Guyton and Hall Textbook of Medical Physiology

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Front cover......Page 1 IFC_Student Consult ad......Page 2 Guyton and Hall Textbook of Medical Physiology......Page 3 Copyright page......Page 6 Dedication......Page 7 Preface......Page 9 Table of Contents......Page 11 Half title page......Page 23 Unit I Introduction to Physiology: The Cell and General Physiology......Page 25 Differences Between Extracellular and Intracellular Fluids.......Page 27 Extracellular Fluid Transport and Mixing System—the Blood Circulatory System......Page 28 Kidneys.......Page 29 Control Systems of the Body......Page 30 Normal Ranges and Physical Characteristics of Important Extracellular Fluid Constituents......Page 31 Gain of a Control System.......Page 32 More Complex Types of Control Systems—Adaptive Control......Page 33 Bibliography......Page 34 Lipids.......Page 35 The Cell Membrane Lipid Barrier Impedes Penetration by Water-Soluble Substances.......Page 36 Integral and Peripheral Cell Membrane Proteins.......Page 37 Endoplasmic Reticulum......Page 38 Lysosomes......Page 39 Mitochondria......Page 40 Nuclear Membrane.......Page 41 Comparison of the Animal Cell with Precellular Forms of Life......Page 42 Phagocytosis.......Page 43 Specific Functions of the Endoplasmic Reticulum......Page 44 Processing of Endoplasmic Secretions by the Golgi Apparatus—Formation of Vesicles.......Page 45 The Mitochondria Extract Energy from Nutrients......Page 46 Uses of ATP for Cellular Function.......Page 47 Mechanism of Ameboid Locomotion.......Page 48 Cilia and Ciliary Movements......Page 49 Bibliography......Page 50 Nucleotides......Page 51 Nucleotides Are Organized to Form Two Strands of DNA Loosely Bound to Each Other......Page 52 Genetic Code......Page 53 Assembly of the RNA Chain from Activated Nucleotides Using the DNA Strand as a Template—The Process of Transcription......Page 54 RNA Codons for the Different Amino Acids.......Page 55 miRNA and Small Interfering RNA......Page 56 Polyribosomes.......Page 57 Chemical Steps in Protein Synthesis.......Page 58 The Promoter Controls Gene Expression.......Page 59 Other Mechanisms for Control of Transcription by the Promoter.......Page 60 Cell Reproduction Begins With Replication of DNA......Page 61 Chromosomes and Their Replication......Page 62 Telophase.......Page 63 Telomeres Prevent the Degradation of Chromosomes.......Page 64 Cancer......Page 65 Invasive Characteristic of the Cancer Cell.......Page 66 Bibliography......Page 67 Unit II Membrane Physiology, Nerve, and Muscle......Page 69 Diffusion......Page 71 Diffusion of Water and Other Lipid-Insoluble Molecules Through Protein Channels.......Page 72 Selective Permeability of Protein Channels.......Page 73 Patch-Clamp Method for Recording Ion Current Flow Through Single Channels.......Page 74 Facilitated Diffusion Requires Membrane Carrier Proteins......Page 75 Effect of Membrane Electrical Potential on Diffusion of Ions—The “Nernst Potential.”......Page 76 Osmotic Pressure......Page 77 “Active Transport” of Substances Through Membranes......Page 78 Sodium-Potassium Pump Transports Sodium Ions Out of Cells and Potassium Ions Into Cells......Page 79 Energetics of Primary Active Transport......Page 80 Sodium Counter-Transport of Calcium and Hydrogen Ions......Page 81 Bibliography......Page 82 The Nernst Equation Describes the Relation of Diffusion Potential to the Ion Concentration Difference Across a Membrane.......Page 85 Measuring the Membrane Potential......Page 86 Leakage of Potassium Through the Nerve Cell Membrane.......Page 87 Contribution of the Na+-K+ Pump.......Page 88 Activation of the Sodium Channel.......Page 89 The “Voltage Clamp” Method for Measuring the Effect of Voltage on Opening and Closing of the Voltage-Gated Channels.......Page 90 Summary of the Events that Cause the Action Potential......Page 91 A Positive-Feedback Cycle Opens the Sodium Channels.......Page 92 Re-Establishing Sodium and Potassium Ionic Gradients After Action Potentials are Completed—Importance of Energy Metabolism......Page 93 Rhythmicity of Some Excitable Tissues—Repetitive Discharge......Page 94 Myelinated and Unmyelinated Nerve Fibers.......Page 95 Excitation—The Process of Eliciting the Action Potential......Page 96 Local Anesthetics.......Page 97 Bibliography......Page 98 Titin Filamentous Molecules Keep the Myosin and Actin Filaments in Place.......Page 99 General Mechanism of Muscle Contraction......Page 101 Myosin Filaments Are Composed of Multiple Myosin Molecules.......Page 102 Inhibition of the Actin Filament by the Troponin-Tropomyosin Complex.......Page 103 ATP as the Energy Source for Contraction—Chemical Events in the Motion of the Myosin Heads.......Page 104 Relation of Velocity of Contraction to Load......Page 105 Three Sources of Energy for Muscle Contraction......Page 106 Characteristics of Isometric Twitches Recorded from Different Muscles.......Page 107 Muscle Contractions of Different Force—Force Summation.......Page 108 Changes in Muscle Strength at the Onset of Contraction—The Staircase Effect (Treppe).......Page 109 “Positioning” of a Body Part by Contraction of Agonist and Antagonist Muscles on Opposite Sides of a Joint—“Coactivation” of Antagonist Muscles.......Page 110 Recovery of Muscle Contraction in Poliomyelitis: Development of Macromotor Units.......Page 111 Bibliography......Page 112 Acetylcholine Opens Ion Channels on Postsynaptic Membranes.......Page 113 End Plate Potential and Excitation of the Skeletal Muscle Fiber.......Page 115 Drugs That Stimulate the Neuromuscular Junction by Inactivating Acetylcholinesterase.......Page 116 Release of Calcium Ions by the Sarcoplasmic Reticulum......Page 117 Excitatory “Pulse” of Calcium Ions.......Page 118 Bibliography......Page 119 Chemical Basis for Smooth Muscle Contraction......Page 121 Comparison of Smooth Muscle Contraction and Skeletal Muscle Contraction......Page 122 Regulation of Contraction by Calcium Ions......Page 123 Role of the Smooth Muscle Sarcoplasmic Reticulum.......Page 124 Possible Mechanism for Regulation of the Latch Phenomenon.......Page 125 Excitatory and Inhibitory Transmitter Substances Secreted at the Smooth Muscle Neuromuscular Junction.......Page 126 Slow Wave Potentials in Unitary Smooth Muscle Can Lead to Spontaneous Generation of Action Potentials.......Page 127 Mechanisms of Smooth Muscle Excitation or Inhibition by Hormones or Local Tissue Factors.......Page 128 Bibliography......Page 129 Unit III The Heart......Page 131 Cardiac Muscle Is a Syncytium.......Page 133 What Causes the Long Action Potential and the Plateau?......Page 134 Refractory Period of Cardiac Muscle.......Page 135 Duration of Contraction.......Page 136 Increasing Heart Rate Decreases Duration of Cardiac Cycle.......Page 137 Pressure Changes in the Atria—a, c, and v Waves.......Page 138 Atrioventricular Valves.......Page 139 Work Output of the Heart......Page 140 “Volume-Pressure Diagram” During the Cardiac Cycle; Cardiac Work Output.......Page 141 Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart......Page 142 Ventricular Function Curves......Page 143 Effect of Sympathetic or Parasympathetic Stimulation on the Cardiac Function Curve.......Page 144 Increasing the Arterial Pressure Load (Up to a Limit) Does Not Decrease the Cardiac Output......Page 145 Bibliography......Page 146 Mechanism of Sinus Nodal Rhythmicity.......Page 147 Self-Excitation of Sinus Nodal Fibers.......Page 148 Rapid Transmission in the Ventricular Purkinje System......Page 149 The Sinus Node is the Normal Pacemaker of the Heart......Page 150 Role of the Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle......Page 151 Mechanism of the Sympathetic Effect.......Page 152 Bibliography......Page 153 Relation of the Monophasic Action Potential of Ventricular Muscle to the QRS and T Waves in the Standard Electrocardiogram.......Page 155 Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram......Page 156 Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle......Page 157 Lead I.......Page 158 Normal Electrocardiograms Recorded from the Three Standard Bipolar Limb Leads.......Page 159 Augmented Unipolar Limb Leads......Page 160 Bibliography......Page 161 The Direction of a Vector is Denoted in Terms of Degrees......Page 163 Vectorial Analysis of Potentials Recorded in Different Leads......Page 164 Vectors that Occur at Successive Intervals During Depolarization of the Ventricles—The QRS Complex......Page 165 Depolarization of the Atria—The P Wave......Page 167 Determining the Electrical Axis from Standard Lead Electrocardiograms......Page 168 Vectorial Analysis of Left Axis Deviation Resulting from Hypertrophy of the Left Ventricle.......Page 169 Vectorial Analysis of Right Axis Deviation in Right Bundle Branch Block.......Page 170 Decreased Voltage Caused by Conditions Surrounding the Heart.......Page 171 Effect of Current of Injury on the QRS Complex......Page 172 The “J Point” is the Zero Reference Potential for Analyzing Current of Injury......Page 173 Acute Anterior Wall Infarction.......Page 174 Recovery from Acute Coronary Thrombosis.......Page 175 Shortened Depolarization in Portions of the Ventricular Muscle Can Cause T-Wave Abnormalities......Page 176 Bibliography......Page 177 Vagal Stimulation Causes Bradycardia.......Page 179 Prolonged P-R (or P-Q) Interval—First-Degree Block.......Page 180 Stokes-Adams Syndrome—Ventricular Escape.......Page 181 A-V Nodal or A-V Bundle Premature Contractions......Page 182 Disorders of Cardiac Repolarization—The Long QT Syndromes.......Page 183 Atrial Paroxysmal Tachycardia......Page 184 Phenomenon of Re-Entry—“Circus Movements” as the Basis for Ventricular Fibrillation......Page 185 Fibrillation Caused by 60-Cycle Alternating Current.......Page 186 Electroshock Defibrillation of the Ventricles......Page 187 Electrocardiogram in Atrial Fibrillation......Page 188 Bibliography......Page 189 Unit IV The Circulation......Page 191 Cross-Sectional Areas and Velocities of Blood Flow.......Page 193 Basic Principles of Circulatory Function......Page 194 Interrelationships of Pressure, Flow, and Resistance......Page 195 Electromagnetic Flowmeter.......Page 196 Turbulent Flow of Blood Under Some Conditions.......Page 197 High-Fidelity Methods for Measuring Blood Pressure.......Page 198 Poiseuille’s Law.......Page 199 Resistance to Blood Flow in Series and Parallel Vascular Circuits.......Page 200 “Autoregulation” Attenuates the Effect of Arterial Pressure on Tissue Blood Flow.......Page 201 Bibliography......Page 202 Volume-Pressure Curves of the Arterial and Venous Circulations......Page 203 Arterial Pressure Pulsations......Page 204 Pressure Pulses Are Damped in the Smaller Arteries, Arterioles, and Capillaries.......Page 205 Auscultatory Method.......Page 206 Mean Arterial Pressure.......Page 207 Venous Resistance and Peripheral Venous Pressure......Page 208 Effect of Gravitational Pressure on Venous Pressure......Page 209 Direct Measurement of Venous Pressure and Right Atrial Pressure.......Page 210 The Spleen as a Reservoir for Storing Red Blood Cells......Page 211 Bibliography......Page 212 “Pores” in the Capillary Membrane.......Page 213 Regulation of Vasomotion.......Page 214 Effect of Molecular Size on Passage Through the Pores.......Page 215 Interstitium and Interstitial Fluid......Page 216 Hydrostatic and Colloid Osmotic Forces Determine Fluid Movement Through the Capillary Membrane.......Page 217 Isogravimetric Method for Indirectly Measuring “Functional” Capillary Pressure.......Page 218 Plasma Proteins Cause Colloid Osmotic Pressure.......Page 219 Analysis of Reabsorption at the Venous End of the Capillary.......Page 220 Effect of Abnormal Imbalance of Forces at the Capillary Membrane.......Page 221 Lymph Channels of the Body......Page 222 Effect of Interstitial Fluid Pressure on Lymph Flow.......Page 223 Lymphatic Capillary Pump.......Page 224 Bibliography......Page 225 Mechanisms of Blood Flow Control......Page 227 Vasodilator Theory for Acute Local Blood Flow Regulation—Possible Special Role of Adenosine.......Page 228 Possible Role of Other Nutrients Besides Oxygen in Control of Local Blood Flow.......Page 229 Autoregulation of Blood Flow During Changes in Arterial Pressure—“Metabolic” and “Myogenic” Mechanisms......Page 230 Special Mechanisms for Acute Blood Flow Control in Specific Tissues......Page 231 Endothelin—A Powerful Vasoconstrictor Released from Damaged Endothelium.......Page 232 Blood Flow Regulation by Changes in Tissue Vascularity......Page 233 Blood Flow Regulation by Development of Collateral Circulation......Page 234 Vascular Remodeling in Response to Chronic Changes in Blood Flow or Blood Pressure......Page 235 Vasopressin.......Page 236 Bibliography......Page 237 Parasympathetic Stimulation Decreases Heart Rate and Contractility.......Page 239 Vasomotor Center in the Brain and Its Control of the Vasoconstrictor System.......Page 240 Control of the Vasomotor Center by Higher Nervous Centers.......Page 241 Nervous Control of Arterial Pressure Is Rapid.......Page 242 Circulatory Reflex Initiated by the Baroreceptors.......Page 243 Pressure “Buffer” Function of the Baroreceptor Control System.......Page 245 Atrial Reflexes That Activate the Kidneys—The “Volume Reflex.”......Page 246 Cushing Reaction to Increased Pressure Around the Brain.......Page 247 Oscillation of the Baroreceptor and Chemoreceptor Reflexes.......Page 248 Bibliography......Page 249 An Experiment Demonstrating the Renal–Body Fluid System for Arterial Pressure Control.......Page 251 Two Key Determinants of Long-Term Arterial Pressure.......Page 252 The Chronic Renal Output Curve Is Much Steeper than the Acute Curve.......Page 253 Increased Fluid Volume Can Elevate Arterial Pressure by Increasing Cardiac Output or Total Peripheral Resistance......Page 254 Importance of Salt (NaCl) in the Renal–Body Fluid Schema for Arterial Pressure Regulation......Page 255 Sequential Changes in Circulatory Function During the Development of Volume-Loading Hypertension.......Page 256 Components of the Renin-Angiotensin System......Page 258 Angiotensin II Causes Renal Retention of Salt and Water—An Important Means for Long-Term Control of Arterial Pressure......Page 259 Role of the Renin-Angiotensin System in Maintaining a Normal Arterial Pressure Despite Large Variations in Salt Intake......Page 260 “One-Kidney” Goldblatt Hypertension.......Page 261 Hypertension in the Upper Part of the Body Caused by Coarctation of the Aorta.......Page 262 Genetic Causes of Hypertension.......Page 263 Graphical Analysis of Arterial Pressure Control in Essential Hypertension.......Page 264 Rapidly Acting Pressure Control Mechanisms That Act Within Seconds or Minutes.......Page 265 Long-Term Mechanisms for Arterial Pressure Regulation.......Page 266 Bibliography......Page 267 Control of Cardiac Output by Venous Return—The Frank-Starling Mechanism of the Heart......Page 269 Long-Term Cardiac Output Varies Inversely with Total Peripheral Resistance When Arterial Pressure Is Unchanged.......Page 270 Heart Hypertrophy Can Increase Pumping Effectiveness.......Page 271 High Cardiac Output Caused by Reduced Total Peripheral Resistance......Page 272 Decrease in Cardiac Output Caused by Noncardiac Peripheral Factors—Decreased Venous Return.......Page 273 Effect of External Pressure Outside the Heart on Cardiac Output Curves.......Page 274 Normal Venous Return Curve......Page 275 Mean Systemic Filling Pressure and Its Relation to Mean Circulatory Filling Pressure.......Page 276 Effect of Resistance to Venous Return on the Venous Return Curve.......Page 277 Effect of Increased Blood Volume on Cardiac Output.......Page 278 Effect of Opening a Large Arteriovenous Fistula.......Page 279 Measurement of Cardiac Output Using the Oxygen Fick Principle......Page 280 Indicator Dilution Method for Measuring Cardiac Output......Page 281 Bibliography......Page 282 Decreased Oxygen in Muscle Greatly Enhances Flow.......Page 283 Sympathetic Stimulation May Increase Arterial Pressure During Exercise......Page 284 Graphical Analysis of the Changes in Cardiac Output During Heavy Exercise.......Page 285 Phasic Changes in Coronary Blood Flow During Systole and Diastole—Effect of Cardiac Muscle Compression.......Page 286 Nervous Control of Coronary Blood Flow......Page 287 Atherosclerosis as a Cause of Ischemic Heart Disease.......Page 288 Myocardial Infarction......Page 289 Damming of Blood in the Body’s Venous System.......Page 290 Stages of Recovery from Acute Myocardial Infarction......Page 291 Angina Pectoris (Cardiac Pain).......Page 292 Bibliography......Page 293 Compensation for Acute Cardiac Failure by Sympathetic Nervous Reflexes.......Page 295 Recovery of the Heart After Myocardial Infarction......Page 296 Graphical Analysis of Decompensated Heart Failure.......Page 297 Mechanism of Action of the Cardiotonic Drugs Such as Digitalis.......Page 298 Acute Cardiac Failure Does Not Cause Immediate Peripheral Edema.......Page 299 Long-Term Fluid Retention by the Kidneys Causes Peripheral Edema in Persisting Heart Failure......Page 300 Diagnosis of Low Cardiac Reserve—Exercise Test.......Page 301 Compensation During the Next Few Days Further Increases Cardiac Output and Venous Return Curves.......Page 302 Treatment of Decompensated Heart Disease with Digitalis.......Page 303 Bibliography......Page 304 Duration and Pitch of the First and Second Heart Sounds.......Page 307 Phonocardiogram.......Page 308 Systolic Murmur of Aortic Stenosis.......Page 309 Increase in Blood Volume.......Page 310 Circulatory Dynamics during Exercise in Patients with Valvular Lesions......Page 311 Closure of the Ductus Arteriosus After Birth.......Page 312 Tetralogy of Fallot is a Right-to-Left Shunt......Page 313 Detrimental Effects of Late Stages of Cardiac Hypertrophy.......Page 314 Bibliography......Page 315 Tissue Deterioration is the End Result of Circulatory Shock......Page 317 Greater Effect of the Sympathetic Nervous Reflexes in Maintaining Arterial Pressure than in Maintaining Cardiac Output.......Page 318 Nonprogressive Shock—Compensated Shock......Page 319 Cardiac Depression.......Page 320 Generalized Cellular Deterioration.......Page 321 Irreversible Shock......Page 322 Neurogenic Shock—Increased Vascular Capacity......Page 323 Special Features of Septic Shock.......Page 324 Treatment by the Head-Down Position.......Page 325 Bibliography......Page 326 Unit V The Body Fluids and Kidneys......Page 327 Water Loss by the Kidneys.......Page 329 Intracellular Fluid Compartment......Page 330 Ionic Composition of Plasma and Interstitial Fluid is Similar......Page 331 Measurement of Fluid Volumes in the Different Body Fluid Compartments—the Indicator-Dilution Principle......Page 332 Measurement of Plasma Volume.......Page 333 Calculation of the Osmolarity and Osmotic Pressure of a Solution.......Page 334 Isotonic, Hypotonic, and Hypertonic Fluids.......Page 335 Calculation of Fluid Shifts and Osmolarities After Infusion of Hypertonic Saline Solution.......Page 336 Causes of Hyponatremia: Excess Water or Loss of Sodium......Page 338 Causes of Hypernatremia: Water Loss or Excess Sodium......Page 339 Factors That Can Increase Capillary Filtration......Page 340 Edema Caused by Decreased Kidney Excretion of Salt and Water.......Page 341 Safety Factor Caused by Low Compliance of the Interstitium in the Negative Pressure Range......Page 342 “Washdown” of the Interstitial Fluid Protein as a Safety Factor Against Edema......Page 343 Bibliography......Page 344 Regulation of Water and Electrolyte Balances.......Page 347 General Organization of the Kidneys and Urinary Tract......Page 348 The Nephron is the Functional Unit of the Kidney......Page 349 Regional Differences in Nephron Structure: Cortical and Juxtamedullary Nephrons.......Page 350 Physiological Anatomy of the Bladder......Page 351 Innervation of the Bladder.......Page 352 Filling of the Bladder and Bladder Wall Tone; the Cystometrogram......Page 353 Automatic Bladder Caused by Spinal Cord Damage Above the Sacral Region.......Page 354 Urine Formation Results From Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion......Page 355 Bibliography......Page 356 Glomerular Capillary Membrane......Page 359 Negatively Charged Large Molecules Are Filtered Less Easily Than Positively Charged Molecules of Equal Molecular Size.......Page 360 Increased Glomerular Capillary Filtration Coefficient Increases GFR......Page 361 Increased Glomerular Capillary Colloid Osmotic Pressure Decreases GFR......Page 362 Increased Glomerular Capillary Hydrostatic Pressure Increases GFR......Page 363 Determinants of Renal Blood Flow......Page 364 Norepinephrine, Epinephrine, and Endothelin Constrict Renal Blood Vessels and Decrease GFR.......Page 365 Autoregulation of GFR and Renal Blood Flow......Page 366 Decreased Macula Densa Sodium Chloride Causes Dilation of Afferent Arterioles and Increased Renin Release.......Page 367 Myogenic Autoregulation of Renal Blood Flow and GFR......Page 368 Other Factors That Increase Renal Blood Flow and GFR: High Protein Intake and Increased Blood Glucose.......Page 369 Bibliography......Page 370 Tubular Reabsorption Includes Passive and Active Mechanisms......Page 371 Primary Active Transport Through the Tubular Membrane Is Linked to Hydrolysis of ATP.......Page 372 Secondary Active Reabsorption Through the Tubular Membrane.......Page 373 Transport Maximum for Substances That Are Actively Reabsorbed.......Page 374 Substances That Are Actively Transported but Do Not Exhibit a Transport Maximum.......Page 375 Reabsorption of Chloride, Urea, and Other Solutes by Passive Diffusion......Page 376 Proximal Tubules Have a High Capacity for Active and Passive Reabsorption.......Page 377 Solute and Water Transport in the Loop of Henle......Page 378 Distal Tubule......Page 379 Principal Cells Reabsorb Sodium and Secrete Potassium.......Page 380 Intercalated Cells Secrete or Reabsorb Hydrogen, Bicarbonate, and Potassium Ions.......Page 381 Summary of Concentrations of Different Solutes in the Different Tubular Segments......Page 382 Glomerulotubular Balance—the Reabsorption Rate Increases in Response to Increased Tubular Load......Page 383 Regulation of Peritubular Capillary Physical Forces.......Page 384 Renal Interstitial Hydrostatic and Colloid Osmotic Pressures.......Page 385 Hormonal Control of Tubular Reabsorption......Page 386 Angiotensin II Increases Sodium and Water Reabsorption.......Page 387 Sympathetic Nervous System Activation Increases Sodium Reabsorption......Page 388 Inulin Clearance Can be Used to Estimate GFR......Page 389 Creatinine Clearance and Plasma Creatinine Concentration Can be Used to Estimate GFR......Page 390 PAH Clearance Can be Used to Estimate RPF......Page 391 Bibliography......Page 392 Renal Mechanisms for Excreting Dilute Urine......Page 395 Tubular Fluid in Distal and Collecting Tubules Is Further Diluted in the Absence of ADH.......Page 396 Urine Specific Gravity......Page 397 Special Characteristics of the Loop of Henle That Cause Solutes to be Trapped in the Renal Medulla......Page 398 Steps Involved in Causing Hyperosmotic Renal Medullary Interstitium.......Page 399 Urea Contributes to Hyperosmotic Renal Medullary Interstitium and Formation of Concentrated Urine......Page 400 Countercurrent Exchange in the Vasa Recta Preserves Hyperosmolarity of the Renal Medulla......Page 401 Descending Loop of Henle.......Page 402 Inner Medullary Collecting Ducts.......Page 403 Failure to Produce ADH: “Central” Diabetes Insipidus.......Page 404 Osmoreceptor-ADH Feedback System......Page 405 ADH Synthesis in Supraoptic and Paraventricular Nuclei of the Hypothalamus and ADH Release From the Posterior Pituitary......Page 406 Quantitative Importance of Osmolarity and Cardiovascular Reflexes in Stimulating ADH Secretion......Page 407 Stimuli for Thirst......Page 408 Role of Angiotensin II and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration......Page 409 Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume......Page 410 Bibliography......Page 411 β-Adrenergic Stimulation Increases Cellular Uptake of Potassium.......Page 413 Overview of Renal Potassium Excretion......Page 414 Potassium Secretion by Principal Cells of Late Distal and Cortical Collecting Tubules......Page 415 Increased Extracellular Fluid Potassium Concentration Stimulates Potassium Secretion.......Page 416 Blockade of the Aldosterone Feedback System Greatly Impairs Control of Potassium Concentration.......Page 417 Increased Distal Tubular Flow Rate Stimulates Potassium Secretion.......Page 418 Beneficial Effects of a Diet High in Potassium and Low in Sodium Content......Page 419 Control of Calcium Excretion by the Kidneys......Page 420 Regulation of Renal Phosphate Excretion......Page 421 Integration of Renal Mechanisms for Control of Extracellular Fluid......Page 422 Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance......Page 423 Pressure Natriuresis and Diuresis are Key Components of a Renal–Body Fluid Feedback for Regulating Body Fluid Volumes and Arterial Pressure......Page 424 Distribution of Extracellular Fluid between the Interstitial Spaces and Vascular System......Page 425 Sympathetic Nervous System Control of Renal Excretion: Arterial Baroreceptor and Low-Pressure Stretch Receptor Reflexes......Page 426 Excessive Ang II Does Not Usually Cause Large Increases in Extracellular Fluid Volume Because Increased Arterial Pressure Counterbalances Ang II–Mediated Sodium Retention.......Page 427 Excess ADH Secretion Usually Causes Only Small Increases in Extracellular Fluid Volume but Large Decreases in Sodium Concentration.......Page 428 Increased Blood Volume and Extracellular Fluid Volume Caused by Heart Diseases......Page 429 Liver Cirrhosis—Decreased Synthesis of Plasma Proteins by the Liver and Sodium Retention by the Kidneys......Page 430 Bibliography......Page 431 Normal H+ Concentration and pH of Body Fluids and Changes That Occur in Acidosis and Alkalosis.......Page 433 Buffering of H+ in the Body Fluids......Page 434 Quantitative Dynamics of the Bicarbonate Buffer System......Page 435 “Buffer Power” Is Determined by the Amount and Relative Concentrations of the Buffer Components.......Page 436 Proteins are Important Intracellular Buffers......Page 437 Increased H+ Concentration Stimulates Alveolar Ventilation......Page 438 Renal Control of Acid-Base Balance......Page 439 H+ is Secreted by Secondary Active Transport in the Early Tubular Segments......Page 440 Primary Active Secretion of H+ in the Intercalated Cells of Late Distal and Collecting Tubules......Page 441 Phosphate Buffer System Carries Excess H+ Into the Urine and Generates New HCO3−......Page 442 Excretion of Excess H+ and Generation of New HCO3− by the Ammonia Buffer System......Page 443 Regulation of Renal Tubular H+ Secretion......Page 444 Acidosis Decreases the HCO3−/H+ Ratio in Renal Tubular Fluid......Page 445 Respiratory Acidosis Results from Decreased Ventilation and Increased Pco2......Page 446 Administration of Diuretics (Except the Carbonic Anhydrase Inhibitors).......Page 447 Clinical Measurements and Analysis of Acid-Base Disorders......Page 448 Complex Acid-Base Disorders and Use of the Acid-Base Nomogram for Diagnosis......Page 449 Bibliography......Page 450 “Loop” Diuretics Decrease Active Sodium-Chloride-Potassium Reabsorption in the Thick Ascending Loop of Henle......Page 451 Carbonic Anhydrase Inhibitors Block Sodium Bicarbonate Reabsorption in the Proximal Tubules......Page 452 Acute Kidney Injury......Page 453 Intrarenal Acute Kidney Injury Caused by Abnormalities Within the Kidney......Page 454 Physiological Effects of Acute Kidney Injury......Page 455 Vicious Cycle of Chronic Kidney Disease Leading to End-Stage Renal Disease......Page 456 Injury to the Renal Vasculature as a Cause of Chronic Kidney Disease......Page 457 Nephrotic Syndrome—Excretion of Protein in the Urine Because of Increased Glomerular Permeability......Page 458 Loss of Functional Nephrons Requires Surviving Nephrons to Excrete More Water and Solutes.......Page 459 Effects of Renal Failure on the Body Fluids—Uremia......Page 460 Osteomalacia in Chronic Kidney Disease Caused by Decreased Production of Active Vitamin D and by Phosphate Retention by the Kidneys.......Page 461 Kidney Diseases That Cause Loss of Entire Nephrons Lead to Chronic Kidney Disease but May Not Cause Hypertension......Page 462 Gitelman’s Syndrome—Decreased Sodium Chloride Reabsorption in the Distal Tubules.......Page 463 Basic Principles of Dialysis......Page 464 Bibliography......Page 465 Unit VI Blood Cells, Immunity, and Blood Coagulation......Page 467 Areas of the Body That Produce Red Blood Cells.......Page 469 Pluripotential Hematopoietic Stem Cells, Growth Inducers, and Differentiation Inducers.......Page 470 Erythropoietin Regulates Red Blood Cell Production......Page 471 Erythropoietin Stimulates Production of Proerythroblasts from Hematopoietic Stem Cells.......Page 472 Hemoglobin Formation......Page 473 Transport and Storage of Iron.......Page 474 The Life Span of Red Blood Cells is About 120 Days......Page 475 Hemolytic Anemia.......Page 476 Bibliography......Page 477 Genesis of White Blood Cells......Page 479 Life Span of White Blood Cells......Page 480 Phagocytosis by Neutrophils.......Page 481 Macrophages in the Lymph Nodes.......Page 482 Macrophages of the Spleen and Bone Marrow.......Page 483 Neutrophil Invasion of the Inflamed Area Is a Second Line of Defense.......Page 484 Feedback Control of the Macrophage and Neutrophil Responses......Page 485 Basophils......Page 486 Effects of Leukemia on the Body......Page 487 Bibliography......Page 488 Both Types of Acquired Immunity are Initiated by Antigens......Page 489 The Thymus Gland Preprocesses the T Lymphocytes.......Page 490 Millions of Specific Types of Lymphocytes Are Stored in the Lymphoid Tissue.......Page 491 Role of the T Cells in Activation of the B Lymphocytes.......Page 492 Nature of the Antibodies......Page 493 Direct Action of Antibodies on Invading Agents.......Page 494 Classical Pathway.......Page 495 Several Types of T Cells and Their Different Functions......Page 496 Cytotoxic T Cells Are “Killer” Cells......Page 497 Immunization by Injection of Antigens......Page 498 “Atopic” Allergies Associated with Excess IgE Antibodies......Page 499 Bibliography......Page 500 Genetic Determination of the Agglutinogens.......Page 501 Acute Hemolysis Occurs in Some Transfusion Reactions.......Page 502 Erythroblastosis Fetalis (“Hemolytic Disease of the Newborn”)......Page 503 Acute Kidney Failure After Transfusion Reactions.......Page 504 Prevention of Graft Rejection by Suppressing the Immune System......Page 505 Bibliography......Page 506 Physical and Chemical Characteristics of Platelets......Page 507 Blood Coagulation in the Ruptured Vessel......Page 508 Prothrombin and Thrombin.......Page 509 Positive Feedback of Clot Formation......Page 510 Intrinsic Pathway for Initiating Clotting......Page 511 Role of Calcium Ions in the Intrinsic and Extrinsic Pathways......Page 512 Plasmin Causes Lysis of Blood Clots......Page 513 Hemophilia......Page 514 Disseminated Intravascular Coagulation......Page 515 Prevention of Blood Coagulation Outside the Body......Page 516 Bibliography......Page 517 Unit VII Respiration......Page 519 Pressures That Cause the Movement of Air in and out of the Lungs......Page 521 Alveolar Pressure—The Air Pressure Inside the Lung Alveoli.......Page 522 Principle of Surface Tension.......Page 523 “Work” of Breathing......Page 524 Pulmonary Capacities......Page 525 Determination of Functional Residual Capacity, Residual Volume, and Total Lung Capacity—Helium Dilution Method......Page 526 Measurement of the Dead Space Volume.......Page 527 Resistance to Airflow in the Bronchial Tree.......Page 528 Mucus Lining the Respiratory Passageways, and Action of Cilia to Clear the Passageways......Page 529 Vocalization......Page 530 Bibliography......Page 531 Pressures in the Pulmonary Artery.......Page 533 Blood Flow Through the Lungs and Its Distribution......Page 534 Zones 1, 2, and 3 of Pulmonary Blood Flow......Page 535 Increased Cardiac Output during Heavy Exercise is Normally Accommodated by the Pulmonary Circulation Without Large Increases in Pulmonary Artery Pressure......Page 536 Capillary Exchange of Fluid in the Lungs and Pulmonary Interstitial Fluid Dynamics......Page 537 “Pulmonary Edema Safety Factor.”......Page 538 Pleural Effusion—Collection of Large Amounts of Free Fluid in the Pleural Space.......Page 539 Bibliography......Page 540 Factors That Determine the Partial Pressure of a Gas Dissolved in a Fluid.......Page 541 Quantifying the Net Rate of Diffusion in Fluids.......Page 542 Alveolar Air is Slowly Renewed by Atmospheric Air......Page 543 Oxygen Concentration and Partial Pressure in the Alveoli......Page 544 Respiratory Membrane.......Page 545 Factors That Affect the Rate of Gas Diffusion Through the Respiratory Membrane......Page 546 Increased Oxygen Diffusing Capacity during Exercise.......Page 547 Effect of the Ventilation-Perfusion Ratio on Alveolar Gas Concentration......Page 548 Concept of “Physiological Shunt” (When Is Below Normal)......Page 549 Bibliography......Page 550 Uptake of Oxygen by the Pulmonary Blood during Exercise.......Page 551 Increasing Tissue Metabolism Decreases Interstitial Fluid Po2.......Page 552 Effect of Rate of Tissue Metabolism and Tissue Blood Flow on Interstitial Pco2.......Page 553 Amount of Oxygen Released From the Hemoglobin When Systemic Arterial Blood Flows Through the Tissues.......Page 554 When Atmospheric Oxygen Concentration Changes Markedly, the Buffer Effect of Hemoglobin Still Maintains Almost Constant Tissue Po2.......Page 555 Rightward Shift of the Oxygen-Hemoglobin Dissociation Curve during Exercise......Page 556 Transport of Oxygen in the Dissolved State......Page 557 Transport of Carbon Dioxide in the Dissolved State......Page 558 When Oxygen Binds with Hemoglobin, Carbon Dioxide is Released (the Haldane Effect) to Increase Carbon Dioxide Transport......Page 559 Bibliography......Page 560 Inspiratory “Ramp” Signal.......Page 563 Control of Overall Respiratory Center Activity......Page 564 Decreased Stimulatory Effect of CO2 After the First 1 to 2 Days.......Page 565 Peripheral Chemoreceptor System for Control of Respiratory Activity—Role of Oxygen in Respiratory Control......Page 566 Effect of Low Arterial Po2 to Stimulate Alveolar Ventilation When Arterial CO2 and Hydrogen Ion Concentrations Remain Normal......Page 567 Composite Effects of Pco2, pH, and Po2 on Alveolar Ventilation......Page 568 Interrelation Between Chemical Factors and Nervous Factors in the Control of Respiration during Exercise.......Page 569 Periodic Breathing.......Page 570 Obstructive Sleep Apnea Is Caused by Blockage of the Upper Airway.......Page 571 Bibliography......Page 572 Determination of Blood PO2.......Page 573 Abnormalities of the Maximum Expiratory Flow-Volume Curve.......Page 574 Chronic Pulmonary Emphysema......Page 575 Pneumonia—Lung Inflammation and Fluid in Alveoli......Page 576 Lack of “Surfactant” as a Cause of Lung Collapse.......Page 577 Hypoxia and Oxygen Therapy......Page 578 Cyanosis......Page 579 Tank Respirator (the “Iron Lung”).......Page 580 Bibliography......Page 581 Unit VIII Aviation, Space, and Deep–Sea Diving Physiology......Page 583 Saturation of Hemoglobin with Oxygen at Different Altitudes.......Page 585 Acclimatization to Low Po2......Page 586 Hypoxia-Inducible Factors—a “Master Switch” for the Body’s Response to Hypoxia......Page 587 Acute Mountain Sickness and High-Altitude Pulmonary Edema......Page 588 Effects on the Circulatory System.......Page 589 Acceleratory Forces in Space Travel.......Page 590 Physiological Challenges of Weightlessness (Microgravity).......Page 591 Bibliography......Page 592 Effect of Very High PO2 on Blood Oxygen Transport.......Page 593 Excessive Intracellular Oxidation as a Cause of Nervous System Oxygen Toxicity—“Oxidizing Free Radicals.”......Page 594 Volume of Nitrogen Dissolved in the Body Fluids at Different Depths.......Page 595 Tank Decompression and Treatment of Decompression Sickness.......Page 596 Self-Contained Underwater Breathing Apparatus (SCUBA) Diving......Page 597 Bibliography......Page 598 Unit IX The Nervous System: A. General Principles and Sensory Physiology......Page 599 Motor Part of the Nervous System—Effectors......Page 601 Role of Synapses in Processing Information......Page 602 Lower Brain or Subcortical Level......Page 603 Types of Synapses—Chemical and Electrical......Page 604 Physiological Anatomy of the Synapse......Page 605 Action of the Transmitter Substance on the Postsynaptic Neuron—Function of “Receptor Proteins”......Page 606 “Second Messenger” System in the Postsynaptic Neuron.......Page 607 Chemical Substances That Function as Synaptic Transmitters......Page 608 Recycling of the Small-Molecule Types of Vesicles.......Page 609 Neuropeptides......Page 610 Concentration Differences of Ions Across the Neuronal Somal Membrane.......Page 611 Generation of Action Potentials in the Initial Segment of the Axon Leaving the Neuron—Threshold for Excitation.......Page 612 Time Course of Postsynaptic Potentials......Page 613 Most Dendrites Cannot Transmit Action Potentials, but They Can Transmit Signals Within the Same Neuron by Electrotonic Conduction.......Page 614 “Excitatory State” Is the Summated Degree of Excitatory Drive to the Neuron.......Page 615 Synaptic Delay.......Page 616 Bibliography......Page 617 Modality of Sensation—The “Labeled Line” Principle......Page 619 Mechanisms of Receptor Potentials.......Page 620 Relation between Stimulus Intensity and the Receptor Potential.......Page 621 Slowly Adapting Receptors Detect Continuous Stimulus Strength—the “Tonic” Receptors.......Page 622 General Classification of Nerve Fibers.......Page 623 Temporal Summation.......Page 624 Threshold and Subthreshold Stimuli—Excitation or Facilitation.......Page 625 Convergence of Signals......Page 626 Reverberatory (Oscillatory) Circuit as a Cause of Signal Prolongation.......Page 627 Rhythmical Signal Output......Page 628 Automatic Short-Term Adjustment of Pathway Sensitivity by the Fatigue Mechanism.......Page 629 Bibliography......Page 630 Tactile Receptors.......Page 631 Detection of Tickle and Itch by Mechanoreceptive Free Nerve Endings.......Page 632 Anatomy of the Dorsal Column–Medial Lemniscal System......Page 633 Spatial Orientation of the Nerve Fibers in the Dorsal Column–Medial Lemniscal System......Page 634 Somatosensory Areas I and II.......Page 635 Layers of the Somatosensory Cortex and Their Function......Page 636 Effect of Removing the Somatosensory Association Area—Amorphosynthesis.......Page 637 Two-Point Discrimination.......Page 638 Weber-Fechner Principle—Detection of “Ratio” of Stimulus Strength.......Page 639 Transmission of Less Critical Sensory Signals in the Anterolateral Pathway......Page 640 Characteristics of Transmission in the Anterolateral Pathway......Page 641 Bibliography......Page 642 Nonadapting Nature of Pain Receptors.......Page 645 Peripheral Pain Fibers—“Fast” and “Slow” Fibers......Page 646 Paleospinothalamic Pathway for Transmitting Slow-Chronic Pain.......Page 647 Surgical Interruption of Pain Pathways.......Page 648 The Brain’s Opiate System—Endorphins and Enkephalins......Page 649 Causes of True Visceral Pain......Page 650 Parietal Pathway for Transmission of Abdominal and Thoracic Pain.......Page 651 Tic Douloureux......Page 652 Headache Caused by Low Cerebrospinal Fluid Pressure.......Page 653 Thermal Receptors and Their Excitation......Page 654 Transmission of Thermal Signals in the Nervous System......Page 655 Bibliography......Page 656 Unit X The Nervous System: B. The Special Senses......Page 657 Convex Lens Focuses Light Rays.......Page 659 Focal Length of a Lens......Page 660 Measurement of the Refractive Power of a Lens—“Diopter”......Page 661 Consideration of All Refractive Surfaces of the Eye as a Single Lens—The “Reduced” Eye.......Page 662 Accommodation Is Controlled by Parasympathetic Nerves.......Page 663 Emmetropia (Normal Vision).......Page 664 Astigmatism.......Page 665 Visual Acuity......Page 666 Determination of Distance by Stereopsis—Binocular Vision.......Page 667 Formation of Aqueous Humor by the Ciliary Body......Page 668 Regulation of Intraocular Pressure.......Page 669 Bibliography......Page 670 Rods and Cones.......Page 671 Pigment Layer of the Retina.......Page 672 Rhodopsin and Its Decomposition by Light Energy.......Page 673 The Rod Receptor Potential is Hyperpolarizing, Not Depolarizing.......Page 674 Duration of the Receptor Potential, and Logarithmic Relation of the Receptor Potential to Light Intensity.......Page 675 Photochemistry of Color Vision by the Cones......Page 676 Value of Light and Dark Adaptation in Vision.......Page 677 Color Test Charts.......Page 678 Neural Function of the Retina......Page 679 Depolarizing and Hyperpolarizing Bipolar Cells......Page 680 W, X, and Y Cells.......Page 681 Transmission of Changes in Light Intensity—The On-Off Response.......Page 682 Transmission of Color Signals by the Ganglion Cells......Page 683 Bibliography......Page 684 Function of the Dorsal Lateral Geniculate Nucleus of the Thalamus......Page 685 Secondary Visual Areas of the Cortex.......Page 686 Interaction of Visual Signals from the Two Separate Eyes.......Page 687 Detection of Line Orientation When a Line Is Displaced Laterally or Vertically in the Visual Field—“Complex” Cells.......Page 688 Effect of Lesions in the Optic Pathway on the Fields of Vision.......Page 689 Neural Pathways for Control of Eye Movements.......Page 690 Saccadic Movements During Reading.......Page 691 Strabismus—Lack of Fusion of the Eyes......Page 692 Control of Accommodation (Focusing the Eyes)......Page 693 Horner’s Syndrome.......Page 694 Bibliography......Page 695 “Impedance Matching” by the Ossicular System.......Page 697 Functional Anatomy of the Cochlea......Page 698 Pattern of Vibration of the Basilar Membrane for Different Sound Frequencies.......Page 699 Excitation of the Hair Cells.......Page 700 Determination of Sound Frequency—the “Place” Principle......Page 701 Threshold for Hearing Sound at Different Frequencies.......Page 702 Firing Rates at Different Levels of the Auditory Pathways.......Page 703 Sound Frequency Perception in the Primary Auditory Cortex.......Page 704 Neural Mechanisms for Detecting Sound Direction.......Page 705 Audiogram for Middle Ear Conduction Deafness.......Page 706 Bibliography......Page 707 Bitter Taste.......Page 709 The Taste Bud and Its Function......Page 710 Transmission of Taste Signals Into the Central Nervous System......Page 711 Olfactory Membrane......Page 712 Mechanism of Excitation of the Olfactory Cells.......Page 713 Gradations of Smell Intensities.......Page 714 The Less Old Olfactory System—The Lateral Olfactory Area.......Page 715 Bibliography......Page 716 Unit XI The Nervous System: C. Motor and Integrative Neurophysiology......Page 717 Alpha Motor Neurons.......Page 719 Multisegmental Connections from One Spinal Cord Level to Other Levels—Propriospinal Fibers.......Page 720 Secondary Ending.......Page 721 Dynamic Stretch Reflex and Static Stretch Reflexes.......Page 722 Role of the Muscle Spindle in Voluntary Motor Activity......Page 723 Clonus—Oscillation of Muscle Jerks.......Page 724 Possible Role of the Tendon Reflex to Equalize Contractile Force Among the Muscle Fibers.......Page 725 Neuronal Mechanism of the Flexor Reflex.......Page 726 Reciprocal Inhibition and Reciprocal Innervation......Page 727 Galloping Reflex.......Page 728 Spinal Cord Transection and Spinal Shock......Page 729 Bibliography......Page 730 Primary Motor Cortex......Page 731 Some Specialized Areas of Motor Control Found in the Human Motor Cortex......Page 732 Corticospinal (Pyramidal) Tract......Page 733 The Red Nucleus Serves as an Alternative Pathway for Transmitting Cortical Signals to the Spinal Cord......Page 734 Dynamic and Static Signals Are Transmitted by the Pyramidal Neurons.......Page 735 Patterns of Movement Elicited by Spinal Cord Centers.......Page 736 Excitatory-Inhibitory Antagonism Between Pontine and Medullary Reticular Nuclei......Page 737 Vestibular Apparatus......Page 738 Directional Sensitivity of the Hair Cells—Kinocilium.......Page 739 Function of the Utricle and Saccule in the Maintenance of Static Equilibrium......Page 740 “Predictive” Function of the Semicircular Duct System in the Maintenance of Equilibrium.......Page 741 Neuronal Connections of the Vestibular Apparatus With the Central Nervous System......Page 742 Bibliography......Page 743 Longitudinal Functional Divisions of the Anterior and Posterior Lobes.......Page 745 Afferent Pathways From Other Parts of the Brain.......Page 746 Deep Cerebellar Nuclei and the Efferent Pathways.......Page 747 Neuronal Circuit of the Functional Unit.......Page 748 Turn-On/Turn-Off and Turn-Off/Turn-On Output Signals from the Cerebellum......Page 749 Function of the Cerebellum in Overall Motor Control......Page 750 Spinocerebellum—Feedback Control of Distal Limb Movements by Way of the Intermediate Cerebellar Cortex and the Interposed Nucleus......Page 751 Cerebrocerebellum—Function of the Large Lateral Zone of the Cerebellar Hemisphere to Plan, Sequence, and Time Complex Movements......Page 752 Past Pointing......Page 753 The Basal Ganglia and Their Motor Functions......Page 754 Neural Pathways of the Putamen Circuit.......Page 755 Function of the Basal Ganglia to Change the Timing and to Scale the Intensity of Movements......Page 756 Functions of Specific Neurotransmitter Substances in the Basal Ganglial System......Page 757 Huntington’s Disease (Huntington’s Chorea)......Page 758 Associated Functions of the Basal Ganglia.......Page 759 Bibliography......Page 760 Physiological Anatomy of the Cerebral Cortex......Page 761 Functions of Specific Cortical Areas......Page 762 Analysis of the Spatial Coordinates of the Body.......Page 763 Area for Recognition of Faces......Page 764 Concept of the Dominant Hemisphere......Page 765 Higher Intellectual Functions of the Prefrontal Association Areas......Page 766 Function of the Brain in Communication—Language Input and Language Output......Page 767 Summary......Page 768 Thoughts, Consciousness, and Memory......Page 769 Short-Term Memory......Page 770 Mechanism for Facilitation.......Page 771 Consolidation of Memory......Page 772 Bibliography......Page 773 Excitation of the Excitatory Area by Peripheral Sensory Signals.......Page 775 Neurohormonal Systems in the Human Brain.......Page 776 Functional Anatomy of the Limbic System; Key Position of the Hypothalamus......Page 778 Cardiovascular Regulation.......Page 779 Regulation of Uterine Contractility and Milk Ejection from the Breasts.......Page 780 “Reward” and “Punishment” Function of the Limbic System......Page 781 Importance of Reward or Punishment in Learning and Memory—Habituation Versus Reinforcement......Page 782 Theoretical Function of the Hippocampus in Learning.......Page 783 Ablation of the Anterior Cingulate Gyri and Subcallosal Gyri.......Page 784 Bibliography......Page 785 Slow-Wave Sleep......Page 787 Neuronal Centers, Neurohumoral Substances, and Mechanisms That Can Cause Sleep—A Possible Specific Role for Serotonin......Page 788 Sleep Has Important Physiological Functions......Page 789 Brain Waves......Page 790 Changes in the EEG at Different Stages of Wakefulness and Sleep......Page 791 Generalized Seizures......Page 792 What Initiates a Generalized Tonic-Clonic Seizure?......Page 793 Depression and Manic-Depressive Psychoses—Decreased Activity of the Norepinephrine and Serotonin Neurotransmitter Systems......Page 794 Alzheimer’s Disease Is Associated With Accumulation of Brain Beta-Amyloid Peptide.......Page 795 Bibliography......Page 796 Sympathetic Nerve Fibers in the Skeletal Nerves.......Page 797 Physiological Anatomy of the Parasympathetic Nervous System......Page 798 Cholinergic and Adrenergic Fibers—Secretion of Acetylcholine or Norepinephrine......Page 799 Synthesis of Norepinephrine, Its Removal, and Its Duration of Action.......Page 800 Adrenergic Receptors—Alpha and Beta Receptors......Page 801 Glands of the Body.......Page 802 Function of the Adrenal Medullae......Page 804 Effect of Loss of Sympathetic or Parasympathetic Tone After Denervation.......Page 805 Other Autonomic Reflexes.......Page 806 Medullary, Pontine, and Mesencephalic Control of the Autonomic Nervous System......Page 807 Parasympathomimetic Drugs (Cholinergic Drugs).......Page 808 Bibliography......Page 809 Excesses of Carbon Dioxide or Hydrogen Ion Concentration Increase Cerebral Blood Flow.......Page 811 Measurement of Cerebral Blood Flow and Effect of Brain Activity on Flow.......Page 812 Cerebral Microcirculation......Page 813 Contrecoup.......Page 814 Absorption of Cerebrospinal Fluid Through the Arachnoidal Villi.......Page 815 Measurement of Cerebrospinal Fluid Pressure.......Page 816 Brain Edema......Page 817 Bibliography......Page 818 Unit XII Gastrointestinal Physiology......Page 819 Slow Waves.......Page 821 Spike Potentials.......Page 822 Neural Control of Gastrointestinal Function—Enteric Nervous System......Page 823 Types of Neurotransmitters Secreted by Enteric Neurons......Page 824 Gastrointestinal Reflexes......Page 825 Hormonal Control of Gastrointestinal Motility......Page 826 Mixing Movements......Page 827 Possible Causes of the Increased Blood Flow During Gastrointestinal Activity.......Page 828 Nervous Control of Gastrointestinal Blood Flow......Page 829 Bibliography......Page 830 Voluntary Stage of Swallowing.......Page 831 Effect of the Pharyngeal Stage of Swallowing on Respiration.......Page 832 Motor Functions of the Stomach......Page 833 Hunger Contractions.......Page 834 Inhibitory Effect of Enterogastric Nervous Reflexes From the Duodenum.......Page 835 Mixing Contractions (Segmentation Contractions)......Page 836 Movements Caused by the Muscularis Mucosae and Muscle Fibers of the Villi.......Page 837 Mixing Movements—“Haustrations.”......Page 838 Defecation Reflexes.......Page 839 Bibliography......Page 840 Parasympathetic Stimulation Increases the Alimentary Tract Glandular Secretion Rate.......Page 841 Secretion of Organic Substances.......Page 842 Secretion of Ions in Saliva.......Page 843 Nervous Regulation of Salivary Secretion......Page 844 Basic Mechanism of Hydrochloric Acid Secretion.......Page 845 Pyloric Glands—Secretion of Mucus and Gastrin......Page 846 Gastric Phase.......Page 847 Chemical Composition of Gastrin and Other Gastrointestinal Hormones......Page 848 Secretion of Bicarbonate Ions......Page 849 Cephalic and Gastric Phases.......Page 850 Bile Secretion by the Liver......Page 851 Physiologic Anatomy of Biliary Secretion......Page 852 Function of Bile Salts in Fat Digestion and Absorption......Page 853 Secretion of Mucus by Brunner’s Glands in the Duodenum......Page 854 Mucus Secretion.......Page 855 Bibliography......Page 856 Digestion of Carbohydrates Begins in the Mouth and Stomach.......Page 857 Digestion of Proteins in the Stomach.......Page 858 Fats of the Diet.......Page 859 Digestion of Cholesterol Esters and Phospholipids.......Page 860 Absorption in the Small Intestine......Page 861 Sodium Is Actively Transported Through the Intestinal Membrane.......Page 862 Absorption of Bicarbonate Ions in the Duodenum and Jejunum.......Page 863 Glucose Is Transported by a Sodium Co-Transport Mechanism.......Page 864 Absorption in the Large Intestine: Formation of Feces......Page 865 Bibliography......Page 866 Gastric Barrier and Its Penetration in Gastritis.......Page 867 Basic Cause of Peptic Ulceration.......Page 868 Nontropical Sprue.......Page 869 Psychogenic Diarrhea.......Page 870 Antiperistalsis, the Prelude to Vomiting.......Page 871 Gases in the Gastrointestinal Tract (Flatus)......Page 872 Bibliography......Page 873 Unit XIII Metabolism and Temperature Regulation......Page 875 Adenosine Triphosphate Is the “Energy Currency” of the Body......Page 877 Transport of Glucose Through the Cell Membrane......Page 878 Glycogenesis—Formation of Glycogen......Page 879 Formation of ATP During Glycolysis.......Page 880 Citric Acid Cycle (Krebs Cycle)......Page 881 Formation of Large Quantities of ATP by Oxidation of Hydrogen—The Process of Oxidative Phosphorylation......Page 882 Effect of ATP and ADP Cell Concentrations in Controlling Glycolysis and Glucose Oxidation......Page 883 Use of Lactic Acid by the Heart for Energy.......Page 884 Formation of Carbohydrates From Proteins and Fats—Gluconeogenesis......Page 885 Bibliography......Page 886 Removal of the Chylomicrons From the Blood......Page 887 “Free Fatty Acids” Are Transported in the Blood in Combination With Albumin......Page 888 Fat Cells (Adipocytes) Store Triglycerides.......Page 889 Degradation of Fatty Acids to Acetyl Coenzyme A by Beta-Oxidation.......Page 890 Formation of Acetoacetic Acid in the Liver and Its Transport in the Blood......Page 891 Efficiency of Carbohydrate Conversion Into Fat.......Page 892 Acceleration of Fat Utilization for Energy in the Absence of Carbohydrates.......Page 893 Phospholipids......Page 894 Factors That Affect Plasma Cholesterol Concentration—Feedback Control of Body Cholesterol.......Page 895 Increased Low-Density Lipoproteins.......Page 896 Other Major Risk Factors for Atherosclerosis......Page 897 Bibliography......Page 898 Blood Amino Acids......Page 899 Active Transport of Amino Acids Into the Cells.......Page 900 Formation of the Plasma Proteins.......Page 901 Deamination—the Removal of Amino Groups From Amino Acids.......Page 902 Effect of Starvation on Protein Degradation.......Page 903 Bibliography......Page 904 Cirrhosis of the Liver Greatly Increases Resistance to Blood Flow.......Page 905 Regulation of Liver Mass—Regeneration......Page 906 Protein Metabolism......Page 907 Measurement of Bilirubin in the Bile as a Clinical Diagnostic Tool......Page 908 Jaundice—Excess Bilirubin in the Extracellular Fluid......Page 909 Bibliography......Page 910 Carbohydrates and Fats Act as “Protein Sparers.”......Page 911 “Respiratory Quotient,” the Ratio of Carbon Dioxide Production to Oxygen Utilization, Can Be Used to Estimate Fat and Carbohydrate Utilization.......Page 912 The Hypothalamus Contains Hunger and Satiety Centers.......Page 913 Neurons and Neurotransmitters in the Hypothalamus That Stimulate or Inhibit Feeding.......Page 914 Ghrelin, a Gastrointestinal Hormone, Increases Feeding.......Page 916 Feedback Signals From Adipose Tissue Regulate Food Intake.......Page 917 Decreased Physical Activity and Abnormal Feeding Regulation as Causes of Obesity......Page 918 Treatment of Obesity......Page 919 Inanition, Anorexia, and Cachexia......Page 920 Storage of Vitamins in the Body.......Page 921 Niacin......Page 922 Pantothenic Acid......Page 923 Magnesium.......Page 924 Fluorine.......Page 925 Bibliography......Page 926 ATP Energizes Glandular Secretion.......Page 927 Anaerobic Energy Utilization During Strenuous Bursts of Activity Is Derived Mainly From Glycolysis.......Page 928 Rate Control of Enzyme-Catalyzed Reactions.......Page 929 The Calorie.......Page 930 Basal Metabolic Rate—The Minimum Energy Expenditure for the Body to Exist......Page 931 Energy Used for Physical Activities......Page 932 Bibliography......Page 933 Insulator System of the Body......Page 935 Radiation Causes Heat Loss in the Form of Infrared Rays.......Page 936 Clothing Reduces Conductive and Convective Heat Loss.......Page 937 Mechanism of Sweat Secretion.......Page 938 Regulation of Body Temperature—Role of the Hypothalamus......Page 939 Temperature-Decreasing Mechanisms When the Body Is Too Hot......Page 940 Sympathetic “Chemical” Excitation of Heat Production.......Page 941 Skin Temperature Can Slightly Alter the Set Point for Core Temperature Control......Page 942 Fever......Page 943 Chills.......Page 944 Cold-Induced Vasodilation Is a Final Protection Against Frostbite at Almost Freezing Temperatures.......Page 945 Bibliography......Page 946 Unit XIV Endocrinology and Reproduction......Page 947 Chemical Structure and Synthesis of Hormones......Page 949 Polypeptide and Protein Hormones Are Stored in Secretory Vesicles Until Needed.......Page 950 Amine Hormones Are Derived From Tyrosine.......Page 952 “Clearance” of Hormones From the Blood.......Page 953 The Number and Sensitivity of Hormone Receptors Are Regulated.......Page 954 G Protein–Linked Hormone Receptors.......Page 955 Enzyme-Linked Hormone Receptors.......Page 956 Adenylyl Cyclase–cAMP Second Messenger System......Page 957 Calcium-Calmodulin Second Messenger System......Page 958 Thyroid Hormones Increase Gene Transcription in the Cell Nucleus......Page 959 Enzyme-Linked Immunosorbent Assay......Page 960 Bibliography......Page 961 The Anterior Pituitary Gland Contains Several Different Cell Types That Synthesize and Secrete Hormones.......Page 963 Hypothalamus Controls Pituitary Secretion......Page 964 Hypothalamic Releasing and Inhibitory Hormones Control Anterior Pituitary Secretion.......Page 965 Growth Hormone Promotes Growth of Many Body Tissues......Page 966 Growth Hormone Decreases Carbohydrate Utilization......Page 967 Growth Hormone Exerts Much of Its Effect Through Intermediate Substances Called Somatomedins......Page 968 Regulation of Growth Hormone Secretion......Page 969 Panhypopituitarism.......Page 970 Possible Role of Decreased Growth Hormone Secretion in Causing Changes Associated with Aging......Page 971 Posterior Pituitary Gland and Its Relation to the Hypothalamus......Page 972 Low Blood Volume and Low Blood Pressure Stimulate ADH Secretion—Vasoconstrictor Effects of ADH.......Page 973 Bibliography......Page 974 Iodide Pump—the Sodium-Iodide Symporter (Iodide Trapping)......Page 975 Formation and Secretion of Thyroglobulin by the Thyroid Cells.......Page 976 Release of Thyroxine and Triiodothyronine From the Thyroid Gland......Page 977 Most of the Thyroxine Secreted by the Thyroid Is Converted to Triiodothyronine.......Page 978 Thyroid Hormones Activate Nuclear Receptors.......Page 979 Effect on Plasma and Liver Fats.......Page 980 Increased Gastrointestinal Motility.......Page 981 TSH (From the Anterior Pituitary Gland) Increases Thyroid Secretion......Page 982 Antithyroid Substances Suppress Thyroid Secretion......Page 983 Thyroid Adenoma.......Page 984 Hypothyroidism......Page 985 Myxedema.......Page 986 Bibliography......Page 987 The Adrenal Cortex Has Three Distinct Layers......Page 989 Glucocorticoids......Page 990 Adrenocortical Hormones Are Bound to Plasma Proteins.......Page 991 Aldosterone Is the Major Mineralocorticoid Secreted by the Adrenals.......Page 992 Excess Aldosterone Causes Hypokalemia and Muscle Weakness; Aldosterone Deficiency Causes Hyperkalemia and Cardiac Toxicity.......Page 993 Cellular Mechanism of Aldosterone Action......Page 994 Regulation of Aldosterone Secretion......Page 995 Decreased Glucose Utilization by Cells.......Page 996 Mobilization of Fatty Acids.......Page 997 Anti-inflammatory Effects of High Levels of Cortisol......Page 998 Cortisol Blocks the Inflammatory Response to Allergic Reactions.......Page 999 Physiological Stress Increases ACTH and Adrenocortical Secretion.......Page 1000 Synthesis and Secretion of ACTH in Association with Melanocyte-Stimulating Hormone, Lipotropin, and Endorphin......Page 1001 Adrenal Androgens......Page 1002 Hyperadrenalism—Cushing’s Syndrome......Page 1003 Treatment of Cushing’s Syndrome.......Page 1004 Bibliography......Page 1005 Insulin is a Hormone Associated with Energy Abundance......Page 1007 Activation of Target cell Receptors by Insulin and the Resulting Cellular Effects......Page 1008 Insulin Promotes Muscle Glucose Uptake and Metabolism......Page 1009 Insulin Promotes Conversion of Excess Glucose Into Fatty Acids and Inhibits Gluconeogenesis in the Liver.......Page 1010 Role of Insulin in Storage of Fat in the Adipose Cells.......Page 1011 Insulin Promotes Protein Synthesis and Storage......Page 1012 Mechanisms Of Insulin Secretion......Page 1013 Feedback Relation Between Blood Glucose Concentration and the Insulin Secretion Rate.......Page 1014 The Role of Insulin (and Other Hormones) in “Switching” between Carbohydrate and Lipid Metabolism......Page 1015 Other Effects of Glucagon......Page 1016 Summary of Blood Glucose Regulation......Page 1017 Diabetes Mellitus......Page 1018 Diabetes Causes Depletion of the Body’s Proteins.......Page 1019 Other Factors That Can Cause Insulin Resistance and Type 2 Diabetes.......Page 1020 Glucose Tolerance Test.......Page 1021 Insulin Shock and Hypoglycemia.......Page 1022 Bibliography......Page 1023 Calcium in the Plasma and interstitial Fluid......Page 1025 Intestinal Absorption and Fecal Excretion of Calcium and Phosphate.......Page 1026 Bone Salts.......Page 1027 Precipitation of Calcium in Nonosseous Tissues Under Abnormal Conditions.......Page 1028 Resorption of Bone—Function of the Osteoclasts.......Page 1029 Control of the Rate of Bone Deposition by Bone “Stress.”......Page 1030 Formation of 1,25-Dihydroxycholecalciferol in the Kidneys and Its Control by Parathyroid Hormone.......Page 1031 “Hormonal” Effect of Vitamin D to Promote Intestinal Calcium Absorption.......Page 1032 Chemistry of Parathyroid Hormone.......Page 1033 Rapid Phase of Calcium and Phosphate Mobilization From Bone—Osteolysis.......Page 1034 Control of Parathyroid Secretion by Calcium Ion Concentration......Page 1035 Increased Plasma Calcium Concentration Stimulates Calcitonin Secretion.......Page 1036 Hormonal Control of Calcium Ion Concentration—The Second Line of Defense.......Page 1037 Effects of Hypercalcemia in Hyperparathyroidism.......Page 1038 Osteomalacia—“Adult Rickets.”......Page 1039 Dentin.......Page 1040 Metabolic Factors Influence Development of the Teeth.......Page 1041 Bibliography......Page 1042 Steps of Spermatogenesis......Page 1045 Sex Chromosomes.......Page 1046 Storage of Sperm in the Testes.......Page 1047 “Capacitation” of Spermatozoa Is Required for Fertilization of the Ovum......Page 1048 Effect of Temperature on Spermatogenesis.......Page 1049 Psychic Element of Male Sexual Stimulation.......Page 1050 Emission and Ejaculation Are Functions of the Sympathetic Nerves.......Page 1051 Production of Estrogen in the Male.......Page 1052 Effect of Testosterone to Cause Descent of the Testes.......Page 1053 Testosterone Increases the Basal Metabolic Rate.......Page 1054 Gonadotropic Hormones: Luteinizing Hormone and Follicle-Stimulating Hormone......Page 1055 Role of Inhibin in Negative Feedback Control of Seminiferous Tubule Activity.......Page 1056 Hypogonadism in the Male......Page 1057 The Function of the Pineal Gland in Controlling Seasonal Fertility in Some Animals......Page 1058 Bibliography......Page 1059 Oogenesis and Follicular Development in the Ovaries......Page 1061 Gonadotropic Hormones and Their Effects on the Ovaries......Page 1063 Development of Antral and Vesicular Follicles.......Page 1064 Initiation of Ovulation.......Page 1065 Functions of the Ovarian Hormones—Estradiol and Progesterone......Page 1066 Synthesis of the Estrogens and Progestins.......Page 1067 Effect of Estrogens on the Uterus and External Female Sex Organs.......Page 1068 Estrogens Have Little Effect on Hair Distribution.......Page 1069 Secretory Phase (Progestational Phase) of the Endometrial Cycle, Occurring After Ovulation.......Page 1070 Intermittent, Pulsatile Secretion of GnRH by the Hypothalamus Stimulates Pulsatile Release of LH from the Anterior Pituitary Gland.......Page 1071 Positive Feedback Effect of Estrogen Before Ovulation—The Preovulatory Luteinizing Hormone Surge......Page 1072 Feedback Oscillation of the Hypothalamic-Pituitary- Ovarian System......Page 1073 Menopause......Page 1074 Stimulation of the Female Sexual Act.......Page 1075 Rhythm Method of Contraception.......Page 1076 Abnormal Conditions That Cause Female Sterility......Page 1077 Bibliography......Page 1078 What Determines the Sex of the Fetus that is Created?......Page 1079 Implantation of the Blastocyst in the Uterus......Page 1080 Placental Permeability and Membrane Diffusion Conductance......Page 1081 Diffusion of Oxygen Through the Placental Membrane.......Page 1082 Function of Human Chorionic Gonadotropin.......Page 1083 Function of Estrogen in Pregnancy.......Page 1084 Increased Parathyroid Gland Secretion.......Page 1085 Maternal Blood Volume Increases During Pregnancy.......Page 1086 Preeclampsia and Eclampsia......Page 1087 Stretch or Irritation of the Cervix.......Page 1088 Mechanics of Parturition......Page 1089 Progesterone Is Required for Full Development of the Lobule-Alveolar System.......Page 1090 Prolactin Promotes Lactation......Page 1091 Milk Composition and the Metabolic Drain on the Mother Caused By Lactation......Page 1092 Bibliography......Page 1093 Respiratory System.......Page 1095 Utilization and Storage of Vitamins......Page 1096 Respiratory Distress Syndrome Is Caused When Surfactant Secretion Is Deficient.......Page 1097 Specific Anatomical Structure of the Fetal Circulation......Page 1098 Closure of the Ductus Venosus.......Page 1099 Blood Characteristics.......Page 1100 Nutritional Needs During the Early Weeks of Life.......Page 1101 Endocrine Problems......Page 1102 Danger of Blindness Caused by Excess Oxygen Therapy in the Premature Infant......Page 1103 Bibliography......Page 1104 Unit XV Sports Physiology......Page 1107 Strength, Power, and Endurance of Muscles......Page 1109 Adenosine Triphosphate.......Page 1110 What Types of Sports Use Which Energy Systems?......Page 1111 Recovery of Muscle Glycogen.......Page 1112 Importance of Maximal Resistance Training.......Page 1113 Limits of Pulmonary Ventilation.......Page 1114 Blood Gases During Exercise.......Page 1115 Work Output, Oxygen Consumption, and Cardiac Output During Exercise.......Page 1116 Relation of Cardiovascular Performance to max.......Page 1117 Replacement of Sodium Chloride and Potassium.......Page 1118 Bibliography......Page 1119 A......Page 1121 B......Page 1126 C......Page 1129 D......Page 1134 E......Page 1135 F......Page 1138 G......Page 1140 H......Page 1142 I......Page 1145 K......Page 1146 L......Page 1147 M......Page 1148 N......Page 1151 O......Page 1152 P......Page 1153 R......Page 1158 S......Page 1160 T......Page 1165 V......Page 1167 Z......Page 1169 IBC_Common Lab Measurements......Page 1171