UNIT I
Introduction to Physiology: The Cell and General
Physiology
CHAPTER 1
Functional Organization of the Human Body
and Control of the “Internal Environment” 3
Cells as the Living Units of the Body 3
Extracellular
Fluid—The “Internal Environment" 3
“Homeostatic"
Mechanisms of the Major Functional Systems 4
Control Systems of
the Body 6
Summary—Automaticity
of the Body 9
CHAPTER 2
The Cell and Its
Functions 11
Organization of the
Cell 11
Physical Structure of
the Cell 12
Comparison of the
Animal Cell with Precellular Forms of Life 17
Functional
Systems of the Cell 18
Locomotion of Cells 23
CHAPTER 3
Genetic Control of
Protein Synthesis, Cell Function, and Cell Reproduction 27
Genes in the Cell
Nucleus 27
The DNA Code in the
Cell Nucleus Is Transferred to an RNA Code in the Cell Cytoplasm—The Process of
Transcription 30
Synthesis of Other
Substances in the Cell 35
Control of Gene
Function and Biochemical Activity in Cells 35
The DNA-Genetic
System Also Controls Cell Reproduction 37
Cell Differentiation 39
Apoptosis—Programmed Cell Death 40
Cancer 40
UNIT II
Membrane Physiology, Nerve, and Muscle
CHAPTER 4
Transport of
Substances Through Cell Membranes 45
The
Lipid Barrier of the Cell Membrane,
and Cell Membrane Transport Proteins 45
Diffusion 46
“Active
Transport" of Substances Through Membranes 52
CHAPTER 5
Membrane Potentials and Action Potentials 57
Basic Physics of
Membrane Potentials 57
Measuring the
Membrane Potential 58
Resting Membrane Potential
of Nerves 59
Nerve Action
Potential 60
Roles of Other Ions
During the Action Potential 64
Propagation of the
Action Potential 64
Re-establishing
Sodium and Potassium Ionic Gradients After Action Potentials Are
Completed—Importance of Energy Metabolism 65
Plateau in Some
Action Potentials 66
Rhythmicity
of Some Excitable Tissues—
Repetitive Discharge 66
Special
Characteristics of Signal Transmission in Nerve Trunks 67
Excitation—The
Process of Eliciting the Action Potential 68
Recording
Membrane Potentials and
Action Potentials 69
CHAPTER 6
Contraction of
Skeletal Muscle 71
Physiologic Anatomy
of Skeletal Muscle 71
General Mechanism of
Muscle Contraction 73
Molecular Mechanism
of Muscle Contraction 74
Energetics of Muscle
Contraction 78
Characteristics of
Whole Muscle Contraction 79
CHAPTER 7
Excitation of Skeletal Muscle:
Neuromuscular Transmission and
Excitation-Contraction
Coupling 83
Transmission of
Impulses from Nerve Endings to Skeletal Muscle Fibers:The Neuromuscular
Junction 83
Molecular Biology of
Acetylcholine Formation and Release 86
Drugs That Enhance or
BlockTransmission at the Neuromuscular Junction 86
Myasthenia Gravis Causes Muscle Paralysis 86
Muscle Action Potential 87
Excitation-Contraction Coupling 88
CHAPTER 8
Excitation and Contraction of Smooth Muscle 91
Contraction of Smooth
Muscle 91
Nervous and Hormonal
Control of Smooth Muscle Contraction 94
UNIT III
The Heart
CHAPTER 9
Cardiac Muscle; The
Heart as a Pump and Function of the Heart Valves 101
Physiology of Cardiac
Muscle 101
Cardiac Cycle 104
Relationship of the
Heart Sounds to Heart Pumping 107
Work Output of the
Heart 107
Chemical Energy
Required for Cardiac Contraction: Oxygen Utilization by the Heart 109
Regulation of Heart
Pumping 110
CHAPTER 10
Rhythmical Excitation
of the Heart 115
Specialized
Excitatory and Conductive System of the Heart 115
Control of Excitation
and Conduction in the Heart 118
CHAPTER 11
The Normal
Electrocardiogram 121
Characteristics
of the Normal
Electrocardiogram 121
Methods for Recording
Electrocardiograms 123
Flow
of Current Around the Heart
during the Cardiac
Cycle 123
Electrocardiographic
Leads 124
CHAPTER 12
Electrocardiographic Interpretation of
Cardiac Muscle and Coronary Blood Flow
Abnormalities:
Vectorial Analysis 129
Principles of
Vectorial Analysis of Electrocardiograms 129
Vectorial Analysis of
the Normal Electrocardiogram 131
Mean Electrical Axis
of the Ventricular QRS—and Its Significance 134
Conditions
That Cause Abnormal Voltages
of the QRS Complex 137
Prolonged and Bizarre
Patterns of the QRS Complex 137
Current of Injury 138
Abnormalities in the
T Wave 141
CHAPTER 13
Cardiac Arrhythmias
and Their Electrocardiographic Interpretation 143
Abnormal Sinus
Rhythms 143
Abnormal Rhythms That
Result from Block of Heart Signals Within the Intracardiac Conduction Pathways 144
Premature
Contractions 146
Paroxysmal
Tachycardia 148
Ventricular
Fibrillation 149
Atrial Fibrillation 151
Atrial Flutter 152
Cardiac Arrest 153
UNIT IV
The Circulation
CHAPTER 14
Overview of the Circulation; Biophysics of
Pressure, Flow, and
Resistance 157
Physical
Characteristics of the Circulation 157
Basic Principles of
Circulatory Function 158
Interrelationships of
Pressure, Flow, and Resistance 159
CHAPTER 15
Vascular Distensibility and Functions of the
Arterial and Venous
Systems 167
Vascular
Distensibility 167
Arterial Pressure
Pulsations 168
Veins and Their
Functions 171
CHAPTER 16
The Microcirculation and Lymphatic System: Capillary
Fluid Exchange,
Interstitial Fluid,
and Lymph Flow 177
Structure
of the Microcirculation
and Capillary System 177
Flow
of Blood in the Capillaries—
Vasomotion 178
Exchange of Water, Nutrients,
and Other Substances Between the Blood and Interstitial Fluid 179
Interstitium and
Interstitial Fluid 180
Fluid
Filtration Across Capillaries Is
Determined
by Hydrostatic and Colloid
Osmotic
Pressures, as Well as Capillary
Filtration
Coefficient 181
Lymphatic System 186
CHAPTER 17
Local and Humoral Control of Tissue
Blood Flow 191
Local Control of
Blood Flow in Response to Tissue Needs 191
Mechanisms of Blood
Flow Control 191
Humoral Control of
the Circulation 199
CHAPTER 18
Nervous Regulation of the Circulation,
and Rapid Control of
Arterial Pressure 201
Nervous Regulation of
the Circulation 201
Role
of the Nervous System in Rapid
Control of Arterial
Pressure 204
Special
Features of Nervous Control
of Arterial Pressure 209
CHAPTER 19
Role of the Kidneys in Long-Term Control of Arterial
Pressure and in Hypertension: The
Integrated System for
Arterial Pressure Regulation 213
Renal-Body
Fluid System for Arterial
Pressure Control 213
The Renin-Angiotensin
System: Its Role in Arterial Pressure Control 220
Summary of the
Integrated, Multifaceted System for Arterial Pressure Regulation 226
CHAPTER 20
Cardiac Output, Venous Return,
and Their Regulation 229
Normal
Values for Cardiac Output at Rest
and During Activity 229
Control
of Cardiac Output by Venous
Return—Role
of the Frank-Starling Mechanism
of the Heart 229
Pathologically
High or Low Cardiac Outputs 232
Methods
for Measuring Cardiac
Output 240
CHAPTER 21
Muscle Blood Flow and Cardiac Output During Exercise; the
Coronary Circulation
and Ischemic Heart
Disease 243
Blood
Flow Regulation in Skeletal Muscle
at Rest and During
Exercise 243
Coronary Circulation 246
CHAPTER 22
Cardiac Failure 255
Circulatory Dynamics
in Cardiac Failure 255
Unilateral Left Heart
Failure 259
Low-Output
Cardiac Failure—
Cardiogenic Shock 259
Edema in Patients
with Cardiac Failure 259
Cardiac Reserve 261
CHAPTER 23
Heart Valves and Heart Sounds;
Valvular and Congenital Heart
Defects 265
Heart Sounds 265
Abnormal Circulatory
Dynamics in Valvular Heart Disease 268
Abnormal Circulatory
Dynamics in Congenital Heart Defects 269
Use of Extracorporeal
Circulation During Cardiac Surgery 271
Hypertrophy
of the Heart in Valvular
and Congenital Heart
Disease 272
CHAPTER 24
Circulatory Shock and
Its Treatment 273
Physiologic Causes of
Shock 273
Shock
Caused by Hypovolemia—
Hemorrhagic Shock 274
Neurogenic
Shock—Increased Vascular
Capacity 279
Anaphylactic Shock
and Histamine Shock 280
Septic Shock 280
Physiology of Treatment in Shock 280
Circulatory Arrest 281
UNITY
The Body Fluids and
Kidneys CHAPTER 25
The Body Fluid
Compartments: Extracellular and Intracellular Fluids; Edema 285
Fluid Intake and
Output Are Balanced During Steady-State Conditions 285
Body Fluid
Compartments 286
Extracellular Fluid
Compartment 287
Blood Volume 287
Constituents of
Extracellular and Intracellular Fluids 287
Measurement of Fluid
Volumes in the Different Body Fluid Compartments—the Indicator- Dilution
Principle 287
Determination
of Volumes of Specific Body
Fluid Compartments 289
Regulation
of Fluid Exchange and Osmotic
Equilibrium
Between Intracellular
and Extracellular
Fluid 290
Basic Principles of
Osmosis and Osmotic Pressure 290
Osmotic Equilibrium
Is Maintained Between Intracellular and Extracellular Fluids 291
Volume
and Osmolality of Extracellular
and Intracellular
Fluids in Abnormal States 292
Glucose
and Other Solutions Administered
for Nutritive
Purposes 294
Clinical
Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia 294
Edema: Excess Fluid
in the Tissues 296
Fluids
in the “Potential Spaces" of the Body 300
CHAPTER 26
Urine Formation by the Kidneys:
I. Glomerular Filtration, Renal Blood Flow,
and Their Control 303
Multiple Functions of
the Kidneys 303
Physiologic Anatomy
of the Kidneys 304
Micturition 307
Physiologic Anatomy
of the Bladder 307
Transport
of Urine from the Kidney Through
the Ureters and into
the Bladder 308
Filling
of the Bladder and Bladder Wall Tone;
the Cystometrogram 309
Micturition Reflex 309
Abnormalities of
Micturition 310
Urine Formation
Results from Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion 310
Glomerular
Filtration—The First Step in Urine Formation 312
Determinants of the
GFR 314
Renal Blood Flow 316
Physiologic
Control of Glomerular Filtration
and Renal Blood Flow 317
Autoregulation
of GFR and Renal Blood Flow 319 CHAPTER 27
Urine Formation by
the Kidneys: II.Tubular Reabsorption and Secretion 323
Renal Tubular
Reabsorption and Secretion 323
Tubular
Reabsorption Includes Passive
and Active Mechanisms 323
Reabsorption and
Secretion Along Different Parts of the Nephron 329
Regulation of Tubular
Reabsorption 334
Use of Clearance
Methods to Quantify Kidney Function 340
CHAPTER 28
Urine Concentration and Dilution; Regulation of
Extracellular Fluid Osmolarity and Sodium
Concentration 345
Kidneys Excrete
Excess Water by Forming Dilute Urine 345
Kidneys Conserve
Water by Excreting Concentrated Urine 346
Quantifying Renal
Urine Concentration and Dilution: “FreeWater” and Osmolar Clearances 354
Disorders of Urinary
Concentrating Ability 354
Control of
Extracellular Fluid Osmolarity and Sodium Concentration 355
Osmoreceptor-ADH
Feedback System 355
Importance of Thirst
in Controlling Extracellular Fluid Osmolarity and Sodium Concentration 357
Salt-Appetite
Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume 360
CHAPTER 29
Renal Regulation of
Potassium, Calcium, Phosphate, and Magnesium; Integration of Renal Mechanisms
for Control of Blood Volume and Extracellular Fluid Volume 361
Regulation of
Extracellular Fluid Potassium Concentration and Potassium Excretion 361
Control of Renal
Calcium Excretion and Extracellular Calcium Ion Concentration 367
Control of Renal
Magnesium Excretion and Extracellular Magnesium Ion Concentration 369
Integration of Renal
Mechanisms for Control of Extracellular Fluid 370
Importance of
Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid
Balance 371
Distribution of
Extracellular Fluid Between the Interstitial Spaces and Vascular System 373
Nervous and Hormonal
Factors Increase the Effectiveness of Renal-Body Fluid Feedback Control 373
Integrated Responses
to Changes in Sodium Intake 376
Conditions
That Cause Large Increases in Blood Volume and Extracellular Fluid Volume 376
Conditions That Cause
Large Increases in Extracellular Fluid Volume but with Normal Blood Volume 377
CHAPTER 30
Acid-Base Regulation 379
H+
Concentration Is Precisely Regulated 379
Acids and Bases—Their
Definitions and Meanings 379
Defending
Against Changes in H+
Concentration:
Buffers, Lungs, and Kidneys 380
Buffering of H+
in the Body Fluids 380
Bicarbonate Buffer
System 381
Phosphate Buffer
System 383
Proteins Are
Important Intracellular Buffers 383
Respiratory
Regulation of Acid-Base Balance 384
Renal Control of
Acid-Base Balance 385
Secretion of H+
and Reabsorption of HCOa by the Renal Tubules 386
Combination of Excess
H+ with Phosphate and Ammonia Buffers in the Tubule Generates
“New" HCOj 388
Quantifying Renal
Acid-Base Excretion 389
Renal
Correction of Acidosis—Increased
Excretion
of H+ and Addition of HCOa to
the Extracellular
Fluid 391
Renal
Correction of Alkalosis—Decreased
Tubular
Secretion of H+ and Increased
Excretion of HCO~ 391
Clinical Causes of
Acid-Base Disorders 392
Treatment of Acidosis
or Alkalosis 393
Clinical Measurements
and Analysis of Acid-Base Disorders 393
CHAPTER 31
Diuretics, Kidney
Diseases 397
Diuretics and Their
Mechanisms of Action 397
Kidney Diseases 399
Acute Renal Failure 399
Chronic Renal
Failure: An Irreversible Decrease in the Number of Functional Nephrons 401
Specific Tubular
Disorders 408
Treatment of Renal
Failure by Transplantation or by Dialysis with an Artificial Kidney 409
UNIT VI
Blood Cells, Immunity, and Blood Coagulation
CHAPTER 32
Red Blood Cells, Anemia, and Polycythemia 413
Red Blood Cells
(Erythrocytes) 413
Anemias 420
Polycythemia 421
CHAPTER 33
Resistance of the Body to Infection:
I. Leukocytes, Granulocytes, the Monocyte-
Macrophage System,
and Inflammation 423
Leukocytes (White
Blood Cells) 423
Neutrophils and
Macrophages Defend Against Infections 425
Monocyte-Macrophage
Cell System (Reticuloendothelial System) 426
Inflammation: Role of
Neutrophils and Macrophages 428
Eosinophils 430
Basophils 431
Leukopenia 431
Leukemias 431
CHAPTER 34
Resistance of the Body to Infection:
II. Immunity and Allergy Innate Immunity 433
Acquired (Adaptive)
Immunity 433
Allergy and
Hypersensitivity 443
CHAPTER 35
Blood Types; Transfusion;
Tissue and Organ Transplantation 445
Antigenicity Causes
Immune Reactions of Blood 445
O-A-B Blood Types 445
Rh Blood Types 447
Transplantation of
Tissues and Organs 449
CHAPTER 36
Hemostasis and Blood
Coagulation 451
Events in Hemostasis 451
Vascular Constriction 451
Mechanism of Blood
Coagulation 453
Conditions That Cause
Excessive Bleeding in Humans 457
Thromboembolic
Conditions in the Human Being 459
Anticoagulants for
Clinical Use 459
Blood Coagulation
Tests 460
UNIT VII
Respiration
CHAPTER 37
Pulmonary Ventilation 465
Mechanics of
Pulmonary Ventilation 465
Pulmonary Volumes and
Capacities 469
Minute Respiratory
Volume Equals Respiratory Rate Times Tidal Volume 471
Alveolar Ventilation 471
Functions of the
Respiratory Passageways 472
CHAPTER 38
Pulmonary Circulation, Pulmonary Edema,
Pleural Fluid 477
Physiologic Anatomy
of the Pulmonary Circulatory System 477
Pressures in the
Pulmonary System 477
Blood Volume of the
Lungs 478
Blood Flow Through
the Lungs and Its Distribution 479
Effect of Hydrostatic
Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow 479 Pulmonary
Capillary Dynamics 481
Fluid in the Pleural
Cavity 483
CHAPTER 39
Physical Principles of Gas Exchange; Diffusion of Oxygen
and Carbon Dioxide
Through the
Respiratory Membrane 485
Physics
of Gas Diffusion and Gas
Partial Pressures 485
Compositions of
Alveolar Air and Atmospheric Air Are Different 487
Diffusion of Gases
Through the Respiratory Membrane 489
Effect of the Ventilation-Perfusion
Ratio on Alveolar Gas Concentration 492
CHAPTER 40
Transport of Oxygen
and Carbon Dioxide in Blood and Tissue Fluids 495
Transport of Oxygen
from the Lungs to the Body Tissues 495
Transport
of Carbon Dioxide in the Blood 502
Respiratory Exchange
Ratio 504
CHAPTER 41
Regulation of
Respiration 505
Respiratory Center 505
Chemical Control of
Respiration 507
Peripheral
Chemoreceptor System for Control of Respiratory Activity—Role of Oxygen in
Respiratory Control 508
Regulation of
Respiration During Exercise 510
Other Factors That
Affect Respiration 512
CHAPTER 42
Respiratory
Insufficiency—Pathophysiology, Diagnosis, Oxygen Therapy 515
Useful Methods for
Studying Respiratory Abnormalities 515
Pathophysiology of
Specific Pulmonary Abnormalities 517
Hypoxia and Oxygen
Therapy 520
Hypercapnia—Excess
Carbon Dioxide in the Body Fluids 522
Artificial
Respiration 522
Aviation, Space, and Deep-Sea Diving Physiology
CHAPTER 43
Aviation, High-Altitude, and
Space Physiology 527
Effects of Low Oxygen
Pressure on the Body 527
Effects of
Acceleratory Forces on the Body in Aviation and Space Physiology 531
“Artificial
Climate" in the Sealed Spacecraft 533
Weightlessness in
Space 533
CHAPTER 44
Physiology of Deep-Sea Diving and
Other Hyperbaric Conditions 535
Effect of High
Partial Pressures of Individual Gases on the Body 535
Scuba (Self-Contained
Underwater Breathing Apparatus) Diving 539
Special Physiologic
Problems in Submarines 540
Hyperbaric Oxygen
Therapy 540
UNIT
IX
The Nervous System: A. General Principles
and Sensory
Physiology CHAPTER 45
Organization of the Nervous System, Basic Functions of
Synapses, and
Neurotransmitters 543
General Design of the
Nervous System 543
Major Levels of
Central Nervous System Function 545
Comparison of the
Nervous System with a Computer 546
Central Nervous
System Synapses 546
Some Special
Characteristics of Synaptic Transmission 557
CHAPTER 46
Sensory Receptors,
Neuronal Circuits for Processing Information 559
Types
of Sensory Receptors and the
Stimuli They Detect 559
Transduction
of Sensory
Stimuli into Nerve
Impulses 560
Nerve Fibers That
Transmit Different Types of Signals and Their Physiologic Classification 563
Transmission of
Signals of Different Intensity in Nerve Tracts—Spatial and Temporal Summation 564
Transmission and
Processing of Signals in Neuronal Pools 564
Instability
and Stability of Neuronal Circuits 569 CHAPTER 47
Somatic Sensations:
I. General Organization, the Tactile and Position Senses 571
Classification of
Somatic Senses 571
Detection and
Transmission of Tactile Sensations 571
Sensory Pathways for
Transmitting Somatic Signals into the Central Nervous System 573
Transmission in the
Dorsal Column-Medial Lemniscal System 573
Transmission
of Less Critical Sensory Signals
in the Anterolateral
Pathway 580
Some Special Aspects
of Somatosensory Function 581
CHAPTER 48
Somatic Sensations:
II. Pain, Headache, and Thermal Sensations 583
Types
of Pain and Their Qualities—Fast Pain
and Slow Pain 583
Pain Receptors and
Their Stimulation 583
Dual
Pathways for Transmission of Pain
Signals into the
Central Nervous System 584
Pain
Suppression (“Analgesia") System in the
Brain and Spinal Cord 586
Referred Pain 588
Visceral Pain 588
Some
Clinical Abnormalities of Pain
and Other Somatic
Sensations 590
Headache 590
Thermal Sensations 592
UNIT X
The Nervous System: B.The Special Senses
CHAPTER 49
The Eye: I. Optics of
Vision 597
Physical Principles
of Optics 597
Optics of the Eye 600
Ophthalmoscope 605
Fluid System of the Eye—Intraocular
Fluid 606
CHAPTER 50
The Eye: II. Receptor and Neural Function
of the Retina 609
Anatomy and Function
of the Structural Elements of the Retina 609
Photochemistry of
Vision 611
Color Vision 615
Neural Function of
the Retina 616
CHAPTER 51
The Eye: III. Central Neurophysiology
of Vision 623
Visual Pathways 623
Organization
and Function of the Visual
Cortex 624
Neuronal Patterns of
Stimulation During Analysis of the Visual Image 626
Fields of Vision;
Perimetry 627
Eye Movements and
Their Control 627
Autonomic Control of
Accommodation and Pupillary Aperture 631
CHAPTER 52
The Sense of Hearing 633
Tympanic Membrane and
the Ossicular System 633 Cochlea 634
Central Auditory
Mechanisms 639
Hearing Abnormalities 642
CHAPTER 53
The Chemical Senses—Taste
and Smell 645
Sense of Taste 645
Sense of Smell 648
UNIT XI
The Nervous System: C. Motor and Integrative
Neurophysiology
CHAPTER 54
Motor Functions of
the Spinal Cord; the Cord Reflexes 655
Organization of the
Spinal Cord for Motor Functions 655
Muscle Sensory
Receptors—Muscle Spindles and Golgi Tendon Organs—And Their Roles in Muscle
Control 657
Flexor Reflex and the
Withdrawal Reflexes 661
Crossed Extensor
Reflex 663
Reciprocal Inhibition
and Reciprocal Innervation 663 Reflexes of Posture and Locomotion 663
Scratch Reflex 664
Spinal Cord Reflexes
That Cause Muscle Spasm 664 Autonomic Reflexes in the Spinal Cord 665
Spinal
Cord Transection and Spinal Shock 665
CHAPTER 55
Cortical and Brain
Stem Control of Motor Function 667
Motor Cortex and
Corticospinal Tract 667
Role of the Brain
Stem in Controlling Motor Function 673
Vestibular Sensations
and Maintenance of Equilibrium 674
Functions of Brain
Stem Nuclei in Controlling Subconscious, Stereotyped Movements 678
CHAPTER 56
Contributions of the
Cerebellum and Basal Ganglia to Overall Motor Control 681
Cerebellum and Its
Motor Functions 681
Basal Ganglia—Their
Motor Functions 689
Integration of the
Many Parts of the Total Motor Control System 694
CHAPTER 57
Cerebral Cortex,
Intellectual Functions of the Brain, Learning, and Memory 697
Physiologic Anatomy
of the Cerebral Cortex 697 Functions of Specific Cortical Areas 698
Function
of the Brain in Communication—
Language Input and
Language Output 703
Function of the
Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories,
Training, and Other Information Between the Two Cerebral Hemispheres 704
Thoughts,
Consciousness, and Memory 705
CHAPTER 58
Behavioral and Motivational Mechanisms of the
Brain—The Limbic
System and the Hypothalamus 711
Activating-Driving
Systems
of the Brain 711
Limbic System 714
Functional Anatomy of
the Limbic System; Key Position of the Hypothalamus 714
Hypothalamus, a Major
Control Headquarters for the Limbic System 715
Specific Functions of
Other Parts of the Limbic System 718
CHAPTER 59
States of Brain
Activity—Sleep, Brain Waves, Epilepsy, Psychoses 721
Sleep 721
Epilepsy 725
Psychotic Behavior
and Dementia—Roles of Specific Neurotransmitter Systems 726
Schizophrenia—Possible
Exaggerated
Function of Part of
the Dopamine System 727
CHAPTER 60
The Autonomic Nervous
System and the Adrenal Medulla 729
General Organization
of the Autonomic Nervous System 729
Basic Characteristics
of Sympathetic and Parasympathetic Function 731
Autonomic Reflexes 738
Stimulation of
Discrete Organs in Some Instances and Mass Stimulation in Other Instances by
the Sympathetic and Parasympathetic Systems 738
Pharmacology of the
Autonomic Nervous System 739
CHAPTER 61
Cerebral Blood Flow, Cerebrospinal Fluid,
and Brain Metabolism 743
Cerebral Blood Flow 743
Cerebrospinal Fluid
System 746
Brain Metabolism 749
UNIT XII
Gastrointestinal Physiology
CHAPTER 62
General Principles of
Gastrointestinal Function—Motility, Nervous Control, and Blood Circulation 753
General Principles of
Gastrointestinal Motility 753 Neural Control of Gastrointestinal Function—
Enteric Nervous System 755
Functional Types of
Movements in the Gastrointestinal Tract 759
Gastrointestinal
Blood Flow—“Splanchnic Circulation" 759
CHAPTER 63
Propulsion and Mixing
of Food in the Alimentary Tract 763
Ingestion of Food 763
Motor Functions of
the Stomach 765
Movements of the
Small Intestine 768
Movements of the
Colon 770
Other Autonomic
Reflexes That Affect Bowel Activity 772
CHAPTER 64
Secretory Functions of the Alimentary Tract 773
General
Principles of Alimentary Tract
Secretion 773
Secretion of Saliva 775
Esophageal Secretion 776
Gastric Secretion 777
Pancreatic Secretion 780
Secretion of Bile by
the Liver; Functions of the Biliary Tree 783
Secretions of the
Small Intestine 786
Secretion of Mucus by
the Large Intestine 787
CHAPTER 65
Digestion and
Absorption in the Gastrointestinal Tract 789
Digestion of the
Various Foods by Hydrolysis 789
Basic Principles of
Gastrointestinal Absorption 793
Absorption in the
Small Intestine 794
Absorption in the
Large Intestine: Formation of Feces 797
CHAPTER 66
Physiology of
Gastrointestinal Disorders 799
Disorders of
Swallowing and of the Esophagus 799
Disorders of the
Stomach 799
Disorders of the
Small Intestine 801
Disorders of the
Large Intestine 802
General Disorders of
the Gastrointestinal Tract 803
UNIT XIII
Metabolism and
Temperature Regulation CHAPTER 67
Metabolism of Carbohydrates, and Formation
of Adenosine
Triphosphate 809
Central Role of
Glucose in Carbohydrate Metabolism 810
Transport of Glucose
Through the Cell Membrane 810
Glycogen Is Stored in
Liver and Muscle 811
Release of Energy
from Glucose by the Glycolytic Pathway 812
Release
of Energy from Glucose by the
Pentose Phosphate
Pathway 816
Formation
of Carbohydrates from Proteins
and
Fats—“Gluconeogenesis" 817
Blood Glucose 817
CHAPTER 68
Lipid Metabolism 819
Transport of Lipids
in the Body Fluids 819
Fat Deposits 821
Use of Triglycerides
for Energy: Formation of Adenosine Triphosphate 822
Regulation
of Energy Release from
Triglycerides 825
Phospholipids and
Cholesterol 826
Atherosclerosis 827
CHAPTER 69
Protein Metabolism 831
Basic Properties 831
Transport and Storage
of Amino Acids 831
Functional Roles of
the Plasma Proteins 833
Hormonal
Regulation of Protein Metabolism 835
CHAPTER 70
The Liver as an Organ 837
Physiologic Anatomy
of the Liver 837
Hepatic Vascular and
Lymph Systems 837
Metabolic Functions
of the Liver 839
Measurement of
Bilirubin in the Bile as a Clinical Diagnostic Tool 840
CHAPTER 71
Dietary Balances; Regulation of Feeding;
Obesity and
Starvation; Vitamins and Minerals 843
Energy Intake and
Output Are Balanced Under Steady-State Conditions 843
Dietary Balances 843
Regulation of Food
Intake and Energy Storage 845
Obesity 850
Inanition, Anorexia,
and Cachexia 851
Starvation 852
Vitamins 852
Mineral Metabolism 855
CHAPTER 72
Energetics and
Metabolic Rate 859
Adenosine
Triphosphate (ATP) Functions as an “Energy Currency" in Metabolism 859
Control of Energy
Release in the Cell 861
Metabolic Rate 862
Energy
Metabolism—Factors That Influence Energy Output 863
CHAPTER 73
Body Temperature Regulation,
and Fever 867
Normal Body
Temperatures 867
Body
Temperature Is Controlled by
Balancing
Heat Production and
Heat Loss 867
Regulation
of Body Temperature—
Role of the
Hypothalamus 871
Abnormalities
of Body Temperature
Regulation 875
UNIT XIV
Endocrinology and Reproduction
CHAPTER 74
Introduction to
Endocrinology 881
Coordination of Body Functions
by Chemical Messengers 881
Chemical Structure
and Synthesis of Hormones 881
Hormone Secretion,
Transport, and Clearance from the Blood 884
Mechanisms of Action
of Hormones 886
Measurement of
Hormone Concentrations in the Blood 891
CHAPTER 75
Pituitary Hormones and Their Control by the
Hypothalamus 895
Pituitary Gland and
Its Relation to the Hypothalamus 895
Hypothalamus Controls
Pituitary Secretion 897
Physiological
Functions of Growth Hormone 898
Posterior
Pituitary Gland and Its Relation to
the Hypothalamus 904
CHAPTER 76
Thyroid Metabolic
Hormones 907
Synthesis and
Secretion of the Thyroid Metabolic Hormones 907
Physiological
Functions of the Thyroid Hormones 910
Regulation of Thyroid
Hormone Secretion 914
Diseases of the
Thyroid 916
CHAPTER 77
Adrenocortical
Hormones 921
Synthesis and
Secretion of Adrenocortical Hormones 921
Functions
of the Mineralocorticoids—
Aldosterone 924
Functions of the
Glucocorticoids 928
Adrenal Androgens 934
Abnormalities of
Adrenocortical Secretion 934
CHAPTER 78
Insulin, Glucagon,
and Diabetes Mellitus 939
Insulin and Its
Metabolic Effects 939
Glucagon and Its
Functions 947
Somatostatin Inhibits
Glucagon and Insulin Secretion 949
Summary of Blood
Glucose Regulation 949
Diabetes Mellitus 950
CHAPTER 79
Parathyroid Hormone, Calcitonin, Calcium
and Phosphate Metabolism, Vitamin D, Bone,
and Teeth 955
Overview
of Calcium and
Phosphate
Regulation in the Extracellular
Fluid and Plasma 955
Bone
and Its Relation to Extracellular Calcium
and Phosphate 957
Vitamin D 960
Parathyroid Hormone 962
Calcitonin 966
Summary of Control of
Calcium Ion Concentration 966
Pathophysiology
of Parathyroid Hormone,
Vitamin D, and Bone
Disease 967
Physiology of the
Teeth 969
CHAPTER 80
Reproductive and Hormonal Functions of
the Male (and Function of the Pineal Gland) 973
Physiologic Anatomy
of the Male Sexual Organs 973
Spermatogenesis 973
Male Sexual Act 978
Testosterone and
Other Male Sex Hormones 979 Abnormalities of Male Sexual Function 984
Erectile Dysfunction
in the Male 985
Pineal Gland—Its
Function in Controlling Seasonal Fertility in Some Animals 986
CHAPTER 81
Female Physiology
Before Pregnancy and Female Hormones 987
Physiologic Anatomy
of the Female Sexual Organs 987
Female Hormonal
System 987
Monthly Ovarian
Cycle; Function of the Gonadotropic Hormones 988
Functions
of the Ovarian Hormones—
Estradiol and
Progesterone 991
Regulation of the
Female Monthly Rhythm—Interplay Between the Ovarian and Hypothalamic-Pituitary
Hormones 996
Abnormalities of
Secretion by the Ovaries 999
Female Sexual Act 1000
Female Fertility 1000
CHAPTER 82
Pregnancy and
Lactation 1003
Maturation and
Fertilization of the Ovum 1003
Early Nutrition of
the Embryo 1005
Function of the
Placenta 1005
Hormonal Factors in
Pregnancy 1007
Response of the
Mother's Body to Pregnancy 1009
Parturition 1011
Lactation 1014
CHAPTER 83
Fetal and Neonatal
Physiology 1019
Growth and Functional
Development of the Fetus 1019
Development of the
Organ Systems 1019
Adjustments of the
Infant to Extrauterine Life 1021
Special Functional
Problems in the Neonate 1023
Special Problems of
Prematurity 1026
Growth and
Development of the Child 1027
UNIT XV
Sports Physiology
CHAPTER 84
Sports Physiology 1031
Muscles in Exercise 1031
Respiration in
Exercise 1036
Cardiovascular System
in Exercise 1038
Body Heat in Exercise 1039
Body Fluids and Salt
in Exercise 1040
Drugs and Athletes 1040
Body Fitness Prolongs
Life 1041
Index 1043
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