наименование:Textbook of Medical Physiology
автор/ы : Guyton Arthur C. ,  Hall John E.
год : 2000
страниц : 1064
издательство : W B Saunders; 10th edition
ISBN: 072168677X

печатное издание


Reviewer: John G. Wood, PhD (University of Kansas Medical Center)
Description: This is the ninth edition of a highly successful textbook of medical physiology, in which physiological concepts are described in a comprehensive, organized manner from the cellular level to integrated systems. .
Purpose: According to the authors, the goals are to emphasize integrated physiology and homeostatic mechanisms and be as accurate as possible. These are clearly worthy objectives, and I believe this is a valuable resource for teaching medical physiology. In general, the book adequately fulfills the authors' objectives.
Audience: The authors indicate that it is written primarily for medical students, and I agree. They are highly respected physiologists who have made many significant contributions to this field.
Features: I found very few (if any) new figures in the chapters on the gastrointestinal system, compared with the previous edition. The references have been updated in the gastrointestinal sections, but I found few changes in the text of this revision.
Assessment: Based upon close reading of the chapters of the gastrointestinal system, there appears to have been little revision of the text in this version. Recent references have been added to the chapters, yet I did not find this material to have been incorporated into the text. Although the book is overall of high quality, I did not see sufficient changes to justify the purchase of this revision.


UNIT I Introduction to Physiology: The Cell and General Physiology
Functional Organization of the Human Body and Control of the "Internal Environment"    2
Cells as the Living Units of the Body    2
Extracellular Fluid—The Internal Environment    2
"Homeostatic" Mechanisms of the Major Functional Systems    3
Homeostasis   3
Extracellular Fluid Transport System—The Circulatory System   3
Origin of Nutrients in the Extracellular Fluid   3
Removal of Metabolic End Products   4
Regulation of Body Functions   4
Reproduction   4
Control Systems of the Body    4
Examples of Control Mechanisms   5
Characteristics of Control Systems    6
Summary—Automaticity of the Body    7
The Cell and Its Function   9
Organization of the Cell    9
Physical Structure of the Cell    10
Membranous Structures of the Cell    10
Cytoplasm and Its Organelles    12 Nucleus    14
Nuclear Membrane    15 Nucleoli and Formation of Ribosomes    15
Comparison of the Animal Cell with Precellular Forms of Life    15
Functional Systems of the Cell    16
Ingestion by the Cell—Endocytosis    16
Digestion of Pinocytic and Phagocytic Foreign Substances in the Cell—Function of the Lysosomes    17
Synthesis and Formation of Cellular Structures by the Endoplasmic Reticulum and the Golgi Apparatus    18
Extraction of Energy from Nutrients—Function of the Mitochondria 19
Locomotion of Cells   21
Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction   24
The Genes    24 Genetic Code   25
The DNA Code Is Transferred to an RNA Code—The Process of Transcription    25
Synthesis of RNA   26
Assembly of the RNA Molecule from Activated Nudeotides Using the DNA Strand as a Template-The Process of Transcription 27 
Messenger RNA—The Codons   27
Transfer RNA—The Anticodons   27
Ribosomal RNA   28
Formation of Proteins on the Ribosomes—The Process of "Translation"   29
Synthesis of Other Substances in the Cell    30
Control of Genetic Function and Biochemical Activity in Cells    30
Genetic Regulation   30
Control of Intracellular Function by Enzyme Regulation   32
The DNA-Genetic System Also Controls Cell Reproduction    32
Cell Reproduction Begins with Replication of the DNA   33
Chromosomes and Their Replication   34
Cell Mitosis   34
Control of Cell Growth and Cell Reproduction   35
Cell Differentiation    35
Cancer   36
UNIT II Membrane Physiology, Nerve, and Muscle
Transport of Substances Through the Cell Membrane   40
The Lipid Barrier of the Cell Membrane and Cell Membrane Transport Proteins    40
Diffusion    40
Diffusion Through the Cell Membrane   41
Diffusion Through Protein Channels and "Gating" of These Channels   42
Facilitated Diffusion   43
Factors That Affect Net Rate of Diffusion   44
Osmosis Across Selectively Permeable Membranes — "Net Diffusion " of Water   45
Active Transport   47
Primary Active Transport   47
Secondary Active Transport—Co-transport and Counter-transport   49
Active Transport Through Cellular Sheets   49

Membrane Potentials and Action Potentials   52
Basic Physics of Membrane Potentials    52
Membrane Potentials Caused by Diffusion   52
Measuring the Membrane Potential   53
Resting Membrane Potential of Nerves   54
Origin of the Normal Resting Membrane Potential   54
Nerve Action Potential    55
Voltage-Gated Sodium and Potassium Channels   56
Summary of the Events That Cause the Action Potential   58
Roles of Other Ions During the Action Potential   59
Initiation of the Action Potential   59
Propagation of the Action Potential    59
Re-establishing Sodium and Potassium Ionic Gradients After Action Potentials Are Completed—Importance of Energy Metabolism 60
Plateau in Some Action Potentials    61
Rhythmicity of Some Excitable Tissues—Repetitive Discharge   61
Special Aspects of Signal Transmission in Nerve Trunks    62
Excitation—The Process of Eliciting the Action Potential    63
"Refractory Period" After an Action Potential During Which a New Stimulus Cannot Be Elicited   64
Inhibition of Excitability— "Stabilizers " and Local Anesthetics   64
Recording Membrane Potentials and Action Potentials    64
Contraction of Skeletal Muscle   67
Physiologic Anatomy of Skeletal Muscle   67
The Skeletal Muscle Fiber   67
General Mechanism of Muscle Contraction   68
Molecular Mechanism of Muscle Contraction    70
Molecular Characteristics of the Contractile Filaments   70
Effect of  Actin and Myosin Filament Overlap on Tension Developed by the Contracting Muscle   72
Relation of Velocity of Contraction to Load   73
Energetics of Muscle Contraction    74
Work Output During Muscle Contraction   74
Sources of Energy for Muscle Contraction   74
Characteristics of Whole Muscle Contraction    74
Mechanics of Skeletal Muscle Contraction   76
Remodeling of Muscle to Match Function   77
Rigor Mortis   78
Excitation of Skeletal Muscle: A. Neuromuscular Transmission and B. Excitation-Contraction Coupling    80
Transmission of Impulses from Nerves to Skeletal Muscle Fibers: The Neuromuscular Junction    80
Secretion by Acetylcholine by the Nerve Terminals   80
Molecular Biology of Acetylcholine Formation and Release   82
Drugs That Affect Transmission at the Neuromuscular Junction   83
Myasthenia Gravis   83
Muscle Action Potential    83 
Spread of the Action Potential to the Interior of the Muscle Fiber by Way of a Transverse Tubule System   84 Excitation-Contraction Coupling    84
Transverse Tubule—Sarcoplasmic Reticulum System   84
Release of Calcium Ions by the Sarcoplasmic Reticulum   85
Contraction and Excitation of Smooth Muscle   87
Contraction of Smooth Muscle    87
Types of Smooth Muscle   87
Contractile Mechanism in Smooth Muscle   87
Regulation of Contraction by Calcium Ions   89
Neural and Hormonal Control of Smooth Muscle Contraction    90
Neuromuscular Junctions of Smooth Muscle   90
Membrane Potentials and Action Potentials in Smooth Muscle   90
Effect of Local Tissue Factors and Hormones to Cause Smooth Muscle Contraction Without Action Potentials   92
Source of Calcium Ions That Cause Contraction:
(1) Through the Cell Membrane and (2) from the Sarcoplasmic Reticulum   93
UNIT III The Heart
Heart Muscle; The Heart as a Pump   96
Physiology of Cardiac Muscle    96
Physiologic Anatomy of Cardiac Muscle   96
Action Potentials in Cardiac Muscle   97
The Cardiac Cycle    99
Diastole and Systole   99
Relationship of the Electrocardiogram to the Cardiac Cycle    100
Function of the Atria as Primer Pumps    100
Function of the Ventricles as Pumps    100
Emptying of the Ventricles During Systole    100
Function of the Valves    101
The Aortic Pressure Curve    101
Relationship of the Heart Sounds to Heart Pumping    102
Work Output of the Heart   102
Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart   103
Regulation of Heart Pumping    103
Intrinsic Regulation of Heart Pumping-The Frank-Starling Mechanism    103
Effect of Potassium and Calcium Ions on Heart Function    106
Effect of Temperature on Heart Function    106
Rhythmical Excitation of the Heart    107
Specialized Excitatory and Conductive System of the Heart    107
Sinus Node (Sinoatrial Node)    107 Internodal Pathways and Transmission of the Cardiac Impulse Through the Atria    109 Atrioventricular Node, and Delay of Impulse Conduction from the Atria to the Ventricles    109
Rapid Transmission in the Ventricular Purkinje System    109
Transmission of the Cardiac Impulse in the Ventricular Muscle    110
Summary of the Spread of the Cardiac Impulse Through the Heart   110
Control of Excitation and Conduction in the Heart    111
The Sinus Node as the Pacemaker of the Heart    111
Role of the  Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle    111
Control of Heart Rhythmicity and Impulse Conduction by the Cardiac Nerves: The Sympathetic and Parasympathetic Nerves 112
The Normal Electrocardiogram    114
Characteristics of the Normal Electrocardiogram    114
Depolarization Waves Versus Repolarization Waves    114
Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram    115
Voltage and Time Calibration of the Electrocardiogram    115
Methods for Recording Electrocardiograms    116
Pen Recorder   116
Flow of Current Around the Heart During the Cardiac Cycle    116
Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle    116
Flow of Electrical Currents in the Chest Around the Heart   116
Electrocardiographic Leads    117
Three Bipolar Limb Leads    117
Chest Leads (Precordial Leads)    118
Augumented  Unipolar Limb Leads    119
Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis    120
Principles of Vectorial Analysis of Electrocardiograms    120
Use of Vectors to Represent Electrical Potentials    120
Denoting the Direction of a Vector in Terms of Degrees    120
Axis of Each of the Standard Bipolar Leads and for Each Unipolar Limb Lead    120
Vectorial Analysis of Potentials Recorded in Different Leads   121
Vectorial Analysis of the Normal Electrocardiogram    122
Vectors That Occur at Successive Intervals During Depolarization of the Ventricles—The QRS Complex   122
Electrocardiogram During Repolarization—The T Wave    123
Depolarization of the Atria—The P Wave   124
Vectorcardiogram    124
Mean Electrical Axis of the Ventricular QRS—And Its Significance    125
Determining the Electrical Axis from Standard Lead Electrocardiograms    125
Abnormal Ventricular Conditions That Cause Axis Deviation    125 
Conditions That Cause Abnormal Voltages of the QRS Complex    127
Increased Voltage in the Standard Bipolar Limb Leads    127
Decreased Voltage of the Electrocardiogram    127
Prolonged and Bizarre Patterns of the QRS Complex    128
Prolonged QRS Complex Resulting from Purkinje System Blocks   128
Conditions That Cause Bizarre QRS Complexes    128
Current of Injury    128
Effect of Current of Injury on the QRS Complex   128
The J Point—The Zero Reference Potential for Analyzing Current of Injury    129
Coronary Ischemia as a Cause of Current of Injury   130
Abnormalities in the T Wave    132
Effect of Slow Conduction of the Depolarization Wave on the Characteristics of the T Wave    132
Prolonged Depolarization in Portions of the Ventricular Muscle as a Cause of Abnormalities in the T Wave    132
Cardiac Arrhythmias and Their Electrocardiographic Interpretation    134
Abnormal Sinus Rhythms    134
Tachycardia    134
Bradycardia    134
Sinus Arrhythmia    134
Abnormal Rhythms That Result from Impulse Conduction Block    135
Sinoatrial Block    135
Atrioventricular Block    135
Incomplete Intraventricular Block—Electrical Alternans    136
Premature Contractions    136
Premature Atrial Contractions    137
A-V Nodal or A-V Bundle Premature Contractions    137
Premature Ventricular Contractions    137
Paroxysmal Tachycardia    138
Atrial Paroxysmal Tachycardia    138
Ventricular Paroxysmal Tachycardia    138
Ventricular Fibrillation    138
Phenomenon of Re-entry—"Circus Movements" as the Basis for Ventricular Fibrillation    139
Atrial Fibrillation    141
Atrial Flutter    142
Cardiac Arrest    142
UNIT IV The Circulation
Overview of the Circulation; Medical Physics of Pressure, Flow, and Resistance    144
Physical Characteristics of the Circulation    144
Basic Theory of Circulatory Function    146
Interrelationships Among Pressure, Flow, and Resistance    146
Blood Flow    147
Blood Pressure    148
Resistance to Blood Flow    149
Effects of Pressure on Vascular Resistance and Tissue Blood Flow    151
Vascular Distensibility, and Functions of the Arterial and Venous Systems    152
Vascular Distensibility    152
Vascular Compliance (or Capacitance)    152
Volume-Pressure Curves of the Arterial and Venous Circulations    152
Delayed Compliance (Stress-Relaxation) of Vessels    153
Arterial Pressure Pulsations    153
Transmission of Pressure Pulses to the Peripheral Arteries     154
Clinical Methods for Measuring Systolic and Diastolic Pressures    155
Veins and Their Functions    156
Venous Pressures—Right Atrial Pressure (Central Venous Pressure) and Peripheral Venous Pressures    156
Blood Reservoir Function of the Veins    160
The Microcirculation and the Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph Flow    162
Structure of the Microcirculation and Capillary System    162
Flow of Blood in the Capillaries—Vasomotion    163
Average Function of the Capillary System    163
Exchange of Nutrients and Other Substances Between the Blood and Interstitial Fluid    164
Diffusion Through the Capillary Membrane    164
The Interstitium and Interstitial Fluid    165
Proteins in the Plasma and Interstitial Fluid Are Especially Important in Controlling Plasma and Interstitial Fluid Volumes    166
Capillary Pressure    166
Interstitial Fluid Pressure    167
Plasma Colloid Osmotic Pressure    168
Interstitial Fluid Colloid Osmotic Pressure    169
Exchange of Fluid Volume Through the Capillary Membrane    169
Starling Equilibrium for Capillary Exchange    170
Lymphatic System    170 Lymph Channels of the Body   170
Formation of Lymph    171 Rate of Lymph Flow    172
Role of the Lymphatic System in Controlling Interstitial Fluid Protein Concentration, Interstitial Fluid Volume, and Interstitial Fluid Pressure    173
Local Control of Blood Flow by the Tissues; and Humoral Regulation    175
Local Control of Blood Flow in Response to Tissue Needs    175
Mechanisms of Blood Flow Control    175
Acute Control of Local Blood Flow    176
Long-Term Blood Flow Regulation    179
Development of Collateral Circulation—A Phenomenon of Long-Term Local Blood Flow Regulation    180
Humoral Regulation of the Circulation    181
Vasoconstrictor Agents    181
Vasodilator Agents    181
Effects of Ions and Other Chemical Factors on Vascular Control   182
Nervous Regulation of the Circulation, and Rapid Control of Arterial Pressure    184
Nervous Regulation of the Circulation    184
Autonomic Nervous System    184
Role of the Nervous System for Rapid Control of Arterial Pressure    187
Increase in Arterial Pressure During Muscle Exercise and Other Types of Stress    188
Reflex Mechanisms for Maintaining Normal Arterial Pressure    188
Central Nervous System Ischemic Response—Control of Arterial Pressure by the Brain's Vasomotor Center in Response to Diminished Brain Blood Flow    191
Special Features of Nervous Control of Arterial Pressure    192
Role of the Skeletal Nerves and Skeletal Muscles in Increasing Cardiac Output and Arterial Pressure    192
Respiratory Waves in the Arterial Pressure    193
Arterial Pressure "Vasomotor" Waves—Oscillation of the Pressure Reflex Control Systems    193
Dominant Role of the Kidney in Long-Term Regulation of Arterial Pressure and in Hypertension: The Integrated System for Pressure Control    195
The Renal-Body Fluid System for Arterial Pressure Control    195
Quantitation of Pressure Diuresis as a Basis for Arterial Pressure Control    195
Hypertension (High Blood Pressure): This Is Often Caused by Excess Extracellular Fluid Volume    199
The Renin-Angiotensin System: Its Role in Pressure Control and in Hypertension    201
Components of the Renin-Angiotensin System   201
Types of Hypertension in Which Angiotensin Is Involved: Hypertension Caused by a Renin-Secreting Tumor or by Infusion of Angiotensin II   203
Other Types of Hypertension Caused by Combinations of Volume-Loading and Vasoconstriction   205
"Essential Hypertension" in Human Beings   205
Summary of the Integrated, Multifaceted System for Arterial Pressure Regulation    207
Cardiac Output, Venous Return, and Their Regulation 200
Normal Values for Cardiac Output at Rest and During Activity 210
Control of Cardiac Output by Venous Return--Role of the Frank-Staffing Mechanism of the Heart 210
Cardiac Output Regulation Is the Sum of Blood Flow Regulation in All the Local Tissues of the Body-Tissue Metabolism Regulates Most Local Blood Flow 211
The Heart Has Limits for the Cardiac Output That B Can Achieve 212
What Is the Role of the Nervous System in Controlling Cardiac Output? 212
Pathologically High and Pathologically Low Cardiac Outputs 213
High Cardiac Output Is" Almost Always Caused by Reduced Total Peripheral Resistance 213
Low Cardiac Output 214
A More Quantitative Analysis of Cardiac Output Regulation 214
Cardiac Output Curves Used in Quantitative Analysis 215
Venous Return Curves 215
Analysis of Cardiac Output and Right Atrial Pressure, Using Simultaneous Cardiac Output and Venous Return Curves 218
Methods for Measuring Cardiac Output 220
Pulsatile Output of the Heart as Measured by an Electromagnetic or Ultrasonic Flowmeter 220
Measurement of Cardiac Output by the Oxygen Fick Method 220
Indicator Dilution Method 221
Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart Disease 223
Blood Flow in Skeletal Muscle and Its Regulalion During Exercise 223
Rate of Blood Flow Through the Muscles 223
Control of Blood Flow Through the Skeletal Muscles 223
Circulatory Readjustments" During Exercise 224
Coronary Circulation 226
Physiologic Anatomy of the Coronary Blood Supply 226
Normal Coronary Blood Flow 226
Control of Coronary Blood Flow 227
Special Features of Cardiac Muscle Metabolism 228
Ischemic Heart Disease 229
Causes of Death After Acute Coronary Occlusion 230
Stages of Recovery from Acute Myocardial Infarction 231
Function of the Heart After Recovery from Myocardial Infarction 232
Pain in Coronary Disease 232
Surgical Treatment of Coronary Disease 233
Cardiac Failure 235
Dynamics of the Circulation in Cardiac Failure 235
Acute Effects" of Moderate Cardiac Failure 235
Chronic Stage of Failure-Fluid Retention Helps to Compensate Cardiac Output 236
Summary of the Changes That Occur After Acute Cardiac Failure-"Compensated Heart Failure" 237
Dynamics of Severe Cardiac Failure--Decompensated Heart Failure 237
Unilateral Left Heart Failure 239
Low-Output Cardiac Failure-Cardiogenic Shock 239
Edema in Patients with Cardiac Failure 239
Cardiac Reserve 241
Appendix 241
Quantitative Graphical Method for Analysis of Cardiac Failure 241
Heart Valves and Heart Sounds; Dynamics of Valvular and Congenital Heart Defects 245
Heart Sounds 245
Normal Heart Sounds" 245
Valvular Lesions 247
Abnormal Circulatory Dynamics in Valvular Heart Disease 248
Dynamics of the Circulation in Aortic Stenosis and Aortic Regurgitation 248
Dynamics of Mitral Stenosis and Mitral Regurgitation 248
Circulatory Dynamics During Exercise in Patients" with Valvular Lesions 249
Abnormal Circulatory Dynamics in Congenital Heart Defects 249
Patent Ductus Arteriosus-A Left-to-Right Shunt 249
Tetralogy of Fallot-A Right-to-Left Shunt 251
Causes of Congenital Anomalies 251
Use of Extracorporeal Circulation During Cardiac Surgery 251
Hypertrophy of the Heart in Valvular and Congenital Heart Disease 252
Circulatory Shock and Physiology of Its Treatment 253
Physiologic Causes of Shock 253
Circulatory Shock Caused by Decreased Cardiac Output 253
Circulatory Shock That Occurs Without Diminished Cardiac Output 253
What Happens to the Arterial Pressure in Circulatory Shock? 253
Tissue Deterioration Is" the End Stage of Circulatory Shock, Whatever the Cause 253
StagesofShock 254
Shock Caused by Hypovolemia--Hemorrhagic Shock 254
Relationship of Bleeding Volume to Cardiac Output and Arterial Pressure 254
Progressive and Nonprogressive Hemorrhagic Shock 255
Irreversible Shock 258
H)povolemic Shock Caused by Plasma Loss 259
H)povolemic Shock Caused by Trauma 259
Neurogenic Shock--Increased Vascular Capacity 259
Anaphylactic Shock and Histamine Shock 259
Septic Shock 260
Physiology of Treatment in Shock 260
Replacement Therapy 260
Treatment of Shock with Sympathomimetic Drugs-Sometimes Useful, Sometimes Not 261
Other Therapy 261
Circulatory Arrest 261
Effect of Circulatory Arrest on the Brain 261
UNIT V The Kidneys and Body Fluids
The Body Fluid Compartments: Extracellular and Intracellular Fluids; Interstitial Fluid and Edema 264
Fluid Intake and Output Are Balanced During Steady-State Conditions 264
Daily Intake of Water 264
Daily Loss of Body Water 264
Body Fluid Compartments 265
Intracellular Fluid Compartment 265
Extracellular Fluid Compartment 266
Blood Volume 266
Constituents of Extracellular and Intracellular Fluids 266
Ionic Compositions of Plasma and Interstitial Fluid Are Similar 266
Important Constituents of the Intracellular Fluid 267
Measurement of Fluid Volumes in the Different Body Fluid Compartments; the Indicator-Dilution Principle 268
Determination of Volumes of Specific Body Fluid Compartments 268
Regulation of Fluid Exchange and Osmotic Equilibria Between Intracellular and Extracellular Fluid 269
Basic Principles of Osmosis and Osmotic Pressure 269
Osmotic Equilibrium Is Maintained Between Intracellular and Extracellular Fluids 271
Volumes and Osmolalities of Extracellular and Intracellular Fluid in Abnormal States 272
Effect of Adding Saline Solution to the Extracellular Fluid 272
Glucose and Other Solutions Administered for Nutritive Purposes 273
Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia 273
Causes of Hyponatremia: Excess Water or Loss of Sodium 274
Causes of Hypernatremia: Water Loss or Excess Sodium 274
Edema: Excess Fluid in the Tissues 274
lntracellular Edema 274
Extracellular Edema 274
Safety Factors That Normally Prevent Edema 276
Fluids in the "Potential Spaces" of the Body 277
Urine Formation by the Kidneys: I. G1omerular Filtration, Renal Blood Flow, and Their Control 279
Multiple Functions of the Kidneys in Homeostasis 279
Physiologic Anatomy of the Kidneys 280
General Organization of the Kidneys and Urinary Tract 280
Renal Blood Supply 281
The Nephron Is the Functional Unit of the Kidney 281
Urine Formation Results from Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion 282
Filtration, Reabsorption, and Secretion of Different Substances 283
Glomerular Filtration--The First Step In Urine Formation 284
Composition of the Glomerular Filtrate 284
GFR Is About 20 Per Cent of the Renal Plasma Flow 284
Glomerular Capillary Membrane 284
Determinants of the Glomerular Filtration Rate 286
Increased Glomerular Capillary Filtration Coefficient (Ks) Increases GFR 286
Increased Bowman's Capsule Hydrostatic Pressure Decreases GFR 287
Increased Glomerular Capillary Colloid Osmotic Pressure Decreases GFR 287
Increased Glomerular Capillary Hydrostatic Pressure Increases GFR 287
Renal Blood Flow 288
Determinants of Renal Blood Flow 288
Blood Flow in the Vasa Recta of the Renal Medulla Is Very Low Compared with Flow in the Renal Cortex 289
Physiologic Control of Glomerular Filtration and Renal Blood Flow 289
Sympathetic Nervous System Activation Decreases GFR 289
Hormonal and Autacoid Control of Renal Circulation 289
Autoregulation of GFR and Renal Blood Flow 290
Importance o.f GFR Autoregulation in Preventing Extreme Changes in Renal Excretion 291
Role of Tubuloglomerular Feedback in Autoregulation of GFR 291
Myogenic Autoregulation of Renal Blood Flow and GFR 293
Other Factors That Increase Renal Blood Flow and GFR: High Protein Intake and Increased Blood Glucose 293
Urine Formation by the Kidneys: II. Tubular Processing of the Glomerular Filtrate 295
Reabsorption and Secretion by the Renal Tubules 295
Tubular Reabsorption Is Selective and Quantitatively Large 295
Tubular Reabsorption Includes Passive and Active Mechanisms 295
Active Transport 296
Passive Water Reabsorption by Osmosis Is Coupled Mainly to Sodium Reabsorption 299
Reabsorption of Chloride, Urea, and Other Solutes by Passive Diffusion 300
Reabsorption and Secretion Along Different Parts of the Nephron 300
Proximal Tubular Reabsorption 300
Solute and Water Transport in the Loop of Henle 302
Distal Tubule 303
Late Distal Tubule and Cortical Collecting Tubule 303
Medullary Collecting Duct 304
Summary of Concentrations of Different Solutes in the Different Tubular Segments 304
Regulation of Tubular Reabsorption 305
Glomerulotubular Balance--The Ability of the Tubules to Increase Reabsorption Rate in Response to Increased Tubular Load 305
Petitubular Capillary and Renal Interstitial Fluid Physical Forces 306
Effect of Arterial Pressure on Urine Output-The Pressure-Natriuresis and Pressure-Diuresis Mechanisms 308
Hormonal Control of Tubular Reabsorption 308
Use of Clearance Methods to Quantify Kidney Function 309
PAH Clearance Can Be Used to Estimate Renal Plasma Flow 311
Filtration Fraction Is Calculated from GFR Divided by Plasma Renal Flow 311
Calculation of Tubular Reabsorption or Secretion from Renal Clearances 311

Regulation of Extracellular Fluid Osmolarity and Sodium Concentration 313
The Kidney Excretes Excess Water by Forming a Dilute Urine 313
Antidiuretic Hormone Controls Urine Concentration 313
Renal Mechanisms for Excreting a Dilute Urine 313
The Kidney Conserves Water by Excreting a Concentrated Urine 315
Obligatory Urine Volume 315
Requirements for Excreting a Concentrated Urine-High ADH Levels and Hyperosmotic Renal Medulla 315
The Countercurrent Mechanism Produces a Hyperosmotic Renal Medullara, Interstitimn 315
Role of the Distal Tubule and Collecting Ducts in Excreting a Concentrated Urine 317
Urea Contributes to Hyperosmotic Renal Medulla Interstitium and to a Concentrated Urine 318
Countercurrent Exchange in the Vasa Recta Preserves Hyperosmolarity of the Renal Medulla 319
Summary of Urine Concentrating Mechanism and Changes in Osmolarity in Different Segments of the Tubules 320
Quantifying Renal Urine Concentration and Dilution: "Free Water" and Osmolar Clearances 321
Disorders of Urinary Concentrating Ability 322
Control of Extracellular Fluid Osmolarity and Sodium Concentration 322
Estimating Plasma Osmolarit T from Plasma Sodium Concentration 322
Osmoreceptor-ADH Feedback System 323
ADH Synthesis in Supraoptic and Paraventricular Nuclei of the Hypothalamus and ADH Release from the Posterior Pituitary 323
Cardiovascular Reflex Stimulation of ADH Release by Decreased Arterial Pressure andCr Decreased Blood Volume 324
Quantitative b.portance of Cardiovascular Reflexes and Osmolarity in Stimulating ADH Secretion 324
Other Stimuli for ADH Secretion 324
Role of Thirst in Controlling Extracellular Fluid Osmolarity and Sodium Concentration 325
Central Neta,ous System Centers for Thirst 325
Stimuli for Thirst 325
Threshold for Osmolar Stimulus of Drinking 326
Integrated Responses of Osmoreceptor-ADH and Thirst Mechanisms in Controlling Extracellular Fluid Osmolarity and Sodium Concentration 326
Role of Angiotensin H and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration 327
Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume 327
Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume; and Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium 329
Control Mechanisms for Regulating Sodium and Water Excretion 329
Sodium Excretion Is Precisely Matched to Intake Under Steady-State Conditions 329
Sodium Excretion Is Controlled by Altering Glomerular Filtration or Tubular Sodium Reabsorption Rates 329
Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance 330
Pressure Natriuresis and Diuresis Are Key Components of a Renal-Body Fluid Feedback Jbr Regulating Body Fluid Volumes and Arterial Pressure 330
Precision of Blood Volume and Extracellular Fluid Volume Regulation 331
Distribution of Extracellular Fluid Between the Interstitial Spaces and Vascular System 332
Nervous and Hormonal Factors Increase the Effectiveness of Renal-Body Fluid Feedback Control 332
Sympathetic Nervous System Control of Renal Excretion: The Arterial Baroreceptor and Low-Pressure Stretch Receptor Reflexes 332
Role of Angiotensin II in Controlling Renal Excretion 333
Role of Aldosterone in Controlling Renal Excretion 334
Role of ADH in Controlling Renal Water Excretion 334
Role of Atrial Natriuretic Peptide in Controlling Renal Excretion 335
Integrated Responses to Changes in Sodium Intake 335
Conditions That Cause Large Increases in Blood Volume and Extracellular Fluid Volume 335
Increased Blood Volume and Extracellular Fluid Volume Caused by Heart Diseases 335
Increased Blood Volume Caused by Increased Capacity of the Circulation 336
Conditions That Cause Large Increases in Extracellular Fluid Volume but with Normal Blood Volume 336
Nephrotic Syndrome--Loss of Plasma Proteins in the Urine and Sodium Retention bv the Kidneys 336
Liver Cirrhosis--Decreased Synthesis of Plasma Proteins by the Liver and Sodium Retention by the Kidneys 336
Regulation of Potassium Excretion and Pot&ssium Concentration in the Extracellular Fluid 336
Regulation of Internal Potassium Distribution 337
Overview of Renal Potassium Excretion 338
Potassium Secretion in the Principal Cells of the Late Distal and Cortical Collecting Tubules 339
Summary of Factors That Regulate Potassium Secretion: Plasma Potassium Concentration, Aldosterone, Tubular Flow Rate, and Hydrogen Ion 339
Control of Renal Calcium Excretion and Extracellular Calcium Ion Concentration 342
Control of Calcium Excretion by the Kidneys 343
Regulation of Renal Phosphate Excretion 343
Control of Renal Magnesium Excretion and Extracellular Magnesium Ion Concentration 344
Regulation of Acid-Base Balance 346
Hydrogen Ion Concentration Is Precisely Regulated 346
Acids and Bases--Their Definitions and Meanings 346
Defenses Against Changes in Hydrogen Ion Concentration: Buffers, Lungs, and Kidneys 347
Buffering of Hydrogen Ions in the Body Fluids 347
The Bicarbonate Buffer System 348
Quantitative Dynamics of the Bicarbonate Buffer System 348
The Phosphate Buffer System 350
Proteins: Important Intracellular Buffers 350
Isohydric Principle: All Buffers in a Common Solution Are in Equilibrium with the Same Hydrogen Ion Concentration 350
Respiratory Regulation of Acid-Base Balance 351
Pulmonary Expiration of C02 Balances Metabolic Formation of CO2 351
Increasing Alveolar Ventilation Decreases Extracellular Fluid Hydrogen Ion Concentration and Raises pH 351
Increased Hydrogen Ion Concentration Stimulates Alveolar Ventilation 351
Renal Control of Acid-Base Balance 352
Secretion of Hydrogen Ions and Reabsorption of Bicarbonate Ions by the Renal Tubule 353
Hydrogen Ions Are Secreted bv Secondary Active Transport in the Early Tubular Segments 353
Filtered Bicarbonate Ions Are Reabsorbed by Interaction with Hydrogen Ions in the Tubules 354
Primary Active Secretion of Hydrogen Ions in the Intercalated Cells of Late Distal and Collecting Tubules 355
Combination of Excess Hydrogen Ions With Phosphate and Ammonia Buffers in the Tubule-A Mechanism for Generating New Bicarbonate Ions 355
The Phosphate Buffer System Carries Excess ttydrogen Ions into the Urine and Generates New Bicarbonate 356
Excretion of Excess Hydrogen Ions and Generation of New Bicarbonate by the Ammonia Buffer System 356
Quantifying Renal Acid-Base Excretion 357
Regulation of Renal Tubular Hydrogen Ion Secretion 357
Renal Correction of Acidosis--Increased Excretion of Hydrogen Ions and Addition of Bicarbonate Ions to the Extracellular Fluid 358
Acidosis Decreases the Ratio of HCO3- /H+ in Renal Tubular Fluid 358
Renal Correction of Alkalosis--Decreased Tubular Secretion of Hydrogen Ions and Increased Excretion of Bicarbonate Ions 359
Alkalosis Increases the Ratio of HC03 /H + in Renal Tubular Fluid 359
Clinical Causes of Acid-Base Disorders 359
Respiratory Acidosis Is Caused by Decreased Ventilation and Increased Pco2 359
Respiratory Alkalosis Results from Increased Ventilation and Decreased Pco2 359
Metabolic Acidosis Results from Decreased Extracellular Fluid Bicarbonate Concentration 360
Metabolic Alkalosis Is Caused by Increased Extracellular Fluid Bicarbonate Concentration 360
Treatment of Acidosis or Alkalosis 360
Clinical Measurements and Analysis of Acid-Base Disorders 361
Complex Acid-Base Disorders and the Use of the Acid-Base Nomogram for Diagnosis 361
Use of Anion Gap to Diagnose Acid-Base Disorders 362
Micturition, Diuretics, and Kidney Diseases Micturition 364
Physiologic Anatomy and Nervous Connections of the Bladder 364
Innervation of the Bladder 364
Transport of Urine from the Kidney Through the Ureters and Into the Bladder 364
Filling of the Bladder and Bladder Wall Tone: The Cystometrogram 365
Micturition Reflex 366
Facilitation or Inhibition of Micturition by the Brain 366
Abnormalities of Micturition 366
Diuretics and Their Mechanisms of Action 367
Osmotic Diuretics Decrease Water Reabsorption by Increasing Osmotic Pressure of Tubular Fhtid 367
"Loop" Diuretics Decrease Active Sodium-Chloride-Potassium Reabsorption in the Thick Ascending Loop of Henle 368
Thiazide Diuretics Inhibit Sodium-Chloride Reabsorption in the Early Distal Tubule 368
Carbonic Anhydrase Inhibitors Block Sodium-Bicarbonate Reabsorption in the Proximal Tubules 368
Competitive Inhibitors of Aldosterone Decrease Sodium Reabsorption from and Potassium Secretion into the Cortical Collecting Tubule 368
Diuretics That Block Sodium Channels in the Collectbtg Tubules Decrease Sodium Reabsorption 368
Kidney Diseases 369
Acute Renal Failure 369
Prerenal Acute Renal Failure Caused by Decreased Blood Flow to the Kidney 369
lntrarenal Acute Renal Failure Caused by Abnormalities Within the Kidney 369
Postrenal Acute Renal Failure Caused by Abnormalities of the Lower Urinary Tract 370
Physiologic Effects of Acute Renal Failure 370
Chronic Renal Failure: An Irreversible Decrease in the Number of Functional Nephrons 371
Vicious Circle of Chronic Renal Faihtre Leading to End-Stage Renal Disease 371
Injury, to the Renal Vasculature as a Cause of Chronic Renal Failure 371
Injury to the Glomeruli as a Cause of Chronic Renal Failure-Glomerulonephritis 372
Injury to the Renal Interstitium as a Cause of Chronic Renal Failure--Pyelonephritis 373
Nephrotic Syndrome--Excretion of Protein in the Urine Because of Increased Glomerular Permeability 373
Abnormal Nephron Function in Chronic Renal Failure 373
Effects of Renal Failure on the Body Fluids--Uremia 375
Hypertension and Kidney Disease 376
Specific Tubular Disorders 377
Treatment of Renal Failure by Dialysis With an Artificial Kidney 377
UNIT VI Blood Cells, Immunity, and Blood Clotting 382
Red Blood Cells, Anemia, and Polycythemia 382
Red Blood Cells (Erythrocytes) 382
Production of Red Blood Cells 382
Fonnation of Hemoglobin 386
Iron Metabolism 387
Destruction of Red Blood Cells 389
The Anemias 389
Effects of Anemia on the Circulatory System 390
Polycythemia 390
Effect of Polycythemia on the Circulatory System 390
Resistance of the Body to Infection: I. Leukocytes, Granulocytes, the Monocyte-Macrophage System, and Inflammation 392
Leukocytes (White Blood Cells) 392
General Characteristics of Leukocytes 392
Genesis of the White Blood Cells 392
Lfe Span of the White Blood Cells 393
Defense Properties of Neutrophils and Macrophages 393
Phagocytosis 394
Monocyte-Macrophage System (Reticuloendothelial System) 395
Inflammation and Role of Neutrophils and Macrophages 397
Inflammation 397
Macrophage and Neutrophil Responses During inflammation 397
Eosinophils 399
Basophils 399
Leukopenia 399
The Leukemias 400
Effects of Leukemia on the Body 400
Resistance of the Body to Infection: II. Immunity and Allergy 402
Innate Immunity 402
Acquired Immunity 402
Basic Types of Acquired Immunity 402
Both Types of Acquired Immunity Are Initiated by Antigens 402
Lymphoo'tes Are the Basis of Acquired Immmunity 403
Preprocessing of the T and B Lymphocytes 403
T Lymphocytes and B-Lymphocyte Antibodies React Highly Specifically Against Specific Antigens--Role of Lymphocyte Clones 404
Origin of the Many Clones of Lymphocytes 405
Specific Attributes of the B-Lymphocyte System--Humoral Immunity and the Antibodies 405
Special Attributes of the T-Lymphocyte System--Activated T Cells and Cell-Mediated Immunity 408
Several Types of T Cells and Their Different Functions 409
Tolerance of the Acquired hnmunity System to One's Own Tissues-Role of Preprocessing in the Thymus and Bone Marrow 410
Immunization 411
Passive Immunity 411
Allergy and Hypersensitivity 411
Allergy Caused by Activated T Cells: Delayed-Reaction Allergy 411
Allergies in the So-Called Allergic Person, Who Has Excess IgE Antibodies 411
Blood Groups; Transfusion; Tissue and Organ Transplantation 413
Antigenicity Causes Immune Reactions of Blood 413
O-A-B Blood Groups 413
A and B Antigens-Agglutinogens 413
Agglutinins 413
Agglutination Process in Transfusion Reactions 414
Blood Typing 414
Rh Blood Types 415
Rh Immune Response 415
Transfusion Reactions Resulting from Mismatched Blood Types 416
Transplantation of Tissues and Organs 416
Attempts to Overcome the Immune Reaction to Transplanted Tissue 417
Hemostasis and Blood Coagulation 419
Events in Hemostasis 419
Vascular Constriction 419
Formation of the Platelet Plug 419
Blood Coagulation in the Ruptured Vessel 420
Fibrous Organization or Dissolution of the Blood Clot 421
Mechanism of Blood Coagulation 421
Conversion of Prothrombin to Thrombin 421
Conversion of Fibrinogen to Fibrin--Formation of the Clot 421
Vicious Circle of Clot Formation 422
Initiation of Coagulation: Formation of Prothrombin Activator 422
Prevention of Blood Clotting in the Normal Vascular System-The Intravascular Anticoagulants 425
Lysis of Blood Clots--Plazmin 425
Conditions That Cause Excessive Bleeding in Human Beings 426
Decreased Prothrombin, Factor VII, Factor IX, and Factor X Caused by Vitamin K Deficiency 426
Hemophilia 426
Thrombocytopenia 426
Thromboembolic Conditions in the Human Being 427
Femoral Venous Thrombosis and Massive Pulmonary Embolism 427
Disseminated intravascular Coagulation 427
Anticoagulants for Clinical Use 428
Heparin as an Intravenous Anticoagulant 428
Coumarins as Anticoagulants 428
Prevention of Blood Coagulation Outside the Body 428
Blood Coagulation Tests 428
Bleeding Time 428
Clotting Time 428
Prothrombin Time 429
UNIT VII Respiration
Pulmonary Ventilation 432
Mechanics of Pulmonary Ventilation 432
Muscles That Cause Lung Expansion and Contraction 432
Movement of Air In and Out of the Lungs-and the Pressures That Cause the Movement 432
Effect of the Thoracic Cage on Lung Expansibility 435
"Work" of Breathing 435
Pulmonary Volumes and Capacities 436
Recording Changes in Pulmonary Volume-Spirometry 436
Abbreviations and Symboh" Used in Pulmonary Function Studies 437
Determination of Functional Residual Capacity, Residual Volume, and Total Lung Capacity-Helium Dilution Method 437
Minute Respiratory Volume Equals Respiratory Rate Times Tidal Volume 438
Alveolar Ventilation 438
Dead Space and Its Effect on Alveolar Ventilation 439
Rate qf Alveolar Ventilation 439
Functions of the Respiratory Passageways 440
Trachea, Bronchi, and Bronchioles 440
Normal Respiratoo' Functions of the Nose 441
Vocalization 442
Pulmonary Circulation; Pulmonary Edema; Pleural Fluid 444
Physiologic Anatomy of the Pulmonary Circulatory System 444
Pressures in the Pulmonary System 444
Blood Volume of the Lungs 445
Blood Flow Through the Lungs and Its Distribution 445
Effect of Hydrostatic Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow 446
Zones I, 2, and 3 of Pulmonat3' Blood Flow 446
Effect of Increased Cardiac Output on the Pulmonary Circulation During Heavy Exercise 447
Function of the Pulmonary Circulation When the Left Atrial Pressure Rises as a Result of Left-Sided Heart Failure 447
Pulmonary Capillary Dynamics 448
Capillary Exchange of Fluid in the Lungs, and Pulmonary Interstitial Fluid Dynamics 448
Pulmonaty Edema 449
Fluids in the Pleural Cavity 450
Physical Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory Membrane 452
Physics of Gas Diffusion and Gas Partial Pressures 452
Molecular Bcis of Gas Diffusion 452
Gas Pressures in a Mixture of Gases-"Partial Pressures" of Individual Gases 452
Pressures of Gases Dissolved in Water and Tissues 452
Vapor Pressure of Water 453
Diffusion of Gases Through Fluids-Pressure Difference Causes Net DifJhsion 453
Diffusion of Gases Through Tissues 454
Composition of Alveolar Air-Its Relation to Atmospheric Air 454
Rate at Which Alveolar Air Is" Renewed by Atmospheric Air 454
Oxygen Concentration and Partial Pressure in the Alveoli 455
C02 Concentration and Partial Pressure in the Alveoli 455
Expired Air 456
Diffusion of Gases Through the Respiratory Membrane 456
Factors That Affect the Rate of Gas DifJhsion Through the Respiratory Membrane 457
Diffusing Capacity of the Respiratory Membrane 458
Effect of the Ventilation-Perfusion Ratio on Alveolar Gas Concentration 460
Po2-Pco2, VA/Q Diagram 460
Concept of "Physiologic Shunt" (When VA/Q Is Below Normal) 461
Concept of "Physiologic Dead Space" (When VA/Q Is Greater Than Normal) 461
Abnormalities of Ventilation-Petfitsion Ratio 461

Transport of Oxygen and Carbon Dioxide in the Blood and Body Fluids 463
Pressures of Oxygen and Carbon Dioxide in the Lungs, Blood, and Tissues 463
Uptake of Oxygen by the Pulmonao' Blood 463
Transport of Oxygen in the Arterial Blood 464
Diffusion of Oxygen from the Peripheral Capillaries into the Tissue Fluid 464
Diffusion of Oxygen from the Peripheral Tissue Capillaries to the Tissue Cells 465
Diffusion of Carbon Dioxide from the Peripheral Tissue Cells into the Tissue Capillaries and from the Pulmonan Capillaries into the Alveoli 465
Transport of Oxygen in the Blood 466
Reversible Combination of Oxygen with Hemoglobin 466
Effect of Hemoglobin to "Buffer" the Tissue PO2 467
Factors That Shift the Oxygen-Hemoglobin Dissociation Curve-Their hnportance for Oxygen Transport 468
Metabolic Use of Oxygen by the Cells 469
Transport of Oxygen in the Dissolved State 469
Combination of Hemoglobin with Carbon Monoxide-Displacement of Oxygen 469
Transport of Carbon Dioxide in the Blood 470
Chemical Forms in Which Carbon Dioxide Is Transported 470
Transport of Carbon Dioxide in the Form of Bicarbonate Ion 470
Carbon Dioxide Dissociation Curve 471
When Oxygen Binds with Hemoglobin. Carbon Dioxide Is Released-The Haldane Effect-to increase C02 Transport 471
Change in Blood Acidity During Carbon Dioxide Transport 472
Respiratory Exchange Ratio 472
Regulation of Respiration 474
Respiratory Center 474
Dorsal Respiratory Group of Neurons-its Control of Inspiration and of Respiratory Rhythm 474
The Pneumotaxic Center Limits the Duration of Inspiration and Increases the Respiratoo' Rate 475
Ventral Respiratory Group of Neurons Functions in Both Inspiration and Expiration 475
Possibility of an "Apneustic Center" in the Lower Pons 475
Lung Inflation Signals Limit Inspiration-The Hering-Breuer Inflation Reflex 475
Control of Overall Respiratory Center Activity 476
Chemical Control of Respiration 476
Direct Chemical Control of Respiratory Center Activity by Carbon Dioxide and Hydrogen Ions 476
Peripheral Chemoreceptor System for Control of Respiratory Activity-Role of Oxygen in Respiratory Control 477
Composite Effects of Pco2, pH, and Po2 on Alveolar Ventilation 479
Regulation of Respiration During Exercise 479
Other Factors That Affect Respiration 481
Periodic Breathing 482
Respiratory Insufficiency-Pathophysiology, Diagnosis, Oxygen Therapy 484
Useful Methods for Studying Respiratory Abnormalities 484
Study of Blood Gases and Blood pH 484
Measurement of Maximum Expiratory Flow 485
Forced Expiratory Vital Capacity and Forced Expiratory Volume 486
Physiologic Peculiarities of Specific Pulmonary Abnormalities 486
Chronic Pulmonary Emphysema 486
Pneumonia 488
Atelectasis 488
Asthma 489
Tuberculosis 489
Hypoxia and Oxygen Therapy 490
Oxygen Therapy in Different Types of Hypoxia 490
Hypercapnia 491
Cyanosis 491
Dyspnea 491
Artificial Respiration 492
UNIT VIII Aviation, Space, and Deep-Sea Diving Physiology
Aviation, High-Altitude, and Space Physiology 496
Effects of Low Oxygen Pressure on the Body 496
Alveolar Poe at Different Elevations 496
Effect of Breathing Pure Oxygen on Alveolar Po2 at Different Altitudes 496
Acute Effects of Hypoxia 497
Acclimatization to Low Poe 497
Natural Acclimatization of Native Human Beings Living at High Altitudes 498
Work Capacity at High Altitudes-The Effect of Acclimatization 499
Chronic Mountain Sickness 499
Acute Mountain Sickness and High-Altitude Pulmonary Edema 499
Effects of Acceleratory Forces on the Body in Aviation and Space Physiology 500
Centrifugal Acceleratoo' Forces 500
Effects of Linear Acceleratory Forces on the Body 501
"Artificial Climate" in the Sealed Spacecraft 502
Weightlessness in Space 502
Physiology of Deep-Sea Diving and Other Hyperbaric Conditions 504
Effect of High Partial Pressures of Gases on the Body Oxygen Toxicity at High Pressures 504
Decompression of the Diver After Exposure to High Pressures 506
Scuba (Self-Contained Underwater Breathing Apparatus) Diving 508
Special Physiologic Problems in Submarines 508
Hyperbaric Oxygen Therapy 509
UNIT IX The Nervous System: A. General Sensory Physiology
Organization of the Nervous System; Basic Functions of Synapses and Transmitter Substances 512
General Design of the Nervous System 512
The Central Nervous System Neuron--The Basic Functional Unit 512
Sensoo' Division of the Nervous System-Sensory Receptors 512
Motor Division-The Effectors 512
Processing of lnformation-"Integrative" Function of the Nervous System 513
Storage of Information-Memory 514
Major Levels of Central Nervous System Function 514
Spinal Cord Level 514
Lower Brain or Subcortical Level 514
Higher Brain or Cortical Level 515
Comparison of the Nervous System With an Electronic Computer 515
Central Nervous System Synapses 515
Types of Synapses-Chemical and Electrical 515
Physiologic Anatomy of the Synapse 516
Chemical Substances That Function as Synaptic Transmitters 519
Electrical Events During Neuronal Excitation 521
Electrical Events in Neuronal Inhibition 522
Special Functions of Dendrites in Exciting Neurons 524
Relation of State of Excitation of the Neuron to Rate of Firing 525
Some Special Characteristics of Synaptic Transmission 525
Sensory Receptors; Neuronal Circuits for Processing Information 528
Types of Sensory Receptors and the Sensory Stimuli They Detect 528
Differential Sensitivity of Receptors 528
Transduction of Sensory Stimuli Into Nerve Impulses 529
Local Electrical Currents at Nerve Endings-Receptor Potentials 529
Adaptation of Receptors 531
Nerve Fibers That Transmit Different Types of Signals and Their Physiologic Classification 532
Transmission of Signals of Different Intensity in Nerve Tracts-Spatial and Temporal Summation 533
Transmission and Processing of Signals in Neuronal Pools 533
Relaying of Signals Through Neuronal Pools 534
Prolongation of a Signal by a Neuronal Pool-"Afterdischarge" 536
Instability and Stability of Neuronal Circuits 538
Principles and Inhibitory Circuits as a Mechanism figr Stabilizing Nervous System Function 538
Synaptic Fatigue as a Means of Stabilizing the Nervous System 538
Somatic Sensations: I. General Organozation; the Tactile and Position Senses 540
Classification of Somatic Senses 540
Detection and Transmission of Tactile Sensations 540
Detection of Vibration 541
Tickling and Itch 542
Sensory Pathways for Transmitting Somatic Signals into the Central Nervous System 542
Dorsal Column-Medial Lemniscal System 542
Anterolateral System 542
Transmission in the Dorsal Column-Medial Lemniscal System 542
Anatomy of the Dorsal Column-Medial Lemniscal System 542
Somatosensory Cortex 544
Somatosensory Association Areas 546
Overall Characteristics of Signal Transmission and Analysis in the Dorsal Column-Medial Lemniscal S3wtem 546
Interpretation of Sensory Stimulus Intensity 548
Judgment of Sthnulus Intensity 548
Position Senses 548
Transmission of Less Critical Sensory Signals in the Anterolateral Pathway 549
Anatomy of the Anterolateral Pathway 549
Some Special Aspects of Somatosensory Function 550
Function of the Thalamus in Somatic Sensation 550
Cortical Control of Sensory Sensitivity-"Corticofugal" Signals 550
Segmental Fields of Sensation-The Dermatomes 551
Somatic Sensations: II. Pain, Headache, and Thermal Sensations 552
Types of Pain and Their Qualities-Fast Pain and Slow Pain 552
Pain Receptors and Their Stimulation 552
Rate of Tissue Damage as a Stbnulus for Pain 553
Dual Transmission of Pain Signals into the Central Nervous System 553
Dual Pain Pathways in the Cord and Brain Stem-The Neospinothalamic Tract and the Paleospinothalamic Tract 554
Pain Suppression ("Analgesia") System in the Brain and Spinal Cord 555
The Brain's Opiate System-The Endorphins and Enkephalins 556
Inhibition of Pain Transmission by Tactile Sensor), Signals 557
Treatment of Pain by Electrical Stimulation 557
Referred Pain 557
Visceral Pain 557
Causes of True Visceral Pain 557
Parietal Pain Caused by Visceral Damage 558
Localization of Visceral Pain-The "Visceral" and the "Parietal" Pain Transmission Pathway 558
Some Clinical Abnormalities of Pain and Other Somatic Sensations 559
Hyperalgesia 559
Thalamic Syndrome 559
Herpes Zoster (Shingles) 559
Tic Douloureux 559
Brown-Sequard Syndrome 560
Headache 560
Headache of Intracranial Origin 560
Extracranial Types of Headache 561
Thermal Sensations 561
Thermal Receptors and Their Excitation 561
Transmission of Thermal Signals in the Nervous System 562
UNIT X The Nervous System: B. The Special Senses
The Eye: I. Optics of Vision 566
Physical Principles of Optics 566
Refraction of Light 566
Application of Refractive Principles to Lenses 566
Focal Length of a Lens 567
Formation of an Image by a Convex Lens 568
Measurement of the Refractive Power of a Lens-The Diopter 569
Optics of the Eye 569
The Eye as a Camera 569
Mechanism of Accommodation 570
Pupilla O' Diameter 571
Errors of Refraction 571
Visual Acuity 573
Deten.ination of Distance of an Object from the Eye- Depth Perception 574
Ophthalmoscope 574
Fluid System of the Eye-Intraocular Fluid 575
Formation of Aqueous Humor by the Ciliary Body 575
Outflow of Aqueous Humor from the Eye 576
Intraocular Pressure 576
The Eye: II. Receptor and Neural Function of the Retina 578
Anatomy and Function of the Structural Elements of the Retina 578
Photochemistry of Vision 579
Rhodopsin-Retinal Visual Cycle, and Excitation of the Rods 580
Automatic Regulation of Retinal Sensitivity Light and Dark Adaptation 582
Color Vision 584
Tricolor Mechanism of Color Detection 584
Color Blindness 584
Neural Function of the Retina 586
Neural Circuitry of the Retina 586
Ganglion Cells 588
Excitation of the Ganglion Cells 588
The Eye: III. Central Neurophysiology of Vision 591
Visual Pathways 591
Function of the Dorsal Lateral Geniculate Nucleus 591
Organization and Function of the Visual Cortex 592
Layered Structure of the Primary Visual Cortex 593
Two Major Pathways for Analysis of Visual Information-
(1) The Fast "Position " and "Motion" Pathway;
(2) The Accurate Color Pathway 594
Neuronal Patterns of Stimulation During Analysis of the Visual Image 594
Detection of Color 595
Effect of Removing the Primary Visual Cortex 595
Fields of Vision; Perimetry 595
Eye Movements and Their Control 596
Fixation Movements of the Eyes 596
Fusion of the Visual hnages from the Two Eyes 598
Autonomic Control of Accommodation and Pupillary Aperture 599
Control of Accommodation (Focusing the Eyes) 599
Control of Pupillary Diameter 600
The Sense of Hearing 602
Tympanic Membrane and the Ossicular System 602
Conduction of Sound rom the Tympanic Membrane to the Cochlea 602
Transmission of Sound Through Bone 603
The Cochlea 603
Functional Anatomy of the Cochlea 603
Transmission of Sound Waves in the Cochlea-The "Traveling Wave" 604
Function of the Organ of Corti 605
Determination of Sound Frequency-The "Place" Principle 607
Determination of Loudness 607
Central Auditory Mechanisms 608
Auditory Pathways 608
Function of the Cerebral Cortex in Hearing 609
Determination of the Direction from Which Sound Comes 610
Centrifugal Signals front the Central Nervous System to Lower Auditory Centers 611
Hearing Abnormalities 611
Types of Deafness 611
The Chemical Senses-Taste and Smell 613
Sense of Taste 613
Primary Sensations of Taste 613
Taste Bud and Its Function 614
Transmission of Taste Signals into the Central Nervous System 615
Taste PreJorence and Control of the Diet 616
Sense of Smell 616
Olfactory Membrane 616
Stimulation of the Olfactory Cells 617
Transmission of Smell Signals into the Central Nervous
System 618
UNIT XI The Nervous System: Neurophysiology C. Motor and Integrative
Motor Functions of the Spinal Cord; The Cord Reflexes 622
Organization of the Spinal Cord for Motor Functions 622
Muscle Sensory Receptors--Muscle Spindles and Golgi Tendon Organs--and Their Roles in Muscle Control 624
Receptor Function of the Muscle Spindle 624
Muscle Stretch Reflex 625
Role of the Muscle Spindle in Voluntary Motor Activity 626
Clinical Applications of the Stretch Reflex 627
Golgi Tendon Reflex 628
Function of the Muscle Spbzdles and Golgi Tendon Organs in Conjunction with Motor Control front Higher Levels of the Brain 628
Flexor Reflex and the Withdrawal Reflexes 629
Crossed Extensor Reflex 630
Reciprocal Inhibition and Reciprocal Innervation 630
Reflexes of Posture and Locomotion 630
Postural and Locomotive Reflexes of the Cord 630
Scratch Reflex 631
Spinal Cord Reflexes That Cause Muscle Spasm 632
Autonomic Reflexes in the Spinal Cord 632
Spinal Cord Transection and Spinal Shock 632
Cortical and Brain Stem Control of Motor Function 634
The Motor Cortex and Corticospinal Tract 634
Primary Motor Cortex 634
Premotor Area 634
Supplementary Motor Area 635
Some Specialized Areas of Motor Control Found in the Human Motor Cortex 635
Transmission of Signals from the Motor Cortex to the Muscles 636
Incoming Fiber Pathways to the Motor Cortex 637
The Red Nucleus Serves as an Alternative Pathway for Transmitting Cortical Signals to the Spinal Cord 637
"Extrapyramidal" System 638
Excitation of the Spinal Cord Motor Control Areas by the Primary Motor Cortex and the Red Nucleus 638
Role of the Brain Stem in Controlling Motor Function 640
Support of the Body Against Gravity-Roles of the Reticular and Vestibular Nuclei 640
Vestibular Sensations and the Maintenance of Equilibrium 641
Vestibular Apparatus 641
Function of the Utricle and Saccule in the Maintenance of Static Equilibrium 643
Detection of Head Rotation by the Semicircular Ducts 644
Vestibular Mechanisms for Stabilizing the Eyes 645
Other Factors Concerned with Equilibrium 645
Functions of Brain Stem Nuclei in Controlling Subconscious, Stereotyped Movements 646
The Cerebellum, the Basal Ganglia, and Overall Motor Control 647
The Cerebellum and Its Motor Functions 647
Anatomical Functional Areas of the Cerebellum 647
Neuronal Circuit of the Cerebellum 648
Function of the Cerebellum in Overall Motor Control 652
Clinical Abnormalities of the Cerebellum 655
The Basal Ganglia-Their Motor Functions 656
Function of the Basal Ganglia in Executing Patterns of Motor Activity-The Putumen Circuit 657
Role of the Basal Ganglia for Cognitive Control of Sequences of Motor Patterns-The Caudate Circuit 657
Function of the Basal Ganglia to Change the Timing and to Scale the Intensity of Movements 658
Functions of Specific Neurotransmitter Substances in the Basal Ganglial System 659
Clinical Syndromes Resulting from Damage to the Basal Ganglia 659
Integration of the Many Parts of the Total Motor Control System 660
Spinal Level 660
Hindbrain Level 660
Motor Cortex Level 660
What Drives Us to Action 661
The Cerebral Cortex; Intellectual Functions of the Brain and Learning and Memory 663
Physiologic Anatomy of the Cerebral Cortex 663
Functions of Specific Cortical Areas 663
Association Areas 665
Comprehensive Interpretative Function of the Posterior Superior Temporal Lobe-"Wernicke's Area" (a General Interpretative Area) 666
Functions of the Parieto-occipitotemporal Cortex in the Nondominant Hemisphere 668
Higher Intellectual Functions of the Prefrontal Association Area 668
Function of the Brain in Communication-Language Input and Language Output 669
Function of the Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories, Training, and Other Information Between the Two Cerebral Hemispheres 671
Thoughts, Consciousness, and Memory 67l
Memory-Roles of Synaptic Facilitation and Synaptic Inhibition 672
Short-Term Memory 673
Intermediate Long-Term Memory 673
Long-Tertn Memory 674
Consolidation of Memory 675
Behavioral and Motivational Mechanisms of the Brain-The Limbic System and the Hypothalamus 678
Activating-Driving Systems of the Brain 678
Control of Cerebral Activity by Continuous Excitation Signals from the Brain Stem 678
Neurohormonal Control of Brain Activity 679
The Limbic System 681
Functional Anatomy of the Limbic System; the Key Position of the Hypothalamus 681
The Hypothalamus, a Major Control Headquarters for the Limbic System 682
Vegetative and Endocrine Control Functions of the Hypothalamus 682
Behavioral Functions of the Hypothalamus and Associated Limbic Structures 684
"Reward" and "Punishment" Function of the Limbic System 684
Importance of Reward and Punishment in Behavior 685
Specific Functions of Other Parts of the Limbic System 686
Functions of the Hippocampus 686
Functions of the Amygdala 686
Function of the Limbic Cortex 687
States of Brain Activity-Sleep; Brain Waves; Epilepsy; Psychoses 689
Sleep 689
Slow-Wave Sleep 689
REM Sleep (Paradoxical Sleep, Desynchronized Sleep) 689
Basic Theories of Sleep 690
Physiologic Effects of Sleep 691
Brain Waves 691
Origin in the Brain of the Brain Waves 692
Effect of Varying Degrees of Cerebral Activity on the Basic Frequency of the EEG 692
Changes in the EEG at Different Stages of Wakefulness and Sleep 693
Epilepsy 693
Grand Mal Epilepsy 693
Petit Mal Epilepsy 694
Focal Epilepsy 694
Psychotic Behavior and Dementia-Roles of Specific Neurotransmitter Systems 694
Depression and Manic-Depressive Psychoses-Decreased Activity of the Norepinephrine and Serotonin Neurotransmitter Systems 695
Sch&ophrenia-Possible Exaggerated Function of Part of the Dopamine System 695
Alzhebner's Disease-Amyloid Plaques and Depressed Memory 695
The Autonomic Nervous System; and the Adrenal Medulla 697
General Organization of the Autonomic Nervous System 697
Physiologic Anatomy of the Sympathetic Nervous System 697
Physiologic Anatomy of the Parasympathetic Nervous System 698
Basic Characteristics of Sympathetic and Parasympathetic Function 699
Cholinergic and Adrenergic Fibers-Secretion of Acetylcholine or Norepinephrine 699
Receptors on the Effector Organs 700
Excitatory and Inhibitory Actions of Sympathetic and Parasympathetic Stimulation 701
Effects of Sympathetic and Parasympathetic Stimulation on Specific Organs 701
Function of the Adrenal Medullae 703
Relation to Sthmulus Rate to Degree of Sympathetic and Parasympathetic Effect 704
Sympathetic and Parasympathetic "Tone" 704
Denervation Supersensitivity of Sympathetic and Parasympathetic Organs After Denervation 705
Autonomic Reflexes 705
Stimulation of Discrete Organs in Some Instances and Mass Stimulation in Other Instances by the Sympathetic and Parasympathetic Systems 705
"Alarm" or "Stress" Response of the Sympathetic Nervous System 706
Medullary, Pontine, and Mesencephalic Control of the Autonomic Nervous System 706
Pharmacology of the Autonomic Nervous System 707
Drugs That Act on Adrenergic Effector Organs-The Sympathomimetic Drugs 707
Drugs That Act on Cholinergic Effector Organs 707
Drugs That Sth.ulate or Block Sympathetic and Parasympathetic Postganglionic Neurons 708
Cerebral Blood Flow; the Cerebrospinal Fluid; and Brain Metabolism Cerebral Blood Flow 709
Normal Rate of Cerebral Blood Flow 709
Regulation of Cerebral Blood Flow 709
Cerebral Microcirculation 7l0
A Cerebral "Stroke" Occurs When Cerebral Blood Vessels Are Blocked 711
Cerebrospinal Fluid System 711
Cushioning Function of the Cerebrospinal Fluid 711
Formation, Flow, and Absorption of Cerebrospinal Fluid 711
Cerebrospinal Fluid Pressure 713
Obstruction to the Flow of Cerebrospinal Fluid Can Cause Hydrocephalus 713
Blood Cerebrospinal Fluid and Blood-Brain Barriers 714
Brain Edema 714
Brain Metabolism 714
UNIT XII Gastrointestinal Physiology
General Principles of Gastrointestinal Function-Motility, Nervous Control, and Blood Circulation General Principles of Gastrointestinal Motility 718
Characteristics of the Gastrointestinal Wall 718
Neural Control of Gastrointestinal Function-The Enteric Nervous System 720
Differences Between the Myenteric and Submucosal Plexuses 720
Types of Neurotransmitters Secreted by the Enteric Neurons 721
Hormonal Control of Gastrointestinal Motility 722
Functional Types of Movements in the Gastrointestinal Tract 723
Propulsive Movements-Peristalsis 723
Mixing Movements 723
Gastrointestinal Blood Flow-The Splanchnic Circulation 724
Anatomy of the Gastrointestinal Blood Supply 724
Effoct of Gut Activity and Metabolic Factors on Gastrointestinal Blood Flow 724
Nervous Control of Gastrointestinal Blood Flow 726
Propulsion and Mixing of Food in the Alimentary Tract 728
Ingestion of Food 728
Mastication (Chewing) 728
Swallowing (Deglutition) 728
Motor Functions of the Stomach 730
Storage Fu.ction of the Stomach 731
Mixing and Propulsion of Food in the Stomach-The Basic Electrieal Rhythm of the Stomach 731
Emptying of the Stomach 73l
Regulation of Stomach Emptying 732
Movements of the Smafl Intestine 733
Mixing Contractions (Segmentation Contractions) 733
Propulsive Movements 734
Function of the lleocecal Valve 734
Movements of the Colon 735
Defecation 736
Other Autonomic Reflexes That Affect Bowel Activity 737
Secretory Functions of the Alimentary Tract General Principles of Alimentary Tract Secretion 738
Anatomical Types of Glands 738
Basic Mechanisms of Stimulation of the Alimentary Tract Glands 738
Basic Mechanism of Secretion by Glandular Cells 739
Lubricating and Protective Properties of Mucus, and Importance of Mucus in the Gastrointestinal Tract 740
Secretion of Saliva 740
Esophageal Secretion 742
Gastric Secretion 742
Characteristics of the Gastric Secretions 742
Regulation of Gastric Secretion by Nervous and Hormonal Mechanisms 744
Stimulation of Gastric Acid Secretion 744
Regulation of Pepsinogen Secretion 744
Phases of Gastric" Secretion 745
Inhibition qf Gastric Secretion by Post-Stomach Intestinal Factors 745
Chemical Composition of Gastrin and Other Gastrointestinal Hormones 746
Pancreatic Secretion 746
The Pancreatic" Digestive Enzymes 746
Secretion o3` Bicarbonate Ions 747
Regulation of Pancreatic Secretion 747
Secretion of Bile by the Liver; Functions of the Biliary Tree 749
Physiologic Anatomy of Biliary Secretion 749
Function q[ Bile Salts in Fat Digestion and Absorption 750
Liver Secretion of Cholesterol; and Gallstone Formation 751
Secretions of the Small Intestine 752
Secretion of Mucus by Brunner's Glands in the Duodenum 752
Secretion of the Intestinal Digestive Juices by the Crypts of Lieberkuhn 752
Regulation of Small Intestinal Secretion 752
Secretions of the Large Intestine 753
Digestion and Absorption in the Gastrointestinal Tract 754
Digestion of the Various Foods 754
Digestion of Carbohydrates 754
Digestion of Proteins 755
Digestion of Fats 756
Basic Principles of Gastrointestinal Absorption 758
Anatomical Basis of Absorption 758
Basic Mechanisms of Absorption 759
Absorption in the Small Intestine 759
Absorption of Water 759
Absorption of lons 759
Absorption of Nutrients 761
Absorption in the Large Intestine: Formation of Feces 762
Physiology of Gastrointestinal Disorders 764
Disorders of Swallowing and of the Esophagus 764
Disorders of the Stomach 764
Peptic Ulcer 765
Disorders of the Small Intestine 766
Abnormal Digestion of Food in the Small Intestine-Pancreatic Failure 766
Malabsorption by the Small Intestinal Mucosa-Sprue 766
Disorders of the Large Intestine 767
Constipation 767
Diarrhea 767
Paralysis of Defecation in Spinal Cord Injuries 767
General Disorders of the Gastrointestinal Tract 768
Vomiting 768
Nausea 769
Gastrointestinal Obstruction 769
Gases in the Gastrointestinal Tract; "Flatus" 769
UNIT XIII Metabolism and Temperature Regulation
Metabolism of Carbohydrates, and Formation of Adenosine Triphosphate 772
Release of Energy from Foods, and the Concept of "Free Energy" 772
Role of Adenosine Triphosphate in Metabolism 772
Central Role of Glucose in Carbohydrate Metabolism 772
Transport of Glucose Through the Cell Membrane 773
Effect of lnsulin to Increase Facilitated Diffusion of Glucose 774
Phasphorylation of Glucose 774
Storage of Glycogen in Liver and Muscle 774
Glycogenesis 774
Removal of Stored Glycogen-Glycogenolysis 774
Release of Energy from the Glucose Molecule by the Glycolytic Pathway 775
Glycolysis. The Formation of Pyruvic Acid 775
Conversion of Pyruvic Acid to Acetyl Coenzyme A 775
Citric Acid Cycle 775
Formation of Large Quantities of ATP by Oxidation of Hydrogen (the Process of Oxidative Phosphorylation 777
Summary of ATP Formation During the Breakdown of Glucose 778
Control of Energy Release from Stored Glycogen When the Body Needs Additional Energy: Effect of ATP and ADP Concentrations in the Cell to Control the Rate of Glycolysis 778
Anaerobic Release of Energy-"Anaerobic Glycolysis" 778
Release of Energy from Glucose by the Pentose Phosphate Pathway 779
Glucose Conversion to Glycogen or Fat 780
Formation of Carbohydrates from Proteins and Fats-"Gluconeogenesis" 780
Blood Glucose 780
Lipid Metabolism 781
Transport of Lipids in the Body Fluids 781
Transport of Triglycerides and Other Lipids from the Gastrointestinal Tract by Lymph-The Chylomicrons 781
Transport of Fatty Acids in the Blood in Combination with Albumin-"Free Fatty Acid" 782
Lipoproteins--Their Special Function in Transporting Cholesterol and Phospholipids 782
Fat Deposits 782
Adipose Tissue 782
Liver Lipids 783
Use of Triglycerides for Energy: Formation of Adenosine Triphosphate 783
Formation of Acetoacetic Acid in the Liver and Its Transport in the Blood 784
Synthesis of Triglycerides frotn Carbohydrates 785
Synthesis of Triglycerides from Proteins 786
Regulation of Energy Release from Triglycerides 786
Obesity 787
Phospholipids and Cholesterol 787
Phospholipids 787
Cholesterol 788
Cellular Structural Functions of Phospholipids and Cholesterol-Especially for Membranes 788
Atherosclerosis 789
Basic Causes of Atherasclerosis-The Roles of Cholesterol and Lipoproteins 789
Other Factors That Lead to Atherosclerosis 789
Prevention of Atherosclerosis 789
Protein Metabolism 791
Basic Properties 791
Amino Acids 791
Transport and Storage of Amino Acids 791
Blood Amino Acids 791
Storage of Amino Acids as Proteins in the Cells 793
Functional Roles of the Plasma Proteins 793
Essential and Nonessential Amino Acids 794
Use of Proteins for Energy 794
Obligatory Degradation of Proteins 795
Hormonal Regulation of Protein Metabolism 795
The Liver as an Organ 797
Physiologic Anatomy of the Liver 797
The Hepatic Vascular and Lymph Systems 797
Blood Flows Through the Liver from the Portal Vein and Hepatic Arterry 797
The Liver Functions as a Blood Reservoir 798
The Liver Has Very High Lymph Flow 798
Hepatic Macrophage System Serves a Blood-Cleansing Function 798
Metabolic Functions of the Liver 798
Carbohydrate Metabolism 798
Fat Metabolism 799
Protein Metabolism 799
Miscellaneous Metabolic Functions of the Liver 799
Measurement of Bilirubin in the Bile as a Clinical Diagnostic Tool 800
Jaundice-Excess Bilirubin in the Extracellular Fluid 800
Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and Minerals 803
Energy Intake and Output Are Balanced Under Steady-State Conditions 803
Dietary Balances 803
Energy Available in Foods 803
Methods for Detennining Metabolic Utilization of Proteins, Carbohydrates, and Fats 804
Regulation of Food Intake and Energy Storage 804
Neural Centers Regulate Food Intake 805
Factors That Regulate Quantity of Food Intake 806
Obesity 807
Abnormal Feeding Regulation as a Pathological Cause of Obesity 808
Treatment of Obesity 808
Inanition 808
Starvation 809
Vitamins 809
Vitamin A 809
Thiamine (Vitamin B2) 810
Niacin 810
Riboflavin (Vitamin Be) 810
Vitamin Bte 811
Folic Acid (Pteroylglutamic Acid) 811
Pyridoxine (Vitamin B6) 81l
Pantothenic Acid 811
Ascorbic Acid (Vitamin C) 812
Vitamin D 812
Vitamin E 812
Vitamin K 812
Mineral Metabolism 812
Energetics and Metabolic Rate 815
Adenosine Triphosphate (ATP) Functions as an "Energy Currency" in Metabolism 815
Phosphocreatine Functions as an Accessoo" Storage Depot for Energy and as an "ATP Buffer" 816
Anaerobic Versus Aerobic Energy 816
Summary of Energy Utilization by the Cells 817
Control of Energy Release in the Cell 817
Metabolic Rate 818
Measurement of the Whole-Body Metabolic Rate 818
Energy Metabolism--Factors That Influence Energy Output 819
Overall Energy Requirements for Daily Activities 819
Basal Metabolic Rate (BMR)-The Minimum Energy Expenditure for the Body to Exist 819
Energy Used for Physical Activities 820
Energy Used for Processing Food-Thermogenie Effect of Food 821
Energy Used for Nonshivering Thermogenesis-Role of Sympathetic Stimulation 821
Body Temperature, Temperature Regulation, and Fever 822
Normal Body Temperature 822
Body Temperature Is Controlled by Balancing Heat Production Against Heat Loss 822
Heat Production 822
Heat Loss 822
Regulation of Body Temperature-Role of the Hypothalamus 826
Neuronal Effector Mechanisms That Decrease or Increase Body Temperature 827
Concept of a "Set-Point" for Temperature Control 829
Behavioral Control of Body Temperature 830
Local Skin Temperature Reflexes 830
Abnormalities of Body Temperature Regulation 830
Fever 830
Exposure of the Body to Extreme Cold 832
UNIT XIV Endocrinology and Reproduction
Introduction to Endocrinology 836
Coordination of Body Functions by Chemical Messengers 836
Chemical Structure and Synthesis of Hormones 836
Hormone Secretion. Transport, and Clearance from the Blood 837
Feedback Control of Hormone Secretion 839
Transport of Hormones in the Blood 840
"Clearance" of Hormones from the Blood 840
Mechanisms of Action of Hormones 840
Hormone Receptors and Their Activation 840
Intracellular Signaling After Hormone Receptor Activation 841
Second Messenger Mechanisms for Mediating Intracellular
Hormonal Functions 841
Hormones That Act Mainly on the Genetic Machinery of the Cell 843
Measurement of Hormone Concentrations in the Blood 844
Radioimmunoassav 844
The Pituitary Hormones and Their Control by the Hypothalamus 846
The Pituitary Gland and Its Relation to the Hypothalamus 846
The Hypothalamus Controls Pituitary Secretion 847
Hypothalamic-Hypophysial Portal System 848
Physiologic Functions of Growth Hormone 849
Growth Hormone Promotes Growth of Many Body Tissues 849
Growth Hormone Has Several Metabolic Effects 849
Growth Hormone Stimulates Cartilage and Bone Growth 850
Growth Hormone Exerts Much of lts Effect Through Intermediate Substances Called "Somatomedins" (Also Called "Insulin-like Growth Factors" 851
Regulation of Growth Hormone Secretion 851
Abnormalities of Growth Hormone Secretion 853
The Posterior Pituitary Gland and Its Relation to the Hypothalamus 854
Chemical Structures of ADH and Oxytocin 855
Physiologic Functions of ADH 855
Oxytocic Hormone 856
The Thyroid Metabolic Hormones 858
Synthesis and Secretion of the Thyroid Metabolic Hormones 858
Iodine Is Required for Fon.ation of Thyroxine 858
Iodide Pump (Iodide Trapping) 858
Thyroglobulin, and Chemistry of Thyroxine and Triiodothyronine Formation 859
Release of Thyroxine and Triiodothyronine from the Thyroid Gland 859
Transport of Thyroxine and Triiodothyronine to the Tissues 860
Physiologic Functions of the Thyroid Hormones 861
Thyroid Hormones Increase the Transcription of Large Numbers of Genes 861
Thyroid Hormones Increase Cellular Metabolic Activity 861
Effect o3" Thyroid Hormone on Growth 861
Effects of Thyroid Hormone on Specific Bodily Mechanisms 862
Regulation of Thyroid Hormone Secretion 864
Anterior Pituitary Secretion of TSH Is Regulated by Thyrotropin-Releasing Hormone from the Hypothalamus 864
Feedback Effect of Thyroid Hormone to Decrease Anterior Pituitary Secretion of TSH 865
Antithyroid Substances 865
Diseases of the Thyroid 865
Hyperthyroidism 865
Hypothyroidism 867
The Adrenocortical Hormones 869
Synthesis and Secretion of Adrenocortical Hormones 869
Functions of the Mineralocorticoids--Aldosterone 872
Renal and Circulatoo" Effects of Aldosterone 872
Aldosterone Stimulates Sodium and Potassium Transport in Sweat Glands, Salivary Glands, and Intestinal Epithelial Cells 873
Cellular Mechanism of Aldosterone Action 873
Regulation of Aldosterone Secretion 874
Functions of the Glucocorticoids 875
Effects of Cortisol on Carbohydrate Metabolism 875
Effects of Cortisol on Protein Metabolism 875
Effects of Cortisol on Fat Metabolism 876
Cortisol Is hnportant in Resisting Stress and Inflammation 876
Other Effects of Cortisol 878
Cellular Mechanism o3` Cortisol Action 878
Regulation of Cortisol Secretion by Adrenocorticotropic Hormone from the Pituitary Gland 878
Adrenal Androgens 880
Abnormalities of Adrenocortical Secretion 880
Hypoadrenalism--Addison's Disease 880
Hyperadrenalism-- Cushing's Syndrome 881
Primary Aldosteronism (Conn's Syndrome) 882
Adrenogenital Syndrome 883
Insulin, Glucagon, and Diabetes Mellitus 884
Insulin and Its Metabolic Effects 884
Effect of Insulin o. Carbohydrate Metabolism 886
Effect of Insulin on Fat Metabolism 887
Effect of Insulin on Protein Metabolism and on Growth 889
Control o3" Insulin Secretion 890
Other Factors That &imulate Insulin Secretion 891
Role o3" Insulin (and Other Ho7nones) in "Switching" Between Carbohydrate and Lipid Metabolism 891
Glucagon and Its Functions 891
Effects on Glucose Metabolism 892
Regulation of Glucagon Secretion 892
Somatostatin Inhibits Glucagon and Insulin Secretion 893
Summary of Blood Glucose Regulation 893
Diabetes Mellitus 894
Type I Diabetes--Lack of Insulin Production by Beta Cells of the Pancreas 894
Type II Diabetes--Resistance to the Metabolic Effects of Insulin 895
Physiology of Diagnosis 896
Treatment of Diabetes 896
Insulinoma--Hyperinsulinism 897
Parathyroid Hormone, Calcitonin, Calcium and Phosphate Metabolism, Vitamin D, Bone, and Teeth 899
Overview of Calcium and Phosphate Regulation in the Extracellular Fluid and Plasma 899
Calcium in the Plasma and Interstitial Fluid 899
Inorganic Phosphate in the Extracellular Fluids 899
Non-bone Physiologic Effects of Altered Calcium and Phosphate Concentrations in the Body Fluids 900
Absorption and Excretion of Calcium and Phosphate 900
Bone and Its Relation to Extracellular Calcium and Phosphate 901
Precipitation and Absorption of Calcium and Phosphate in Bone-Equilibrium with the Extracellular Fluids 902
Calcium Exchange Between Bone and Extracellular Fluid 902
Deposition and Absorption of Bone--Remodeling of Bone 903
Vitamin D 904
Actions of Vitamin D 905
Parathyroid Hormone 906
Effect of Parathyroid Hormone on Calcium and Phosphate Concentrations in the Extracellular Fluid 906
Control of Parathyroid Secretion by Calcium Ion Concentration 908
Calcitonin 908
Summary of Control of Calcium Ion Concentration 909
Pathophysiology of Parathyroid Hormone, Vitamin D, and Bone Disease 910
Hypoparathyroidism 910
Primary Hyperparathyroidism 910
Secondary Hyperparathyroidism 911
Rickets-- Vitamin D Deficiency 911
Osteoporosis-Decreased Bone Matrix 912
Physiology of the Teeth 912
Function of the Different Parts of the Teeth 912
Dentition 913
Mineral Exchange in Teeth 914
Dental Abnormalities 914
Reproductive and Hormonal Functions of the Male (and Function of the Pineal Gland) 916
Physiologic Anatomy of the Male Sexual Organs 916
Spermatogenesis 916
Steps of Spermatogenesis 916
Function of the Seminal Vesicles 918
Function of the Prostate Gland 918 Semen 919
Abnormal Spermatogenesis and Male Fertility 920
The Male Sexual Act 921
Neuronal Stimulus for Performance of the Male Sexual Act 921
Stages of the Male Sexual Act 921
Testosterone and Other Male Sex Hormones 922
Secretion, Metabolism. and Chemistry of the Male Sex Hormone 922
Functions of Testosterone 923
Basic lntracellular Mechanism of Action of Testosterone 925
Control of Male Sexual Functions by Hormones from the Hypothalamus and Anterior Pituitary Gland 925
Abnormalities of Male Sexual Function 926
The Prostate Gland and Its Abnormalities 926
Hypogonadism in the Male 927
Testicular Tumors and Hypergonadism in the Male 927
The Pineal Gland--Its Function in Controlling Seasonal Fertility in Some Animals 927
Female Physiology Before Pregnancy; and the Female Hormones 929
Physiologic Anatomy of the Female Sexual Organs 929
Female Hormonal System 929
The Monthly Ovarian Cycle; Function of the Gonadotropic Hormones 929
Gonadotropic Hormones and Their Effects on the Ovaries 930
Ovarian Follicle Growth--The "Follicular" Phase of the Ovarian Cycle 930
The Corpus Luteum-The "Luteal" Phase of the Ovarian Cycle 932
Summary 933
Functions of the Ovarian Hormones--Estradiol and
Progesterone 933
Chemistry of the Sex Hormones 933
Functions of the Estrogens--Their Effects on the Primary and Secondary Female Sex Characteristics 934
Functions of Progesterone 936
The Monthly Endometrial Cycle and Menstruation 936
Regulation of the Female Monthly Rhythm--Interplay Between the Ovarian and Hypothalamic-Pituitary Hormones 937
Feedback Oscillation of the Hypothalamic-Pituitary-Ovarian System 938
Puberty and Menarche 939
Menopause 940
Abnormalities of Secretion by the Ovaries 940
The Female Sexual Act 941
Female Fertility 941
Pregnancy and Lactation 944
Maturation and Fertilization of the Ovum 944
Transport of the Fertilized Ovum in the Fallopian Tube 945
Implantation of the Blastocyst in the Uterus 945
Early Nutrition of the Embryo 945
Function of the Placenta 946
Developmental and Physiologic Anatomy of the Placenta 946
Hormonal Factors in Pregnancy 948
Human Chorionic Gonadotropin and Its Effect to Cause Persistence of the Corpus Luteum and to Prevent Menstruation 948
Secretion of Estrogens by the Placenta 949
Secretion of Progesterone by the Placenta 949
Human Chorionic Somatomammotropin 949
Other Hormonal Factors in Pregnancy 950
Response of the Mother's Body to Pregnancy 950
Parturition 952
Increased Uterine Excitability Near Term 952
Onset of Labor-A Positive Feedback Theory for Its Initiation 952
Abdominal Muscle Contractions During Labor 953
Mechanics of Parturition 953
Separation and Deliveo, of the Placenta 954
Labor Pains 954
Involution of the Uterus After Parturition 954
Lactation 954
Development of the Breasts 954
Initiation of Lactation--Function of Prolactin 955
Ejection (or "Let-Down") Process in Milk Secretion-Function of Oxytocin-956
Milk Composition and the Metabolic Drain on the Mother Caused by Lactation 956
Fetal and Neonatal Physiology 958
Growth and Functional Development of the Fetus 958
Development of the Organ Systems 958
Adjustments of the Infant to Extrauterine Life 960
Onset of Breathing 960
Circulatory Readjustments at Birth 960
Nutrition of the Neonate 962
Special Functional Problems in the Neonate 962
Respiratory System 962
Circulation 962
Fluid Balance, Acid-Base Balance, and Renal Function 963
Liver Function 963
Digestion, Absorption, Metabolism of Energy Foods, and Nutrition 963
Immunity 964
Endocrine Problems 964
Special Problems of Prematurity 965
hnmature Development of the Premature Infant 965
Instability of the Homeostatic Control Systems in the Premature Infant 965
Danger of Blindness Caused by Excess Oxygen Therapy in the Premature Infant 965
Growth and Development of the Child 965
Behavioral Growth 965
UNIT XV Sports Physiology
Sports Physiology 968
The Female and the Male Athlete 968
The Muscles in Exercise 968
Strength, Power, and Endurance of Muscles 968
Muscle Metabolic" Systems in Exercise 969
Nutrients Used During Muscle Activity 972
Effect of Athletic Training on Muscles and Muscle Performance 972
Respiration in Exercise 973
The Cardiovascular System in Exercise 975
Body Heat in Exercise 976
Body Fluids and Salt in Exercise 977
Drugs and Athletes 977
Body Fitness Prolongs Life 977
Index 979