Textbook of medical physiology

UNIT I: Introduction to Physiology: The Cell and General Physiology......Page 37
Extracellular Fluid—The “Internal Environment”......Page 39
“Homeostatic” Mechanisms of the Major Functional Systems......Page 40
Control Systems of the Body......Page 42
Summary—Automaticity of the Body......Page 45
Organization of the Cell......Page 47
Physical Structure of the Cell......Page 48
Comparison of the Animal Cell with Precellular Forms of Life......Page 54
Functional Systems of the Cell......Page 55
Locomotion of Cells......Page 60
Genes in the Cell Nucleus......Page 63
The DNA Code in the Cell Nucleus Is Transferred to an RNA Code in the Cell Cytoplasm—The Process of Transcription......Page 66
Control of Gene Function and Biochemical Activity in Cells......Page 71
The DNA-Genetic System Also Controls Cell Reproduction......Page 73
Cancer......Page 76
UNIT II: Membrane Physiology, Nerve, and Muscle......Page 79
The Lipid Barrier of the Cell Membrane, and Cell Membrane Transport Proteins......Page 81
Diffusion......Page 82
“Active Transport” of Substances Through Membranes......Page 88
Basic Physics of Membrane Potentials......Page 93
Measuring the Membrane Potential......Page 94
Resting Membrane Potential of Nerves......Page 95
Nerve Action Potential......Page 97
Roles of Other Ions During the Action Potential......Page 100
Propagation of the Action Potential......Page 101
Plateau in Some Action Potentials......Page 102
RHYTHMICITY OF SOME EXCITABLE TISSUES—REPETITIVE DISCHARGE......Page 103
Special Characteristics of Signal Transmission in Nerve Trunks......Page 104
Excitation—The Process of Eliciting the Action Potential......Page 105
Recording Membrane Potentials and Action Potentials......Page 106
Physiologic Anatomy of Skeletal Muscle......Page 108
Molecular Mechanism  of Muscle Contraction......Page 110
Energetics of Muscle Contraction......Page 114
Characteristics of Whole Muscle Contraction......Page 116
Transmission of Impulses from Nerve Endings to Skeletal Muscle Fibers:  The Neuromuscular Junction......Page 121
Drugs That Enhance or Block Transmission at the Neuromuscular Junction......Page 124
Excitation-Contraction Coupling......Page 125
Contraction of Smooth Muscle......Page 128
Nervous and Hormonal Control of Smooth Muscle Contraction......Page 131
UNIT III: The Heart......Page 137
Physiology of Cardiac Muscle......Page 139
The Cardiac Cycle......Page 142
Relationship of the Heart Sounds to Heart Pumping......Page 145
Work Output of the Heart......Page 146
Regulation of Heart Pumping......Page 147
Specialized Excitatory and Conductive System of the Heart......Page 152
Control of Excitation and Conduction in the Heart......Page 156
Characteristics of the Normal Electrocardiogram......Page 159
Flow of Current Around the Heart During the Cardiac Cycle......Page 162
Electrocardiographic Leads......Page 163
Principles of Vectorial Analysis of Electrocardiograms......Page 167
Vectorial Analysis of the Normal Electrocardiogram......Page 170
Mean Electrical Axis of the Ventricular QRS—And Its Significance......Page 173
Conditions That Cause Abnormal Voltages of the QRS Complex......Page 176
Current of Injury......Page 177
Abnormalities in the T Wave......Page 181
Abnormal Sinus Rhythms......Page 183
Abnormal Rhythms That Result from Block of Heart Signals Within the Intracardiac Conduction Pathways......Page 184
Premature Contractions......Page 186
Paroxysmal Tachycardia......Page 187
Ventricular Fibrillation......Page 188
Atrial Fibrillation......Page 191
Cardiac Arrest......Page 192
UNIT IV: The Circulation......Page 195
Physical Characteristics of the Circulation......Page 197
Basic Theory of Circulatory Function......Page 199
Interrelationships Among Pressure, Flow, and Resistance......Page 200
Vascular Distensibility......Page 207
Arterial Pressure Pulsations......Page 209
Veins and Their Functions......Page 212
Structure of the Microcirculation and Capillary System......Page 217
Flow of Blood in the Capillaries—Vasomotion......Page 218
Exchange of Water, Nutrients, and Other Substances Between the Blood and Interstitial Fluid......Page 219
The Interstitium and Interstitial Fluid......Page 220
Fluid Filtration Across Capillaries Is Determined by Hydrostatic and Colloid Osmotic Pressures, and Capillary Filtration Coef......Page 221
Lymphatic System......Page 226
Local Control of Blood Flow in Response to Tissue Needs......Page 231
Mechanisms of Blood Flow Control......Page 232
Humoral Control of the Circulation......Page 237
Nervous Regulation of the Circulation......Page 240
Role of the Nervous System in Rapid Control of Arterial Pressure......Page 244
Special Features of Nervous Control of Arterial Pressure......Page 249
Renal–Body Fluid System for Arterial Pressure Control......Page 252
The Renin-Angiotensin System: Its Role in Pressure Control and in Hypertension......Page 259
Summary of the Integrated, Multifaceted System for Arterial Pressure Regulation......Page 266
Control of Cardiac Output by Venous Return—Role of the Frank-Starling Mechanism of the Heart......Page 268
Pathologically High and Pathologically Low Cardiac Outputs......Page 272
Methods for Measuring Cardiac Output......Page 279
Blood Flow in Skeletal Muscle and Blood Flow Regulation During Exercise......Page 282
Coronary Circulation......Page 285
Dynamics of the Circulation in Cardiac Failure......Page 294
Low-Output Cardiac Failure—Cardiogenic Shock......Page 298
Edema in Patients with Cardiac Failure......Page 299
Heart Sounds......Page 305
Abnormal Circulatory Dynamics in Valvular Heart Disease......Page 308
Abnormal Circulatory Dynamics in Congenital Heart Defects......Page 310
Hypertrophy of the Heart in Valvular and Congenital Heart Disease......Page 312
Physiologic Causes of Shock......Page 314
Shock Caused by Hypovolemia—Hemorrhagic Shock......Page 315
Anaphylactic Shock and Histamine Shock......Page 321
Physiology of Treatment  in Shock......Page 322
Circulatory Arrest......Page 323
UNIT V: The Body Fluids and Kidneys......Page 325
Fluid Intake and Output Are Balanced During Steady-State Conditions......Page 327
Body Fluid Compartments......Page 328
Constituents of Extracellular and Intracellular Fluids......Page 329
Determination of Volumes of Specific Body Fluid Compartments......Page 331
Basic Principles of Osmosis and Osmotic Pressure......Page 332
Osmotic Equilibrium Is Maintained Between Intracellular and Extracellular Fluids......Page 334
Volume and Osmolality of Extracellular and Intracellular Fluids in Abnormal States......Page 335
Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia......Page 337
Edema: Excess Fluid in the Tissues......Page 338
Fluids in the “Potential Spaces” of the Body......Page 341
Multiple Functions of the Kidneys in Homeostasis......Page 343
Physiologic Anatomy of the Kidneys......Page 344
Physiologic Anatomy and Nervous Connections of the Bladder......Page 347
Filling of the Bladder and Bladder Wall Tone; the Cystometrogram......Page 348
Abnormalities of Micturition......Page 349
Urine Formation Results from Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion......Page 350
Glomerular Filtration—The First Step in Urine Formation......Page 352
Determinants of the GFR......Page 353
Renal Blood Flow......Page 356
Physiologic Control of Glomerular Filtration and Renal Blood Flow......Page 357
Autoregulation of GFR and Renal Blood Flow......Page 359
Reabsorption and Secretion by the Renal Tubules......Page 363
Tubular Reabsorption Includes Passive and Active Mechanisms......Page 364
Reabsorption and Secretion Along Different Parts of the Nephron......Page 369
Regulation of Tubular Reabsorption......Page 375
Use of Clearance Methods to Quantify Kidney Function......Page 379
The Kidneys Excrete Excess Water by Forming a Dilute Urine......Page 384
The Kidneys Conserve Water by Excreting a Concentrated Urine......Page 386
Disorders of Urinary Concentrating Ability......Page 393
Osmoreceptor-ADH Feedback System......Page 394
Role of Thirst in Controlling Extracellular Fluid Osmolarity and Sodium Concentration......Page 397
Salt-Appetite Mechanism  for Controlling Extracellular Fluid Sodium Concentration and Volume......Page 399
Regulation of Potassium Excretion and Potassium Concentration in Extracellular Fluid......Page 401
Control of Renal Calcium Excretion and Extracellular Calcium Ion Concentration......Page 407
Integration of Renal Mechanisms for Control of Extracellular Fluid......Page 409
Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance......Page 410
Distribution of Extracellular Fluid Between the Interstitial Spaces and Vascular System......Page 412
Nervous and Hormonal Factors Increase the Effectiveness of Renal-Body Fluid Feedback Control......Page 413
Conditions That Cause Large Increases in Blood Volume and Extracellular Fluid Volume......Page 416
Conditions That Cause Large Increases in Extracellular Fluid Volume but with Normal Blood Volume......Page 417
Acids and Bases—Their Definitions  and Meanings......Page 419
Defenses Against Changes in Hydrogen Ion Concentration: Buffers, Lungs, and Kidneys......Page 420
Bicarbonate Buffer System......Page 421
Proteins: Important Intracellular Buffers......Page 423
Respiratory Regulation of Acid-Base Balance......Page 424
Secretion of Hydrogen Ions and Reabsorption of Bicarbonate Ions by the Renal Tubules......Page 426
Combination of Excess Hydrogen Ions with Phosphate and Ammonia Buffers in the Tubule—A Mechanism  for Generating “New” Bicarb......Page 428
Quantifying Renal Acid-Base Excretion......Page 430
Renal Correction of Alkalosis—Decreased Tubular Secretion of Hydrogen Ions and Increased Excretion of Bicarbonate Ions......Page 432
Clinical Causes of Acid-Base Disorders......Page 433
Clinical Measurements and Analysis of Acid-Base Disorders......Page 434
Diuretics and Their Mechanisms of Action......Page 438
Acute Renal Failure......Page 440
Chronic Renal Failure: An Irreversible Decrease in the Number of Functional Nephrons......Page 442
Specific Tubular Disorders......Page 449
Treatment of Renal Failure by Dialysis with an Artificial Kidney......Page 450
UNIT VI: Blood Cells, Immunity, and Blood Clotting......Page 453
Red Blood Cells (Erythrocytes)......Page 455
Anemias......Page 462
Polycythemia......Page 463
Leukocytes (White Blood Cells)......Page 465
Neutrophils and Macrophages Defend Against Infections......Page 467
Monocyte-Macrophage Cell System (Reticuloendothelial System)......Page 468
Inflammation: Role of Neutrophils and Macrophages......Page 470
Leukopenia......Page 472
The Leukemias......Page 473
Acquired (Adaptive) Immunity......Page 475
ALLERGY AND HYPERSENSITIVITY......Page 485
O-A-B Blood Types......Page 487
Rh Blood Types......Page 489
Transplantation of Tissues and Organs......Page 491
Events in Hemostasis......Page 493
Mechanism of Blood Coagulation......Page 495
Conditions That Cause Excessive Bleeding in Human Beings......Page 500
Thromboembolic Conditions in the Human Being......Page 501
Anticoagulants for Clinical Use......Page 502
Blood Coagulation Tests......Page 503
UNIT VII: Respiration......Page 505
Mechanics of Pulmonary Ventilation......Page 507
Pulmonary Volumes and Capacities......Page 511
Alveolar Ventilation......Page 513
Functions of the Respiratory Passageways......Page 514
Pressures in the Pulmonary System......Page 519
Blood Volume of the Lungs......Page 520
Effect of Hydrostatic Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow......Page 521
Pulmonary Capillary Dynamics......Page 523
Fluid in the Pleural Cavity......Page 525
Physics of Gas Diffusion and Gas Partial Pressures......Page 527
Composition of Alveolar Air—Its Relation to Atmospheric Air......Page 529
Diffusion of Gases Through the Respiratory Membrane......Page 532
Effect of the Ventilation-Perfusion Ratio on Alveolar Gas Concentration......Page 535
Transport of Oxygen from the Lungs to the Body Tissues......Page 538
Transport of Carbon Dioxide in the Blood......Page 546
Respiratory Exchange Ratio......Page 548
Respiratory Center......Page 550
Chemical Control of Respiration......Page 552
Peripheral Chemoreceptor System for Control of Respiratory Activity—Role of Oxygen in Respiratory Control......Page 554
Regulation of Respiration During Exercise......Page 556
Other Factors That Affect Respiration......Page 557
CHAPTER 42: Respiratory Insufficiency—Pathophysiology, Diagnosis, Oxygen Therapy......Page 560
Physiologic Peculiarities of Specific Pulmonary Abnormalities......Page 562
Hypoxia and Oxygen Therapy......Page 566
Hypercapnia......Page 567
Artificial Respiration......Page 568
UNIT VIII: Aviation, Space, and Deep-Sea Diving Physiology......Page 571
Effects of Low Oxygen Pressure on the Body......Page 573
Effects of Acceleratory Forces on the Body in Aviation and Space Physiology......Page 577
Weightlessness in Space......Page 579
Effect of High Partial Pressures of Individual Gases on the Body......Page 581
Scuba (Self-Contained Underwater Breathing Apparatus) Diving......Page 585
Hyperbaric Oxygen Therapy......Page 586
UNIT IX: The Nervous System: A. General Principles and Sensory Physiology......Page 589
General Design of the Nervous System......Page 591
Major Levels of Central Nervous System Function......Page 593
Comparison of the Nervous System with a Computer......Page 594
Central Nervous System Synapses......Page 595
Some Special Characteristics of Synaptic Transmission......Page 606
Types of Sensory Receptors and the Sensory Stimuli They Detect......Page 608
Transduction of Sensory Stimuli into Nerve Impulses......Page 609
Nerve Fibers That Transmit Different Types of Signals, and Their Physiologic Classification......Page 612
Transmission of Signals of Different Intensity in Nerve Tracts—Spatial and Temporal Summation......Page 613
Transmission and Processing of Signals in Neuronal Pools......Page 614
Instability and Stability of Neuronal Circuits......Page 619
Detection and Transmission of Tactile Sensations......Page 621
Sensory Pathways for Transmitting Somatic Signals into the Central Nervous System......Page 623
Transmission in the Dorsal Column–Medial Lemniscal System......Page 624
Transmission of Less Critical Sensory Signals in the Anterolateral Pathway......Page 631
Some Special Aspects of Somatosensory Function......Page 632
Pain Receptors and Their Stimulation......Page 634
Dual Pathways for Transmission of Pain Signals into the Central Nervous System......Page 636
Pain Suppression (“Analgesia”) System in the Brain and Spinal Cord......Page 638
Visceral Pain......Page 639
Some Clinical Abnormalities of Pain and Other Somatic Sensations......Page 641
Headache......Page 642
Thermal Sensations......Page 643
UNIT X: The Nervous System: B. The Special Senses......Page 647
Physical Principles of Optics......Page 649
Optics of the Eye......Page 653
Ophthalmoscope......Page 658
Fluid System of the Eye—Intraocular Fluid......Page 659
Anatomy and Function of the Structural Elements of the Retina......Page 662
Photochemistry of Vision......Page 664
Color Vision......Page 668
Neural Function of the Retina......Page 669
Visual Pathways......Page 676
Organization and Function of the Visual Cortex......Page 677
Neuronal Patterns of Stimulation During Analysis of the Visual Image......Page 679
Fields of Vision; Perimetry......Page 680
Eye Movements and Their Control......Page 681
Autonomic Control of Accommodation and  Pupillary Aperture......Page 684
Tympanic Membrane and the Ossicular System......Page 687
Cochlea......Page 688
Central Auditory Mechanisms......Page 693
Hearing Abnormalities......Page 696
Sense of Taste......Page 699
Sense of Smell......Page 703
UNIT XI: The Nervous System: C. Motor and Integrative Neurophysiology......Page 707
Organization of the Spinal Cord for Motor Functions......Page 709
Muscle Sensory Receptors—Muscle Spindles and Golgi Tendon Organs—And Their Roles in Muscle Control......Page 711
Flexor Reflex and the Withdrawal Reflexes......Page 716
Reciprocal Inhibition and Reciprocal Innervation......Page 717
Reflexes of Posture and Locomotion Locomotion......Page 718
Autonomic Reflexes in the Spinal Cord......Page 719
Spinal Cord Transection and Spinal Shock......Page 720
MOTOR CORTEX AND CORTICOSPINAL TRACT......Page 721
Role of the Brain Stem in Controlling Motor Function......Page 727
Vestibular Sensations and Maintenance of Equilibrium......Page 728
Functions of Brain Stem Nuclei in Controlling Subconscious, Stereotyped Movements......Page 733
Cerebellum and Its Motor Functions......Page 734
Basal Ganglia—Their Motor Functions......Page 743
Integration of the Many Parts of the Total Motor Control System......Page 748
Physiologic Anatomy of the Cerebral Cortex......Page 750
Functions of Specific Cortical Areas......Page 751
Function of the Brain in Communication—Language Input and Language Output......Page 756
Function of the Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories, Training, and Other Information Betwe......Page 758
Thoughts, Consciousness, and Memory......Page 759
Activating-Driving Systems of the Brain......Page 764
Functional Anatomy of the Limbic System; Key Position of the Hypothalamus......Page 767
Hypothalamus, a Major Control Headquarters for the Limbic System......Page 768
Specific Functions of Other Parts of the Limbic System......Page 772
Sleep......Page 775
Brain Waves......Page 777
Epilepsy......Page 779
Psychotic Behavior and Dementia—Roles of Specific Neurotransmitter Systems......Page 781
General Organization of the Autonomic Nervous System......Page 784
Basic Characteristics of Sympathetic and Parasympathetic Function......Page 786
Stimulation of Discrete Organs in Some Instances and Mass Stimulation in Other Instances by the Sympathetic and Parasympathet......Page 793
Pharmacology of the Autonomic Nervous System......Page 795
Cerebral Blood Flow......Page 797
Cerebrospinal Fluid System......Page 799
Brain Metabolism......Page 803
UNIT XII: Gastrointestinal Physiology......Page 805
General Principles of Gastrointestinal Motility......Page 807
Neural Control of Gastrointestinal Function—Enteric Nervous System......Page 809
Functional Types of Movements in the Gastrointestinal Tract......Page 812
Gastrointestinal Blood Flow—“Splanchnic Circulation”......Page 813
Ingestion of Food......Page 817
Motor Functions of the Stomach......Page 820
Movements of the Small Intestine......Page 822
Movements of the Colon......Page 824
Other Autonomic Reflexes That Affect Bowel Activity......Page 826
General Principles of Alimentary Tract Secretion......Page 827
Secretion of Saliva......Page 829
Gastric Secretion......Page 831
Pancreatic Secretion......Page 835
Secretion of Bile by the Liver; Functions of the Biliary Tree......Page 838
Secretions of the Small Intestine......Page 841
Secretions of the Large Intestine......Page 842
Digestion of the Various Foods by Hydrolysis......Page 844
Basic Principles of Gastrointestinal Absorption......Page 848
Absorption in the Small Intestine......Page 849
Absorption in the Large Intestine: Formation of Feces......Page 853
Disorders of the Stomach......Page 855
Disorders of the Small Intestine......Page 857
Disorders of the Large Intestine......Page 858
General Disorders of the Gastrointestinal Tract......Page 859
UNIT XIII: Metabolism and Temperature Regulation......Page 863
CHAPTER 67: Metabolism of Carbohydrates, and Formation of Adenosine Triphosphate......Page 865
Central Role of Glucose in Carbohydrate Metabolism......Page 866
Glycogen Is Stored in Liver and Muscle......Page 867
Release of Energy from the Glucose Molecule by the Glycolytic Pathway......Page 868
Release of Energy from Glucose by the Pentose Phosphate Pathway......Page 873
Formation of Carbohydrates from Proteins and Fats—“Gluconeogenesis”......Page 874
Blood Glucose......Page 875
Transport of Lipids in the Body Fluids......Page 876
Use of Triglycerides for Energy: Formation of Adenosine Triphosphate......Page 878
Phospholipids and Cholesterol......Page 882
Atherosclerosis......Page 884
Basic Properties......Page 888
Transport and Storage of Amino Acids......Page 890
Functional Roles of the Plasma Proteins......Page 891
Hormonal Regulation of Protein Metabolism......Page 893
Hepatic Vascular and Lymph Systems......Page 895
Metabolic Functions of the Liver......Page 897
Measurement of Bilirubin in the Bile as a Clinical Diagnostic Tool......Page 898
Dietary Balances......Page 901
Regulation of Food Intake and Energy Storage......Page 903
Obesity......Page 908
Starvation......Page 910
Vitamins......Page 911
Mineral Metabolism......Page 914
Adenosine Triphosphate (ATP) Functions as an “Energy Currency” in Metabolism......Page 917
Metabolic Rate......Page 920
Energy Metabolism—Factors That Influence Energy Output......Page 921
Body Temperature Is Controlled by Balancing Heat Production Against Heat Loss......Page 925
Regulation of Body Temperature—Role of the Hypothalamus......Page 930
Abnormalities of Body Temperature Regulation......Page 934
UNIT XIV: Endocrinology and Reproduction......Page 939
Coordination of Body Functions by Chemical Messengers......Page 941
Chemical Structure and Synthesis of Hormones......Page 942
Hormone Secretion, Transport, and Clearance from the Blood......Page 944
Mechanisms of Action of Hormones......Page 946
Measurement of Hormone Concentrations in the Blood......Page 951
Pituitary Gland and Its Relation to the Hypothalamus......Page 954
Hypothalamus Controls Pituitary Secretion......Page 955
Physiological Functions of Growth Hormone......Page 957
Posterior Pituitary Gland and Its Relation to the Hypothalamus......Page 963
Synthesis and Secretion of the Thyroid Metabolic Hormones......Page 967
Physiologic Functions of the Thyroid Hormones......Page 970
Regulation of Thyroid Hormone Secretion......Page 974
Diseases of the Thyroid......Page 976
Synthesis and Secretion of Adrenocortical Hormones......Page 980
Functions of the Mineralocorticoids-Aldosterone......Page 983
Functions of the Glucocorticoids......Page 986
Abnormalities of Adrenocortical Secretion......Page 993
Insulin and Its Metabolic Effects......Page 997
Glucagon and Its Functions......Page 1006
Summary of Blood Glucose Regulation......Page 1007
Diabetes Mellitus......Page 1008
Overview of Calcium and Phosphate Regulation in the Extracellular Fluid and Plasma......Page 1014
Bone and Its Relation to Extracellular Calcium and Phosphate......Page 1016
Vitamin D......Page 1019
Parathyroid Hormone......Page 1021
Calcitonin......Page 1024
Summary of Control of Calcium Ion Concentration......Page 1025
Pathophysiology of Parathyroid Hormone, Vitamin D, and Bone Disease......Page 1026
Physiology of the Teeth......Page 1028
Spermatogenesis......Page 1032
Male Sexual Act......Page 1037
Testosterone and Other Male Sex Hormones......Page 1039
Abnormalities of Male Sexual Function......Page 1044
Pineal Gland—Its Function in Controlling Seasonal Fertility in Some Animals......Page 1045
Female Hormonal System......Page 1047
Monthly Ovarian Cycle; Function of the Gonadotropic Hormones......Page 1048
Functions of the Ovarian Hormones—Estradiol and Progesterone......Page 1052
Regulation of the Female Monthly Rhythm—Interplay Between the Ovarian and Hypothalamic-Pituitary Hormones......Page 1055
Female Sexual Act......Page 1059
Female Fertility......Page 1060
Maturation and Fertilization of the Ovum......Page 1063
Function of the Placenta......Page 1065
Hormonal Factors in Pregnancy......Page 1067
Response of the Mother’s Body to Pregnancy......Page 1070
Parturition......Page 1072
Lactation......Page 1074
Growth and Functional Development of the Fetus......Page 1078
Adjustments of the Infant to Extrauterine Life......Page 1080
Special Functional Problems in the Neonate......Page 1083
Special Problems of Prematurity......Page 1086
Growth and Development of the Child......Page 1087
UNIT XV: Sports Physiology......Page 1089
Muscles in Exercise......Page 1091
Respiration in Exercise......Page 1097
Cardiovascular System in Exercise......Page 1098
Drugs and Athletes......Page 1101
Body Fitness Prolongs Life......Page 1102
INDEX......Page 1103