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SECTION Ⅰ. INTRODUCTION1

1. The General Cellular Basls of Medical Physioloogy1

Introduction1

General Principles1

Functional Morphology of the Cell8

Structure Function of DNA RNA17

Transport Across Cell Membranes27

The Capillary Wall35

Intercellular Communication35

Structure40

Homeostasis46

Aging46

Section Ⅰ References:47

2. Excitable Tissue:Nerve49

Introduction49

Nerve Cells49

SECTION Ⅱ. PHYSIOLOGY OF NERVE MUSCLE CELLS49

Excitation Conduction51

Ionic Basis of Excitation Conduction56

Neurotrophins58

Nerve Fiber Types Function58

Properties of Mixed Nerves58

Glia61

3. Excitable Tissue:Muscle62

Introduction62

Skeletal Muscle62

Morphology62

Electrical Phenomena Ionic Fluxes65

Contractile Responses65

Energy Sources Metabolism70

Properties of Muscles in the Intact Organism72

Electrical Properties74

Cardiac Muscle74

Morphology74

Mechanical Properties75

Metabolism77

Pacemaker Tissue78

Smooth Muscle78

Morphology78

Visceral Smooth Muscle78

Multi-unit Smooth Muscle80

Synaptic Transmission81

Functional Anatomy81

Introduction81

4. Synaptic Junctional Transmission81

Electrical Events in Postsynaptic Neurons84

Inhibition Facilitation at Synapses88

Chemical Transmission of Synaptic Activity90

Principal Neurotransmitter Systems93

Synaptic Plasticity Learning110

Neuromuscular Transmission110

Neuromuscular Junction110

Nerve Endings in Smooth Cardiac Muscle112

Denervation Hypersensitivity113

The Senses115

5. Initlatlon of Impulses in Sense Organs115

Introduction115

Sense Organs Receptors115

Electrical Chemical Events in Receptors117

Ionic Basis of Excitation118

Coding of Sensory Information119

SectionⅡReferences:121

SECTION Ⅲ FUNCTIONS OF THE NERVOUS SYSTEM123

6. Reflexes123

Introduction123

Monosynaptic Reflexes: The Stretch Reflex123

Polysynaptic Reflexes: The Withdrawal Reflex129

General Properties of Reflexes130

Introduction132

Pathways132

7. Cutaneous ,Deep, Visceral Sensation132

Touch135

Proprioception136

Temperature136

Pain136

Other Sensations142

Anatomic Considerations144

Introduction144

8. Vision144

The Image-Forming Mechanism149

The Photoreceptor Mechanism152

Responses in the Visual Pathways Cortex155

Color Vision159

Other Aspects of Visual Function161

Eye Movements163

9. Hearing Equllibrium166

Introduction166

Anatomic Considerations166

Hair Cells170

Hearing172

Vestibular Function178

10. Smell Taste180

Introduction180

Smell180

Taste183

Receptor Organs Pathways183

The Reticular Formation the Reticular Activating System187

11. Alert Behavior, Sleep, the Electrical Activity of the Brain187

The Thalamus the Cerebral Cortex187

Introduction187

Evoked Cortical Potentials188

The Electroencephalogram189

Physiologic Basis of the EEG, Consciousness, Sleep191

General Principles197

12. Control of Posture Movement197

Introduction197

Anatomy Function198

Corticospinal Corticobulbar System198

Posture-Regulating Systems201

Spinal Integration203

Medullary Components204

Midbrain Components206

Cortical Components207

Basal Ganglia207

Cerebellum211

Anatomic Organization of Autonomic Outflow217

13. The Autonomic Nervous System217

Introduction217

Chemical Transmission at Autonomic Junctions219

Responses of Effector Organs to Autonomic Nerver Impulses221

14. Central Regulation of Visceral Function224

Introduction224

Medulla Oblongata224

Hypothalamus225

Anatomic Considerations225

Relation to Autonomic Function226

Hypothalamic Function226

Relation to Cyclic Phenomena227

Relation to Sleep227

Hunger228

Thirst232

Control of Posterior Pituitary Secretion233

Control of Anterior Pituitary Secretion239

Temperature Regulation242

Introduction248

Anatomic Considerations248

15. Neural Basls of Instinctual Behavior Emotions248

Limbic Functions249

Sexual Behavior249

Fear Rage252

Motivation Addiction253

Brain Chemistry Behavior254

Effects of Adrenal Androgens Estrogens256

Learning Memory259

Methods259

Introduction259

16. Higher Functions of the Nervous System : Conditioned Reflexes, Learning, Related Phenomena259

Functions of the Neocortex264

Section Ⅲ References:269

Introduction271

17. Energy Balance, Metabolism, Nutrition271

SECTION Ⅳ. ENDOCRINOLOGY,METABOLISM, REPRODUCTIVE FUNCTION271

Energy Metabolism271

Intermediary Metabolism274

Carbohydrate Metabolism278

Protein Metabolism284

Fat Metabolism290

Nutrition302

Anatomic Consideration307

Introduction307

18. The Thyroid Gland307

Formation Secretion of Thyroid Hormones308

Transport Metabolism of Thyroid Hormones311

Effects of Thyroid Hormones313

Regulation of Thyroid Secretion316

Clinical Correlates317

19. Endocrine Functions of the Pancreas Regulation of Carbohydrate Metabolism322

Introduction322

Islet Cell Structure322

Structure, Biosynthesis, Secretion of Insulin323

Effects of Insulin324

Fate of Secreted Insulin324

Mechanism of Action327

Consequences of Insulin Deficiency328

Insulin Excess333

Regulation of Insulin Secretion334

Glucagon337

Other Islet Cell Hormones339

Effects of Other Hormones Exercise on Carbohydrate Metabolism340

Hypoglycemia Diabetes Mellitus in Humans341

Adrenal Morphology344

Introduction344

20. The Adrenal Medulla Adrenal Cortex344

Adrenal Medulla346

Structure Function of Medullary Hormones346

Regulation of Adrenal Medullary Secretion348

Adrenal Cortex349

Structure Biosynthesis of Adrenocortical Hormones349

Transport, Metabolism, Excretion of Adrenocortical Hormones354

Physiologic Effects of Glucocorticoids356

Pharmacologic Pathologic Effects of Glucocorticoids358

Regulation of Glucocorticoid Secretio359

Effects of Mineralocorticoids362

Regulation of Aldosterone Secretion364

Role of Mineralocorticoids in the Regulation of Salt Balance366

Summary of the Effects of Adrenocortical Hyper- Hypofunction in Humans366

Introduction369

Calcium Phosphorus Metabolism369

21. Hormonal Control of Calcium Metabolism the Physiology of Bone369

Bone Physiology370

Vitamin D the Hydroxycholecalciferols375

The Parathyroid Glands377

Calctionin380

Effects of Other Hormones Humoral Agents on Calcium Metabolism382

Introduction383

22. The Pituitary Gland383

Intermediate-Lobe Hormones384

Morphology384

Growth Hormone386

Physiology of Growth392

Pituitary Insufficiency395

Pituitary Hyperfunction in Humans396

23. The Gonads: Development Function of the Reproductive System398

Introduction398

Sex Differentiation Development398

Chromosomal Sex398

Embryology of the Human Reproductive System400

Aberrant Sexual Differentiation401

Puberty405

Precocious Delayed Puberty407

Menopause408

Pituitary Gonadotropins Prolactin408

The Male Reproductive System410

Gametogenesis Ejaculation411

Endocrine Function of the Testes415

The Menstrual Cycle419

The Female Reproductive System419

Abnormalities of Testicular Function419

Control of Testicular Function419

Ovarian Hormones425

Control of Ovarian Function430

Abnormalities of Ovarian Function433

Pregnancy433

Lactation436

24.Endocrlne Functlons of the Kidneys, Heart, Pineal Giand439

Introduction439

The Renin-Angiotensin System439

Erythropoietin444

Hormones of the Heart Other Natriuretic Factors445

Pineal Gland447

SectionⅣReferences:449

SECTIONⅤ.GASTROINTESTINAL FUNCTION453

25.Digestion Absorption453

Introduction453

Catbohydrates453

Proteins Nucleic Acids456

Lipids458

Absorption of Water Electrolytes459

Absorption of Vitamins Minerals462

General Considerations464

Introduction464

26.Regulation of Gastrolntestinal Function464

Gastrointestinal Hormones466

Mouth Esophagus472

Stomach475

Exocrine Portion of the Pancreas481

Liver Biliary System483

Small Intestine489

Colon492

SectionⅤReferences:496

Bone Marrow499

Introduction499

Blood499

27.Circulating Body Fiuids499

SECTIONⅥ.CIRCULATION499

White Blood Cells500

Immunity504

Platelets514

Red Blood Cells515

Blood Types519

Plasma522

Hemostasis524

Lymph527

Origin Spread of Cardiac Excitation528

Introduction528

28.Origin or the Heartbeat the Eiectrical Activity of the Heart528

The Electrocardiogram530

Cardiac Arrhythmias535

Eiectrocardiographic Findings in Other Cardiac Systemic Diseass541

29.The Heart as a Pump545

Introduction545

Mechanical Events of the Cardiac Cycle545

Cardiac Output550

30.Dynamlcs of Blood Lymph Flow556

Introduction556

Anatomic Considerations556

Biophysical Considerations560

Arterial Arteriolar Circulation565

Capillary Circulation568

Lymphatic Circulation Interstitial Fluid Volume570

Venous Circulation572

31.Cardiovascular Regulatory Mechanisms574

Introduction574

Local Regulatory Mechanisms574

Substances Secreted by the Endothelium575

Systemic Regulation by Hormones577

Systemic Regulation by the Nervous System579

Anatomic Considerations588

Cerebral Circulation588

Introduction588

32.Circulation Through Speciai Regions588

Cerebrospinal Fluid589

The Blood-Brain Barrier591

Cerebral Blood Flow593

Regulation of Cerebral Circulation595

Brain Metabolism Oxygen Requirements596

Coronary Circulation597

Splanchnic Circulation601

Circulation of the Skin602

Placental Fetal Circulation603

Compensations for Gravitational Effects607

Introduction607

33.Cardiovascular Homeostasis in Heaith Disease607

Exercise609

Inflammation Wound Healing612

Shock613

Hypertension618

Heart Failure620

SectionⅥReferences:622

SECTIONⅦ.RESPIRATION625

34.Pulmonary Function625

Introduction625

Properties of Gases625

Anatomy of the Lungs626

Mechanics of Respiration627

Gas Exchange in the Lungs637

Pulmonary Circulation639

Other Functions of the Respiratory System642

35.Gas Transport Between the Lungs the Tissues644

Introduction644

Oxygen Transport644

Carbon Dioxide Transport647

36.Regulation of Respiration649

Introduction649

Neural Control of Breathing649

Regulation of Respiratory Activity650

Chemical Control of Breathing651

Nonchemical Influences on Respiration656

37.Respiratory Adjustments in Health Disease658

Introduction658

Effects of Exercise658

Hypoxia660

Hypoxic Hypoxia661

Other Forms of Hypoxia667

Oxygen Treatment668

Hypercapnia Hypocapnia668

Other Respiratory Abnormalities669

Effects of Increased Barometric Pressure670

Artificial Respiration672

SectionⅦReferences:673

SECTIONⅧ.FORMATION EXCRETION OF URINE675

38.Renal Function Micturition675

Introduction675

Functional Anatomy675

Renal Circulation679

Glomerular Filtration681

Tubular Function684

Water Excretion689

Acidification of the Urine Bicarbonate Excretion694

Regulation of Na+ Cl- Excretion697

Regulation of K+ Excretion699

Diuretics699

Effects of Disordered Renal Function700

Filling of the Bladder701

Emptying of the Bladder701

39.Regulation of Extracellular Fluid Composition Volume704

Introduction704

Defense of Tonicity704

Defense of Volume704

Defense of Specific Ionic Composition705

Defense of H+ Concentration705

SectionⅧReferences:713

Appendix714

Ceneral References714

Normal Values the Statistical Evaluation of Data714

Abbreviations Symbols Commonly Used in Physiology716

Some Standard Respiratory Symbols722

Equivalents of Metric, United States, English Measures723

Greek Alphabet723

Self-Study: Objectives, Essay Questions, Multiple-Choice Questions725

Answers to Quantitative Multiple-Choice Questions775

Index781

Tables781