Medical Physiology: Principles for Clinical Medicine

Half Title......Page 2
Title......Page 3
Copyright......Page 4
Contributors......Page 23
Preface......Page 8
Reviewers......Page 26
Contents......Page 29
PART I: CELLULAR PHYSIOLOGY......Page 39
CHAPTER 1: Medical Physiology: An Overview......Page 40
Scope of Medical Physiology......Page 41
Future Direction of Medical Physiology......Page 47
CHAPTER 2: Cell Signaling, Membrane Transport, and Membrane Potential......Page 52
Basis of Physiologic Regulation......Page 54
Plasma Membrane Structure......Page 63
Solute Transport Mechanisms......Page 69
Water Movement across the Plasma Membrane......Page 95
Resting Membrane Potential......Page 102
Communication and Signaling Modes......Page 112
Molecular Basis of Cellular Signaling......Page 117
Second Messengers......Page 132
PART II: NEUROMUSCULAR PHYSIOLOGY......Page 152
CHAPTER 3: Action Potential, Synaptic Transmission, and Nerve Function......Page 153
The Nervous System......Page 154
Action Potentials......Page 165
Synaptic Transmission......Page 181
Neurotransmission......Page 189
CHAPTER 4: Sensory Physiology......Page 213
Sensory Systems......Page 214
Somatosensory System......Page 231
Visual System......Page 238
Auditory System......Page 260
Vestibular System......Page 280
Gustatory and Olfactory Systems......Page 292
CHAPTER 5: Motor System......Page 312
Skeleton as Framework for Movement......Page 313
Muscle Function and Body Movement......Page 316
Nervous System Components for the Control of Movement......Page 317
Spinal Cord in the Control of Movement......Page 330
Supraspinal Influences on Motor Control......Page 340
Cerebral Cortex Role in Motor Control......Page 348
Basal Ganglia and Motor Control......Page 361
Cerebellum in the Control of Movement......Page 368
CHAPTER 6: Autonomic Nervous System......Page 382
Anatomy of the Autonomic Nervous System......Page 384
Neurotransmitters of the Autonomic Nervous System......Page 391
The Parasympathetic Nervous System......Page 401
Sympathetic Nervous System......Page 405
Autonomic Integration......Page 410
CHAPTER 7: Integrative Functions of the Central Nervous System......Page 433
Hypothalamus......Page 438
Brain Electrical Activity......Page 463
Functional Components of the Forebrain......Page 474
Higher Cognitive Skills......Page 488
CHAPTER 8: Skeletal and Smooth Muscle......Page 503
Skeletal Muscle......Page 505
Motor Neurons and Excitation––Contraction Coupling in Skeletal Muscle......Page 514
Mechanics of Skeletal Muscle Contraction......Page 533
Skeletal Muscle Metabolism and Fiber Types......Page 563
Muscle Plasticity, Epigenetics, and Endocrine Muscle......Page 566
Smooth Muscle......Page 568
PART III: BLOOD AND IMMUNOLOGY......Page 597
Blood Functions......Page 598
Soluble Components of Blood and their Tests......Page 601
Formed Elements of Blood and Common Diagnostic Tests......Page 613
Red Blood Cells......Page 619
White Blood Cells......Page 637
Platelet Formation......Page 648
Blood Cell Formation......Page 649
Blood Clotting......Page 652
CHAPTER 10: Immunology, Organ Interaction, and Homeostasis......Page 681
Immune System Components......Page 683
Immune System Activation......Page 688
Immune Detection System......Page 694
Immune System Defenses......Page 696
Cell-Mediated and Humoral Responses......Page 709
Acute and Chronic Inflammation......Page 724
Chronic Inflammation......Page 734
Anti-inflammatory Drugs......Page 736
Organ Transplantation and Immunology......Page 739
Immunologic Disorders......Page 744
Neuroendoimmunology......Page 751
PART IV: CARDIOVASCULAR PHYSIOLOGY......Page 765
CHAPTER 11: Overview of the Cardiovascular System and Hemodynamics......Page 766
Functional Organization......Page 769
Physics of Blood Containment and Movement......Page 777
Physical Dynamics of Blood Flow......Page 786
Distribution of Pressure, Flow, Velocity, and Blood Volume......Page 804
CHAPTER 12: Electrical Activity of the Heart......Page 815
Electrophysiology of Cardiac Muscle......Page 817
Pathophysiology of Abnormal Generation of Cardiac Action Potentials......Page 836
The Electrocardiogram......Page 841
CHAPTER 13: Cardiac Muscle Mechanics and the Cardiac Pump......Page 885
Cardiac Excitation–Contraction Coupling......Page 889
The Cardiac Cycle......Page 895
Determinants of Myocardial Performance......Page 902
Determinants of Myocardial Oxygen Demand and Clinical Evaluation of Cardiac Performance......Page 921
Cardiac Output......Page 928
The Measurement of Cardiac Output......Page 934
Imaging Techniques for Measuring Cardiac Structures, Volumes, Blood Flow, and Cardiac Output......Page 939
CHAPTER 14: The Systemic Circulation......Page 953
Determinants of Arterial Pressures......Page 954
Arterial Pressure Measurement......Page 963
Peripheral and Central Blood Volume......Page 970
Coupling of Vascular and Cardiac Function......Page 976
CHAPTER 15: Microcirculation and Lymphatic System......Page 995
Structure and Function of the Microcirculation......Page 996
The Lymphatic System......Page 1006
Solute Exchange between the Vasculature and Tissues......Page 1010
Water Exchange between the Vasculature and Interstitium......Page 1019
Regulation of Microvascular Resistance......Page 1030
CHAPTER 16: Special Circulations......Page 1058
Coronary Circulation......Page 1061
Cerebral Circulation......Page 1067
Circulation of the Small Intestine......Page 1077
Hepatic Circulation......Page 1086
Skeletal Muscle Circulation......Page 1090
Cutaneous Circulation......Page 1094
Fetal and Placental Circulations......Page 1099
CHAPTER 17: Control Mechanisms in Cardiovascular Function......Page 1119
Autonomic Neural Control of the Cardiovascular System......Page 1121
Hormonal Control of the Cardiovascular System......Page 1141
Circulatory Shock......Page 1156
PART V: RESPIRATORY PHYSIOLOGY......Page 1173
CHAPTER 18: Ventilation and the Mechanics of Breathing......Page 1174
Lung Structural and Functional Relationships......Page 1176
Pulmonary Pressures and Airflow during Breathing......Page 1183
Spirometry and Lung Volumes......Page 1204
Minute Ventilation......Page 1212
Elastic Properties of Lung and Chest Wall......Page 1227
Airway Resistance and the Work of Breathing......Page 1254
CHAPTER 19: Gas Transfer and Transport......Page 1283
Gas Diffusion and Uptake......Page 1284
Diffusing Capacity......Page 1296
Gas Transport by the Blood......Page 1302
Respiratory Causes of Hypoxemia......Page 1318
CHAPTER 20: Pulmonary Circulation and Ventilation/Perfusion......Page 1347
Functional Organization......Page 1348
Hemodynamic Features......Page 1353
Fluid Exchange in Pulmonary Capillaries......Page 1367
Blood Flow Distribution in the Lungs......Page 1372
Shunts and Venous Admixture......Page 1384
CHAPTER 21: Control of Ventilation......Page 1400
Neural and Voluntary Control of Breathing......Page 1401
Neural Reflexes in The Control of Breathing......Page 1413
Physiologic Responses to Altered Oxygen and Carbon Dioxide......Page 1428
Control of Breathing during Sleep......Page 1436
Control of Breathing in Unusual Environments......Page 1443
PART VI: RENAL PHYSIOLOGY AND BODY FLUIDS......Page 1463
CHAPTER 22: Kidney Function......Page 1464
Overview of Renal Function......Page 1466
Nephron: Functional Unit of The Kidney......Page 1470
Renal Blood Flow......Page 1480
Glomerular Filtration......Page 1487
Glomerular Hemodynamic Forces......Page 1492
Tubular Reabsorption......Page 1501
Tubule Secretion......Page 1520
Urinary Concentration Mechanisms......Page 1529
Renal Clearance and Assessing Glomerular Function......Page 1553
Micturition......Page 1569
CHAPTER 23: Regulation of Fluid and Electrolyte Balance......Page 1583
Fluid Compartments of the Body......Page 1585
Fluid Balance......Page 1597
Disturbances in Fluid–Electrolyte Balance......Page 1611
Sodium Balance......Page 1617
Potassium Balance......Page 1639
Calcium Balance......Page 1652
Magnesium Balance......Page 1655
Phosphate Balance......Page 1658
CHAPTER 24: Acid–Base Homeostasis......Page 1672
Basic Principles of Acid–Base Interaction......Page 1674
Metabolic Production of Acids......Page 1683
Integration of the Body’s Buffering Systems......Page 1687
Regulation of Intracellular pH......Page 1722
Physiologic Disturbances of Acid–Base Balance......Page 1726
PART VII: GASTROINTESTINAL PHYSIOLOGY......Page 1761
CHAPTER 25: Gastrointestinal System Functions......Page 1762
Functional Overview of Digestive System......Page 1764
Salivary Secretion......Page 1766
Gastric Secretion......Page 1778
Pancreatic Secretion......Page 1795
Biliary Secretion......Page 1808
Intestinal Secretion......Page 1823
Carbohydrate Digestion and Absorption......Page 1828
Lipid Digestion and Absorption......Page 1841
Protein Digestion and Absorption......Page 1852
Vitamin Absorption......Page 1864
Electrolyte and Mineral Absorption......Page 1873
Water Absorption......Page 1886
CHAPTER 26: Liver Functions and Immune Surveillance......Page 1897
Liver Structure and Function......Page 1899
Drug Metabolism in the Liver......Page 1910
Energy Metabolism in the Liver......Page 1916
Protein and Amino Acid Metabolism in the Liver......Page 1929
Liver as a Nutrient Storage Organ......Page 1933
Endocrine Functions of the Liver......Page 1941
Liver and Immune Responses......Page 1943
CHAPTER 27: Motility and Gastrointestinal Regulation......Page 1954
Organization of the Digestive System......Page 1957
Gastrointestinal System Motility......Page 1967
Esophageal and Gastric Motility......Page 1975
Small Intestinal Motility......Page 1986
Large Intestinal Motility......Page 1989
Smooth Muscle Contraction......Page 2002
Neural Control of Gut Motility and Digestive Function......Page 2016
Synaptic Transmission in the Enteric Nervous System......Page 2030
Enteric Motor Neurons......Page 2041
PART VIII: TEMPERATURE REGULATION AND EXERCISE PHYSIOLOGY......Page 2071
CHAPTER 28: Regulation of Body Temperature......Page 2072
Body Temperature and Heat Transfer......Page 2075
Balance between Heat Production and Heat Loss......Page 2086
Metabolic Rate and Heat Production at Rest......Page 2090
Heat Dissipation......Page 2104
Thermoregulatory Control......Page 2118
Thermoregulatory Responses during Exercise......Page 2131
Heat Acclimatization......Page 2137
Responses to Cold......Page 2142
Clinical Aspects of Thermoregulation......Page 2146
CHAPTER 29: Exercise Physiology......Page 2166
Oxygen Uptake and Exercise......Page 2168
Cardiovascular Responses to Exercise......Page 2175
Respiratory Responses to Exercise......Page 2189
Skeletal Muscle and Bone Responses to Exercise......Page 2194
Obesity, Aging, and Immune Responses to Exercise......Page 2203
PART IX: ENDOCRINE PHYSIOLOGY......Page 2220
CHAPTER 30: Endocrine Control Mechanisms......Page 2221
General Endocrine Concepts......Page 2222
Chemical Nature of Hormones......Page 2233
Measurement of Circulating Hormones......Page 2239
Mechanisms of Hormone Action......Page 2254
CHAPTER 31: Hypothalamus and the Pituitary Gland......Page 2270
Hypothalamic–Pituitary Axis......Page 2272
Posterior Pituitary Hormones......Page 2279
Anterior Pituitary Hormones......Page 2282
CHAPTER 32: Thyroid Gland......Page 2324
Thyroid Hormone Synthesis, Secretion, and Metabolism......Page 2326
Thyroid Hormone Effects on the Body......Page 2341
Abnormalities of Thyroid Function in Adults......Page 2352
CHAPTER 33: Adrenal Gland......Page 2366
Adrenal Cortex Synthesizes and Secretes Steroid Hormones......Page 2368
Adrenal Medulla Catecholamines......Page 2400
CHAPTER 34: Endocrine Pancreas......Page 2415
Islets of Langerhans......Page 2417
Mechanisms of Islet Hormone Synthesis and Secretion......Page 2421
Insulin and Glucagon Action......Page 2435
Diabetes Mellitus......Page 2452
CHAPTER 35: Endocrine Regulation of Calcium, Phosphate, and Bone Homeostasis......Page 2470
Overview of Calcium and Phosphate in the Body......Page 2471
Calcium and Phosphate Metabolism......Page 2482
Plasma Calcium and Phosphate Regulation......Page 2491
Bone Dysfunction......Page 2506
PART X: REPRODUCTIVE PHYSIOLOGY......Page 2519
CHAPTER 36: Male Reproductive System......Page 2520
Endocrine Glands of the Male Reproductive System......Page 2521
Testicular Function and Regulation......Page 2523
Spermatogenesis......Page 2544
Endocrine Function of the Testis......Page 2552
Androgen Action and Male Development......Page 2559
Male Reproductive Disorders......Page 2568
CHAPTER 37: Female Reproductive System......Page 2578
Hormonal Regulation of the Female Reproductive System......Page 2580
Female Reproductive Organs......Page 2585
Ovarian Cycle......Page 2588
Menstrual Cycle......Page 2605
Infertility......Page 2620
CHAPTER 38: Fertilization, Pregnancy, and Fetal Development......Page 2629
Fertilization and Implantation......Page 2632
Placental Nutrient Uptake, Waste Elimination, and Gas Exchange......Page 2642
Hormones Required for a Successful Pregnancy......Page 2647
Postpartum Lactation......Page 2661
Puberty Onset......Page 2668
Sexual Development......Page 2674
Appendix A: Common Abbreviations in Physiology......Page 2693
Appendix B: Normal Blood, Plasma, or Serum Values......Page 2705
Glossary......Page 2709
Index......Page 2894