医用生理学概要 英文版PDF电子书下载

SECTION Ⅰ. INTRODUCTION 1

1. The General Cellular Basls of Medical Physioloogy 1

Introduction 1

General Principles 1

Functional Morphology of the Cell 8

Structure Function of DNA RNA 17

Transport Across Cell Membranes 27

The Capillary Wall 35

Intercellular Communication 35

Structure 40

Homeostasis 46

Aging 46

Section Ⅰ References: 47

2. Excitable Tissue:Nerve 49

Introduction 49

Nerve Cells 49

SECTION Ⅱ. PHYSIOLOGY OF NERVE MUSCLE CELLS 49

Excitation Conduction 51

Ionic Basis of Excitation Conduction 56

Neurotrophins 58

Nerve Fiber Types Function 58

Properties of Mixed Nerves 58

Glia 61

3. Excitable Tissue:Muscle 62

Introduction 62

Skeletal Muscle 62

Morphology 62

Electrical Phenomena Ionic Fluxes 65

Contractile Responses 65

Energy Sources Metabolism 70

Properties of Muscles in the Intact Organism 72

Electrical Properties 74

Cardiac Muscle 74

Morphology 74

Mechanical Properties 75

Metabolism 77

Pacemaker Tissue 78

Smooth Muscle 78

Morphology 78

Visceral Smooth Muscle 78

Multi-unit Smooth Muscle 80

Synaptic Transmission 81

Functional Anatomy 81

Introduction 81

4. Synaptic Junctional Transmission 81

Electrical Events in Postsynaptic Neurons 84

Inhibition Facilitation at Synapses 88

Chemical Transmission of Synaptic Activity 90

Principal Neurotransmitter Systems 93

Synaptic Plasticity Learning 110

Neuromuscular Transmission 110

Neuromuscular Junction 110

Nerve Endings in Smooth Cardiac Muscle 112

Denervation Hypersensitivity 113

The Senses 115

5. Initlatlon of Impulses in Sense Organs 115

Introduction 115

Sense Organs Receptors 115

Electrical Chemical Events in Receptors 117

Ionic Basis of Excitation 118

Coding of Sensory Information 119

SectionⅡReferences: 121

SECTION Ⅲ FUNCTIONS OF THE NERVOUS SYSTEM 123

6. Reflexes 123

Introduction 123

Monosynaptic Reflexes: The Stretch Reflex 123

Polysynaptic Reflexes: The Withdrawal Reflex 129

General Properties of Reflexes 130

Introduction 132

Pathways 132

7. Cutaneous ,Deep, Visceral Sensation 132

Touch 135

Proprioception 136

Temperature 136

Pain 136

Other Sensations 142

Anatomic Considerations 144

Introduction 144

8. Vision 144

The Image-Forming Mechanism 149

The Photoreceptor Mechanism 152

Responses in the Visual Pathways Cortex 155

Color Vision 159

Other Aspects of Visual Function 161

Eye Movements 163

9. Hearing Equllibrium 166

Introduction 166

Anatomic Considerations 166

Hair Cells 170

Hearing 172

Vestibular Function 178

10. Smell Taste 180

Introduction 180

Smell 180

Taste 183

Receptor Organs Pathways 183

The Reticular Formation the Reticular Activating System 187

11. Alert Behavior, Sleep, the Electrical Activity of the Brain 187

The Thalamus the Cerebral Cortex 187

Introduction 187

Evoked Cortical Potentials 188

The Electroencephalogram 189

Physiologic Basis of the EEG, Consciousness, Sleep 191

General Principles 197

12. Control of Posture Movement 197

Introduction 197

Anatomy Function 198

Corticospinal Corticobulbar System 198

Posture-Regulating Systems 201

Spinal Integration 203

Medullary Components 204

Midbrain Components 206

Cortical Components 207

Basal Ganglia 207

Cerebellum 211

Anatomic Organization of Autonomic Outflow 217

13. The Autonomic Nervous System 217

Introduction 217

Chemical Transmission at Autonomic Junctions 219

Responses of Effector Organs to Autonomic Nerver Impulses 221

14. Central Regulation of Visceral Function 224

Introduction 224

Medulla Oblongata 224

Hypothalamus 225

Anatomic Considerations 225

Relation to Autonomic Function 226

Hypothalamic Function 226

Relation to Cyclic Phenomena 227

Relation to Sleep 227

Hunger 228

Thirst 232

Control of Posterior Pituitary Secretion 233

Control of Anterior Pituitary Secretion 239

Temperature Regulation 242

Introduction 248

Anatomic Considerations 248

15. Neural Basls of Instinctual Behavior Emotions 248

Limbic Functions 249

Sexual Behavior 249

Fear Rage 252

Motivation Addiction 253

Brain Chemistry Behavior 254

Effects of Adrenal Androgens Estrogens 256

Learning Memory 259

Methods 259

Introduction 259

16. Higher Functions of the Nervous System : Conditioned Reflexes, Learning, Related Phenomena 259

Functions of the Neocortex 264

Section Ⅲ References: 269

Introduction 271

17. Energy Balance, Metabolism, Nutrition 271

SECTION Ⅳ. ENDOCRINOLOGY,METABOLISM, REPRODUCTIVE FUNCTION 271

Energy Metabolism 271

Intermediary Metabolism 274

Carbohydrate Metabolism 278

Protein Metabolism 284

Fat Metabolism 290

Nutrition 302

Anatomic Consideration 307

Introduction 307

18. The Thyroid Gland 307

Formation Secretion of Thyroid Hormones 308

Transport Metabolism of Thyroid Hormones 311

Effects of Thyroid Hormones 313

Regulation of Thyroid Secretion 316

Clinical Correlates 317

19. Endocrine Functions of the Pancreas Regulation of Carbohydrate Metabolism 322

Introduction 322

Islet Cell Structure 322

Structure, Biosynthesis, Secretion of Insulin 323

Effects of Insulin 324

Fate of Secreted Insulin 324

Mechanism of Action 327

Consequences of Insulin Deficiency 328

Insulin Excess 333

Regulation of Insulin Secretion 334

Glucagon 337

Other Islet Cell Hormones 339

Effects of Other Hormones Exercise on Carbohydrate Metabolism 340

Hypoglycemia Diabetes Mellitus in Humans 341

Adrenal Morphology 344

Introduction 344

20. The Adrenal Medulla Adrenal Cortex 344

Adrenal Medulla 346

Structure Function of Medullary Hormones 346

Regulation of Adrenal Medullary Secretion 348

Adrenal Cortex 349

Structure Biosynthesis of Adrenocortical Hormones 349

Transport, Metabolism, Excretion of Adrenocortical Hormones 354

Physiologic Effects of Glucocorticoids 356

Pharmacologic Pathologic Effects of Glucocorticoids 358

Regulation of Glucocorticoid Secretio 359

Effects of Mineralocorticoids 362

Regulation of Aldosterone Secretion 364

Role of Mineralocorticoids in the Regulation of Salt Balance 366

Summary of the Effects of Adrenocortical Hyper- Hypofunction in Humans 366

Introduction 369

Calcium Phosphorus Metabolism 369

21. Hormonal Control of Calcium Metabolism the Physiology of Bone 369

Bone Physiology 370

Vitamin D the Hydroxycholecalciferols 375

The Parathyroid Glands 377

Calctionin 380

Effects of Other Hormones Humoral Agents on Calcium Metabolism 382

Introduction 383

22. The Pituitary Gland 383

Intermediate-Lobe Hormones 384

Morphology 384

Growth Hormone 386

Physiology of Growth 392

Pituitary Insufficiency 395

Pituitary Hyperfunction in Humans 396

23. The Gonads: Development Function of the Reproductive System 398

Introduction 398

Sex Differentiation Development 398

Chromosomal Sex 398

Embryology of the Human Reproductive System 400

Aberrant Sexual Differentiation 401

Puberty 405

Precocious Delayed Puberty 407

Menopause 408

Pituitary Gonadotropins Prolactin 408

The Male Reproductive System 410

Gametogenesis Ejaculation 411

Endocrine Function of the Testes 415

The Menstrual Cycle 419

The Female Reproductive System 419

Abnormalities of Testicular Function 419

Control of Testicular Function 419

Ovarian Hormones 425

Control of Ovarian Function 430

Abnormalities of Ovarian Function 433

Pregnancy 433

Lactation 436

24.Endocrlne Functlons of the Kidneys, Heart, Pineal Giand 439

Introduction 439

The Renin-Angiotensin System 439

Erythropoietin 444

Hormones of the Heart Other Natriuretic Factors 445

Pineal Gland 447

SectionⅣReferences: 449

SECTIONⅤ.GASTROINTESTINAL FUNCTION 453

25.Digestion Absorption 453

Introduction 453

Catbohydrates 453

Proteins Nucleic Acids 456

Lipids 458

Absorption of Water Electrolytes 459

Absorption of Vitamins Minerals 462

General Considerations 464

Introduction 464

26.Regulation of Gastrolntestinal Function 464

Gastrointestinal Hormones 466

Mouth Esophagus 472

Stomach 475

Exocrine Portion of the Pancreas 481

Liver Biliary System 483

Small Intestine 489

Colon 492

SectionⅤReferences: 496

Bone Marrow 499

Introduction 499

Blood 499

27.Circulating Body Fiuids 499

SECTIONⅥ.CIRCULATION 499

White Blood Cells 500

Immunity 504

Platelets 514

Red Blood Cells 515

Blood Types 519

Plasma 522

Hemostasis 524

Lymph 527

Origin Spread of Cardiac Excitation 528

Introduction 528

28.Origin or the Heartbeat the Eiectrical Activity of the Heart 528

The Electrocardiogram 530

Cardiac Arrhythmias 535

Eiectrocardiographic Findings in Other Cardiac Systemic Diseass 541

29.The Heart as a Pump 545

Introduction 545

Mechanical Events of the Cardiac Cycle 545

Cardiac Output 550

30.Dynamlcs of Blood Lymph Flow 556

Introduction 556

Anatomic Considerations 556

Biophysical Considerations 560

Arterial Arteriolar Circulation 565

Capillary Circulation 568

Lymphatic Circulation Interstitial Fluid Volume 570

Venous Circulation 572

31.Cardiovascular Regulatory Mechanisms 574

Introduction 574

Local Regulatory Mechanisms 574

Substances Secreted by the Endothelium 575

Systemic Regulation by Hormones 577

Systemic Regulation by the Nervous System 579

Anatomic Considerations 588

Cerebral Circulation 588

Introduction 588

32.Circulation Through Speciai Regions 588

Cerebrospinal Fluid 589

The Blood-Brain Barrier 591

Cerebral Blood Flow 593

Regulation of Cerebral Circulation 595

Brain Metabolism Oxygen Requirements 596

Coronary Circulation 597

Splanchnic Circulation 601

Circulation of the Skin 602

Placental Fetal Circulation 603

Compensations for Gravitational Effects 607

Introduction 607

33.Cardiovascular Homeostasis in Heaith Disease 607

Exercise 609

Inflammation Wound Healing 612

Shock 613

Hypertension 618

Heart Failure 620

SectionⅥReferences: 622

SECTIONⅦ.RESPIRATION 625

34.Pulmonary Function 625

Introduction 625

Properties of Gases 625

Anatomy of the Lungs 626

Mechanics of Respiration 627

Gas Exchange in the Lungs 637

Pulmonary Circulation 639

Other Functions of the Respiratory System 642

35.Gas Transport Between the Lungs the Tissues 644

Introduction 644

Oxygen Transport 644

Carbon Dioxide Transport 647

36.Regulation of Respiration 649

Introduction 649

Neural Control of Breathing 649

Regulation of Respiratory Activity 650

Chemical Control of Breathing 651

Nonchemical Influences on Respiration 656

37.Respiratory Adjustments in Health Disease 658

Introduction 658

Effects of Exercise 658

Hypoxia 660

Hypoxic Hypoxia 661

Other Forms of Hypoxia 667

Oxygen Treatment 668

Hypercapnia Hypocapnia 668

Other Respiratory Abnormalities 669

Effects of Increased Barometric Pressure 670

Artificial Respiration 672

SectionⅦReferences: 673

SECTIONⅧ.FORMATION EXCRETION OF URINE 675

38.Renal Function Micturition 675

Introduction 675

Functional Anatomy 675

Renal Circulation 679

Glomerular Filtration 681

Tubular Function 684

Water Excretion 689

Acidification of the Urine Bicarbonate Excretion 694

Regulation of Na+ Cl- Excretion 697

Regulation of K+ Excretion 699

Diuretics 699

Effects of Disordered Renal Function 700

Filling of the Bladder 701

Emptying of the Bladder 701

39.Regulation of Extracellular Fluid Composition Volume 704

Introduction 704

Defense of Tonicity 704

Defense of Volume 704

Defense of Specific Ionic Composition 705

Defense of H+ Concentration 705

SectionⅧReferences: 713

Appendix 714

Ceneral References 714

Normal Values the Statistical Evaluation of Data 714

Abbreviations Symbols Commonly Used in Physiology 716

Some Standard Respiratory Symbols 722

Equivalents of Metric, United States, English Measures 723

Greek Alphabet 723

Self-Study: Objectives, Essay Questions, Multiple-Choice Questions 725

Answers to Quantitative Multiple-Choice Questions 775

Index 781

Tables 781