Guyton and Hall Textbook of Medical Physiology

Front cover......Page 1
IFC_Student Consult ad......Page 2
Guyton and Hall Textbook of Medical Physiology......Page 3
Copyright page......Page 6
Dedication......Page 7
Preface......Page 9
Table of Contents......Page 11
Half title page......Page 23
Unit I Introduction to Physiology: The Cell and General Physiology......Page 25
Differences Between Extracellular and Intracellular Fluids.......Page 27
Extracellular Fluid Transport and Mixing System—the Blood Circulatory System......Page 28
Kidneys.......Page 29
Control Systems of the Body......Page 30
Normal Ranges and Physical Characteristics of Important Extracellular Fluid Constituents......Page 31
Gain of a Control System.......Page 32
More Complex Types of Control Systems—Adaptive Control......Page 33
Bibliography......Page 34
Lipids.......Page 35
The Cell Membrane Lipid Barrier Impedes Penetration by Water-Soluble Substances.......Page 36
Integral and Peripheral Cell Membrane Proteins.......Page 37
Endoplasmic Reticulum......Page 38
Lysosomes......Page 39
Mitochondria......Page 40
Nuclear Membrane.......Page 41
Comparison of the Animal Cell with Precellular Forms of Life......Page 42
Phagocytosis.......Page 43
Specific Functions of the Endoplasmic Reticulum......Page 44
Processing of Endoplasmic Secretions by the Golgi Apparatus—Formation of Vesicles.......Page 45
The Mitochondria Extract Energy from Nutrients......Page 46
Uses of ATP for Cellular Function.......Page 47
Mechanism of Ameboid Locomotion.......Page 48
Cilia and Ciliary Movements......Page 49
Bibliography......Page 50
Nucleotides......Page 51
Nucleotides Are Organized to Form Two Strands of DNA Loosely Bound to Each Other......Page 52
Genetic Code......Page 53
Assembly of the RNA Chain from Activated Nucleotides Using the DNA Strand as a Template—The Process of Transcription......Page 54
RNA Codons for the Different Amino Acids.......Page 55
miRNA and Small Interfering RNA......Page 56
Polyribosomes.......Page 57
Chemical Steps in Protein Synthesis.......Page 58
The Promoter Controls Gene Expression.......Page 59
Other Mechanisms for Control of Transcription by the Promoter.......Page 60
Cell Reproduction Begins With Replication of DNA......Page 61
Chromosomes and Their Replication......Page 62
Telophase.......Page 63
Telomeres Prevent the Degradation of Chromosomes.......Page 64
Cancer......Page 65
Invasive Characteristic of the Cancer Cell.......Page 66
Bibliography......Page 67
Unit II Membrane Physiology, Nerve, and Muscle......Page 69
Diffusion......Page 71
Diffusion of Water and Other Lipid-Insoluble Molecules Through Protein Channels.......Page 72
Selective Permeability of Protein Channels.......Page 73
Patch-Clamp Method for Recording Ion Current Flow Through Single Channels.......Page 74
Facilitated Diffusion Requires Membrane Carrier Proteins......Page 75
Effect of Membrane Electrical Potential on Diffusion of Ions—The “Nernst Potential.”......Page 76
Osmotic Pressure......Page 77
“Active Transport” of Substances Through Membranes......Page 78
Sodium-Potassium Pump Transports Sodium Ions Out of Cells and Potassium Ions Into Cells......Page 79
Energetics of Primary Active Transport......Page 80
Sodium Counter-Transport of Calcium and Hydrogen Ions......Page 81
Bibliography......Page 82
The Nernst Equation Describes the Relation of Diffusion Potential to the Ion Concentration Difference Across a Membrane.......Page 85
Measuring the Membrane Potential......Page 86
Leakage of Potassium Through the Nerve Cell Membrane.......Page 87
Contribution of the Na+-K+ Pump.......Page 88
Activation of the Sodium Channel.......Page 89
The “Voltage Clamp” Method for Measuring the Effect of Voltage on Opening and Closing of the Voltage-Gated Channels.......Page 90
Summary of the Events that Cause the Action Potential......Page 91
A Positive-Feedback Cycle Opens the Sodium Channels.......Page 92
Re-Establishing Sodium and Potassium Ionic Gradients After Action Potentials are Completed—Importance of Energy Metabolism......Page 93
Rhythmicity of Some Excitable Tissues—Repetitive Discharge......Page 94
Myelinated and Unmyelinated Nerve Fibers.......Page 95
Excitation—The Process of Eliciting the Action Potential......Page 96
Local Anesthetics.......Page 97
Bibliography......Page 98
Titin Filamentous Molecules Keep the Myosin and Actin Filaments in Place.......Page 99
General Mechanism of Muscle Contraction......Page 101
Myosin Filaments Are Composed of Multiple Myosin Molecules.......Page 102
Inhibition of the Actin Filament by the Troponin-Tropomyosin Complex.......Page 103
ATP as the Energy Source for Contraction—Chemical Events in the Motion of the Myosin Heads.......Page 104
Relation of Velocity of Contraction to Load......Page 105
Three Sources of Energy for Muscle Contraction......Page 106
Characteristics of Isometric Twitches Recorded from Different Muscles.......Page 107
Muscle Contractions of Different Force—Force Summation.......Page 108
Changes in Muscle Strength at the Onset of Contraction—The Staircase Effect (Treppe).......Page 109
“Positioning” of a Body Part by Contraction of Agonist and Antagonist Muscles on Opposite Sides of a Joint—“Coactivation” of Antagonist Muscles.......Page 110
Recovery of Muscle Contraction in Poliomyelitis: Development of Macromotor Units.......Page 111
Bibliography......Page 112
Acetylcholine Opens Ion Channels on Postsynaptic Membranes.......Page 113
End Plate Potential and Excitation of the Skeletal Muscle Fiber.......Page 115
Drugs That Stimulate the Neuromuscular Junction by Inactivating Acetylcholinesterase.......Page 116
Release of Calcium Ions by the Sarcoplasmic Reticulum......Page 117
Excitatory “Pulse” of Calcium Ions.......Page 118
Bibliography......Page 119
Chemical Basis for Smooth Muscle Contraction......Page 121
Comparison of Smooth Muscle Contraction and Skeletal Muscle Contraction......Page 122
Regulation of Contraction by Calcium Ions......Page 123
Role of the Smooth Muscle Sarcoplasmic Reticulum.......Page 124
Possible Mechanism for Regulation of the Latch Phenomenon.......Page 125
Excitatory and Inhibitory Transmitter Substances Secreted at the Smooth Muscle Neuromuscular Junction.......Page 126
Slow Wave Potentials in Unitary Smooth Muscle Can Lead to Spontaneous Generation of Action Potentials.......Page 127
Mechanisms of Smooth Muscle Excitation or Inhibition by Hormones or Local Tissue Factors.......Page 128
Bibliography......Page 129
Unit III The Heart......Page 131
Cardiac Muscle Is a Syncytium.......Page 133
What Causes the Long Action Potential and the Plateau?......Page 134
Refractory Period of Cardiac Muscle.......Page 135
Duration of Contraction.......Page 136
Increasing Heart Rate Decreases Duration of Cardiac Cycle.......Page 137
Pressure Changes in the Atria—a, c, and v Waves.......Page 138
Atrioventricular Valves.......Page 139
Work Output of the Heart......Page 140
“Volume-Pressure Diagram” During the Cardiac Cycle; Cardiac Work Output.......Page 141
Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart......Page 142
Ventricular Function Curves......Page 143
Effect of Sympathetic or Parasympathetic Stimulation on the Cardiac Function Curve.......Page 144
Increasing the Arterial Pressure Load (Up to a Limit) Does Not Decrease the Cardiac Output......Page 145
Bibliography......Page 146
Mechanism of Sinus Nodal Rhythmicity.......Page 147
Self-Excitation of Sinus Nodal Fibers.......Page 148
Rapid Transmission in the Ventricular Purkinje System......Page 149
The Sinus Node is the Normal Pacemaker of the Heart......Page 150
Role of the Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle......Page 151
Mechanism of the Sympathetic Effect.......Page 152
Bibliography......Page 153
Relation of the Monophasic Action Potential of Ventricular Muscle to the QRS and T Waves in the Standard Electrocardiogram.......Page 155
Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram......Page 156
Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle......Page 157
Lead I.......Page 158
Normal Electrocardiograms Recorded from the Three Standard Bipolar Limb Leads.......Page 159
Augmented Unipolar Limb Leads......Page 160
Bibliography......Page 161
The Direction of a Vector is Denoted in Terms of Degrees......Page 163
Vectorial Analysis of Potentials Recorded in Different Leads......Page 164
Vectors that Occur at Successive Intervals During Depolarization of the Ventricles—The QRS Complex......Page 165
Depolarization of the Atria—The P Wave......Page 167
Determining the Electrical Axis from Standard Lead Electrocardiograms......Page 168
Vectorial Analysis of Left Axis Deviation Resulting from Hypertrophy of the Left Ventricle.......Page 169
Vectorial Analysis of Right Axis Deviation in Right Bundle Branch Block.......Page 170
Decreased Voltage Caused by Conditions Surrounding the Heart.......Page 171
Effect of Current of Injury on the QRS Complex......Page 172
The “J Point” is the Zero Reference Potential for Analyzing Current of Injury......Page 173
Acute Anterior Wall Infarction.......Page 174
Recovery from Acute Coronary Thrombosis.......Page 175
Shortened Depolarization in Portions of the Ventricular Muscle Can Cause T-Wave Abnormalities......Page 176
Bibliography......Page 177
Vagal Stimulation Causes Bradycardia.......Page 179
Prolonged P-R (or P-Q) Interval—First-Degree Block.......Page 180
Stokes-Adams Syndrome—Ventricular Escape.......Page 181
A-V Nodal or A-V Bundle Premature Contractions......Page 182
Disorders of Cardiac Repolarization—The Long QT Syndromes.......Page 183
Atrial Paroxysmal Tachycardia......Page 184
Phenomenon of Re-Entry—“Circus Movements” as the Basis for Ventricular Fibrillation......Page 185
Fibrillation Caused by 60-Cycle Alternating Current.......Page 186
Electroshock Defibrillation of the Ventricles......Page 187
Electrocardiogram in Atrial Fibrillation......Page 188
Bibliography......Page 189
Unit IV The Circulation......Page 191
Cross-Sectional Areas and Velocities of Blood Flow.......Page 193
Basic Principles of Circulatory Function......Page 194
Interrelationships of Pressure, Flow, and Resistance......Page 195
Electromagnetic Flowmeter.......Page 196
Turbulent Flow of Blood Under Some Conditions.......Page 197
High-Fidelity Methods for Measuring Blood Pressure.......Page 198
Poiseuille’s Law.......Page 199
Resistance to Blood Flow in Series and Parallel Vascular Circuits.......Page 200
“Autoregulation” Attenuates the Effect of Arterial Pressure on Tissue Blood Flow.......Page 201
Bibliography......Page 202
Volume-Pressure Curves of the Arterial and Venous Circulations......Page 203
Arterial Pressure Pulsations......Page 204
Pressure Pulses Are Damped in the Smaller Arteries, Arterioles, and Capillaries.......Page 205
Auscultatory Method.......Page 206
Mean Arterial Pressure.......Page 207
Venous Resistance and Peripheral Venous Pressure......Page 208
Effect of Gravitational Pressure on Venous Pressure......Page 209
Direct Measurement of Venous Pressure and Right Atrial Pressure.......Page 210
The Spleen as a Reservoir for Storing Red Blood Cells......Page 211
Bibliography......Page 212
“Pores” in the Capillary Membrane.......Page 213
Regulation of Vasomotion.......Page 214
Effect of Molecular Size on Passage Through the Pores.......Page 215
Interstitium and Interstitial Fluid......Page 216
Hydrostatic and Colloid Osmotic Forces Determine Fluid Movement Through the Capillary Membrane.......Page 217
Isogravimetric Method for Indirectly Measuring “Functional” Capillary Pressure.......Page 218
Plasma Proteins Cause Colloid Osmotic Pressure.......Page 219
Analysis of Reabsorption at the Venous End of the Capillary.......Page 220
Effect of Abnormal Imbalance of Forces at the Capillary Membrane.......Page 221
Lymph Channels of the Body......Page 222
Effect of Interstitial Fluid Pressure on Lymph Flow.......Page 223
Lymphatic Capillary Pump.......Page 224
Bibliography......Page 225
Mechanisms of Blood Flow Control......Page 227
Vasodilator Theory for Acute Local Blood Flow Regulation—Possible Special Role of Adenosine.......Page 228
Possible Role of Other Nutrients Besides Oxygen in Control of Local Blood Flow.......Page 229
Autoregulation of Blood Flow During Changes in Arterial Pressure—“Metabolic” and “Myogenic” Mechanisms......Page 230
Special Mechanisms for Acute Blood Flow Control in Specific Tissues......Page 231
Endothelin—A Powerful Vasoconstrictor Released from Damaged Endothelium.......Page 232
Blood Flow Regulation by Changes in Tissue Vascularity......Page 233
Blood Flow Regulation by Development of Collateral Circulation......Page 234
Vascular Remodeling in Response to Chronic Changes in Blood Flow or Blood Pressure......Page 235
Vasopressin.......Page 236
Bibliography......Page 237
Parasympathetic Stimulation Decreases Heart Rate and Contractility.......Page 239
Vasomotor Center in the Brain and Its Control of the Vasoconstrictor System.......Page 240
Control of the Vasomotor Center by Higher Nervous Centers.......Page 241
Nervous Control of Arterial Pressure Is Rapid.......Page 242
Circulatory Reflex Initiated by the Baroreceptors.......Page 243
Pressure “Buffer” Function of the Baroreceptor Control System.......Page 245
Atrial Reflexes That Activate the Kidneys—The “Volume Reflex.”......Page 246
Cushing Reaction to Increased Pressure Around the Brain.......Page 247
Oscillation of the Baroreceptor and Chemoreceptor Reflexes.......Page 248
Bibliography......Page 249
An Experiment Demonstrating the Renal–Body Fluid System for Arterial Pressure Control.......Page 251
Two Key Determinants of Long-Term Arterial Pressure.......Page 252
The Chronic Renal Output Curve Is Much Steeper than the Acute Curve.......Page 253
Increased Fluid Volume Can Elevate Arterial Pressure by Increasing Cardiac Output or Total Peripheral Resistance......Page 254
Importance of Salt (NaCl) in the Renal–Body Fluid Schema for Arterial Pressure Regulation......Page 255
Sequential Changes in Circulatory Function During the Development of Volume-Loading Hypertension.......Page 256
Components of the Renin-Angiotensin System......Page 258
Angiotensin II Causes Renal Retention of Salt and Water—An Important Means for Long-Term Control of Arterial Pressure......Page 259
Role of the Renin-Angiotensin System in Maintaining a Normal Arterial Pressure Despite Large Variations in Salt Intake......Page 260
“One-Kidney” Goldblatt Hypertension.......Page 261
Hypertension in the Upper Part of the Body Caused by Coarctation of the Aorta.......Page 262
Genetic Causes of Hypertension.......Page 263
Graphical Analysis of Arterial Pressure Control in Essential Hypertension.......Page 264
Rapidly Acting Pressure Control Mechanisms That Act Within Seconds or Minutes.......Page 265
Long-Term Mechanisms for Arterial Pressure Regulation.......Page 266
Bibliography......Page 267
Control of Cardiac Output by Venous Return—The Frank-Starling Mechanism of the Heart......Page 269
Long-Term Cardiac Output Varies Inversely with Total Peripheral Resistance When Arterial Pressure Is Unchanged.......Page 270
Heart Hypertrophy Can Increase Pumping Effectiveness.......Page 271
High Cardiac Output Caused by Reduced Total Peripheral Resistance......Page 272
Decrease in Cardiac Output Caused by Noncardiac Peripheral Factors—Decreased Venous Return.......Page 273
Effect of External Pressure Outside the Heart on Cardiac Output Curves.......Page 274
Normal Venous Return Curve......Page 275
Mean Systemic Filling Pressure and Its Relation to Mean Circulatory Filling Pressure.......Page 276
Effect of Resistance to Venous Return on the Venous Return Curve.......Page 277
Effect of Increased Blood Volume on Cardiac Output.......Page 278
Effect of Opening a Large Arteriovenous Fistula.......Page 279
Measurement of Cardiac Output Using the Oxygen Fick Principle......Page 280
Indicator Dilution Method for Measuring Cardiac Output......Page 281
Bibliography......Page 282
Decreased Oxygen in Muscle Greatly Enhances Flow.......Page 283
Sympathetic Stimulation May Increase Arterial Pressure During Exercise......Page 284
Graphical Analysis of the Changes in Cardiac Output During Heavy Exercise.......Page 285
Phasic Changes in Coronary Blood Flow During Systole and Diastole—Effect of Cardiac Muscle Compression.......Page 286
Nervous Control of Coronary Blood Flow......Page 287
Atherosclerosis as a Cause of Ischemic Heart Disease.......Page 288
Myocardial Infarction......Page 289
Damming of Blood in the Body’s Venous System.......Page 290
Stages of Recovery from Acute Myocardial Infarction......Page 291
Angina Pectoris (Cardiac Pain).......Page 292
Bibliography......Page 293
Compensation for Acute Cardiac Failure by Sympathetic Nervous Reflexes.......Page 295
Recovery of the Heart After Myocardial Infarction......Page 296
Graphical Analysis of Decompensated Heart Failure.......Page 297
Mechanism of Action of the Cardiotonic Drugs Such as Digitalis.......Page 298
Acute Cardiac Failure Does Not Cause Immediate Peripheral Edema.......Page 299
Long-Term Fluid Retention by the Kidneys Causes Peripheral Edema in Persisting Heart Failure......Page 300
Diagnosis of Low Cardiac Reserve—Exercise Test.......Page 301
Compensation During the Next Few Days Further Increases Cardiac Output and Venous Return Curves.......Page 302
Treatment of Decompensated Heart Disease with Digitalis.......Page 303
Bibliography......Page 304
Duration and Pitch of the First and Second Heart Sounds.......Page 307
Phonocardiogram.......Page 308
Systolic Murmur of Aortic Stenosis.......Page 309
Increase in Blood Volume.......Page 310
Circulatory Dynamics during Exercise in Patients with Valvular Lesions......Page 311
Closure of the Ductus Arteriosus After Birth.......Page 312
Tetralogy of Fallot is a Right-to-Left Shunt......Page 313
Detrimental Effects of Late Stages of Cardiac Hypertrophy.......Page 314
Bibliography......Page 315
Tissue Deterioration is the End Result of Circulatory Shock......Page 317
Greater Effect of the Sympathetic Nervous Reflexes in Maintaining Arterial Pressure than in Maintaining Cardiac Output.......Page 318
Nonprogressive Shock—Compensated Shock......Page 319
Cardiac Depression.......Page 320
Generalized Cellular Deterioration.......Page 321
Irreversible Shock......Page 322
Neurogenic Shock—Increased Vascular Capacity......Page 323
Special Features of Septic Shock.......Page 324
Treatment by the Head-Down Position.......Page 325
Bibliography......Page 326
Unit V The Body Fluids and Kidneys......Page 327
Water Loss by the Kidneys.......Page 329
Intracellular Fluid Compartment......Page 330
Ionic Composition of Plasma and Interstitial Fluid is Similar......Page 331
Measurement of Fluid Volumes in the Different Body Fluid Compartments—the Indicator-Dilution Principle......Page 332
Measurement of Plasma Volume.......Page 333
Calculation of the Osmolarity and Osmotic Pressure of a Solution.......Page 334
Isotonic, Hypotonic, and Hypertonic Fluids.......Page 335
Calculation of Fluid Shifts and Osmolarities After Infusion of Hypertonic Saline Solution.......Page 336
Causes of Hyponatremia: Excess Water or Loss of Sodium......Page 338
Causes of Hypernatremia: Water Loss or Excess Sodium......Page 339
Factors That Can Increase Capillary Filtration......Page 340
Edema Caused by Decreased Kidney Excretion of Salt and Water.......Page 341
Safety Factor Caused by Low Compliance of the Interstitium in the Negative Pressure Range......Page 342
“Washdown” of the Interstitial Fluid Protein as a Safety Factor Against Edema......Page 343
Bibliography......Page 344
Regulation of Water and Electrolyte Balances.......Page 347
General Organization of the Kidneys and Urinary Tract......Page 348
The Nephron is the Functional Unit of the Kidney......Page 349
Regional Differences in Nephron Structure: Cortical and Juxtamedullary Nephrons.......Page 350
Physiological Anatomy of the Bladder......Page 351
Innervation of the Bladder.......Page 352
Filling of the Bladder and Bladder Wall Tone; the Cystometrogram......Page 353
Automatic Bladder Caused by Spinal Cord Damage Above the Sacral Region.......Page 354
Urine Formation Results From Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion......Page 355
Bibliography......Page 356
Glomerular Capillary Membrane......Page 359
Negatively Charged Large Molecules Are Filtered Less Easily Than Positively Charged Molecules of Equal Molecular Size.......Page 360
Increased Glomerular Capillary Filtration Coefficient Increases GFR......Page 361
Increased Glomerular Capillary Colloid Osmotic Pressure Decreases GFR......Page 362
Increased Glomerular Capillary Hydrostatic Pressure Increases GFR......Page 363
Determinants of Renal Blood Flow......Page 364
Norepinephrine, Epinephrine, and Endothelin Constrict Renal Blood Vessels and Decrease GFR.......Page 365
Autoregulation of GFR and Renal Blood Flow......Page 366
Decreased Macula Densa Sodium Chloride Causes Dilation of Afferent Arterioles and Increased Renin Release.......Page 367
Myogenic Autoregulation of Renal Blood Flow and GFR......Page 368
Other Factors That Increase Renal Blood Flow and GFR: High Protein Intake and Increased Blood Glucose.......Page 369
Bibliography......Page 370
Tubular Reabsorption Includes Passive and Active Mechanisms......Page 371
Primary Active Transport Through the Tubular Membrane Is Linked to Hydrolysis of ATP.......Page 372
Secondary Active Reabsorption Through the Tubular Membrane.......Page 373
Transport Maximum for Substances That Are Actively Reabsorbed.......Page 374
Substances That Are Actively Transported but Do Not Exhibit a Transport Maximum.......Page 375
Reabsorption of Chloride, Urea, and Other Solutes by Passive Diffusion......Page 376
Proximal Tubules Have a High Capacity for Active and Passive Reabsorption.......Page 377
Solute and Water Transport in the Loop of Henle......Page 378
Distal Tubule......Page 379
Principal Cells Reabsorb Sodium and Secrete Potassium.......Page 380
Intercalated Cells Secrete or Reabsorb Hydrogen, Bicarbonate, and Potassium Ions.......Page 381
Summary of Concentrations of Different Solutes in the Different Tubular Segments......Page 382
Glomerulotubular Balance—the Reabsorption Rate Increases in Response to Increased Tubular Load......Page 383
Regulation of Peritubular Capillary Physical Forces.......Page 384
Renal Interstitial Hydrostatic and Colloid Osmotic Pressures.......Page 385
Hormonal Control of Tubular Reabsorption......Page 386
Angiotensin II Increases Sodium and Water Reabsorption.......Page 387
Sympathetic Nervous System Activation Increases Sodium Reabsorption......Page 388
Inulin Clearance Can be Used to Estimate GFR......Page 389
Creatinine Clearance and Plasma Creatinine Concentration Can be Used to Estimate GFR......Page 390
PAH Clearance Can be Used to Estimate RPF......Page 391
Bibliography......Page 392
Renal Mechanisms for Excreting Dilute Urine......Page 395
Tubular Fluid in Distal and Collecting Tubules Is Further Diluted in the Absence of ADH.......Page 396
Urine Specific Gravity......Page 397
Special Characteristics of the Loop of Henle That Cause Solutes to be Trapped in the Renal Medulla......Page 398
Steps Involved in Causing Hyperosmotic Renal Medullary Interstitium.......Page 399
Urea Contributes to Hyperosmotic Renal Medullary Interstitium and Formation of Concentrated Urine......Page 400
Countercurrent Exchange in the Vasa Recta Preserves Hyperosmolarity of the Renal Medulla......Page 401
Descending Loop of Henle.......Page 402
Inner Medullary Collecting Ducts.......Page 403
Failure to Produce ADH: “Central” Diabetes Insipidus.......Page 404
Osmoreceptor-ADH Feedback System......Page 405
ADH Synthesis in Supraoptic and Paraventricular Nuclei of the Hypothalamus and ADH Release From the Posterior Pituitary......Page 406
Quantitative Importance of Osmolarity and Cardiovascular Reflexes in Stimulating ADH Secretion......Page 407
Stimuli for Thirst......Page 408
Role of Angiotensin II and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration......Page 409
Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume......Page 410
Bibliography......Page 411
β-Adrenergic Stimulation Increases Cellular Uptake of Potassium.......Page 413
Overview of Renal Potassium Excretion......Page 414
Potassium Secretion by Principal Cells of Late Distal and Cortical Collecting Tubules......Page 415
Increased Extracellular Fluid Potassium Concentration Stimulates Potassium Secretion.......Page 416
Blockade of the Aldosterone Feedback System Greatly Impairs Control of Potassium Concentration.......Page 417
Increased Distal Tubular Flow Rate Stimulates Potassium Secretion.......Page 418
Beneficial Effects of a Diet High in Potassium and Low in Sodium Content......Page 419
Control of Calcium Excretion by the Kidneys......Page 420
Regulation of Renal Phosphate Excretion......Page 421
Integration of Renal Mechanisms for Control of Extracellular Fluid......Page 422
Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance......Page 423
Pressure Natriuresis and Diuresis are Key Components of a Renal–Body Fluid Feedback for Regulating Body Fluid Volumes and Arterial Pressure......Page 424
Distribution of Extracellular Fluid between the Interstitial Spaces and Vascular System......Page 425
Sympathetic Nervous System Control of Renal Excretion: Arterial Baroreceptor and Low-Pressure Stretch Receptor Reflexes......Page 426
Excessive Ang II Does Not Usually Cause Large Increases in Extracellular Fluid Volume Because Increased Arterial Pressure Counterbalances Ang II–Mediated Sodium Retention.......Page 427
Excess ADH Secretion Usually Causes Only Small Increases in Extracellular Fluid Volume but Large Decreases in Sodium Concentration.......Page 428
Increased Blood Volume and Extracellular Fluid Volume Caused by Heart Diseases......Page 429
Liver Cirrhosis—Decreased Synthesis of Plasma Proteins by the Liver and Sodium Retention by the Kidneys......Page 430
Bibliography......Page 431
Normal H+ Concentration and pH of Body Fluids and Changes That Occur in Acidosis and Alkalosis.......Page 433
Buffering of H+ in the Body Fluids......Page 434
Quantitative Dynamics of the Bicarbonate Buffer System......Page 435
“Buffer Power” Is Determined by the Amount and Relative Concentrations of the Buffer Components.......Page 436
Proteins are Important Intracellular Buffers......Page 437
Increased H+ Concentration Stimulates Alveolar Ventilation......Page 438
Renal Control of Acid-Base Balance......Page 439
H+ is Secreted by Secondary Active Transport in the Early Tubular Segments......Page 440
Primary Active Secretion of H+ in the Intercalated Cells of Late Distal and Collecting Tubules......Page 441
Phosphate Buffer System Carries Excess H+ Into the Urine and Generates New HCO3−......Page 442
Excretion of Excess H+ and Generation of New HCO3− by the Ammonia Buffer System......Page 443
Regulation of Renal Tubular H+ Secretion......Page 444
Acidosis Decreases the HCO3−/H+ Ratio in Renal Tubular Fluid......Page 445
Respiratory Acidosis Results from Decreased Ventilation and Increased Pco2......Page 446
Administration of Diuretics (Except the Carbonic Anhydrase Inhibitors).......Page 447
Clinical Measurements and Analysis of Acid-Base Disorders......Page 448
Complex Acid-Base Disorders and Use of the Acid-Base Nomogram for Diagnosis......Page 449
Bibliography......Page 450
“Loop” Diuretics Decrease Active Sodium-Chloride-Potassium Reabsorption in the Thick Ascending Loop of Henle......Page 451
Carbonic Anhydrase Inhibitors Block Sodium Bicarbonate Reabsorption in the Proximal Tubules......Page 452
Acute Kidney Injury......Page 453
Intrarenal Acute Kidney Injury Caused by Abnormalities Within the Kidney......Page 454
Physiological Effects of Acute Kidney Injury......Page 455
Vicious Cycle of Chronic Kidney Disease Leading to End-Stage Renal Disease......Page 456
Injury to the Renal Vasculature as a Cause of Chronic Kidney Disease......Page 457
Nephrotic Syndrome—Excretion of Protein in the Urine Because of Increased Glomerular Permeability......Page 458
Loss of Functional Nephrons Requires Surviving Nephrons to Excrete More Water and Solutes.......Page 459
Effects of Renal Failure on the Body Fluids—Uremia......Page 460
Osteomalacia in Chronic Kidney Disease Caused by Decreased Production of Active Vitamin D and by Phosphate Retention by the Kidneys.......Page 461
Kidney Diseases That Cause Loss of Entire Nephrons Lead to Chronic Kidney Disease but May Not Cause Hypertension......Page 462
Gitelman’s Syndrome—Decreased Sodium Chloride Reabsorption in the Distal Tubules.......Page 463
Basic Principles of Dialysis......Page 464
Bibliography......Page 465
Unit VI Blood Cells, Immunity, and Blood Coagulation......Page 467
Areas of the Body That Produce Red Blood Cells.......Page 469
Pluripotential Hematopoietic Stem Cells, Growth Inducers, and Differentiation Inducers.......Page 470
Erythropoietin Regulates Red Blood Cell Production......Page 471
Erythropoietin Stimulates Production of Proerythroblasts from Hematopoietic Stem Cells.......Page 472
Hemoglobin Formation......Page 473
Transport and Storage of Iron.......Page 474
The Life Span of Red Blood Cells is About 120 Days......Page 475
Hemolytic Anemia.......Page 476
Bibliography......Page 477
Genesis of White Blood Cells......Page 479
Life Span of White Blood Cells......Page 480
Phagocytosis by Neutrophils.......Page 481
Macrophages in the Lymph Nodes.......Page 482
Macrophages of the Spleen and Bone Marrow.......Page 483
Neutrophil Invasion of the Inflamed Area Is a Second Line of Defense.......Page 484
Feedback Control of the Macrophage and Neutrophil Responses......Page 485
Basophils......Page 486
Effects of Leukemia on the Body......Page 487
Bibliography......Page 488
Both Types of Acquired Immunity are Initiated by Antigens......Page 489
The Thymus Gland Preprocesses the T Lymphocytes.......Page 490
Millions of Specific Types of Lymphocytes Are Stored in the Lymphoid Tissue.......Page 491
Role of the T Cells in Activation of the B Lymphocytes.......Page 492
Nature of the Antibodies......Page 493
Direct Action of Antibodies on Invading Agents.......Page 494
Classical Pathway.......Page 495
Several Types of T Cells and Their Different Functions......Page 496
Cytotoxic T Cells Are “Killer” Cells......Page 497
Immunization by Injection of Antigens......Page 498
“Atopic” Allergies Associated with Excess IgE Antibodies......Page 499
Bibliography......Page 500
Genetic Determination of the Agglutinogens.......Page 501
Acute Hemolysis Occurs in Some Transfusion Reactions.......Page 502
Erythroblastosis Fetalis (“Hemolytic Disease of the Newborn”)......Page 503
Acute Kidney Failure After Transfusion Reactions.......Page 504
Prevention of Graft Rejection by Suppressing the Immune System......Page 505
Bibliography......Page 506
Physical and Chemical Characteristics of Platelets......Page 507
Blood Coagulation in the Ruptured Vessel......Page 508
Prothrombin and Thrombin.......Page 509
Positive Feedback of Clot Formation......Page 510
Intrinsic Pathway for Initiating Clotting......Page 511
Role of Calcium Ions in the Intrinsic and Extrinsic Pathways......Page 512
Plasmin Causes Lysis of Blood Clots......Page 513
Hemophilia......Page 514
Disseminated Intravascular Coagulation......Page 515
Prevention of Blood Coagulation Outside the Body......Page 516
Bibliography......Page 517
Unit VII Respiration......Page 519
Pressures That Cause the Movement of Air in and out of the Lungs......Page 521
Alveolar Pressure—The Air Pressure Inside the Lung Alveoli.......Page 522
Principle of Surface Tension.......Page 523
“Work” of Breathing......Page 524
Pulmonary Capacities......Page 525
Determination of Functional Residual Capacity, Residual Volume, and Total Lung Capacity—Helium Dilution Method......Page 526
Measurement of the Dead Space Volume.......Page 527
Resistance to Airflow in the Bronchial Tree.......Page 528
Mucus Lining the Respiratory Passageways, and Action of Cilia to Clear the Passageways......Page 529
Vocalization......Page 530
Bibliography......Page 531
Pressures in the Pulmonary Artery.......Page 533
Blood Flow Through the Lungs and Its Distribution......Page 534
Zones 1, 2, and 3 of Pulmonary Blood Flow......Page 535
Increased Cardiac Output during Heavy Exercise is Normally Accommodated by the Pulmonary Circulation Without Large Increases in Pulmonary Artery Pressure......Page 536
Capillary Exchange of Fluid in the Lungs and Pulmonary Interstitial Fluid Dynamics......Page 537
“Pulmonary Edema Safety Factor.”......Page 538
Pleural Effusion—Collection of Large Amounts of Free Fluid in the Pleural Space.......Page 539
Bibliography......Page 540
Factors That Determine the Partial Pressure of a Gas Dissolved in a Fluid.......Page 541
Quantifying the Net Rate of Diffusion in Fluids.......Page 542
Alveolar Air is Slowly Renewed by Atmospheric Air......Page 543
Oxygen Concentration and Partial Pressure in the Alveoli......Page 544
Respiratory Membrane.......Page 545
Factors That Affect the Rate of Gas Diffusion Through the Respiratory Membrane......Page 546
Increased Oxygen Diffusing Capacity during Exercise.......Page 547
Effect of the Ventilation-Perfusion Ratio on Alveolar Gas Concentration......Page 548
Concept of “Physiological Shunt” (When Is Below Normal)......Page 549
Bibliography......Page 550
Uptake of Oxygen by the Pulmonary Blood during Exercise.......Page 551
Increasing Tissue Metabolism Decreases Interstitial Fluid Po2.......Page 552
Effect of Rate of Tissue Metabolism and Tissue Blood Flow on Interstitial Pco2.......Page 553
Amount of Oxygen Released From the Hemoglobin When Systemic Arterial Blood Flows Through the Tissues.......Page 554
When Atmospheric Oxygen Concentration Changes Markedly, the Buffer Effect of Hemoglobin Still Maintains Almost Constant Tissue Po2.......Page 555
Rightward Shift of the Oxygen-Hemoglobin Dissociation Curve during Exercise......Page 556
Transport of Oxygen in the Dissolved State......Page 557
Transport of Carbon Dioxide in the Dissolved State......Page 558
When Oxygen Binds with Hemoglobin, Carbon Dioxide is Released (the Haldane Effect) to Increase Carbon Dioxide Transport......Page 559
Bibliography......Page 560
Inspiratory “Ramp” Signal.......Page 563
Control of Overall Respiratory Center Activity......Page 564
Decreased Stimulatory Effect of CO2 After the First 1 to 2 Days.......Page 565
Peripheral Chemoreceptor System for Control of Respiratory Activity—Role of Oxygen in Respiratory Control......Page 566
Effect of Low Arterial Po2 to Stimulate Alveolar Ventilation When Arterial CO2 and Hydrogen Ion Concentrations Remain Normal......Page 567
Composite Effects of Pco2, pH, and Po2 on Alveolar Ventilation......Page 568
Interrelation Between Chemical Factors and Nervous Factors in the Control of Respiration during Exercise.......Page 569
Periodic Breathing.......Page 570
Obstructive Sleep Apnea Is Caused by Blockage of the Upper Airway.......Page 571
Bibliography......Page 572
Determination of Blood PO2.......Page 573
Abnormalities of the Maximum Expiratory Flow-Volume Curve.......Page 574
Chronic Pulmonary Emphysema......Page 575
Pneumonia—Lung Inflammation and Fluid in Alveoli......Page 576
Lack of “Surfactant” as a Cause of Lung Collapse.......Page 577
Hypoxia and Oxygen Therapy......Page 578
Cyanosis......Page 579
Tank Respirator (the “Iron Lung”).......Page 580
Bibliography......Page 581
Unit VIII Aviation, Space, and Deep–Sea Diving Physiology......Page 583
Saturation of Hemoglobin with Oxygen at Different Altitudes.......Page 585
Acclimatization to Low Po2......Page 586
Hypoxia-Inducible Factors—a “Master Switch” for the Body’s Response to Hypoxia......Page 587
Acute Mountain Sickness and High-Altitude Pulmonary Edema......Page 588
Effects on the Circulatory System.......Page 589
Acceleratory Forces in Space Travel.......Page 590
Physiological Challenges of Weightlessness (Microgravity).......Page 591
Bibliography......Page 592
Effect of Very High PO2 on Blood Oxygen Transport.......Page 593
Excessive Intracellular Oxidation as a Cause of Nervous System Oxygen Toxicity—“Oxidizing Free Radicals.”......Page 594
Volume of Nitrogen Dissolved in the Body Fluids at Different Depths.......Page 595
Tank Decompression and Treatment of Decompression Sickness.......Page 596
Self-Contained Underwater Breathing Apparatus (SCUBA) Diving......Page 597
Bibliography......Page 598
Unit IX The Nervous System: A. General Principles and Sensory Physiology......Page 599
Motor Part of the Nervous System—Effectors......Page 601
Role of Synapses in Processing Information......Page 602
Lower Brain or Subcortical Level......Page 603
Types of Synapses—Chemical and Electrical......Page 604
Physiological Anatomy of the Synapse......Page 605
Action of the Transmitter Substance on the Postsynaptic Neuron—Function of “Receptor Proteins”......Page 606
“Second Messenger” System in the Postsynaptic Neuron.......Page 607
Chemical Substances That Function as Synaptic Transmitters......Page 608
Recycling of the Small-Molecule Types of Vesicles.......Page 609
Neuropeptides......Page 610
Concentration Differences of Ions Across the Neuronal Somal Membrane.......Page 611
Generation of Action Potentials in the Initial Segment of the Axon Leaving the Neuron—Threshold for Excitation.......Page 612
Time Course of Postsynaptic Potentials......Page 613
Most Dendrites Cannot Transmit Action Potentials, but They Can Transmit Signals Within the Same Neuron by Electrotonic Conduction.......Page 614
“Excitatory State” Is the Summated Degree of Excitatory Drive to the Neuron.......Page 615
Synaptic Delay.......Page 616
Bibliography......Page 617
Modality of Sensation—The “Labeled Line” Principle......Page 619
Mechanisms of Receptor Potentials.......Page 620
Relation between Stimulus Intensity and the Receptor Potential.......Page 621
Slowly Adapting Receptors Detect Continuous Stimulus Strength—the “Tonic” Receptors.......Page 622
General Classification of Nerve Fibers.......Page 623
Temporal Summation.......Page 624
Threshold and Subthreshold Stimuli—Excitation or Facilitation.......Page 625
Convergence of Signals......Page 626
Reverberatory (Oscillatory) Circuit as a Cause of Signal Prolongation.......Page 627
Rhythmical Signal Output......Page 628
Automatic Short-Term Adjustment of Pathway Sensitivity by the Fatigue Mechanism.......Page 629
Bibliography......Page 630
Tactile Receptors.......Page 631
Detection of Tickle and Itch by Mechanoreceptive Free Nerve Endings.......Page 632
Anatomy of the Dorsal Column–Medial Lemniscal System......Page 633
Spatial Orientation of the Nerve Fibers in the Dorsal Column–Medial Lemniscal System......Page 634
Somatosensory Areas I and II.......Page 635
Layers of the Somatosensory Cortex and Their Function......Page 636
Effect of Removing the Somatosensory Association Area—Amorphosynthesis.......Page 637
Two-Point Discrimination.......Page 638
Weber-Fechner Principle—Detection of “Ratio” of Stimulus Strength.......Page 639
Transmission of Less Critical Sensory Signals in the Anterolateral Pathway......Page 640
Characteristics of Transmission in the Anterolateral Pathway......Page 641
Bibliography......Page 642
Nonadapting Nature of Pain Receptors.......Page 645
Peripheral Pain Fibers—“Fast” and “Slow” Fibers......Page 646
Paleospinothalamic Pathway for Transmitting Slow-Chronic Pain.......Page 647
Surgical Interruption of Pain Pathways.......Page 648
The Brain’s Opiate System—Endorphins and Enkephalins......Page 649
Causes of True Visceral Pain......Page 650
Parietal Pathway for Transmission of Abdominal and Thoracic Pain.......Page 651
Tic Douloureux......Page 652
Headache Caused by Low Cerebrospinal Fluid Pressure.......Page 653
Thermal Receptors and Their Excitation......Page 654
Transmission of Thermal Signals in the Nervous System......Page 655
Bibliography......Page 656
Unit X The Nervous System: B. The Special Senses......Page 657
Convex Lens Focuses Light Rays.......Page 659
Focal Length of a Lens......Page 660
Measurement of the Refractive Power of a Lens—“Diopter”......Page 661
Consideration of All Refractive Surfaces of the Eye as a Single Lens—The “Reduced” Eye.......Page 662
Accommodation Is Controlled by Parasympathetic Nerves.......Page 663
Emmetropia (Normal Vision).......Page 664
Astigmatism.......Page 665
Visual Acuity......Page 666
Determination of Distance by Stereopsis—Binocular Vision.......Page 667
Formation of Aqueous Humor by the Ciliary Body......Page 668
Regulation of Intraocular Pressure.......Page 669
Bibliography......Page 670
Rods and Cones.......Page 671
Pigment Layer of the Retina.......Page 672
Rhodopsin and Its Decomposition by Light Energy.......Page 673
The Rod Receptor Potential is Hyperpolarizing, Not Depolarizing.......Page 674
Duration of the Receptor Potential, and Logarithmic Relation of the Receptor Potential to Light Intensity.......Page 675
Photochemistry of Color Vision by the Cones......Page 676
Value of Light and Dark Adaptation in Vision.......Page 677
Color Test Charts.......Page 678
Neural Function of the Retina......Page 679
Depolarizing and Hyperpolarizing Bipolar Cells......Page 680
W, X, and Y Cells.......Page 681
Transmission of Changes in Light Intensity—The On-Off Response.......Page 682
Transmission of Color Signals by the Ganglion Cells......Page 683
Bibliography......Page 684
Function of the Dorsal Lateral Geniculate Nucleus of the Thalamus......Page 685
Secondary Visual Areas of the Cortex.......Page 686
Interaction of Visual Signals from the Two Separate Eyes.......Page 687
Detection of Line Orientation When a Line Is Displaced Laterally or Vertically in the Visual Field—“Complex” Cells.......Page 688
Effect of Lesions in the Optic Pathway on the Fields of Vision.......Page 689
Neural Pathways for Control of Eye Movements.......Page 690
Saccadic Movements During Reading.......Page 691
Strabismus—Lack of Fusion of the Eyes......Page 692
Control of Accommodation (Focusing the Eyes)......Page 693
Horner’s Syndrome.......Page 694
Bibliography......Page 695
“Impedance Matching” by the Ossicular System.......Page 697
Functional Anatomy of the Cochlea......Page 698
Pattern of Vibration of the Basilar Membrane for Different Sound Frequencies.......Page 699
Excitation of the Hair Cells.......Page 700
Determination of Sound Frequency—the “Place” Principle......Page 701
Threshold for Hearing Sound at Different Frequencies.......Page 702
Firing Rates at Different Levels of the Auditory Pathways.......Page 703
Sound Frequency Perception in the Primary Auditory Cortex.......Page 704
Neural Mechanisms for Detecting Sound Direction.......Page 705
Audiogram for Middle Ear Conduction Deafness.......Page 706
Bibliography......Page 707
Bitter Taste.......Page 709
The Taste Bud and Its Function......Page 710
Transmission of Taste Signals Into the Central Nervous System......Page 711
Olfactory Membrane......Page 712
Mechanism of Excitation of the Olfactory Cells.......Page 713
Gradations of Smell Intensities.......Page 714
The Less Old Olfactory System—The Lateral Olfactory Area.......Page 715
Bibliography......Page 716
Unit XI The Nervous System: C. Motor and Integrative Neurophysiology......Page 717
Alpha Motor Neurons.......Page 719
Multisegmental Connections from One Spinal Cord Level to Other Levels—Propriospinal Fibers.......Page 720
Secondary Ending.......Page 721
Dynamic Stretch Reflex and Static Stretch Reflexes.......Page 722
Role of the Muscle Spindle in Voluntary Motor Activity......Page 723
Clonus—Oscillation of Muscle Jerks.......Page 724
Possible Role of the Tendon Reflex to Equalize Contractile Force Among the Muscle Fibers.......Page 725
Neuronal Mechanism of the Flexor Reflex.......Page 726
Reciprocal Inhibition and Reciprocal Innervation......Page 727
Galloping Reflex.......Page 728
Spinal Cord Transection and Spinal Shock......Page 729
Bibliography......Page 730
Primary Motor Cortex......Page 731
Some Specialized Areas of Motor Control Found in the Human Motor Cortex......Page 732
Corticospinal (Pyramidal) Tract......Page 733
The Red Nucleus Serves as an Alternative Pathway for Transmitting Cortical Signals to the Spinal Cord......Page 734
Dynamic and Static Signals Are Transmitted by the Pyramidal Neurons.......Page 735
Patterns of Movement Elicited by Spinal Cord Centers.......Page 736
Excitatory-Inhibitory Antagonism Between Pontine and Medullary Reticular Nuclei......Page 737
Vestibular Apparatus......Page 738
Directional Sensitivity of the Hair Cells—Kinocilium.......Page 739
Function of the Utricle and Saccule in the Maintenance of Static Equilibrium......Page 740
“Predictive” Function of the Semicircular Duct System in the Maintenance of Equilibrium.......Page 741
Neuronal Connections of the Vestibular Apparatus With the Central Nervous System......Page 742
Bibliography......Page 743
Longitudinal Functional Divisions of the Anterior and Posterior Lobes.......Page 745
Afferent Pathways From Other Parts of the Brain.......Page 746
Deep Cerebellar Nuclei and the Efferent Pathways.......Page 747
Neuronal Circuit of the Functional Unit.......Page 748
Turn-On/Turn-Off and Turn-Off/Turn-On Output Signals from the Cerebellum......Page 749
Function of the Cerebellum in Overall Motor Control......Page 750
Spinocerebellum—Feedback Control of Distal Limb Movements by Way of the Intermediate Cerebellar Cortex and the Interposed Nucleus......Page 751
Cerebrocerebellum—Function of the Large Lateral Zone of the Cerebellar Hemisphere to Plan, Sequence, and Time Complex Movements......Page 752
Past Pointing......Page 753
The Basal Ganglia and Their Motor Functions......Page 754
Neural Pathways of the Putamen Circuit.......Page 755
Function of the Basal Ganglia to Change the Timing and to Scale the Intensity of Movements......Page 756
Functions of Specific Neurotransmitter Substances in the Basal Ganglial System......Page 757
Huntington’s Disease (Huntington’s Chorea)......Page 758
Associated Functions of the Basal Ganglia.......Page 759
Bibliography......Page 760
Physiological Anatomy of the Cerebral Cortex......Page 761
Functions of Specific Cortical Areas......Page 762
Analysis of the Spatial Coordinates of the Body.......Page 763
Area for Recognition of Faces......Page 764
Concept of the Dominant Hemisphere......Page 765
Higher Intellectual Functions of the Prefrontal Association Areas......Page 766
Function of the Brain in Communication—Language Input and Language Output......Page 767
Summary......Page 768
Thoughts, Consciousness, and Memory......Page 769
Short-Term Memory......Page 770
Mechanism for Facilitation.......Page 771
Consolidation of Memory......Page 772
Bibliography......Page 773
Excitation of the Excitatory Area by Peripheral Sensory Signals.......Page 775
Neurohormonal Systems in the Human Brain.......Page 776
Functional Anatomy of the Limbic System; Key Position of the Hypothalamus......Page 778
Cardiovascular Regulation.......Page 779
Regulation of Uterine Contractility and Milk Ejection from the Breasts.......Page 780
“Reward” and “Punishment” Function of the Limbic System......Page 781
Importance of Reward or Punishment in Learning and Memory—Habituation Versus Reinforcement......Page 782
Theoretical Function of the Hippocampus in Learning.......Page 783
Ablation of the Anterior Cingulate Gyri and Subcallosal Gyri.......Page 784
Bibliography......Page 785
Slow-Wave Sleep......Page 787
Neuronal Centers, Neurohumoral Substances, and Mechanisms That Can Cause Sleep—A Possible Specific Role for Serotonin......Page 788
Sleep Has Important Physiological Functions......Page 789
Brain Waves......Page 790
Changes in the EEG at Different Stages of Wakefulness and Sleep......Page 791
Generalized Seizures......Page 792
What Initiates a Generalized Tonic-Clonic Seizure?......Page 793
Depression and Manic-Depressive Psychoses—Decreased Activity of the Norepinephrine and Serotonin Neurotransmitter Systems......Page 794
Alzheimer’s Disease Is Associated With Accumulation of Brain Beta-Amyloid Peptide.......Page 795
Bibliography......Page 796
Sympathetic Nerve Fibers in the Skeletal Nerves.......Page 797
Physiological Anatomy of the Parasympathetic Nervous System......Page 798
Cholinergic and Adrenergic Fibers—Secretion of Acetylcholine or Norepinephrine......Page 799
Synthesis of Norepinephrine, Its Removal, and Its Duration of Action.......Page 800
Adrenergic Receptors—Alpha and Beta Receptors......Page 801
Glands of the Body.......Page 802
Function of the Adrenal Medullae......Page 804
Effect of Loss of Sympathetic or Parasympathetic Tone After Denervation.......Page 805
Other Autonomic Reflexes.......Page 806
Medullary, Pontine, and Mesencephalic Control of the Autonomic Nervous System......Page 807
Parasympathomimetic Drugs (Cholinergic Drugs).......Page 808
Bibliography......Page 809
Excesses of Carbon Dioxide or Hydrogen Ion Concentration Increase Cerebral Blood Flow.......Page 811
Measurement of Cerebral Blood Flow and Effect of Brain Activity on Flow.......Page 812
Cerebral Microcirculation......Page 813
Contrecoup.......Page 814
Absorption of Cerebrospinal Fluid Through the Arachnoidal Villi.......Page 815
Measurement of Cerebrospinal Fluid Pressure.......Page 816
Brain Edema......Page 817
Bibliography......Page 818
Unit XII Gastrointestinal Physiology......Page 819
Slow Waves.......Page 821
Spike Potentials.......Page 822
Neural Control of Gastrointestinal Function—Enteric Nervous System......Page 823
Types of Neurotransmitters Secreted by Enteric Neurons......Page 824
Gastrointestinal Reflexes......Page 825
Hormonal Control of Gastrointestinal Motility......Page 826
Mixing Movements......Page 827
Possible Causes of the Increased Blood Flow During Gastrointestinal Activity.......Page 828
Nervous Control of Gastrointestinal Blood Flow......Page 829
Bibliography......Page 830
Voluntary Stage of Swallowing.......Page 831
Effect of the Pharyngeal Stage of Swallowing on Respiration.......Page 832
Motor Functions of the Stomach......Page 833
Hunger Contractions.......Page 834
Inhibitory Effect of Enterogastric Nervous Reflexes From the Duodenum.......Page 835
Mixing Contractions (Segmentation Contractions)......Page 836
Movements Caused by the Muscularis Mucosae and Muscle Fibers of the Villi.......Page 837
Mixing Movements—“Haustrations.”......Page 838
Defecation Reflexes.......Page 839
Bibliography......Page 840
Parasympathetic Stimulation Increases the Alimentary Tract Glandular Secretion Rate.......Page 841
Secretion of Organic Substances.......Page 842
Secretion of Ions in Saliva.......Page 843
Nervous Regulation of Salivary Secretion......Page 844
Basic Mechanism of Hydrochloric Acid Secretion.......Page 845
Pyloric Glands—Secretion of Mucus and Gastrin......Page 846
Gastric Phase.......Page 847
Chemical Composition of Gastrin and Other Gastrointestinal Hormones......Page 848
Secretion of Bicarbonate Ions......Page 849
Cephalic and Gastric Phases.......Page 850
Bile Secretion by the Liver......Page 851
Physiologic Anatomy of Biliary Secretion......Page 852
Function of Bile Salts in Fat Digestion and Absorption......Page 853
Secretion of Mucus by Brunner’s Glands in the Duodenum......Page 854
Mucus Secretion.......Page 855
Bibliography......Page 856
Digestion of Carbohydrates Begins in the Mouth and Stomach.......Page 857
Digestion of Proteins in the Stomach.......Page 858
Fats of the Diet.......Page 859
Digestion of Cholesterol Esters and Phospholipids.......Page 860
Absorption in the Small Intestine......Page 861
Sodium Is Actively Transported Through the Intestinal Membrane.......Page 862
Absorption of Bicarbonate Ions in the Duodenum and Jejunum.......Page 863
Glucose Is Transported by a Sodium Co-Transport Mechanism.......Page 864
Absorption in the Large Intestine: Formation of Feces......Page 865
Bibliography......Page 866
Gastric Barrier and Its Penetration in Gastritis.......Page 867
Basic Cause of Peptic Ulceration.......Page 868
Nontropical Sprue.......Page 869
Psychogenic Diarrhea.......Page 870
Antiperistalsis, the Prelude to Vomiting.......Page 871
Gases in the Gastrointestinal Tract (Flatus)......Page 872
Bibliography......Page 873
Unit XIII Metabolism and Temperature Regulation......Page 875
Adenosine Triphosphate Is the “Energy Currency” of the Body......Page 877
Transport of Glucose Through the Cell Membrane......Page 878
Glycogenesis—Formation of Glycogen......Page 879
Formation of ATP During Glycolysis.......Page 880
Citric Acid Cycle (Krebs Cycle)......Page 881
Formation of Large Quantities of ATP by Oxidation of Hydrogen—The Process of Oxidative Phosphorylation......Page 882
Effect of ATP and ADP Cell Concentrations in Controlling Glycolysis and Glucose Oxidation......Page 883
Use of Lactic Acid by the Heart for Energy.......Page 884
Formation of Carbohydrates From Proteins and Fats—Gluconeogenesis......Page 885
Bibliography......Page 886
Removal of the Chylomicrons From the Blood......Page 887
“Free Fatty Acids” Are Transported in the Blood in Combination With Albumin......Page 888
Fat Cells (Adipocytes) Store Triglycerides.......Page 889
Degradation of Fatty Acids to Acetyl Coenzyme A by Beta-Oxidation.......Page 890
Formation of Acetoacetic Acid in the Liver and Its Transport in the Blood......Page 891
Efficiency of Carbohydrate Conversion Into Fat.......Page 892
Acceleration of Fat Utilization for Energy in the Absence of Carbohydrates.......Page 893
Phospholipids......Page 894
Factors That Affect Plasma Cholesterol Concentration—Feedback Control of Body Cholesterol.......Page 895
Increased Low-Density Lipoproteins.......Page 896
Other Major Risk Factors for Atherosclerosis......Page 897
Bibliography......Page 898
Blood Amino Acids......Page 899
Active Transport of Amino Acids Into the Cells.......Page 900
Formation of the Plasma Proteins.......Page 901
Deamination—the Removal of Amino Groups From Amino Acids.......Page 902
Effect of Starvation on Protein Degradation.......Page 903
Bibliography......Page 904
Cirrhosis of the Liver Greatly Increases Resistance to Blood Flow.......Page 905
Regulation of Liver Mass—Regeneration......Page 906
Protein Metabolism......Page 907
Measurement of Bilirubin in the Bile as a Clinical Diagnostic Tool......Page 908
Jaundice—Excess Bilirubin in the Extracellular Fluid......Page 909
Bibliography......Page 910
Carbohydrates and Fats Act as “Protein Sparers.”......Page 911
“Respiratory Quotient,” the Ratio of Carbon Dioxide Production to Oxygen Utilization, Can Be Used to Estimate Fat and Carbohydrate Utilization.......Page 912
The Hypothalamus Contains Hunger and Satiety Centers.......Page 913
Neurons and Neurotransmitters in the Hypothalamus That Stimulate or Inhibit Feeding.......Page 914
Ghrelin, a Gastrointestinal Hormone, Increases Feeding.......Page 916
Feedback Signals From Adipose Tissue Regulate Food Intake.......Page 917
Decreased Physical Activity and Abnormal Feeding Regulation as Causes of Obesity......Page 918
Treatment of Obesity......Page 919
Inanition, Anorexia, and Cachexia......Page 920
Storage of Vitamins in the Body.......Page 921
Niacin......Page 922
Pantothenic Acid......Page 923
Magnesium.......Page 924
Fluorine.......Page 925
Bibliography......Page 926
ATP Energizes Glandular Secretion.......Page 927
Anaerobic Energy Utilization During Strenuous Bursts of Activity Is Derived Mainly From Glycolysis.......Page 928
Rate Control of Enzyme-Catalyzed Reactions.......Page 929
The Calorie.......Page 930
Basal Metabolic Rate—The Minimum Energy Expenditure for the Body to Exist......Page 931
Energy Used for Physical Activities......Page 932
Bibliography......Page 933
Insulator System of the Body......Page 935
Radiation Causes Heat Loss in the Form of Infrared Rays.......Page 936
Clothing Reduces Conductive and Convective Heat Loss.......Page 937
Mechanism of Sweat Secretion.......Page 938
Regulation of Body Temperature—Role of the Hypothalamus......Page 939
Temperature-Decreasing Mechanisms When the Body Is Too Hot......Page 940
Sympathetic “Chemical” Excitation of Heat Production.......Page 941
Skin Temperature Can Slightly Alter the Set Point for Core Temperature Control......Page 942
Fever......Page 943
Chills.......Page 944
Cold-Induced Vasodilation Is a Final Protection Against Frostbite at Almost Freezing Temperatures.......Page 945
Bibliography......Page 946
Unit XIV Endocrinology and Reproduction......Page 947
Chemical Structure and Synthesis of Hormones......Page 949
Polypeptide and Protein Hormones Are Stored in Secretory Vesicles Until Needed.......Page 950
Amine Hormones Are Derived From Tyrosine.......Page 952
“Clearance” of Hormones From the Blood.......Page 953
The Number and Sensitivity of Hormone Receptors Are Regulated.......Page 954
G Protein–Linked Hormone Receptors.......Page 955
Enzyme-Linked Hormone Receptors.......Page 956
Adenylyl Cyclase–cAMP Second Messenger System......Page 957
Calcium-Calmodulin Second Messenger System......Page 958
Thyroid Hormones Increase Gene Transcription in the Cell Nucleus......Page 959
Enzyme-Linked Immunosorbent Assay......Page 960
Bibliography......Page 961
The Anterior Pituitary Gland Contains Several Different Cell Types That Synthesize and Secrete Hormones.......Page 963
Hypothalamus Controls Pituitary Secretion......Page 964
Hypothalamic Releasing and Inhibitory Hormones Control Anterior Pituitary Secretion.......Page 965
Growth Hormone Promotes Growth of Many Body Tissues......Page 966
Growth Hormone Decreases Carbohydrate Utilization......Page 967
Growth Hormone Exerts Much of Its Effect Through Intermediate Substances Called Somatomedins......Page 968
Regulation of Growth Hormone Secretion......Page 969
Panhypopituitarism.......Page 970
Possible Role of Decreased Growth Hormone Secretion in Causing Changes Associated with Aging......Page 971
Posterior Pituitary Gland and Its Relation to the Hypothalamus......Page 972
Low Blood Volume and Low Blood Pressure Stimulate ADH Secretion—Vasoconstrictor Effects of ADH.......Page 973
Bibliography......Page 974
Iodide Pump—the Sodium-Iodide Symporter (Iodide Trapping)......Page 975
Formation and Secretion of Thyroglobulin by the Thyroid Cells.......Page 976
Release of Thyroxine and Triiodothyronine From the Thyroid Gland......Page 977
Most of the Thyroxine Secreted by the Thyroid Is Converted to Triiodothyronine.......Page 978
Thyroid Hormones Activate Nuclear Receptors.......Page 979
Effect on Plasma and Liver Fats.......Page 980
Increased Gastrointestinal Motility.......Page 981
TSH (From the Anterior Pituitary Gland) Increases Thyroid Secretion......Page 982
Antithyroid Substances Suppress Thyroid Secretion......Page 983
Thyroid Adenoma.......Page 984
Hypothyroidism......Page 985
Myxedema.......Page 986
Bibliography......Page 987
The Adrenal Cortex Has Three Distinct Layers......Page 989
Glucocorticoids......Page 990
Adrenocortical Hormones Are Bound to Plasma Proteins.......Page 991
Aldosterone Is the Major Mineralocorticoid Secreted by the Adrenals.......Page 992
Excess Aldosterone Causes Hypokalemia and Muscle Weakness; Aldosterone Deficiency Causes Hyperkalemia and Cardiac Toxicity.......Page 993
Cellular Mechanism of Aldosterone Action......Page 994
Regulation of Aldosterone Secretion......Page 995
Decreased Glucose Utilization by Cells.......Page 996
Mobilization of Fatty Acids.......Page 997
Anti-inflammatory Effects of High Levels of Cortisol......Page 998
Cortisol Blocks the Inflammatory Response to Allergic Reactions.......Page 999
Physiological Stress Increases ACTH and Adrenocortical Secretion.......Page 1000
Synthesis and Secretion of ACTH in Association with Melanocyte-Stimulating Hormone, Lipotropin, and Endorphin......Page 1001
Adrenal Androgens......Page 1002
Hyperadrenalism—Cushing’s Syndrome......Page 1003
Treatment of Cushing’s Syndrome.......Page 1004
Bibliography......Page 1005
Insulin is a Hormone Associated with Energy Abundance......Page 1007
Activation of Target cell Receptors by Insulin and the Resulting Cellular Effects......Page 1008
Insulin Promotes Muscle Glucose Uptake and Metabolism......Page 1009
Insulin Promotes Conversion of Excess Glucose Into Fatty Acids and Inhibits Gluconeogenesis in the Liver.......Page 1010
Role of Insulin in Storage of Fat in the Adipose Cells.......Page 1011
Insulin Promotes Protein Synthesis and Storage......Page 1012
Mechanisms Of Insulin Secretion......Page 1013
Feedback Relation Between Blood Glucose Concentration and the Insulin Secretion Rate.......Page 1014
The Role of Insulin (and Other Hormones) in “Switching” between Carbohydrate and Lipid Metabolism......Page 1015
Other Effects of Glucagon......Page 1016
Summary of Blood Glucose Regulation......Page 1017
Diabetes Mellitus......Page 1018
Diabetes Causes Depletion of the Body’s Proteins.......Page 1019
Other Factors That Can Cause Insulin Resistance and Type 2 Diabetes.......Page 1020
Glucose Tolerance Test.......Page 1021
Insulin Shock and Hypoglycemia.......Page 1022
Bibliography......Page 1023
Calcium in the Plasma and interstitial Fluid......Page 1025
Intestinal Absorption and Fecal Excretion of Calcium and Phosphate.......Page 1026
Bone Salts.......Page 1027
Precipitation of Calcium in Nonosseous Tissues Under Abnormal Conditions.......Page 1028
Resorption of Bone—Function of the Osteoclasts.......Page 1029
Control of the Rate of Bone Deposition by Bone “Stress.”......Page 1030
Formation of 1,25-Dihydroxycholecalciferol in the Kidneys and Its Control by Parathyroid Hormone.......Page 1031
“Hormonal” Effect of Vitamin D to Promote Intestinal Calcium Absorption.......Page 1032
Chemistry of Parathyroid Hormone.......Page 1033
Rapid Phase of Calcium and Phosphate Mobilization From Bone—Osteolysis.......Page 1034
Control of Parathyroid Secretion by Calcium Ion Concentration......Page 1035
Increased Plasma Calcium Concentration Stimulates Calcitonin Secretion.......Page 1036
Hormonal Control of Calcium Ion Concentration—The Second Line of Defense.......Page 1037
Effects of Hypercalcemia in Hyperparathyroidism.......Page 1038
Osteomalacia—“Adult Rickets.”......Page 1039
Dentin.......Page 1040
Metabolic Factors Influence Development of the Teeth.......Page 1041
Bibliography......Page 1042
Steps of Spermatogenesis......Page 1045
Sex Chromosomes.......Page 1046
Storage of Sperm in the Testes.......Page 1047
“Capacitation” of Spermatozoa Is Required for Fertilization of the Ovum......Page 1048
Effect of Temperature on Spermatogenesis.......Page 1049
Psychic Element of Male Sexual Stimulation.......Page 1050
Emission and Ejaculation Are Functions of the Sympathetic Nerves.......Page 1051
Production of Estrogen in the Male.......Page 1052
Effect of Testosterone to Cause Descent of the Testes.......Page 1053
Testosterone Increases the Basal Metabolic Rate.......Page 1054
Gonadotropic Hormones: Luteinizing Hormone and Follicle-Stimulating Hormone......Page 1055
Role of Inhibin in Negative Feedback Control of Seminiferous Tubule Activity.......Page 1056
Hypogonadism in the Male......Page 1057
The Function of the Pineal Gland in Controlling Seasonal Fertility in Some Animals......Page 1058
Bibliography......Page 1059
Oogenesis and Follicular Development in the Ovaries......Page 1061
Gonadotropic Hormones and Their Effects on the Ovaries......Page 1063
Development of Antral and Vesicular Follicles.......Page 1064
Initiation of Ovulation.......Page 1065
Functions of the Ovarian Hormones—Estradiol and Progesterone......Page 1066
Synthesis of the Estrogens and Progestins.......Page 1067
Effect of Estrogens on the Uterus and External Female Sex Organs.......Page 1068
Estrogens Have Little Effect on Hair Distribution.......Page 1069
Secretory Phase (Progestational Phase) of the Endometrial Cycle, Occurring After Ovulation.......Page 1070
Intermittent, Pulsatile Secretion of GnRH by the Hypothalamus Stimulates Pulsatile Release of LH from the Anterior Pituitary Gland.......Page 1071
Positive Feedback Effect of Estrogen Before Ovulation—The Preovulatory Luteinizing Hormone Surge......Page 1072
Feedback Oscillation of the Hypothalamic-Pituitary- Ovarian System......Page 1073
Menopause......Page 1074
Stimulation of the Female Sexual Act.......Page 1075
Rhythm Method of Contraception.......Page 1076
Abnormal Conditions That Cause Female Sterility......Page 1077
Bibliography......Page 1078
What Determines the Sex of the Fetus that is Created?......Page 1079
Implantation of the Blastocyst in the Uterus......Page 1080
Placental Permeability and Membrane Diffusion Conductance......Page 1081
Diffusion of Oxygen Through the Placental Membrane.......Page 1082
Function of Human Chorionic Gonadotropin.......Page 1083
Function of Estrogen in Pregnancy.......Page 1084
Increased Parathyroid Gland Secretion.......Page 1085
Maternal Blood Volume Increases During Pregnancy.......Page 1086
Preeclampsia and Eclampsia......Page 1087
Stretch or Irritation of the Cervix.......Page 1088
Mechanics of Parturition......Page 1089
Progesterone Is Required for Full Development of the Lobule-Alveolar System.......Page 1090
Prolactin Promotes Lactation......Page 1091
Milk Composition and the Metabolic Drain on the Mother Caused By Lactation......Page 1092
Bibliography......Page 1093
Respiratory System.......Page 1095
Utilization and Storage of Vitamins......Page 1096
Respiratory Distress Syndrome Is Caused When Surfactant Secretion Is Deficient.......Page 1097
Specific Anatomical Structure of the Fetal Circulation......Page 1098
Closure of the Ductus Venosus.......Page 1099
Blood Characteristics.......Page 1100
Nutritional Needs During the Early Weeks of Life.......Page 1101
Endocrine Problems......Page 1102
Danger of Blindness Caused by Excess Oxygen Therapy in the Premature Infant......Page 1103
Bibliography......Page 1104
Unit XV Sports Physiology......Page 1107
Strength, Power, and Endurance of Muscles......Page 1109
Adenosine Triphosphate.......Page 1110
What Types of Sports Use Which Energy Systems?......Page 1111
Recovery of Muscle Glycogen.......Page 1112
Importance of Maximal Resistance Training.......Page 1113
Limits of Pulmonary Ventilation.......Page 1114
Blood Gases During Exercise.......Page 1115
Work Output, Oxygen Consumption, and Cardiac Output During Exercise.......Page 1116
Relation of Cardiovascular Performance to max.......Page 1117
Replacement of Sodium Chloride and Potassium.......Page 1118
Bibliography......Page 1119
A......Page 1121
B......Page 1126
C......Page 1129
D......Page 1134
E......Page 1135
F......Page 1138
G......Page 1140
H......Page 1142
I......Page 1145
K......Page 1146
L......Page 1147
M......Page 1148
N......Page 1151
O......Page 1152
P......Page 1153
R......Page 1158
S......Page 1160
T......Page 1165
V......Page 1167
Z......Page 1169
IBC_Common Lab Measurements......Page 1171