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