Additional Information
Book Details
Abstract
Physiology is a comprehensive presentation of core physiologic concepts with a focus on mechanisms. Renowned physiology instructor Linda S. Costanzo covers important concepts in the field, both at the organ system and cellular levels. Easy to read and user-friendly, the revised fourth edition stresses essential and relevant content with absolute clarity and includes concise step-by-step explanations complemented by numerous tables and abundant illustrations. It provides information on the underlying principles of cellular physiology, the autonomic nervous system, and neurophysiology, as well as the cardiovascular, respiratory, renal, acid-base, gastrointestinal, endocrine, and reproductive organ systems. This book is ideal as both a textbook and as a review guide for the boards.
- Provides step-by-step explanations and easy-to-follow diagrams clearly depicting physiologic principles.
- Integrates equations and sample problems throughout the text.
- Presents chapter summaries for quick overviews of important points.
- Contains boxed Clinical Physiology Cases to provide you with more clinical examples and a more thorough understanding of application.
- Provides questions at the end of each chapter for an extensive review of the material and to reinforce your understanding and retention.
- Offers a full-color design and all full-color illustrations throughout.
- Features increased coverage of pathophysiology in the neurophysiology, gastrointestinal, renal, acid-base, and endocrine chapters to emphasize this important component of the USMLE exam.
- Incorporates further practice in solving physiology equations through the inclusion of additional problem-solving questions throughout the text.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Physiology, 5/e | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Preface | vii | ||
| Acknowledgments | ix | ||
| Table Of Contents | xi | ||
| 1 Cellular Physiology | 1 | ||
| Volume and Composition of Body Fluids | 1 | ||
| Distribution of Water in the Body Fluid Compartments | 1 | ||
| Composition of Body Fluid Compartments | 2 | ||
| Units for Measuring Solute Concentrations | 2 | ||
| Electroneutrality of Body Fluid Compartments | 3 | ||
| Composition of Intracellular Fluid and Extracellular Fluid | 3 | ||
| Creation of Concentration Differences across Cell Membranes | 3 | ||
| Concentration Differences between Plasma and Interstitial Fluids | 4 | ||
| Characteristics of Cell Membranes | 4 | ||
| Phospholipid Component of Cell Membranes | 4 | ||
| Protein Component of Cell Membranes | 4 | ||
| Transport across Cell Membranes | 5 | ||
| Simple Diffusion | 6 | ||
| Diffusion of Nonelectrolytes | 6 | ||
| Concentration Gradient (CA − CB) | 6 | ||
| Partition Coefficient (K) | 7 | ||
| Diffusion Coefficient (D) | 7 | ||
| Thickness of the Membrane (ΔX) | 7 | ||
| Surface Area (A) | 7 | ||
| Diffusion of Electrolytes | 7 | ||
| Facilitated Diffusion | 8 | ||
| Primary Active Transport | 8 | ||
| Na+-K+ ATPase (Na+-K+ Pump) | 8 | ||
| Ca2+ ATPase (Ca2+ Pump) | 9 | ||
| H+-K+ ATPase (H+-K+ Pump) | 10 | ||
| Secondary Active Transport | 10 | ||
| Cotransport | 10 | ||
| Countertransport | 11 | ||
| Osmosis | 12 | ||
| Osmolarity | 12 | ||
| Osmolality | 12 | ||
| Osmotic Pressure | 12 | ||
| Diffusion Potentials and Equilibrium Potentials | 14 | ||
| Ion Channels | 14 | ||
| Diffusion Potentials | 15 | ||
| Equilibrium Potentials | 15 | ||
| Example of Na+ Equilibrium Potential | 15 | ||
| Example of Cl− Equilibrium Potential | 16 | ||
| Nernst Equation | 16 | ||
| Driving Force | 17 | ||
| Ionic Current | 18 | ||
| Resting Membrane Potential | 18 | ||
| Action Potentials | 19 | ||
| Terminology | 19 | ||
| Characteristics of Action Potentials | 19 | ||
| Ionic Basis of the Action Potential | 19 | ||
| The Nerve Na+ Channel | 21 | ||
| Refractory Periods | 21 | ||
| Absolute Refractory Period | 22 | ||
| Relative Refractory Period | 22 | ||
| Accommodation | 22 | ||
| Propagation of Action Potentials | 23 | ||
| Conduction Velocity | 23 | ||
| Changes in Conduction Velocity | 24 | ||
| Synaptic and Neuromuscular Transmission | 24 | ||
| Types of Synapses | 25 | ||
| Electrical Synapses | 25 | ||
| Chemical Synapses | 25 | ||
| Neuromuscular Junction—Example of a Chemical Synapse | 26 | ||
| Motor Units | 26 | ||
| Sequence of Events at the Neuromuscular Junction | 26 | ||
| Agents That Alter Neuromuscular Function | 27 | ||
| Types of Synaptic Arrangements | 28 | ||
| Synaptic Input—Excitatory and Inhibitory Postsynaptic Potentials | 29 | ||
| Excitatory Postsynaptic Potentials | 29 | ||
| Inhibitory Postsynaptic Potentials | 29 | ||
| Integration of Synaptic Information | 29 | ||
| Spatial Summation | 29 | ||
| Temporal Summation | 29 | ||
| Other Phenomena That Alter Synaptic Activity | 29 | ||
| Neurotransmitters | 29 | ||
| Acetylcholine | 29 | ||
| Norepinephrine, Epinephrine, and Dopamine | 30 | ||
| Serotonin | 30 | ||
| Histamine | 30 | ||
| Glutamate | 31 | ||
| Glycine | 31 | ||
| γ-Aminobutyric Acid (GABA) | 32 | ||
| Nitric Oxide | 32 | ||
| Neuropeptides | 33 | ||
| Purines | 33 | ||
| Skeletal Muscle | 33 | ||
| Muscle Filaments | 33 | ||
| Thick Filaments | 33 | ||
| Thin Filaments | 33 | ||
| Arrangement of Thick and Thin Filaments in Sarcomeres | 34 | ||
| Cytoskeletal Proteins | 35 | ||
| Transverse Tubules and the Sarcoplasmic Reticulum | 35 | ||
| Excitation-Contraction Coupling in Skeletal Muscle | 36 | ||
| Mechanism of Tetanus | 38 | ||
| Length-Tension Relationship | 38 | ||
| Force-Velocity Relationship | 39 | ||
| Smooth Muscle | 39 | ||
| Types of Smooth Muscle | 40 | ||
| Unitary Smooth Muscle | 40 | ||
| Multiunit Smooth Muscle | 40 | ||
| Excitation-Contraction Coupling in Smooth Muscle | 40 | ||
| Steps in Excitation-Contraction Coupling in Smooth Muscle | 40 | ||
| Mechanisms That Increase Intracellular Ca2+ Concentration in Smooth Muscle | 42 | ||
| Ca2+-Independent Changes in Smooth Muscle Contraction | 43 | ||
| Summary | 43 | ||
| Selected Readings | 44 | ||
| 2 Autonomic Nervous System | 45 | ||
| Organization and General Features of the Autonomic Nervous System | 45 | ||
| Terminology | 46 | ||
| Neuroeffector Junctions of the Autonomic Nervous System | 46 | ||
| Sympathetic Nervous System | 47 | ||
| Origin of Preganglionic Neurons | 49 | ||
| Location of Autonomic Ganglia | 49 | ||
| Length of Preganglionic and Postganglionic Axons | 49 | ||
| Neurotransmitters and Types of Receptors | 49 | ||
| Sympathetic Adrenergic Varicosities | 49 | ||
| Adrenal Medulla | 49 | ||
| Fight or Flight Response | 50 | ||
| Parasympathetic Nervous System | 52 | ||
| Origin of Preganglionic Neurons | 52 | ||
| Location of Autonomic Ganglia | 52 | ||
| Length of Preganglionic and Postganglionic Axons | 52 | ||
| Neurotransmitters and Types of Receptors | 52 | ||
| Parasympathetic Cholinergic Varicosities | 52 | ||
| Autonomic Innervation of the Organ Systems | 53 | ||
| Reciprocal Functions—Sympathetic and Parasympathetic | 54 | ||
| Sinoatrial Node | 54 | ||
| Urinary Bladder | 54 | ||
| Pupil | 54 | ||
| Coordination of Function within Organs | 55 | ||
| Types of Receptors | 55 | ||
| Hypothalamic and Brain Stem Centers | 56 | ||
| Autonomic Receptors | 56 | ||
| G Proteins | 58 | ||
| Adrenoreceptors | 58 | ||
| α1 Receptors | 58 | ||
| α2 Receptors | 58 | ||
| β1 Receptors | 59 | ||
| β2 Receptors | 61 | ||
| Responses of Adrenoreceptors to Norepinephrine and Epinephrine | 61 | ||
| Cholinoreceptors | 61 | ||
| Nicotinic Receptors | 61 | ||
| Muscarinic Receptors | 62 | ||
| Summary | 63 | ||
| Selected Readings | 64 | ||
| 3 Neurophysiology | 65 | ||
| Organization of the Nervous System | 65 | ||
| Spinal Cord | 66 | ||
| Brain Stem | 66 | ||
| Cerebellum | 67 | ||
| Thalamus and Hypothalamus | 67 | ||
| Cerebral Hemispheres | 68 | ||
| General Features of Sensory and Motor Systems | 68 | ||
| Synaptic Relays | 68 | ||
| Topographic Organization | 68 | ||
| Decussations | 68 | ||
| Types of Nerve Fibers | 69 | ||
| Sensory Systems | 69 | ||
| Sensory Pathways | 69 | ||
| Sensory Receptors | 71 | ||
| Types of Receptors | 71 | ||
| Sensory Transduction and Receptor Potentials | 71 | ||
| Receptive Fields | 72 | ||
| Sensory Coding | 73 | ||
| Adaptation of Sensory Receptors | 74 | ||
| Somatosensory System and Pain | 75 | ||
| Types of Somatosensory Receptors | 75 | ||
| Mechanoreceptors | 75 | ||
| Thermoreceptors | 76 | ||
| Nociceptors | 77 | ||
| Somatosensory Pathways | 77 | ||
| Dorsal Column System | 77 | ||
| Anterolateral System | 77 | ||
| Vision | 79 | ||
| Structures of the Eye | 79 | ||
| Photoreception | 80 | ||
| Layers of the Retina | 80 | ||
| Structure of the Photoreceptors | 82 | ||
| Steps in Photoreception | 83 | ||
| Visual Receptive Fields | 84 | ||
| Photoreceptors, Horizontal Cells, and Bipolar Cells | 84 | ||
| Amacrine Cells | 85 | ||
| Ganglion Cells | 85 | ||
| Lateral Geniculate Cells of the Thalamus | 85 | ||
| Visual Cortex | 85 | ||
| Optic Pathways | 85 | ||
| Audition | 86 | ||
| Structures of the Ear | 86 | ||
| Auditory Transduction | 87 | ||
| Cochlea and Organ of Corti | 88 | ||
| Steps in Auditory Transduction | 89 | ||
| Encoding of Sound | 90 | ||
| Auditory Pathways | 90 | ||
| Vestibular System | 90 | ||
| Vestibular Organ | 90 | ||
| Vestibular Transduction | 91 | ||
| Semicircular Canals | 91 | ||
| Otolith Organs | 91 | ||
| Vestibular Pathways | 93 | ||
| Vestibulo-Ocular Reflexes | 93 | ||
| Testing Vestibulo-ocular Reflexes | 93 | ||
| Olfaction | 93 | ||
| Olfactory Epithelium and Receptors | 93 | ||
| Olfactory Transduction | 94 | ||
| Encoding Olfactory Stimuli | 95 | ||
| Olfactory Pathways | 95 | ||
| Taste | 95 | ||
| Taste Buds and Receptors | 95 | ||
| Taste Transduction | 96 | ||
| Encoding Taste Stimuli | 97 | ||
| Taste Pathways | 97 | ||
| Motor Systems | 97 | ||
| Organization of Motor Function by the Spinal Cord | 98 | ||
| Motor Units | 98 | ||
| Types of Motoneurons | 98 | ||
| Types of Muscle Fibers | 98 | ||
| Muscle Spindles | 98 | ||
| Intrafusal Muscle Fibers of Muscle Spindles | 98 | ||
| Innervation of Muscle Spindles | 98 | ||
| Function of Muscle Spindles | 99 | ||
| Spinal Cord Reflexes | 100 | ||
| Stretch Reflex | 100 | ||
| Golgi Tendon Reflex | 101 | ||
| Flexor-Withdrawal Reflex | 102 | ||
| Control of Posture and Movement by the Brain Stem | 102 | ||
| Cerebellum | 103 | ||
| Layers of the Cerebellar Cortex | 103 | ||
| Input to the Cerebellar Cortex | 104 | ||
| Interneurons of the Cerebellum | 104 | ||
| Output of the Cerebellar Cortex | 104 | ||
| Disorders of the Cerebellum | 104 | ||
| Basal Ganglia | 104 | ||
| Diseases of the Basal Ganglia | 106 | ||
| Motor Cortex | 106 | ||
| Higher Functions of the Nervous System | 106 | ||
| Electroencephalogram | 106 | ||
| Learning and Memory | 107 | ||
| Cerebrospinal Fluid | 108 | ||
| Formation of Cerebrospinal Fluid | 108 | ||
| Functions of Cerebrospinal Fluid | 109 | ||
| Summary | 109 | ||
| Selected Readings | 111 | ||
| 4 Cardiovascular Physiology | 113 | ||
| Circuitry of the Cardiovascular System | 113 | ||
| Left and Right Sides of the Heart | 113 | ||
| Blood Vessels | 114 | ||
| Circuitry | 114 | ||
| Hemodynamics | 115 | ||
| Types and Characteristics of Blood Vessels | 115 | ||
| Velocity of Blood Flow | 117 | ||
| Relationships between Blood Flow, Pressure, and Resistance | 118 | ||
| Resistance to Blood Flow | 119 | ||
| Poiseuille Equation | 119 | ||
| Series and Parallel Resistances | 120 | ||
| Laminar Flow and Reynolds Number | 121 | ||
| Shear | 122 | ||
| Compliance of Blood Vessels | 122 | ||
| Pressures in the Cardiovascular System | 123 | ||
| Pressure Profile in the Vasculature | 124 | ||
| Arterial Pressure in the Systemic Circulation | 124 | ||
| Venous Pressures in the Systemic Circulation | 127 | ||
| Pressures in the Pulmonary Circulation | 127 | ||
| Cardiac Electrophysiology | 127 | ||
| Cardiac Action Potentials | 127 | ||
| Origin and Spread of Excitation within the Heart | 127 | ||
| Concepts Associated with Cardiac Action Potentials | 128 | ||
| Action Potentials of Ventricles, Atria, and the Purkinje System | 129 | ||
| Action Potentials in the Sinoatrial Node | 132 | ||
| Latent Pacemakers | 133 | ||
| Conduction Velocity | 133 | ||
| Conduction of the Cardiac Action Potential | 133 | ||
| Mechanism of Propagation of Cardiac Action Potential | 134 | ||
| Excitability and Refractory Periods | 134 | ||
| Autonomic Effects on the Heart and Blood Vessels | 136 | ||
| Autonomic Effects on Heart Rate | 136 | ||
| Autonomic Effects on Conduction Velocity in the Atrioventricular Node | 138 | ||
| Electrocardiogram | 138 | ||
| Cardiac Muscle Contraction | 140 | ||
| Myocardial Cell Structure | 140 | ||
| Excitation-Contraction Coupling | 140 | ||
| Contractility | 141 | ||
| Mechanisms for Changing Contractility | 141 | ||
| Effects of the Autonomic Nervous System on Contractility | 141 | ||
| Effect of Heart Rate on Contractility | 142 | ||
| Effect of Cardiac Glycosides on Contractility | 142 | ||
| Length-Tension Relationship in Cardiac Muscle | 144 | ||
| Stroke Volume, Ejection Fraction, and Cardiac Output | 145 | ||
| Stroke Volume | 145 | ||
| Ejection Fraction | 145 | ||
| Cardiac Output | 145 | ||
| Frank-Starling Relationship | 146 | ||
| Ventricular Pressure-Volume Loops | 147 | ||
| Normal Ventricular Pressure-Volume Loop | 147 | ||
| Changes in Ventricular Pressure-Volume Loops | 148 | ||
| Cardiac Work | 148 | ||
| Myocardial Oxygen Consumption | 149 | ||
| Measurement of Cardiac Output—Fick Principle | 149 | ||
| Cardiac Cycle | 150 | ||
| Atrial Systole (A) | 150 | ||
| Isovolumetric Ventricular Contraction (B) | 150 | ||
| Rapid Ventricular Ejection (C) | 152 | ||
| Reduced Ventricular Ejection (D) | 152 | ||
| Isovolumetric Ventricular Relaxation (E) | 153 | ||
| Rapid Ventricular Filling (F) | 153 | ||
| Reduced Ventricular Filling (Diastasis) (G) | 153 | ||
| Relationships between Cardiac Output and Venous Return | 153 | ||
| Cardiac Function Curve | 153 | ||
| Vascular Function Curve | 154 | ||
| Mean Systemic Pressure | 154 | ||
| Slope of the Vascular Function Curve | 155 | ||
| Combining Cardiac and Vascular Function Curves | 155 | ||
| Inotropic Effects | 156 | ||
| Effects of Changes in Blood Volume | 157 | ||
| Effects of Changes in Total Peripheral Resistance | 157 | ||
| Regulation of Arterial Pressure | 158 | ||
| Baroreceptor Reflex | 159 | ||
| Baroreceptors | 159 | ||
| Brain Stem Cardiovascular Centers | 160 | ||
| Integrated Function of the Baroreceptor Reflex | 161 | ||
| Response of the Baroreceptor Reflex to Hemorrhage | 161 | ||
| Test of Baroreceptor Reflex: Valsalva Maneuver | 161 | ||
| Renin–Angiotensin II–Aldosterone System | 162 | ||
| Other Regulatory Mechanisms | 164 | ||
| Peripheral Chemoreceptors in Carotid and Aortic Bodies | 164 | ||
| Central Chemoreceptors | 165 | ||
| Antidiuretic Hormone | 165 | ||
| Cardiopulmonary (Low-Pressure) Baroreceptors | 165 | ||
| Microcirculation | 166 | ||
| Exchange of Substances Across the Capillary Wall | 166 | ||
| Fluid Exchange Across Capillaries | 166 | ||
| Starling Equation | 166 | ||
| Changes in Starling Forces | 168 | ||
| Lymph | 168 | ||
| Special Circulations | 169 | ||
| Mechanisms for Control of Regional Blood Flow | 169 | ||
| Local Control of Blood Flow | 169 | ||
| Neural and Hormonal Control of Blood Flow | 170 | ||
| Coronary Circulation | 171 | ||
| Cerebral Circulation | 171 | ||
| Pulmonary Circulation | 172 | ||
| Renal Circulation | 172 | ||
| Skeletal Muscle Circulation | 172 | ||
| Skin Circulation | 172 | ||
| Temperature Regulation | 172 | ||
| Mechanisms for Generating Heat | 173 | ||
| Thyroid Hormones | 173 | ||
| Sympathetic Nervous System | 173 | ||
| Shivering | 173 | ||
| Mechanisms for Dissipating Heat | 173 | ||
| Regulation of Body Temperature | 173 | ||
| Fever | 174 | ||
| Disturbances of Temperature Regulation | 174 | ||
| Integrative Functions of the Cardiovascular System | 174 | ||
| Responses to Exercise | 174 | ||
| Central Command | 174 | ||
| Local Responses in Muscle | 175 | ||
| Overall Responses to Exercise | 175 | ||
| Responses to Hemorrhage | 176 | ||
| Decreased Arterial Pressure—Initiating Event | 176 | ||
| Responses of the Baroreceptor Reflex | 178 | ||
| Responses of the Renin–Angiotensin II–Aldosterone System | 179 | ||
| Responses in the Capillaries | 179 | ||
| Responses of Antidiuretic Hormone | 179 | ||
| Other Responses in Hemorrhage | 179 | ||
| Responses to Changes in Posture | 179 | ||
| Pooling of Blood in the Extremities—Initiating Event | 179 | ||
| Response of the Baroreceptor Reflex | 180 | ||
| Summary | 181 | ||
| Selected Readings | 184 | ||
| 5 Respiratory Physiology | 185 | ||
| Structure of the Respiratory System | 185 | ||
| Airways | 185 | ||
| Conducting Zone | 185 | ||
| Respiratory Zone | 186 | ||
| Pulmonary Blood Flow | 187 | ||
| Lung Volumes and Capacities | 187 | ||
| Lung Volumes | 187 | ||
| Lung Capacities | 187 | ||
| Dead Space | 189 | ||
| Anatomic Dead Space | 189 | ||
| Physiologic Dead Space | 189 | ||
| Ventilation Rates | 190 | ||
| Alveolar Ventilation Equation | 191 | ||
| Alveolar Gas Equation | 192 | ||
| Forced Expiratory Volumes | 193 | ||
| Mechanics of Breathing | 194 | ||
| Muscles Used for Breathing | 194 | ||
| Muscles of Inspiration | 194 | ||
| Muscles of Expiration | 194 | ||
| Compliance | 194 | ||
| Compliance of the Lungs | 194 | ||
| Compliance of the Chest Wall | 195 | ||
| Pressure-Volume Curves for the Lungs, Chest Wall, and Combined Lung and Chest Wall | 196 | ||
| Diseases of Lung Compliance | 198 | ||
| Surface Tension of Alveoli | 199 | ||
| Surfactant | 200 | ||
| Airflow, Pressure, and Resistance Relationships | 200 | ||
| Airway Resistance | 200 | ||
| Changes in Airway Resistance | 201 | ||
| Breathing Cycle | 201 | ||
| Rest | 203 | ||
| Inspiration | 203 | ||
| Expiration | 203 | ||
| Forced Expiration | 203 | ||
| Gas Exchange | 204 | ||
| Gas Laws | 204 | ||
| General Gas Law | 204 | ||
| Boyle’s Law | 205 | ||
| Dalton’s Law of Partial Pressures | 205 | ||
| Henry’s Law for Concentrations of Dissolved Gases | 205 | ||
| Diffusion of Gases—Fick’s Law | 206 | ||
| Forms of Gases in Solution | 206 | ||
| Overview—Gas Transport in the Lungs | 207 | ||
| Diffusion-Limited and Perfusion-Limited Gas Exchange | 209 | ||
| Diffusion-Limited Gas Exchange | 210 | ||
| Perfusion-Limited Gas Exchange | 210 | ||
| O2 Transport—Perfusion-Limited and Diffusion-Limited | 210 | ||
| Oxygen Transport in Blood | 212 | ||
| Forms of O2 in Blood | 212 | ||
| Dissolved O2 | 212 | ||
| O2 Bound to Hemoglobin | 212 | ||
| O2-Binding Capacity and O2 Content | 212 | ||
| O2 Delivery to Tissues | 213 | ||
| O2-Hemoglobin Dissociation Curve | 213 | ||
| Sigmoidal Shape | 214 | ||
| P50 | 214 | ||
| Loading and Unloading of O2 | 214 | ||
| Changes in the O2-Hemoglobin Dissociation Curve | 216 | ||
| Shifts to the Right | 216 | ||
| Shifts to the Left | 216 | ||
| Carbon Monoxide | 216 | ||
| Erythropoietin | 217 | ||
| Carbon Dioxide Transport in Blood | 218 | ||
| Forms of CO2 in Blood | 218 | ||
| Dissolved CO2 | 218 | ||
| Carbaminohemoglobin | 219 | ||
| HCO3− | 219 | ||
| Ventilation/Perfusion Relationships | 220 | ||
| Pulmonary Blood Flow | 220 | ||
| Pulmonary Blood Flow, Pressure, and Resistance Relationships | 220 | ||
| Regulation of Pulmonary Blood Flow | 220 | ||
| Distribution of Pulmonary Blood Flow | 221 | ||
| Shunts | 222 | ||
| Ventilation/Perfusion Ratios | 224 | ||
| Normal Value for () | 224 | ||
| Distribution of in the Lung | 224 | ||
| Ventilation/Perfusion Defects | 225 | ||
| Control of Breathing | 226 | ||
| Brain Stem Control of Breathing | 226 | ||
| Medullary Respiratory Center | 228 | ||
| Apneustic Center | 228 | ||
| Pneumotaxic Center | 228 | ||
| Cerebral Cortex | 228 | ||
| Chemoreceptors | 228 | ||
| Central Chemoreceptors | 228 | ||
| Peripheral Chemoreceptors | 229 | ||
| Other Receptors | 229 | ||
| Integrative Functions | 230 | ||
| Responses to Exercise | 230 | ||
| Arterial Po2 and Pco2 | 230 | ||
| Venous Pco2 | 230 | ||
| Muscle and Joint Receptors | 231 | ||
| Cardiac Output and Pulmonary Blood Flow | 231 | ||
| O2-Hemoglobin Dissociation Curve | 232 | ||
| Adaptation to High Altitude | 232 | ||
| Hyperventilation | 232 | ||
| Polycythemia | 233 | ||
| 2,3-DPG and O2-Hemoglobin Dissociation Curve | 233 | ||
| Pulmonary Vasoconstriction | 233 | ||
| Acute Altitude Sickness | 234 | ||
| Hypoxemia and Hypoxia | 234 | ||
| Hypoxemia | 234 | ||
| Hypoxia | 235 | ||
| Summary | 235 | ||
| Selected Readings | 237 | ||
| 6 Renal Physiology | 239 | ||
| Anatomy and Blood Supply | 239 | ||
| Gross Anatomic Features of the Kidney | 239 | ||
| Structure of the Nephron | 239 | ||
| Renal Vasculature | 240 | ||
| Body Fluids | 240 | ||
| Distribution of Water among the Body Fluids | 241 | ||
| Total Body Water | 241 | ||
| Intracellular Fluid | 242 | ||
| Extracellular Fluid | 242 | ||
| Measuring Volumes of Body Fluid Compartments | 243 | ||
| Shifts of Water between Body Fluid Compartments | 244 | ||
| Isosmotic Volume Contraction—Diarrhea | 246 | ||
| Hyperosmotic Volume Contraction— Water Deprivation | 247 | ||
| Hyposmotic Volume Contraction—Adrenal Insufficiency | 248 | ||
| Isosmotic Volume Expansion—Infusion of NaCl | 248 | ||
| Hyperosmotic Volume Expansion—High NaCl Intake | 248 | ||
| Hyposmotic Volume Expansion—SIADH | 248 | ||
| Renal Clearance | 248 | ||
| Clearance of Various Substances | 250 | ||
| Clearance Ratios | 250 | ||
| Renal Blood Flow | 250 | ||
| Regulation of Renal Blood Flow | 251 | ||
| Autoregulation of Renal Blood Flow | 252 | ||
| Measurement of Renal Plasma Flow and Renal Blood Flow | 252 | ||
| Measuring True Renal Plasma Flow— Fick Principle | 252 | ||
| Measuring Effective Renal Plasma Flow— Clearance of Para-Aminohippuric Acid | 254 | ||
| Measuring Renal Blood Flow | 254 | ||
| Glomerular Filtration | 254 | ||
| Characteristics of the Glomerular Filtration Barrier | 255 | ||
| Layers of the Glomerular Capillary | 255 | ||
| Endothelium | 255 | ||
| Basement Membrane | 255 | ||
| Epithelium | 255 | ||
| Negative Charge on the Glomerular Capillary Barrier | 255 | ||
| Starling Forces Across Glomerular Capillaries | 256 | ||
| Starling Equation | 256 | ||
| Changes in Starling Pressures | 258 | ||
| Measurement of Glomerular Filtration Rate | 259 | ||
| Clearance of Inulin | 259 | ||
| Other Markers for Glomerular Filtration Rate | 260 | ||
| Filtration Fraction | 260 | ||
| Reabsorption and Secretion | 261 | ||
| Measurement of Reabsorption and Secretion | 261 | ||
| Glucose—Example of Reabsorption | 262 | ||
| Cellular Mechanism for Glucose Reabsorption | 262 | ||
| Glucose Titration Curve and Tm | 262 | ||
| Glucosuria | 264 | ||
| Urea—Example of Passive Reabsorption | 264 | ||
| Para-Aminohippuric Acid—Example of Secretion | 266 | ||
| Weak Acids and Bases—Non-Ionic Diffusion | 267 | ||
| Terminology Associated with the Single Nephron | 267 | ||
| [TF/P]X Ratio | 268 | ||
| [TF/P]Inulin | 268 | ||
| [TF/P]X/[TF/P]Inulin | 269 | ||
| Sodium Balance | 269 | ||
| Overall Handling of Na | 269 | ||
| Proximal Convoluted Tubule | 271 | ||
| Early Proximal Convoluted Tubule | 271 | ||
| Late Proximal Convoluted Tubule | 273 | ||
| Isosmotic Reabsorption | 273 | ||
| TF/P Ratios Along the Proximal Tubule | 274 | ||
| Glomerulotubular Balance | 275 | ||
| Changes in Extracellular Fluid Volume | 275 | ||
| Loop of Henle | 276 | ||
| Thin Descending Limb and Thin Ascending Limb | 276 | ||
| Thick Ascending Limb | 276 | ||
| Distal Tubule and Collecting Duct | 277 | ||
| Early Distal Tubule | 277 | ||
| Late Distal Tubule and Collecting Duct | 278 | ||
| Regulation of Na+ Balance | 279 | ||
| Response to Increased Na+ Intake | 280 | ||
| Response to Decreased Na+ Intake | 280 | ||
| Potassium Balance | 280 | ||
| Internal K+ Balance | 280 | ||
| Insulin | 281 | ||
| Acid-Base Abnormalities | 281 | ||
| Adrenergic Agonists and Antagonists | 283 | ||
| Osmolarity | 283 | ||
| Cell Lysis | 283 | ||
| Exercise | 283 | ||
| External K+ Balance—Renal Mechanisms | 283 | ||
| K+ Reabsorption by α-Intercalated Cells | 284 | ||
| K+ Secretion by Principal Cells | 284 | ||
| Phosphate, Calcium, and Magnesium Balance | 287 | ||
| Phosphate | 287 | ||
| Calcium | 288 | ||
| Magnesium | 290 | ||
| Water Balance—Concentration and Dilution of Urine | 290 | ||
| Regulation of Body Fluid Osmolarity | 290 | ||
| Response to Water Deprivation | 290 | ||
| Response to Water Drinking | 291 | ||
| Corticopapillary Osmotic Gradient | 292 | ||
| Countercurrent Multiplication | 292 | ||
| Single Effect | 292 | ||
| Flow of Tubular Fluid | 293 | ||
| Urea Recycling | 294 | ||
| Vasa Recta | 295 | ||
| Antidiuretic Hormone | 295 | ||
| Production of Hyperosmotic Urine | 296 | ||
| Steps in Production of Hyperosmotic Urine | 297 | ||
| SIADH | 297 | ||
| Production of Hyposmotic Urine | 298 | ||
| Steps in Production of Hyposmotic Urine | 298 | ||
| Central Diabetes Insipidus | 299 | ||
| Nephrogenic Diabetes Insipidus | 299 | ||
| Free-Water Clearance | 299 | ||
| Measurement of CH2O | 300 | ||
| Significance of CH2O | 300 | ||
| Summary | 300 | ||
| Selected Readings | 302 | ||
| 7 Acid-Base Physiology | 303 | ||
| pH of Body Fluids | 303 | ||
| Acid Production in the Body | 304 | ||
| CO2 | 304 | ||
| Fixed Acid | 304 | ||
| Buffering | 304 | ||
| Principles of Buffering | 304 | ||
| Henderson-Hasselbalch Equation | 305 | ||
| Titration Curves | 306 | ||
| Extracellular Fluid Buffers | 306 | ||
| HCO3−/CO2 Buffer | 306 | ||
| HPO4−2/H2PO4− Buffer | 309 | ||
| Intracellular Fluid Buffers | 309 | ||
| Organic Phosphates | 309 | ||
| Proteins | 309 | ||
| Renal Mechanisms in Acid-Base Balance | 310 | ||
| Reabsorption of Filtered HCO3− | 310 | ||
| Mechanism of HCO3− Reabsorption in the Proximal Tubule | 310 | ||
| Effect of Filtered Load of HCO3− | 311 | ||
| Effect of Extracellular Fluid Volume | 311 | ||
| Effect of Pco2 | 311 | ||
| Excretion of H+ as Titratable Acid | 311 | ||
| Mechanism of Excretion of Titratable Acid | 311 | ||
| Amount of Urinary Buffer | 312 | ||
| pK of Urinary Buffers | 313 | ||
| Excretion of H+ as NH4 | 313 | ||
| Mechanism of Excretion of H+ as NH4 | 313 | ||
| Effect of Urinary pH on Excretion of NH4 | 315 | ||
| Effect of Acidosis on NH3 Synthesis | 315 | ||
| Effect of Plasma K+ Concentration on NH3 Synthesis | 315 | ||
| Comparison of Titratable Acid and NH4+ Excretion | 315 | ||
| Acid-Base Disorders | 316 | ||
| Anion Gap of Plasma | 317 | ||
| Increased Anion Gap | 318 | ||
| Normal Anion Gap | 318 | ||
| Acid-Base Map | 318 | ||
| Rules for Compensatory Responses | 318 | ||
| Metabolic Acidosis | 320 | ||
| Metabolic Alkalosis | 322 | ||
| Respiratory Acidosis | 324 | ||
| Respiratory Alkalosis | 326 | ||
| Summary | 327 | ||
| Selected Readings | 328 | ||
| 8 Gastrointestinal Physiology | 329 | ||
| Structure of the Gastrointestinal Tract | 329 | ||
| Innervation of the Gastrointestinal Tract | 330 | ||
| Parasympathetic Innervation | 330 | ||
| Sympathetic Innervation | 332 | ||
| Intrinsic Innervation | 332 | ||
| Gastrointestinal Regulatory Substances | 332 | ||
| Characteristics of Gastrointestinal Peptides | 333 | ||
| Gastrointestinal Hormones | 334 | ||
| Gastrin | 334 | ||
| Cholecystokinin | 335 | ||
| Secretin | 336 | ||
| Glucose-Dependent Insulinotropic Peptide | 337 | ||
| Candidate Hormones | 337 | ||
| Paracrines | 337 | ||
| Neurocrines | 337 | ||
| Satiety | 337 | ||
| Motility | 338 | ||
| Slow Waves | 338 | ||
| Chewing and Swallowing | 339 | ||
| Chewing | 339 | ||
| Swallowing | 340 | ||
| Esophageal Motility | 340 | ||
| Gastric Motility | 341 | ||
| Structure and Innervation of the Stomach | 341 | ||
| Receptive Relaxation | 342 | ||
| Mixing and Digestion | 342 | ||
| Gastric Emptying | 343 | ||
| Small Intestinal Motility | 343 | ||
| Segmentation Contractions | 343 | ||
| Peristaltic Contractions | 343 | ||
| Vomiting | 345 | ||
| Large Intestinal Motility | 345 | ||
| Segmentation Contractions | 345 | ||
| Mass Movements | 345 | ||
| Defecation | 345 | ||
| Gastrocolic Reflex | 345 | ||
| Secretion | 345 | ||
| Salivary Secretion | 345 | ||
| Structure of the Salivary Glands | 345 | ||
| Formation of Saliva | 346 | ||
| Effect of Flow Rate on Composition of Saliva | 347 | ||
| Regulation of Salivary Secretion | 348 | ||
| Gastric Secretion | 349 | ||
| Structure and Cell Types of the Gastric Mucosa | 349 | ||
| HCl Secretion | 350 | ||
| Cellular Mechanism | 350 | ||
| Substances That Alter Hcl Secretion | 351 | ||
| Stimulation of H+ Secretion | 352 | ||
| Inhibition of Hcl Secretion | 354 | ||
| Peptic Ulcer Disease | 354 | ||
| Pepsinogen Secretion | 356 | ||
| Intrinsic Factor Secretion | 356 | ||
| Pancreatic Secretion | 356 | ||
| Structure of the Pancreatic Exocrine Glands | 356 | ||
| Formation of Pancreatic Secretion | 356 | ||
| Effect of Flow Rate on Composition of Pancreatic Juice | 358 | ||
| Regulation of Pancreatic Secretion | 358 | ||
| Bile Secretion | 359 | ||
| Overview of the Biliary System | 359 | ||
| Composition of Bile | 360 | ||
| Function of the Gallbladder | 362 | ||
| Enterohepatic Circulation of Bile Salts | 363 | ||
| Digestion and Absorption | 363 | ||
| Carbohydrates | 365 | ||
| Digestion of Carbohydrates | 365 | ||
| Absorption of Carbohydrates | 365 | ||
| Disorders of Carbohydrate Digestion and Absorption | 366 | ||
| Proteins | 366 | ||
| Digestion of Proteins | 366 | ||
| Absorption of Proteins | 368 | ||
| Disorders of Protein Digestion and Absorption | 369 | ||
| Lipids | 369 | ||
| Digestion of Lipids | 370 | ||
| Stomach | 370 | ||
| Small Intestine | 370 | ||
| Absorption of Lipids | 370 | ||
| Abnormalities of Lipid Digestion and Absorption | 371 | ||
| Vitamins | 373 | ||
| Fat-Soluble Vitamins | 373 | ||
| Water-Soluble Vitamins | 373 | ||
| Calcium | 373 | ||
| Iron | 374 | ||
| Intestinal Fluid and Electrolyte Transport | 374 | ||
| Intestinal Absorption | 374 | ||
| Jejunum | 376 | ||
| Ileum | 376 | ||
| Colon | 376 | ||
| Intestinal Secretion | 376 | ||
| Diarrhea | 377 | ||
| Decreased Surface Area for Absorption | 378 | ||
| Osmotic Diarrhea | 378 | ||
| Secretory Diarrhea | 378 | ||
| Liver Physiology | 378 | ||
| Bile Formation and Secretion | 378 | ||
| Bilirubin Production and Excretion | 378 | ||
| Metabolic Functions of the Liver | 378 | ||
| Detoxification of Substances | 380 | ||
| Summary | 380 | ||
| Selected Readings | 382 | ||
| 9 Endocrine Physiology | 383 | ||
| Hormone Synthesis | 383 | ||
| Peptide and Protein Hormone Synthesis | 383 | ||
| Steroid Hormone Synthesis | 387 | ||
| Amine Hormone Synthesis | 387 | ||
| Regulation of Hormone Secretion | 387 | ||
| Negative Feedback | 387 | ||
| Positive Feedback | 388 | ||
| Regulation of Hormone Receptors | 389 | ||
| Down-Regulation | 389 | ||
| Up-Regulation | 389 | ||
| Mechanisms of Hormone Action and Second Messengers | 389 | ||
| G Proteins | 390 | ||
| Adenylyl Cyclase Mechanism | 390 | ||
| Phospholipase C Mechanism | 391 | ||
| Catalytic Receptor Mechanisms | 392 | ||
| Guanylyl Cyclase | 393 | ||
| Serine/Threonine Kinases | 393 | ||
| Tyrosine Kinases | 393 | ||
| Steroid and Thyroid Hormone Mechanism | 394 | ||
| Hypothalamic-Pituitary Relationships | 394 | ||
| Relationship of the Hypothalamus to the Posterior Pituitary | 395 | ||
| Relationship of the Hypothalamus to the Anterior Pituitary | 396 | ||
| Anterior Lobe Hormones | 397 | ||
| TSH, FSH, and LH Family | 398 | ||
| ACTH Family | 398 | ||
| Growth Hormone | 398 | ||
| Chemistry of Growth Hormone | 399 | ||
| Regulation of Growth Hormone Secretion | 399 | ||
| Actions of Growth Hormone | 400 | ||
| Pathophysiology of Growth Hormone | 400 | ||
| Prolactin | 401 | ||
| Chemistry of Prolactin | 401 | ||
| Regulation of Prolactin Secretion | 401 | ||
| Actions of Prolactin | 402 | ||
| Pathophysiology of Prolactin | 402 | ||
| Posterior Lobe Hormones | 402 | ||
| Synthesis and Secretion of Antidiuretic Hormone and Oxytocin | 403 | ||
| Synthesis and Processing | 403 | ||
| Secretion | 404 | ||
| Antidiuretic Hormone | 404 | ||
| Regulation of Antidiuretic Hormone Secretion | 404 | ||
| Actions of Antidiuretic Hormone | 404 | ||
| Pathophysiology of Antidiuretic Hormone | 405 | ||
| Oxytocin | 406 | ||
| Regulation of Oxytocin Secretion | 406 | ||
| Actions of Oxytocin | 407 | ||
| Thyroid Hormones | 407 | ||
| Synthesis and Transport of Thyroid Hormones | 407 | ||
| Synthesis of Thyroid Hormones | 407 | ||
| Binding of Thyroid Hormones in the Circulation | 410 | ||
| Activation of T4 in Target Tissues | 410 | ||
| Regulation of Thyroid Hormone Secretion | 410 | ||
| Actions of Thyroid Hormones | 411 | ||
| Pathophysiology of Thyroid Hormone | 413 | ||
| Hyperthyroidism | 413 | ||
| Hypothyroidism | 414 | ||
| Goiter | 415 | ||
| Adrenal Medulla and Cortex | 415 | ||
| Synthesis of Adrenocortical Steroid Hormones | 416 | ||
| Structures of Adrenocortical Steroids | 416 | ||
| Biosynthetic Pathways in the Adrenal Cortex | 416 | ||
| Regulation of Secretion of Adrenocortical Steroids | 419 | ||
| Regulation of Glucocorticoid and Adrenal Androgen Secretion | 420 | ||
| Regulation of Aldosterone Secretion | 421 | ||
| Actions of Adrenocortical Steroids | 422 | ||
| Actions of Glucocorticoids | 422 | ||
| Actions of Mineralocorticoids | 423 | ||
| Actions of Adrenal Androgens | 423 | ||
| Pathophysiology of the Adrenal Cortex | 423 | ||
| Addison Disease | 424 | ||
| Secondary Adrenocortical Insufficiency | 424 | ||
| Cushing Syndrome | 425 | ||
| Conn Syndrome | 427 | ||
| 21β-Hydroxylase Deficiency | 427 | ||
| 17α-Hydroxylase Deficiency | 428 | ||
| Endocrine Pancreas | 428 | ||
| Insulin | 429 | ||
| Structure and Synthesis of Insulin | 429 | ||
| Regulation of Insulin Secretion | 430 | ||
| Mechanism of Action of Insulin | 431 | ||
| Actions of Insulin | 432 | ||
| Pathophysiology of Insulin | 433 | ||
| Glucagon | 433 | ||
| Structure and Synthesis of Glucagon | 434 | ||
| Regulation of Glucagon Secretion | 434 | ||
| Actions of Glucagon | 434 | ||
| Somatostatin | 434 | ||
| Regulation of Calcium and Phosphate Metabolism | 435 | ||
| Forms of Ca2+ in Blood | 435 | ||
| Overall Calcium Homeostasis | 437 | ||
| Parathyroid Hormone | 437 | ||
| Structure of Parathyroid Hormone | 438 | ||
| Regulation of Parathyroid Hormone Secretion | 438 | ||
| Actions of Parathyroid Hormone | 439 | ||
| Pathophysiology of Parathyroid Hormone | 440 | ||
| Calcitonin | 443 | ||
| Vitamin D | 443 | ||
| Synthesis of Vitamin D | 443 | ||
| Regulation of Vitamin D Synthesis | 444 | ||
| Actions of Vitamin D | 444 | ||
| Pathophysiology of Vitamin D | 444 | ||
| Summary | 445 | ||
| Selected Readings | 446 | ||
| 10 Reproductive Physiology | 447 | ||
| Sexual Differentiation | 447 | ||
| Genetic Sex | 447 | ||
| Gonadal Sex | 447 | ||
| Phenotypic Sex | 448 | ||
| Puberty | 449 | ||
| Gonadotropin Secretion Over the Lifetime | 449 | ||
| Pulsatile Secretion of GnRH, FSH, and LH | 450 | ||
| Characteristics of Puberty | 451 | ||
| Male Reproductive Physiology | 452 | ||
| Structure of the Testes | 452 | ||
| Spermatogenesis | 452 | ||
| Storage of Sperm, Ejaculation, and Function of Sex Accessory Glands | 452 | ||
| Synthesis and Secretion of Testosterone | 453 | ||
| Regulation of the Testes | 453 | ||
| GnRH | 453 | ||
| FSH and LH | 454 | ||
| Negative Feedback | 454 | ||
| Actions of Androgens | 454 | ||
| Female Reproductive Physiology | 455 | ||
| Oogenesis | 457 | ||
| Synthesis and Secretion of Estrogen and Progesterone | 457 | ||
| Regulation of the Ovaries | 459 | ||
| GnRH | 459 | ||
| FSH and LH | 459 | ||
| Negative and Positive Feedback | 459 | ||
| Actions of Estrogen and Progesterone | 460 | ||
| Development of the Female Reproductive Tract | 461 | ||
| Menstrual Cycle | 461 | ||
| Breasts | 461 | ||
| Pregnancy | 461 | ||
| Other Actions of Estrogen and Progesterone | 462 | ||
| Events of the Menstrual Cycle | 462 | ||
| Pregnancy | 462 | ||
| Events of Early Pregnancy | 464 | ||
| Hormones of Pregnancy | 464 | ||
| Parturition | 465 | ||
| Lactation | 465 | ||
| Hormonal Contraception | 466 | ||
| Menopause | 466 | ||
| Summary | 467 | ||
| Selected Readings | 468 | ||
| Appendix I Common Abbreviations and Symbols | 469 | ||
| Appendix II Normal Values and Constants | 471 | ||
| Challenge Yourself Answers | 473 | ||
| Chapter 1 | 473 | ||
| Chapter 2 | 473 | ||
| Chapter 3 | 473 | ||
| Chapter 4 | 474 | ||
| Chapter 5 | 474 | ||
| Chapter 6 | 475 | ||
| Chapter 7 | 475 | ||
| Chapter 8 | 476 | ||
| Chapter 9 | 476 | ||
| Chapter 10 | 476 | ||
| Index | 477 | ||
| A | 477 | ||
| B | 479 | ||
| C | 481 | ||
| D | 483 | ||
| E | 484 | ||
| F | 485 | ||
| G | 486 | ||
| H | 487 | ||
| I | 489 | ||
| J | 490 | ||
| K | 490 | ||
| L | 490 | ||
| M | 491 | ||
| N | 492 | ||
| O | 493 | ||
| P | 494 | ||
| Q | 496 | ||
| R | 496 | ||
| S | 497 | ||
| T | 500 | ||
| U | 501 | ||
| V | 501 | ||
| W | 502 | ||
| Z | 502 | ||
| Inside Back Cover | ibc1 |