Human physiology: an integrated approach

Cover......Page 1
Brief Contents......Page 2
Title Page......Page 6
Copyright Page......Page 7
About The Author......Page 8
Dedication Page......Page 10
Acknowledgments......Page 14
Contents......Page 16
 CHAPTER 1: Introduction to Physiology......Page 38
   RUNNING PROBLEM What to Believe?......Page 39
   Emerging Concepts The Changing World of Omics......Page 40
  Function and Mechanism......Page 41
  Themes in Physiology......Page 42
   Focus on . . . Mapping......Page 43
   Theme 2: Living Organisms Need Energy......Page 45
  Homeostasis......Page 46
   Homeostasis Depends on Mass Balance......Page 47
   Excretion Clears Substances from the Body......Page 49
   Local Control Is Restricted to a Tissue......Page 50
   Response Loops Begin with a Stimulus......Page 51
   Negative Feedback Loops Are Homeostatic......Page 52
   Positive Feedback Loops Are Not Homeostatic......Page 53
   Biological Rhythms Result from Changes in a Setpoint......Page 54
  The Science of Physiology......Page 55
   Good Scientific Experiments Must Be Carefully Designed......Page 56
   Focus on . . . Graphing......Page 57
   The Results of Human Experiments Can Be Difficult to Interpret......Page 59
  CHAPTER SUMMARY......Page 62
  REVIEW QUESTIONS......Page 63
 CHAPTER 2: Molecular Interactions......Page 65
   Most Biomolecules Contain Carbon, Hydrogen, and Oxygen......Page 66
   Covalent Bonds between Atoms Create Molecules......Page 70
   Noncovalent Bonds Facilitate Reversible Interactions......Page 76
   Molecular Shape Is Related to Molecular Function......Page 77
   Hydrogen Ions in Solution Can Alter Molecular Shape......Page 78
   Proteins Are Selective about the Molecules They Bind......Page 83
   Binding Reactions Obey the Law of Mass Action......Page 84
   Multiple Factors Alter Protein Binding......Page 85
   Reaction Rate Can Reach a Maximum......Page 88
  CHAPTER SUMMARY......Page 92
  REVIEW QUESTIONS......Page 93
 CHAPTER 3: Compartmentation: Cells and Tissues......Page 95
   The Lumens of Some Organs Are Outside the Body......Page 96
   Membranes Are Mostly Lipid and Protein......Page 98
   Membrane Proteins May Be Loosely or Tightly Bound to the Membrane......Page 99
  Intracellular Compartments......Page 101
   Inclusions Are in Direct Contact with the Cytosol......Page 102
   The Cytoskeleton Is a Changeable Scaffold......Page 105
   Motor Proteins Create Movement......Page 106
   Organelles Create Compartments for Specialized Functions......Page 107
   The Nucleus Is the Cell’s Control Center......Page 108
   Cell Junctions Hold Cells Together to Form Tissues......Page 110
   Epithelia Provide Protection and Regulate Exchange......Page 112
   Connective Tissues Provide Support and Barriers......Page 117
   Muscle and Neural Tissues Are Excitable......Page 119
   Apoptosis Is a Tidy Form of Cell Death......Page 121
   Emerging Concepts Induced Pluripotent Stems Cells......Page 122
   Focus on . . . The Skin......Page 123
   Organs......Page 124
  CHAPTER SUMMARY......Page 125
  REVIEW QUESTIONS......Page 127
 CHAPTER 4: Energy and Cellular Metabolism......Page 129
  Energy in Biological Systems......Page 130
   Energy Comes in Two Forms: Kinetic and Potential......Page 131
   Thermodynamics Is the Study of Energy Use......Page 132
   Energy Is Trapped or Released during Reactions......Page 133
  Enzymes......Page 135
   Enzymes May Be Activated, Inactivated, or Modulated......Page 136
   Enzymes Lower Activation Energy of Reactions......Page 137
   Enzymatic Reactions Can Be Categorized......Page 138
   Cells Regulate Their Metabolic Pathways......Page 139
   Catabolic Pathways Produce ATP......Page 141
   Anaerobic Metabolism Makes Two ATP......Page 146
   Proteins Are the Key to Cell Function......Page 147
   DNA Guides the Synthesis of RNA......Page 150
   Emerging Concepts Purple Petunias and RNAi......Page 151
   Proteins Undergo Posttranslational Modification......Page 152
  CHAPTER SUMMARY......Page 155
  REVIEW QUESTIONS......Page 156
 CHAPTER 5: Membrane Dynamics......Page 158
  Homeostasis Does Not Mean Equilibrium......Page 159
   The Body Is in Osmotic Equilibrium......Page 161
   Osmolarity Describes the Number of Particles in Solution......Page 162
   Tonicity Describes the Volume Change of a Cell......Page 163
   Cell Membranes Are Selectively Permeable......Page 168
  Diffusion......Page 169
   Lipophilic Molecules Cross Membranes by Simple Diffusion......Page 171
   Membrane Proteins Have Four Major Functions......Page 173
   Channel Proteins Form Open, Water‐Filled Passageways......Page 175
   Carrier Proteins Change Conformation to Move Molecules......Page 176
   Facilitated Diffusion Uses Carrier Proteins......Page 178
   Active Transport Moves Substances against Their ‐Concentration Gradients......Page 179
   Carrier‐Mediated Transport Exhibits Specificity, Competition, and Saturation......Page 181
   Phagocytosis Creates Vesicles Using the Cytoskeleton......Page 183
   Exocytosis Releases Molecules Too Large for Transport Proteins......Page 184
   Epithelial Transport May Be Paracellular or Transcellular......Page 186
   Transcellular Transport of Glucose Uses Membrane Proteins......Page 187
   Transcytosis Uses Vesicles to Cross an Epithelium......Page 188
   The Cell Membrane Enables Separation of Electrical Charge in the Body......Page 189
   All Living Cells Have a Membrane Potential......Page 190
   The Resting Membrane Potential Is Due Mostly to Potassium......Page 193
   Changes in Ion Permeability Change the Membrane Potential......Page 194
  Integrated Membrane Processes: Insulin Secretion......Page 195
  CHAPTER SUMMARY......Page 197
  REVIEW QUESTIONS......Page 198
 CHAPTER 6: Communication, Integration, and Homeostasis......Page 201
   Contact‐Dependent Signals Require Cell‐to‐Cell Contact......Page 202
   Cytokines May Act as Both Local and Long‐Distance Signals......Page 204
   Receptor Proteins Are Located Inside the Cell or on the Cell Membrane......Page 205
   Membrane Proteins Facilitate Signal Transduction......Page 207
   The Most Rapid Signal Pathways Change Ion Flow through Channels......Page 208
   G Protein‐Coupled Receptors Also Use Lipid‐Derived Second Messengers......Page 210
  Novel Signal Molecules......Page 212
   Calcium Is an Important Intracellular Signal......Page 213
   BIOTECHNOLOGY Calcium Signals Glow in the Dark......Page 214
   Some Lipids Are Important Paracrine Signals......Page 215
   One Ligand May Have Multiple Receptors......Page 216
   Up and Down‐Regulation Enable Cells to Modulate Responses......Page 217
  Homeostatic Reflex Pathways......Page 218
   Long‐Distance Pathways Maintain Homeostasis......Page 219
   Control Systems Vary in Their Speed and Specificity......Page 223
   Complex Reflex Control Pathways Have Several Integrating Centers......Page 225
  CHAPTER SUMMARY......Page 228
  REVIEW QUESTIONS......Page 229
 CHAPTER 7: Introduction to the Endocrine System......Page 231
   Hormones Have Been Known Since Ancient Times......Page 232
   What Makes a Chemical a Hormone?......Page 233
   Hormone Action Must Be Terminated......Page 234
   Most Hormones Are Peptides or Proteins......Page 236
   Steroid Hormones Are Derived from Cholesterol......Page 237
   Some Hormones Are Derived from Single Amino Acids......Page 239
   The Pituitary Gland Is Actually Two Fused Glands......Page 242
   The Anterior Pituitary Secretes Six Hormones......Page 244
   Anterior Pituitary Hormones Control Growth, Metabolism, and Reproduction......Page 246
   Feedback Loops Are Different in the Hypothalamic‐Pituitary Pathway......Page 248
  Hormone Interactions......Page 249
   Antagonistic Hormones Have Opposing Effects......Page 250
   Hypersecretion Exaggerates a Hormone’s Effects......Page 251
   Diagnosis of Endocrine Pathologies Depends on the Complexity of the Reflex......Page 252
  Hormone Evolution......Page 254
   Focus on . . . The Pineal Gland......Page 255
  CHAPTER SUMMARY......Page 257
  REVIEW QUESTIONS......Page 258
 CHAPTER 8: Neurons: Cellular and Network Properties......Page 260
  Organization of the Nervous System......Page 261
   Neurons Carry Electrical Signals......Page 263
   Establishing Synapses Depends on Chemical Signals......Page 266
   Glial Cells Provide Support for Neurons......Page 268
   Can Stem Cells Repair Damaged Neurons?......Page 270
   The GHK Equation Predicts Membrane Potential Using Multiple Ions......Page 271
   Gated Channels Control the Ion Permeability of the Neuron......Page 272
   Current Flow Obeys Ohm’s Law......Page 273
   Graded Potentials Reflect Stimulus Strength......Page 274
   Action Potentials Travel Long Distances......Page 276
   Na+ and K+ Move across the Membrane during Action Potentials......Page 277
   Axonal Na+ Channels Have Two Gates......Page 279
   Action Potentials Will Not Fire during the Absolute Refractory Period......Page 280
   Larger Neurons Conduct Action Potentials Faster......Page 282
   Conduction Is Faster in Myelinated Axons......Page 284
   Chemical Factors Alter Electrical Activity......Page 285
   Neurons Communicate at Synapses......Page 286
   Neurons Secrete Chemical Signals......Page 287
   Neurotransmitters Are Highly Varied......Page 288
   CLINICAL FOCUS Myasthenia Gravis......Page 290
   Neurotransmitters Are Released from Vesicles......Page 291
   Stronger Stimuli Release More Neurotransmitter......Page 294
   Postsynaptic Responses May Be Slow or Fast......Page 295
   Synaptic Activity Can Be Modified......Page 298
   Disorders of Synaptic Transmission Are Responsible for Many Diseases......Page 301
  CHAPTER SUMMARY......Page 303
  REVIEW QUESTIONS......Page 305
 CHAPTER 9: The Central Nervous System......Page 308
  Evolution of Nervous Systems......Page 309
   The CNS Is Divided into Gray Matter and White Matter......Page 311
   The Brain Floats in Cerebrospinal Fluid......Page 314
   The Blood‐Brain Barrier Protects the Brain......Page 316
   Neural Tissue Has Special Metabolic Requirements......Page 317
  The Spinal Cord......Page 318
  The Brain......Page 319
   The Brain Stem Is the Oldest Part of the Brain......Page 320
   The Diencephalon Contains the Centers for Homeostasis......Page 322
   The Cerebrum Is the Site of Higher Brain Functions......Page 324
  Brain Function......Page 325
   The Cerebral Cortex Is Organized into Functional Areas......Page 326
   The Spinal Cord and Brain Integrate Sensory Information......Page 327
   The Motor System Governs Output from the CNS......Page 328
   Why Do We Sleep?......Page 329
   Emerging Concepts Brain Glymphatics......Page 331
   Physiological Functions Exhibit Circadian Rhythms......Page 332
   Emotion and Motivation Involve Complex Neural Pathways......Page 333
   Learning and Memory Change Synaptic Connections in the Brain......Page 334
   Memory Is the Ability to Retain and Recall Information......Page 335
   Language Is the Most Elaborate Cognitive Behavior......Page 337
   Personality Is a Combination of Experience and Inheritance......Page 338
  CHAPTER SUMMARY......Page 340
  REVIEW QUESTIONS......Page 342
 CHAPTER 10: Sensory Physiology......Page 344
  General Properties of Sensory Systems......Page 345
   Receptors Are Sensitive to Particular Forms of Energy......Page 346
   The CNS Integrates Sensory Information......Page 347
   Coding and Processing Distinguish Stimulus Properties......Page 349
   Pathways for Somatic Perception Project to the Cortex and Cerebellum......Page 352
   Touch Receptors Respond to Many Different Stimuli......Page 354
   Nociceptors Initiate Protective Responses......Page 355
   CLINICAL FOCUS Natural Painkillers......Page 357
   Olfaction Is One of the Oldest Senses......Page 359
   Taste Is a Combination of Five Basic Sensations......Page 361
   Taste Transduction Uses Receptors and Channels......Page 362
  The Ear: Hearing......Page 365
   Sound Transduction Is a Multistep Process......Page 366
   The Cochlea Is Filled with Fluid......Page 367
   Auditory Pathways Project to the Auditory Cortex......Page 370
   Hearing Loss May Result from Mechanical or Neural Damage......Page 371
   The Semicircular Canals Sense Rotational Acceleration......Page 372
   Equilibrium Pathways Project Primarily to the Cerebellum......Page 374
   The Skull Protects the Eye......Page 375
   Light Enters the Eye through the Cornea......Page 376
   The Lens Focuses Light on the Retina......Page 378
   Phototransduction Occurs at the Retina......Page 380
   Photoreceptors Transduce Light into Electrical Signals......Page 381
   Signal Processing Begins in the Retina......Page 384
  CHAPTER SUMMARY......Page 389
  REVIEW QUESTIONS......Page 390
 CHAPTER 11: Efferent Division: Autonomic and Somatic Motor Control......Page 392
  The Autonomic Division......Page 393
   Autonomic Reflexes Are Important for Homeostasis......Page 394
   Autonomic Pathways Have Two Efferent Neurons in Series......Page 395
   Autonomic Pathways Control Smooth and Cardiac Muscle and Glands......Page 396
   Autonomic Neurotransmitters Are Synthesized in the Axon......Page 399
   Autonomic Receptors Have Multiple Subtypes......Page 400
   Autonomic Agonists and Antagonists Are Important Tools in Research and Medicine......Page 401
   CLINICAL FOCUS Diabetes: Autonomic Neuropathy......Page 403
   Summary of Sympathetic and Parasympathetic Branches......Page 404
   A Somatic Motor Pathway Consists of One Neuron......Page 405
   The Neuromuscular Junction Contains Nicotinic Receptors......Page 407
  CHAPTER SUMMARY......Page 408
  REVIEW QUESTIONS......Page 409
 CHAPTER 12: Muscles......Page 411
  RUNNING PROBLEM Periodic Paralysis......Page 412
   Skeletal Muscles Are Composed of Muscle Fibers......Page 413
   Myofibrils Are Muscle Fiber Contractile Structures......Page 414
   Muscle Contraction Creates Force......Page 417
   Actin and Myosin Slide Past Each Other during Contraction......Page 419
   Calcium Signals Initiate Contraction......Page 420
   Myosin Heads Step along Actin Filaments......Page 421
   BIOTECHNOLOGY Watching Myosin Work......Page 422
   Skeletal Muscle Contraction Requires a Steady Supply of ATP......Page 425
   Fatigue Has Multiple Causes......Page 426
   Skeletal Muscle Is Classified by Speed and Fatigue Resistance......Page 427
   Resting Fiber Length Affects Tension......Page 429
   A Motor Unit Is One Motor Neuron and Its Muscle Fibers......Page 430
   Contraction Force Depends on the Types and Numbers of Motor Units......Page 431
   Isotonic Contractions Move Loads; Isometric Contractions Create Force without Movement......Page 432
   Bones and Muscles around Joints Form Levers and Fulcrums......Page 434
   Muscle Disorders Have Multiple Causes......Page 436
  Smooth Muscle......Page 437
   Smooth Muscle Is More Variable Than Skeletal Muscle......Page 438
   Smooth Muscle Lacks Sarcomeres......Page 439
   Myosin Phosphorylation Controls Contraction......Page 440
   Calcium Initiates Smooth Muscle Contraction......Page 442
   Some Smooth Muscles Have Unstable Membrane Potentials......Page 443
   Chemical Signals Influence Smooth Muscle Activity......Page 444
  Cardiac Muscle......Page 446
  CHAPTER SUMMARY......Page 447
  REVIEW QUESTIONS......Page 448
 CHAPTER 13: Integrative Physiology I: Control of Body Movement......Page 451
   RUNNING PROBLEM Tetanus......Page 452
  Skeletal Muscle Reflexes......Page 454
   Muscle Spindles Respond to Muscle Stretch......Page 455
   Stretch Reflexes and Reciprocal Inhibition Control Movement around a Joint......Page 457
   Flexion Reflexes Pull Limbs Away from Painful Stimuli......Page 458
  The Integrated Control of Body Movement......Page 459
   Movement Can Be Classified as Reflex, Voluntary, or Rhythmic......Page 460
   The CNS Integrates Movement......Page 462
   Emerging Concepts Visualization Techniques in Sports......Page 465
  CHAPTER SUMMARY......Page 466
  REVIEW QUESTIONS......Page 467
 CHAPTER 14: Cardiovascular Physiology......Page 469
   The Cardiovascular System Transports Materials throughout the Body......Page 470
   The Cardiovascular System Consists of the Heart, Blood Vessels, and Blood......Page 471
   Pressure Changes in Liquids without a Change in Volume......Page 473
   Resistance Opposes Flow......Page 475
   Velocity Depends on the Flow Rate and the Cross‐Sectional Area......Page 476
   The Heart Has Four Chambers......Page 477
   Heart Valves Ensure One‐Way Flow in the Heart......Page 480
   The Coronary Circulation Supplies Blood to the Heart......Page 482
   Cardiac Muscle Cells Contract without Innervation......Page 483
   Cardiac Muscle Contraction Can Be Graded......Page 484
   Myocardial Action Potentials Vary......Page 485
   Electrical Signals Coordinate Contraction......Page 489
   Pacemakers Set the Heart Rate......Page 490
   The Electrocardiogram Reflects Electrical Activity......Page 492
   The Heart Contracts and Relaxes during a Cardiac Cycle......Page 496
   Pressure‐Volume Curves Represent One Cardiac Cycle......Page 499
   The Autonomic Division Modulates Heart Rate......Page 501
   Multiple Factors Influence Stroke Volume......Page 503
   Contractility Is Controlled by the Nervous and Endocrine Systems......Page 504
   EDV and Arterial Blood Pressure Determine Afterload......Page 507
  CHAPTER SUMMARY......Page 509
  REVIEW QUESTIONS......Page 511
 CHAPTER 15: Blood Flow and the Control of Blood Pressure......Page 513
  RUNNING PROBLEM Essential Hypertension......Page 514
   Arteries and Arterioles Carry Blood Away from the Heart......Page 515
   Exchange Takes Place in the Capillaries......Page 516
   Angiogenesis Creates New Blood Vessels......Page 517
   Blood Pressure Is Highest in Arteries and Lowest in Veins......Page 518
   Arterial Blood Pressure Reflects the Driving Pressure for Blood Flow......Page 519
   Blood Pressure Is Estimated by Sphygmomanometry......Page 520
   Changes in Blood Volume Affect Blood Pressure......Page 521
   CLINICAL FOCUS SHOCK......Page 522
   Myogenic Autoregulation Adjusts Blood Flow......Page 523
   Paracrine Signals Influence Vascular Smooth Muscle......Page 525
  Distribution of Blood to the Tissues......Page 526
   Coronary Blood Flow Parallels the Work of the Heart......Page 528
   The Baroreceptor Reflex Controls Blood Pressure......Page 529
   Orthostatic Hypotension Triggers the Baroreceptor Reflex......Page 531
  Exchange at the Capillaries......Page 532
   Most Capillary Exchange Takes Place by Diffusion and Transcytosis......Page 533
   Capillary Filtration and Absorption Take Place by Bulk Flow......Page 534
  The Lymphatic System......Page 536
   Edema Results from Alterations in Capillary Exchange......Page 537
   Risk Factors for CVD Include Smoking and Obesity......Page 538
   Hypertension Represents a Failure of Homeostasis......Page 539
   Emerging Concepts Inflammatory Markers for Cardiovascular Disease......Page 541
  CHAPTER SUMMARY......Page 542
  REVIEW QUESTIONS......Page 544
 CHAPTER 16: Blood......Page 547
   Plasma Is Extracellular Matrix......Page 548
   Blood Cells Are Produced in the Bone Marrow......Page 550
   Hematopoiesis Is Controlled by Cytokines......Page 551
   Erythropoietin Regulates RBC Production......Page 552
   RBCs Live about Four Months......Page 554
   Focus on . . . Bone Marrow......Page 555
   RBC Disorders Decrease Oxygen Transport......Page 556
  Platelets......Page 559
   Platelet Activation Begins the Clotting Process......Page 560
   Coagulation Converts a Platelet Plug into a Clot......Page 561
   Anticoagulants Prevent Coagulation......Page 564
  CHAPTER SUMMARY......Page 566
  REVIEW QUESTIONS......Page 567
 CHAPTER 17: Mechanics of Breathing......Page 569
  The Respiratory System......Page 570
   Pleural Sacs Enclose the Lungs......Page 571
   Airways Connect Lungs to the External Environment......Page 574
   Alveoli Are the Site of Gas Exchange......Page 575
   Pulmonary Circulation Is High‐Flow, Low‐Pressure......Page 576
   Boyle’s Law Describes Pressure‐Volume Relationships......Page 577
   Lung Volumes Change during Ventilation......Page 579
   Inspiration Occurs When Alveolar Pressure Decreases......Page 581
   Expiration Occurs When Alveolar Pressure Increases......Page 583
   Intrapleural Pressure Changes during Ventilation......Page 584
   Lung Compliance and Elastance May Change in Disease States......Page 585
   Surfactant Decreases the Work of Breathing......Page 586
   Airway Diameter Determines Airway Resistance......Page 587
   Rate and Depth of Breathing Determine the Efficiency of Breathing......Page 588
   Ventilation and Alveolar Blood Flow Are Matched......Page 590
   Auscultation and Spirometry Assess Pulmonary Function......Page 593
  CHAPTER SUMMARY......Page 595
  REVIEW QUESTIONS......Page 596
 CHAPTER 18: Gas Exchange and Transport......Page 599
  Gas Exchange in the Lungs and Tissues......Page 600
   Lower Alveolar Po2 Decreases Oxygen Uptake......Page 601
   Diffusion Problems Cause Hypoxia......Page 602
   Gas Solubility Affects Diffusion......Page 604
   Hemoglobin Binds to Oxygen......Page 606
   Oxygen Binding Obeys the Law of Mass Action......Page 607
   Po2 Determines Oxygen‐Hb Binding......Page 608
   Oxygen Binding Is Expressed as a Percentage......Page 609
   Several Factors Affect Binding......Page 610
   Carbon Dioxide Is Transported in Three Ways......Page 612
  Regulation of Ventilation......Page 615
   Neurons in the Medulla Control Breathing......Page 616
   CO2 Oxygen, and pH Influence Ventilation......Page 617
   Higher Brain Centers Affect Patterns of Ventilation......Page 619
  CHAPTER SUMMARY......Page 621
  REVIEW QUESTIONS......Page 622
 CHAPTER 19: The Kidneys......Page 624
  RUNNING PROBLEM Gout......Page 625
   The Nephron Is the Functional Unit of the Kidney......Page 626
   The Nephron Modifies Fluid Volume and Osmolarity......Page 629
  Filtration......Page 631
   Emerging Concepts Diabetes: Diabetic Nephropathy......Page 632
   Capillary Pressure Causes Filtration......Page 633
   GFR Is Subject to Autoregulation......Page 635
   Reabsorption May Be Active or Passive......Page 637
   Renal Transport Can Reach Saturation......Page 639
   BIOTECHNOLOGY Artificial Kidneys......Page 640
   Peritubular Capillary Pressures Favor Reabsorption......Page 641
  Secretion......Page 642
   Competition Decreases Penicillin Secretion......Page 643
   Clearance Is a Noninvasive Way to Measure GFR......Page 644
   Clearance Helps Us Determine Renal Handling......Page 646
  Micturition......Page 649
  CHAPTER SUMMARY......Page 651
  REVIEW QUESTIONS......Page 652
 CHAPTER 20: Integrative Physiology II: Fluid and Electrolyte Balance......Page 655
   RUNNING PROBLEM Hyponatremia......Page 656
   Daily Water Intake and Excretion Are Balanced......Page 657
   The Renal Medulla Creates Concentrated Urine......Page 658
   Vasopressin Controls Water Reabsorption......Page 660
   The Loop of Henle Is a Countercurrent Multiplier......Page 662
  Sodium Balance and ECF Volume......Page 666
   Low Blood Pressure Stimulates Aldosterone Secretion......Page 667
   Natriuretic Peptides Promote Na+ and Water Excretion......Page 669
  Potassium Balance......Page 672
  Integrated Control of Volume, Osmolarity, and Blood Pressure......Page 673
   Osmolarity and Volume Can Change Independently......Page 674
   Dehydration Triggers Homeostatic Responses......Page 675
   pH Changes Can Denature Proteins......Page 678
   pH Homeostasis Depends on Buffers, Lungs, and Kidneys......Page 679
   Buffer Systems Include Proteins, Phosphate Ions, and HCO3......Page 680
   Ventilation Can Compensate for pH Disturbances......Page 681
   The Proximal Tubule Secretes H+ and Reabsorbs HCO3......Page 682
   The Distal Nephron Controls Acid Excretion......Page 683
   Acid‐Base Disturbances May Be Respiratory or Metabolic......Page 684
  CHAPTER SUMMARY......Page 688
  REVIEW QUESTIONS......Page 689
 CHAPTER 21: The Digestive System......Page 691
   The Digestive System Is a Tube......Page 692
   The GI Tract Wall Has Four Layers......Page 695
  Digestive Function and Processes......Page 696
   We Secrete More Fluid than We Ingest......Page 697
   Motility: GI Smooth Muscle Contracts Spontaneously......Page 698
   CLINICAL FOCUS Diabetes: Delayed Gastric Emptying......Page 700
   The Enteric Nervous System Can Act Independently......Page 701
   GI Peptides Include Hormones, Neuropeptides, and Cytokines......Page 702
  Integrated Function: The Cephalic Phase......Page 704
   Swallowing Moves Food from Mouth to Stomach......Page 705
   The Stomach Stores Food......Page 706
   Gastric Secretions Protect and Digest......Page 707
  Integrated Function: The Intestinal Phase......Page 710
   The Pancreas Secretes Enzymes and Bicarbonate......Page 711
   Most Digestion Occurs in the Small Intestine......Page 713
   FOCUS ON... The Liver......Page 714
   Carbohydrates Are Absorbed as Monosaccharides......Page 715
   Proteins Are Digested into Small Peptides and Amino Acids......Page 717
   Some Larger Peptides Can Be Absorbed Intact......Page 718
   Regulation of the Intestinal Phase......Page 720
   The Large Intestine Concentrates Waste......Page 721
   Diarrhea Can Cause Dehydration......Page 723
   Vomiting Is a Protective Reflex......Page 724
  CHAPTER SUMMARY......Page 726
  REVIEW QUESTIONS......Page 727
 CHAPTER 22: Metabolism and Energy Balance......Page 729
   RUNNING PROBLEM Eating Disorders......Page 730
  Energy Balance......Page 731
   Oxygen Consumption Reflects Energy Use......Page 732
   CLINICAL FOCUS Estimating Fat–The Body Mass Index......Page 733
   Energy Is Stored in Fat and Glycogen......Page 734
   Enzymes Control the Direction of Metabolism......Page 735
   Fats Store Energy......Page 737
   Plasma Cholesterol Predicts Heart Disease......Page 740
   Glycogen Converts to Glucose......Page 741
   Proteins Can Be Used to Make ATP......Page 742
   Lipids Store More Energy than Glucose or Protein......Page 743
   The Insulin‐to‐Glucagon Ratio Regulates Metabolism......Page 744
   Insulin Promotes Anabolism......Page 745
   Glucagon Is Dominant in the Fasted State......Page 748
   Diabetes Mellitus Is a Family of Diseases......Page 749
   Type 1 Diabetics Are Prone to Ketoacidosis......Page 752
   Type 2 Diabetics Often Have Elevated Insulin Levels......Page 754
   Metabolic Syndrome Links Diabetes and Cardiovascular Disease......Page 755
   Body Temperature Balances Heat Production, Gain, and Loss......Page 756
   Body Temperature Is Homeostatically Regulated......Page 757
   Movement and Metabolism Produce Heat......Page 759
   The Body’s Thermostat Can Be Reset......Page 760
  CHAPTER SUMMARY......Page 762
  REVIEW QUESTIONS......Page 763
 CHAPTER 23: Endocrine Control of Growth and Metabolism......Page 765
   The Adrenal Cortex Secretes Steroid Hormones......Page 766
   Cortisol Is Essential for Life......Page 768
   Cortisol Pathologies Result from Too Much or Too Little Hormone......Page 770
   Thyroid Hormones Contain Iodine......Page 771
   TSH Controls the Thyroid Gland......Page 773
   Thyroid Pathologies Affect Quality of Life......Page 774
   Growth Hormone Is Anabolic......Page 776
   Tissue Growth Requires Hormones and Paracrine Factors......Page 778
   CLINICAL FOCUS New Growth Charts......Page 779
  Calcium Balance......Page 780
   Plasma Calcium Is Closely Regulated......Page 781
   Three Hormones Control Calcium Balance......Page 783
   Multiple Factors Control Bone Remodeling......Page 784
   Calcium and Phosphate Homeostasis Are Linked......Page 785
   Osteoporosis Is a Disease of Bone Loss......Page 787
  CHAPTER SUMMARY......Page 788
  REVIEW QUESTIONS......Page 789
 CHAPTER 24: The Immune System......Page 791
  RUNNING PROBLEM HPV: To Vaccinate or Not?......Page 792
   Leukocytes Are the Immune Cells......Page 794
  Development of Immune Cells......Page 797
   The Immune System Must Recognize “Self”......Page 798
   Many Molecules of the Innate Immune Response Are Always Present......Page 799
  Antigen Presentation and Recognition Molecules......Page 800
   B Lymphocytes Produce Antibodies......Page 801
   Bacteria and Viruses Require Different Defense Mechanisms......Page 802
   Innate Immunity Provides Nonspecific Responses......Page 803
   Adaptive Immunity Creates Antigen‐Specific Responses......Page 805
   Antibody Functions......Page 806
   Bacterial Invasion Causes Inflammation......Page 809
   Viral Infections Require Intracellular Defense......Page 810
   Specific Antigens Trigger Allergic Responses......Page 813
   MHC Proteins Allow Recognition of Foreign Tissue......Page 814
  Immune System Pathologies......Page 815
  Neuro‐Endocrine‐Immune Interactions......Page 816
   Stress Alters Immune System Function......Page 817
   Modern Medicine Includes Mind‐Body Therapeutics......Page 818
  CHAPTER SUMMARY......Page 819
  REVIEW QUESTIONS......Page 821
 CHAPTER 25: Integrative Physiology III: Exercise......Page 823
  Metabolism and Exercise......Page 824
   Hormones Regulate Metabolism during Exercise......Page 825
   Oxygen Consumption Is Related to Exercise Intensity......Page 826
  Ventilatory Responses to Exercise......Page 827
   Muscle Blood Flow Increases during Exercise......Page 828
   The Baroreceptor Reflex Adjusts to Exercise......Page 829
  Feedforward Responses to Exercise......Page 830
  Exercise and Health......Page 831
   Type 2 Diabetes Mellitus May Improve with Exercise......Page 832
   Stress and the Immune System May Be Influenced by Exercise......Page 833
  CHAPTER SUMMARY......Page 834
  REVIEW QUESTIONS......Page 835
 CHAPTER 26: Reproduction and Development......Page 837
  Sex Determination......Page 838
   Sexual Differentiation Occurs Early in Development......Page 839
   CLINICAL FOCUS X‐Linked Inherited Disorders......Page 842
   Gametogenesis Begins in Utero......Page 843
   The Brain Directs Reproduction......Page 844
  Male Reproduction......Page 847
   Testes Produce Sperm and Hormones......Page 848
   Spermatogenesis Requires Gonadotropins and Testosterone......Page 851
  Female Reproduction......Page 852
   A Menstrual Cycle Lasts about One Month......Page 855
   Hormonal Control of the Menstrual Cycle Is Complex......Page 856
   The Human Sexual Response Has Four Phases......Page 860
   Sexual Dysfunction Affects Males and Females......Page 861
   Contraceptives Are Designed to Prevent Pregnancy......Page 862
   Fertilization Requires Capacitation......Page 863
   The Placenta Secretes Hormones During Pregnancy......Page 864
   The Mammary Glands Secrete Milk During Lactation......Page 867
   Menopause and Andropause Are a Consequence of Aging......Page 870
  CHAPTER SUMMARY......Page 871
  REVIEW QUESTIONS......Page 873
 Appendix A Answers......Page 876
 Appendix B Physics and Math......Page 911
 Appendix C Genetics......Page 914
Photo Credits......Page 918
Glossary/Index......Page 920
End Paper......Page 979