- -

UNITI

Introduction to Physiology: The Cell andGeneralPhysiology .

CHAPTER 1

FunctionalOrganization of the Human Bodyand Control of the "Internal Environment" 3

Cellsas the LivingUnits of the Body 3ExtracellularFluid- The "InternalEnvironment" 3

IIHomeostatic"Mechanisms of the MajorFunctionalSystems 4ControlSystems of the Body 6Summary-Automaticityof the Body 9

CHAPTER2TheCeUand Its Functions 11

Organizationof the Cell 11PhysicalStructure of the Cell 12Comparisonof the Animal CellwithPrecellularFormsof Life 17

FunctionalSystems of the Cell 18Locomotionof Cells 23

CHAPTER3GeneticControl of Protein Synthesis, CeUFunction,and CeUReproduction 27Genesin the CellNucleus 27

TheDNACode in the CellNucleus IsTransferredto an RNACode in the CellCytoplasm- The Process of Transcription 30Synthesisof Other Substances in the Cell 35Controlof Gene Function and BiochemicalActivityin Cells 35TheDNA-GeneticSystem AlsoControls CellReproduction 37CellDifferentiation 39

Contents

Apoptosis-Programmed CellDeathCancer

4040

UNIT 11

Membrane Physiology, Nerve, and Muscle

CHAPTER 4

Transport of Substances Through CeUMembranes 45

The LipidBarrierof the CellMembrane,and CellMembrane Transport Proteins 45Diffusion 46

"ActiveTransport" of Substances ThroughMembranes 52

CHAPTER 5Membrane Potentials and Action Potentials 57

BasicPhysicsof Membrane Potentials 57

Measuring the Membrane Potential 58Resting Membrane Potential of Nerves 59Nerve Action Potential 60

Rolesof Other lons Duringthe ActionPotential 64

Propagation of the Action Potential 64Re-establishing Sodium and Potassiumlonic Gradients AfterAction Potentials AreCompleted-Importance of EnergyMetabolism 65

Plateau in Some Action Potentials 66

Rhythmicity of Some ExcitableTissues-Repetitive Discharge 66Special Characteristics of SignalTransmissionin Nerve Trunks 67

Excitation- The Process of ElicitingtheAction Potential 68

RecordingMembrane Potentials andAction Potentials 69

CHAPTER6Contraction of Skeletal Muscle

Physiologic Anatomy of Skeletal MuscleGeneral Mechanism of Muscle Contraction

Molecular Mechanism of Muscle Contraction

Energetics of Muscle ContractionCharacteristics of Whole MuscleContraction

CHAPTER 7

Excitation of Skeletal Muscle:Neuromuscular Transmission andExcitation-Contraction Coupling 83Transmission of Impulses from Nerve Endingsto Skeletal Muscle Fibers:The NeuromuscularJunction 83

Molecular Biologyof Acetylcholine Formationand Release 86

DrugsThat Enhance or BlockTransmissionat the Neuromuscular Junction 86

Myasthenia GravisCauses Muscle Paralysis 86MuscleAction Potential 87

Excitation-Contraction Coupling 88

CHAPTER8Excitation and Contraction of Smooth Muscle 91Contraction of Smooth Muscle 91

Nervous and Hormonal Control of SmoothMuscleContraction 94

UNIT 11/

The Heart

CHAPTER 9

Cardiac Muscle;The Heart as a Pump andFunction of the Heart Valves 101

Physiologyof Cardiac Muscle 101

Cardiac Cycle 104

Relationship of the Heart Sounds to HeartPumping 107Work Output of the Heart 107ChemicalEnergyRequiredfor CardiacContraction:OxygenUtilizationby the Heart 109

Regulation of Heart Pumping 110

CHAPTER10

Rhythmical Excitation of the Heart 115

Specialized Excitatory and Conductive Systemof the Heart 115Control of Excitation and Conduction in theHeart 118

7171

7374

78

CHAPTER 11

The Normal ElectrocardiogramCharacteristics of the Normal

Electrocardiogram

Methods for Recording ElectrocardiogramsFlow of Current Around the Heart

during the Cardiac Cycle

Electrocardiographic Leads79

CHAPTER 12

Electrocardiographic Interpretation ofCardiac Muscle and Coronary Blood FlowAbnormalities: Vectorial Analysis

PrincipIes of Vectorial Analysis ofElectrocardiograms

Vectorial Analysis of the NormalElectrocardiogramMean Electrical Axis of the Ventricular

QRS-and Its Significance

Conditions That Cause Abnormal Voltagesof the QRS Complex

Prolonged and Bizarre Patterns of the QRSComplex

Current of InjuryAbnormalities in the T Wave

CHAPTER13

Cardiac Arrhythmias and TheirElectrocardiographic InterpretationAbnormal Sinus RhythmsAbnormal RhythmsThat Result from Blockof Heart SignalsWithin the IntracardiacConduction pathwaysPremature Contractions

paroxysmalTachycardiaVentricular FibrillationAtrial Fibrillation

Atrial FlutterCardiacArrest

121

121

123

123

124

129

129

131

134

137

137

138

141

143

143

144

146

148

149

151

152

153

The Circulation

UNITIV

CHAPTER14

Overview of the Circulation; Biophysics ofPressure, Flow,and Resistance

PhysicalCharacteristics of the CirculationBasicPrincipIesof Circulatory FunctionInterrelationships of Pressure, Flow,andResistance

157157158

159

CHAPTER15 CHAPTER20

Vascular Distensibility and Functions of the Cardiac Output, Venous Return,Arterial and Venous Systems 167 and Their Regulation 229

VascularDistensibility 167 Normal Values for Cardiac Output at RestArterialPressure Pulsations 168 and During Activity 229

VeinsandTheir Functions 171 Control of Cardiac Output by VenousReturn-Role of the Frank-Starling Mechanism

CHAPTER16 of the Heart 229

The Microcirculation and Lymphatic Pathologically High or Low Cardiac Outputs 232

System: CapiUary Fluid Exchange, Methods for Measuring CardiacInterstitial Fluid, and Lymph Flow 177 Output 240Structure of the Microcirculation

and Capillary System 177 CHAPTER21

Flowof Bloodin the Capillaries- Muscle Blood Flow and Cardiac OutputVasomotion 178 During Exercise; the Coronary Circulation

Exchangeof Water, Nutrients, and Otherand Ischemic Heart Disease 243

Substances Between the Blood and Blood Flow Regulation in Skeletal MuscleInterstitial Fluid 179 at Rest and During Exercise 243

Interstitium and Interstitial Fluid 180 Coronary Circulation 246

FluidFiltrationAcrossCapillaries Is CHAPTER22Determined by Hydrostatic and Colloid Cardiac Failure 255Osmotic Pressures, as Well as CapillaryFiltrationCoefficient 181 Circulatory Dynamics in Cardiac Failure 255

LymphaticSystem 186 Unilateral Left Heart Failure 259

CHAPTER17Low-Output Cardiac Failure-Cardiogenic Shock 259

Localand Humoral Control of Tissue Edema in Patients with Cardiac Failure 259BloodFlow 191

LocalControl of Blood Flow in Response toCardiac Reserve 261

TissueNeeds 191 CHAPTER23Mechanisms of Blood Flow Control 191 Heart Valves and Heart Sounds;Humoral Control of the Circulation 199 Valvular and Congenital Heart

Defects 265CHAPTER18 Heart Sounds 265NervousRegulation of the Circulation, Abnormal Circulatory Dynamics in Valvularand Rapid Control of Arterial Pressure 201 Heart Disease 268Nervous Regulation of the Circulation 201

Abnormal Circulatory DynamicsRoleof the Nervous System in Rapid in Congenital Heart Defects 269Controlof Arterial Pressure 204

Use of Extracorporeal Circulation DuringSpecialFeatures of Nervous Control Cardiac Surgery 271ofArterialPressure 209

Hypertrophy of the Heart in Valvular

CHAPTER19 and Congenital Heart Disease 272

Roleof the Kidneys in Long- Term Control of CHAPTER24Arterial Pressure and in Hypertension: The Circulatory Shock and Its Treatment 273Integrated System for Arterial PressureRegulation 213 Physiologic Causes of Shock 273

Renal-Body Fluid System for Arterial Shock Caused by Hypovolemia-PressureControl 213 Hemorrhagic Shock 274

TheRenin-Angiotensin System: Its Role Neurogenic Shock-Increased VascularinArterial Pressure Control 220 Capacity 279

Summary of the Integrated, Multifaceted Anaphylactic Shock and Histamine Shock 280

System for Arterial Pressure Regulation 226 Septic Shock 280

Physiologyof Treatment in Shock 280Circulatory Arrest 281

UNITV

The Body Fluids and Kidneys

CHAPTER25

The Body Fluid Compartments: ExtraceUularand IntraceUular Fluids; Edema 285

FluidIntake and Output Are BalancedDuring Steady-State Conditions 285

Body FluidCompartments 286ExtracellularFluidCompartment 287BloodVolume 287Constituents of Extracellularand IntracellularFluids 287

Measurement of FluidVolumesin the DifferentBody FluidCompartments-the Indicator-Dilution PrincipIe 287Determination of Volumes of Specific BodyFluidCompartments 289Regulation of FluidExchangeand OsmoticEquilibriumBetween Intracellularand ExtracellularFluid 290

BasicPrincipIesof Osmosis and OsmoticPressure 290

Osmotic EquilibriumIs Maintained BetweenIntracellular and ExtracellularFluids 291

Volume and Osmolality of Extracellularand Intracellular Fluids inAbnormal States 292Glucose and Other Solutions Administeredfor Nutritive Purposes 294ClinicalAbnormalities of FluidVolumeRegulation:Hyponatremia and Hypernatremia 294Edema:ExcessFluid in the Tissues 296

Fluidsinthe "PotentialSpaces"of the Body 300

CHAPTER26

Urine Formation by the Kidneys:l. Glomerular Filtration, Renal Blood Flow,and TheirControl 303

MultipleFunctionsof the Kidneys 303PhysiologicAnatomy of the Kidneys 304Micturition 307

PhysiologicAnatomy of the Bladder 307Transport of Urine from the KidneyThroughthe Ureters and into the Bladder 308

Fittingof the Bladderand BladderWallTone;the Cystometrogram 309Micturition Reflex 309

Abnormalities of Micturition 310Urine Formation Results from GlomerularFiltration,Tubular Reabsorption, and TubularSecretion 310

Glomerular Filtration- The First Step inUrine Formation 312Determinants of the GFR 314Renal Blood Flow 316

PhysiologicControl of Glomerular Filtrationand RenalBlood Flow 317

Autoregulation of GFRand Renal Blood Flow 319

CHAPTER27

Urine Formation by the Kidneys: 11.TubularReabsorption and Secretion 323

RenalTubular Reabsorption and Secretion 323Tubular Reabsorption Includes Passiveand Active Mechanisms 323

Reabsorption and Secretion Along DifferentParts of the Nephron 329

Regulation of Tubular Reabsorption 334Use of Clearance Methods to Quantify KidneyFunction 340

CHAPTER 28

Urine Concentration and Dilution; Regulationof ExtraceUular Fluid Osmolarity and SodiumConcentration 345

KidneysExcrete ExcessWater by FormingDilute Urine 345

KidneysConserveWater by ExcretingConcentrated Urine 346

Quantifying Renal Urine Concentrationand Dilution:"FreeWater" and OsmolarClearances 354

Disorders of Urinary Concentrating Ability 354Control of ExtracellularFluidOsmolarity andSodium Concentration 355

Osmoreceptor-ADH Feedback System 355

Importance ofThirst in ControllingExtracellularFluidOsmolarity and SodiumConcentration 357

Salt-Appetite Mechanism for ControllingExtracellularFluidSodium Concentration andVolume 360

CHAPTER29

Renal Regulation of Potassium, Calcium,Phosphate, and Magnesium; Integrationof Renal Mechanisms for Control of BloodVolume and ExtraceUular FluidVolume 361

Regulation of ExtracellularFluidPotassiumConcentration and Potassium Excretion 361

Control of Renal Calcium Excretionand Extracellular Calcium Ion Concentration 367

Control of Renal Magnesium Excretion andExtracellular Magnesium Ion Concentration 369

Integration of Renal Mechanisms for Controlof Extracellular Fluid 370

Importance of Pressure Natriuresis andPressure Diuresis in Maintaining Body Sodiumand Fluid Balance 371

Distribution of Extracellular FluidBetween the Interstitial Spaces andVascularSystem 373Nervous and Hormonal Factors Increase the

Effectiveness of Renal-Body Fluid FeedbackControl 373

Integrated Responses to Changes in SodiumIntake 376

Conditions That Cause Large Increases inBloodVolume and Extracellular Fluid Volume 376

Conditions That Cause Large Increases inExtracellular Fluid Volume but with NormalBloodVolume 377

CHAPTER 30

Acid-BaseRegulation 379W Concentration Is precisely Regulated 379Acidsand Bases- Their Definitions andMeanings 379

DefendingAgainst Changes in H+Concentration:Buffers.Lungs,and Kidneys 380

Bufferingof H+in the Body Fluids 380BicarbonateBufferSystem 381

PhosphateBufferSystem 383ProteinsAreImportant Intracellular Buffers 383

RespiratoryRegulationof Acid-BaseBalance 384RenalControlof Acid-BaseBalance 385

Secretionof H+and Reabsorption of HC03"bythe RenalTubules 386Combinationof ExcessH+with PhosphateandAmmoniaBuffersin the Tubule Generates"New"HCO- 388

3

Quantifying Renal Acid-Base Excretion 389RenalCorrection of Acidosis-Increased

Excretionof H+and Addition of HC03"tothe Extracellular Fluid 391

RenalCorrection of Alkalosis-DecreasedTubular Secretion of H+and Increased

Excretionof HC03" 391ClinicalCauses of Acid-Base Disorders 392

Treatment of Acidosis or Alkalosis 393

ClinicalMeasurements and Analysis ofAcid-BaseDisorders 393

CHAPTER31

Diuretics, Kidney Diseases 397Diuretics and Their Mechanisms of Action 397

KidneyDiseases 399Acute RenalFailure 399Chronic RenalFailure:An IrreversibleDecreasein the Number of Functional Nephrons 401SpecificTubular Disorders 408Treatment of Renal Failureby Transplantationor by Dialysiswith an Artificial Kidney 409

UNITVI

Blood CeUs,Immunity, and BloodCoagulation

CHAPTER32

RedBloodCeUs,Anemia,and Polycythemia 413Red Blood Cells (Erythrocytes) 413Anemias 420

Polycythemia 421

CHAPTER33

Resistance of the Body to Infedion:l. Leukocytes, Granulocytes, the Monocyte-Macrophage System, and Inflammation 423Leukocytes (White BloodCells) 423Neutrophils and Macrophages DefendAgainst Infections 425Monocyte-Macrophage CellSystem(Reticuloendothelial System) 426Inflammation: Roleof Neutrophilsand Macrophages 428Eosinophils 430Basophils 431Leukopenia 431Leukemias 431

CHAPTER34

Resistance of the Body to Infedion:11.Immunity and AUergy Innate Immunity 433

Acquired (Adaptive) Immunity 433

Allergyand Hypersensitivity 443

CHAPTER35

Blood Types;Transfusion; Tissue and OrganTransplantation 445Antigenicity Causes Immune Reactions ofBlood 445

O-A-B Blood Types 445Rh Blood Types 447

Transplantation of Tissues and Organs 449

CHAPTER 36

Hemostasis and Blood Coagulation 451Events in Hemostasis 451VascularConstriction 451

Mechanism of BloodCoagulation 453Conditions That Cause ExcessiveBleedinginHumans 457Thromboembolic Conditions in theHuman Being 459Anticoagulants for ClínicalUse 459

BloodCoagulation Tests 460

UNITVII

Respiration

CHAPTER 37

Pulmonary Ventilation 465Mechanics of Pulmonary Ventilation 465

Pulmonary Volumes and Capacities 469Minute RespiratoryVolume EqualsRespiratoryRate TimesTidalVolume 471AlveolarVentilation 471

Functions of the Respiratory Passageways 472

CHAPTER 38

Pulmonary Circulation, Pulmonary Edema,Pleural Fluid 477

PhysiologicAnatomy of the PulmonaryCirculatory System 477

Pressures in the Pulmonary System 477BloodVolume of the Lungs 478

Blood FlowThrough the Lungsand ItsDistribution 479

Effectof Hydrostatic Pressure Gradients inthe Lungson RegionalPulmonary Blood Flow 479

Pulmonary Capillary Dynamics 481Fluid in the Pleural Cavity 483

CHAPTER39

Physical Principles of Gas Exchange;Diffusion of Oxygen and Carbon DioxideThrough the Respiratory Membrane 485Physicsof Gas Diffusionand GasPartial Pressures 485

Compositions of AlveolarAirand AtmosphericAirAre Different 487

Diffusionof Gases Through the RespiratoryMembrane 489Effectof the Ventilation-Perfusion Ratio onAlveolarGas Concentration 492

CHAPTER40

Transport of Oxygen and Carbon Dioxide inBlood and Tissue Fluids 495

Transport of Oxygen from the Lungsto theBodyTissues 495Transport of Carbon Dioxidein the Blood 502

Respiratory ExchangeRatio 504CHAPTER 41

Regulation of Respiration 505

Respiratory Center 505

Chemical Control of Respiration 507Peripheral Chemoreceptor System for Controlof RespiratoryActivity-Role of Oxygen inRespiratory Control 508

Regulation of Respiration During Exercise 510Other FactorsThat Affect Respiration 512

CHAPTER42

Respiratory Insufficiency-Pathophysiology,Diagnosis, Oxygen Therapy 515

Useful Methods for Studying RespiratoryAbnormalíties 515

Pathophysiology of Specific PulmonaryAbnormalities 517

Hypoxia and Oxygen Therapy 520Hypercapnia-Excess Carbon Dioxidein theBody Fluids 522Artificial Respiration 522

UNITVIII

Aviation, Space, and Deep-Sea DivingPhysiology

CHAPTER43

Aviation,High-Altitude, andSpace Physiology 527

Effectsof LowOxygen Pressure on the Body 527

Effectsof Acceleratory Forceson the BodyinAviationand Space Physiology 531"ArtificialClimate" in the Sealed Spacecraft 533

Weightlessness in Space 533

CHAPTER 44

Physiology of Deep-Sea Diving andOther Hyperbaric Conditions 535Effectof High Partíal Pressures of IndividualGases on the Body 535Scuba (Self-Contained Underwater BreathingApparatus) Diving 539Special PhysiologicProblems in Submarines 540

Hyperbaric Oxygen Therapy 540

UNITIX

The Nervous System: A.General Principlesand Sensory Physiology

CHAPTER45

Organization of the Nervous System, BasicFunctions of Synapses, andNeurotransmitters 543

GeneralDesign of the Nervous System 543Major Levels of Central Nervous SystemFunction 545

Comparison of the Nervous System with aComputer 546

Central Nervous System Synapses 546

Some Special Characteristics of SynapticTransmission 557

CHAPTER46

SensoryReceptors, Neuronal Circuits forProcessingInformation 559Typesof Sensory Receptors and theStimuliThey Detect 559Transductionof SensoryStimulíinto Nerve Impulses 560NerveFibersThat Transmit DifferentTypes ofSignalsand Their PhysiologicClassification 563Transmissionof Signals of Different IntensityinNerveTracts-Spatial and TemporalSummation 564

Transmissionand Processingof Signals inNeuronalPools 564

Instabilityand Stability of Neuronal Circuits 569CHAPTER 47

SomaticSensations: l. General Organization,the Tactileand Position Senses 571Classificationof Somatic Senses 571

Detectionand Transmissionof TactileSensations 571

Sensorypathways for Transmitting SomaticSignals¡nto the Central Nervous System 573Transmissionin the Dorsal Column-MediallemniscalSystem 573Transmissionof LessCritical Sensory Signalsinthe Anterolateral pathway 580SomeSpecialAspects of SomatosensoryFunction 581

CHAPTER48

SomaticSensations: 11.Pain, Headache, andThermalSensations 583

Typesof Painand Their Qualities-Fast PainandSlowPain 583

Pain Receptors and Their Stimulation 583

Dual Pathways for Transmission of PainSignals into the Central Nervous System 584Pain Suppression ("Analgesia")System in theBrainand Spinal Cord 586Referred Pain 588

VisceralPain 588Some ClínicalAbnormalities of Painand Other Somatic Sensations 590Headache 590Thermal Sensations 592

UNITX

The Nervous System: B.The Special Senses

CHAPTER49

The Eye:1.Optics of Vision 597Physical PrincipIesof Optics 597

Optics of the Eye 600Ophthalmoscope 605FluidSystem of the Eye-Intraocular Fluid 606

CHAPTER50

The Eye:11.Receptor and Neural Functionof the Retina 609

Anatomy and Function of the StructuralElements of the Retina 609

Photochemistry of Vision 611ColorVision 615

Neural Fundion ofthe Retina 616

CHAPTER51

The Eye:111.Central Neurophysiologyof Vision 623

Visual Pathways 623

Organization and Function of the VisualCortex 624

Neuronal Patterns of Stimulation DuringAnalysisof the Visuallmage 626Fieldsof Vision;Perimetry 627

Eye Movements and Their Control 627Autonomic Control of Accommodationand PupillaryAperture 631

CHAPTER 52

The Senseof Hearing 633

Tympanic Membrane and the Ossicular System 633Cochlea 634

Central Auditory Mechanisms 639

Hearing Abnormalities 642

CHAPTER53The Chemical Senses- Taste and SmeU

Sense ofTaste

Sense of Smell

645

645648

UNITXI

The Nervous System: C. Motor andIntegrative Neurophysiology

CHAPTER 54

Motor Functions of the Spinal Cord; the CordReflexes 655

Organization of the Spinal Cord for MotorFunctions 655

MuscleSensory Receptors-Muscle Spindlesand GolgiTendon Organs-And Their Rolesin Muscle Control 657FlexorReflexand the Withdrawal Reflexes 661Crossed Extensor Reflex 663

Reciprocallnhibition and Reciprocallnnervation 663Reflexesof Posture and Locomotion 663Scratch Reflex 664

Spinal Cord ReflexesThat Cause Muscle Spasm 664Autonomic Reflexesin the SpinalCord 665

Spinal CordTransection and Spinal Shock 665

CHAPTER55Cortical and Brain Stem Control of MotorFunction 667

Motor Cortex and CorticospinalTract 667Roleof the BrainStem in Controlling MotorFunction 673

Vestibular Sensations and Maintenance ofEquilibrium 674Functions of BrainStem Nuclei in ControllingSubconscious, Stereotyped Movements 678

CHAPTER56Contributions of the CerebeUum and BasalGanglia to OveraU Motor Control 681Cerebellum and Its Motor Functions 681

Basal Ganglia- Their Motor Functions 689Integration of the Many Parts of the TotalMotor Control System 694

CHAPTER 57

Cerebral Cortex, InteUectual Functions of theBrain, Learning, and Memory 697PhysiologicAnatomy of the Cerebral Cortex 697Functions of SpecificCorticalAreas 698

Function of the Brainin Communication-Language Input and Language Output 703Function of the Corpus Callosum and AnteriorCommissure to TransferThoughts, Memories,Training,and Other Information Between theTwo Cerebral Hemispheres 704Thoughts, Consciousness, and Memory 705

CHAPTER 58

Behavioral and Motivational Mechanisms of theBrain- The limbic System and theHypothalamus 711Activating-DrivingSystemsof the Brain 711

LimbicSystem 714FunctionalAnatomy of the LimbicSystem; KeyPosition of the Hypothalamus 714Hypothalamus, a Major Control Headquartersfor the LimbicSystem 715

Specific Functions of Other Parts of the LimbicSystem 718

CHAPTER59

States of Brain Activity-Sleep, BrainWaves,Epilepsy, Psychoses 721

Sleep 721

Epilepsy 725Psychotic Behaviorand Dementia-Rolesof Specific Neurotransmitter Systems 726Schizophrenia-Possible ExaggeratedFunction of Part of the Dopamine System 727

CHAPTER60

The Autonomic Nervous System and theAdrenal MeduUa 729

General Organization of the AutonomicNervous System 729BasicCharacteristics of Sympathetic andParasympathetic Function 731Autonomic Reflexes 738

Stimulation of Discrete Organs in SomeInstances and Mass Stimulation in OtherInstances by the Sympathetic andParasympathetic Systems 738Pharmacology of the Autonomic NervousSystem 739

CHAPTER 61

Cerebral Blood Flow,Cerebrospinal Fluid,and Brain Metabolism 743Cerebral Blood Flow 743

Cerebrospinal FluidSystem 746BrainMetabolism 749

UNIT XII

Gastrointestinal Physiology

CHAPTER62

GeneralPrinciples of GastrointestinalFunction-Motility, Nervous Control, andBloodCirculation 753

GeneralPrinciplesof Gastrointestinal Motility 753NeuralControl of Gastrointestinal Function-EntericNervous System 755FunctionalTypes of Movements in theGastrointestinalTract 759

Gastrointestinal Blood Flow-IISplanchnicCirculation" 759

CHAPTER63

Propulsionand Mixingof Food in theAlimentaryTract 763

Ingestionof Food 763MotorFunctionsof the Stomach 765Movementsof the Smalllntestine 768

Movementsof the Colon 770

OtherAutonomic ReflexesThat Affect BowelActivity 772

CHAPTER64

SecretoryFunctions of the Alimentary Tract 773

General Principles of Alimentary TractSecretion 773

Secretion of Saliva 775

Esophageal Secretion 776Gastric Secretion 777

Pancreatic Secretion 780

Secretion of Bile by the Liver; Functions of theBiliaryTree 783Secretions of the Smalllntestine 786

Secretion of Mucus by the Large Intestine 787

CHAPTER65

Digestionand Absorption in theGastrointestinal Tract 789

Digestionof the VariousFoods by Hydrolysis 789BasicPrinciplesof Gastrointestinal Absorption 793

Absorptionin the Smalllntestine 794Absorptionin the LargeIntestine: Formation ofFeces 797

CHAPTER66

Physiologyof Gastrointestinal Disorders 799

Disordersof Swallowing and of the Esophagus 799

Disorders of the Stomach 799

Disorders of the Smalllntestine 801

Disorders of the LargeIntestine 802General Disorders of the GastrointestinalTract 803

UNITXIII

MetaboLism and Temperature Regulation

CHAPTER 67

Metabolism of Carbohydrates, and Formationof AdenosineTriphosphate 809Central Roleof Glucose in CarbohydrateMetabolism 810

Transport of Glucose Through the CellMembrnne 810

Glycogen 15Stored in Liverand Muscle 811Release of Energy from Glucose by theGlycolytic pathway 812Release of Energy from Glucose by thePentose Phosphate pathway 816Formation of Carbohydrates from Proteinsand Fats-"Gluconeogenesis" 817BloodGlucose 817

CHAPTER 68

LipidMetabolism 819Transport of Lipidsin the Body Fluids 819Fat Deposits 821Use ofTriglycerides for Energy:Formation ofAdenosine Triphosphate 822Regulation of EnergyRelease fromTriglycerides 825Phospholipids and Cholesterol 826Atherosclerosis 827

CHAPTER 69

Protein Metabolism 831

BasicProperties 831Transport and Storage of AminoAcids 831Functional Rolesof the Plasma Proteins 833

Hormonal Regulation of Protein Metabolism 835

CHAPTER 70

The Liveras an Organ 837

PhysiologicAnatomy of the Liver 837Hepatic Vascularand LymphSystems 837Metabolic Functions of the Liver 839Measurement of Bilirubinin the Bileas aClinicalDiagnosticTool 840

CHAPTER71

Dietary Balances; Regulation of Feeding;Obesity and Starvation; Vitamins andMinerals 843

Energy Intake and Output Are Balanced UnderSteady-State Conditions 843Dietary Balances 843

Regulation of Food Intake and EnergyStorage 845Obesity 850Inanition,Anorexia,and Cachexia 851Starvation 852Vitamins 852

MineralMetabolism 855

CHAPTER72

Energetics and Metabolic Rate 859Adenosine Triphosphate (ATP)Functions asan IIEnergyCurrency" in Metabolism 859Control of EnergyRelease in the Cell 861Metabolic Rate 862

EnergyMetabolism-Factors That InfluenceEnergyOutput 863

CHAPTER73

BodyTemperature Regulation,and Fever 867

Normal BodyTemperatures 867

BodyTemperature 15Controlled byBalancing Heat Production andHeat Loss 867

Regulation of BodyTemperature-Roleof the Hypothalamus 871Abnormalities of BodyTemperatureRegulation 875

UNIT XIV

Endocrinology and Reproduction

CHAPTER 74

Introduction to Endocrinology 881

Coordination of Body Functions by ChemicalMessengers 881

Chemical Structure and Synthesis ofHormones 881

Hormone Secretion,Transport, and Clearancefrom the Blood 884Mechanisms of Action of Hormones 886Measurement of Hormone Concentrationsin the Blood 891

CHAPTER75

Pituitary HormonesandTheirControl by theHypothalamus 895Pituitary Gland and Its Relation to theHypothalamus 895Hypothalamus Controls Pituitary Secretion 897PhysiologicalFunctions of Growth Hormone 898Posterior Pituitary Gland and Its Relation tothe Hypothalamus 904

CHAPTER76

Thyroid Metabolic Hormones 907

Synthesis and Secretion of the ThyroidMetabolic Hormones 907

PhysiologicalFunctions of the ThyroidHormones 910

Regulation of Thyroid Hormone Secretion 914

Diseases of the Thyroid 916

CHAPTER77Adrenocortical Hormones 921

Synthesis and Secretion of AdrenocorticalHormones 921

Functions of the Mineralocorticoids-Aldosterone 924

Functions of the Glucocorticoids 928

AdrenalAndrogens 934Abnormalities of Adrenocortical Secretion 934

CHAPTER78

Insulin, Glucagon, and Diabetes MeUitus 939Insulin and Its Metabolic Effects 939

Glucagon and Its Functions 947

Somatostatin Inhibits Glucagon and InsulinSecretion 949

Summary of Blood Glucose Regulation 949Diabetes Mellitus 950

CHAPTER 79

Parathyroid Hormone, Calcitonin, Calciumand Phosphate Metabolism, Vitamin D,Bone,andTeeth 955Overviewof CalciumandPhosphate Regulation in the ExtracellularFluidand Plasma 955Bone and Its Relation to ExtracellularCalciumand Phosphate 957Vitamin D 960

Parathyroid Hormone 962Calcitonin 966

Summary of Control of Calcium IonConcentration 966

Pathophysiologyof Parathyroid Hormone,Vitamin D,and Bone Disease

Physiologyof the Teeth

CHAPTER80

Reproductive and Hormonal Functions ofthe Male (and Function of the Pineal Gland)

PhysiologicAnatomy of the Male SexualOrgans

SpermatogenesisMaleSexualAct

Testosteroneand Other Male SexHormones

Abnormalitiesof Male Sexual Function

ErectileDysfunction in the Male

PinealGland-Its Function in ControllingSeasonalFertility in SomeAnimals

CHAPTER81

FemalePhysiology Before Pregnancy andFemaleHormones

PhysiologicAnatomy of the FemaleSexualOrgans

FemaleHormonal System

MonthlyOvarian Cycle; Function of theGonadotropicHormonesFunctionsof the Ovarian Hormones-Estradioland Progesterone

Regulationof the FemaleMonthlyRhythm-Interplay Between the OvarianandHypothalamic-Pituitary Hormones

Abnormalitiesof Secretion by the OvariesFemaleSexual Act

FemaleFertility

CHAPTER 82

Pregnancyand LactationMaturationand Fertilization of the Ovum

EarlyNutrition of the Embryo

967

969

973

973973

978979984985

986

987

987

987

988

991

996999

10001000

1003

10031005

Function of the Placenta

Hormonal Factors in PregnancyResponseof the Mother's Body to PregnancyParturitionLactation

CHAPTER83

Fetal and Neonatal Physiology

Growth and Functional Developm~nt of theFetus

Development of the Organ Systems

Adjustments of the Infant to Extrauterine life

Special Functional Problems in the Neonate

Special Problems of Prematurity

Growth and Development of the Child

10051007100910111014

1019

10191019

102110231026

1027

Sports Physiology

UNIT XV

CHAPTER 84

Sports PhysiologyMuscles in Exercise

Respiration in Exercise

Cardiovascular System in Exercise

Body Heat in Exercise

Body Fluids and Salt in Exercise

Drugs and AthletesBody FitnessProlongs life

Index

1031

1031

1036

1038

1039

1040

1040

1041

1043