Medical Physiology

Instructions for online access......Page 4481
Cover image......Page 2
Title Page......Page 3
Table of Contents......Page 4
Copyright......Page 23
Contributors......Page 26
Video Table of Contents......Page 32
Preface to the Third Edition......Page 33
The eBook......Page 36
Acknowledgments......Page 37
Preface to the First Edition......Page 40
Target Audience......Page 41
Content of the Textbook......Page 42
Emphasis of the Textbook......Page 43
Creating the Textbook......Page 44
Special Features......Page 45
Acknowledgments......Page 46
Section I Introduction......Page 47
Chapter 1 Foundations of Physiology......Page 48
References......Page 59
Section II Physiology of Cells and Molecules......Page 60
Chapter 2 Functional Organization of the Cell......Page 61
Structure of Biological Membranes......Page 63
Function of Membrane Proteins......Page 85
Cellular Organelles and the Cytoskeleton......Page 94
Synthesis and Recycling of Membrane Proteins......Page 118
Specialized Cell Types......Page 161
References......Page 169
Chapter 3 Signal Transduction......Page 171
Mechanisms of Cellular Communication......Page 173
Receptors That are Ion Channels......Page 186
Receptors Coupled to G Proteins......Page 187
Receptors That are Catalytic......Page 231
Nuclear Receptors......Page 248
References......Page 253
Chapter 4 Regulation of Gene Expression......Page 255
From Genes to Proteins......Page 257
The Promoter and Regulatory Elements......Page 270
Transcription Factors......Page 283
Regulation of Inducible Gene Expression by Signal-Transduction Pathways......Page 307
Epigenetic Regulation of Gene Expression......Page 323
Post-Translational Regulation of Gene Expression......Page 332
References......Page 346
Glossary......Page 348
Chapter 5 Transport of Solutes and Water......Page 355
The Intracellular and Extracellular Fluids......Page 357
Solute Transport Across Cell Membranes......Page 368
Regulation of Intracellular Ion Concentrations......Page 443
Water Transport and the Regulation of Cell Volume......Page 451
Transport of Solutes and Water Across Epithelia......Page 476
References......Page 489
Chapter 6 Electrophysiology of the Cell Membrane......Page 494
Ionic Basis of Membrane Potentials......Page 500
Electrical Model of a Cell Membrane......Page 543
Molecular Physiology of Ion Channels......Page 576
References......Page 604
Chapter 7 Electrical Excitability and Action Potentials......Page 607
Mechanisms of Nerve and Muscle Action Potentials......Page 609
Physiology of Voltage-Gated Channels and Their Relatives......Page 642
Propagation of Action Potentials......Page 689
References......Page 706
Chapter 8 Synaptic Transmission and the Neuromuscular Junction......Page 709
Mechanisms of Synaptic Transmission......Page 711
Synaptic Transmission at the Neuromuscular Junction......Page 723
Toxins and Drugs Affecting Synaptic Transmission......Page 772
References......Page 786
Chapter 9 Cellular Physiology of Skeletal, Cardiac, and Smooth Muscle......Page 788
Skeletal Muscle......Page 791
Cardiac Muscle......Page 838
Smooth Muscle......Page 843
Diversity among Muscles......Page 861
References......Page 867
Section III The Nervous System......Page 870
Chapter 10 Organization of the Nervous System......Page 871
Cells of the Nervous System......Page 876
Development of Neurons and Glial Cells......Page 892
Subdivisions of the Nervous System......Page 912
References......Page 927
Chapter 11 The Neuronal Microenvironment......Page 928
Cerebrospinal Fluid......Page 931
Brain Extracellular Space......Page 949
The Blood-Brain Barrier......Page 956
Glial Cells......Page 964
References......Page 986
Chapter 12 Physiology of Neurons......Page 988
Signal Conduction in Dendrites......Page 994
Control of Spiking Patterns in the Soma......Page 1002
Axonal Conduction......Page 1008
References......Page 1022
Chapter 13 Synaptic Transmission in the Nervous System......Page 1025
Neuronal Synapses......Page 1029
Neurotransmitter Systems of the Brain......Page 1047
Fast Amino Acid–Mediated Synapses in the CNS......Page 1072
Plasticity of Central Synapses......Page 1088
References......Page 1102
Chapter 14 The Autonomic Nervous System......Page 1105
Organization of the Visceral Control System......Page 1107
Synaptic Physiology of the Autonomic Nervous System......Page 1124
Central Nervous System Control of the Viscera......Page 1142
References......Page 1159
Chapter 15 Sensory Transduction......Page 1161
Chemoreception......Page 1165
Visual Transduction......Page 1180
Vestibular and Auditory Transduction: Hair Cells......Page 1214
Somatic Sensory Receptors, Proprioception, and Pain......Page 1255
References......Page 1273
Chapter 16 Circuits of the Central Nervous System......Page 1276
Elements of Neural Circuits......Page 1278
Simple, Stereotyped Responses: Spinal Reflex Circuits......Page 1286
Rhythmic Activity: Central Pattern Generators......Page 1296
Spatial Representations: Sensory and Motor Maps in the Brain......Page 1302
Temporal Representations: Time-Measuring Circuits......Page 1318
References......Page 1326
Section IV The Cardiovascular System......Page 1328
Chapter 17 Organization of the Cardiovascular System......Page 1329
Elements of the Cardiovascular System......Page 1331
Hemodynamics......Page 1335
How Blood Flows......Page 1350
Origins of Pressure in the Circulation......Page 1358
How to Measure Blood Pressure, Blood Flow, and Cardiac Volumes......Page 1366
References......Page 1388
Chapter 18 Blood......Page 1390
Blood Composition......Page 1392
Blood Viscosity......Page 1418
Hemostasis and Fibrinolysis......Page 1429
References......Page 1445
Chapter 19 Arteries and Veins......Page 1446
Arterial Distribution and Venous Collection Systems......Page 1448
Elastic Properties of Blood Vessels......Page 1466
References......Page 1503
Chapter 20 The Microcirculation......Page 1505
Capillary Exchange of Solutes......Page 1511
Capillary Exchange of Water......Page 1530
Lymphatics......Page 1562
Regulation of the Microcirculation......Page 1571
References......Page 1587
Chapter 21 Cardiac Electrophysiology and the Electrocardiogram......Page 1589
Electrophysiology of Cardiac Cells......Page 1594
The Electrocardiogram......Page 1629
Cardiac Arrhythmias......Page 1646
References......Page 1662
Chapter 22 The Heart as a Pump......Page 1664
The Cardiac Cycle......Page 1666
Cardiac Dynamics......Page 1698
From Contractile Filaments to a Regulated Pump......Page 1714
References......Page 1741
Chapter 23 Regulation of Arterial Pressure and Cardiac Output......Page 1743
Short-Term Regulation of Arterial Pressure......Page 1745
Regulation of Cardiac Output......Page 1786
Matching of Venous Return and Cardiac Output......Page 1797
Intermediate- and Long-Term Control of the Circulation......Page 1810
References......Page 1822
Chapter 24 Special Circulations......Page 1824
The Brain......Page 1828
The Heart......Page 1839
The Skeletal Muscle......Page 1848
The Splanchnic Organs......Page 1857
The Skin......Page 1869
References......Page 1874
Chapter 25 Integrated Control of the Cardiovascular System......Page 1876
Interaction among the Different Cardiovascular Control Systems......Page 1878
Response to Erect Posture......Page 1885
Responses to Acute Emotional Stress......Page 1897
Response to Exercise......Page 1907
Response to Hemorrhage......Page 1917
References......Page 1929
Section V The Respiratory System......Page 1931
Chapter 26 Organization of the Respiratory System......Page 1932
Comparative Physiology of Respiration......Page 1934
Organization of the Respiratory System in Humans......Page 1969
Lung Volumes and Capacities......Page 1985
References......Page 1998
Chapter 27 Mechanics of Ventilation......Page 2000
Static Properties of the Lung......Page 2002
Dynamic Properties of the Lung......Page 2036
References......Page 2075
Chapter 28 Acid-Base Physiology......Page 2077
pH and Buffers......Page 2079
Acid-Base Chemistry When Is the Only Buffer......Page 2104
Acid-Base Chemistry in the Presence of and Buffers—The Davenport Diagram......Page 2116
pH Regulation of Intracellular Fluid......Page 2141
References......Page 2149
Chapter 29 Transport of Oxygen and Carbon Dioxide in the Blood......Page 2151
Carriage of O2......Page 2153
Carriage of CO2......Page 2184
References......Page 2200
Chapter 30 Gas Exchange in the Lungs......Page 2202
Diffusion of Gases......Page 2204
Diffusion and Perfusion Limitations on Gas Transport......Page 2218
References......Page 2253
Chapter 31 Ventilation and Perfusion of the Lungs......Page 2255
Ventilation......Page 2257
Perfusion of the Lung......Page 2297
Matching Ventilation and Perfusion......Page 2314
References......Page 2359
Chapter 32 Control of Ventilation......Page 2361
Overview of the Respiratory Control System......Page 2363
Neurons That Control Ventilation......Page 2370
Generation of the Respiratory Rhythm......Page 2385
Chemical Control of Ventilation......Page 2405
Modulation of Ventilatory Control......Page 2430
References......Page 2442
Section VI The Urinary System......Page 2444
Chapter 33 Organization of the Urinary System......Page 2445
Functional Anatomy of the Kidney......Page 2447
Main Elements of Renal Function......Page 2467
Measuring Renal Clearance and Transport......Page 2471
The Ureters and Bladder......Page 2491
References......Page 2501
Chapter 34 Glomerular Filtration and Renal Blood Flow......Page 2503
Glomerular Filtration......Page 2505
Renal Blood Flow......Page 2530
Control of Renal Blood Flow and Glomerular Filtration......Page 2547
References......Page 2559
Chapter 35 Transport of Sodium and Chloride......Page 2561
Na+ and Cl− Transport by Different Segments of The Nephron......Page 2564
Na+ and Cl−, and Water Transport at the Cellular and Molecular Level......Page 2572
Regulation of Na+ and Cl− Transport......Page 2589
References......Page 2609
Chapter 36 Transport of Urea, Glucose, Phosphate, Calcium, Magnesium, and Organic Solutes......Page 2612
Urea......Page 2614
Glucose......Page 2620
Other Organic Solutes......Page 2629
Phosphate......Page 2656
Calcium......Page 2664
Magnesium......Page 2673
References......Page 2678
Chapter 37 Transport of Potassium......Page 2682
Potassium Balance and the Overall Renal Handling of Potassium......Page 2684
Potassium Transport by Different Segments of the Nephron......Page 2697
Potassium Transport at the Cellular and Molecular Levels......Page 2702
Regulation of Renal Potassium Excretion......Page 2710
References......Page 2728
Chapter 38 Urine Concentration and Dilution......Page 2730
Water Balance and the Overall Renal Handling of Water......Page 2732
Water Transport by Different Segments of the Nephron......Page 2740
Generation of a Hyperosmotic Medulla and Urine......Page 2744
Regulation by Arginine Vasopressin......Page 2768
References......Page 2778
Chapter 39 Transport of Acids and Bases......Page 2780
Acid-Base Balance and the Overall Renal Handling of Acid......Page 2782
Acid-Base Transport by Different Segments of the Nephron......Page 2797
Acid-Base Transport at the Cellular and Molecular Levels......Page 2801
Regulation of Renal Acid Secretion......Page 2823
References......Page 2837
Chapter 40 Integration of Salt and Water Balance......Page 2841
Control of Extracellular Fluid Volume......Page 2845
Control of Water Content (Extracellular Osmolality)......Page 2868
References......Page 2886
Section VII The Gastrointestinal System......Page 2888
Chapter 41 Organization of the Gastrointestinal System......Page 2889
Overview of Digestive Processes......Page 2891
Regulation of Gastrointestinal Function......Page 2901
Gastrointestinal Motility......Page 2910
References......Page 2926
Chapter 42 Gastric Function......Page 2928
Functional Anatomy of the Stomach......Page 2930
Acid Secretion......Page 2937
Pepsinogen Secretion......Page 2957
Protection of the Gastric Surface Epithelium and Neutralization of Acid in the Duodenum......Page 2961
Filling and Emptying of the Stomach......Page 2970
References......Page 2977
Chapter 43 Pancreatic and Salivary Glands......Page 2980
Overview of Exocrine Gland Physiology......Page 2982
Pancreatic Acinar Cell......Page 2990
Pancreatic Duct Cell......Page 2999
Composition, Function, and Control of Pancreatic Secretion......Page 3007
Salivary Acinar Cell......Page 3024
Salivary Duct Cell......Page 3028
Composition, Function, and Control of Salivary Secretion......Page 3032
References......Page 3039
Chapter 44 Intestinal Fluid and Electrolyte Movement......Page 3041
Functional Anatomy......Page 3043
Overview of Fluid and Electrolyte Movement in the Intestines......Page 3048
Cellular Mechanisms of Na+ Absorption......Page 3058
Cellular Mechanisms of Cl− Absorption and Secretion......Page 3065
Cellular Mechanisms of K+ Absorption and Secretion......Page 3074
Regulation of Intestinal Ion Transport......Page 3080
References......Page 3087
Chapter 45 Nutrient Digestion and Absorption......Page 3089
Carbohydrate Digestion......Page 3094
Carbohydrate Absorption......Page 3105
Protein Digestion......Page 3110
Protein, Peptide, and Amino-Acid Absorption......Page 3117
Lipid Digestion......Page 3125
Lipid Absorption......Page 3137
Digestion and Absorption of Vitamins and Minerals......Page 3148
Nutritional Requirements......Page 3168
References......Page 3175
Chapter 46 Hepatobiliary Function......Page 3178
Overview of Liver Physiology......Page 3180
Functional Anatomy of the Liver and Biliary Tree......Page 3182
Uptake, Processing, and Secretion of Compounds by Hepatocytes......Page 3193
Bile Formation......Page 3219
Enterohepatic Circulation of Bile Acids......Page 3235
The Liver as a Metabolic Organ......Page 3241
References......Page 3264
Section VIII The Endocrine System......Page 3268
Chapter 47 Organization of Endocrine Control......Page 3269
Principles of Endocrine Function......Page 3272
Peptide Hormones......Page 3290
Amine Hormones......Page 3297
Steroid and Thyroid Hormones......Page 3300
References......Page 3310
Chapter 48 Endocrine Regulation of Growth and Body Mass......Page 3312
Growth Hormone......Page 3315
Growth-Promoting Hormones......Page 3331
Regulation of Body Mass......Page 3343
References......Page 3356
Chapter 49 The Thyroid Gland......Page 3358
Synthesis of Thyroid Hormones......Page 3362
Action of Thyroid Hormones......Page 3374
Hypothalamic-Pituitary-Thyroid Axis......Page 3386
References......Page 3396
Chapter 50 The Adrenal Gland......Page 3398
The Adrenal Cortex: Cortisol......Page 3402
The Adrenal Cortex: Aldosterone......Page 3421
The Adrenal Medulla......Page 3439
References......Page 3450
Chapter 51 The Endocrine Pancreas......Page 3452
Insulin......Page 3457
Glucagon......Page 3500
Somatostatin......Page 3509
References......Page 3511
Chapter 52 The Parathyroid Glands and Vitamin D......Page 3513
Calcium and Phosphate Balance......Page 3515
Physiology of Bone......Page 3520
Parathyroid Hormone......Page 3528
Vitamin D......Page 3540
Calcitonin and Other Hormones......Page 3552
References......Page 3559
Section IX The Reproductive System......Page 3561
Chapter 53 Sexual Differentiation......Page 3562
Genetic Aspects of Sexual Differentiation......Page 3566
Differentiation of the Gonads......Page 3579
Development of the Accessory Sex Organs......Page 3584
Differentiation of the External Genitalia......Page 3591
Endocrine and Paracrine Control of Sexual Differentiation......Page 3597
Puberty......Page 3609
References......Page 3618
Chapter 54 The Male Reproductive System......Page 3620
Hypothalamic-Pituitary-Gonadal Axis......Page 3624
Testosterone......Page 3637
Biology of Spermatogenesis and Semen......Page 3647
Male Sex Act......Page 3665
References......Page 3676
Chapter 55 The Female Reproductive System......Page 3678
Hypothalamic-Pituitary-Gonadal Axis and Control of the Menstrual Cycle......Page 3683
Ovarian Steroids......Page 3704
The Ovarian Cycle: Folliculogenesis, Ovulation, and Formation of the Corpus Luteum......Page 3715
The Endometrial Cycle......Page 3728
Female Sex Act......Page 3734
Menopause......Page 3739
References......Page 3742
Chapter 56 Fertilization, Pregnancy, and Lactation......Page 3744
Transport of Gametes and Fertilization......Page 3746
Implantation of the Developing Embryo......Page 3757
Physiology of the Placenta......Page 3770
The Maternal-Placental-Fetal Unit......Page 3779
Response of the Mother to Pregnancy......Page 3786
Parturition......Page 3791
Lactation......Page 3800
References......Page 3809
Chapter 57 Fetal and Neonatal Physiology......Page 3812
Biology of Fetal Growth......Page 3814
Development and Maturation of the Cardiopulmonary System......Page 3828
Cardiopulmonary Adjustments at Birth......Page 3845
Neonatal Physiology......Page 3856
References......Page 3869
Section X Physiology of Everyday Life......Page 3871
Chapter 58 Metabolism......Page 3872
Forms of Energy......Page 3876
Energy Balance......Page 3885
Energy Interconversion From Cycling between 6-Carbon and 3-Carbon Molecules......Page 3890
Energy Capture (Anabolism)......Page 3908
Energy Liberation (Catabolism)......Page 3916
Integrative Metabolism During Fasting......Page 3935
References......Page 3945
Chapter 59 Regulation of Body Temperature......Page 3947
Heat and Temperature: Advantages of Homeothermy......Page 3949
Modes of Heat Transfer......Page 3954
Active Regulation of Body Temperature by the Central Nervous System......Page 3969
Hypothermia, Hyperthermia, and Fever......Page 3979
References......Page 3989
Chapter 60 Exercise Physiology and Sports Science......Page 3991
Motor Units and Muscle Function......Page 3993
Conversion of Chemical Energy to Mechanical Work......Page 4007
Muscle Fatigue......Page 4018
Determinants of Maximal O2 Uptake and Consumption......Page 4024
Sweating......Page 4034
Endurance (Aerobic) Training......Page 4042
References......Page 4049
Chapter 61 Environmental Physiology......Page 4051
The Environment......Page 4053
Diving Physiology......Page 4069
High-Altitude Physiology......Page 4091
Flight and Space Physiology......Page 4101
References......Page 4108
Chapter 62 The Physiology of Aging......Page 4109
Concepts in Aging......Page 4112
Cellular and Molecular Mechanisms of Aging......Page 4121
Aging of the Human Physiological Systems......Page 4137
Aging Slowly......Page 4149
References......Page 4157
Index......Page 4160