Introduction to Physiology: The Cell and General Physiology

Functional Organization of the Human Body
and Control of the “Internal Environment” 3
Cells as the Living Units of the Body 3
Extracellular Fluid—The “Internal
Environment” 3
“Homeostatic” Mechanisms of the Major
Functional Systems 4
Control Systems of the Body 6
Summary—Automaticity of the Body 9
The Cell and Its Functions 11
Organization of the Cell 11
Physical Structure of the Cell 12
Comparison of the Animal Cell with
Precellular Forms of Life 17
Functional Systems of the Cell 18
Locomotion of Cells 23
Genetic Control of Protein Synthesis, Cell
Function, and Cell Reproduction 27
Genes in the Cell Nucleus 27
The DNA Code in the Cell Nucleus Is
Transferred to an RNA Code in the Cell
Cytoplasm—The Process of Transcription 30
Synthesis of Other Substances in the Cell 35
Control of Gene Function and Biochemical
Activity in Cells 35
The DNA-Genetic System Also Controls Cell
Reproduction 37
Cell Differentiation 39

Apoptosis—Programmed Cell Death 40
Cancer 40

Membrane Physiology, Nerve, and Muscle

Transport of Substances Through Cell
Membranes 45
The Lipid Barrier of the Cell Membrane,
and Cell Membrane Transport Proteins 45
Diffusion 46
“Active Transport” of Substances Through
Membranes 52
Membrane Potentials and Action Potentials 57
Basic Physics of Membrane Potentials 57
Measuring the Membrane Potential 58
Resting Membrane Potential of Nerves 59
Nerve Action Potential 60
Roles of Other Ions During the Action
Potential 64
Propagation of the Action Potential 64
Re-establishing Sodium and Potassium
Ionic Gradients After Action Potentials Are
Completed—Importance of Energy
Metabolism 65
Plateau in Some Action Potentials 66
Rhythmicity of Some Excitable Tissues—
Repetitive Discharge 66
Special Characteristics of Signal Transmission
in Nerve Trunks 67
Excitation—The Process of Eliciting the
Action Potential 68
Recording Membrane Potentials and
Action Potentials 69

Contraction of Skeletal Muscle 71
Physiologic Anatomy of Skeletal Muscle 71
General Mechanism of Muscle Contraction 73
Molecular Mechanism of Muscle Contraction 74
Energetics of Muscle Contraction 78
Characteristics of Whole Muscle
Contraction 79
Excitation of Skeletal Muscle:
Neuromuscular Transmission and
Excitation-Contraction Coupling 83
Transmission of Impulses from Nerve Endings
to Skeletal Muscle Fibers: The Neuromuscular
Junction 83
Molecular Biology of Acetylcholine Formation
and Release 86
Drugs That Enhance or Block Transmission
at the Neuromuscular Junction 86
Myasthenia Gravis Causes Muscle Paralysis 86
Muscle Action Potential 87
Excitation-Contraction Coupling 88
Excitation and Contraction of Smooth Muscle 91
Contraction of Smooth Muscle 91
Nervous and Hormonal Control of Smooth
Muscle Contraction 94
The Heart
Cardiac Muscle; The Heart as a Pump and
Function of the Heart Valves 101
Physiology of Cardiac Muscle 101
Cardiac Cycle 104
Relationship of the Heart Sounds to Heart
Pumping 107
Work Output of the Heart 107
Chemical Energy Required for Cardiac Contraction:
Oxygen Utilization by the Heart 109
Regulation of Heart Pumping 110
Rhythmical Excitation of the Heart 115
Specialized Excitatory and Conductive System
of the Heart 115
Control of Excitation and Conduction in the
Heart 118

The Normal Electrocardiogram 121
Characteristics of the Normal
Electrocardiogram 121
Methods for Recording Electrocardiograms 123
Flow of Current Around the Heart
during the Cardiac Cycle 123
Electrocardiographic Leads 124
Electrocardiographic Interpretation of
Cardiac Muscle and Coronary Blood Flow
Abnormalities: Vectorial Analysis 129
Principles of Vectorial Analysis of
Electrocardiograms 129
Vectorial Analysis of the Normal
Electrocardiogram 131
Mean Electrical Axis of the Ventricular
QRS—and Its Significance 134
Conditions That Cause Abnormal Voltages
of the QRS Complex 137
Prolonged and Bizarre Patterns of the QRS
Complex 137
Current of Injury 138
Abnormalities in the T Wave 141
Cardiac Arrhythmias and Their
Electrocardiographic Interpretation 143
Abnormal Sinus Rhythms 143
Abnormal Rhythms That Result from Block
of Heart Signals Within the Intracardiac
Conduction Pathways 144
Premature Contractions 146
Paroxysmal Tachycardia 148
Ventricular Fibrillation 149
Atrial Fibrillation 151
Atrial Flutter 152
Cardiac Arrest 153
The Circulation
Overview of the Circulation; Biophysics of
Pressure, Flow, and Resistance 157
Physical Characteristics of the Circulation 157
Basic Principles of Circulatory Function 158
Interrelationships of Pressure, Flow, and
Resistance 159

Vascular Distensibility and Functions of the
Arterial and Venous Systems 167
Vascular Distensibility 167
Arterial Pressure Pulsations 168
Veins and Their Functions 171
The Microcirculation and Lymphatic
System: Capillary Fluid Exchange,
Interstitial Fluid, and Lymph Flow 177
Structure of the Microcirculation
and Capillary System 177
Flow of Blood in the Capillaries—
Vasomotion 178
Exchange of Water, Nutrients, and Other
Substances Between the Blood and
Interstitial Fluid 179
Interstitium and Interstitial Fluid 180
Fluid Filtration Across Capillaries Is
Determined by Hydrostatic and Colloid
Osmotic Pressures, as Well as Capillary
Filtration Coefficient 181
Lymphatic System 186
Local and Humoral Control of Tissue
Blood Flow 191
Local Control of Blood Flow in Response to
Tissue Needs 191
Mechanisms of Blood Flow Control 191
Humoral Control of the Circulation 199
Nervous Regulation of the Circulation,
and Rapid Control of Arterial Pressure 201
Nervous Regulation of the Circulation 201
Role of the Nervous System in Rapid
Control of Arterial Pressure 204
Special Features of Nervous Control
of Arterial Pressure 209
Role of the Kidneys in Long-Term Control of
Arterial Pressure and in Hypertension: The
Integrated System for Arterial Pressure
Regulation 213
Renal–Body Fluid System for Arterial
Pressure Control 213
The Renin-Angiotensin System: Its Role
in Arterial Pressure Control 220
Summary of the Integrated, Multifaceted
System for Arterial Pressure Regulation 226

Cardiac Output, Venous Return,
and Their Regulation 229
Normal Values for Cardiac Output at Rest
and During Activity 229
Control of Cardiac Output by Venous
Return—Role of the Frank-Starling Mechanism
of the Heart 229
Pathologically High or Low Cardiac Outputs 232
Methods for Measuring Cardiac
Output 240
Muscle Blood Flow and Cardiac Output
During Exercise; the Coronary Circulation
and Ischemic Heart Disease 243
Blood Flow Regulation in Skeletal Muscle
at Rest and During Exercise 243
Coronary Circulation 246
Cardiac Failure 255
Circulatory Dynamics in Cardiac Failure 255
Unilateral Left Heart Failure 259
Low-Output Cardiac Failure—
Cardiogenic Shock 259
Edema in Patients with Cardiac Failure 259
Cardiac Reserve 261
Heart Valves and Heart Sounds;
Valvular and Congenital Heart
Defects 265
Heart Sounds 265
Abnormal Circulatory Dynamics in Valvular
Heart Disease 268
Abnormal Circulatory Dynamics
in Congenital Heart Defects 269
Use of Extracorporeal Circulation During
Cardiac Surgery 271
Hypertrophy of the Heart in Valvular
and Congenital Heart Disease 272
Circulatory Shock and Its Treatment 273
Physiologic Causes of Shock 273
Shock Caused by Hypovolemia—
Hemorrhagic Shock 274
Neurogenic Shock—Increased Vascular
Capacity 279
Anaphylactic Shock and Histamine Shock 280
Septic Shock 280

Physiology of Treatment in Shock 280
Circulatory Arrest 281
The Body Fluids and Kidneys
The Body Fluid Compartments: Extracellular
and Intracellular Fluids; Edema 285
Fluid Intake and Output Are Balanced
During Steady-State Conditions 285
Body Fluid Compartments 286
Extracellular Fluid Compartment 287
Blood Volume 287
Constituents of Extracellular and Intracellular
Fluids 287
Measurement of Fluid Volumes in the Different
Body Fluid Compartments—the Indicator-
Dilution Principle 287
Determination of Volumes of Specific Body
Fluid Compartments 289
Regulation of Fluid Exchange and Osmotic
Equilibrium Between Intracellular
and Extracellular Fluid 290
Basic Principles of Osmosis and Osmotic
Pressure 290
Osmotic Equilibrium Is Maintained Between
Intracellular and Extracellular Fluids 291
Volume and Osmolality of Extracellular
and Intracellular Fluids in Abnormal States 292
Glucose and Other Solutions Administered
for Nutritive Purposes 294
Clinical Abnormalities of Fluid Volume
Regulation: Hyponatremia and Hypernatremia 294
Edema: Excess Fluid in the Tissues 296
Fluids in the “Potential Spaces” of the Body 300
Urine Formation by the Kidneys:
I. Glomerular Filtration, Renal Blood Flow,
and Their Control 303
Multiple Functions of the Kidneys 303
Physiologic Anatomy of the Kidneys 304
Micturition 307
Physiologic Anatomy of the Bladder 307
Transport of Urine from the Kidney Through
the Ureters and into the Bladder 308
Filling of the Bladder and Bladder Wall Tone;
the Cystometrogram 309
Micturition Reflex 309

Abnormalities of Micturition 310
Urine Formation Results from Glomerular
Filtration, Tubular Reabsorption, and Tubular
Secretion 310
Glomerular Filtration—The First Step in
Urine Formation 312
Determinants of the GFR 314
Renal Blood Flow 316
Physiologic Control of Glomerular Filtration
and Renal Blood Flow 317
Autoregulation of GFR and Renal Blood Flow 319
Urine Formation by the Kidneys: II. Tubular
Reabsorption and Secretion 323
Renal Tubular Reabsorption and Secretion 323
Tubular Reabsorption Includes Passive
and Active Mechanisms 323
Reabsorption and Secretion Along Different
Parts of the Nephron 329
Regulation of Tubular Reabsorption 334
Use of Clearance Methods to Quantify Kidney
Function 340
Urine Concentration and Dilution; Regulation
of Extracellular Fluid Osmolarity and Sodium
Concentration 345
Kidneys Excrete Excess Water by Forming
Dilute Urine 345
Kidneys Conserve Water by Excreting
Concentrated Urine 346
Quantifying Renal Urine Concentration
and Dilution: “Free Water” and Osmolar
Clearances 354
Disorders of Urinary Concentrating Ability 354
Control of Extracellular Fluid Osmolarity and
Sodium Concentration 355
Osmoreceptor-ADH Feedback System 355
Importance of Thirst in Controlling
Extracellular Fluid Osmolarity and Sodium
Concentration 357
Salt-Appetite Mechanism for Controlling
Extracellular Fluid Sodium Concentration and
Volume 360
Renal Regulation of Potassium, Calcium,
Phosphate, and Magnesium; Integration
of Renal Mechanisms for Control of Blood
Volume and Extracellular Fluid Volume 361
Regulation of Extracellular Fluid Potassium
Concentration and Potassium Excretion 361

Control of Renal Calcium Excretion
and Extracellular Calcium Ion Concentration 367
Control of Renal Magnesium Excretion and
Extracellular Magnesium Ion Concentration 369
Integration of Renal Mechanisms for Control
of Extracellular Fluid 370
Importance of Pressure Natriuresis and
Pressure Diuresis in Maintaining Body Sodium
and Fluid Balance 371
Distribution of Extracellular Fluid
Between the Interstitial Spaces and
Vascular System 373
Nervous and Hormonal Factors Increase the
Effectiveness of Renal–Body Fluid Feedback
Control 373
Integrated Responses to Changes in Sodium
Intake 376
Conditions That Cause Large Increases in
Blood Volume and Extracellular Fluid Volume 376
Conditions That Cause Large Increases in
Extracellular Fluid Volume but with Normal
Blood Volume 377
Acid-Base Regulation 379
H+ Concentration Is Precisely Regulated 379
Acids and Bases—Their Definitions and
Meanings 379
Defending Against Changes in H+
Concentration: Buffers, Lungs, and Kidneys 380
Buffering of H+ in the Body Fluids 380
Bicarbonate Buffer System 381
Phosphate Buffer System 383
Proteins Are Important Intracellular Buffers 383
Respiratory Regulation of Acid-Base Balance 384
Renal Control of Acid-Base Balance 385
Secretion of H+ and Reabsorption of HCO3

by the Renal Tubules 386
Combination of Excess H+ with Phosphate
and Ammonia Buffers in the Tubule Generates
“New” HCO3
− 388
Quantifying Renal Acid-Base Excretion 389
Renal Correction of Acidosis—Increased
Excretion of H+ and Addition of HCO3
− to
the Extracellular Fluid 391
Renal Correction of Alkalosis—Decreased
Tubular Secretion of H+ and Increased
Excretion of HCO3
− 391
Clinical Causes of Acid-Base Disorders 392
Treatment of Acidosis or Alkalosis 393
Clinical Measurements and Analysis of
Acid-Base Disorders 393

Diuretics, Kidney Diseases 397
Diuretics and Their Mechanisms of Action 397
Kidney Diseases 399
Acute Renal Failure 399
Chronic Renal Failure: An Irreversible Decrease
in the Number of Functional Nephrons 401
Specific Tubular Disorders 408
Treatment of Renal Failure by Transplantation
or by Dialysis with an Artificial Kidney 409
Blood Cells, Immunity, and Blood
Red Blood Cells, Anemia, and Polycythemia 413
Red Blood Cells (Erythrocytes) 413
Anemias 420
Polycythemia 421
Resistance of the Body to Infection:
I. Leukocytes, Granulocytes, the Monocyte-
Macrophage System, and Inflammation 423
Leukocytes (White Blood Cells) 423
Neutrophils and Macrophages Defend
Against Infections 425
Monocyte-Macrophage Cell System
(Reticuloendothelial System) 426
Inflammation: Role of Neutrophils
and Macrophages 428
Eosinophils 430
Basophils 431
Leukopenia 431
Leukemias 431
Resistance of the Body to Infection:
II. Immunity and Allergy Innate Immunity 433
Acquired (Adaptive) Immunity 433
Allergy and Hypersensitivity 443
Blood Types; Transfusion; Tissue and Organ
Transplantation 445
Antigenicity Causes Immune Reactions of
Blood 445
O-A-B Blood Types 445
Rh Blood Types 447
Transplantation of Tissues and Organs 449

Hemostasis and Blood Coagulation 451
Events in Hemostasis 451
Vascular Constriction 451
Mechanism of Blood Coagulation 453
Conditions That Cause Excessive Bleeding in
Humans 457
Thromboembolic Conditions in the
Human Being 459
Anticoagulants for Clinical Use 459
Blood Coagulation Tests 460
Pulmonary Ventilation 465
Mechanics of Pulmonary Ventilation 465
Pulmonary Volumes and Capacities 469
Minute Respiratory Volume Equals Respiratory
Rate Times Tidal Volume 471
Alveolar Ventilation 471
Functions of the Respiratory Passageways 472
Pulmonary Circulation, Pulmonary Edema,
Pleural Fluid 477
Physiologic Anatomy of the Pulmonary
Circulatory System 477
Pressures in the Pulmonary System 477
Blood Volume of the Lungs 478
Blood Flow Through the Lungs and Its
Distribution 479
Effect of Hydrostatic Pressure Gradients in
the Lungs on Regional Pulmonary Blood Flow 479
Pulmonary Capillary Dynamics 481
Fluid in the Pleural Cavity 483
Physical Principles of Gas Exchange;
Diffusion of Oxygen and Carbon Dioxide
Through the Respiratory Membrane 485
Physics of Gas Diffusion and Gas
Partial Pressures 485
Compositions of Alveolar Air and Atmospheric
Air Are Different 487
Diffusion of Gases Through the Respiratory
Membrane 489
Effect of the Ventilation-Perfusion Ratio on
Alveolar Gas Concentration 492

Transport of Oxygen and Carbon Dioxide in
Blood and Tissue Fluids 495
Transport of Oxygen from the Lungs to the
Body Tissues 495
Transport of Carbon Dioxide in the Blood 502
Respiratory Exchange Ratio 504
Regulation of Respiration 505
Respiratory Center 505
Chemical Control of Respiration 507
Peripheral Chemoreceptor System for Control
of Respiratory Activity—Role of Oxygen in
Respiratory Control 508
Regulation of Respiration During Exercise 510
Other Factors That Affect Respiration 512
Respiratory Insufficiency—Pathophysiology,
Diagnosis, Oxygen Therapy 515
Useful Methods for Studying Respiratory
Abnormalities 515
Pathophysiology of Specific Pulmonary
Abnormalities 517
Hypoxia and Oxygen Therapy 520
Hypercapnia—Excess Carbon Dioxide in the
Body Fluids 522
Artificial Respiration 522
Aviation, Space, and Deep-Sea Diving
Aviation, High-Altitude, and
Space Physiology 527
Effects of Low Oxygen Pressure on the Body 527
Effects of Acceleratory Forces on the Body in
Aviation and Space Physiology 531
“Artificial Climate” in the Sealed Spacecraft 533
Weightlessness in Space 533
Physiology of Deep-Sea Diving and
Other Hyperbaric Conditions 535
Effect of High Partial Pressures of Individual
Gases on the Body 535
Scuba (Self-Contained Underwater Breathing
Apparatus) Diving 539
Special Physiologic Problems in Submarines 540
Hyperbaric Oxygen Therapy 540

The Nervous System: A. General Principles
and Sensory Physiology
Organization of the Nervous System, Basic
Functions of Synapses, and
Neurotransmitters 543
General Design of the Nervous System 543
Major Levels of Central Nervous System
Function 545
Comparison of the Nervous System with a
Computer 546
Central Nervous System Synapses 546
Some Special Characteristics of Synaptic
Transmission 557
Sensory Receptors, Neuronal Circuits for
Processing Information 559
Types of Sensory Receptors and the
Stimuli They Detect 559
Transduction of Sensory
Stimuli into Nerve Impulses 560
Nerve Fibers That Transmit Different Types of
Signals and Their Physiologic Classification 563
Transmission of Signals of Different Intensity
in Nerve Tracts—Spatial and Temporal
Summation 564
Transmission and Processing of Signals in
Neuronal Pools 564
Instability and Stability of Neuronal Circuits 569
Somatic Sensations: I. General Organization,
the Tactile and Position Senses 571
Classification of Somatic Senses 571
Detection and Transmission of Tactile
Sensations 571
Sensory Pathways for Transmitting Somatic
Signals into the Central Nervous System 573
Transmission in the Dorsal Column–Medial
Lemniscal System 573
Transmission of Less Critical Sensory Signals
in the Anterolateral Pathway 580
Some Special Aspects of Somatosensory
Function 581
Somatic Sensations: II. Pain, Headache, and
Thermal Sensations 583
Types of Pain and Their Qualities—Fast Pain
and Slow Pain 583

Pain Receptors and Their Stimulation 583
Dual Pathways for Transmission of Pain
Signals into the Central Nervous System 584
Pain Suppression (“Analgesia”) System in the
Brain and Spinal Cord 586
Referred Pain 588
Visceral Pain 588
Some Clinical Abnormalities of Pain
and Other Somatic Sensations 590
Headache 590
Thermal Sensations 592
The Nervous System: B. The Special Senses
The Eye: I. Optics of Vision 597
Physical Principles of Optics 597
Optics of the Eye 600
Ophthalmoscope 605
Fluid System of the Eye—Intraocular Fluid 606
The Eye: II. Receptor and Neural Function
of the Retina 609
Anatomy and Function of the Structural
Elements of the Retina 609
Photochemistry of Vision 611
Color Vision 615
Neural Function of the Retina 616
The Eye: III. Central Neurophysiology
of Vision 623
Visual Pathways 623
Organization and Function of the Visual
Cortex 624
Neuronal Patterns of Stimulation During
Analysis of the Visual Image 626
Fields of Vision; Perimetry 627
Eye Movements and Their Control 627
Autonomic Control of Accommodation
and Pupillary Aperture 631
The Sense of Hearing 633
Tympanic Membrane and the Ossicular System 633
Cochlea 634
Central Auditory Mechanisms 639
Hearing Abnormalities 642

The Chemical Senses—Taste and Smell 645
Sense of Taste 645
Sense of Smell 648
The Nervous System: C. Motor and
Integrative Neurophysiology
Motor Functions of the Spinal Cord; the Cord
Reflexes 655
Organization of the Spinal Cord for Motor
Functions 655
Muscle Sensory Receptors—Muscle Spindles
and Golgi Tendon Organs—And Their Roles
in Muscle Control 657
Flexor Reflex and the Withdrawal Reflexes 661
Crossed Extensor Reflex 663
Reciprocal Inhibition and Reciprocal Innervation 663
Reflexes of Posture and Locomotion 663
Scratch Reflex 664
Spinal Cord Reflexes That Cause Muscle Spasm 664
Autonomic Reflexes in the Spinal Cord 665
Spinal Cord Transection and Spinal Shock 665
Cortical and Brain Stem Control of Motor
Function 667
Motor Cortex and Corticospinal Tract 667
Role of the Brain Stem in Controlling Motor
Function 673
Vestibular Sensations and Maintenance of
Equilibrium 674
Functions of Brain Stem Nuclei in Controlling
Subconscious, Stereotyped Movements 678
Contributions of the Cerebellum and Basal
Ganglia to Overall Motor Control 681
Cerebellum and Its Motor Functions 681
Basal Ganglia—Their Motor Functions 689
Integration of the Many Parts of the Total
Motor Control System 694
Cerebral Cortex, Intellectual Functions of the
Brain, Learning, and Memory 697
Physiologic Anatomy of the Cerebral Cortex 697
Functions of Specific Cortical Areas 698

Function of the Brain in Communication—
Language Input and Language Output 703
Function of the Corpus Callosum and Anterior
Commissure to Transfer Thoughts, Memories,
Training, and Other Information Between the
Two Cerebral Hemispheres 704
Thoughts, Consciousness, and Memory 705
Behavioral and Motivational Mechanisms of the
Brain—The Limbic System and the
Hypothalamus 711
Activating-Driving Systems
of the Brain 711
Limbic System 714
Functional Anatomy of the Limbic System; Key
Position of the Hypothalamus 714
Hypothalamus, a Major Control Headquarters
for the Limbic System 715
Specific Functions of Other Parts of the Limbic
System 718
States of Brain Activity—Sleep, Brain Waves,
Epilepsy, Psychoses 721
Sleep 721
Epilepsy 725
Psychotic Behavior and Dementia—Roles
of Specific Neurotransmitter Systems 726
Schizophrenia—Possible Exaggerated
Function of Part of the Dopamine System 727
The Autonomic Nervous System and the
Adrenal Medulla 729
General Organization of the Autonomic
Nervous System 729
Basic Characteristics of Sympathetic and
Parasympathetic Function 731
Autonomic Reflexes 738
Stimulation of Discrete Organs in Some
Instances and Mass Stimulation in Other
Instances by the Sympathetic and
Parasympathetic Systems 738
Pharmacology of the Autonomic Nervous
System 739
Cerebral Blood Flow, Cerebrospinal Fluid,
and Brain Metabolism 743
Cerebral Blood Flow 743
Cerebrospinal Fluid System 746
Brain Metabolism 749

Gastrointestinal Physiology
General Principles of Gastrointestinal
Function—Motility, Nervous Control, and
Blood Circulation 753
General Principles of Gastrointestinal Motility 753
Neural Control of Gastrointestinal Function—
Enteric Nervous System 755
Functional Types of Movements in the
Gastrointestinal Tract 759
Gastrointestinal Blood Flow—“Splanchnic
Circulation” 759
Propulsion and Mixing of Food in the
Alimentary Tract 763
Ingestion of Food 763
Motor Functions of the Stomach 765
Movements of the Small Intestine 768
Movements of the Colon 770
Other Autonomic Reflexes That Affect Bowel
Activity 772
Secretory Functions of the Alimentary Tract 773
General Principles of Alimentary Tract
Secretion 773
Secretion of Saliva 775
Esophageal Secretion 776
Gastric Secretion 777
Pancreatic Secretion 780
Secretion of Bile by the Liver; Functions of the
Biliary Tree 783
Secretions of the Small Intestine 786
Secretion of Mucus by the Large Intestine 787
Digestion and Absorption in the
Gastrointestinal Tract 789
Digestion of the Various Foods by Hydrolysis 789
Basic Principles of Gastrointestinal Absorption 793
Absorption in the Small Intestine 794
Absorption in the Large Intestine: Formation of
Feces 797
Physiology of Gastrointestinal Disorders 799
Disorders of Swallowing and of the Esophagus 799

Disorders of the Stomach 799
Disorders of the Small Intestine 801
Disorders of the Large Intestine 802
General Disorders of the Gastrointestinal
Tract 803
Metabolism and Temperature Regulation
Metabolism of Carbohydrates, and Formation
of Adenosine Triphosphate 809
Central Role of Glucose in Carbohydrate
Metabolism 810
Transport of Glucose Through the Cell
Membrane 810
Glycogen Is Stored in Liver and Muscle 811
Release of Energy from Glucose by the
Glycolytic Pathway 812
Release of Energy from Glucose by the
Pentose Phosphate Pathway 816
Formation of Carbohydrates from Proteins
and Fats—“Gluconeogenesis” 817
Blood Glucose 817
Lipid Metabolism 819
Transport of Lipids in the Body Fluids 819
Fat Deposits 821
Use of Triglycerides for Energy: Formation of
Adenosine Triphosphate 822
Regulation of Energy Release from
Triglycerides 825
Phospholipids and Cholesterol 826
Atherosclerosis 827
Protein Metabolism 831
Basic Properties 831
Transport and Storage of Amino Acids 831
Functional Roles of the Plasma Proteins 833
Hormonal Regulation of Protein Metabolism 835
The Liver as an Organ 837
Physiologic Anatomy of the Liver 837
Hepatic Vascular and Lymph Systems 837
Metabolic Functions of the Liver 839
Measurement of Bilirubin in the Bile as a
Clinical Diagnostic Tool 840

Dietary Balances; Regulation of Feeding;
Obesity and Starvation; Vitamins and
Minerals 843
Energy Intake and Output Are Balanced Under
Steady-State Conditions 843
Dietary Balances 843
Regulation of Food Intake and Energy
Storage 845
Obesity 850
Inanition, Anorexia, and Cachexia 851
Starvation 852
Vitamins 852
Mineral Metabolism 855
Energetics and Metabolic Rate 859
Adenosine Triphosphate (ATP) Functions as
an “Energy Currency” in Metabolism 859
Control of Energy Release in the Cell 861
Metabolic Rate 862
Energy Metabolism—Factors That Influence
Energy Output 863
Body Temperature Regulation,
and Fever 867
Normal Body Temperatures 867
Body Temperature Is Controlled by
Balancing Heat Production and
Heat Loss 867
Regulation of Body Temperature—
Role of the Hypothalamus 871
Abnormalities of Body Temperature
Regulation 875
Endocrinology and Reproduction
Introduction to Endocrinology 881
Coordination of Body Functions by Chemical
Messengers 881
Chemical Structure and Synthesis of
Hormones 881
Hormone Secretion, Transport, and Clearance
from the Blood 884
Mechanisms of Action of Hormones 886
Measurement of Hormone Concentrations
in the Blood 891

Pituitary Hormones and Their Control by the
Hypothalamus 895
Pituitary Gland and Its Relation to the
Hypothalamus 895
Hypothalamus Controls Pituitary Secretion 897
Physiological Functions of Growth Hormone 898
Posterior Pituitary Gland and Its Relation to
the Hypothalamus 904
Thyroid Metabolic Hormones 907
Synthesis and Secretion of the Thyroid
Metabolic Hormones 907
Physiological Functions of the Thyroid
Hormones 910
Regulation of Thyroid Hormone Secretion 914
Diseases of the Thyroid 916
Adrenocortical Hormones 921
Synthesis and Secretion of Adrenocortical
Hormones 921
Functions of the Mineralocorticoids—
Aldosterone 924
Functions of the Glucocorticoids 928
Adrenal Androgens 934
Abnormalities of Adrenocortical Secretion 934
Insulin, Glucagon, and Diabetes Mellitus 939
Insulin and Its Metabolic Effects 939
Glucagon and Its Functions 947
Somatostatin Inhibits Glucagon and Insulin
Secretion 949
Summary of Blood Glucose Regulation 949
Diabetes Mellitus 950
Parathyroid Hormone, Calcitonin, Calcium
and Phosphate Metabolism, Vitamin D, Bone,
and Teeth 955
Overview of Calcium and
Phosphate Regulation in the Extracellular
Fluid and Plasma 955
Bone and Its Relation to Extracellular Calcium
and Phosphate 957
Vitamin D 960
Parathyroid Hormone 962
Calcitonin 966
Summary of Control of Calcium Ion
Concentration 966

Pathophysiology of Parathyroid Hormone,
Vitamin D, and Bone Disease 967
Physiology of the Teeth 969
Reproductive and Hormonal Functions of
the Male (and Function of the Pineal Gland) 973
Physiologic Anatomy of the Male Sexual
Organs 973
Spermatogenesis 973
Male Sexual Act 978
Testosterone and Other Male Sex Hormones 979
Abnormalities of Male Sexual Function 984
Erectile Dysfunction in the Male 985
Pineal Gland—Its Function in Controlling
Seasonal Fertility in Some Animals 986
Female Physiology Before Pregnancy and
Female Hormones 987
Physiologic Anatomy of the Female Sexual
Organs 987
Female Hormonal System 987
Monthly Ovarian Cycle; Function of the
Gonadotropic Hormones 988
Functions of the Ovarian Hormones—
Estradiol and Progesterone 991
Regulation of the Female Monthly
Rhythm—Interplay Between the Ovarian
and Hypothalamic-Pituitary Hormones 996
Abnormalities of Secretion by the Ovaries 999
Female Sexual Act 1000
Female Fertility 1000
Pregnancy and Lactation 1003
Maturation and Fertilization of the Ovum 1003
Early Nutrition of the Embryo 1005

Function of the Placenta 1005
Hormonal Factors in Pregnancy 1007
Response of the Mother’s Body to Pregnancy 1009
Parturition 1011
Lactation 1014
Fetal and Neonatal Physiology 1019
Growth and Functional Development of the
Fetus 1019
Development of the Organ Systems 1019
Adjustments of the Infant to Extrauterine Life 1021
Special Functional Problems in the Neonate 1023
Special Problems of Prematurity 1026
Growth and Development of the Child 1027
Sports Physiology
Sports Physiology 1031
Muscles in Exercise 1031
Respiration in Exercise 1036
Cardiovascular System in Exercise 1038
Body Heat in Exercise 1039
Body Fluids and Salt in Exercise 1040
Drugs and Athletes 1040
Body Fitness Prolongs Life 1041
Index 1043

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