Medical Physiology

Preface v
Contributors ix
Reviewers x
PART I CELLULAR PHYSIOLOGY 1
CHAPTER 1 Medical Physiology: An Overview 1
Scope of Physiology 1
Recent Directions for Medical Physiology 2
CHAPTER 2 Membrane Transport and Cell Signaling 9
Basis of Physiologic Regulation 9
Cytosol and the Plasma Membrane 11
Solute Transport Mechanisms 14
Water Movement Across the Plasma Membrane 22
Communication and Signaling Modes 25
Molecular Basis of Cellular Signaling 26
PART II NEUROMUSCULAR PHYSIOLOGY 37
CHAPTER 3 Action Potential, Synaptic Transmission, and Nerve Function 37
The Nervous System 37
Resting Membrane Potential 40
Action Potentials 43
Synaptic Transmission 47
Neurotransmission 50
CHAPTER 4 Sensory Physiology 59
Sensory Systems 59
Somatosensory System 64
Visual System 67
Auditory System 74
Vestibular System 82
Gustatory and Olfactory Systems 84
CHAPTER 5 Motor System 93
Skeleton as Framework for Movement 93
Muscle Function and Body Movement 93
Nervous System Components for the Control of Movement 94
Spinal Cord in the Control of Movement 98
Supraspinal Influences on Motor Control 102
Cerebral Cortex Role in Motor Control 104
Basal Ganglia and Motor Control 109
Cerebellum in the Control of Movement 112
CHAPTER 6 Autonomic Nervous System 118
Anatomy of the Autonomic Nervous System 118
Neurotransmitters of the Autonomic Nervous System 119
CONTENTSThe Parasympathetic Nervous System 123
Sympathetic Nervous System 125
Autonomic Integration 128
CHAPTER 7 Integrative Functions of the Central Nervous System 136
Hypothalamus 136
Brain Electrical Activity 144
Functional Components of the Forebrain 147
Higher Cognitive Skills 153
CHAPTER 8 Skeletal and Smooth Muscle 160
Skeletal Muscle 160
Excitation–Contraction Coupling in Skeletal Muscle 163
The Neuromuscular Motor Unit and Mechanics of Skeletal Muscle Contraction 170
Loading Conditions and Muscle Mechanics 173
Muscle Plasticity, Epigenetics, and Endocrine Muscle 180
Smooth Muscle 180
Activation–Contraction Coupling in Smooth Muscle 185
PART III BLOOD AND IMMUNOLOGY 196
CHAPTER 9 Blood Composition and Function 196
Blood Functions 196
Whole Blood 197
Soluble Components of Blood and their Tests 197
Formed Elements of Blood and Common Diagnostic Tests 200
Red Blood Cells 204
White Blood Cells 207
Platelet Formation 210
Blood Cell Formation 210
Blood Clotting 210
CHAPTER 10 Immunology, Organ Interaction, and Homeostasis 218
Immune System Components 218
Immune System Activation 219
Immune Detection System 221
Immune System Defenses 221
Cell-Mediated and Humoral Responses 224
Acute and Chronic Inflammation 231
Chronic Inflammation 233
Anti-inflammatory Drugs 234
Organ Transplantation and Immunology 235
Immunologic Disorders 237
Neuroendoimmunology 239
PART IV CARDIOVASCULAR PHYSIOLOGY 245
CHAPTER 11 Overview of the Cardiovascular System and Hemodynamics 245
Functional Organization of the Cardiovascular System 246
Hemodynamics: The Physics of Blood Containment and Movement 247
Rheology 256
Distribution of Pressure, Flow, Velocity, and Blood Volume 256CHAPTER 12 Electrical Activity of the Heart 262
Electrophysiology of Cardiac Muscle 263
The Pathophysiology of Abnormal Generation of Cardiac Action Potentials 269
The Electrocardiogram 270
CHAPTER 13 Mechanics of the Cardiac Pump 288
Excitation–Contraction Coupling in Cardiac Muscle 289
The Cardiac Cycle 292
Determinants of Myocardial Performance 294
Determinants of Myocardial Oxygen Demand and Clinical Evaluation of Cardiac Performance 300
Cardiac Output 303
Imaging Techniques for Measuring Cardiac Structures, Volumes, Blood Flow, and Cardiac Output 306
CHAPTER 14 Interactions between the Heart and the Systemic Circulation 313
Components of Arterial Pressure 313
Clinical Measurement of Arterial Pressure 316
The Concept of Peripheral and Central Blood Volume 318
Interconnections between Vascular and Cardiac Function 320
CHAPTER 15 Regulation of Organ Blood Flow and Capillary Transport 328
Local Regulation of Organ Blood Flow 328
The Microcirculation and Capillary Dynamics 335
Solute Exchange between the Cardiovascular System and Tissues 337
Capillary Water Transport 339
The Lymphatic System 342
CHAPTER 16 Special Vascular Physiology of Individual Organs 349
The Coronary Circulation 349
The Cerebral Circulation 351
The Circulation of the Small Intestine 354
The Hepatic Circulation 356
Skeletal Muscle Circulation 357
The Cutaneous Circulation 359
Fetal and Placental Circulations 360
CHAPTER 17 Neurohumoral Control Mechanisms in Cardiovascular
Function 369
Autonomic Neural Control of the Cardiovascular System 369
Hormonal Control of the Cardiovascular System 377
Circulatory Shock 381
PART V RESPIRATORY PHYSIOLOGY 389
CHAPTER 18 Ventilation and the Mechanics of Breathing 389
Lung Structural and Functional Relationships 390
Pulmonary Pressures and Airflow during Breathing 391
Spirometry and Lung Volumes 396
Minute Ventilation versus Alveolar Ventilation 399
Elastic Properties of Lung and Chest Wall 404
Airway Resistance and the Work of Breathing 411
CHAPTER 19 Gas Transfer and Transport 421
Gas Diffusion and Uptake 421
Diffusing Capacity 424
Gas Transport by the Blood 424CHAPTER 20 Pulmonary Circulation and Matching Ventilation/Perfusion 436
Functional Organization 436
Pulmonary Hemodynamic 437
Fluid Exchange in the Pulmonary Capillaries 441
Blood Flow Distribution in the Lungs 443
Shunts and Venous Admixture 444
CHAPTER 21 Control of Breathing 451
Involuntary and Voluntary Control of Breathing 451
Pulmonary Neural Reflexes Modify Breathing 454
Physiologic Responses to Altered Oxygen and Carbon Dioxide 456
Ventilatory Responses to Altered Environments 457
Control of Breathing During Sleep 459
Control of Breathing in Unusual Environments 461
PART VI RENAL PHYSIOLOGY AND BODY FLUIDS 470
CHAPTER 22 Kidney Function 470
Overview of Renal Function 470
The Nephron: The Functional Unit of the Kidney 471
Renal Blood Flow 474
Glomerular Filtration 476
Renal Clearance and Kidney Function 480
Basic Principles of Renal Tubular Transport 484
Tubule Secretion 490
Urinary Concentration Mechanisms and Water Conservation by the Kidney 493
Micturition 498
CHAPTER 23 Regulation of Fluid and Electrolyte Balance 505
Fluid Compartments of the Body 505
Water Balance 511
Fluid–Electrolyte Disturbances and Renal Function 514
Sodium Balance 515
Potassium Balance 522
Renal Handling of Calcium 525
Renal Handling of Magnesium 526
Renal Handling of Phosphate 526
CHAPTER 24 Acid–Base Homeostasis 533
Basic Principles of Acid–Base Chemistry 533
Metabolic Production of Acids in the Body 535
The Body’s Integrated Buffering Systems 536
Regulation of Intracellular pH 544
Physiologic Disturbances of Acid–Base Balance 545
PART VII GASTROINTESTINAL PHYSIOLOGY 556
CHAPTER 25 Gastrointestinal Motility 556
Organization of the Digestive System 557
Gastrointestinal Motility 559
Swallowing and Esophageal Motility 561
Esophageal Motility 562
Gastric Motility 563Large Intestinal Motility 567
Intestinal Smooth Muscle 570
Gut Motility and Digestive Function 571
Enteric Motor Neurons 574
CHAPTER 26 Gastrointestinal Secretory Functions 584
Gastrointestinal Secretion 584
Salivary Secretion 584
Gastric Secretion 587
Pancreatic Secretion 593
Biliary Secretion 597
Intestinal Secretion 599
CHAPTER 27 Gastrointestinal Digestion and Absorption of Nutrients 605
The Gastrointestinal System 605
Gastric Digestion and Absorption 606
The Small Intestine 607
Digestion and Absorption: Carbohydrates 608
Digestion and Absorption: Lipids 609
Digestion and Absorption: Proteins 613
Absorption: Vitamins 615
Absorption: Electrolytes and Minerals 617
Absorption: Water 620
Liver Function 621
Liver: Carbohydrate Metabolism 624
Liver: Lipid Metabolism 626
Liver: Protein Metabolism 628
Liver: Nutrient Storage 629
Liver: Drug Metabolism 631
Liver: Endocrine Function 633
Liver: Immune Function 633
PART VIII TEMPERATURE REGULATION AND EXERCISE PHYSIOLOGY 639
CHAPTER 28 Regulation of Body Temperature 639
Body Temperature and Heat Transfer 639
Thermoregulation: Heat Production and Heat Loss 642
Metabolic Rate and Heat Production at Rest 643
Heat Dissipation 646
Thermoregulatory Control 650
Thermoregulatory Responses During Exercise 653
Heat Acclimatization 655
Physiological Responses to Cold 657
Clinical Aspects of Thermoregulation 658
CHAPTER 29 Exercise Physiology 666
Oxygen Uptake and Exercise 666
Cardiovascular Responses to Exercise 667
Respiratory Responses to Exercise 671
Exercise-Induced Changes in Skeletal Muscle Dynamics and Bone Metabolism 673
Obesity, Aging, and Immune Responses to Exercis 677PART IX ENDOCRINE PHYSIOLOGY 683
CHAPTER 30 Endocrine Control Mechanisms 683
General Endocrine Concepts 683
Chemical Nature of Hormones 686
Measurement of Circulating Hormones 689
Mechanisms of Hormone Action 691
CHAPTER 31 Hypothalamus and the Pituitary Gland 696
Structure of the Hypothalamic–Pituitary Axis 696
Posterior Pituitary Hormones 698
Anterior Pituitary Hormones 699
Hypothalamic–Pituitary Regulation of Growth 704
CHAPTER 32 Thyroid Gland 713
Thyroid Hormone Synthesis, Secretion, and Metabolism 713
Thyroid Hormone Effects on the Body 718
Abnormalities of Thyroid Function in Adults 720
CHAPTER 33 Adrenal Gland 727
Adrenal Steroid Hormone Synthesis, Secretion, and Metabolism 727
Glucocorticoid Effects on the Body 734
Adrenal Catecholamines 737
CHAPTER 34 Endocrine Pancreas 742
Islets of Langerhans 742
Mechanisms of Islet Hormone Synthesis and Secretion 743
Insulin and Glucagon Action 748
Diabetes Mellitus 751
CHAPTER 35 Endocrine Regulations of Calcium, Phosphate, and Bone
Homeostasis 759
Overview of Calcium and Phosphate in the Body 759
Calcium and Phosphate Metabolism 761
Plasma Calcium and Phosphate Regulation 763
Bone Dysfunction 766
PART X REPRODUCTIVE PHYSIOLOGY 773
CHAPTER 36 Male Reproductive System 773
The Endocrine Glands of the Male Reproductive System 773
Testicular Function and Regulation 773
Spermatogenesis 779
Endocrine Function of the Testis 781
Androgen Action and Male Development 783
Male Reproductive Disorders 786
CHAPTER 37 Female Reproductive System 791
Female Reproductive Organs 791
Puberty 792
Hormonal Regulation of the Female Reproductive System 794
Ovarian Steroid Synthesis 796
Ovarian Cycle 798
Menstrual Cycle 801
Female Reproductive System Disorders 805CHAPTER 38 Fertilization, Pregnancy, and Fetal Development 810
Fertilization, Implantation, and Placenta Development 810
Maternal Adaptation during and Following Pregnancy 816
Fetal Development and Growth 820
Contraception 824
PART XI AGING 829
CHAPTER 39 Physiology of Aging and Organ Function 829
Aging Defined 829
Science of Aging 830
Physiological Changes and Aging 833
Aging and Respiratory Changes 834
Aging and Musculoskeletal Changes 835
Aging and Gastrointestinal Changes 836
Aging and the Endocrine System 837
Aging and the Sensory System 838
Aging and the Urinary System 839
Appendix A: Common Abbreviations in Physiology 845
Appendix B: Normal Blood, Plasma, or Serum Values 848
Glossary 851
Index 911
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