UNIT Ⅰ Introduction to Physiology: The Cell and General Physiology 2
CHAPTER 1 Functional Organization of the Human Body and Control of the Internal Environment 2
Cells as the Living Units of the Body 2
Extracellular Fluid—The Internal Environment 2
Homeostatic Mechanisms of the Major Functional Systems 3
Homeostasis 3
Extracellular Fluid Transport System—The Circulatory System 3
Origin of Nutrients in the Extracellular Fluid 3
Control Systems of the Body 4
Reproduction 4
Regulation of Body Functions 4
Removal of Metabolic End Products 4
Examples of Control Mechanisms 5
Characteristics of Control Systems 6
Summary—Automaticity of the Body 7
CHAPTER 2 The Cell and Its Function 9
Organization of the Cell 9
Physical Structure of the Cell 10
Membranous Structures of the Cell 10
Cytoplasm and Its Organelles 12
Nucleus 14
Nucleoli and Formation of Ribosomes 15
Comparison of the Animal Cell with Precellular Forms of Life 15
Nuclear Membrane 15
Functional Systems of the Cell 16
Ingestion by the Cell—Endocytosis 16
Digestion of Pinocytic and Phagocytic Foreign Substances in the Cell—Function of the Lysosomes 17
Synthesis and Formation of Cellular Structures by the Endoplasmic Reticulum and the Golgi Apparatus 18
Extraction of Energy from Nutrients—Function of the Mitochondria 19
Locomotion of Cells 21
CHAPTER 3 Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction 24
The Genes 24
Genetic Code 25
The DNA Code Is Transferred to an RNA Code—The Process of Transcription 25
Synthesis of RNA 26
Assembly of the RNA Molecule from Activated Nucleotides Using the DNA Strand as a Template—The Process of Transcription 27
Messenger RNA—The Codons 27
Transfer RNA—The Anticodons 27
Ribosomal RNA 28
Formation of Proteins on the Ribosomes—The Process of Translation 29
Synthesis of Other Substances in the Cell 30
Control of Genetic Function and Biochemical Activity in Cells 30
Genetic Regulation 30
Control of Intracellular Function by Enzyme Regulation 32
The DNA-Genetic System Also Controls Cell Reproduction 32
Cell Reproduction Begins with Replication of the DNA 33
Cell Mitosis 34
Chromosomes and Their Replication 34
Control of Cell Growth and Cell Reproduction 35
Cell Differentiation 35
Cancer 36
UNIT Ⅱ Membrane Physiology, Nerve, and Muscle 40
CHAPTER 4 Transport of Substances Through the Cell Membrane 40
The Lipid Barrier of the Cell Membrane and Cell Membrane Transport Proteins 40
Diffusion 40
Diffusion Through the Cell Membrane 41
Diffusion Through Protein Channels and Gating of These Channels 42
Facilitated Diffusion 43
Factors That Affect Net Rate of Diffusion 44
Osmosis Across Selectively Permeable Membranes— Net Diffusion of Water 45
Active Transport 47
Primary Active Transport 47
Secondary Active Transport—Co-transport and Counter-transport 49
Active Transport Through Cellular Sheets 49
CHAPTER 5 Membrane Potentials and Action Potentials 52
Basic Physics of Membrane Potentials 52
Membrane Potentials Caused by Diffusion 52
Measuring the Membrane Potential 53
Resting Membrane Potential of Nerves 54
Origin of the Normal Resting Membrane Potential 54
Nerve Action Potential 55
Voltage-Gated Sodium and Potassium Channels 56
Summary of the Events That Cause the Action Potential 58
Roles of Other Ions During the Action Potential 59
Initiation of the Action Potential 59
Propagation of the Action Potential 59
Re-establishing Sodium and Potassium Ionic Gradients After Action Potentials Are Completed—Importance of Energy Metabolism 60
Plateau in Some Action Potentials 61
Rhythmicity of Some Excitable Tissues—Repetitive Discharge 61
Special Aspects of Signal Transmission in Nerve Trunks 62
Excitation—The Process of Eliciting the Action Potential 63
Recording Membrane Potentials and Action Potentials 64
Refractory Period After an Action Potential During Which a New Stimulus Can not Be Elicited 64
Inhibition of Excitability— Stabilizers and Local Anesthetics 64
CHAPTER 6 Contraction of Skeletal Muscle 67
Physiologic Anatomy of Skeletal Muscle 67
The Skeletal Muscle Fiber 67
General Mechanism of Muscle Contraction 68
Molecular Mechanism of Muscle Contraction 70
Molecular Characteristics of the Contractile Filaments 70
Efeet of Actin and Myosin Filament Overlap on Tension Developed by the Contracting Muscle 72
Relation of Velocity of Contraction to Load 73
Characteristics of Whole Muscle Contraction 74
Sources of Energy for Muscle Contraction 74
Work Output During Muscle Contraction 74
Energetics of Muscle Contraction 74
Mechanics of Skeletal Muscle Contraction 76
Remodeling of Muscle to Match Function 77
Rigor Mortis 78
CHAPTER 7 Excitation of Skeletal Muscle: A. Neuromuscular Transmission and B. Excitation-Contraction Coupling 80
Transmission of Impulses from Nerves to Skeletal Muscle Fibers: The Neuromuscular Junction 80
Secretion by Acetylcholine by the Nerve Terminals 80
Molecular Biology of Acetylcholine Formation and Release 82
Muscle Action Potential 83
Myasthenia Gravis 83
Drugs That Affect Transmission at the Neuromuscular Junction 83
Spread of the Action Potential to the Interior of the Muscle Fiber by Way of a Transverse Tubule System 84
Excitation-Contraction Coupling 84
Transverse Tubule—Sarcoplasmic Reticulum System 84
Release of Calcium Ions by the Sarcoplasmic Reticulum 85
CHAPTER 8 Contraction and Excitation of Smooth Muscle 87
Contraction of Smooth Muscle 87
Types of Smooth Muscle 87
Contractile Mechanism in Smooth Muscle 87
Regulation of Contraction by Calcium Ions 89
Neuromuscular Junctions of Smooth Muscle 90
Membrane Potentials and Action Potentials in Smooth Muscle 90
Neural and Hormonal Control of Smooth Muscle Contraction 90
Effect of Local Tissue Factors and Hormones to Cause Smooth Muscle Contraction Without Action Potentials 92
Source of Calcium Ions That Cause Contraction:(1)Through the Cell Membrane and (2)from the Sarcoplasmic Reticulum 93
UNIT Ⅲ The Heart 96
CHAPTER 9 Heart Muscle; The Heart as a Pump 96
Physiology of Cardiac Muscle 96
Physiologic Anatomy of Cardiac Muscle 96
Action Potentials in Cardiac Muscle 97
The Cardiac Cycle 99
Diastole and Systole 99
Function of the Ventricles as Pumps 100
Emptying of the Ventricles During Systole 100
Function of the Atria as Primer Pumps 100
Relationship of the Electrocardiogram to the Cardiac Cycle 100
Function of the Valves 101
The Aortic Pressure Curve 101
Relationship of the Heart Sounds to Heart Pumping 102
Work Output of the Heart 102
Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart 103
Regulation of Heart Pumping 103
Intrinsic Regulation of Heart Pumping—The Frank-Starling Mechanism 103
Effect of Potassium and Calcium Ions on Heart Function 106
Effect of Temperature on Heart Function 106
Sinus Node (Sinoatrial Node) 107
Specialized Excitatory and Conductive System of the Heart 107
CHAPTER 10 Rhythmical Excitation of the Heart 107
Internodal Pathways and Transmission of the Cardiac Impulse Through the Atria 109
Atrioventricular Node, and Delay of Impulse Conduction from the Atria to the Ventricles 109
Rapid Transmission in the Ventricular Purkinje System 109
Transmission of the Cardiac Impulse in the Ventricular Muscle 110
Summary of the Spread of the Cardiac Impulse Through the Heart 110
Control of Excitation and Conduction in the Heart 111
The Sinus Node as the Pacemaker of the Heart 111
Role of the Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle 111
Control of Heart Rhythmicity and Impulse Conduction by the Cardiac Nerves: The Sympathetic and Parasympathetic Nerves 112
Depolarization Waves Versus Repolarization Waves 114
Characteristics of the Normal Electrocardiogram 114
CHAPTER 11 The Normal Electrocardiogram 114
Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram 115
Voltage and Time Calibration of the Electrocardiogram 115
Methods for Recording Electrocardiograms 116
Pen Recorder 116
Flow of Current Around the Heart During the Cardiac Cycle 116
Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle 116
Flow of Electrical Currents in the Chest Around the Heart 116
Electrocardiographic Leads 117
Three Bipolar Limb Leads 117
Chest Leads (Precordial Leads) 118
Augumented Unipolar Limb Leads 119
Principles of Vectorial Analysis of Electrocardiograms 120
Use of Vectors to Represent Electrical Potentials 120
Denoting the Direction of a Vector in Terms of Degrees 120
Axis of Each of the Standard Bipolar Leads and for Each Unipolar Limb Lead 120
CHAPTER 12 Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis 120
Vectorial Analysis of Potentials Recorded in Different Leads 121
Vectorial Analysis of the Normal Electrocardiogram 122
Vectors That Occur at Successive Intervals During Depolarization of the Ventricles—The QRS Complex 122
Electrocardiogram During Repolarization—The T Wave 123
Depolarization of the Atria—The P Wave 124
Vectorcardiogram 124
Abnormal Ventricular Conditions That Cause Axis Deviation 125
Mean Electrical Axis of the Ventricular QRS—And Its Significance 125
Determining the Electrical Axis from Standard Lead Electrocardiograms 125
Conditions That Cause Abnormal Voltages of the QRS Complex 127
Increased Voltage in the Standard Bipolar Limb Leads 127
Decreased Voltage of the Electrocardiogram 127
Prolonged and Bizarre Patterns of the QRS Complex 128
Prolonged QRS Complex as a Result of Cardiac Hypertrophy or Dilatation 128
Prolonged QRS Complex Resulting from Purkinje System Blocks 128
Conditions That Cause Bizarre QRS Complexes 128
Current of Injury 128
Effect of Current of Injury on the QRS Complex 128
The J Point—The Zero Reference Potential for Analyzing Current of Injury 129
Coronary Ischemia as a Cause of Current of Injury 130
Abnormalities in the T Wave 132
Effect of Slow Conduction of the Depolarization Wave on the Characteristics of the T Wave 132
Prolonged Depolarization in Portions of the Ventricular Muscle as a Cause of Abnormalities in the T Wave 132
CHAPTER 13 Cardiac Arrhythmias and Their Electrocardiographic Interpretation 134
Abnormal Sinus Rhythms 134
Tachycardia 134
Bradycardia 134
Sinus Arrhythmia 134
Atrioventricular Block 135
Sinoatrial Block 135
Abnormal Rhythms That Result from Impulse Conduction Block 135
Incomplete Intraventricular Block—Electrical Alternans 136
Premature Contractions 136
Premature Atrial Contractions 137
A-V Nodal or A-V Bundle Premature Contractions 137
Premature Ventricular Contractions 137
Paroxysmal Tachycardia 138
Atrial Paroxysmal Tachycardia 138
Ventricular Paroxysmal Tachycardia 138
Ventricular Fibrillation 138
Phenomenon of Re-entry— Circus Movements as the Basis for Ventricular Fibrillation 139
Atrial Fibrillation 141
Atrial Flutter 142
Cardiac Arrest 142
UNIT Ⅳ The Circulation 144
CHAPTER 14 Overview of the Circulation; Medical Physics of Pressure, Flow, and Resistance 144
Physical Characteristics of the Circulation 144
Basic Theory of Circulatory Function 146
Interrelationships Among Pressure, Flow, and Resistance 146
Blood Flow 147
Blood Pressure 148
Resistance to Blood Flow 149
Effects of Pressure on Vascular Resistance and Tissue Blood Flow 151
CHAPTER 15 Vascular Distensibility, and Functions of the Arterial and Venous Systems 152
Vascular Distensibility 152
Vascular Compliance (or Capacitance) 152
Volume-Pressure Curves of the Arterial and Venous Circulations 152
Delayed Compliance (Stress-Relaxation) of Vessels 153
Arterial Pressure Pulsations 153
Transmission of Pressure Pulses to the Peripheral Arteries 154
Clinical Methods for Measuring Systolic and Diastolic Pressures 155
Veins and Their Functions 156
Venous Pressures—Right Atrial Pressure (Central Venous Pressure) and Peripheral Venous Pressures 156
Blood Reservoir Function of the Veins 160
Structure of the Microcirculation and Capillary System 162
CHAPTER 16 The Microcirculation and the Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph Flow 162
Flow of Blood in the Capillaries—Vasomotion 163
Average Function of the Capillary System 163
Exchange of Nutrients and Other Substances Between the Blood and Interstitial Fluid 164
Diffusion Through the Capillary Membrane 164
The Interstitium and Interstitial Fluid 165
Proteins in the Plasma and Interstitial Fluid Are Especially Important in Controlling Plasma and Interstitial Fluid Volumes 166
Capillary Pressure 166
Interstitial Fluid Pressure 167
Plasma Colloid Osmotic Pressure 168
Exchange of Fluid Volume Through the Capillary Membrane 169
Interstitial Fluid Colloid Osmotic Pressure 169
Starling Equilibrium for Capillary Exchange 170
Lymphatic System 170
Lymph Channels of the Body 170
Formation of Lymph 171
Rate of Lymph Flow 172
Role of the Lymphatic System in Controlling Interstitial Fluid Protein Concentration, Interstitial Fluid Volume, and Interstitial Fluid Pressure 173
CHAPTER 17 Local Control of Blood Flow by the Tissues; and Humoral Regulation 175
Local Control of Blood Flow in Response to Tissue Needs 175
Mechanisms of Blood Flow Control 175
Acute Control of Local Blood Flow 176
Long-Term Blood Flow Regulation 179
Development of Collateral Circulation—A Phenomenon of Long-Term Local Blood Flow Regulation 180
Vasoconstrictor Agents 181
Vasodilator Agents 181
Humoral Regulation of the Circulation 181
Effects of Ions and Other Chemical Factors on Vascular Control 182
CHAPTER 18 Nervous Regulation of the Circulation, and Rapid Control of Arterial Pressure 184
Nervous Regulation of the Circulation 184
Autonomic Nervous System 184
Role of the Nervous System for Rapid Control of Arterial Pressure 187
Increase in Arterial Pressure During Muscle Exercise and Other Types of Stress 188
Reflex Mechanisms for Maintaining Normal Arterial Pressure 188
Central Nervous System Ischemic Response—Control of Arterial Pressure by the Brain s Vasomotor Center in Response to Diminished Brain Blood Flow 191
Role of the Skeletal Nerves and Skeletal Muscles in Increasing Cardiac Output and Arterial Pressure 192
Special Features of Nervous Control of Arterial Pressure 192
Respiratory Waves in the Arterial Pressure 193
Arterial Pressure Vasomotor Waves—Oscillation of the Pressure Reflex Control Systems 193
CHAPTER 19 Dominant Role of the Kidney in Long-Term Regulation of Arterial Pressure and in Hypertension: The Integrated System for Pressure Control 195
The Renal-Body Fluid System for Arterial Pressure Control 195
Quantitation of Pressure Diuresis as a Basis for Arterial Pressure Control 195
Hypertension (High Blood Pressure): This Is Often Caused by Excess Extracellular Fluid Volume 199
The Renin-Angiotensin System: Its Role in Pressure Control and in Hypertension 201
Components of the Renin-Angiotensin System 201
Types of Hypertension in Which Angiotensin Is Involved: Hypertension Caused by a Renin-Secreting Tumor or by Infusion of Angiotensin Ⅱ 203
Other Types of Hypertension Caused by Combinations of Volume-Loading and Vasoconstriction 205
“Essential Hypertension” in Human Beings 205
Summary of the Integrated, Multifaceted System for Arterial Pressure Regulation 207
CHAPTER 20 Cardiac Output, Venous Return, and Their Regulation 210
Normal Values for Cardiac Output at Rest and During Activity 210
Control of Cardiac Output by Venous Return—Role of the Frank-Starling Mechanism of the Heart 210
Cardiac Output Regulation Is the Sum of Blood Flow Regulation in All the Local Tissues of the Body—Tissue Metabolism Regulates Most Local Blood Flow 211
The Heart Has Limits for the Cardiac Output That It Can Achieve 212
What Is the Role of the Nervous System in Controlling Cardiac Output? 212
Pathologically High and Pathologically Low Cardiac Outputs 213
High Cardiac Output Is Almost Always Caused by Reduced Total Peripheral Resistance 213
Low Cardiac Output 214
A More Quantitative Analysis of Cardiac Output Regulation 214
Venous Return Curves 215
Cardiac Output Curves Used in Quantitative Analysis 215
Analysis of Cardiac Output and Right Atrial Pressure, Using Simultaneous Cardiac Output and Venous Return Curves 218
Methods for Measuring Cardiac Output 220
Pulsatile Output of the Heart as Measured by an Electromagnetic or Ultrasonic Flowmeter 220
Measurement of Cardiac Output by the Oxygen Fick Method 220
Indicator Dilution Method 221
CHAPTER 21 Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart Disease 223
Blood Flow in Skeletal Muscle and Its Regulation During Exercise 223
Rate of Blood Flow Through the Muscles 223
Control of Blood Flow Through the Skeletal Muscles 223
Circulatory Readjustments During Exercise 224
Normal Coronary Blood Flow 226
Coronary Circulation 226
Physiologic Anatomy of the Coronary Blood Supply 226
Control of Coronary Blood Flow 227
Special Features of Cardiac Muscle Metabolism 228
Ischemie Heart Disease 229
Causes of Death After Acute Coronary Occlusion 230
Stages of Recovery from Acute Myocardial Infarction 231
Function of the Heart After Recovery from Myocardial Infarction 232
Pain in Coronary Disease 232
Surgical Treatment of Coronary Disease 233
Acute Effects of Moderate Cardiac Failure 235
Dynamics of the Circulation in Cardiac Failure 235
CHAPTER 22 Cardiac Failure 235
Chronic Stage of Failure-Fluid Retention Helps to Compensate Cardiac Output 236
Summary of the Changes That Occur After Acute Cardiac Failure— Compensated Heart Failure 237
Dynamics of Severe Cardiac Failure—Decompensated Heart Failure 237
Unilateral Left Heart Failure 239
Low-Output Cardiac Failure—Cardiogenic Shock 239
Edema in Patients with Cardiac Failure 239
Cardiac Reserve 241
Appendix 241
Quantitative Graphical Method for Analysis of Cardiac Failure 241
Normal Heart Sounds 245
Heart Sounds 245
CHAPTER 23 Heart Valves and Heart Sounds; Dynamics of Valvular and Congenital Heart Defects 245
Valvular Lesions 247
Abnormal Circulatory Dynamics in Valvular Heart Disease 248
Dynamics of the Circulation in Aortic Stenosis and Aortic Regurgitation 248
Dynamics of Mitral Stenosis and Mitral Regurgitation 248
Circulatory Dynamics During Exercise in Patients with Valvular Lesions 249
Abnormal Circulatory Dynamics in Congenital Heart Defects 249
Patent Ductus Arteriosus—A Left-to-Right Shunt 249
Tetralogy of Fallot—A Right-to-Left Shunt 251
Causes of Congenital Anomalies 251
Use of Extracorporeal Circulation During Cardiac Surgery 251
Hypertrophy of the Heart in Valvular and Congenital Heart Disease 252
CHAPTER 24 Circulatory Shock and Physiology of Its Treatment 253
Physiologic Causes of Shock 253
Circulatory Shock Caused by Decreased Cardiac Output 253
Circulatory Shock That Occurs Without Diminished Cardiac Output 253
What Happens to the Arterial Pressure in Circulatory Shock? 253
Tissue Deterioration Is the End Stage of Circulatory Shock, Whatever the Cause 253
Stages of Shock 254
Shock Caused by Hypovolemia—Hemorrhagic Shock 254
Relationship of Bleeding Volume to Cardiac Output and Arterial Pressure 254
Progressive and Nonprogressive Hemorrhagic Shock 255
Irreversible Shock 258
Anaphylactic Shock and Histamine Shock 259
Neurogenic Shock—Increased Vascular Capacity 259
Hypovolemic Shock Caused by Plasma Loss 259
Hypovolemic Shock Caused by Trauma 259
Septic Shock 260
Physiology of Treatment in Shock 260
Replacement Therapy 260
Treatment of Shock with Sympathomimetic Drugs—Sometimes Useful, Sometimes Not 261
Other Therapy 261
Circulatory Arrest 261
Effect of Circulatory Arrest on the Brain 261
Daily loss of Body Water 264
Daily Intake of Water 264
Fluid Intake and Output Are Balanced During Steady-State Conditions 264
CHAPTER 25 The Body Fluid Compartments: Extracellular and Intracellular Fluids; Interstitial Fluid and Edema 264
UNIT Ⅴ The Kidneys and Body Fluids 264
Body Fluid Compartments 265
Intracellular Fluid Compartment 265
Extracellular Fluid Compartment 266
Blood Volume 266
Constituents of Extracellular and Intracellular Fluids 266
Ionic Compositions of Plasma and Interstitial Fluid Are Similar 266
Important Constituents of the Intracellular Fluid 267
Determination of Volumes of Specitic Body Fluid Compartments 268
Measurement of Fluid Volumes in the Different Body Fluid Compartments; the Indicator-Dilution Principle 268
Basic Principles of Osmosis and Osmotic Pressure 269
Regulation of Fluid Exchange and Osmotic Equilibria Between Intracellular and Extracellular Fluid 269
Osmotic Equilibrium Is Maintained Between Intracellular and Extracellular Fluids 271
Volumes and Osmolalities of Extracellular and Intracellular Fluid in Abnormal States 272
Effect of Adding Saline Solution to the Extracellular Fluid 272
Glucose and Other Solutions Administered for Nutritive Purposes 273
Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia 273
Edema: Excess Fluid in the Tissues 274
Intracellular Edema 274
Extracellular Edema 274
Causes of Hypernatremia: Water Loss or Excess Sodium 274
Causes of Hyponatremia: Excess Water or loss of Sodium 274
Safety Factors That Normally Prevent Edema 276
Fluids in the Potential Spaces of the Body 277
CHAPTER 26 Urine Formation by the Kidneys: I. Glomerular Filtration, Renal Blood Flow, and Their Control 279
Multiple Functions of the Kidneys in Homeostasis 279
Physiologic Anatomy of the Kidneys 280
General Organization of the Kidneys and Urinary Tract 280
Renal Blood Supply 281
The Nephron Is the Functional Unit of the Kidney 281
Urine Formation Results from Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion 282
Filtration, Reabsorption, and Secretion of Different Substances 283
Glomerular Capillary Membrane 284
GFR Is About 20 Per Cent of the Renal Plasma Flow 284
Glomerular Filtration—The First Step In Urine Formation 284
Composition of the Glomerular Filtrate 284
Determinants of the Glomerular Filtration Rate 286
Increased Glomerular Capillary Filtration Coefficient (K1) Increases GFR 286
Increased Bowman s Capsule Hydrostatic Pressure Decreases GFR 287
Increased Glomerular Capillary Colloid Osmotic Pressure Decreases GFR 287
Increased Glomerular Capillary Hydrostatic Pressure Increases GFR 287
Renal Blood Flow 288
Determinants of Renal Blood Flow 288
Hormonal and Autacoid Control of Renal Circulation 289
Sympathetic Nervous System Activation Decreases GFR 289
Physiologic Control of Glomerular Filtration and Renal Blood Flow 289
Blood Flow in the Vasa Recta of the Renal Medulla Is Very Low Compared with Flow in the Renal Cortex 289
Autoregulation of GFR and Renal Blood Flow 290
Importance of GFR Autoregulation in Preventing Extreme Changes in Renal Excretion 291
Role of Tubuloglomerular Feedback in Autoregulation of GFR 291
Myogenic Autoregulation of Renal Blood Flow and GFR 293
Other Factors That Increase Renal Blood Flow and GFR: High Protein Intake and Increased Blood Glucose 293
CHAPTER 27 Urine Formation by the Kidneys: Ⅱ.Tubular Processing of the Glomerular Filtrate 295
Reabsorption and Secretion by the Renal Tubules 295
Tubular Reabsorption Is Selective and Quantitatively large 295
Tubular Reabsorption Includes Passive and Active Mechanisms 295
Active Transport 296
Passive Water Reabsorption by Osmosis Is Coupled Mainly to Sodium Reabsorption 299
Reabsorption of Chloride, Urea, and Other Solutes by Passive Diffusion 300
Reabsorption and Secretion Along Different Parts of the Nephron 300
Proximal Tubular Reabsorption 300
Solute and Water Transport in the Loop of Henle 302
Distal Tubule 303
late Distal Tubule and Cortical Collecting Tubule 303
Medullary Collecting Duct 304
Summary of Concentrations of Different Solutes in the Different Tubular Segments 304
Regulation of Tubular Reabsorption 305
Glomerulotubular Balance—The Ability of the Tubules to Increase Reabsorption Rate in Response to Increased Tubular load 305
Peritubular Capillary and Renal Interstitial Fluid Physical Forces 306
Effect of Arterial Pressure on Urine Output—The Pressure-Natriuresis and Pressure-Diuresis Mechanisms 308
Hormonal Control of Tubular Reabsorption 308
Use of Clearance Methods to Quantify Kidney Function 309
PAH Clearance Can Be Used to Estimate Renal Plasma Flow 311
Filtration Fraction Is Calculated from GFR Divided by Plasma Renal Flow 311
Calculation of Tubular Reabsorption or Secretion from Renal Clearances 311
CHAPTER 28 Regulation of Extracellular Fluid Osmolarity and Sodium Concentration 313
The Kidney Excretes Excess Water by Forming a Dilute Urine 313
Antidiuretic Hormone Controls Urine Concentration 313
Renal Mechanisms for Excreting a Dilute Urine 313
The Countercurrent Mechanism Produces a Hyperosmotic Renal Medullary Interstitium 315
Requirements for Excreting a Concentrated Urine—High ADH Levels and Hyperosmotic Renal Medulla 315
Obligatory Urine Volume 315
The Kidney Conserves Water by Excreting a Concentrated Urine 315
Role of the Distal Tubule and Collecting Ducts in Excreting a Concentrated Urine 317
Urea Contributes to Hyperosmotic Renal Medullary Interstitium and to a Concentrated Urine 318
Countercurrent Exchange in the Vasa Recta Preserves Hyperosmolarity of the Renal Medulla 319
Summary of Urine Concentrating Mechanism and Changes in Osmolarity in Different Segments of the Tubules 320
Quantifying Renal Urine Concentration and Dilution: Free Water and Osmolar Clearances 321
Disorders of Urinary Concentrating Ability 322
Control of Extracellular Fluid Osmolarity and Sodium Concentration 322
Estimating Plasma Osmolarity from Plasma Sodium Concentration 322
ADH Synthesis in Supraoptic and Paraventricular Nuclei of the Hypothalamus and ADH Release from the Posterior Pituitary 323
Osmoreceptor-ADH Feedback System 323
Cardiovascular Reflex Stimulation of ADH Release by Decreased Arterial Pressure and/or Decreased Blood Volume 324
Quantitative Importance of Cardiovascular Reflexes and Osmolarity in Stimulating ADH Secretion 324
Other Stimuli for ADH Secretion 324
Role of Thirst in Controlling Extracellular Fluid Osmolarity and Sodium Concentration 325
Central Nervous System Centers for Thirst 325
Stimuli for Thirst 325
Threshold for Osmolar Stimulus of Drinking 326
Integrated Responses of Osmoreceptor-ADH and Thirst Mechanisms in Controlling Extracellular Fluid Osmolarity and Sodium Concentration 326
Role of Angiotensin Ⅱ and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration 327
Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume 327
Sodium Excretion Is Controlled by Altering Glomerular Filtration or Tubular Sodium Reabsorption Rates 329
Sodium Excretion Is Precisely Matched to Intake Under Steady-State Conditions 329
CHAPTER 29 Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume; and Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium 329
Control Mechanisms for Regulating Sodium and Water Excretion 329
Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance 330
Pressure Natriuresis and Diuresis Are Key Components of a Renal-Body Fluid Feedback for Regulating Body Fluid Volumes and Arterial Pressure 330
Precision of Blood Volume and Extracellular Fluid Volume Regulation 331
Distribution of Extracellular Fluid Between the Interstitial Spaces and Vascular System 332
Nervous and Hormonal Factors Increase the Effectiveness of Renal-Body Fluid Feedback Control 332
Sympathetic Nervous System Control of Renal Excretion: The Arterial Baroreceptor and Low-Pressure Stretch Receptor Reflexes 332
Role of Angiotensin Ⅱ in Controlling Renal Excretion 333
Role of Aldosterone in Controlling Renal Excretion 334
Role of ADH in Controlling Renal Water Excretion 334
Conditions That Cause Large Increases in Blood Volume and Extracellular Fluid Volume 335
Increased Blood Volume and Extracellular Fluid Volume Caused by Heart Diseases 335
Role of Atrial Natriuretic Peptide in Controlling Renal Excretion 335
Integrated Responses to Changes in Sodium Intake 335
Increased Blood Volume Caused by Increased Capacity of the Circulation 336
Conditions That Cause Large Increases in Extracellular Fluid Volume but with Normal Blood Volume 336
Nephrotic Syndrome—Loss of Plasma Proteins in the Urine and Sodium Retention by the Kidneys 336
Liver Cirrhosis—Decreased Synthesis of Plasma Proteins by the Liver and Sodium Retention by the Kidneys 336
Regulation of Potassium Excretion and Potassium Concentration in the Extracellular Fluid 336
Regulation of Internal Potassium Distribution 337
Overview of Renal Potassium Excretion 338
Summary of Factors That Regulate Potassium Secretion: Plasma Potassium Concentration, Aldosterone, Tubular Flow Rate, and Hydrogen Ion 339
Potassium Secretion in the Principal Cells of the Late Distal and Cortical Collecting Tubules 339
Control of Renal Calcium Excretion and Extracellular Calcium Ion Concentration 342
Control of Calcium Excretion by the Kidneys 343
Regulation of Renal Phosphate Excretion 343
Control of Renal Magnesium Excretion and Extracellular Magnesium Ion Concentration 344
CHAPTER 30 Regulation of Acid-Base Balance 346
Hydrogen Ion Concentration Is Precisely Regulated 346
Acids and Bases—Their Definitions and Meanings 346
Defenses Against Changes in Hydrogen Ion Concentration: Buffers, Lungs, and Kidneys 347
Buffering of Hydrogen Ions in the Body Fluids 347
Quantitative Dynamics of the Bicarbonate Buffer System 348
The Bicarbonate Buffer System 348
The Phosphate Buffer System 350
Proteins: Important Intracellular Buffers 350
Isohydric Principle: All Buffers in a Common Solution Are in Equilibrium with the Same Hydrogen Ion Concentration 350
Respiratory Regulation of Acid-Base Balance 351
Pulmonary Expiration of CO2 Balances Metabolic Formation of CO2 351
Increasing Alveolar Ventilation Decreases Extracellular Fluid Hydrogen Ion Concentration and Raises pH 351
Increased Hydrogen Ion Concentration Stimulates Alveolar Ventilation 351
Renal Control of Acid-Base Balance 352
Secretion of Hydrogen Ions and Reabsorption of Bicarbonate Ions by the Renal Tubule 353
Hydrogen Ions Are Secreted by Secondary Active Transport in the Early Tubular Segments 353
Filtered Bicarbonate Ions Are Reabsorbed by Interaction with Hydrogen Ions in the Tubules 354
Combination of Excess Hydrogen Ions With Phosphate and Ammonia Buffers in the Tubule—A Mechanism for Generating New Bicarbonate Ions 355
Primary Active Secretion of Hydrogen Ions in the Intercalated Cells of Late Distal and Collecting Tubules 355
The Phosphate Buffer System Carries Excess Hydrogen Ions into the Urine and Generates New Bicarbonate 356
Excretion of Excess Hydrogen Ions and Generation of New Bicarbonate by the Ammonia Buffer System 356
Quantifying Renal Acid-Base Excretion 357
Regulation of Renal Tubular Hydrogen Ion Secretion 357
Renal Correction of Acidosis—Increased Excretion of Hydrogen Ions and Addition of Bicarbonate Ions to the Extracellular Fluid 358
Acidosis Decreases the Ratio of HCO3-/H+ in Renal Tubular Fluid 358
Respiratory Alkalosis Results from Increased Ventilation and Decreased PCO2 359
Respiratory Acidosis Is Caused by Decreased Ventilation and Increased PCO2 359
Clinical Causes of Acid-Base Disorders 359
Alkalosis Increases the Ratio of HCO3-/H+ in Renal Tubular Fluid 359
Renal Correction of Alkalosis—Decreased Tubular Secretion of Hydrogen Ions and Increased Excretion of Bicarbonate Ions 359
Metabolic Acidosis Results from Decreased Extracellular Fluid Bicarbonate Concentration 360
Metabolic Alkalosis Is Caused by Increased Extracellular Fluid Bicarbonate Concentration 360
Treatment of Acidosis or Alkalosis 360
Clinical Measurements and Analysis of Acid-Base Disorders 361
Complex Acid-Base Disorders and the Use of the Acid-Base Nomogram for Diagnosis 361
Use of Anion Gap to Diagnose Acid-Base Disorders 362
Innervation of the Bladder 364
Physiologic Anatomy and Nervous Connections of the Bladder 364
Transport of Urine from the Kidney Through the Ureters and Into the Bladder 364
CHAPTER 31 Micturition, Diuretics, and Kidney Diseases 364
Micturition 364
Filling of the Bladder and Bladder Wall Tone; The Cystometrogram 365
Micturition Reflex 366
Facilitation or Inhibition of Micturition by the Brain 366
Abnormalities of Micturition 366
Diuretics and Their Mechanisms of Action 367
Osmotic Diuretics Decrease Water Reabsorption by Increasing Osmotic Pressure of Tubular Fluid 367
Carbonic Anhydrase Inhibitors Block Sodium-Bicarbonate Reabsorption in the Proximal Tubules 368
Diuretics That Block Sodium Channels in the Collecting Tubules Decrease Sodium Reabsorption 368
Competitive Inhibitors of Aldosterone Decrease Sodium Reabsorption from and Potassium Secretion into the Cortical Collecting Tubule 368
Thiazide Diuretics Inhibit Sodium-Chloride Reabsorption in the Early Distal Tubule 368
Loop Diuretics Decrease Active Sodium-Chloride-Potassium Reabsorption in the Thick Ascending Loop of Henle 368
Kidney Diseases 369
Acute Renal Failure 369
Prerenal Acute Renal Failure Caused by Decreased Blood Flow to the Kidney 369
Intrarenal Acute Renal Failure Caused by Abnormalities Within the Kidney 369
Postrenal Acute Renal Failure Caused by Abnormalities of the Lower Urinary Tract 370
Physiologic Effects of Acute Renal Failure 370
Chronic Renal Failure: An Irreversible Decrease in the Number of Functional Nephrons 371
Vicious Circle of Chronic Renal Failure Leading to End-Stage Renal Disease 371
Injury to the Renal Vasculature as a Cause of Chronic Renal Failure 371
Injury to the Glomeruli as a Cause of Chronic Renal Failure—Glomerulonephritis 372
Nephrotic Syndrome—Excretion of Protein in the Urine Because of Increased Glomerular Permeability 373
Abnormal Nephron Function in Chronic Renal Failure 373
Injury to the Renal Interstitium as a Cause of Chronic Renal Failure—Pyelonephritis 373
Effects of Renal Failure on the Body Fluids—Uremia 375
Hypertension and Kidney Disease 376
Specific Tubular Disorders 377
Treatment of Renal Failure by Dialysis With an Artificial Kidney 377
UNIT Ⅵ Blood Cells, Immunity, and Blood Clotting 382
CHAPTER 32 Red Blood Cells, Anemia, and Polycythemia 382
Red Blood Cells (Erythrocytes) 382
Production of Red Blood Cells 382
Formation of Hemoglobin 386
Iron Metabolism 387
Destruction of Red Blood Cells 389
The Anemias 389
Effects of Anemia on the Circulatory System 390
Polycythemia 390
Effect of Polycythemia on the Circulatory System 390
CHAPTER 33 Resistance of the Body to Infection: Ⅰ. Leukocytes, Granulocytes, the Monocyte-Macrophage System, and Inflammation 392
Leukocytes (White Blood Cells) 392
General Characteristics of Leukocytes 392
Genesis of the White Blood Cells 392
Life Span of the White Blood Cells 393
Defense Properties of Neutrophils and Macrophages 393
Phagocytosis 394
Monocyte-Macrophage System (Reticuloendothelial System) 395
Inflammation and Role of Neutrophils and Macrophages 397
Inflammation 397
Macrophage and Neutrophil Responses During Inflammation 397
Eosinophils 399
Basophils 399
Leukopenia 399
The Leukemias 400
Effects of Leukemia on the Body 400
Both Types of Acquired Immunity Are Initiated by Antigens 402
Basic Types of Acquired Immunity 402
Acquired Immunity 402
Innate Immunity 402
CHAPTER 34 Resistance of the Body to Infection: Ⅱ. Immunity and Allergy 402
Lymphocytes Are the Basis of Acquired Immunity 403
Preprocessing of the T and B Lymphocytes 403
T Lymphocytes and B-Lymphocyte Antibodies React Highly Specifically Against Specific Antigens—Role of Lymphocyte Clones 404
Origin of the Many Clones of Lymphocytes 405
Specific Attributes of the B-Lymphocyte System—Humoral Immunity and the Antibodies 405
Special Attributes of the T-Lymphocyte System—Activated T Cells and Cell-Mediated Immunity 408
Several Types of T Cells and Their Different Functions 409
Tolerance of the Acquired Immunity System to One s Own Tissues—Role of Preprocessing in the Thymus and Bone Marrow 410
Allergies in the So-Called Allergic Person, Who Has Excess IgE Antibodies 411
Allergy Caused by Activated T Cells: Delayed-Reaction Allergy 411
Immunization 411
Passive Immunity 411
Allergy and Hypersensitivity 411
CHAPTER 35 Blood Groups; Transfusion; Tissue and Organ Transplantation 413
Antigenicity Causes Immune Reactions of Blood 413
O-A-B Blood Groups 413
A and B Antigens—Agglutinogens 413
Agglutinins 413
Agglutination Process in Transfusion Reactions 414
Blood Typing 414
Rh Immune Response 415
Rh Blood Types 415
Transfusion Reactions Resulting from Mismatched Blood Types 416
Transplantation of Tissues and Organs 416
Attempts to Overcome the Immune Reaction to Transplanted Tissue 417
CHAPTER 36 Hemostasis and Blood Coagulation 419
Events in Hemostasis 419
Vascular Constriction 419
Formation of the Platelet Plug 419
Blood Coagulation in the Ruptured Vessel 420
Conversion of Fibrinogen to Fibrin—Formation of the Clot 421
Conversion of Prothrombin to Thrombin 421
Fibrous Organization or Dissolution of the Blood Clot 421
Mechanism of Blood Coagulation 421
Vicious Circle of Clot Formation 422
Initiation of Coagulation: Formation of Prothrombin Activator 422
Prevention of Blood Clotting in the Normal Vascular System—The Intravascular Anticoagulants 425
Lysis of Blood Clots—Plasmin 425
Conditions That Cause Excessive Bleeding in Human Beings 426
Decreased Prothrombin, Factor Ⅶ, Factor Ⅸ, and Factor Ⅹ Caused by Vitamin K Deficiency 426
Hemophilia 426
Thrombocytopenia 426
Disseminated Intravascular Coagulation 427
Thromboembolic Conditions in the Human Being 427
Femoral Venous Thrombosis and Massive Pulmonary Embolism 427
Anticoagulants for Clinical Use 428
Heparin as an Intravenous Anticoagulant 428
Coumarins as Anticoagulants 428
Prevention of Blood Coagulation Outside the Body 428
Blood Coagulation Tests 428
Bleeding Time 428
Clotting Time 428
Prothrombin Time 429
Muscles That Cause Lung Expansion and Contraction 432
Mechanics of Pulmonary Ventilation 432
Movement of Air In and Out of the Lungs—and the Pressures That Cause the Movement 432
CHAPTER 37 Pulmonary Ventilation 432
UNIT Ⅶ Respiration 432
Effect of the Thoracic Cage on Lung Expansibility 435
Work of Breathing 435
Pulmonary Volumes and Capacities 436
Recording Changes in Pulmonary Volume—Spirometry 436
Abbreviations and Symbols Used in Pulmonary Function Studies 437
Determination of Functional Residual Capacity, Residual Volume, and Total Lung Capacity—Helium Dilution Method 437
Minute Respiratory Volume Equals Respiratory Rate Times Tidal Volume 438
Alveolar Ventilation 438
Rate of Alveolar Ventilation 439
Dead Space and Its Effect on Alveolar Ventilation 439
Functions of the Respiratory Passageways 440
Trachea, Bronchi, and Bronchioles 440
Normal Respiratory Functions of the Nose 441
Vocalization 442
CHAPTER 38 Pulmonary Circulation; Pulmonary Edema; Pleural Fluid 444
Physiologic Anatomy of the Pulmonary Circulatory System 444
Pressures in the Pulmonary System 444
Blood Volume of the Lungs 445
Blood Flow Through the Lungs and Its Distribution 445
Effect of Hydrostatic Pressure Gradients in the Lungs on Regional Pulmonary Blood Flow 446
Zones 1, 2, and 3 of Pulmonary Blood Flow 446
Function of the Pulmonary Circulation When the Left Atrial Pressure Rises as a Result of Left-Sided Heart Failure 447
Effect of Increased Cardiac Output on the Pulmonary Circulation During Heavy Exercise 447
Capillary Exchange of Fluid in the Lungs, and Pulmonary Interstitial Fluid Dynamics 448
Pulmonary Capillary Dynamics 448
Pulmonary Edema 449
Fluids in the Pleural Cavity 450
CHAPTER 39 Physical Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory Membrane 452
Physics of Gas Diffusion and Gas Partial Pressures 452
Molecular Basis of Gas Diffusion 452
Gas Pressures in a Mixture of Gases— Partial Pressures of Individual Gases 452
Pressures of Gases Dissolved in Water and Tissues 452
Vapor Pressure of Water 453
Diffusion of Gases Through Fluids—Pressure Difference Causes Net Diffusion 453
Rate at Which Alveolar Air Is Renewed by Atmospheric Air 454
Diffusion of Gases Through Tissues 454
Composition of Alveolar Air—Its Relation to Atmospheric Air 454
Oxygen Concentration and Partial Pressure in the Alveoli 455
CO2 Concentration and Partial Pressure in the Alveoli 455
Expired Air 456
Diffusion of Gases Through the Respiratory Membrane 456
Factors That Affect the Rate of Gas Diffusion Through the Respiratory Membrane 457
Diffusing Capacity of the Respiratory Membrane 458
Effect of the Ventilation-Perfusion Ratio on Alveolar Gas Concentration 460
PO2-PCO2, VA/Q Diagram 460
Abnormalities of Ventilation-Perfusion Ratio 461
Concept of Physiologic Dead Space (When VA/Q Is Creater Than Normal) 461
Concept of Physiologic Shunt (When VA/Q Is Below Normal) 461
CHAPTER 40 Transport of Oxygen and Carbon Dioxide in the Blood and Body Fluids 463
Pressures of Oxygen and Carbon Dioxide in the Lungs, Blood, and Tissues 463
Uptake of Oxygen by the Pulmonary Blood 463
Transport of Oxygen in the Arterial Blood 464
Diffusion of Oxygen from the Peripheral Capillaries into the Tissue Fluid 464
Diffusion of Oxygen from the Peripheral Tissue Capillaries to the Tissue Cells 465
Diffusion of Carbon Dioxide from the Peripheral Tissue Cells into the Tissue Capillaries and from the Pulmonary Capillaries into the Alveoli 465
Transport of Oxygen in the Blood 466
Reversible Combination of Oxygen with Hemoglobin 466
Effect of Hemoglobin to Buffer the Tissue Po2 467
Factors That Shift the Oxygen-Hemoglobin Dissociation Curve—Their Importance for Oxygen Transport 468
Metabolic Use of Oxygen by the Cells 469
Transport of Oxygen in the Dissolved State 469
Combination of Hemoglobin with Carbon Monoxide—Displacement of Oxygen 469
Transport of Carbon Dioxide in the Blood 470
Chemical Forms in Which Carbon Dioxide Is Transported 470
Transport of Carbon Dioxide in the Form of Bicarbonate Ion 470
Carbon Dioxide Dissociation Curve 471
When Oxygen Binds with Hemoglobin, Carbon Dioxide Is Released—The Haldane Effect—to Increase CO2 Transport 471
Change in Blood Acidity During Carbon Dioxide Transport 472
Respiratory Exchange Ratio 472
Dorsal Respiratory Group of Neurons—Its Control of Inspiration and of Respiratory Rhythm 474
Respiratory Center 474
CHAPTER 41 Regulation of Respiration 474
The Pneumotaxic Center Limits the Duration of Inspiration and Increases the Respiratory Rate 475
Ventral Respiratory Group of Neurons Functions in Both Inspiration and Expiration 475
Possibility of an Apneustic Center in the Lower Pons 475
Lung Inflation Signals Limit Inspiration—The Hering-Breuer Inflation Reflex 475
Control of Overall Respiratory Center Activity 476
Chemical Control of Respiration 476
Direct Chemical Control of Respiratory Center Activity by Carbon Dioxide and Hydrogen Ions 476
Peripheral Chemoreceptor System for Control of Respiratory Activity—Role of Oxygen in Respiratory Control 477
Composite Effects of Pco2, pH, and Po2 on Alveolar Ventilation 479
Regulation of Respiration During Exercise 479
Other Factors That Affect Respiration 481
Periodic Breathing 482
CHAPTER 42 Respiratory Insufficiency—Pathophysiology, Diagnosis, Oxygen Therapy 484
Useful Methods for Studying Respiratory Abnormalities 484
Study of Blood Gases and Blood pH 484
Measurement of Maximum Expiratory Flow 485
Forced Expiratory Vital Capacity and Forced Expiratory Volume 486
Physiologic Peculiarities of Specific Pulmonary Abnormalities 486
Chronic Pulmonary Emphysema 486
Pneumonia 488
Atelectasis 488
Asthma 489
Tuberculosis 489
Oxygen Therapy in Different Types of Hypoxia 490
Hypoxia and Oxygen Therapy 490
Hypercapnia 491
Cyanosis 491
Dyspnea 491
Artificial Respiration 492
UNIT Ⅷ Aviation, Space, and Deep-Sea Diving Physiology 496
CHAPTER 43 Aviation, High-Altitude, and Space Physiology 496
Effects of Low Oxygen Pressure on the Body 496
Alveolar PO2 at Different Elevations 496
Effect of Breathing Pure Oxygen on Alveolar PO2 at Different Altitudes 496
Acclimatization to Low PO2 497
Acute Effects of Hypoxia 497
Natural Acclimatization of Native Human Beings Living at High Altitudes 498
Work Capacity at High Altitudes—The Effect of Acclimatization 499
Chronic Mountain Sickness 499
Acute Mountain Sickness and High-Altitude Pulmonary Edema 499
Effects of Acceleratory Forces on the Body in Aviation and Space Physiology 500
Centrifugal Acceleratory Forces 500
Effects of Linear Acceleratory Forces on the Body 501
Artificial Climate in the Sealed Spacecraft 502
Weightlessness in Space 502
Effect of High Partial Pressures of Gases on the Body 504
Oxygen Toxicity at High Pressures 504
CHAPTER 44 Physiology of Deep-Sea Diving and Other Hyperbaric Conditions 504
Decompression of the Diver After Exposure to High Pressures 506
Scuba (Self-Contained Underwater Breathing Apparatus)Diving 508
Special Physiologic Problems in Submarines 508
Hyperbaric Oxygen Therapy 509
UNIT Ⅸ The Nervous System: A. General Principles and Sensory Physiology 512
CHAPTER 45 Organization of the Nervous System; Basic Functions of Synapses and Transmitter Substances 512
General Design of the Nervous System 512
The Central Nervous System Neuron—The Basic Functional Unit 512
Sensory Division of the Nervous System—Sensory Receptors 512
Motor Division—The Effectors 512
Processing of Information— Integrative Function of the Nervous System 513
Storage of Information—Memory 514
Major Levels of Central Nervous System Function 514
Spinal Cord Level 514
Lower Brain or Subcortical Level 514
Higher Brain or Cortical Level 515
Comparison of the Nervous System With an Electronic Computer 515
Central Nervous System Synapses 515
Types of Synapses—Chemical and Electrical 515
Physiologic Anatomy of the Synapse 516
Chemical Substances That Function as Synaptic Transmitters 519
Electrical Events During Neuronal Excitation 521
Electrical Events in Neuronal Inhibition 522
Special Functions of Dendrites in Exciting Neurons 524
Relation of State of Excitation of the Neuron to Rate of Firing 525
Some Special Characteristics of Synaptic Transmission 525
CHAPTER 46 Sensory Receptors; Neuronal Circuits for Processing Information 528
Types of Sensory Receptors and the Sensory Stimuli They Detect 528
Differential Sensitivity of Receptors 528
Transduction of Sensory Stimuli Into Nerve Impulses 529
Local Electrical Currents at Nerve Endings—Receptor Potentials 529
Adaptation of Receptors 531
Nerve Fibers That Transmit Different Types of Signals and Their Physiologic Classification 532
Transmission and Processing of Signals in Neuronal Pools 533
Transmission of Signals of Different Intensity in Nerve Tracts—Spatial and Temporal Summation 533
Relaying of Signals Through Neuronal Pools 534
Prolongation of a Signal by a Neuronal Pool— Afterdischarge 536
Instability and Stability of Neuronal Circuits 538
Inhibitory Circuits as a Mechanism for Stabilizing Nervous System Function 538
Synaptic Fatigue as a Means of Stabilizing the Nervous System 538
CHAPTER 47 Somatic Sensations: Ⅰ. General Organization; the Tactile and Position Senses 540
Classification of Somatic Senses 540
Detection and Transmission of Tactile Sensations 540
Detection of Vibration 541
Anatomy of the Dorsal Column-Medial Lemniscal System 542
Transmission in the Dorsal Column-Medial Lemniscal System 542
Anterolateral System 542
Sensory Pathways for Transmitting Somatic Signals into the Central Nervous System 542
Tickling and Itch 542
Dorsal Column-Medial Lemniscal System 542
Somatosensory Cortex 544
Somatosensory Association Areas 546
Overall Characteristics of Signal Transmission and Analysis in the Dorsal Column-Medial Lemniscal System 546
Interpretation of Sensory Stimulus Intensity 548
Judgment of Stimulus Intensity 548
Position Senses 548
Transmission of Less Critical Sensory Signals in the Anterolateral Pathway 549
Anatomy of the Anterolateral Pathway 549
Cortical Control of Sensory Sensitivity— Corticofugal Signals 550
Some Special Aspects of Somatosensory Function 550
Function of the Thalamus in Somatic Sensation 550
Segmental Fields of Sensation—The Dermatomes 551
CHAPTER 48 Somatic Sensations: Ⅱ. Pain, Headache, and Thermal Sensations 552
Types of Pain and Their Qualities—Fast Pain and Slow Pain 552
Pain Receptors and Their Stimulation 552
Rate of Tissue Damage as a Stimulus for Pain 553
Dual Transmission of Pain Signals into the Central Nervous System 553
Dual Pain Pathways in the Cord and Brain Stem—The Neospinothalamic Tract and the Paleospinothalamic Tract 554
Pain Suppression ( Analgesia ) System in the Brain and Spinal Cord 555
The Brain s Opiate System—The Endorphins and Enkephalins 556
Causes of True Visceral Pain 557
Visceral Pain 557
Inhibition of Pain Transmission by Tactile Sensory Signals 557
Referred Pain 557
Treatment of Pain by Electrical Stimulation 557
Parietal Pain Caused by Visceral Damage 558
Localization of Visceral Pain—The Visceral and the Parietal Pain Transmission Pathways 558
Some Clinical Abnormalities of Pain and Other Somatic Sensations 559
Hyperalgesia 559
Thalamic Syndrome 559
Herpes Zoster (Shingles) 559
Tic Douloureux 559
Headache of Intracranial Origin 560
Headache 560
Brown-Sequard Syndrome 560
Extracranial Types of Headache 561
Thermal Sensations 561
Thermal Receptors and Their Excitation 561
Transmission of Thermal Signals in the Nervous System 562
UNIT Ⅹ The Nervous System: B. The Special Senses 566
CHAPTER 49 The Eye: Ⅰ. Optics of Vision 566
Physical Principles of Optics 566
Refraction of Light 566
Application of Refractive Principles to Lenses 566
Focal Length of a Lens 567
Formation of an Image by a Convex Lens 568
Measurement of the Refractive Power of a Lens—The Diopter 569
Optics of the Eye 569
The Eye as a Camera 569
Mechanism of Accommodation 570
Pupillary Diameter 571
Errors of Refraction 571
Visual Acuity 573
Determination of Distance of an Object from the Eye—Depth Perception 574
Ophthalmoscope 574
Formation of Aqueous Humor by the Ciliary Body 575
Fluid System of the Eye—Intraocular Fluid 575
Outflow of Aqueous Humor from the Eye 576
Intraocular Pressure 576
CHAPTER 50 The Eye: Ⅱ. Receptor and Neural Function of the Retina 578
Anatomy and Function of the Structural Elements of the Retina 578
Photochemistry of Vision 579
Rhodopsin-Retinal Visual Cycle, and Excitation of the Rods 580
Automatic Regulation of Retinal Sensitivity—Light and Dark Adaptation 582
Color Vision 584
Tricolor Mechanism of Color Detection 584
Color Blindness 584
Neural Circuitry of the Retina 586
Neural Function of the Retina 586
Ganglion Cells 588
Excitation of the Ganglion Cells 588
CHAPTER 51 The Eye: Ⅲ. Central Neurophysiology of Vision 591
Visual Pathways 591
Function of the Dorsal Lateral Geniculate Nucleus 591
Organization and Function of the Visual Cortex 592
Layered Structure of the Primary Visual Cortex 593
Two Major Pathways for Analysis of Visual Information—(1) The Fast Position and Motion Pathway; (2) The Accurate Color Pathway 594
Neuronal Patterns of Stimulation During Analysis of the Visual Image 594
Fields of Vision; Perimetry 595
Effect of Removing the Primary Visual Cortex 595
Detection of Color 595
Eye Movements and Their Control 596
Fixation Movements of the Eyes 596
Fusion of the Visual Images from the Two Eyes 598
Autonomic Control of Accommodation and Pupillary Aperture 599
Control of Accommodation (Focusing the Eyes) 599
Control of Pupillary Diameter 600
CHAPTER 52 The Sense of Hearing 602
Tympanic Membrane and the Ossicular System 602
Conduction of Sound from the Tympanic Membrane to the Cochlea 602
Functional Anatomy of the Cochlea 603
The Cochlea 603
Transmission of Sound Through Bone 603
Transmission of Sound Waves in the Cochlea—The Traveling Wave 604
Function of the Organ of Corti 605
Determination of Sound Frequency—The Place Principle 607
Determination of Loudness 607
Central Auditory Mechanisms 608
Auditory Pathways 608
Function of the Cerebral Cortex in Hearing 609
Determination of the Direction from Which Sound Comes 610
Hearing Abnormalities 611
Types of Deafness 611
Centrifugal Signals from the Central Nervous System to Lower Auditory Centers 611
CHAPTER 53 The Chemical Senses—Taste and Smell 613
Sense of Taste 613
Primary Sensations of Taste 613
Taste Bud and Its Function 614
Transmission of Taste Signals into the Central Nervous System 615
Taste Preference and Control of the Diet 616
Sense of Smell 616
Olfactory Membrane 616
Stimulation of the Olfactory Cells 617
Transmission of Smell Signals into the Central Nervous System 618
Organization of the Spinal Cord for Motor Functions 622
CHAPTER 54 Motor Functions of the Spinal Cord; The Cord Reflexes 622
UNIT Ⅺ The Nervous System: C. Motor and Integrative Neurophysiology 622
Muscle Sensory Receptors—Muscle Spindles and Golgi Tendon Organs—and Their Roles in Muscle Control 624
Receptor Function of the Muscle Spindle 624
Muscle Stretch Reflex 625
Role of the Muscle Spindle in Voluntary Motor Activity 626
Clinical Applications of the Stretch Reflex 627
Golgi Tendon Reflex 628
Function of the Muscle Spindles and Golgi Tendon Organs in Conjunction with Motor Control from Higher Levels of the Brain 628
Flexor Reflex and the Withdrawal Reflexes 629
Reflexes of Posture and Locomotion 630
Postural and Locomotive Reflexes of the Cord 630
Reciprocal Inhibition and Reciprocal Innervation 630
Crossed Extensor Reflex 630
Scratch Reflex 631
Spinal Cord Reflexes That Cause Muscle Spasm 632
Autonomic Reflexes in the Spinal Cord 632
Spinal Cord Transection and Spinal Shock 632
CHAPTER 55 Cortical and Brain Stem Control of Motor Function 634
The Motor Cortex and Corticospinal Tract 634
Primary Motor Cortex 634
Premotor Area 634
Some Specialized Areas of Motor Control Found in the Human Motor Cortex 635
Supplementary Motor Area 635
Transmission of Signals from the Motor Cortex to the Muscles 636
Incoming Fiber Pathways to the Motor Cortex 637
The Red Nucleus Serves as an Alternative Pathway for Transmitting Cortical Signals to the Spinal Cord 637
Extrapyramidal System 638
Excitation of the Spinal Cord Motor Control Areas by the Primary Motor Cortex and the Red Nucleus 638
Role of the Brain Stem in Controlling Motor Function 640
Support of the Body Against Gravity—Roles of the Reticular and Vestibular Nuclei 640
Vestibular Sensations and the Maintenance of Equilibrium 641
Vestibular Apparatus 641
Function of the Utricle and Saccule in the Maintenance of Static Equilibrium 643
Detection of Head Rotation by the Semicircular Ducts 644
Vestibular Mechanisms for Stabilizing the Eyes 645
Other Factors Concerned with Equilibrium 645
Functions of Brain Stem Nuclei in Controlling Subconscious, Stereotyped Movements 646
CHAPTER 56 The Cerebellum, the Basal Ganglia, and Overall Motor Control 647
The Cerebellum and Its Motor Functions 647
Anatomical Functional Areas of the Cerebellum 647
Neuronal Circuit of the Cerebellum 648
Function of the Cerebellum in Overall Motor Control 652
Clinical Abnormalities of the Cerebellum 655
The Basal Ganglia—Their Motor Functions 656
Function of the Basal Ganglia in Executing Patterns of Motor Activity—The Putamen Circuit 657
Role of the Basal Ganglia for Cognitive Control of Sequences of Motor Patterns—The Caudate Circuit 657
Function of the Basal Ganglia to Change the Timing and to Scale the Intensity of Movements 658
Functions of Specific Neurotransmitter Substances in the Basal Ganglial System 659
Clinical Syndromes Resulting from Damage to the Basal Ganglia 659
Integration of the Many Parts of the Total Motor Control System 660
Spinal Level 660
Hindbrain Level 660
Motor Cortex Level 660
What Drives Us to Action? 661
CHAPTER 57 The Cerebral Cortex; Intellectual Functions of the Brain; and Learning and Memory 663
Physiologic Anatomy of the Cerebral Cortex 663
Functions of Specific Cortical Areas 663
Association Areas 665
Comprehensive Interpretative Function Of the Posterior Superior Temporal Lobe— Wernicke s Area (a General Interpretative Area) 666
Functions of the Parieto-occipitotemporal Cortex in the Nondominant Hemisphere 668
Higher Intellectual Functions of the Prefrontal Association Area 668
Function of the Brain in Communication—Language Input and Language Output 669
Function of the Corpus Callosum and Anterior Commissure to Transfer Thoughts, Memories. Training, and Other Information Between the Two Cerebral Hemispheres 671
Thoughts, Consciousness, and Memory 671
Memory—Roles of Synaptic Facilitation and Synaptic Inhibition 672
Short-Term Memory 673
Intermediate Long-Term Memory 673
Long-Term Memory 674
Consolidation of Memory 675
Control of Cerebral Activity by Continuous Excitatory Signals from the Brain Stem 678
Activating-Driving Systems of the Brain 678
CHAPTER 58 Behavioral and Motivational Mechanisms of the Brain—The Limbic System and the Hypothalamus 678
Neurohormonal Control of Brain Activity 679
The Limbic System 681
Functional Anatomy of the Limbic System: the Key Position of the Hypothalamus 681
The Hypothalamus, a Major Control Headquarters for the Limbic System 682
Vegetative and Endocrine Control Functions of the Hypothalamus 682
Behavioral Functions of the Hypothalamus and Associated Limbic Structures 684
Reward and Punishment Function of the Limbic System 684
Importance of Reward and