Textbook of Medical Physiology

Title page......Page 2
Table of Contents......Page 3
Copyright......Page 23
Dedication......Page 26
Preface......Page 27
Part I. General Physiology......Page 30
Section 1. General Physiology......Page 31
Introduction......Page 32
1.1.  Functional organization, composition and internal environment of human body......Page 34
Functional organization of the human body......Page 35
Body composition......Page 38
Internal environment and homeostasis......Page 45
Cell structure......Page 50
The cell membrane......Page 61
Intercellular junctions......Page 65
1.3.  Transport through cell membrane......Page 70
Passive transport......Page 71
Active transport......Page 89
Vesicular transport......Page 97
Other transport processes......Page 103
Introduction......Page 105
Genesis of membrane potential......Page 106
Recording of membrane potential......Page 112
1.5.  Genetics: An overview......Page 113
Structural and functional characteristics of substrate for genetics......Page 114
Applied genetics......Page 133
Part II. Systemic Physiology......Page 157
Section 2. Nerve Muscle Physiology......Page 158
Introduction......Page 159
2.1.  The nerve......Page 161
Functional anatomy......Page 162
Biological activities......Page 175
Electrical properties of nerve fibre......Page 178
Physiological properties of nerve fibres......Page 216
Nerve fibre types......Page 217
Degeneration and regeneration of neurons......Page 221
Factors promoting neuronal growth......Page 229
2.2.  Neuromuscular junction......Page 233
Structure of neuromuscular junction......Page 234
Neuromuscular transmission......Page 235
Drugs affecting and disorders of neuromuscular junction......Page 241
2.3.  Skeletal muscle......Page 245
Introduction......Page 246
Functional anatomy and organization......Page 247
Process of muscle excitability and contractility......Page 259
Characteristics of muscle excitability and contractility......Page 271
Some characteristics of the skeletal muscles in the intact body......Page 305
Electromyography and common disorders of muscles......Page 314
Source of energy and metabolic phenomenon during muscle contraction......Page 322
2.4.  Smooth muscle and cardiac muscle......Page 331
Smooth muscle......Page 332
Cardiac muscle......Page 351
Comparison of skeletal, smooth and cardiac muscles......Page 352
Section 3. Blood and Immune System......Page 354
Introduction......Page 355
Functions of blood......Page 356
Immune system......Page 358
Plasma......Page 359
Plasma proteins......Page 361
3.2.  Red blood cells and anaemias......Page 378
Characteristic features of red blood cells......Page 380
Formation of red blood cells......Page 399
Haemoglobin......Page 416
Red cell fragility......Page 437
Lifespan and fate of red blood cells......Page 439
Bilirubin and jaundice......Page 445
Anaemias......Page 452
3.3.  White blood cells......Page 478
White blood cells types and their counts......Page 479
Formation of white blood cells......Page 482
Morphology, functions, lifespan and variations in counts of WBCs......Page 491
Applied aspects......Page 519
3.4.  Immune mechanisms......Page 521
Introduction......Page 522
Architecture (components) of immune system......Page 523
Immunity......Page 533
Antigens......Page 539
Antibodies......Page 543
Development of immune response......Page 556
Other immune mechanism-related aspects......Page 575
3.5.  Platelets, haemostasis and blood coagulation......Page 598
Platelets......Page 599
Haemostasis......Page 610
Blood coagulation......Page 612
Clotting factors......Page 613
Mechanism of coagulation......Page 617
Antihaemostatic mechanisms......Page 632
Bleeding disorders......Page 642
3.6.  Blood groups and blood transfusion......Page 658
Blood groups......Page 659
Blood transfusion......Page 676
Blood components......Page 684
Section 4. Cardiovascular System......Page 688
Introduction......Page 689
Physiology of CVS......Page 690
4.1.  Functional anatomy of heart and physiology of cardiac muscle......Page 692
Functional anatomy of heart......Page 693
Physiology of cardiac muscle......Page 700
4.2.  Origin and spread of cardiac impulse and electrocardiography......Page 725
Origin and spread of cardiac impulse......Page 726
Electrocardiography......Page 743
4.3.  Heart as a pump: Cardiac cycle, cardiac output, and venous return......Page 803
Cardiac cycle......Page 804
Cardiac output and venous return......Page 835
4.4.  Dynamics of circulation: Pressure and flow of blood and lymph......Page 877
Introduction......Page 878
Functional organization and structure of vascular system......Page 879
Haemodynamics......Page 886
Pressure and flow in various functional segments of systemic vascular tree......Page 921
Blood pressure......Page 953
4.5.  Cardiovascular regulation......Page 984
Introduction......Page 985
Neural control mechanism......Page 987
Humoral control mechanisms......Page 1025
Local control mechanisms......Page 1030
4.6.  Regional circulation......Page 1043
Coronary circulation......Page 1044
Cerebral circulation......Page 1068
Cutaneous circulation......Page 1080
Skeletal muscle circulation......Page 1088
Splanchnic circulation......Page 1093
4.7.  Cardiovascular homeostasis in health and disease......Page 1107
Cardiovascular homeostasis in health......Page 1108
Cardiovascular homeostasis in diseases......Page 1121
Section 5. Respiratory System......Page 1145
Introduction......Page 1146
Functional anatomy......Page 1148
Functions of the respiratory system......Page 1155
5.2.  Pulmonary ventilation......Page 1161
Introduction......Page 1162
Mechanics of pulmonary ventilation......Page 1163
Lung volumes and capacities......Page 1174
Pulmonary elastance and compliance......Page 1187
Work of breathing......Page 1202
Functional anatomy......Page 1209
Characteristic features of pulmonary circulation......Page 1211
Regulation of pulmonary blood flow......Page 1220
5.4.  Pulmonary diffusion......Page 1225
Introduction......Page 1226
Physics of gas diffusion and gas partial pressures......Page 1227
Alveolar ventilation......Page 1231
Alveolar ventilation–perfusion ratio......Page 1239
Alveolar air......Page 1243
Diffusion of gases through the respiratory membrane......Page 1246
5.5.  Transport of gases......Page 1259
Transport of oxygen......Page 1260
Transport of carbon dioxide......Page 1278
5.6.  Regulation of respiration......Page 1290
Introduction......Page 1291
Neural regulation of respiration......Page 1293
5.7.  Respiration: Applied aspects......Page 1333
Introduction......Page 1334
Respiratory adjustments to stresses in health......Page 1335
Disturbances of respiration......Page 1336
Artificial respiration and cardiopulmonary resuscitation......Page 1383
Pulmonary function tests......Page 1389
Section 6. Excretory System......Page 1402
Introduction......Page 1403
Functions of excretory organs......Page 1405
Overview of excretory system......Page 1406
6.1.  Kidneys: Functional anatomy and blood flow......Page 1407
Functional anatomy of kidneys......Page 1408
Renal blood flow......Page 1420
6.2.  Mechanism of urine formation: Glomerular filtration and tubular transport......Page 1436
Introduction......Page 1437
Glomerular filtration......Page 1438
Tubular reabsorption and secretion......Page 1449
6.3.  Concentration, dilution and acidification of urine......Page 1515
Concentration and dilution of urine: A mechanism to regulate urine volume and osmolality......Page 1516
Acidification of urine......Page 1540
6.4.  Regulation of body fluid osmolality, composition and volume......Page 1555
Introduction......Page 1556
Body fluid compartments......Page 1557
Control of body fluid osmolality......Page 1558
Regulation of extracellular fluid volume and composition......Page 1564
Defence of specific ion composition......Page 1578
Disturbances of volume and concentration of body fluid......Page 1579
6.5.  Applied renal physiology including renal function tests......Page 1588
Pathophysiology of common renal disorders......Page 1589
Diuretics......Page 1601
Renal function tests......Page 1604
Dialysis and renal transplantation......Page 1628
6.6.  Physiology of micturition......Page 1632
Urinary bladder and urethra......Page 1633
Physiology of micturition......Page 1637
Abnormalities of micturition......Page 1645
Section 7. Gastrointestinal System......Page 1649
Introduction......Page 1650
Functions of gastrointestinal system......Page 1651
Physiology of gastrointestinal tract......Page 1652
7.1.  Functional anatomy and general principles of functions of gastrointestinal system......Page 1656
Functional anatomy......Page 1657
General principles of gastrointestinal functions......Page 1667
7.2.  Physiological activities in mouth, pharynx and oesophagus......Page 1678
Mastication......Page 1679
Lubrication of food by saliva......Page 1681
Deglutition (swallowing)......Page 1695
7.3.  Physiological activities in stomach......Page 1705
Functional anatomy......Page 1706
Physiology of gastric secretion......Page 1712
Physiology of gastric motility......Page 1734
Functions of stomach......Page 1745
Applied aspects......Page 1747
7.4.  Pancreas, liver and gallbladder......Page 1762
Pancreas......Page 1763
Liver and gallbladder......Page 1787
Functional anatomy......Page 1824
Small intestinal secretions......Page 1830
Motility of small intestine......Page 1832
Functions of small intestine......Page 1843
Applied aspects......Page 1844
7.6.  Physiological activities in large intestine......Page 1847
Functional anatomy......Page 1848
Large intestinal secretions and bacterial activity......Page 1851
Motility of large intestine......Page 1854
Defaecation......Page 1858
Functions of large intestine......Page 1865
Applied aspects......Page 1866
7.7.  Digestion and absorption......Page 1872
Digestion and absorption of carbohydrates......Page 1873
Digestion and absorption of proteins......Page 1882
Digestion and absorption of fats......Page 1889
Absorption of water, electrolytes, minerals and vitamins......Page 1900
Applied aspects......Page 1910
Section 8. Endocrinal System......Page 1919
Introduction......Page 1920
Relationship between endocrine and neural physiology......Page 1921
Organization of endocrine system......Page 1922
8.1.  General principles of endocrinal system......Page 1924
Hormones: Definition and classification......Page 1925
Hormones: General considerations......Page 1930
Hormone: Receptors and mechanism of action......Page 1940
Measurement of hormones......Page 1959
8.2.  Endocrinal functions of hypothalamus and pituitary gland......Page 1962
Introduction and functional anatomy......Page 1963
Endocrinal aspects of hypothalamus......Page 1972
Anterior pituitary hormones......Page 1976
Posterior pituitary hormones......Page 2003
Functional anatomy......Page 2024
Thyroid hormones......Page 2026
Applied aspects of thyroid hormones......Page 2052
8.4.  Endocrinal control of calcium metabolism and bone physiology......Page 2068
Introduction......Page 2069
Calcium, phosphorus and magnesium metabolism......Page 2070
Bone physiology......Page 2085
Calcitropic hormones......Page 2104
Applied aspects......Page 2128
8.5.  Adrenal glands......Page 2146
Functional anatomy......Page 2147
Hormones of adrenal cortex......Page 2153
Applied aspects......Page 2197
Hormones of adrenal medulla......Page 2207
8.6.  Pancreatic and gastrointestinal hormones......Page 2236
Endocrine pancreas......Page 2237
Applied aspects......Page 2288
Gastrointestinal hormones......Page 2308
8.7.  Endocrinal functions of other organs and local hormones......Page 2309
Hormones of the heart......Page 2310
Hormones of the kidney......Page 2313
Pineal gland......Page 2317
Thymus......Page 2323
Local hormones......Page 2325
Section 9. Reproductive System......Page 2332
Introduction......Page 2333
9.1.  Sexual growth and development......Page 2335
Prepubertal sexual growth and development......Page 2336
Puberty and adolescence......Page 2363
An overview of male reproductive system......Page 2377
Functional anatomy of testes......Page 2381
Functions of testes......Page 2389
Control of androgen secretion......Page 2414
Applied aspects......Page 2419
9.3.  Female reproductive physiology......Page 2425
An overview of female reproductive system......Page 2426
Ovaries......Page 2434
Female sexual cycle......Page 2457
9.4.  Physiology of coitus, pregnancy and parturition......Page 2485
Physiology of coitus......Page 2487
Physiology of pregnancy......Page 2493
Physiology of parturition......Page 2535
Applied aspects......Page 2544
9.5.  Physiology of lactation......Page 2547
Development and functional anatomy of breast......Page 2548
Physiology of lactation......Page 2558
9.6.  Physiology of contraception......Page 2567
Introduction......Page 2568
Contraceptive methods in females......Page 2569
Contraceptive methods in males......Page 2582
Section 10. Nervous System......Page 2590
Organization of nervous system......Page 2592
Anatomical divisions of the nervous system......Page 2593
Functional divisions of the nervous system......Page 2594
Understanding the nervous system......Page 2595
10.1.  Physiological anatomy, functions and lesions of spinal cord and brainstem......Page 2598
Physiological anatomy and functions of spinal cord......Page 2599
Physiological anatomy and functions of brainstem......Page 2612
Tracts of spinal cord and brainstem......Page 2621
Lesions of spinal cord and brainstem......Page 2648
10.2.  Physiological anatomy, functions and lesions of cerebellum and basal ganglia......Page 2671
Cerebellum......Page 2673
Basal ganglia......Page 2710
10.3.  Physiological anatomy, functions and lesions of thalamus and hypothalamus......Page 2734
Thalamus......Page 2735
Hypothalamus......Page 2751
10.4.  Physiological anatomy and functions of cerebral cortex and white matter of cerebrum......Page 2774
Cerebral cortex......Page 2775
White matter of cerebrum......Page 2810
Anatomical considerations......Page 2819
Physiological considerations......Page 2832
Applied aspects......Page 2842
10.6.  Meninges, cerebrospinal fluid, blood–brain barrier and cerebral blood flow......Page 2852
Meninges of the brain......Page 2853
Cerebrospinal fluid......Page 2854
Blood–brain barrier and blood–CSF barrier......Page 2860
Cerebral blood flow......Page 2864
Synapse: Definition and types......Page 2865
Chemical synapse......Page 2869
Neurotransmitters......Page 2898
10.8.  Somatosensory system......Page 2928
General sensory mechanism......Page 2929
Somatosensory system......Page 2952
10.9.  Somatic motor system......Page 3004
Introduction......Page 3005
Components of somatic motor control system......Page 3009
Skeletal muscles: The effector organ of somatic motor system......Page 3021
Reflex activity......Page 3028
Regulation of posture......Page 3061
Vestibular apparatus and equilibrium......Page 3092
10.10.  Limbic system and physiology of emotional, behavioural and motivational mechanisms......Page 3116
Limbic system......Page 3117
Physiology of emotions......Page 3128
Physiology of motivation......Page 3137
Monoaminergic neuronal tracts and physiological basis of psychotic disorders......Page 3140
Physiological basis of psychotic disorders......Page 3141
10.11.  Reticular formation, electrical activity of the brain, and alert behaviour and sleep......Page 3144
Reticular formation and reticular activating system......Page 3145
Electrical activity of the brain......Page 3153
Wakefulness and sleep......Page 3180
10.12.  Some higher functions of nervous system......Page 3206
Language and speech......Page 3207
Learning and memory......Page 3218
Higher intellectual functions of the prefrontal association cortex......Page 3248
Section 11. Special Senses......Page 3250
Introduction......Page 3251
11.1.  Sense of vision......Page 3254
Introduction and functional anatomy......Page 3255
Maintenance of clear refractive media of the eye......Page 3261
The image forming mechanism......Page 3272
Physiology of vision......Page 3291
Field of vision and binocular vision......Page 3349
Physiology of ocular motility......Page 3359
Aqueous humour and intraocular pressure......Page 3366
Physiology of pupil......Page 3372
11.2.  Sense of hearing......Page 3378
Functional anatomy......Page 3379
Physiology of hearing......Page 3394
Applied aspects......Page 3420
11.3.  Chemical senses: Smell and taste......Page 3432
The sense of smell......Page 3433
Sense of taste......Page 3449
Part III. Specialized Integrative Physiology......Page 3465
Section 12. Specialized Integrative Physiology......Page 3466
Introduction......Page 3467
12.1.  Physiology of exercise and sports......Page 3469
Introduction......Page 3470
Responses to exercise......Page 3471
Effects of training......Page 3495
12.2.  Environmental physiology......Page 3503
High-altitude physiology......Page 3504
Physiology of high atmospheric pressure......Page 3512
12.3.  Physiology of acid–base balance......Page 3521
General considerations......Page 3522
Maintenance of blood pH......Page 3524
Acid–base disorders......Page 3540
Analysis and clinical evaluation of acid–base disorders......Page 3553
12.4.  Physiology of body temperature regulation......Page 3559
Body temperature......Page 3560
Heat balance......Page 3566
Regulation of body temperature......Page 3574
Abnormalities of body temperature regulation......Page 3585
Growth and development......Page 3590
Behavioural development......Page 3597
12.6.  Physiology of fetus, neonate and childhood......Page 3600
Role of placenta in fetal physiology......Page 3601
Systemic physiology of fetus, newborn and childhood......Page 3606
12.7.  Geriatric physiology......Page 3632
Age-related changes in different organ systems......Page 3633
Theories of ageing......Page 3643
Modulating the process of ageing......Page 3647
Index......Page 3648