Principles of Human Physiology

Cover
Title Page
Copyright Page
About the Author
Preface
Acknowledgments
Brief Contents
Contents
List of Boxes
1 Introduction to Physiology
	1.1 Organization of the Body
		Cells, Tissues, Organs, and Organ Systems
		The Overall Body Plan: A Simplified View
	1.2 Homeostasis: A Central Organizing Principle of Physiology
		Negative Feedback Control in Homeostasis
	1.3 The Diabetes Epidemic
		Prevalence of Diabetes
		Obesity and Diabetes
		Classification of Diabetes
		Diagnosing Diabetes Mellitus
		Symptoms of Diabetes Mellitus
		Treatment of Diabetes Mellitus
	Chapter Summary
	Exercises
2 The Cell Structure and Function
	2.1 Biomolecules
		Carbohydrates
		Monosaccharides, Disaccharides, and Polysaccharides
		Lipids
		Amino Acids and Proteins
		Nucleotides and Nucleic Acids
	2.2 Cell Structure
		Structure of the Plasma Membrane
		Structure of the Nucleus
		Contents of the Cytosol
		Structure of Membranous Organelles
		Structure of Nonmembranous Organelles
	2.3 Cell-to-Cell Adhesions
		Tight Junctions
		Desmosomes
		Gap Junctions
	2.4 General Cell Functions
		Metabolism
		Cellular Transport
		Intercellular Communication
	2.5 Protein Synthesis
		The Role of the Genetic Code
		Transcription
		Destination of Proteins
		Post-translational Processing and Packaging of Proteins
		Regulation of Protein Synthesis
		Protein Degradation
	2.6 Cell Division
		Replication of DNA
		The Cell Cycle
	Chapter Summary
	Exercises
3 Cell Metabolism
	3.1 Types of Metabolic Reactions
		Hydrolysis and Condensation Reactions
		Phosphorylation and Dephosphorylation Reactions
		Oxidation-Reduction Reactions
	3.2 Metabolic Reactions and Energy
		Energy and the Laws of Thermodynamics
		Energy Changes in Reactions
		Activation Energy
	3.3 Reaction Rates
		Factors Affecting the Rates of Chemical Reactions
		The Role of Enzymes in Chemical Reactions
	3.4 ATP: The Medium of Energy Exchange
	3.5 Glucose Oxidation: The Central Reaction of Energy Metabolism
		Coupling Glucose Oxidation to ATP Synthesis
	3.6 Stages of Glucose Oxidation: Glycolysis, the Krebs Cycle, and Oxidative Phosphorylation
		Glycolysis
		The Krebs Cycle
		Oxidative Phosphorylation
		The Electron Transport Chain
		Summary of Glucose Oxidation
		Glucose Catabolism in the Absence of Oxygen
	3.7 Energy Storage and Use: Metabolism of Carbohydrates, Fats, and Proteins
		Glycogen Metabolism
		Gluconeogenesis: Formation of New Glucose
		Fat Metabolism
		Protein Metabolism
	Chapter Summary
	Exercises
4 
Cell Membrane Transport
	4.1 Factors Affecting the Direction of Transport
		Passive Transport Versus Active Transport
		Driving Forces Acting on Molecules
	4.2 Rate of Transport
	4.3 Passive Transport
		Simple Diffusion: Passive Transport Through the Lipid Bilayer
		Facilitated Diffusion: Passive Transport Utilizing Membrane Proteins
		Diffusion Through Channels
	4.4 Active Transport
		Primary Active Transport
		Secondary Active Transport
		Factors Affecting Rates of Active Transport
		Coexistence of Active and Passive Transport Mechanisms in Cells
	4.5 Osmosis: Passive Transport of Water Across Membranes
		Osmolarity
		Osmotic Pressure
		Tonicity
	4.6 Transport of Material Within Membrane-Bound Compartments
		Transport of Molecules into Cells by Endocytosis
		Transport of Molecules Out of Cells by Exocytosis
	4.7 Epithelial Transport: Movement of Molecules Across Two Membranes
		Epithelial Solute Transport
		Epithelial Structure
		Epithelial Water Transport
		Transcytosis
	Chapter Summary
	Exercises
5  Chemical Messengers
	5.1 Mechanisms of Intercellular Communication
		Direct Communication Through Gap Junctions
		Indirect Communication Through Chemical Messengers
	5.2 Chemical Messengers
		Functional Classification of Chemical Messengers
		Chemical Classification of Messengers
		Synthesis and Release of Chemical Messengers
		Transport of Messengers
	5.3 Signal Transduction Mechanisms
		Properties of Receptors
		Signal Transduction Mechanisms for Responses Mediated by Intracellular Receptors
		Signal Transduction Mechanisms for Responses Mediated by Membrane-Bound Receptors
	5.4 Long-Distance Communication via the Nervous and Endocrine Systems
	Chapter Summary
	Exercises
6 The Endocrine System:Endocrine Glandsand Hormone Actions
	6.1 Primary Endocrine Organs
		Hypothalamus and Pituitary Gland
		Pineal Gland
		Thyroid Gland and Parathyroid Glands
		Thymus
		Adrenal Glands
		Pancreas
		Gonads
	6.2 Secondary Endocrine Organs
	6.3 Hormone Actions at the Target Cell
		Control of Hormone Levels in Blood
	6.4 Abnormal Secretion of Hormones
	6.5 Hormone Interactions
	Chapter Summary
	Exercises
7 Nerve Cells and Electrical Signaling
	7.1 Overview of the Nervous System
	7.2 Cells of the Nervous System
		Neurons
		Glial Cells
	7.3 Establishment of the Resting Membrane Potential
		Determining the Equilibrium Potentials for Potassium and Sodium Ions
		Resting Membrane Potential of Neurons
		Neurons at Rest
	7.4 Electrical Signaling Through Changes in Membrane Potential
		Describing Changes in Membrane Potential
		Graded Potentials
		Action Potentials
		Propagation of Action Potentials
	7.5 Maintaining Neural Stability
	Chapter Summary
	Exercises
8 Synaptic Transmission and Neural Integration
	8.1 Electrical Synapses
	8.2 Chemical Synapses
		Functional Anatomy of Chemical Synapses
		Signal Transduction Mechanisms at Chemical Synapses
		Excitatory Synapses
		Inhibitory Synapses
	8.3 Neural Integration
		Summation
		Frequency Coding
	8.4 Presynaptic Modulation
		Presynaptic Facilitation
		Presynaptic Inhibition
	8.5 Neurotransmitters: Structure, Synthesis, and Degradation
		Acetylcholine
		Biogenic Amines
		Purines
		Amino Acid Neurotransmitters
		Neuropeptides
		Unique Neurotransmitters
	Chapter Summary
	Exercises
9 The Nervous System:Central Nervous System
	9.1 General Anatomy of the Central Nervous System
		Glial Cells
		Physical Support of the Central Nervous System
		Blood Supply to the Central Nervous System
		The Blood-Brain Barrier
		Gray Matter and White Matter
	9.2 The Spinal Cord
		Spinal Nerves
		Spinal Cord Gray and White Matter
	9.3 The Brain
		Cerebral Cortex
		Subcortical Nuclei
		Diencephalon
		Limbic System
	9.4 Integrated CNS Function: Involuntary Movement Through Reflexes
		Stretch Reflex
		Withdrawal and Crossed-Extensor Reflexes
	9.5 Integrated CNS Function: Voluntary Motor Control
		Neural Components for Smooth Voluntary Movements
		Lateral Pathways Control Voluntary Movement
		Ventromedial Pathways Control Voluntary and Involuntary Movements
		The Control of Posture by the Brainstem
		The Role of the Cerebellum in Motor Coordination
		The Basal Nuclei in Motor Control
	9.6 Integrated CNS Function: Language
	9.7 Integrated CNS Function: Sleep
		Functions of Sleep
		Sleep-Wake Cycles
		Electrical Activity During Wakefulness and Sleep
	9.8 Integrated CNS Function: Emotions and Motivation
	9.9 Integrated CNS Function: Learning and Memory
		Learning
		Memory
		Plasticity in the Nervous System
	Chapter Summary
	Exercises
10 The Nervous System: Sensory Systems
	10.1 General Principles of Sensory Physiology
		Receptor Physiology
		Sensory Pathways
		Sensory Coding
	10.2 The Somatosensory System
		Somatosensory Receptors
		The Somatosensory Cortex
		Somatosensory Pathways
		Pain Perception
	10.3 Vision
		Anatomy of the Eye
		The Nature and Behavior of Light Waves
		Accommodation
		Clinical Defects in Vision
		Regulating the Amount of Light Entering the Eye
		The Retina
		Phototransduction
		Rods versus Cones
		Color Vision
		Light Input to Circadian Rhythms
		Bleaching of Photoreceptors in Light
		Neural Processing in the Retina
		Neural Pathways for Vision
		Parallel Processing in the Visual System
		Depth Perception
	10.4 The Ear and Hearing
		Anatomy of the Ear
		The Nature of Sound Waves
		Sound Amplification in the Middle Ear
		Signal Transduction for Sound
		Neural Pathways for Sound
	10.5 The Ear and Equilibrium
		Anatomy of the Vestibular Apparatus
		The Semicircular Canals and the Transduction of Rotation
		The Utricle and Saccule and the Transduction of Linear Acceleration
		Neural Pathways for Equilibrium
	10.6 Taste
		Anatomy of Taste Buds
		Signal Transduction in Taste
		Neural Pathway for Taste
	10.7 Olfaction
		Anatomy of the Olfactory System
		Olfactory Signal Transduction
		Neural Pathway for Olfaction
	Chapter Summary
	Exercises
11 The Nervous System:Autonomic and MotorSystems
	11.1 The Autonomic Nervous System
		Dual Innervation in the Autonomic Nervous System
		Anatomy of the Autonomic Nervous System
		Autonomic Neurotransmitters and Receptors
		Autonomic Neuroeffector Junctions
		Regulation of Autonomic Function
	11.2 The Somatic Nervous System
		Anatomy of the Somatic Nervous System
		The Neuromuscular Junction
	Chapter Summary
	Exercises
12 Muscle Physiology
	12.1 Skeletal Muscle Structure
		Structure at the Cellular Level
		Structure at the Molecular Level
	12.2 The Mechanism of Force Generation in Muscle
		The Sliding-Filament Model
		The Crossbridge Cycle: How Muscles Generate Force
		Excitation-Contraction Coupling: How Muscle Contractions Are Turned On and Off
	12.3 The Mechanics of Skeletal Muscle Contraction
		The Twitch
		Factors Affecting the Force Generated by Individual Muscle Fibers
		Regulation of the Force Generated by Whole Muscles
		Velocity of Shortening
	12.4 Skeletal Muscle Metabolism
		Muscle Cell Metabolism: How Muscle Cells Generate ATP
		Types of Skeletal Muscle Fibers
	12.5 Control of Skeletal Muscle Activity
		Muscle Activity Across Joints
		Muscle Receptors for Coordinated Activity
	12.6 Smooth and Cardiac Muscle
		Smooth Muscle
		Cardiac Muscle
	Chapter Summary
	Exercises
13 The Cardiovascular System: Cardiac Function
	13.1 An Overview of the Cardiovascular System
		The Heart
		Blood Vessels
		Blood
	13.2 The Path of Blood Flow Through the Heart and Vasculature
		Series Flow Through the Cardiovascular System
		Parallel Flow Within the Systemic or Pulmonary Circuit
	13.3 Anatomy of the Heart
		Myocardium and the Heart Wall
		Valves and Unidirectional Blood Flow
	13.4 Electrical Activity of the Heart
		The Conduction System of the Heart
		Spread of Excitation Through the Heart Muscle
		The Ionic Basis of Electrical Activity in the Heart
		Recording the Electrical Activity of the Heart with an Electrocardiogram
	13.5 The Cardiac Cycle
		Phases of the Cardiac Cycle
		Atrial and Ventricular Pressure
		Aortic Pressure
		Ventricular Volume
		Pressure-Volume Curve
		Heart Sounds
	13.6 Cardiac Output and Its Control
		Autonomic Input to the Heart
		Factors Affecting Cardiac Output: Changes in Heart Rate
		Factors Affecting Cardiac Output: Changes in Stroke Volume
		Integration of Factors Affecting Cardiac Output
	Chapter Summary
	Exercises
14 The Cardiovascular System: Blood Vessels, Blood Flow,and Blood Pressure
	14.1 Physical Laws Governing Blood Flow and Blood Pressure
		Pressure Gradients in the Cardiovascular System
		Resistance in the Cardiovascular System
		Relating Pressure Gradients and Resistance in the Systemic Circulation
	14.2 Overview of the Vasculature
	14.3 Arteries
		Arteries: A Pressure Reservoir
		Arterial Blood Pressure
	14.4 Arterioles
		Arterioles and Resistance to Blood Flow
		Intrinsic Control of Blood Flow Distribution to Organs
		Extrinsic Control of Arteriole Radius and Mean Arterial Pressure
	14.5 Capillaries and Venules
		Capillary Anatomy
		Local Control of Blood Flow Through Capillary Beds
		Movement of Material Across Capillary Walls
		Venules
	14.6 Veins
		Veins: A Volume Reservoir
		Factors That Influence Venous Pressure and Venous Return
	14.7 The Lymphatic System
	14.8 Mean Arterial Pressure and Its Regulation
		Determinants of Mean Arterial Pressure: Heart Rate, Stroke Volume, and Total Peripheral Resistance
		Regulation of Mean Arterial Pressure
		Control of Blood Pressure by LowPressure Baroreceptors (Volume Receptors)
	14.9 Other Cardiovascular Regulatory Processes
		Respiratory Sinus Arrhythmia
		Chemoreceptor Reflexes
		Thermoregulatory Responses
	Chapter Summary
	Exercises
15 
The Cardiovascular System: Blood
	15.1 Overview of the Composition of Blood: The Hematocrit
	15.3 Erythrocytes
	15.2 Plasma
		Oxygen and Carbon Dioxide Transport
		Life Cycle of Erythrocytes
	15.4 Leukocytes
		Basophils
		Monocytes
		Neutrophils
		Eosinophils
		Lymphocytes
	15.5 Platelets and Hemostasis
		Vascular Spasm
		Platelet Plug
		Formation of a Blood Clot
	15.6 Diabetes and Cardiovascular Disease
	Chapter Summary
	Exercises
16 The Respiratory System: Pulmonary Ventilation
	16.1 Overview of Respiratory Function
	16.2 Anatomy of the Respiratory System
		Upper Airways
		The Respiratory Tract
		Structures of the Thoracic Cavity
	16.3 Forces for Pulmonary Ventilation
		Pulmonary Pressures
		Mechanics of Breathing
	16.4 Factors Affecting Pulmonary Ventilation
		Lung Compliance
		Airway Resistance
	16.5 Clinical Significance of Respiratory Volumes and Air Flows
		Lung Volumes and Capacities
		Pulmonary Function Tests
		Alveolar Ventilation
	Chapter Summary
	Exercises
17 The Respiratory System:Gas Exchange and Regulation of Breathing
	17.1 Overview of the Pulmonary Circulation
	17.2 Diffusion of Gases
		Partial Pressure of Gases
		Solubility of Gases in Liquids
	17.3 Exchange of Oxygen and Carbon Dioxide
		Gas Exchange in the Lungs
		Gas Exchange in Respiring Tissue
		Determinants of Alveolar Po2 and Pco2
	17.4 Transport of Gases in the Blood
		Oxygen Transport in the Blood
		Carbon Dioxide Transport in the Blood
	17.5 Central Regulation of Ventilation
		Neural Control of Breathing by Motor Neurons
		Generation of the Breathing Rhythm in the Brainstem
		Peripheral Input to Respiratory Centers
	17.6 Control of Ventilation by Chemoreceptors
		Chemoreceptors
		Chemoreceptor Reflexes
	17.7 Local Regulation of Ventilation and Perfusion
		Ventilation-Perfusion Ratios
		Local Control of Ventilation and Perfusion
	17.8 The Respiratory System in Acid-Base Homeostasis
		Acid-Base Disturbances in Blood
		The Role of the Respiratory System in Acid-Base Balance
	Chapter Summary
	Exercises
18 Urinary System: Renal Function
	18.1 Functions of the Urinary System
	18.2 Anatomy of the Urinary System
		Structures of the Urinary System
		Macroscopic Anatomy of the Kidney
		Microscopic Anatomy of the Kidney
		Blood Supply to the Kidney
	18.3 Basic Renal Exchange Processes
		Glomerular Filtration
		Reabsorption
		Transport Maximum
		Secretion
	18.4 Regional Specialization of the Renal Tubules
		Nonregulated Reabsorption in the Proximal Tubule
		Regulated Reabsorption and Secretion in the Distal Tubule and Collecting Duct
		Water Conservation in the Loop of Henle
	18.5 Excretion
		Clearance
		Excretion Rate
		Micturition
	Chapter Summary
	Exercises
19 The Urinary System:Fluid and ElectrolyteBalance
	19.1 The Concept of Balance
		Factors Affecting the Plasma Composition
		Solute and Water Balance
	19.2 Water Balance
		Osmolarity and the Movement of Water
		Water Reabsorption in the Proximal Tubule
		Establishment of the Medullary Osmotic Gradient
		Role of the Medullary Osmotic Gradient in Water Reabsorption in the Distal Tubule and Collecting Duct
	19.3 Sodium Balance
		Mechanisms of Sodium Reabsorption in the Renal Tubule
		The Effects of Aldosterone
		Atrial Natriuretic Peptide
	19.4 Potassium Balance
		Renal Handling of Potassium Ions
		Regulation of Potassium Secretion by Aldosterone
	19.5 Calcium Balance
		Renal Handling of Calcium Ions
		Hormonal Control of Plasma Calcium Concentrations
	19.6 Interactions Between Fluid and Electrolyte Regulation
	19.7 Acid-Base Balance
		Sources of Acid-Base Disturbances
		Defense Mechanisms Against Acid-Base Disturbances
		Compensation for Acid-Base Disturbances
	Chapter Summary
	Exercises
20 The Gastrointestinal System
	20.1 Overview of Gastrointestinal System Processes
	20.2 Functional Anatomy of the Gastrointestinal System
		The Gastrointestinal Tract
		The Accessory Glands
	20.3 Digestion and Absorption of Nutrients and Water
		Carbohydrates
		Proteins
		Lipids
		Absorption of Vitamins
		Absorption of Minerals
		Absorption of Water
	20.4 General Principles of Gastrointestinal Regulation
		Neural and Endocrine Pathways of Gastrointestinal Control
		Regulation of Food Intake
	20.5 Gastrointestinal Secretion and Its Regulation
		Saliva Secretion
		Acid and Pepsinogen Secretion in the Stomach
		Secretion of Pancreatic Juice and Bile
		Rates of Fluid Movement in the Digestive System
	20.6 Gastrointestinal Motility and Its Regulation
		Electrical Activity in Gastrointestinal Smooth Muscle
		Peristalsis and Segmentation
		Chewing and Swallowing
		Gastric Motility
		Motility of the Small Intestine
		Motility of the Colon
	Chapter Summary
	Exercises
21 The Endocrine System: Regulation of Energy Metabolism and Growth
	21.1 An Overview of WholeBody Metabolism
		Anabolism
		Regulation of Metabolic Pathways
	21.2 Energy Intake, Utilization, and Storage
		Uptake, Utilization, and Storage of Energy in Carbohydrates
		Uptake, Utilization, and Storage of Energy in Proteins
		Uptake, Utilization, and Storage of Energy in Fats
	21.3 Energy Balance
		Energy Input
		Energy Output
		Metabolic Rate
		Negative and Positive Energy Balance
	21.4 Energy Metabolism During the Absorptive and Postabsorptive States
		Metabolism During the Absorptive State
		Metabolism During the Postabsorptive State
	21.5 Regulation of Absorptive and Postabsorptive Metabolism
		The Role of Insulin
		The Role of Glucagon
		Negative Feedback Control of Blood Glucose Levels by Insulin and Glucagon
		Effects of Epinephrine and Sympathetic Nervous Activity on Metabolism
	21.6 Thermoregulation
		Temperature Balance
		Mechanisms of Heat Transfer Between the Body and the External Environment
		Regulation of Body Temperature
		Alterations in the Set Point for Thermoregulation: Fever
	21.7 Hormonal Regulation of Growth
		Body Growth
		Effects of Growth Hormone
		Other Hormones That Affect Growth
	21.8 Thyroid Hormones
		Synthesis and Secretion of Thyroid Hormones
		Actions of Thyroid Hormones
	21.9 Glucocorticoids
		Factors Affecting Secretion of Glucocorticoids
		Actions of Glucocorticoids
		The Role of Cortisol in the Stress Response
		Effects of Abnormal Glucocorticoid Secretion
	Chapter Summary
	Exercises
22 The Reproductive System
	22.1 An Overview of Reproductive Physiology
		The Role of Gametes in Sexual Reproduction
		Gene Sorting and Packaging in Gametogenesis: Meiosis
		Components of the Reproductive System
		Events Following Fertilization
		Patterns of Reproductive Activity over the Human Life Span
	22.2 The Male Reproductive System
		Functional Anatomy of the Male Reproductive Organs
		Hormonal Regulation of Reproductive Function in Males
		Sperm and Their Development
		The Sexual Response in Males
	22.3 The Female Reproductive System
		Functional Anatomy of the Female Reproductive Organs
		Ova and Their Development
		The Sexual Response in Females
		The Menstrual Cycle
		Long-Term Hormonal Regulation of Female Reproductive Function
	22.4 Fertilization, Implantation, and Pregnancy
		Events of Fertilization
		Early Embryonic Development and Implantation
		Later Embryonic and Fetal Development
		Hormonal Changes During Pregnancy
	22.5 Parturition and Lactation
		Events of Parturition
		Lactation
	Chapter Summary
	Exercises
23 The Immune System
	23.1 Anatomy of the Immune System
		Physical Barriers
		Leukocytes
		Lymphoid Tissues
	23.2 Pathogens That Activate the Immune Response
		Viruses
		Bacteria
		Fungi
		Parasites
	23.3 Organization of the Body’s Defenses
		Nonspecific Defenses
		Specific Defenses: Immune Responses
	23.4 Humoral Immunity
		The Role of B Lymphocytes in Antibody Production
		Antibody Function in Humoral Immunity
	23.5 CellMediated Immunity
		Roles of T Lymphocytes in CellMediated Immunity
		Helper T Cell Activation
		Cytotoxic T Cell Activation: The Destruction of VirusInfected Cells and Tumor Cells
	23.6 Immune Responses in Health and Disease
		Generating Immunity: Immunization
		Roles of the Immune System in Transfusion and Transplantation
		Immune Dysfunctions
	Chapter Summary
	Exercises
24 Diabetes Mellitus
	24.1 Classification of Diabetes Mellitus
		Type 1 Diabetes Mellitus
		Type 2 Diabetes Mellitus
	24.2 Acute Effects of Diabetes Mellitus
		Acute Hyperglycemia
		Diabetic Ketoacidosis
		Hyperosmolar Nonketotic Coma
		Hypoglycemic Coma
	24.3 Chronic Complications of Diabetes Mellitus: Early Stages
	24.4 Chronic Complications of Diabetes Mellitus: Advanced Stages
		Adverse Effects of Hyperglycemia
		Effects of Diabetes Mellitus on the Microvasculature
	24.5 Progression of Diabetes Mellitus to Critical States
		Effects of Diabetes on the Macrovasculature
		Diabetic Cardiomyopathy
	24.6 Delayed Wound Healing
		Wound Healing
		Altered Wound Healing in Diabetes
	24.7 Treatment and Management of Diabetes Mellitus
	24.8 Current Research on Diabetes Mellitus
		New Techniques for Insulin Administration
		Development of New Medicines for the Treatment of Diabetes Mellitus
		Nonpharmaceutical Therapies for the Treatment of Diabetes Mellitus
	Chapter Summary
	Exercises
Answers to Figure Questions, Apply Your
Knowledge, and End-of-Chapter Multiple
Choice and Objective Questions
Credits
Glossary
Index