscle
		Length-Tension Relationship
		Force-Velocity Relationship
	Key Points
13 - Cardiac Muscle
	Basic Organization of Cardiac Muscle Cells
	Control of Cardiac Muscle Activity
		Excitation-Contraction Coupling
		Contraction Mechanism
		Relaxation of Cardiac Muscle
	Regulation of the Force of Contraction
		Intracellular Calcium
		β-Adrenergic Agonists
		Stretch
	Cardiac Muscle Metabolism
	Cardiac Muscle Hypertrophy
	Key Concepts
14 - Smooth Muscle
	Overview of Smooth Muscle
		Types of Smooth Muscle
	Structure of Smooth Muscle Cells
		Cell-to-Cell Contact
		Cells and Membranes
		Contractile Apparatus
		Cytoskeleton
	Control of Smooth Muscle Activity
	Innervation of Smooth Muscle
	Regulation of Contraction
		Phasic Versus Tonic Contraction
		Energetics and Metabolism
	Regulation of Myoplasmic Calcium Concentration
		Sarcoplasmic Reticulum
		Sarcolemma
		Myogenic Response
	Development and Hypertrophy
	Synthetic and Secretory Functions
	Biophysical Properties of Smooth Muscle
		Length-Tension Relationship
		Force-Velocity Relationship
	Key Points
15 - Overview of Circulation
	.
	The Heart
	The Cardiovascular Circuit
	Blood Vessels
	Key Points
16 - Elements of Cardiac Function
	Overview of Cardiac Function
	Electrical Properties of the Heart
		Cardiac Action Potentials
		Ionic Basis of Membrane Potential
		Fast-Response (Ventricular) Action Potentials
			Upstroke (Phase 0)
			Initial Repolarization (Phase 1)
			Plateau (Phase 2)
			Final Repolarization (Phase 3)
			Resting Membrane Potential (Phase 4)
		Slow-Response (SA Node) Action Potentials
			Upstroke (Phase 0)
			Final Repolarization (Phase 3)
			Diastole (Phase 4)
		Excitability of Cardiac Myocytes
			Fast-Response Cells
			Slow-Response Cells
			Frequency-Dependent Effects on Excitability
		Propagation of Cardiac Impulses
			Passive Properties
			Active Properties
	Normal Sinus Rhythm
		Initiation of the Heartbeat
		Sinoatrial Node
		Atrial Conduction
		Atrioventricular Conduction
		Ventricular Conduction
	Arrhythmogenic Mechanisms
		Triggered Activity
			Early Afterdepolarizations
			Delayed Afterdepolarizations
		Reentry
	Electrocardiography
		Scalar Electrocardiography
		Standard Limb Leads
	Arrhythmias
		Altered Sinoatrial Rhythms
		Atrioventricular Conduction Blocks
		Premature Depolarizations
		Ectopic Tachycardias
		Fibrillation
	The Cardiac Pump
		Cardiac Excitation-Contraction Coupling
			Ca++ Channels and E-C Coupling
			SR Ca++ Content and Ca++ Flux Balance
			Modulation of Cardiac E-C Coupling Mechanisms
			Relaxation
			Force-Frequency Relationship
			Contractility
		Physical Factors Influencing Myocardial Contraction
			Length Dependence of Cardiac Contraction
			Preload and Afterload
		Structure of the Heart as a Pump
			Cardiac Chambers
			Cardiac Valves
				Atrioventricular Valves
				Semilunar Valves
			The Pericardium
		Heart Sounds
		The Cardiac Cycle
			Ventricular Systole
				Isovolumic Contraction
				Ejection
			Ventricular Diastole
				Isovolumic Relaxation
				Rapid Filling Phase
				Diastasis
			Atrial Systole
			Indices of Contractility in the Intact Heart
			Pressure-Volume Relationship, Left Ventricle
		Measurement of Cardiac Output
			The Fick Principle
			Cardiac Oxygen Consumption and Work
			Cardiac Efficiency
			Myocardial Adenosine Triphosphate and Its Relation to Mechanical Function
			Substrate Utilization
	Key Points
17 - Properties of the Vasculature
	Hemodynamics
		Velocity of the Bloodstream
		Relationship Between Velocity and Pressure
		Relationship Between Pressure and Flow
			Poiseuille’s Law
			Resistance to Flow
			Resistances in Series and in Parallel
				Resistance of Vessels in Series
				Resistance of Vessels in Parallel
			Laminar and Turbulent Flow
			Shear Stress on the Vessel Wall
		Rheologic Properties of Blood
	The Arterial System
		Arterial Elasticity
		Determinants of Arterial Blood Pressure
			Mean Arterial Pressure
			Arterial Pulse Pressure
				Stroke Volume
				Arterial Compliance
				Total Peripheral Resistance and Arterial Diastolic Pressure
				Effect of Arterial Compliance on Myocardial Energy Consumption
			Peripheral Arterial Pressure Curves
		Blood Pressure Measurement in Humans
	The Venous System
		Capacitance and Resistance
		Gravity
		Muscular Activity and Venous Valves
	Microcirculation and Lymphatic System
		Microcirculation
			Functional Properties of Capillaries
			Vasoactive Role of the Capillary Endothelium
			Passive Role of the Capillary Endothelium
				Transcapillary Exchange
					Diffusion
					Capillary Filtration
					Hydrostatic Forces
					Osmotic Forces
					Balance of Hydrostatic and Osmotic Forces
					Capillary Filtration Coefficient
					Disturbances in Hydrostatic-Osmotic Balance
					Pinocytosis
		Lymphatic System
	Coronary Circulation
		Functional Anatomy of Coronary Vessels
		Factors That Influence Coronary Blood Flow
			Physical Factors
			Neural and Neurohumoral Factors
			Metabolic Factors
		Effects of Diminished Coronary Blood Flow
		Coronary Collateral Circulation and Vasodilators
	Cutaneous Circulation
		Regulation of Skin Blood Flow
			Neural Factors
			The Role of Temperature in the Regulation of Skin Blood Flow
		Skin Color: Relationship to Skin Blood Volume, Oxyhemoglobin, and Blood Flow
	Skeletal Muscle Circulation
		Regulation of Skeletal Muscle Blood Flow
			Neural Factors
			Local Factors
	Cerebral Circulation
		Regulation of Cerebral Blood Flow
			Blood-Brain Barrier
			Neural Factors
			Local Factors
	Intestinal Circulation
		Anatomy
		Neural Regulation
		Autoregulation
		Functional Hyperemia
	Hepatic Circulation
		Anatomy
		Hemodynamics
		Regulation of Flow
	Fetal Circulation
		In Utero
		Circulatory Changes That Occur at Birth
	Key Points
18 - Regulation of the Heart and Vasculature
	Regulation of Heart Rate and Myocardial Performance
	Nervous Control of the Heart Rate
		Parasympathetic Pathways
		Sympathetic Pathways
		Control by Higher Centers
		Baroreceptor Reflex
		Bainbridge Reflex, Atrial Receptors, and Atrial Natriuretic Peptide
		Respiratory Sinus Arrhythmia
		Chemoreceptor Reflex
		Ventricular Receptor Reflexes
	Regulation of Myocardial Performance
		Intrinsic Regulation of Myocardial Performance
			Frank-Starling Mechanism
			Balance Between Right and Left Ventricular Output
			Rate-Induced Regulation
		Extrinsic Regulation of Myocardial Performance
			Nervous Control
				Sympathetic Influences
				Parasympathetic Influences
			Chemical Control
				Adrenomedullary Hormones
				Adrenocortical Hormones
				Thyroid Hormones
				Insulin
				Glucagon
				Anterior Pituitary Hormones
			Blood Gases
				Oxygen
				Carbon Dioxide and Acidosis
	Regulation of the Peripheral Circulation
		Intrinsic or Local Control of Peripheral Blood Flow
			Autoregulation and Myogenic Regulation
			Endothelium-Mediated Regulation
			Metabolic Regulation
				Candidate Vasodilator Substances
				Basal Vessel Tone
				Reactive Hyperemia
				Coordination of Arterial and Arteriolar Dilation
		Extrinsic Control of Peripheral Blood Flow
			Sympathetic Neural Vasoconstriction
			Sympathetic Constrictor Influence on Resistance and Capacitance Vessels
			Parasympathetic Neural Influence
			Humoral Factors
			Vascular Reflexes
				Arterial Baroreceptors
				Cardiopulmonary Baroreceptors
				Peripheral Chemoreceptors
				Hypothalamus
				Cerebrum
				Skin and Viscera
				Pulmonary Reflexes
				Central Chemoreceptors
		Balance Between Extrinsic and Intrinsic Factors in Regulation of Peripheral Blood Flow
	Key Points
19 - Integrated Control of the Cardiovascular System
	Regulation of Cardiac Output and Blood Pressure
	Vascular Function Curve
		Effects of Cardiac Arrest on Arterial and Venous Pressure
		Factors That Influence the Vascular Function Curve
			Dependence of Venous Pressure on Cardiac Output
			Blood Volume
			Venomotor Tone
			Blood Reservoirs
			Peripheral Resistance
			Interrelationships Between Cardiac Output and Venous Return
	Relating the Cardiac Function Curve to the Vascular Function Curve
		Coupling Between the Heart and the Vasculature
		Myocardial Contractility
		Blood Volume
		Peripheral Resistance
	A More Complete Theoretical Model: The Two-Pump System
	Role of the Heart Rate in Control of Cardiac Output
	Ancillary Factors That Affect the Venous System and Cardiac Output
		Circulatory Effects of Respiratory Activity
	Interplay of Central and Peripheral Factors in Control of the Circulation
		Exercise
			Mild to Moderate Exercise
				Peripheral Resistance
				Cardiac Output
				Venous Return
				Coupling Between Heart and Vasculature During Exercise
				Arterial Pressure
			Severe Exercise
			Postexercise Recovery
			Limits of Exercise Performance
			Physical Training and Conditioning
		Hemorrhage
			Course of Arterial Blood Pressure Changes
			Compensatory Mechanisms
				Baroreceptor Reflexes
				Chemoreceptor Reflexes
				Cerebral Ischemia
				Reabsorption of Tissue Fluids
				Endogenous Vasoconstrictors
				Renal Conservation of Salt and Water
			Decompensatory Mechanisms
				Cardiac Failure
				Acidosis
				Central Nervous System Depression
				Aberrations in Blood Clotting
				Depression of the Mononuclear Phagocytic System
			Interactions of Positive and Negative Feedback Mechanisms
	Key Points
20 - Introduction to the Respiratory System
	Lung Anatomical Structure/Function Relationships
		Upper Airways: Nose, Sinuses, and Pharynx
		Lower Airway: Trachea, Bronchi, Bronchioles, and Respiratory Unit
	Circulatory Systems in the Lung
		Pulmonary Circulation
			Structure of the Pulmonary Circulation
			Structures of the Extra-Alveolar and Alveolar Vessels and the Pulmonary Microcirculation
			Structure of the Alveolar-Capillary Network
		Bronchial Circulation
	Innervation
		Central Control of Respiration
		Muscles of Respiration
	Lung Embryology, Development, Aging, and Repair
	Key Points
21 - Static Lung and Chest Wall Mechanics
	Pressures in the Respiratory System
	How a Pressure Gradient Is Created
	Lung Volumes and Their Measurement
	Lung Volumes and Capacities
	Determinants of Lung Volume
	Pressure-Volume Relationships
	Lung Compliance
	Surface Tension and Surfactant
		Surface Tension
		Surfactant
	Key Points
22 - Dynamic Lung and Chest Wall Mechanics
	Dynamic Lung Mechanics
		Airflow in Airways
			Patterns of Airflow
		Airway Resistance
		Factors That Contribute to Airway Resistance
		Neurohumoral Regulation of Airway Resistance
		Measurement of Expiratory Flow
			The Spirogram
			Flow-Volume Loop
		Determinants of Maximal Flow
		Flow Limitation and the Equal Pressure Point
		Dynamic Compliance
	Work of Breathing
	Key Concepts
23 - Ventilation, Perfusion, and Ventilation/Perfusion Relationships
	Ventilation
	Dead Space Ventilation: Anatomical and Physiological
		Anatomical Dead Space
		Physiological Dead Space
	Alveolar Ventilation
		Composition of Air
		Alveolar Gas Composition
		Arterial Gas Composition
		Distribution of Ventilation
	Pulmonary Vascular Resistance
	Distribution of Pulmonary Blood Flow
	Active Regulation of Blood Flow
	Ventilation/Perfusion Relationships
		Regional Differences in Ventilation/Perfusion Ratios
		Alveolar-Arterial Difference for Oxygen
	Arterial Blood Hypoxemia, Hypoxia, and Hypercarbia
		Ventilation/Perfusion Abnormalities and Shunts
			Anatomical Shunts
			Physiological Shunts
	Low Ventilation/Perfusion
	Alveolar Hypoventilation
	Diffusion Abnormalities
	Mechanisms of Hypercapnia
	Effect of 100% Oxygen on Arterial Blood Gas Abnormalities
	Regional Differences
	Key Points
24 - Oxygen and Carbon Dioxide Transport
	Gas Diffusion
		Diffusion of Gases From Regions of Higher to Lower Partial Pressure in the Lungs
		Oxygen and Carbon Dioxide Exchange in the Lung Is Perfusion Limited
	Oxygen Transport
		Hemoglobin
		Oxyhemoglobin Dissociation Curve
		Physiological Factors That Shift the Oxyhemoglobin Dissociation Curve
			Hydrogen Ion Concentration and Carbon Dioxide
			2,3-Diphosphoglycerate
			Fetal Hemoglobin (HgbF)
			Carbon Monoxide
		Oxygen Saturation, Content, and Delivery
		Erythropoiesis
	Carbon Dioxide Transport
		Glucose Metabolism and Carbon Dioxide Production
		Bicarbonate and Carbon Dioxide Transport
	Regulation of Hydrogen Ion Concentration and Acid-Base Balance
	Carbon Dioxide Dissociation Curve
	Key Points
25 - Control of Respiration
	Ventilatory Control: An Overview
	Response to Carbon Dioxide
	Control of Ventilation: The Details
		The Respiratory Control Center
		Central Chemoreceptors
		Peripheral Chemoreceptors
		Pulmonary Mechanoreceptors
			Chest Wall and Lung Reflexes
			Sensory Receptors and Reflexes
	Exercise
	Abnormalities in the Control of Breathing
	Key Points
	26 - Host Defense and Metabolism in the Lung
	Host Defense
		Mucociliary Clearance System
			Periciliary Fluid Layer
			Mucus Layer
			Ciliated Cells and Cilia
		Particle Deposition and Clearance
	Mucosal Immune System: Adaptive and Innate Immunity
		Mucosal Immune System
		Specialized Adaptive Lymphoid Cells
			Plasma Cells Producing Immunoglobulin A
			T Lymphocytes With γδ T Cell Receptors
		Specialized Innate Lymphoid Cells
			Macrophages and Dendritic Cells
				Macrophages
				Dendritic Cells
			Natural Killer and Invariant Natural Killer T Lymphoid Cells
	Epithelial Cells and Commensal Microbiota Protect the Lumen of the Airways
		Epithelial Cells
		Lung Microbiome-Commensal Microbiota
	Clinical Manifestations Associated With Abnormalities in Mucosal Innate and Adaptive Immunity
	Metabolic Functions of the Lung
	Key Points
27 - Functional Anatomy and General Principles of Regulation in the Gastrointestinal Tract
	Functional Anatomy
		Cellular Specialization
			Mucosa
			Submucosa
			Muscle Layers
			Serosa
	Regulatory Mechanisms in the Gastrointestinal Tract
		Endocrine Regulation
		Paracrine Regulation
		Neural Regulation of Gastrointestinal Function
			Extrinsic Neural Innervation
			Intrinsic Neural Innervation
	Response of the GI Tract to a Meal
	Key Concepts
28 - The Cephalic, Oral, and Esophageal Phases of the Integrated Response to a Meal
	LEARNING OBJECTIVES
	Cephalic and Oral Phases
		Properties of Secretion
			General Considerations
			Constituents of Secretions
		Salivary Secretion
			Functional Anatomy of the Salivary Glands
			Composition of Saliva
			Metabolism and Blood Flow of Salivary Glands
			Regulation of Salivary Secretion
			Ionic Mechanisms of Salivary Secretion
				Ion Transport in Acinar Cells
				Ion Transport in Ductular Cells
		Swallowing
	Esophageal Phase
		Functional Anatomy of the Esophagus and Associated Structures
		Motor Activity During the Esophageal Phase
	Key Concepts
29 - The Gastric Phase of the Integrated Response to a Meal
	Functional Anatomy of the Stomach
	Gastric Secretion
		Composition of Gastric Secretions
			Inorganic Constituents of Gastric Secretion
			Organic Constituents of Gastric Secretions
		Cellular Mechanisms of Gastric Acid Secretion
			Secretion of HCO3−
		Secretion of Mucus
		Regulation of Gastric Secretion
	Digestion in the Stomach
		Gastric Mucosal Protection and Defense
	Gastrointestinal Motility
		Functional Anatomy of Gastrointestinal Smooth Muscle
		Electrophysiology of Gastrointestinal Smooth Muscle
		Specialized Patterns of Motility
	Gastric Motility
		Functional Anatomy of the Stomach
		Control of Gastric Motility in the Gastric Phase
	Key Concepts
30 - The Small Intestinal Phase of the Integrated Response to a Meal
	Gastric Emptying in the Small Intestinal Phase
		Pancreatic Secretion
			Characteristics and Control of Ductular Secretion
			Characteristics and Control of Acinar Secretion
		Biliary Secretion
	Carbohydrate Assimilation
		Digestion of Carbohydrates
		Uptake of Carbohydrates
	Protein Assimilation
		Digestion of Proteins
	Uptake of Peptides and Amino Acids
	Lipid Assimilation
		Emulsification and Solubilization of Lipids
		Digestion of Lipids
		Uptake of Lipids and Subsequent Handling
	Water and Electrolyte Secretion and Absorption
	Absorption of Minerals and Water-Soluble Vitamins
	Motor Patterns of the Small Intestine
	Key Concepts
31 - The Colonic Phase of the Integrated Response to a Meal
	LEARNING OBJECTIVES
	Overview of the Large Intestine
		Signals That Regulate Colonic Function
		Patterns of Colonic Motility
			Functional Anatomy of the Colonic Musculature
			Colonic Motility Responses
		Transport Mechanisms in the Colon
		Colonic Microbiota
		Defecation
	Key Concepts
32 - Transport and Metabolic Functions of the Liver
	Overview of the Liver and its Functions
		Metabolic Functions of the Liver
		The Liver and Detoxification
		Role of the Liver in Excretion
	Structural Features of the Liver and Biliary System
	Bile Formation and Secretion
		Bile Acid Synthesis
		Hepatic Aspects of the Enterohepatic Circulation of Bile Acids
		Other Bile Constituents
		Bile Modification in the Ductules
		Role of the Gallbladder
		Bilirubin Formation and Excretion by the Liver
	Ammonia Handling by the Liver
	Clinical Assessment of Liver Function
	Key Concepts
33 - Elements of Renal Function
	Overview of Renal Function
	Functional Anatomy of the Kidneys
		Gross Anatomy
		Ultrastructure of the Nephron
		Ultrastructure of the Glomerulus
		Ultrastructure of the Juxtaglomerular Apparatus
		Innervation of the Kidneys
	Assessment of Renal Function
		Renal Clearance
		Glomerular Filtration Rate
	Glomerular Filtration
		Determinants of Ultrafiltrate Composition
		Dynamics of Ultrafiltration
	Renal Blood Flow
	Regulation of Renal Blood Flow and Glomerular Filtration Rate
		Sympathetic Nerves
		Angiotensin II
		Prostaglandins
		Nitric Oxide
		Endothelin
		Bradykinin
		Adenosine
		Natriuretic Peptides
		Adenosine Triphosphate
		Glucocorticoids
		Histamine
		Dopamine
		Hormones
	Key Points
34 - Solute and Water Transport Along the Nephron: Tubular Function
	Solute and Water Reabsorption Along the Nephron
		Proximal Tubule
		Na+ Reabsorption
			Water Reabsorption
			Protein Reabsorption
			Secretion of Organic Anions and Organic Cations
		Henle’s Loop
		Distal Tubule and Collecting Duct
	Regulation of NaCl and Water Reabsorption
	Key Points
35 - Control of Body Fluid Osmolality and Volume
	Control of Body Fluid Osmolality: Urine Concentration and Dilution
		Arginine Vasopressin
			Osmotic Control of AVP Secretion
			Hemodynamic (Nonosmotic) Control of AVP Secretion
			AVP Actions on the Kidneys
		Thirst
		Renal Mechanisms for Dilution and Concentration of Urine
			Medullary Interstitium
			Vasa Recta Function
		Assessment of Renal Diluting and Concentrating Ability
	Control of Extracellular Fluid Volume and Regulation of Renal NaCl Excretion
		Concept of Effective Circulating Volume
		Volume-Sensing Systems
			Volume Sensors in the Low-Pressure Cardiopulmonary Circuit
			Volume Sensors in the High-Pressure Arterial Circuit
		Volume Sensor Signals
			Renal Sympathetic Nerves
			Renin-Angiotensin-Aldosterone System
			Natriuretic Peptides
			Arginine Vasopressin
		Control of NaCl Excretion During Euvolemia
			Mechanisms for Maintaining Constant Delivery of NaCl to the Distal Tubule
			Regulation of Distal Tubule and Collecting Duct NaCl Reabsorption
		Control of NaCl Excretion During Volume Expansion
		Control of NaCl Excretion During Volume Contraction
	Key Concepts
36 - Potassium, Calcium, and Phosphate Homeostasis
	K+ Homeostasis
	Regulation of Plasma [K+]
		Epinephrine
		Insulin
		Aldosterone
	Alterations in Plasma [K+]
		Acid-Base Balance
		Plasma Osmolality
		Cell Lysis
		Exercise
	K+ Excretion by the Kidneys
	Cellular Mechanism of K+ Transport by Principal and Intercalated Cells in the DT and CCD
	K+ Excretion by the DT and CCD
		Plasma [K+]
		Na+ Delivery and Tubular Fluid Flow (K+ Sensing by Renal Epithelial Cells)
		Aldosterone
		AVP
		Glucocorticoids
		The Acid-Base Status
	Overview of Calcium and Inorganic Phosphate Homeostasis
		Calcium
			Overview of Calcium Homeostasis
			Calcium Transport Along the Nephron
			Regulation of Urinary Calcium Excretion
		Phosphate
			Overview of Phosphate Homeostasis
			Phosphate Transport Along the Nephron
			Regulation of Urinary Phosphate Excretion
	Integrative Review of Parathyroid Hormone and Calcitriol on Ca++ and Pi Homeostasis
	Key Concepts
37 - Role of the Kidneys in the Regulation of Acid-Base Balance
	The HCO3− Buffer System
	Overview of Acid-Base Balance
	Net Acid Excretion by the Kidneys
		HCO3− Reabsorption Along the Nephron
		Regulation of H+ Secretion
		Formation of New HCO3−
	Response to Acid-Base Disorders
		Extracellular and Intracellular Buffers
		Respiratory Compensation
		Renal Compensation
	Simple Acid-Base Disorders
		Types of Acid-Base Disorders
			Metabolic Acidosis
			Metabolic Alkalosis
			Respiratory Acidosis
			Respiratory Alkalosis
		Analysis of Acid-Base Disorders
	Key Concepts
38 - Introduction to the Endocrine System
	Configuration of Feedback Loops Within the Endocrine System
	Chemical Nature of Hormones
		Proteins/Peptides
		Catecholamines
		Steroid Hormones
		Iodothyronines
	Transport of Hormones in the Circulation
	Cellular Responses to Hormones
	Key Concepts
	39 - Hormonal Regulation of Energy Metabolism
	Continual Energy Supply and Demand: The Challenge
	Integrated Overview of Energy Metabolism
		Digestive Phase
		Fasting Phase
	Pancreatic Hormones Involved in Metabolic Homeostasis During Different Metabolic Phases
		Insulin
			Insulin Receptor
		Glucagon
		Catecholamines: Epinephrine and Norepinephrine
	Hormonal Regulation of Specific Metabolic Reactions and Pathways
		Hepatocyte Metabolism: Digestive vs. Fasting Phases
		Skeletal Muscle and Adipose Tissue Metabolism: Digestive vs. Fasting Phases
		Protein Metabolism in All Hormone Target Cells: Digestive vs. Fasting Phases
		Metabolic Roles of Lipoproteins: Digestive vs. Fasting Phases
			Digestive Phase: Chylomicrons and Chylomicron Remnants (Fig. 39.16A)
			Fasting Phase: VLDL, IDL, and LDL (Fig. 39.16B)
	Leptin and Energy Balance
		Leptin
			Structure, Synthesis, and Secretion
		Energy Storage
		Body Mass Index
		Central Mechanisms Involved in Energy Balance
	Key Concepts
40 - Hormonal Regulation of Calcium and Phosphate Metabolism
	Crucial Roles of Calcium and Phosphate in Cellular Physiology
	Hormonal Regulation of Calcium and Phosphate: PTH, Vitamin D, and FGF23
		Parathyroid Hormone
			Structure, Synthesis, and Secretion
			Parathyroid Hormone Receptor
		Vitamin D
			Structure, Synthesis, and Transport of Active Vitamin D Metabolites
			1,25-Dihydroxyvitamin D Receptor
		Fibroblast Growth Factor-23
	Hormonal Effects on Target Organs
		Kidney
		Small Intestine
		Bone
	Regulation of Bone Formation
		Regulation by Gonadal and Adrenal Steroid Hormones
	Integrated Physiological Regulation of Ca++/Pi Metabolism
		Hypocalcemic Challenge
		Hypophosphatemic Challenge
	Key Concepts
41 - The Hypothalamus and Pituitary Gland
	Anatomy
	The Neurohypophysis
		Synthesis of ADH and Oxytocin
		Actions and Regulation of ADH and Oxytocin
	The Adenohypophysis
		Endocrine Axes
		Endocrine Function of the Adenohypophysis
			Corticotropes
			Thyrotropes
			The Gonadotrope
			The Somatotrope
				Growth Hormone Actions
			The Lactotrope
	Key Concepts
42 - The Thyroid Gland
	Anatomy and Histology of the Thyroid Gland
	Thyroid Hormones
		Iodide Balance
		Overview of Thyroid Hormone Synthesis
		Synthesis of Iodothyronines on a Thyroglobulin Backbone
		Secretion of Thyroid Hormones
	Transport of Thyroid Hormones
	Cellular Entry and Peripheral Conversion of Thyroid Hormones
	Regulation of Thyroid Function
	Physiological Effects of Thyroid Hormone
		Cardiovascular Effects
		Effects on Basal Metabolic Rate and Thermogenesis
		Respiratory Effects
		Skeletal Muscle Effects
		Effects on the Autonomic Nervous System and Catecholamine Action
		Effects on Growth and Maturation
		Effects on Bone, Hard Tissue, and Dermis
		Effects on the Nervous System
		Effects on Reproductive Organs and Endocrine Glands
	Key Concepts
43 - The Adrenal Gland
	Anatomy
	Adrenal Medulla
		Synthesis of Epinephrine
		Mechanism of Action of Catecholamines
		Physiological Actions of Adrenomedullary Catecholamines
		Metabolism of Catecholamines
	Adrenal Cortex
		Zona Fasciculata
			Transport and Metabolism of Cortisol
			Mechanism of Action of Cortisol
			Physiological Actions of Cortisol
				Metabolic Actions
				Cardiovascular Actions
				Anti-inflammatory and Immunosuppressive Actions
				Effects of Cortisol on the Reproductive Systems
				Effects of Cortisol on Bone
				Actions of Cortisol on Connective Tissue
				Actions of Cortisol on the Kidney
				Actions of Cortisol on Muscle
				Actions of Cortisol on the Gastrointestinal Tract
			Psychological Effects of Cortisol
			Effects of Cortisol During Fetal Development
			Regulation of Cortisol Production
		Zona Reticularis
			Androgen Synthesis by the Zona Reticularis
			Metabolism and Fate of DHEAS and DHEA
			Physiological Actions of Adrenal Androgens
			Regulation of Zona Reticularis Function
		Zona Glomerulosa
			Transport and Metabolism of Aldosterone
			Mechanism of Aldosterone Action
			Physiological Actions of Aldosterone
	Key Concepts
44 - The Male and Female Reproductive Systems
	The Male Reproductive System
		The Testis
			Histophysiology
			Intratubular Compartment
				Developing Sperm Cells
				The Sertoli Cell
			Peritubular Compartment
				The Leydig Cell
		Fates and Actions of Androgens
			Intratesticular Androgen
			Peripheral Conversion to Estrogen
			Peripheral Conversion to Dihydrotestosterone
			Peripheral Testosterone Actions
			Mechanism of Androgen Action
			Transport and Metabolism of Androgens
		Hypothalamic-Pituitary-Testicular Axis
			Regulation of Leydig Cell Function
			Regulation of Sertoli Cell Function
		Male Reproductive Tract
		Andropause
	The Female Reproductive System
		The Ovary
			Growth, Development, and Function of the Ovarian Follicle
				Resting Primordial Follicle
					Growth and Structure
					The Gamete
				Growing Preantral Follicles
					Growth and Structure
					The Gamete
					Endocrine Function
				Growing Antral Follicles
					Growth and Structure
					The Gamete
					Endocrine Function
				Dominant Follicle
					Growth and Structure
					The Gamete
					Endocrine Function
				The Dominant Follicle During the Periovulatory Period
					Growth and Structure
					The Gamete
					Endocrine Function
				The Corpus Luteum
					Growth and Structure
					The Gamete
					Endocrine Function
				Atretic Follicles
			Follicular Development With Respect to the Monthly Menstrual Cycle
			Regulation of Late Stages of Follicular Development, Ovulation, and Luteinization: The Human Menstrual Cycle
		The Oviduct
			Structure and Function
			Hormonal Regulation During the Menstrual Cycle
		The Uterus
			Structure and Function
			Hormonal Regulation of the Uterine Endometrium During the Menstrual Cycle
				Proliferative Phase
				Secretory Phase
				Menstrual Phase
			Hormonal Regulation of the Myometrium
		The Cervix
			Structure and Function
			Hormonal Regulation of Cervical Mucus During the Menstrual Cycle
		The Vagina
			Structure and Function
			Hormonal Regulation During the Menstrual Cycle
		The External Genitalia
			Structure and Function
			Hormonal Regulation During the Menstrual Cycle
		Biology of 17β-Estradiol and Progesterone
			Biological Effects of Estrogen and Progesterone
			Transport and Metabolism of Ovarian Steroids
		Ontogeny of the Reproductive Systems
		Pregnancy
			Fertilization, Early Embryogenesis, Implantation, and Placentation
				Synchronization With Maternal Ovarian and Reproductive Tract Function
				Fertilization
				Early Embryogenesis and Implantation
				Placental Endocrinology
					Human Chorionic Gonadotropin
					Progesterone
					Estrogen
					Human Placental Lactogen
			Diabetogenicity of Pregnancy
			Parturition
				Placental CRH and the Fetal Adrenal Axis
				Estrogen and Progesterone Secretion
				Oxytocin
				Prostaglandins
				Uterine Size
		Mammogenesis and Lactation
			Structure of the Mammary Gland
			Hormonal Regulation of Mammary Gland Development
		Menopause
	Key Concepts
	Acknowledgment