Guyton and Hall Textbook of Medical Physiology_3rd SAE

Cover image

Title page

Table of Contents

Copyright

Dedication

Preface to the third South Asia edition

Preface to the second South Asia edition

Preface to the first South Asia edition

Preface to the 14th edition

Videos

Competency map

    List of Illustrations

    List of Tables

SECTION I. General Physiology

1.  Functional organization of the human body and control of the “internal environment”

    Cells are the living units of the body

    Extracellular fluid—the “internal environment”

    Homeostasis—maintenance of a nearly constant internal environment PY1.2

    Control systems of the body

    Summary—automaticity of the body

    Further readings

2.  The cell and its functions

    Organization of the cell

    Physical structure of the cell PY1.1

    Functional systems of the cell PY1.1

    Further readings

3.  Genetic control of protein synthesis, cell function, and cell reproduction PY1.1

    Genes in the cell nucleus control protein synthesis

    The DNA code in the cell nucleus is transferred to RNA code in the cell cytoplasm—the process of transcription

    Control of gene function and biochemical activity in cells

    Genetic testing

    The DNA–genetic system controls cell reproduction

    Cell differentiation

    Apoptosis PY1.4

    Further readings

4.  Transport of substances through cell membranes

    Diffusion PY1.5

    “Active transport” of substances through membranes PY1.5

    Further readings

5.  The body fluid compartments

    Fluid intake and output are balanced during steady-state conditions

    Body fluid compartments PY1.6

    Blood volume

    Constituents of extracellular and intracellular fluids PY1.6

    Measurement of fluid volumes in the different body fluid compartments—the indicator–dilution principle PY1.6

    Determination of volumes of specific body fluid compartments

    Further readings

6.  Intracellular and extracellular
fluid compartments and edema PY1.6

    Basic principles of osmosis 
and osmotic pressure

    Osmotic equilibrium is maintained between intracellular and extracellular fluids

    Volume and osmolality of extracellular and intracellular 
fluids in abnormal states

    Clinical abnormalities of fluid volume regulation: Hyponatremia and hypernatremia

    Edema: Excess fluid in the tissues

    Fluids in the “potential spaces” 
of the body

    Further readings

7.  Resting membrane potential

    Basic physics of membrane potentials PY1.8

    Measuring the membrane potential

    Resting membrane potential of neurons

    Impermeant anions (the Gibbs–Donnan phenomenon)

    Further readings

SECTION II. Nerve and Muscle Physiology

8.  The neuron: Stimulus and excitability

    Characteristics of a stimulus PY1.8

    Excitation—the process of eliciting the action potential

    Further readings

9.  Action potential of the nerve PY1.8

    Voltage-gated sodium and potassium channels

    Summary of the events that cause the action potential

    Roles of other ions during the action potential

    Local potentials

    Refractory period

    Further readings

10.  Propagation of the nerve impulse PY3.2

    Special characteristics of signal transmission in nerve trunks

    Further readings

11.  Peripheral nerve damage

    The nature and causes if peripheral neuropathy

    Nerve injury

    Wallerian degeneration PY3.3

    Functional assessment of nerve damage using the strength–duration curve PY3.17

    Nerve regeneration PY3.3

    Further readings

12.  Neuromuscular transmission PY3.4

    Secretion of acetylcholine by the nerve terminals

    Molecular biology of acetylcholine formation and release

    Drugs that enhance or block transmission at the neuromuscular junction PY3.5

    Myasthenia gravis PY3.6

    Lambert-Eaton syndrome

    Muscle action potential—comparison with nerve action potential

    Further readings

13.  Excitation–contraction coupling PY3.4; PY3.8

    Transverse tubule–sarcoplasmic reticulum system

    Release of calcium ions by the sarcoplasmic reticulum

    Further readings

14.  Molecular basis of skeletal muscle contraction PY3.7 PY3.9

    Physiological anatomy of skeletal muscle

    General mechanism of muscle contraction

    Molecular mechanism of muscle contraction

    Further readings

15.  Chemical changes during skeletal muscle contraction PY3.11

    Energetics of muscle contraction

    Further readings

16.  Characteristics of skeletal muscle contraction PY3.8, 3.10, 3.12

    The amount of actin and myosin filament overlap determines tension developed by the contracting muscle

    Relation of velocity of contraction to load

    Mechanics of skeletal muscle contraction

    Muscular dystrophy PY3.13

    Further readings

17.  Applied skeletal muscle physiology

    Blood flow regulation in skeletal muscle at rest and during exercise PY3.11

    Muscles in exercise PY3.11

    Gender differences in athletic performance PY11.4

    Drugs and athletes

    Further readings

SECTION III. Blood and Its Constituents

18.  Introduction to blood and plasma proteins PY2.1

    Functional roles of the plasma proteins PY2.2

    Separation of plasma proteins

    Plasmapheresis

    Further readings

19.  Red blood cells (erythrocytes) PY2.3

    Shape and size of red blood cells

    Concentration of red blood cells in the blood

    Quantity of hemoglobin in the cells

    Life span of red blood cells is about 120 days

    Erythrocyte sedimentation rate

    Further readings

20.  Erythropoiesis PY2.4

    Areas of the body that produce red blood cells

    Genesis of blood cells

    Stages of differentiation of red blood cells

    Erythropoietin regulates red blood cell production

    Maturation of red blood cells—requirement for vitamin B12 (cyanocobalamin) and folic acid

    Further readings

21.  Hemoglobin

    Formation of hemoglobin PY2.3

    Iron metabolism

    Further readings

22.  Anemia and polycythemia PY2.5

    Anemia

    RBC indices in anemia

    Polycythemia

    Further readings

23.  Jaundice

    Hemolytic jaundice is caused by hemolysis of red blood cells PY2.5

    Obstructive jaundice is caused by obstruction of bile ducts or liver disease

    Diagnostic differences between hemolytic and obstructive jaundice

    Further readings

24.  White blood cells PY2.6

    Leukocytes (white blood cells)

    Neutrophils and macrophages defend against infections

    Monocyte–macrophage cell system (reticuloendothelial system)

    Eosinophils

    Basophils

    Leukopenia

    Leukemias

    Further readings

25.  Immunity and allergy

    Acquired (adaptive) immunity PY2.10

    Allergy and hypersensitivity

    Further readings

26.  Platelets

    Thrombopoiesis PY2.7

    Hemostasis events PY2.7

    Vascular constriction

    Thrombocytopenia

    Thromboembolic conditions

    Bleeding time

    Further readings

27.  Blood coagulation PY2.8

    Conversion of prothrombin to thrombin

    Conversion of fibrinogen to fibrin—formation of the clot

    Positive feedback of clot formation

    Initiation of coagulation: Formation of prothrombin activator

    Intravascular anticoagulants prevent blood clotting in the normal vascular system

    Plasmin causes lysis of blood clots

    Conditions that cause excessive bleeding in humans

    Anticoagulants for clinical use

    Blood coagulation tests

    Further readings

28.  Blood groups PY2.9

    Multiplicity of antigens in the blood cells

    O–A–B blood types

    Rh blood types

    Further readings

SECTION IV. Cardiovascular Physiology

29.  Organization of the cardiovascular system PY5.7, 5.8

    Physical characteristics of the circulation

    Basic principles of circulatory function

    Further readings

30.  Properties of cardiac muscle PY5.2

    Anatomical characteristics of cardiac muscle

    Physiological characteristics of cardiac muscle

    Further readings

31.  Cardiac action potentials PY5.4

    Membrane potentials for the SA node and muscle fibers

    Control of cardiac action potentials by the sympathetic and parasympathetic nerves

    Effect of drugs on the cardiac action potential

    Further readings

32.  Origin and conduction of the cardiac impulse PY5.1, 5.4

    Specialized excitatory and conductive system of the heart

    Control of excitation and conduction in the heart

    Further readings

33.  The normal electrocardiogram

    Characteristics of the normal electrocardiogram PY5.5

    Flow of current around the heart during the cardiac cycle

    Electrocardiographic leads

34.  Clinical applications of the electrocardiogram

    Abnormal sinus rhythms PY5.6

    Abnormal rhythms that result from block of heart signals within the intracardiac conduction pathways

    Premature contractions

    Paroxysmal tachycardia

    Ventricular fibrillation

    Atrial fibrillation

    Atrial flutter

    Cardiac arrest

    Vectorial analysis of the ECG and its application to ventricular hypertrophy

    Vectorial analysis of the normal electrocardiogram

    Mean electrical axis of the ventricular QRS—and its significance

    Coronary ischemia

    Further readings

35.  Cardiac cycle

    Diastole and systole

    Oxygen utilization by the heart

    Efficiency of cardiac contraction

    Further readings

36.  Cardiac output and venous return PY5.8, 5.9

    Normal values for cardiac output at rest and during activity

    Control of cardiac output by venous return—the Frank–Starling mechanism of the heart

    Venous return curves

    Analysis of cardiac output and right atrial pressure using simultaneous cardiac output and venous return curves

    Methods for measuring cardiac output

    Further readings

37.  Regulation of cardiac output PY5.8, 5.9

    Intrinsic regulation of heart pumping—the Frank–Starling mechanism

    Effect of potassium and calcium ions on heart function

    Effect of temperature on heart function

    Increasing the arterial pressure load (up to a limit) does not decrease the cardiac output

    Further readings

38.  Hemodynamics PY5.7

    Interrelationships of pressure, flow, and resistance

    Further readings

39.  Microcirculation PY5.10

    Structure of the microcirculation and capillary system

    Flow of blood in the capillaries—vasomotion

    Exchange of water, nutrients, and other substances between the blood and interstitial fluid

    Interstitium and interstitial fluid

    Fluid filtration across capillaries

    Further readings

40.  The lymphatic system PY5.10

    Formation of lymph

    Rate of lymph flow

    The lymphatic system plays a key role in controlling interstitial fluid protein concentration, volume, and pressure

    Further readings

41.  The venous system PY5.7

    Right atrial pressure (central venous pressure) and its regulation PY5.8

    Peripheral venous pressure and its determinants

    Blood reservoir function of the veins

    Further readings

42.  Determinants of arterial blood pressure

    Arterial pressure pulsations

    Vascular distensibility PY5.9

    Clinical methods for measuring systolic and diastolic pressures

    Further readings

43.  Short-term regulation of 
arterial blood pressure PY5.8, 5.9

    Autonomic nervous system

    Role of the nervous system in rapid control of arterial pressure

    Special features of nervous control of arterial pressure

    Further readings

44.  Long-term regulation of 
arterial blood pressure PY5.8, 5.9

    Quantification of pressure diuresis as a basis for arterial pressure control

    The renin–angiotensin system: Its role in arterial pressure control

    Further readings

45.  Local and humoral control of blood flow

    Variations in blood flow in different tissues and organs PY5.8. 5.10

    Mechanisms of blood flow control

    Humoral control of the circulation

    Further readings

46.  Coronary circulation

    Physiological anatomy of the 
coronary blood supply PY5.10

    Normal coronary blood flow—averages 5% of cardiac output

    Control of coronary blood flow

    Special features of cardiac muscle metabolism

    Ischemic heart disease

    Causes of death after acute coronary occlusion

    Stages of recovery from acute myocardial infarction

    Function of the heart after recovery from myocardial infarction

    Pain in coronary heart disease

    Surgical treatment of coronary artery disease

    Further readings

47.  Cerebral circulation

    Anatomy of cerebral blood flow

    Regulation of cerebral 
blood flow PY5.10

    Cerebral microcirculation

    “Cerebral stroke” occurs when cerebral blood vessels are blocked

    Further readings

48.  Splanchnic circulation

    Anatomy of the gastrointestinal blood supply PY5.10

    Effect of gut activity and metabolic factors on gastrointestinal blood flow

    Nervous control of gastrointestinal blood flow.

    Further readings

49.  Fetal and neonatal circulation

    Circulatory readjustments at birth PY5.10

    Special functional problems in the circulation of the neonate

    Abnormal circulatory dynamics in congenital heart defects

    Further readings

50.  Valvular heart disease

    Causes of heart sounds

    Valvular lesions

    Abnormal circulatory dynamics 
in valvular heart disease PY5.11

    Hypertrophy of the heart in valvular heart disease

    Further readings

51.  Cardiac failure

    Circulatory dynamics in cardiac 
failure PY5.11

    Unilateral left heart failure

    Low-output cardiac failure—cardiogenic shock

    Edema in patients with cardiac failure

    Cardiac reserve

    Further readings

52.  Circulatory shock

    Physiological causes of shock PY5.11

    Causes of shock

    Physiology of treatment in shock

    Circulatory arrest

    Further readings

SECTION V. Respiratory Physiology

53.  Organization of the respiratory system

    Anatomical organization of the lungs and airways PY6.1

    Physical laws applicable in respiratory physiology

    Nonrespiratory functions of the lungs

    Further readings

54.  Mechanics of breathing

    Mechanics of pulmonary ventilation PY6.2

    Minute respiratory volume

    Alveolar ventilation

    Further readings

55.  Lung volumes and capacities

    Lung function tests PY6.7

    Pulmonary volumes and 
capacities PY6.2

    Mucus lining the respiratory passageways, and cilia action to clear the passageways

    Flow–volume curves

    Further readings

56.  Ventilation

    Minute respiratory volume (minute ventilation)

    Alveolar ventilation PY6.2

    Maximum voluntary ventilation

    Breathing reserve

    Gas pressures in a mixture of gases—”partial pressures” of individual gases

    Pressures of gases dissolved in water and tissues

    Relationship between alveolar ventilation and partial pressures of oxygen and carbon dioxide

    Causes of hypoventilation and hyperventilation

    Further readings

57.  Pulmonary circulation

    Physiological anatomy of the pulmonary circulatory system PY6.1

    Pressures in the pulmonary system

    Pulmonary vascular resistance

    Blood volume of the lungs

    Blood flow through the lungs and its distribution

    Effect of hydrostatic pressure gradients in the lungs on regional pulmonary blood flow

    Pulmonary capillary dynamics

    Further readings

58.  Diffusion of gases

    Physics of gas diffusion and gas partial pressures

    Diffusion of gases through the respiratory membrane PY6.2

    Diffusion and perfusion limitations of gas transfer

    Further readings

59.  Oxygen transport

    Compositions of alveolar air and atmospheric air are different

    Methods of oxygen transport PY6.3

    Hypoxia and oxygen therapy PY6.6, 6.5

    Further readings

60.  Carbon dioxide transport

    Transport of CO2 in the blood PY6.3

    Respiratory exchange ratio

    Further readings

61.  Chemical regulation of respiration

    Chemical control of respiration PY6.3

    Peripheral chemoreceptor system—role of oxygen in respiratory control

    Regulation of respiration during exercise

    Further readings

62.  Neural regulation of respiration

    Respiratory center PY6.3

    Other factors that affect 
respiration PY6.6

    Further readings

63.  Respiration in unusual environments

    Effects of low oxygen pressure 
on the body PY6.4

    Physiology of deep-sea diving and other hyperbaric conditions PY6.4

    Changes that occur with 
deep-sea diving PY6.5

    Self-contained underwater breathing apparatus (SCUBA) diving

    Further readings

64.  Applied respiratory physiology

    Respiratory disorders PY6.6

    Hypercapnia—excess carbon dioxide in the body fluids PY6.6

    Artificial respiration PY6.5

    Oxygen therapy

    Hyperbaric oxygen therapy

    Further readings

SECTION VI. Gastrointestinal Physiology

65.  Organization of the gastrointestinal system PY4.1

    General principles of gastrointestinal motility

    Types of smooth muscle

    Contractile mechanism in smooth muscle

    Neural control of gastrointestinal function—enteric nervous system PY4.1

    Gastrointestinal blood flow—“splanchnic circulation”

    Gut-Brain-Axis PY4.6

    Further readings

66.  Salivary glands and secretion PY4.2

    General principles of alimentary tract secretion

    Secretion of saliva

    Further readings

67.  Gastric secretions PY4.2

    Esophageal secretion

    Gastric secretion

    Pathophysiology and treatment modalities for acid peptic disease

    Gastric function tests PY4.8

    Further readings

68.  Exocrine pancreas PY4.2

    Pancreatic secretion

    Further readings

69.  Functions of the liver PY4.7

    Physiological anatomy of the liver

    Hepatic vascular and lymph systems

    Metabolic functions of the liver

    Bile secretion by the liver PY4.2

    Measurement of bilirubin in the bile as a clinical diagnostic tool

    Liver function tests PY4.8

    Further readings

70.  Digestion and absorption of carbohydrates PY4.4

    General principles of digestion PY4.4

    Digestion of the various foods by hydrolysis

    Basic principles of gastrointestinal absorption

    Absorption in the small intestine

    Further readings

71.  Digestion and absorption of proteins PY4.4

    Hydrolysis of proteins

    Basic principles of gastrointestinal absorption

    Further readings

72.  Digestion and absorption of fats PY4.4

    Digestion of the various foods by hydrolysis

    Absorption in the small intestine

    Steatorrhea

    Further readings

73.  Functions of the small and large intestine PY4.2

    Secretions of the small intestine PY4.2

    Secretion of mucus by the large intestine PY4.2

    Absorption in the large intestine: Formation of feces PY4.3, 4.4

    Further readings

74.  Gastrointestinal motility PY4.3

    Functional movements in the gastrointestinal tract PY4.3

    Ingestion of food

    Motor functions of the stomach

    Migrating motor complex

    Movements of the small intestine

    Movements of the colon

    Other autonomic reflexes that affect bowel activity

    Further readings

75.  Physiology of gastrointestinal diseases PY4.9

    Disorders of swallowing and the esophagus

    Disorders of the stomach

    Disorders of the small intestine

    Disorders of the large intestine

    General disorders of the gastrointestinal tract

    Further readings

SECTION VII. Renal Physiology

76.  Functional anatomy of the kidney

    Multiple functions of the kidneys PY7.1

    Physiological anatomy of the kidneys

    Further readings

77.  Urine formation by the kidneys: Renal blood flow, glomerular filtration, and their control

    General principles: Urine formation results from glomerular filtration, tubular reabsorption, and tubular secretion PY7.1

    Renal blood flow

    Autoregulation of GFR and renal 
blood flow

    Glomerular filtration—the first 
step in urine formation PY7.2

    Use of clearance methods to measure glomerular filtration rate (GFR) and renal blood flow (RBF) PY7.4

    Determinants of the GFR

    Physiological control of glomerular filtration and renal blood flow PY7.5

    Further readings

78.  Tubular function

    Renal tubular reabsorption and secretion PY7.3

    Glomerulotubular balance

    Tubular reabsorption includes passive and active mechanisms

    Further readings

79.  Concentration and dilution of urine

    Antidiuretic hormone controls urine concentration PY7.3

    Kidneys conserve water by excreting concentrated urine

    Quantifying renal urine concentration and dilution: “free water” and osmolar clearances

    Disorders of urinary concentrating ability

    Further readings

80.  Control of extracellular fluid osmolarity and sodium concentration PY7.5

    Osmoreceptor–ADH feedback system

    Importance of thirst in controlling extracellular fluid osmolarity and sodium concentration

    Salt-appetite mechanism for controlling extracellular fluid sodium concentration and volume

    Further readings

81.  Renal regulation of potassium, calcium, phosphate, and magnesium

    Regulation of extracellular fluid potassium concentration and 
potassium excretion PY7.5

    Control of renal calcium excretion and extracellular calcium ion concentration

    Control of renal magnesium excretion and extracellular magnesium ion concentration

    Further readings

82.  Acid–base regulation PY1.7, PY7.5

    H+ concentration is precisely regulated

    Acids and bases—their definitions and meanings

    Defending against changes in H+ concentration: Buffers, lungs, and kidneys

    Buffering of H+ in the body fluids

    Bicarbonate buffer system

    Phosphate buffer system

    Proteins are important intracellular buffers

    Respiratory regulation of acid–base balance

    Renal control of acid–base balance

    Secretion of H+ and reabsorption of HCO3− by the renal tubules

    Combination of excess H+ with phosphate and ammonia buffers in the tubule generates “new” HCO3−

    Regulation of renal tubular H+ secretion

    Renal correction of acidosis—increased excretion of H+ and addition of HCO3− to the extracellular fluid

    Renal correction of alkalosis—decreased tubular secretion of H+ and increased excretion of HCO3−

    Clinical causes of acid–base disorders

    Treatment of acidosis or alkalosis

    Clinical measurements and analysis of acid–base disorders

    Further readings

83.  Micturition

    Physiological anatomy of the bladder PY7.6

    Transport of urine from the kidney through the ureters and into the bladder

    Filling of the bladder and bladder wall tone; the cystometrogram PY7.9

    Micturition reflex

    Abnormalities of micturition

    Further readings

84.  Applied physiology of the renal system

    Renal function tests PY7.8

    Concentration and dilution tests of renal function

    Diuretics and their mechanisms of action

    Kidney diseases

    Acute kidney injury

    Chronic kidney disease is often associated with irreversible loss of functional nephrons

    Specific tubular disorders

    Treatment of renal failure by transplantation or by dialysis with an artificial kidney PY7.7

    Further readings

SECTION VIII. The Endocrine System

85.  Organization of the endocrine system

    Definition of a hormone

    Coordination of body functions by chemical messengers PY1.3, py8.2

    Feedback control of hormone secretion

    Further readings

86.  Hormone–receptor interactions

    Chemical structure and 
synthesis of hormones PY1.3, 8.6

    Hormone secretion, transport, and clearance from the blood

    Mechanisms of action of hormones

    Measurement of hormone concentrations in the blood

    Further readings

87.  Anterior pituitary gland and hypothalamus PY8.2

    Pituitary gland and its relation to the hypothalamus

    Hypothalamus controls pituitary secretion

    Physiological functions of growth hormone

    Further readings

88.  Posterior pituitary gland PY8.2

    Posterior pituitary hormones are synthesized by cell bodies in the hypothalamus

    Posterior pituitary gland and its relation to the hypothalamus

    Disorders of posterior pituitary hormone secretions

    Further readings

89.  Thyroid gland, thymus and pineal gland PY8.2, 8.3

    Synthesis and secretion of the thyroid metabolic hormones

    Metabolism and excretion of the thyroid hormones

    Physiological functions of the thyroid hormones

    Regulation of thyroid hormone secretion

    Diseases of the thyroid

    Endocrine functions of the thymus gland PY8.3

    Pineal gland PY8.3

    Further readings

90.  Calcium homeostasis PY8.1

    Physiological effects of calcium

    Outline of calcium metabolism PY8.1

    Mechanism of bone calcification

    Parathyroid hormone

    Vitamin D

    Calcitonin

    Summary of control of calcium ion concentration

    Pathophysiology of parathyroid hormone, vitamin D, and bone disease

    Further readings

91.  Adrenal cortex PY8.2, 8.4

    Anatomy of the adrenal glands

    Corticosteroids: Mineralocorticoids, glucocorticoids, and androgens

    Synthesis and secretion of adrenocortical hormones

    Functions of the mineralocorticoids—aldosterone

    Functions of glucocorticoids

    Adrenal androgens

    Abnormalities of adrenocortical secretion

    Further readings

92.  Adrenal medulla PY8.2, 8.4

    Special nature of the sympathetic nerve endings in the adrenal medullae

    Biosynthesis of epinephrine and norepinephrine, its removal, and its duration of action

    Factors that control the secretion of catecholamines from the adrenal medulla

    Adrenergic receptors—alpha and beta receptors

    Physiological effects of catecholamines

    Further readings

93.  Endocrine pancreas and glucose homeostasis

    Insulin and its metabolic effects PY8.2

    Glucagon and its functions

    Somatostatin inhibits glucagon and insulin secretion

    Summary of blood glucose regulation

    Diabetes mellitus

    Further readings

SECTION IX. Reproductive Physiology

94.  Physiological anatomy of the male sexual organs and spermatogenesis PY9.3

    Spermatogenesis PY9.9

    Further readings

95.  Testosterone and other male sex hormones

    Functions of testosterone PY9.7

    Basic intracellular mechanism of action of testosterone PY9.2

    Control of male sexual functions by hormones from the hypothalamus and anterior pituitary gland

    Abnormalities of male sexual function PY9.1

    Further readings

96.  Female physiology before pregnancy and female hormones

    Physiological anatomy of the female sexual organs PY9.2

    Oogenesis and follicular development in the ovaries

    Female hormonal system PY9.5

    Female monthly sexual cycle (menstrual cycle) PY9.4

    Regulation of the female monthly rhythm—interplay between the ovarian and hypothalamic–pituitary hormones

    Functions of the ovarian hormones—estradiol and progesterone

    Puberty and menarche

    Menopause PY9.11

    Rhythm method of contraception

    Hormonal suppression of fertility—”the pill” PY9.6

    Further readings

97.  The Sexual Act and fertilization

    Psychic element of male sexual stimulation

    Integration of the male Sexual Act in the spinal cord

    Stages of the male Sexual Act

    Erectile dysfunction in the male

    Female Sexual Act

    Fertilization PY9.8

    What determines the sex of the fetus that is created?

    Clinical approach to the infertile couple PY9.12

    Cryptorchidism

    Further readings

98.  Physiology of pregnancy PY9.8

    Entry of the ovum into the fallopian tube (uterine tube)

    Fertilization of the ovum

    Transport of the fertilized ovum in the fallopian tube

    Implantation of the blastocyst in the uterus

    Early nutrition of the embryo

    Anatomy and function of the placenta

    Hormonal factors in pregnancy

    Response of the mother’s body to pregnancy

    Further readings

99.  Parturition and lactation PY9.8

    Parturition

    Lactation

    Further readings

SECTION X. Central Nervous System

100.  Organization of the central nervous system PY10.1

    General design of the nervous system

    Major levels of central nervous system function

    Further readings

PART I. Sensory System

101.  Synapses

    Types of synapses—chemical and electrical

    Physiological anatomy of the synapse PY10.2

    Chemical substances that function as synaptic transmitters

    Electrical events during neuronal inhibition

    Some special characteristics of synaptic transmission (box 101.1)

    Further readings

102.  Sensory receptors PY10.2

    Types of sensory receptors and the stimuli they detect

    Transduction of sensory stimuli into nerve impulses

    Nerve fibers that transmit different types of signals and their physiological classification

    Transmission of signals of different intensity in nerve tracts—spatial and temporal summation

    Further readings

103.  Somatic sensory pathways PY10.2, 10.3

    Classification of somatic senses

    Detection and transmission of tactile sensations

    Sensory pathways for transmitting somatic signals into the central nervous system PY10.6

    Transmission in the dorsal column–medial lemniscal system

    Transmission of less critical sensory signals in the anterolateral pathway

    Some special aspects of somatosensory function

    Further readings

104.  Pain and temperature

    Types of pain and their qualities—fast pain and slow pain

    Pain receptors and their stimulation PY10.2

    Dual pathways for transmission of pain signals into the central nervous system

    Pain suppression (“analgesia”) system in the brain and spinal cord

    Referred pain

    Visceral pain

    Some clinical abnormalities of pain and other somatic sensations PY10.3, 10.6

    Thermal sensations

    Further readings

105.  Somatosensory cortex

    Somatosensory areas I and II PY10.3

    Layers of the somatosensory cortex and their function

    Functions of somatosensory area I PY10.6

    Somatosensory association areas

    Overall characteristics of signal transmission and analysis in the dorsal column–medial lemniscal–cortical system

    Further readings

PART II. Special Senses

106.  Taste and smell PY10.13, 10.14

    Sense of taste

    Sense of smell

    Further readings

107.  Hearing PY10.15, 10.16, 10.19

    Middle ear

    Cochlea

    Central auditory mechanisms

    Hearing abnormalities

    Tympanogram and tympanometry

    Auditory evoked potentials

    Further readings

108.  Optics of vision PY10.17

    Physical principles of optics

    Optics of the eye

    Fluid system of the eye—intraocular fluid

    Further readings

109.  The retina PY10.17

    Anatomy and function of the structural elements of the retina

    Photochemistry of vision

    Color vision

    Neural function of the retina

    Further readings

110.  Visual pathways and central processing PY10.18, 10.19

    Organization and function of the visual cortex

    Neuronal patterns of stimulation during analysis of the visual image

    Fields of vision; perimetry

    Eye movements and their control

    Autonomic control of accommodation and pupillary aperture

    Visual evoked potentials (VEP)

    Further readings

PART III. Motor System

111.  Introduction to the motor system: Spinal cord PY10.4

    Organization of the spinal cord for motor functions

    Autonomic reflexes in the spinal cord

    Spinal cord transection and spinal shock

    Hemisection of the cord

    Tabes dorsalis

    Syringomyelia

    Further readings

112.  Cortical and brainstem control of motor function: The pyramidal tract PY10.4

    Motor cortex and corticospinal (pyramidal) tract

    Further readings

113.  Muscle spindle

    Muscle sensory receptors—muscle spindles and golgi tendon organs—and their roles in muscle control PY10.4

    Further readings

114.  Motor reflexes PY10.4

    Reflexes

    Flexor reflex and the withdrawal reflexes

    Crossed extensor reflex

    Reciprocal inhibition and reciprocal innervation

    Spinal cord reflexes that cause muscle spasm

    Further readings

115.  Regulation of tone and posture PY10.4

    Support of the body against gravity—roles of the reticular and vestibular nuclei

    Postural and locomotive reflexes of the cord

    Further readings

116.  Cerebellum

    Cerebellum and its motor functions PY10.4, PY10.7

    Further readings

117.  Vestibular apparatus

    Maintenance of equilibrium PY10.4

    Functions of the vestibular system

    Detection of head rotation by the semicircular ducts

    Vestibular mechanisms for stabilizing the eyes

    Tests for vestibular function

    Further readings

118.  Basal ganglia

    Neuronal circuitry of the basal ganglia

    Function of the basal ganglia in executing patterns of motor activity—the putamen circuit PY10.4, PY10.7

    Role of the basal ganglia for cognitive control of sequences of motor patterns—the caudate circuit

    Function of the basal ganglia to change the timing and to scale the intensity of movements

    Functions of specific neurotransmitter substances in the basal ganglial system

    Summary of integrated functions of the basal ganglia

    Clinical syndromes resulting from damage to the basal ganglia

    Further readings

PART IV. Other Functions and Activities of the Brain

119.  The autonomic nervous system

    General organization of the autonomic nervous system PY10.5

    Basic characteristics of sympathetic and parasympathetic function

    Stimulation of discrete organs in some instances and “mass stimulation” in other instances by the sympathetic and parasympathetic systems

    Pharmacology of the autonomic nervous system

    Disorders of the autonomic nervous systems

    Further readings

120.  Functions of the hypothalamus PY10.7

    Vegetative and endocrine control functions of the hypothalamus

    Further readings

121.  Cerebrospinal fluid

    Cushioning function of the cerebrospinal fluid

    Formation, flow, and absorption of cerebrospinal fluid

    Cerebrospinal fluid pressure

    Obstruction to flow of cerebrospinal fluid can cause hydrocephalus

    Blood–cerebrospinal fluid and blood–brain barriers

    Brain edema

    Lumbar puncture

    Further readings

122.  Electroencephalography, epilepsy and meditation PY10.12, 11.12

    Electroencephalography

    Seizures and epilepsy

    Meditation

    Further readings

123.  Sleep, coma and brain death PY11.11

    Two types of sleep—slow-wave sleep and rapid eye movement sleep

    Basic theories of sleep

    Sleep has important physiological functions

    Disorders of sleep

    Coma and brain death

    Further readings

124.  The limbic system and behavior PY10.10

    Activating—driving systems of the brain

    Limbic system PY10.7

    Functional anatomy of the limbic system

    Specific functions of other parts of the limbic system

    Depression and manic–depressive psychoses—decreased activity of the norepinephrine and serotonin neurotransmitter systems

    Schizophrenia—possible exaggerated function of part of the dopamine system

    Further readings

125.  Learning and memory PY10.9

    Learning

    Thoughts, consciousness, and memory

    Alzheimer disease—amyloid plaques and depressed memory

    Further readings

126.  Cortical function, cerebral lateralization, and speech

    Physiological anatomy of the cerebral cortex

    Functions of specific cortical areas

    Function of the brain in communication—language input and language output PY10.9

    Function of the corpus callosum and anterior commissure to transfer thoughts, memories, training, and other information between the two cerebral hemispheres

    Further readings

SECTION XI. Integrative Physiology

127.  Components of energy expenditure

    Components of 24-hour energy expenditure

    Metabolic rate and its measurement

    Further readings

128.  Body temperature regulation and cutaneous circulation

    Normal body temperatures

    Body temperature is controlled by balancing heat production and heat loss PY11.1

    Cutaneous circulation

    Sweating and its regulation by the autonomic nervous system

    Other mechanisms of heat loss in lower animals—panting

    Regulation of body temperature—role of the hypothalamus

    Behavioral control of body temperature PY11.2

    Abnormalities of body temperature regulation PY11.3

    Further readings

129.  Physiology of starvation and obesity PY11.5

    Starvation

    Obesity

    Further readings

130.  Physiology of physical activity and inactivity PY11.5

    Physical activity during the day occurs across multiple domains

    Physical activity increases energy expenditure

    Physical activity has health benefits

    Models of physical inactivity in humans

    Consequences of physical inactivity

    Sedentary behavior such as prolonged sitting can offset some of the gains of physical activity and exercise with regard to health

    Further readings

131.  Physiological responses to exercise in extreme heat and cold

    Cardiovascular changes during acute exercise PY11.8

    Respiratory changes during acute exercise

    Increase in muscle temperature (Tm) within physiological limits increases muscle performance

    Regulation of cardiovascular and respiratory function during acute exercise

    Exercise under conditions of heat stress

    Exercise under conditions of extreme cold

    Further readings

132.  Physiology of stress PY8.5

    A current understanding of the stress system

    Further readings

133.  Transition from fetus to newborn, 
and infancy PY11.6

    Cardiovascular and circulatory changes

    The body fluids and the renal system

    Blood cells and immunity

    Respiratory system

    Central nervous system

    Gastrointestinal tract

    Thermal adaptation

    Physiology of growth: Hormones and related factors

    Further readings

134.  Physiological changes with aging PY11.7

    Definition of aging

    Chronological and biological aging

    Theories of aging

    System-wise changes that occur with aging

    Further readings

Index