Guyton and Hall Textbook of Medical Physiology

1264 Pages·2016·59.71 MB·English

by  John E. Hall

Cover image Page: i
Title Page Page: i
Table of Contents Page: i
Copyright Page: iv
Dedication Page: v
Preface Page: vii
Unit I Introduction to Physiology: The Cell and General Physiology Page: viii
Chapter 1 Functional Organization of the Human Body and Control of the “Internal Environment” Page: 3
Cells are the Living Units of the Body Page: 3
Extracellular Fluid—the “Internal Environment” Page: 3
Homeostasis—Maintenance of A Nearly Constant Internal Environment Page: 4
Control Systems of the Body Page: 6
Summary—Automaticity of the Body Page: 10
Bibliography Page: 10
Chapter 2 The Cell and Its Functions Page: 11
Organization of the Cell Page: 11
Physical Structure of the Cell Page: 12
Comparison of the Animal Cell with Precellular Forms of Life Page: 18
Functional Systems of the Cell Page: 19
Locomotion of Cells Page: 24
Bibliography Page: 26
Chapter 3 Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction Page: 27
Genes in the Cell Nucleus Control Protein Synthesis Page: 27
The DNA Code in the Cell Nucleus is Transferred to RNA Code in the Cell Cytoplasm—The Process of Transcription Page: 30
Synthesis of Other Substances in the Cell Page: 35
Control of Gene Function and Biochemical Activity in Cells Page: 35
The DNA–Genetic System Controls Cell Reproduction Page: 37
Cell Differentiation Page: 41
Apoptosis—Programmed Cell Death Page: 41
Cancer Page: 41
Bibliography Page: 43
Unit II Membrane Physiology, Nerve, and Muscle Page: 43
Chapter 4 Transport of Substances Through Cell Membranes Page: 47
The Cell Membrane Consists of a Lipid Bilayer with Cell Membrane Transport Proteins Page: 47
Diffusion Page: 47
“Active Transport” of Substances Through Membranes Page: 54
Bibliography Page: 58
Chapter 5 Membrane Potentials and Action Potentials Page: 61
Basic Physics of Membrane Potentials Page: 61
Measuring the Membrane Potential Page: 62
Resting Membrane Potential of Neurons Page: 63
Neuron Action Potential Page: 65
Propagation of the Action Potential Page: 69
Re-Establishing Sodium and Potassium Ionic Gradients After Action Potentials are Completed—Importance of Energy Metabolism Page: 69
Plateau in Some Action Potentials Page: 70
Rhythmicity of Some Excitable Tissues—Repetitive Discharge Page: 70
Special Characteristics of Signal Transmission in Nerve Trunks Page: 71
Bibliography Page: 74
Chapter 6 Contraction of Skeletal Muscle Page: 75
Physiological Anatomy of Skeletal Muscle Page: 75
General Mechanism of Muscle Contraction Page: 77
Molecular Mechanism of Muscle Contraction Page: 78
Energetics of Muscle Contraction Page: 82
Characteristics of Whole Muscle Contraction Page: 83
Bibliography Page: 88
Chapter 7 Excitation of Skeletal Muscle Page: 89
Transmission of Impulses from Nerve Endings to Skeletal Muscle Fibers: the Neuromuscular Junction Page: 89
Muscle Action Potential Page: 93
Excitation-Contraction Coupling Page: 93
Bibliography Page: 95
Chapter 8 Excitation and Contraction of Smooth Muscle Page: 97
Contraction of Smooth Muscle Page: 97
Regulation of Contraction by Calcium Ions Page: 99
Nervous and Hormonal Control of Smooth Muscle Contraction Page: 102
Bibliography Page: 105
Unit III The Heart Page: 105
Chapter 9 Cardiac Muscle; The Heart as a Pump and Function of the Heart Valves Page: 109
Physiology of Cardiac Muscle Page: 109
Cardiac Cycle Page: 113
Regulation of Heart Pumping Page: 119
Bibliography Page: 122
Chapter 10 Rhythmical Excitation of the Heart Page: 123
Specialized Excitatory and Conductive System of the Heart Page: 123
Control of Excitation and Conduction in the Heart Page: 126
Bibliography Page: 129
Chapter 11 The Normal Electrocardiogram Page: 131
Characteristics of the Normal Electrocardiogram Page: 131
Flow of Current Around the Heart During the Cardiac Cycle Page: 133
Electrocardiographic Leads Page: 134
Methods for Recording Electrocardiograms Page: 137
Bibliography Page: 137
Chapter 12 Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities Page: 139
Principles of Vectorial Analysis of Electrocardiograms Page: 139
Vectorial Analysis of the Normal Electrocardiogram Page: 141
Mean Electrical Axis of the Ventricular QRS and Its Significance Page: 144
Conditions that Cause Abnormal Voltages of the QRS Complex Page: 147
Prolonged and Bizarre Patterns of the QRS Complex Page: 148
Current of Injury Page: 148
Abnormalities in the T Wave Page: 152
Bibliography Page: 153
Chapter 13 Cardiac Arrhythmias and Their Electrocardiographic Interpretation Page: 155
Abnormal Sinus Rhythms Page: 155
Abnormal Rhythms that Result from Block of Heart Signals within the Intracardiac Conduction Pathways Page: 156
Premature Contractions Page: 158
Paroxysmal Tachycardia Page: 160
Ventricular Fibrillation Page: 161
Atrial Fibrillation Page: 164
Atrial Flutter Page: 165
Cardiac Arrest Page: 165
Bibliography Page: 165
Unit IV The Circulation Page: 166
Chapter 14 Overview of the Circulation; Biophysics of Pressure, Flow, and Resistance Page: 169
Physical Characteristics of the Circulation Page: 169
Basic Principles of Circulatory Function Page: 170
Interrelationships of Pressure, Flow, and Resistance Page: 171
Bibliography Page: 178
Chapter 15 Vascular Distensibility and Functions of the Arterial and Venous Systems Page: 179
Vascular Distensibility Page: 179
Arterial Pressure Pulsations Page: 180
Veins and Their Functions Page: 184
Bibliography Page: 188
Chapter 16 The Microcirculation and Lymphatic System Page: 189
Structure of the Microcirculation and Capillary System Page: 189
Flow of Blood in the Capillaries—Vasomotion Page: 190
Exchange of Water, Nutrients, and Other Substances between the Blood and Interstitial Fluid Page: 191
Interstitium and Interstitial Fluid Page: 192
Fluid Filtration Across Capillaries is Determined by Hydrostatic and Colloid Osmotic Pressures and the Capillary Filtration Coefficient Page: 193
Lymphatic System Page: 198
Bibliography Page: 201
Chapter 17 Local and Humoral Control of Tissue Blood Flow Page: 203
Local Control of Blood Flow in Response to Tissue Needs Page: 203
Mechanisms of Blood Flow Control Page: 203
Humoral Control of the Circulation Page: 212
Bibliography Page: 213
Chapter 18 Nervous Regulation of the Circulation and Rapid Control of Arterial Pressure Page: 215
Nervous Regulation of the Circulation Page: 215
Special Features of Nervous Control of Arterial Pressure Page: 224
Bibliography Page: 225
Chapter 19 Role of the Kidneys in Long-Term Control of Arterial Pressure and in Hypertension Page: 227
Renal–Body Fluid System for Arterial Pressure Control Page: 227
The Renin-Angiotensin System: Its Role in Arterial Pressure Control Page: 234
Summary of the Integrated, Multifaceted System for Arterial Pressure Regulation Page: 241
Bibliography Page: 243
Chapter 20 Cardiac Output, Venous Return, and Their Regulation Page: 245
Normal Values for Cardiac Output at Rest and During Activity Page: 245
Control of Cardiac Output by Venous Return—The Frank-Starling Mechanism of the Heart Page: 245
Pathologically High or Low Cardiac Outputs Page: 248
Methods for Measuring Cardiac Output Page: 256
Bibliography Page: 258
Chapter 21 Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart Disease Page: 259
Blood Flow Regulation in Skeletal Muscle at Rest and During Exercise Page: 259
Coronary Circulation Page: 262
Bibliography Page: 269
Chapter 22 Cardiac Failure Page: 271
Circulatory Dynamics in Cardiac Failure Page: 271
Unilateral Left Heart Failure Page: 275
Low-Output Cardiac Failure—Cardiogenic Shock Page: 275
Edema in Patients with Cardiac Failure Page: 275
Cardiac Reserve Page: 277
Bibliography Page: 280
Chapter 23 Heart Valves and Heart Sounds; Valvular and Congenital Heart Defects Page: 283
Heart Sounds Page: 283
Abnormal Circulatory Dynamics in Valvular Heart Disease Page: 285
Abnormal Circulatory Dynamics in Congenital Heart Defects Page: 288
Use of Extracorporeal Circulation during Cardiac Surgery Page: 290
Hypertrophy of the Heart in Valvular and Congenital Heart Disease Page: 290
Bibliography Page: 291
Chapter 24 Circulatory Shock and Its Treatment Page: 293
Physiological Causes of Shock Page: 293
Shock Caused by Hypovolemia—Hemorrhagic Shock Page: 294
Neurogenic Shock—Increased Vascular Capacity Page: 299
Anaphylactic Shock and Histamine Shock Page: 300
Septic Shock Page: 300
Physiology of Treatment in Shock Page: 301
Circulatory Arrest Page: 302
Bibliography Page: 302
Unit V The Body Fluids and Kidneys Page: 302
Chapter 25 The Body Fluid Compartments Page: 305
Fluid Intake and Output are Balanced during Steady-State Conditions Page: 305
Body Fluid Compartments Page: 306
Constituents of Extracellular and Intracellular Fluids Page: 307
Measurement of Fluid Volumes in the Different Body Fluid Compartments—the Indicator-Dilution Principle Page: 308
Determination of Volumes of Specific Body Fluid Compartments Page: 309
Regulation of Fluid Exchange and Osmotic Equilibrium between Intracellular and Extracellular Fluid Page: 310
Volume and Osmolality of Extracellular and Intracellular Fluids in Abnormal States Page: 312
Glucose and Other Solutions Administered for Nutritive Purposes Page: 314
Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia Page: 314
Edema: Excess Fluid in the Tissues Page: 316
Fluids in the “Potential Spaces” of the Body Page: 320
Bibliography Page: 320
Chapter 26 The Urinary System Page: 323
Multiple Functions of the Kidneys Page: 323
Physiological Anatomy of the Kidneys Page: 324
Micturition Page: 327
Urine Formation Results From Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion Page: 331
Bibliography Page: 332
Chapter 27 Glomerular Filtration, Renal Blood Flow, and Their Control Page: 335
Glomerular Filtration—the First Step in Urine Formation Page: 335
Determinants of the GFR Page: 337
Renal Blood Flow Page: 340
Physiological Control of Glomerular Filtration and Renal Blood Flow Page: 341
Autoregulation of GFR and Renal Blood Flow Page: 342
Bibliography Page: 346
Chapter 28 Renal Tubular Reabsorption and Secretion Page: 347
Tubular Reabsorption is Quantitatively Large and Highly Selective Page: 347
Tubular Reabsorption Includes Passive and Active Mechanisms Page: 347
Reabsorption and Secretion Along Different Parts of the Nephron Page: 353
Regulation of Tubular Reabsorption Page: 359
Use of Clearance Methods to Quantify Kidney Function Page: 365
Bibliography Page: 368
Chapter 29 Urine Concentration and Dilution; Regulation of Extracellular Fluid Osmolarity and Sodium Concentration Page: 371
Kidneys Excrete Excess Water by Forming Dilute Urine Page: 371
Kidneys Conserve Water by Excreting Concentrated Urine Page: 373
Special Characteristics of the Loop of Henle That Cause Solutes to be Trapped in the Renal Medulla Page: 374
Control of Extracellular Fluid Osmolarity and Sodium Concentration Page: 381
Osmoreceptor-ADH Feedback System Page: 381
Importance of Thirst in Controlling Extracellular Fluid Osmolarity and Sodium Concentration Page: 384
Bibliography Page: 387
Chapter 30 Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium; Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume Page: 389
Regulation of Extracellular Fluid Potassium Concentration and Potassium Excretion Page: 389
Control of Renal Calcium Excretion and Extracellular Calcium Ion Concentration Page: 396
Control of Renal Magnesium Excretion and Extracellular Magnesium Ion Concentration Page: 398
Integration of Renal Mechanisms for Control of Extracellular Fluid Page: 398
Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance Page: 399
Distribution of Extracellular Fluid between the Interstitial Spaces and Vascular System Page: 401
Nervous and Hormonal Factors Increase the Effectiveness of Renal–Body Fluid Feedback Control Page: 402
Integrated Responses to Changes in Sodium Intake Page: 405
Conditions That Cause Large Increases in Blood Volume and Extracellular Fluid Volume Page: 405
Conditions That Cause Large Increases in Extracellular Fluid Volume but with Normal Blood Volume Page: 406
Bibliography Page: 407
Chapter 31 Acid-Base Regulation Page: 409
H+ Concentration is Precisely Regulated Page: 409
Acids and Bases—Their Definitions and Meanings Page: 409
Defending Against Changes in H+ Concentration: Buffers, Lungs, and Kidneys Page: 410
Buffering of H+ in the Body Fluids Page: 410
Bicarbonate Buffer System Page: 411
Phosphate Buffer System Page: 413
Proteins are Important Intracellular Buffers Page: 413
Respiratory Regulation of Acid-Base Balance Page: 414
Renal Control of Acid-Base Balance Page: 415
Secretion of H+ and Reabsorption of HCO3− by the Renal Tubules Page: 416
Combination of Excess H+ with Phosphate and Ammonia Buffers in the Tubule Generates “New” HCO3− Page: 418
Quantifying Renal Acid-Base Excretion Page: 420
Renal Correction of Acidosis—Increased Excretion of H+ and Addition of HCO3− to the Extracellular Fluid Page: 421
Renal Correction of Alkalosis—Decreased Tubular Secretion of H+ and Increased Excretion of HCO3− Page: 422
Clinical Causes of Acid-Base Disorders Page: 422
Bibliography Page: 426
Chapter 32 Diuretics, Kidney Diseases Page: 427
Diuretics and Their Mechanisms of Action Page: 427
Kidney Diseases Page: 429
Acute Kidney Injury Page: 429
Chronic Kidney Disease is Often Associated with Irreversible Loss of Functional Nephrons Page: 432
Treatment of Renal Failure by Transplantation or by Dialysis With an Artificial Kidney Page: 440
Bibliography Page: 441
Unit VI Blood Cells, Immunity, and Blood Coagulation Page: 442
Chapter 33 Red Blood Cells, Anemia, and Polycythemia Page: 445
Red Blood Cells (Erythrocytes) Page: 445
Anemias Page: 452
Polycythemia Page: 453
Bibliography Page: 453
Chapter 34 Resistance of the Body to Infection Page: 455
Leukocytes (White Blood Cells) Page: 455
Neutrophils and Macrophages Defend Against Infections Page: 457
Monocyte-Macrophage Cell System (Reticuloendothelial System) Page: 458
Inflammation: Role of Neutrophils and Macrophages Page: 460
Eosinophils Page: 462
Basophils Page: 462
Leukopenia Page: 463
Leukemias Page: 463
Bibliography Page: 464
Chapter 35 Resistance of the Body to Infection Page: 465
Acquired (Adaptive) Immunity Page: 465
Allergy and Hypersensitivity Page: 475
Bibliography Page: 476
Chapter 36 Blood Types; Transfusion; Tissue and Organ Transplantation Page: 477
Antigenicity Causes Immune Reactions of Blood Page: 477
O-A-B Blood Types Page: 477
Rh Blood Types Page: 479
Transplantation of Tissues and Organs Page: 481
Bibliography Page: 482
Chapter 37 Hemostasis and Blood Coagulation Page: 483
Hemostasis Events Page: 483
Mechanism of Blood Coagulation Page: 485
Conditions That Cause Excessive Bleeding in Humans Page: 490
Thromboembolic Conditions Page: 491
Anticoagulants for Clinical Use Page: 492
Blood Coagulation Tests Page: 493
Bibliography Page: 493
Unit VII Respiration Page: 494
Chapter 38 Pulmonary Ventilation Page: 497
Mechanics of Pulmonary Ventilation Page: 497
Pulmonary Volumes and Capacities Page: 501
Alveolar Ventilation Page: 503
Functions of the Respiratory Passageways Page: 504
Bibliography Page: 507
Chapter 39 Pulmonary Circulation, Pulmonary Edema, Pleural Fluid Page: 509
Physiological Anatomy of the Pulmonary Circulatory System Page: 509
Pressures in the Pulmonary System Page: 509
Blood Volume of the Lungs Page: 510
Blood Flow Through the Lungs and Its Distribution Page: 510
Effect of Hydrostatic Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow Page: 511
Pulmonary Capillary Dynamics Page: 513
Fluid in the Pleural Cavity Page: 515
Bibliography Page: 516
Chapter 40 Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory Membrane Page: 517
Physics of Gas Diffusion and Gas Partial Pressures Page: 517
Compositions of Alveolar Air and Atmospheric Air are Different Page: 519
Diffusion of Gases Through the Respiratory Membrane Page: 521
Bibliography Page: 526
Chapter 41 Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids Page: 527
Transport of Oxygen From the Lungs to the Body Tissues Page: 527
Transport of Carbon Dioxide in the Blood Page: 534
Respiratory Exchange Ratio Page: 536
Bibliography Page: 536
Chapter 42 Regulation of Respiration Page: 539
Respiratory Center Page: 539
Chemical Control of Respiration Page: 541
Peripheral Chemoreceptor System for Control of Respiratory Activity—Role of Oxygen in Respiratory Control Page: 542
Regulation of Respiration during Exercise Page: 545
Other Factors That Affect Respiration Page: 546
Bibliography Page: 548
Chapter 43 Respiratory Insufficiency—Pathophysiology, Diagnosis, Oxygen Therapy Page: 549
Useful Methods for Studying Respiratory Abnormalities Page: 549
Pathophysiology of Specific Pulmonary Abnormalities Page: 551
Hypoxia and Oxygen Therapy Page: 554
Hypercapnia—Excess Carbon Dioxide in the Body Fluids Page: 556
Artificial Respiration Page: 556
Bibliography Page: 557
Unit VIII Aviation, Space, and Deep–Sea Diving Physiology Page: 557
Chapter 44 Aviation, High Altitude, and Space Physiology Page: 561
Effects of Low Oxygen Pressure on the Body Page: 561
Effects of Acceleratory Forces on the Body in Aviation and Space Physiology Page: 565
“Artificial Climate” in the Sealed Spacecraft Page: 567
Weightlessness in Space Page: 567
Bibliography Page: 568
Chapter 45 Physiology of Deep-Sea Diving and Other Hyperbaric Conditions Page: 569
Effect of High Partial Pressures of Individual Gases on the Body Page: 569
Self-Contained Underwater Breathing Apparatus (SCUBA) Diving Page: 573
Special Physiological Problems in Submarines Page: 574
Hyperbaric Oxygen Therapy Page: 574
Bibliography Page: 574
Unit IX The Nervous System: A. General Principles and Sensory Physiology Page: 574
Chapter 46 Organization of the Nervous System, Basic Functions of Synapses, and Neurotransmitters Page: 577
General Design of the Nervous System Page: 577
Major Levels of Central Nervous System Function Page: 579
Comparison of the Nervous System to a Computer Page: 580
Central Nervous System Synapses Page: 580
Some Special Characteristics of Synaptic Transmission Page: 592
Bibliography Page: 593
Chapter 47 Sensory Receptors, Neuronal Circuits for Processing Information Page: 595
Types of Sensory Receptors and the Stimuli They Detect Page: 595
Transduction of Sensory Stimuli Into Nerve Impulses Page: 596
Transmission of Signals of Different Intensity in Nerve Tracts—Spatial and Temporal Summation Page: 600
Transmission and Processing of Signals in Neuronal Pools Page: 601
Instability and Stability of Neuronal Circuits Page: 605
Bibliography Page: 606
Chapter 48 Somatic Sensations Page: 607
Classification of Somatic Senses Page: 607
Detection and Transmission of Tactile Sensations Page: 607
Sensory Pathways for Transmitting Somatic Signals Into the Central Nervous System Page: 609
Transmission in the Dorsal Column–Medial Lemniscal System Page: 609
Transmission of Less Critical Sensory Signals in the Anterolateral Pathway Page: 616
Some Special Aspects of Somatosensory Function Page: 618
Bibliography Page: 618
Chapter 49 Somatic Sensations Page: 621
Types of Pain and Their Qualities—Fast Pain and Slow Pain Page: 621
Pain Receptors and Their Stimulation Page: 621
Dual Pathways for Transmission of Pain Signals Into the Central Nervous System Page: 622
Pain Suppression (Analgesia) System in the Brain and Spinal Cord Page: 625
Referred Pain Page: 626
Visceral Pain Page: 626
Some Clinical Abnormalities of Pain and Other Somatic Sensations Page: 628
Headache Page: 629
Thermal Sensations Page: 630
Bibliography Page: 632
Unit X The Nervous System: B. The Special Senses Page: 632
Chapter 50 The Eye Page: 635
Physical Principles of Optics Page: 635
Optics of the Eye Page: 638
Fluid System of the Eye—Intraocular Fluid Page: 644
Bibliography Page: 646
Chapter 51 The Eye Page: 647
Anatomy and Function of the Structural Elements of the Retina Page: 647
Photochemistry of Vision Page: 649
Color Vision Page: 654
Neural Function of the Retina Page: 655
Bibliography Page: 660
Chapter 52 The Eye Page: 661
Visual Pathways Page: 661
Organization and Function of the Visual Cortex Page: 662
Neuronal Patterns of Stimulation during Analysis of the Visual Image Page: 664
Eye Movements and Their Control Page: 666
Autonomic Control of Accommodation and Pupillary Aperture Page: 669
Bibliography Page: 671
Chapter 53 The Sense of Hearing Page: 673
Tympanic Membrane and the Ossicular System Page: 673
Cochlea Page: 674
Central Auditory Mechanisms Page: 679
Hearing Abnormalities Page: 682
Bibliography Page: 683
Chapter 54 The Chemical Senses—Taste and Smell Page: 685
Sense of Taste Page: 685
Sense of Smell Page: 688
Bibliography Page: 692
Unit XI The Nervous System: C. Motor and Integrative Neurophysiology Page: 692
Chapter 55 Motor Functions of the Spinal Cord; the Cord Reflexes Page: 695
Organization of the Spinal Cord for Motor Functions Page: 695
Muscle Sensory Receptors—Muscle Spindles and Golgi Tendon Organs—and Their Roles in Muscle Control Page: 697
Flexor Reflex and the Withdrawal Reflexes Page: 702
Crossed Extensor Reflex Page: 703
Reciprocal Inhibition and Reciprocal Innervation Page: 703
Reflexes of Posture and Locomotion Page: 704
Scratch Reflex Page: 705
Spinal Cord Reflexes That Cause Muscle Spasm Page: 705
Autonomic Reflexes in the Spinal Cord Page: 705
Spinal Cord Transection and Spinal Shock Page: 705
Bibliography Page: 706
Chapter 56 Cortical and Brain Stem Control of Motor Function Page: 707
Motor Cortex and Corticospinal Tract Page: 707
Control of Motor Functions by the Brain Stem Page: 713
Vestibular Sensations and Maintenance of Equilibrium Page: 714
Functions of Brain Stem Nuclei in Controlling Subconscious, Stereotyped Movements Page: 719
Bibliography Page: 719
Chapter 57 Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control Page: 721
The Cerebellum and Its Motor Functions Page: 721
The Basal Ganglia and Their Motor Functions Page: 730
Integration of the Many Parts of the Total Motor Control System Page: 735
Bibliography Page: 736
Chapter 58 Cerebral Cortex, Intellectual Functions of the Brain, Learning, and Memory Page: 737
Physiological Anatomy of the Cerebral Cortex Page: 737
Functions of Specific Cortical Areas Page: 738
Function of the Brain in Communication—Language Input and Language Output Page: 743
Function of the Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories, Training, and Other Information between the Two Cerebral Hemispheres Page: 745
Thoughts, Consciousness, and Memory Page: 745
Bibliography Page: 749
Chapter 59 Behavioral and Motivational Mechanisms of the Brain—The Limbic System and the Hypothalamus Page: 751
Activating—Driving Systems of the Brain Page: 751
Limbic System Page: 754
The Hypothalamus, a Major Control Headquarters for the Limbic System Page: 755
Specific Functions of Other Parts of the Limbic System Page: 759
Bibliography Page: 761
Chapter 60 States of Brain Activity—Sleep, Brain Waves, Epilepsy, Psychoses, and Dementia Page: 763
Sleep Page: 763
Brain Waves Page: 766
Seizures and Epilepsy Page: 768
Psychotic Behavior—Roles of Specific Neurotransmitter Systems Page: 770
Alzheimer's Disease—Amyloid Plaques and Depressed Memory Page: 771
Bibliography Page: 772
Chapter 61 The Autonomic Nervous System and the Adrenal Medulla Page: 773
General Organization of the Autonomic Nervous System Page: 773
Basic Characteristics of Sympathetic and Parasympathetic Function Page: 775
Autonomic Reflexes Page: 782
Stimulation of Discrete Organs in Some Instances and Mass Stimulation in Other Instances by the Sympathetic and Parasympathetic Systems Page: 783
Pharmacology of the Autonomic Nervous System Page: 784
Bibliography Page: 785
Chapter 62 Cerebral Blood Flow, Cerebrospinal Fluid, and Brain Metabolism Page: 787
Cerebral Blood Flow Page: 787
Cerebrospinal Fluid System Page: 790
Brain Metabolism Page: 794
Bibliography Page: 794
Unit XII Gastrointestinal Physiology Page: 794
Chapter 63 General Principles of Gastrointestinal Function—Motility, Nervous Control, and Blood Circulation Page: 797
General Principles of Gastrointestinal Motility Page: 797
Neural Control of Gastrointestinal Function—Enteric Nervous System Page: 799
Hormonal Control of Gastrointestinal Motility Page: 802
Functional Types of Movements in the Gastrointestinal Tract Page: 803
Gastrointestinal Blood Flow—Splanchnic Circulation Page: 804
Bibliography Page: 806
Chapter 64 Propulsion and Mixing of Food in the Alimentary Tract Page: 807
Ingestion of Food Page: 807
Motor Functions of the Stomach Page: 809
Movements of the Small Intestine Page: 812
Movements of the Colon Page: 814
Other Autonomic Reflexes That Affect Bowel Activity Page: 816
Bibliography Page: 816
Chapter 65 Secretory Functions of the Alimentary Tract Page: 817
General Principles of Alimentary Tract Secretion Page: 817
Secretion of Saliva Page: 819
Esophageal Secretion Page: 821
Gastric Secretion Page: 821
Pancreatic Secretion Page: 825
Bile Secretion by the Liver Page: 827
Secretions of the Small Intestine Page: 830
Secretion of Mucus by the Large Intestine Page: 831
Bibliography Page: 832
Chapter 66 Digestion and Absorption in the Gastrointestinal Tract Page: 833
Digestion of the Various Foods by Hydrolysis Page: 833
Basic Principles of Gastrointestinal Absorption Page: 837
Absorption in the Small Intestine Page: 837
Absorption in the Large Intestine: Formation of Feces Page: 841
Bibliography Page: 842
Chapter 67 Physiology of Gastrointestinal Disorders Page: 843
Disorders of Swallowing and the Esophagus Page: 843
Disorders of the Stomach Page: 843
Disorders of the Small Intestine Page: 845
Disorders of the Large Intestine Page: 846
General Disorders of the Gastrointestinal Tract Page: 847
Bibliography Page: 849
Unit XIII Metabolism and Temperature Regulation Page: 849
Chapter 68 Metabolism of Carbohydrates and Formation of Adenosine Triphosphate Page: 853
Release of Energy From Foods and “Free Energy” Page: 853
Adenosine Triphosphate Is the “Energy Currency” of the Body Page: 853
Central Role of Glucose in Carbohydrate Metabolism Page: 854
Transport of Glucose Through the Cell Membrane Page: 854
Glycogen Is Stored in the Liver and Muscle Page: 855
Release of Energy From Glucose by the Glycolytic Pathway Page: 856
Formation of Large Quantities of ATP by Oxidation of Hydrogen—The Process of Oxidative Phosphorylation Page: 858
Summary of ATP Formation During the Breakdown of Glucose Page: 859
Anaerobic Release of Energy—Anaerobic Glycolysis Page: 860
Release of Energy From Glucose by the Pentose Phosphate Pathway Page: 861
Formation of Carbohydrates From Proteins and Fats—Gluconeogenesis Page: 861
Bibliography Page: 862
Chapter 69 Lipid Metabolism Page: 863
Basic Chemical Structure of Triglycerides (Neutral Fat) Page: 863
Transport of Lipids in the Body Fluids Page: 863
Fat Deposits Page: 865
Use of Triglycerides for Energy: Formation of Adenosine Triphosphate Page: 866
Regulation of Energy Release From Triglycerides Page: 869
Phospholipids and Cholesterol Page: 870
Atherosclerosis Page: 872
Bibliography Page: 874
Chapter 70 Protein Metabolism Page: 875
Basic Properties of Proteins Page: 875
Transport and Storage of Amino Acids Page: 875
Functional Roles of the Plasma Proteins Page: 877
Hormonal Regulation of Protein Metabolism Page: 880
Bibliography Page: 880
Chapter 71 The Liver as an Organ Page: 881
Physiological Anatomy of the Liver Page: 881
Hepatic Vascular and Lymph Systems Page: 881
Metabolic Functions of the Liver Page: 883
Protein Metabolism Page: 883
Measurement of Bilirubin in the Bile as a Clinical Diagnostic Tool Page: 884
Bibliography Page: 886
Chapter 72 Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and Minerals Page: 887
Energy Intake and Output are Balanced Under Steady-State Conditions Page: 887
Dietary Balances Page: 887
Regulation of Food Intake and Energy Storage Page: 889
Obesity Page: 894
Inanition, Anorexia, and Cachexia Page: 896
Starvation Page: 897
Vitamins Page: 897
Mineral Metabolism Page: 900
Bibliography Page: 902
Chapter 73 Energetics and Metabolic Rate Page: 903
Adenosine Triphosphate Functions as an “Energy Currency” in Metabolism Page: 903
Control of Energy Release in the Cell Page: 905
Metabolic Rate Page: 906
Energy Metabolism—Factors That Influence Energy Output Page: 907
Bibliography Page: 909
Chapter 74 Body Temperature Regulation and Fever Page: 911
Normal Body Temperatures Page: 911
Body Temperature is Controlled by Balancing Heat Production and Heat Loss Page: 911
Regulation of Body Temperature—Role of the Hypothalamus Page: 915
Abnormalities of Body Temperature Regulation Page: 919
Bibliography Page: 922
Unit XIV Endocrinology and Reproduction Page: 922
Chapter 75 Introduction to Endocrinology Page: 925
Coordination of Body Functions by Chemical Messengers Page: 925
Chemical Structure and Synthesis of Hormones Page: 928
Hormone Secretion, Transport, and Clearance From the Blood Page: 929
Mechanisms of Action of Hormones Page: 930
Measurement of Hormone Concentrations in the Blood Page: 936
Bibliography Page: 937
Chapter 76 Pituitary Hormones and Their Control by the Hypothalamus Page: 939
Pituitary Gland and Its Relation to the Hypothalamus Page: 939
Hypothalamus Controls Pituitary Secretion Page: 940
Physiological Functions of Growth Hormone Page: 942
Posterior Pituitary Gland and Its Relation to the Hypothalamus Page: 948
Bibliography Page: 950
Chapter 77 Thyroid Metabolic Hormones Page: 951
Synthesis and Secretion of the Thyroid Metabolic Hormones Page: 951
Physiological Functions of the Thyroid Hormones Page: 954
Regulation of Thyroid Hormone Secretion Page: 958
Diseases of the Thyroid Page: 960
Bibliography Page: 963
Chapter 78 Adrenocortical Hormones Page: 965
Corticosteroids: Mineralocorticoids, Glucocorticoids, and Androgens Page: 965
Synthesis and Secretion of Adrenocortical Hormones Page: 965
Functions of the Mineralocorticoids—Aldosterone Page: 968
Functions of Glucocorticoids Page: 972
Adrenal Androgens Page: 978
Abnormalities of Adrenocortical Secretion Page: 979
Bibliography Page: 981
Chapter 79 Insulin, Glucagon, and Diabetes Mellitus Page: 983
Physiological Anatomy of the Pancreas Page: 983
Insulin and its Metabolic Effects Page: 983
Glucagon and its Functions Page: 992
Somatostatin Inhibits Glucagon and Insulin Secretion Page: 993
Summary of Blood Glucose Regulation Page: 993
Diabetes Mellitus Page: 994
Bibliography Page: 999
Chapter 80 Parathyroid Hormone, Calcitonin, Calcium and Phosphate Metabolism, Vitamin D, Bone, and Teeth Page: 1001
Overview of Calcium and Phosphate Regulation in the Extracellular Fluid and Plasma Page: 1001
Bone and Its Relation to Extracellular Calcium and Phosphate Page: 1003
Vitamin D Page: 1007
Parathyroid Hormone Page: 1009
Calcitonin Page: 1012
Summary of Control of Calcium Ion Concentration Page: 1013
Pathophysiology of Parathyroid Hormone, Vitamin D, and Bone Disease Page: 1014
Physiology of the Teeth Page: 1016
Bibliography Page: 1018
Chapter 81 Reproductive and Hormonal Functions of the Male (and Function of the Pineal Gland) Page: 1021
Physiological Anatomy of the Male Sexual Organs Page: 1021
Spermatogenesis Page: 1021
Male Sexual Act Page: 1026
Testosterone and Other Male Sex Hormones Page: 1028
Abnormalities of Male Sexual Function Page: 1033
Erectile Dysfunction in the Male Page: 1034
The Function of the Pineal Gland in Controlling Seasonal Fertility in Some Animals Page: 1034
Bibliography Page: 1035
Chapter 82 Female Physiology Before Pregnancy and Female Hormones Page: 1037
Physiological Anatomy of the Female Sexual Organs Page: 1037
Oogenesis and Follicular Development in the Ovaries Page: 1037
Female Hormonal System Page: 1039
Monthly Ovarian Cycle; Function of the Gonadotropic Hormones Page: 1039
Functions of the Ovarian Hormones—Estradiol and Progesterone Page: 1042
Regulation of the Female Monthly Rhythm—Interplay Between the Ovarian and Hypothalamic-Pituitary Hormones Page: 1047
Abnormalities of Secretion by the Ovaries Page: 1051
Female Sexual Act Page: 1051
Female Fertility Page: 1052
Hormonal Suppression of Fertility—“The Pill” Page: 1053
Abnormal Conditions That Cause Female Sterility Page: 1053
Bibliography Page: 1054
Chapter 83 Pregnancy and Lactation Page: 1055
Maturation and Fertilization of the Ovum Page: 1055
Early Nutrition of the Embryo Page: 1057
Anatomy and Function of the Placenta Page: 1057
Hormonal Factors in Pregnancy Page: 1059
Response of the Mother's Body to Pregnancy Page: 1062
Parturition Page: 1064
Lactation Page: 1066
Bibliography Page: 1069
Chapter 84 Fetal and Neonatal Physiology Page: 1071
Growth and Functional Development of the Fetus Page: 1071
Development of the Organ Systems Page: 1071
Fetal Metabolism Page: 1072
Adjustments of the Infant to Extrauterine Life Page: 1073
Special Functional Problems in the Neonate Page: 1076
Special Problems of Prematurity Page: 1079
Growth and Development of the Child Page: 1080
Bibliography Page: 1080
Unit XV Sports Physiology Page: 1081
Chapter 85 Sports Physiology Page: 1085
Female and Male Athletes Page: 1085
Muscles in Exercise Page: 1085
Respiration in Exercise Page: 1090
Cardiovascular System in Exercise Page: 1092
Body Heat in Exercise Page: 1094
Body Fluids and Salt in Exercise Page: 1094
Drugs and Athletes Page: 1095
Body Fitness Prolongs Life Page: 1095
Bibliography Page: 1095
Index Page: 1097
Normal Values for Selected Common Laboratory Measurements Page: IBC1