• Cover
• Note to Instructors
• Guyton and Hall Textbook of Medical Physiology
• Copyright
• Dedication
• Preface
• 1 - Functional Organization of the Human Body and Control of the “Internal Environment”
• 2 - The Cell and Its Functions
• 3 - Genetic Control of Protein Synthesis, Cell Function, and Cell Reproduction
• 4 - Transport of Substances Through Cell Membranes
• 5 - Membrane Potentials and Action Potentials
  • Basic Physics of Membrane Potentials
    • Membrane Potentials Caused by Ion Concentration Differences Across a Selectively Permeable Membrane
      • The Nernst Equation Describes the Relationship of Diffusion Potential to the Ion Concentration Difference Across a Membrane. The...
        • The Goldman Equation Is Used to Calculate the Diffusion Potential When the Membrane Is Permeable to Several Different Ions. When...
      • Measuring the Membrane Potential
  • Resting Membrane Potential of Neurons
    • Active Transport of Sodium and Potassium Ions Through the Membrane—the Sodium-­Potassium (Na+-­K+) Pump. Recall from Chapter 4 t...
      • Origin of the Normal Resting Membrane Potential
        • Contribution of the Potassium Diffusion Potential. In Figure 5-­5A, we assume that the only movement of ions through the membran...
        • Contribution of Sodium Diffusion Through the Nerve Membrane. Figure 5-­5B shows the addition of slight permeability of the nerve...
        • Contribution of the Na+-­K+ Pump. In Figure 5-­5C, the Na+-­K+ pump is shown to provide an additional contribution to the restin...
  • Neuron Action Potential
    • Resting Stage. The resting stage is the resting membrane potential before the action potential begins. The membrane is said to b...
      • Depolarization Stage. At this time, the membrane suddenly becomes permeable to sodium ions, allowing rapid diffusion of positive...
        • Repolarization Stage. Within a few 10,000ths of a second after the membrane becomes highly permeable to sodium ions, the sodium ...
      • Activation and Inactivation of the Voltage-­Gated Sodium Channel
        • Activation of the Sodium Channel. When the membrane potential becomes less negative than during the resting state, rising from −...
        • Inactivation of the Sodium Channel. The upper right panel of Figure 5-­7 shows a third state of the sodium channel. The same inc...
      • Voltage-­Gated Potassium Channel and Its Activation
    • Initiation of the Action Potential
      • A Positive-­Feedback Cycle Opens the Sodium Channels. As long as the membrane of the nerve fiber remains undisturbed, no action ...
        • Initiation of the Action Potential Occurs Only After the Threshold Potential is Reached. An action potential will not occur unti...
  • Propagation of the Action Potential
    • Direction of Propagation. As demonstrated in Figure 5-­11, an excitable membrane has no single direction of propagation, but the...
  • Plateau in Some Action Potentials
  • Rhythmicity of Some Excitable Tissues—Repetitive Discharge
  • Special Characteristics of Signal Transmission in Nerve Trunks
    • Myelinated and Unmyelinated Nerve Fibers. Figure 5-­15 shows a cross section of a typical small nerve, revealing many large nerv...
      • Saltatory Conduction in Myelinated Fibers from Node to Node. Even though almost no ions can flow through the thick myelin sheath...
        • Velocity of Conduction in Nerve Fibers. The velocity of action potential conduction in nerve fibers varies from as little as 0.2...
  • Excitation—The Process of Eliciting the Action Potential
    • Threshold for Excitation and Acute Local Potentials. A weak negative electrical stimulus may not be able to excite a fiber. Howe...
      • Inhibition of Excitability—Stabilizers and Local Anesthetics
      • In contrast to the factors that increase nerve excitability, membrane-­stabilizing factors can decrease excitability. For exampl...
• 6 - Contraction of Skeletal Muscle
• 7 - Excitation of Skeletal Muscle: Neuromuscular Transmission and Excitation-­Contraction Coupling
  • Neuromuscular Junction and Transmission of Impulses from Nerve Endings to Skeletal Muscle Fibers
    • Acetylcholine Opens Ion Channels on Postsynaptic Membranes. Figure 7-2 also shows many small acetylcholine receptors and voltage...
      • Destruction of the Released Acetylcholine by Acetylcholinesterase. The acetylcholine, once released into the synaptic space, con...
        • End Plate Potential and Excitation of the Skeletal Muscle Fiber. The sudden insurgence of sodium ions into the muscle fiber when...
        • Safety Factor for Transmission at the Neuromuscular Junction—Fatigue of the Junction. Ordinarily, each impulse that arrives at t...
  • Muscle Action Potential
  • Excitation-­Contraction Coupling
    • Transverse Tubule–Sarcoplasmic Reticulum System
      • Release of Calcium Ions by the Sarcoplasmic Reticulum
        • Calcium Pump Removes Calcium Ions from the ­Myofibrillar Fluid After Contraction Occurs. Once the calcium ions have been release...
        • Excitatory Pulse of Calcium Ions. The normal resting state concentration (<10−7 molar) of calcium ions in the cytosol that bathe...
• 8 - Excitation and Contraction of Smooth Muscle
  • Contraction of Smooth Muscle
    • Types of Smooth Muscle
      • Multi-­Unit Smooth Muscle. Multi-­unit smooth muscle is composed of discrete, separate, smooth muscle fibers. Each fiber operate...
        • Unitary Smooth Muscle. Unitary smooth muscle is also called syncytial smooth muscle or visceral smooth muscle. The term unitary ...
  • Contractile Mechanism in Smooth Muscle
    • Chemical Basis for Smooth Muscle Contraction
      • Physical Basis for Smooth Muscle Contraction
      • Comparison of Smooth Muscle Contraction and Skeletal Muscle Contraction
        • Slow Cycling of the Myosin Cross-­Bridges. The rapidity of cycling of the myosin cross-­bridges in smooth muscle—that is, their ...
        • Low Energy Requirement to Sustain Smooth Muscle Contraction. Only 1/10 to 1/300 as much energy is required to sustain the same t...
        • Slowness of Onset of Contraction and Relaxation of the Total Smooth Muscle Tissue. A typical smooth muscle tissue begins to cont...
        • Maximum Force of Contraction Is Often Greater in Smooth Muscle Than in Skeletal Muscle. Despite the relatively few myosin filame...
        • Latch Mechanism Facilitates Prolonged Holding of Contractions of Smooth Muscle. Once smooth muscle has developed full contractio...
        • Stress-­Relaxation of Smooth Muscle. Another important characteristic of smooth muscle, especially the visceral unitary type of ...
  • Regulation of Contraction by Calcium Ions
    • Calcium Ions Combine with Calmodulin to Cause Activation of Myosin Kinase and Phosphorylation of the Myosin Head. In place of tr...
      • Source of Calcium Ions That Cause Contraction
        • Role of the Smooth Muscle Sarcoplasmic Reticulum. Figure 8-4 shows a few slightly developed sarcoplasmic tubules that lie near t...
        • Smooth Muscle Contraction Is Dependent on Extracellular Calcium Ion Concentration. Whereas changing the extracellular fluid calc...
        • A Calcium Pump Is Required to Cause Smooth Muscle Relaxation. To cause relaxation of smooth muscle after it has contracted, the ...
        • Myosin Phosphatase Is Important in Cessation of Contraction. Relaxation of the smooth muscle occurs when the calcium channels cl...
        • Possible Mechanism for Regulating the Latch Phenomenon. Because of the importance of the latch phenomenon in smooth muscle, and ...
  • Nervous and Hormonal Control of Smooth Muscle Contraction
  • Neuromuscular Junctions of Smooth Muscle
    • Physiologic Anatomy of Smooth Muscle Neuromuscular Junctions. Neuromuscular junctions of the highly structured type found on ske...
  • Membrane Potentials and Action Potentials in Smooth Muscle
    • Membrane Potentials in Smooth Muscle. The quantitative voltage of the membrane potential of smooth muscle depends on the momenta...
      • Action Potentials in Unitary Smooth Muscle. Action potentials occur in unitary smooth muscle (e.g., visceral muscle) in the same...
        • Spike Potentials. Typical spike action potentials, such as those seen in skeletal muscle, occur in most types of unitary smooth ...
        • Action Potentials with Plateaus. Figure 8-7C shows a smooth muscle action potential with a plateau. The onset of this action pot...
        • Calcium Channels Are Important in Generating the Smooth Muscle Action Potential. The smooth muscle cell membrane has far more vo...
        • Slow Wave Potentials in Unitary Smooth Muscle Can Lead to Spontaneous Generation of Action Potentials. Some smooth muscle is sel...
        • Excitation of Visceral Smooth Muscle by Muscle Stretch. When visceral (unitary) smooth muscle is stretched sufficiently, spontan...
      • Local Tissue Factors and Hormones Can Cause Smooth Muscle Contraction Without Action Potentials
        • Smooth Muscle Contraction in Response to Local Tissue Chemical Factors. In Chapter 17, we discuss control of contraction of the ...
        • Effects of Hormones on Smooth Muscle Contraction. Many circulating hormones in the blood affect smooth muscle contraction to som...
        • Mechanisms of Smooth Muscle Excitation or Inhibition by Hormones or Local Tissue Factors. Some hormone receptors in the smooth m...
• 9 - Cardiac Muscle; The Heart as a Pump and Function of the Heart Valves
  • Physiology of Cardiac Muscle
    • Cardiac Muscle Anatomy
  • Cardiac Cycle
    • Diastole and Systole
      • Relationship of the Electrocardiogram to the Cardiac Cycle
      • The Atria Function as Primer Pumps for the Ventricles
  • Function of The Ventricles as Pumps
    • The Ventricles Fill with Blood During Diastole. During ventricular systole, large amounts of blood accumulate in the right and l...
      • Period of Ejection. When the left ventricular pressure rises slightly above 80 mm Hg (and the right ventricular pressure rises s...
        • Period of Isovolumic (Isometric) Relaxation. At the end of systole, ventricular relaxation begins suddenly, allowing both the ri...
        • End-­Diastolic Volume, End-­Systolic Volume, and Stroke Volume Output. During diastole, normal filling of the ventricles increas...
  • The Heart Valves Prevent Backflow of Blood During Systole
    • Atrioventricular Valves. The A-­V valves (i.e., the tricuspid and mitral valves) prevent backflow of blood from the ventricles t...
    • Aortic Pressure Curve
      • Volume-­Pressure Diagram During the Cardiac Cycle; Cardiac Work Output. The red lines in Figure 9-­10 form a loop called the vol...
        • Concepts of Preload and Afterload. In assessing the contractile properties of muscle, it is important to specify the degree of t...
  • Regulation of Heart Pumping
    • What Is the Explanation of the Frank-­Starling Mechanism When an extra amount of blood flows into the ventricles, the cardiac mu...
      • Ventricular Function Curves
      • Control of the Heart by the Sympathetic and Parasympathetic Nerves
• 10 - Rhythmical Excitation of the Heart
  • Specialized Excitatory and Conductive System of the Heart
    • Sinus (Sinoatrial) Node
      • Mechanism of Sinus Nodal Rhythmicity. Figure 10-­2 shows action potentials recorded from inside a sinus nodal fiber for three he...
        • Leakiness of Sinus Nodal Fibers to Sodium and Calcium Causes Self-­Excitation. Because of the high sodium ion concentration in t...
        • Cause of the Slow Conduction. The slow conduction in the transitional, nodal, and penetrating A-­V bundle fibers is caused mainl...
        • The A-­V Bundle Is Normally a One-­Way Conduction Path. A special characteristic of the A-­V bundle is the inability, except in ...
        • Distribution of the Purkinje Fibers in the Ventricles—Left and Right Bundle Branches. After penetrating the fibrous tissue betwe...
    • The Sinus Node is the Normal Pacemaker of the Heart
      • Abnormal Pacemakers—Ectopic Pacemaker. Occasio­nally, some other part of the heart develops a rhythmical discharge rate that is ...
        • Parasympathetic (Vagal) Stimulation Slows the Cardiac Rhythm and Conduction. Stimulation of the parasympathetic nerves to the he...
        • Mechanism of the Vagal Effects. The acetylcholine released at the vagal nerve endings greatly increases the permeability of the ...
        • Sympathetic Stimulation Increases the Cardiac Rhythm and Conduction. Sympathetic stimulation causes essentially the opposite eff...
        • Mechanism of the Sympathetic Effect. Stimulation of the sympathetic nerves releases norepinephrine at the sympathetic nerve endi...
• 11 - Fundamentals of Electrocardiography
  • Waveforms of the Normal Electrocardiogram
    • Relation of the Monophasic Action Potential of Ventricular Muscle to the QRS and T Waves in the Standard Electrocardiogram. The ...
      • Normal Voltages in the Electrocardiogram. The recorded voltages of the waves in the normal ECG depend on the manner in which the...
        • P-­Q or P-­R Interval. The time between the beginning of the P wave and the beginning of the QRS complex is the interval between...
        • Q-­T Interval. Contraction of the ventricle lasts almost from the beginning of the Q wave (or R wave, if the Q wave is absent) t...
        • Heart Rate as Determined from the Electrocardiogram. The rate of the heartbeat can be determined easily from an ECG because the ...
      • Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle
      • Flow of Electrical Currents in the Chest Around the Heart
  • Electrocardiographic Leads
    • Three Standard Bipolar Limb Leads
      • Lead I. In recording limb lead I, the negative terminal of the electrocardiograph is connected to the right arm, and the positiv...
        • Lead II. To record limb lead II, the negative terminal of the electrocardiograph is connected to the right arm and the positive ...
        • Lead III. To record limb lead III, the negative terminal of the electrocardiograph is connected to the left arm, and the positiv...
        • Einthoven’s Triangle. In Figure 11-­6, the triangle, called Einthoven’s triangle, is drawn around the area of the heart. This tr...
        • Einthoven’s Law. Einthoven’s law states that if the ECGs are recorded simultaneously with the three limb leads, the sum of the p...
        • Normal Electrocardiograms Recorded from the Three Standard Bipolar Limb Leads. Figure 11-­7 shows recordings of the ECGs in lead...
      • Precordial Leads
      • Augmented Limb Leads
• 12 - Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis
• 13 - Cardiac Arrhythmias and Their Electrocardiographic Interpretation
  • Abnormal Sinus Rhythms
    • Tachycardia
    • Bradycardia
      • Bradycardia in Athletes. The well-­trained athlete’s heart is often larger and considerably stronger than that of a normal perso...
        • Vagal Stimulation Causes Bradycardia. Any circulatory reflex that stimulates the vagus nerves causes release of acetylcholine at...
    • Sinus Arrhythmia
  • Heart Block Within the Intracardiac Conduction Pathways
    • Sinoatrial Block
    • Atrioventricular Block
  • Incomplete Atrioventricular Block
    • First-­Degree Block—Prolonged P-­R Interval. The usual lapse of time between the beginning of the P wave and the beginning of th...
      • Second-­Degree Block. When conduction through the A-­V bundle is slowed enough to increase the P-­R interval to 0.25 to 0.45 sec...
        • Complete A-­V Block (Third-­Degree Block). When the condition causing poor conduction in the A-­V node or A-­V bundle becomes se...
        • Stokes-­Adams Syndrome—Ventricular Escape. In some patients with A-­V block, the total block comes and goes; that is, impulses a...
  • Premature Contractions
    • Causes of Premature Contractions
    • Premature Atrial Contractions
      • Pulse Deficit. When the heart contracts ahead of schedule, the ventricles will not have filled with blood normally, and the stro...
        • Vector Analysis of the Origin of an Ectopic Premature Ventricular Contraction. In Chapter 12, the principles of vectorial analys...
        • Disorders of Cardiac Repolarization—the Long QT Syndromes. Recall that the Q wave corresponds to ventricular depolarization, whe...
  • Paroxysmal Tachycardia
    • Paroxysmal Atrial Tachycardia
    • Ventricular Tachycardia
  • Ventricular Fibrillation
    • Ventricular Defibrillation
  • Atrial Fibrillation
  • Atrial Flutter
  • Cardiac Arrest
• 14 - Overview of the Circulation: Pressure, Flow, and Resistance
  • Physical Characteristics of the Circulation
    • Functional Parts of the Circulation. Before discussing the details of circulatory function, it is important to understand the ro...
      • Volumes of Blood in the Different Parts of the Circulation. Figure 14-1 provides an overview of the circulation and lists the pe...
        • Cross-­Sectional Areas and Velocities of Blood Flow. If all the systemic vessels of each type were put side by side, their appro...
        • Pressures in the Various Portions of the Circulation. Because the heart pumps blood continually into the aorta, the mean pressur...
  • Basic Principles of Circulatory Function
  • Interrelationships of Pressure, Flow, and Resistance
    • Blood Flow
      • Methods for Measuring Blood Flow. Many mechanical and mechanoelectrical flowmeter devices can be inserted in series with a blood...
        • Electromagnetic Flowmeter. An electromagnetic flowmeter, the principles of which are illustrated in Figure 14-4, can be used to ...
        • Ultrasonic Doppler Flowmeter. Another type of flowmeter that can be applied to the outside of the vessel and that has many of th...
        • Laminar Flow of Blood in Vessels. When blood flows at a steady rate through a long smooth blood vessel, it flows in streamlines,...
        • Parabolic Velocity Profile During Laminar Flow. When laminar flow occurs, the velocity of flow in the center of the vessel is fa...
        • Turbulent Flow of Blood Under Some Conditions. When the rate of blood flow becomes too great, when it passes by an obstruction i...
  • Blood Pressure
  • Resistance to Blood Flow
    • Units of Resistance. Resistance is the impediment to blood flow in a vessel, but it cannot be measured by any direct means. Inst...
      • Expression of Resistance in CGS Units. Occasionally, a basic physical unit called the CGS (centimeters, grams, seconds) unit is ...
        • Total Peripheral Vascular Resistance and Total Pulmonary Vascular Resistance. The rate of blood flow through the entire circulat...
        • Conductance of Blood in a Vessel Is the Reciprocal of Resistance. Conductance is a measure of the blood flow through a vessel fo...
        • Small Changes in Vessel Diameter Markedly Change Its Conductance. Slight changes in the diameter of a vessel cause tremendous ch...
        • Poiseuille’s Law. The cause of this great increase in conductance when the diameter increases can be explained by referring to F...
        • Importance of the Vessel Diameter Fourth Power Law in Determining Arteriolar Resistance. In the systemic circulation, about two ...
        • Resistance to Blood Flow in Series and Parallel Vascular Circuits. Blood pumped by the heart flows from the high-­pressure part ...
      • Effect of Blood Hematocrit and Blood Viscosity on Vascular Resistance and Blood Flow
        • Hematocrit—the Proportion of Blood That Is Red Blood Cells. If a person has a hematocrit of 40, this means that 40% of the blood...
        • Increasing Hematocrit Markedly Increases Blood Viscosity. The viscosity of blood increases markedly as the hematocrit increases,...
  • Effects of Pressure on Vascular Resistance and Tissue Blood Flow
    • Autoregulation Attenuates the Effect of Arterial Pressure on Tissue Blood Flow. From the discussion thus far, one might expect a...
      • Pressure-­Flow Relationship in Passive Vascular Beds. In isolated blood vessels or in tissues that do not exhibit autoregulation...
        • Vascular Wall Tension. Tension on the blood vessel wall develops in response to transmural pressure gradients and causes vascula...
        • Vascular Shear Stress. As blood flows it creates a frictional force, or drag, on the endothelial cells lining the blood vessels ...
• 15 - Vascular Distensibility and Functions of the Arterial and Venous Systems
  • Vascular Distensibility
    • Units of Vascular Distensibility. Vascular distensibility normally is expressed as the fractional increase in volume for each mi...
      • The Veins Are Much More Distensible Than the Arteries. The walls of the arteries are thicker and far stronger than those of the ...
        • Effect of Sympathetic Stimulation or Sympathetic Inhibition on the Volume-­Pressure Relationships of the Arterial and Venous Sys...
        • Delayed Compliance (Stress-­Relaxation) of Vessels. The term delayed compliance means that a vessel exposed to increased volume ...
  • Arterial Pressure Pulsations
    • Abnormal Pressure Pulse Contours
      • Pressure Pulses Are Damped in the Smaller Arteries, Arterioles, and Capillaries. Figure 15-6 shows typical changes in the pressu...
        • Auscultatory Method. Figure 15-7 shows the auscultatory method for determining systolic and diastolic arterial pressures. A stet...
        • Automated Oscillometric Method. Systolic and diastolic arterial pressures are often measured using automated oscillometric devic...
        • Normal Arterial Pressures as Measured by the Auscultatory and Oscillatory Methods. Figure 15-8 shows the approximate normal syst...
        • Mean Arterial Pressure. The mean arterial pressure is the average of the arterial pressures measured millisecond by millisecond ...
  • Veins and Their Functions
    • Venous Resistance and Peripheral Venous Pressure
      • Effect of High Right Atrial Pressure on Peripheral Venous Pressure. When the right atrial pressure rises above its normal value ...
        • Effect of Intra-­abdominal Pressure on Venous Pressures of the Leg. The pressure in the abdominal cavity of a recumbent person n...
      • Effect of Gravitational Pressure on Venous Pressure
        • Effect of the Gravitational Factor on Arterial and Other Pressures. The gravitational factor also affects pressures in the perip...
      • Venous Valves and the Venous Pump: Their Effects on Venous Pressure
        • Venous Valve Incompetence Causes Varicose Veins. The valves of the venous system may become incompetent or even be destroyed whe...
    • Specific Blood Reservoirs
      • Blood-­Cleansing Function of the Spleen—Removal of Old Cells Blood cells passing through the splenic pulp before entering the si...
        • Reticuloendothelial Cells of the Spleen. The pulp of the spleen contains many large phagocytic reticuloendothelial cells, and th...
• 16 - The Microcirculation and Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph Flow
  • Structure of the Microcirculation and Capillary System
    • Structure of the Capillary Wall. Figure 16-­2 shows the ultramicroscopic structure of typical endothelial cells in the capillary...
      • Pores in the Capillary Membrane. Figure 16-­2 shows two small passageways connecting the interior of the capillary with the exte...
        • Special Types of Pores in Capillaries of Certain Organs. The pores in capillaries of some organs have special characteristics to...
  • Flow of Blood in the Capillaries—Vasomotion
    • Regulation of Vasomotion. The most important factor affecting the degree of opening and closing of the metarterioles and precapi...
      • Average Function of the Capillary System. Despite the fact that blood flow through each capillary is intermittent, so many capil...
        • Diffusion Through the Capillary Membrane Is the Most ­Important Means of Transferring Substances ­Between Plasma and Interstitia...
        • Lipid-­Soluble Substances Diffuse Directly Through the Cell Membranes of the Capillary Endothelium. If a substance is lipid-­sol...
        • Water-­Soluble, Non–Lipid-­Soluble Substances ­Diffuse Through Intercellular Pores in the Capillary ­Membrane. Many substances n...
        • Effect of Molecular Size on Passage Through the Pores. The width of the capillary intercellular cleft pores, 6 to 7 nanometers, ...
        • Diffusion Through the Capillary Membrane Is Proportional to the Concentration Difference Between the Two Sides of the Membrane. ...
  • Interstitium and Interstitial Fluid
    • Gel in the Interstitium. The fluid in the interstitium is derived by filtration and diffusion from the capillaries. It contains ...
  • Fluid Filtration Across Capillaries
    • Capillary Hydrostatic Pressure
      • Interstitial Fluid Pressures in Tightly Encased ­Tissues. Some tissues of the body are surrounded by tight encasements, such as ...
        • Summary: Interstitial Fluid Pressure in Loose Subcutaneous Tissue Usually Subatmospheric. Although the aforementioned different ...
        • Pumping by the Lymphatic System—Basic Cause of the Negative Interstitial Fluid Pressure. The lymphatic system is discussed later...
  • Plasma Colloid Osmotic Pressure
    • Plasma Proteins Cause Colloid Osmotic Pressure. As discussed in Chapter 4, only the molecules or ions that fail to pass through ...
      • Normal Values for Plasma Colloid Osmotic Pressure. The colloid osmotic pressure of normal human plasma averages about 28 mm Hg; ...
        • Analysis of the Forces Causing Filtration at the ­Arterial End of the Capillary. The approximate average forces operative at the...
        • Analysis of Reabsorption at the Venous End of the Capillary. The low blood pressure at the venous end of the capillary changes t...
    • Capillary Filtration Coefficient
  • Lymphatic System
    • Lymph Channels of the Body
    • Formation of Lymph
    • Rate of Lymph Flow
      • Effect of Interstitial Fluid Pressure on Lymph Flow. Figure 16-­8 shows the effect of different levels of interstitial fluid hyd...
        • Lymphatic Pump Increases Lymph Flow. Valves exist in all lymph channels. Figure 16-­9 shows typical valves for collecting lympha...
        • Pumping Caused by External Intermittent Compression of the Lymphatics. In addition to the pumping caused by intrinsic intermitte...
        • Lymphatic Capillary Pump. The terminal lymphatic capillary is also capable of pumping lymph, in addition to the pumping by the l...
        • Summary of Factors That Determine Lymph Flow. From the previous discussion, one can see that the two primary factors that determ...
      • Lymphatic System Plays a Key Role in Controlling Interstitial Fluid Protein Concentration, Volume, and Pressure
      • Significance of Negative Interstitial Fluid Pressure for Holding Body Tissues Together
• 17 - Local and Humoral Control of Tissue Blood Flow
  • Local Control of Blood Flow in Response to Tissue Needs
    • Variations in Blood Flow in Different Tissues and ­Organs. Note the very large blood flows listed in Table 17-­1 for some organs...
  • Mechanisms of Blood Flow Control
  • Acute Control of Local Blood Flow
    • Increases in Tissue Metabolism Increase Tissue Blood Flow
      • Reduced Oxygen Availability Increases Tissue Blood Flow. One of the most necessary of the metabolic nutrients is oxygen. Wheneve...
        • Vasodilator Theory for Acute Local Blood Flow Regulation—Possible Special Role of Adenosine. According to the vasodilator theory...
        • Oxygen Demand Theory for Local Blood Flow ­Control. Although the vasodilator theory is widely accepted, several critical facts h...
        • Possible Role of Other Nutrients Besides Oxygen in Control of Local Blood Flow. Under special conditions, it has been shown that...
      • Special Examples of Acute Metabolic Control of Local Blood Flow
        • Reactive Hyperemia Occurs After Tissue Blood Supply Is Blocked for a Short Time. When the blood supply to a tissue is blocked fo...
        • Active Hyperemia Occurs When Tissue Metabolic Rate Increases. When a tissue becomes highly active, such as an exercising muscle,...
      • Autoregulation of Blood Flow During Changes in Arterial Pressure—Metabolic and Myogenic Mechanisms
      • Special Mechanisms for Acute Blood Flow Control in Specific Tissues
      • Control of Tissue Blood Flow: Endothelium-­Derived Relaxing or Constricting Factors
        • Nitric Oxide Is a Vasodilator Released from Healthy ­Endothelial Cells. The most important of the endothelium-­derived relaxing ...
        • Endothelin Is a Powerful Vasoconstrictor Released From Damaged Endothelium. Endothelial cells also release vasoconstrictor subst...
    • Long-­Term Blood Flow Regulation
      • Blood Flow Regulation by Changes in Tissue Vascularity
        • Role of Oxygen in Long-­Term Regulation. Oxygen is important not only for acute control of local blood flow but also for long-­t...
        • Importance of Vascular Growth Factors in Formation of New Blood Vessels. A dozen or more factors that increase growth of new blo...
        • Vascularity Determined by Maximum Blood Flow Need, Not by Average Need. An especially valuable characteristic of long-­term vasc...
      • Blood Flow Regulation by Development of Collateral Circulation
      • Vascular Remodeling in Response to Chronic Changes in Blood Flow or Blood Pressure
  • Humoral Control of the Circulation
  • VasoconstrictorS
    • Norepinephrine and Epinephrine. Norepinephrine is an especially powerful vasoconstrictor hormone; epinephrine is less powerful a...
      • Angiotensin II. Angiotensin II is another powerful vasoconstrictor substance. As little as one millionth of a gram can increase ...
        • Vasopressin. Vasopressin, also called antidiuretic hormone, is even more powerful than angiotensin II as a vasoconstrictor, thus...
  • Vasodilators
    • Bradykinin. Several substances called kinins cause powerful vasodilation when formed in the blood and tissue fluids of some orga...
      • Histamine. Histamine is released in almost every tissue of the body if the tissue becomes damaged or inflamed or is the subject ...
        • Most Vasodilators or Vasoconstrictors Have Little ­Effect on Long-­Term Blood Flow Unless They Alter the Metabolic Rate of the T...
• 18 - Nervous Regulation of the Circulation and Rapid Control of Arterial Pressure
  • Nervous Regulation of the Circulation
    • Autonomic Nervous System
      • Sympathetic Nervous System. Figure 18-­1 shows the anatomy of sympathetic nervous control of the circulation. Sympathetic vasomo...
        • Sympathetic Innervation of the Blood Vessels. Figure 18-­2 shows the distribution of sympathetic nerve fibers to the blood vesse...
        • Sympathetic Stimulation Increases Heart Rate and Contractility. Sympathetic fibers also go directly to the heart, as shown in Fi...
        • Parasympathetic Stimulation Decreases Heart Rate and Contractility. Although the parasympathetic nervous system is exceedingly i...
      • Sympathetic Vasoconstrictor System and Its Control by the Central Nervous System
        • Vasomotor Center in the Brain and Its Control of the Vasoconstrictor System. Located bilaterally mainly in the reticular substan...
        • Continuous Partial Constriction of Blood Vessels by Sympathetic Vasoconstrictor Tone. Under normal conditions, the vasoconstrict...
        • Control of Heart Activity by the Vasomotor Center. At the same time that the vasomotor center regulates the amount of vascular c...
        • Control of the Vasomotor Center by Higher ­Nervous Centers. Large numbers of small neurons located throughout the reticular subs...
        • Norepinephrine Is the Sympathetic Vasoconstrictor Neurotransmitter. The substance secreted at the ­endings of the vasoconstricto...
        • Adrenal Medullae and Their Relationship to the Sympathetic Vasoconstrictor System. Sympathetic impulses are transmitted to the a...
      • Role of the Nervous System in Rapid Control of Arterial Pressure
        • Nervous Control of Arterial Pressure Is Rapid. An especially important characteristic of nervous control of arterial pressure is...
    • Reflex Mechanisms for Maintaining Normal Arterial Pressure
      • Baroreceptor Arterial Pressure Control System—Baroreceptor Reflexes
        • Physiologic Anatomy of the Baroreceptors and Their Innervation. Baroreceptors are spray-­type nerve endings that lie in the wall...
        • Response of the Baroreceptors to Changes in Arterial Pressure. Figure 18-­6 shows the effects of different arterial pressure lev...
        • Circulatory Reflex Initiated by the Baroreceptors. After the baroreceptor signals have entered the nucleus tractus solitarius of...
        • Baroreceptors Attenuate Blood Pressure Changes During Changes in Body Posture. The ability of the baroreceptors to maintain rela...
        • Pressure Buffer Function of the Baroreceptor Control System. Because the baroreceptor system opposes increases or decreases in a...
        • Are the Baroreceptors Important in Long-­Term ­Regulation of Arterial Pressure Although the arterial baroreceptors provide power...
        • Control of Arterial Pressure by the Carotid and Aortic Chemoreceptors—Effect of Low Oxygen on Arterial Pressure. Closely associa...
        • Atrial and Pulmonary Artery Reflexes Regulate Arterial Pressure. The atria and pulmonary arteries have stretch receptors in thei...
        • Atrial Reflexes That Activate the Kidneys—The ­Volume Reflex. Stretch of the atria and activation of low-­pressure atrial recept...
        • Increased Atrial Pressure Raises Heart Rate—Bainbridge Reflex. Increases in atrial pressure sometimes increase the heart rate as...
        • Importance of CNS Ischemic Response as a Regulator of Arterial Pressure. Despite the powerful nature of the CNS ischemic respons...
        • Cushing Reaction to Increased Pressure Around the Brain. The Cushing reaction is a special type of CNS ischemic response that re...
    • Role of the Skeletal Nerves and ­Skeletal Muscles in ­Increasing ­Cardiac Output and Arterial Pressure
      • Abdominal Compression Reflex Increases Cardiac Output and Arterial Pressure. When a baroreceptor or chemoreceptor reflex is elic...
        • Skeletal Muscle Contraction Increases Cardiac ­Output and Arterial Pressure During Exercise. When the skeletal muscles contract ...
      • Arterial Pressure Vasomotor Waves—Oscillation of Pressure Reflex Control Systems
        • Oscillation of Baroreceptor and Chemoreceptor Reflexes. The vasomotor waves of Figure 18-­11B are often seen in experimental pre...
        • Oscillation of CNS Ischemic Response. The record in Figure 18-­11A resulted from oscillation of the CNS ischemic pressure contro...
• 19 - Role of the Kidneys in Long-­Term Control of Arterial Pressure and in Hypertension: The ­Integrated System for Arterial Pressure Regulation
  • Renal–Body Fluid System for Arterial Pressure Control
    • Figure 19-­1 shows the approximate average effect of different arterial pressure levels on the renal output of salt and water by...
      • Experiment Demonstrating the Renal–Body Fluid System for Arterial Pressure Control. Figure 19-­2 shows the results of an experim...
        • Renal–Body Fluid Mechanism Provides Nearly Infinite Feedback Gain for Long-­term Arterial Pressure Control. Figure 19-­1 shows t...
        • Two Key Determinants of Long-­Term Arterial Pressure. In Figure 19-­1, one can also see that two basic long-­term factors determ...
        • Chronic Renal Output Curve Much Steeper Than the Acute Curve. An important characteristic of pressure natriuresis (and pressure ...
      • Failure of Increased Total Peripheral Resistance to Elevate Long-­Term Level of Arterial Pressure if Fluid Intake and Renal Func...
      • Increased Fluid Volume Can Elevate Arterial Pressure by Increasing Cardiac Output or Total Peripheral Resistance
      • Importance of Salt (NaCl) in the Renal–Body Fluid Schema for Arterial Pressure Regulation
        • Experimental Volume-­Loading Hypertension Caused by Reduced Kidney Mass and Increased Salt Intake. Figure 19-­7 shows a typical ...
        • Sequential Changes in Circulatory Function During Development of Volume-­Loading Hypertension. It is especially instructive to s...
      • Volume-­Loading Hypertension in Patients Who Have No Kidneys but Are Being Maintained With an Artificial Kidney
      • Hypertension Caused by Excess Aldosterone
  • Role of the Renin-­Angiotensin System in Arterial Pressure Control
    • Rapidity and Intensity of the Vasoconstrictor Pressure Response to the Renin-­Angiotensin System
      • Angiotensin II Causes Renal Retention of Salt and Water—An Important Means for Long-­Term Control of Arterial Pressure
        • Mechanisms of the Direct Renal Effects of Angiotensin II to Cause Renal Retention of Salt and Water. Angiotensin has several dir...
        • Angiotensin II Increases Kidney Salt and Water ­Retention by Stimulating Aldosterone. Angiotensin II is also one of the most pow...
      • Role of the Renin-­Angiotensin System in Maintaining a Normal Arterial Pressure Despite Large Variations in Salt Intake
        • One-­Kidney Goldblatt Hypertension. When one kidney is removed, and a constrictor is placed on the renal artery of the remaining...
        • Two-­Kidney Goldblatt Hypertension. Hypertension also can result when the artery to only one kidney is constricted while the art...
        • Hypertension Caused by Diseased Kidneys That Secrete Renin Chronically. Often, patchy areas of one or both kidneys are diseased ...
    • Primary (Essential) Hypertension
      • Graphic Analysis of Arterial Pressure Control in Essential Hypertension. Figure 19-­15 is a graphic analysis of essential hypert...
        • Treatment of Essential Hypertension. As a first step, current guidelines for treating hypertension recommend lifestyle modificat...
  • Summary of Integrated Multifaceted Systems for Arterial Pressure Regulation
    • Arterial Pressure Control Mechanisms That Act Within Seconds or Minutes. The rapidly acting pressure control mechanisms are almo...
      • Arterial Pressure Control Mechanisms That Act After Many Minutes. Several pressure control mechanisms exhibit significant respon...
        • Long-­Term Mechanisms for Arterial Pressure Regulation. The goal of this chapter has been to explain the role of the kidneys in ...
• 20 - Cardiac Output, Venous Return, and Their Regulation
  • Normal Values for Cardiac Output at Rest and During Activity
  • Control of Cardiac Output by Venous Return—Frank-­Starling Mechanism of the Heart
    • Cardiac Output Is the Sum of All Tissue Blood Flows—Tissue Metabolism Regulates Most Local Blood Flow
      • Limits for the Cardiac Output
      • Factors That Cause a Hypereffective Heart
        • Nervous Excitation Can Increase Heart Pumping. In Chapter 9, we saw that a combination of sympathetic stimulation and parasympat...
        • Heart Hypertrophy Can Increase Pumping Effectiveness. A long-­term increased workload, but not so much excess load that it damag...
      • Factors That Cause a Hypoeffective Heart
  • Nervous System Regulation of Cardiac Output
    • Importance of Nervous System For Maintaining Arterial Pressure When Peripheral Blood Vessels Are Dilated and Venous Return and C...
      • Effect of Nervous System to Increase Arterial Pressure During Exercise. During exercise, intense increases in metabolism in acti...
        • Effect of External Pressure Outside the Heart on Cardiac Output Curves. Figure 20-­8 shows the effect of changes in external car...
        • Combinations of Different Patterns of Cardiac Output Curves. Figure 20-­9 shows that the final cardiac output curve can change a...
    • Venous Return Curves
      • Normal Venous Return Curve
        • Plateau in Venous Return Curve at Negative Atrial Pressures Caused by Collapse of the Large Veins. When the right atrial pressur...
      • Mean Circulatory Filling Pressure, Mean Systemic Filling Pressure—Effects on Venous Return
        • Increased Blood Volume Raises Mean Circulatory Filling Pressure. The greater the volume of blood in the circulation, the greater...
        • Sympathetic Nervous Stimulation Increases Mean Circulatory Filling Pressure. The green curve and blue curve in Figure 20-­11 sho...
        • Mean Systemic Filling Pressure and Relationship to Mean Circulatory Filling Pressure. The mean systemic filling pressure (Psf) i...
        • Effect on Venous Return Curve of Changes in Mean Systemic Filling Pressure. Figure 20-­12 shows the effects on the venous return...
        • When Pressure Gradient for Venous Return Is Zero There Is No Venous Return. When the right atrial pressure rises to equal the Ps...
      • Resistance to Venous Return
        • Effect of Resistance to Venous Return on the Venous Return Curve. Figure 20-­13 demonstrates the effect of different levels of r...
        • Combinations of Venous Return Curve Patterns. Figure 20-­14 shows the effects on the venous return curve caused by simultaneous ...
        • Effect of Increased Blood Volume on Cardiac Output. A sudden increase in blood volume of about 20% increases the cardiac output ...
        • Compensatory Effects Initiated in Response to Increased Blood Volume. The greatly increased cardiac output caused by increased b...
        • Effect of Sympathetic Stimulation on Cardiac Output. Sympathetic stimulation affects the heart and systemic circulation: (1) it ...
        • Effect of Sympathetic Inhibition on Cardiac Output. The sympathetic nervous system can be blocked by inducing total spinal anest...
        • Effect of Opening a Large Arteriovenous Fistula. Figure 20-­17 shows various stages of circulatory changes that occur after open...
        • Other Analyses of Cardiac Output Regulation. In Chapter 21, analysis of cardiac output regulation during exercise is presented. ...
  • Methods For Measuring Cardiac Output
    • Pulsatile Output of the Heart Measured by Electromagnetic or Ultrasonic Flowmeter
      • Measurement of Cardiac Output Using the Oxygen Fick Principle
      • Indicator Dilution Method
      • Echocardiography
      • Thoracic Electrical Bioimpedance Method
      • Bibliography
• 21 - Muscle Blood Flow and Cardiac Output ­During Exercise; the Coronary Circulation and Ischemic Heart Disease
  • Blood Flow Regulation in Skeletal Muscle at Rest and During Exercise
    • Skeletal Muscle Blood Flow Rate
      • Blood Flow During Muscle Contractions. Figure 21-­1 shows a record of blood flow changes in a calf muscle of a leg during strong...
        • Increased Blood Flow in Muscle Capillaries During Exercise. During rest, some muscle capillaries have little or no flowing blood...
  • Control of Skeletal Muscle Blood Flow
    • Decreased Oxygen in Muscle Greatly Enhances Flow. The large increase in muscle blood flow that occurs during skeletal muscle act...
      • Effects of Sympathetic Activation
      • Sympathetic Stimulation May Increase Arterial Pressure During Exercise
        • Why Is Increased Arterial Pressure During Exercise Important When muscles are stimulated maximally in a laboratory experiment, b...
      • Importance of Increased Cardiac Output During Exercise
        • Graphic Analysis of Changes in Cardiac Output ­During Heavy Exercise. Figure 21-­2 shows a graphic analysis of the large increas...
  • Coronary Circulation
    • Cardiac Muscle Compression Causes Phasic Changes in Coronary Blood Flow During Systole and Diastole. Figure 21-­4 shows the chan...
  • Control of Coronary Blood Flow
    • Local Muscle Metabolism Is the Primary Controller of Coronary Flow
      • Nervous Control of Coronary Blood Flow
        • Direct Effects of Nervous Stimuli on Coronary ­Vasculature. The distribution of parasympathetic (vagal) nerve fibers to the vent...
    • Ischemic Heart Disease
      • Acute Coronary Artery Occlusion
        • Lifesaving Value of Collateral Circulation in the Heart. The degree of damage to the heart muscle caused by slowly developing at...
      • Myocardial Infarction
        • Subendocardial Infarction. The subendocardial muscle frequently becomes infarcted, even when there is no evidence of infarction ...
        • Decreased Cardiac Output—Systolic Stretch and ­Cardiac Shock. When some of the cardiac muscle fibers are not functioning and oth...
        • Damming of Blood in the Body’s Venous System. When the heart is not pumping blood forward, it must be damming blood in the atria...
        • Fibrillation of the Ventricles After Myocardial Infarction. In many people who die of coronary occlusion, death occurs because o...
        • Rupture of Infarcted Area. During the first day or so after an acute infarct, there is little danger of rupture of the ischemic ...
        • Replacement of Dead Muscle by Scar Tissue. In the lower part of Figure 21-­8, the various stages of recovery after a large myoca...
        • Value of Rest in Treating Myocardial Infarction. The degree of cardiac cellular death is determined by the degree of ischemia an...
    • Pain in Coronary Heart Disease
      • Angina Pectoris (Cardiac Pain). In most people who sustain progressive constriction of their coronary arteries, cardiac pain, ca...
        • Drug Treatment. Several vasodilator drugs, when administered during an acute anginal attack, can often provide immediate relief ...
  • Surgical Treatment of Coronary Artery Disease
    • Aortic-­Coronary Bypass Surgery. In many patients with coronary ischemia, the constricted areas of the coronary arteries are loc...
• 22 - Cardiac Failure
• 23 - Heart Valves and Heart Sounds; Valvular and Congenital Heart Defects
• 24 - Circulatory Shock and Its Treatment
  • Physiological Causes of Shock
    • Circulatory Shock Caused by Decreased Cardiac Output
    • Stages of Shock
  • Shock Caused by Hypovolemia—Hemorrhagic Shock
    • Relationship of Bleeding Volume to Cardiac Output and Arterial Pressure
      • Sympathetic Reflex Compensations in Shock—Their Special Value to Maintain Arterial Pressure. The decrease in arterial pressure a...
        • Greater Effect of Sympathetic Nervous Reflexes in Maintaining Arterial Pressure Than in Maintaining Cardiac Output. Referring ag...
        • Protection of Coronary and Cerebral Blood Flow by the Reflexes. A special value of the maintenance of normal arterial pressure, ...
      • Nonprogressive Shock—Compensated Shock
      • Progressive Shock—Caused by Vicious Cycle of Cardiovascular Deterioration
        • Cardiac Depression. When the arterial pressure falls low enough, coronary blood flow decreases below that required for adequate ...
        • Vasomotor Failure. In the early stages of shock, various circulatory reflexes cause intense activity of the sympathetic nervous ...
        • Blockage of Very Small Vessels by Sludged Blood. In time, blockage occurs in many of the very small blood vessels in the circula...
        • Increased Capillary Permeability. After many hours of capillary hypoxia and lack of other nutrients, the permeability of the cap...
        • Release of Toxins by Ischemic Tissue. Shock has been suggested to cause tissues to release toxic substances, such as histamine, ...
        • Cardiac Depression Caused by Endotoxin. Endotoxin is released from the bodies of dead gram-­negative bacteria in the intestines....
        • Generalized Cellular Deterioration. As shock becomes severe, many signs of generalized cellular deterioration occur throughout t...
        • Patchy Areas of Tissue Necrosis Caused by Patchy Blood Flows in Different Organs. Not all cells of the body are equally damaged ...
        • Acidosis in Shock. Metabolic derangements that occur in shocked tissue can lead to acidosis throughout the body. This results fr...
        • Positive Feedback Deterioration of Tissues in Shock and Vicious Cycle of Progressive Shock. All the factors just discussed that ...
    • Irreversible Shock
  • Neurogenic Shock—Increased Vascular Capacity
  • Anaphylactic Shock and Histamine Shock
  • Septic Shock
  • Physiology of Treatment in Shock
    • Replacement Therapy
      • Blood and Plasma Transfusion. If a person is in shock caused by hemorrhage, the best possible therapy is usually transfusion of ...
        • Dextran Solution as a Plasma Substitute. The principal requirement of a truly effective plasma substitute is that it remain in t...
  • Other Therapy
    • Treatment by the Head-­Down Position. When the pressure falls too low in most types of shock, especially in hemorrhagic and neur...
      • Oxygen Therapy. Because a major deleterious effect of most types of shock is too little delivery of oxygen to the tissues, givin...
        • Treatment With Glucocorticoids. Glucocorticoids—adrenal cortex hormones that control glucose metabolism—are frequently given to ...
  • Circulatory Arrest
• 25 - Regulation of Body Fluid Compartments: Extracellular and Intracellular Fluids; Edema
  • Fluid Intake and Output ARE Balanced During Steady-­State Conditions
    • Daily Intake of Water
  • Daily Loss of Body Water
    • Insensible Water Loss. Some water losses cannot be precisely regulated. For example, humans experience continuous water loss by ...
      • Fluid Loss in Sweat. The amount of water lost by sweating is highly variable, depending on physical activity and environmental t...
        • Water Loss in Feces. Only a small amount of water (100 ml/day) normally is lost in the feces. This loss can increase to several ...
        • Water Loss by the Kidneys. The remaining water loss from the body occurs in the urine excreted by the kidneys. Multiple mechanis...
  • Body Fluid Compartments
    • Intracellular Fluid Compartment
    • Extracellular Fluid Compartment
    • Blood Volume
  • Constituents of Extracellular and Intracellular Fluids
    • Intracellular Fluid Constituents
  • Measurement of Body Fluid Compartment Volumes—Indicator-­Dilution Principle
  • Determination of Volumes of Specific Body Fluid Compartments
    • Measurement of Total Body Water. Radioactive water (tritium, 3H2O) or heavy water (deuterium, 2H2O) can be used to measure total...
      • Measurement of Extracellular Fluid Volume. The volume of extracellular fluid can be estimated using any of several substances th...
        • Calculation of Intracellular Volume. The intracellular volume cannot be measured directly. However, it can be calculated as foll...
        • Measurement of Plasma Volume. Plasma volume can be measured using a substance that does not readily penetrate capillary membrane...
        • Calculation of Interstitial Fluid Volume. Interstitial fluid volume cannot be measured directly, but it can be calculated as fol...
        • Measurement of Blood Volume. If one measures the hematocrit (the fraction of the total blood volume composed of cells) and plasm...
  • Fluid Exchange and Osmotic Equilibrium Between Intracellular and Extracellular Fluid
    • Osmolality and Osmolarity. The osmolal concentration of a solution is called osmolality when the concentration is expressed as o...
      • Calculation of the Osmolarity and Osmotic Pressure of a Solution. Using the van’t Hoff law, one can calculate the potential osmo...
        • Osmolarity of Body Fluids. Referring back to Table 25-­2, note the approximate osmolarity of the various osmotically active subs...
        • Corrected Osmolar Activity of Body Fluids. At the bottom of Table 25-­2 are shown corrected osmolar activities of plasma, inters...
      • Osmotic Equilibrium Between Intracellular and Extracellular Fluids
        • Isotonic, Hypotonic, and Hypertonic Fluids. The effects of different concentrations of impermeant solutes in the extracellular f...
        • Isosmotic, Hyperosmotic, and Hypo-­Osmotic Fluids. The terms isotonic, hypotonic, and hypertonic refer to whether solutions will...
        • Osmotic Equilibrium Between Intracellular and ­Extracellular Fluids Is Rapidly Attained. Transfer of fluid across the cell membr...
  • Volume and Osmolality of Extracellular and Intracellular Fluids in Abnormal States
    • Effect of Adding Saline Solution to the Extracellular Fluid
  • Glucose and Other Solutions Administered For Nutritive Purposes
  • Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia
    • Causes of Hyponatremia: Excess Water or Loss of Sodium
      • Hyponatremia Causes Cell Edema
      • Causes of Hypernatremia: Water Loss or Excess Sodium
      • Hypernatremia Causes Cell Shrinkage
  • Edema: Excess Fluid in the Tissues
    • Intracellular Edema
    • Extracellular Edema
      • Factors That Can Increase Capillary Filtration
      • Lymphedema—Failure of Lymph Vessels to Return Fluid and Protein to the Blood
      • Summary of Causes of Extracellular Edema
        • Edema Caused by Heart Failure. One of the most serious and common causes of edema is heart failure, which was discussed in Chapt...
        • Edema Caused by Decreased Kidney Excretion of Salt and Water. Most sodium chloride added to the blood remains in the extracellul...
        • Edema Caused by Decreased Plasma Proteins. Failure to produce normal amounts of proteins or leakage of proteins from the plasma ...
      • Safety Factor Caused by Low Compliance of the Interstitium in the Negative Pressure Range
        • Importance of Interstitial Gel in Preventing Fluid ­Accumulation in the Interstitium. Note in Figure 25-­8 that in normal tissue...
        • Importance of Proteoglycan Filaments as a Spacer for Cells and in Preventing Rapid Flow of Fluid in ­Tissues. The proteoglycan f...
      • Increased Lymph Flow as a Safety Factor Against Edema
      • Washdown of Interstitial Fluid Protein as a Safety Factor Against Edema
  • Fluids in Potential Spaces of the Body
    • Fluid Is Exchanged Between Capillaries and Potential Spaces. The surface membrane of a potential space usually does not offer si...
      • Lymphatic Vessels Drain Protein From the Potential Spaces. Proteins collect in the potential spaces because of leakage out of th...
        • Edema Fluid in the Potential Spaces Is Called ­Effusion. When edema occurs in the subcutaneous tissues adjacent to the potential...
• 26 - The Urinary System: Functional Anatomy and Urine Formation by the Kidneys
  • Multiple Functions of the Kidneys
    • Excretion of Metabolic Waste Products, Foreign Chemicals, Drugs, and Hormone Metabolites. The kidneys are the primary means for ...
      • Regulation of Water and Electrolyte Balances. For main­tenance of homeostasis, excretion of water and electrolytes must match in...
        • Regulation of Arterial Pressure. As discussed in Chapter 19, the kidneys play a dominant role in long-­term regulation of arteri...
        • Regulation of Acid–­Base Balance. The kidneys contribute to acid–base regulation, along with the lungs and body fluid buffers, b...
        • Regulation of Erythrocyte Production. The kidneys secrete erythropoietin, which stimulates production of red blood cells by hema...
        • Regulation of 1,25-­Dihydroxyvitamin D3 Production. The kidneys produce 1,25-­dihydroxyvitamin D3 (calcitriol), the active form ...
        • Glucose Synthesis. The kidneys synthesize glucose from amino acids and other precursors during prolonged fasting, a process refe...
    • General Organization of the Kidneys and Urinary Tract
    • Renal Blood Supply
  • Micturition
    • Innervation of the Bladder. The principal nerve supply of the bladder is via the pelvic nerves, which connect with the spinal co...
    • Micturition Reflex
  • Urine Formation Results from Glomerular Filtration, Tubular Reabsorption, and Tubular Secretion
• 27 - Glomerular Filtration, Renal Blood Flow, and Their Control
  • Glomerular Filtration—The First Step in Urine Formation
    • Glomerular Capillary Membrane
      • Filterability of Solutes Inversely Related to Their Size. The glomerular capillary membrane is thicker than most other capillari...
        • Negatively Charged Large Molecules Are Filtered Less Easily Than Positively Charged Molecules of Equal Molecular Size. The molec...
        • Minimal-­Change Nephropathy and Increased Glomerular Permeability to Plasma Proteins. In minimal-­change nephropathy, the glomer...
  • Determinants of the Glomerular Filtration Rate
  • Renal Blood Flow
    • Determinants of Renal Blood Flow
  • Physiological Control of Glomerular Filtration and Renal Blood Flow
    • Norepinephrine, Epinephrine, and Endothelin Constrict Renal Blood Vessels and Decrease Glomerular ­Filtration Rate. Hormones tha...
      • Angiotensin II Preferentially Constricts Efferent ­Arterioles in Most Physiological Conditions. A powerful renal vasoconstrictor...
        • Endothelial-­Derived Nitric Oxide Decreases ­Renal ­Vascular Resistance and Increases Glomerular ­Filtration Rate. An autacoid t...
        • Prostaglandins and Bradykinin Decrease Renal ­Vascular Resistance and Tend to Increase ­Glomerular Filtration Rate. Prostaglandi...
  • Autoregulation of Glomerular Filtration Rate and Renal Blood Flow
    • Importance of Glomerular Filtration Rate Autoregulation in Preventing Extreme Changes in Renal Excretion
• 28 - Renal Tubular Reabsorption and Secretion
  • Tubular Reabsorption is Quantitatively Large and Highly Selective
  • Tubular Reabsorption Includes Passive and Active Mechanisms
    • Active Transport
  • Reabsorption and Secretion Along Different Parts of the Nephron
    • Proximal Tubular Reabsorption
    • Distal Tubules
    • Medullary Collecting Ducts
  • Regulation of Tubular Reabsorption
  • Use of Clearance Methods to Quantify Kidney Function
• 29 - Urine Concentration and Dilution; Regulation of Extracellular Fluid Osmolarity and Sodium Concentration
  • Kidneys Excrete Excess Water by Forming Dilute Urine
    • Tubular Fluid Remains Isosmotic in Proximal Tubules. As fluid flows through the proximal tubule, solutes and water are reabsorbe...
      • Tubular Fluid Is Diluted in the Ascending Loop of Henle. In the ascending limb of the loop of Henle, especially in the thick seg...
        • Tubular Fluid in Distal and Collecting Tubules Is Further Diluted in Absence of ADH. As the dilute fluid in the early distal tub...
  • Kidneys Conserve Water by Excreting Concentrated Urine
  • Countercurrent Multiplier Mechanism Produces Hyperosmotic Renal Medullary Interstitium
  • Loop of Henle Characteristics That Cause Solutes to be Trapped in the Renal Medulla
    • Steps Involved in Causing Hyperosmotic Renal Medullary Interstitium. Keeping in mind these characteristics of the loop of Henle,...
      • Recirculation of Urea from Collecting Duct to Loop of Henle Contributes to Hyperosmotic Renal Medulla. A healthy person usually ...
        • Increased Medullary Blood Flow Reduces Urine-­Concentrating Ability. Certain vasodilators can markedly increase renal medullary ...
        • Proximal Tubule. About 65% of most filtered electrolytes is reabsorbed in the proximal tubule. However, the proximal tubular mem...
        • Descending Loop of Henle. As fluid flows down the descending loop of Henle, water is absorbed into the medulla. The descending l...
        • Thin Ascending Loop of Henle. The thin ascending limb is essentially impermeable to water but reabsorbs some sodium chloride. Be...
        • Thick Ascending Loop of Henle. The thick part of the ascending loop of Henle is also virtually impermeable to water, but large a...
        • Early Distal Tubule. The early distal tubule has properties similar to those of the thick ascending loop of Henle, so further di...
        • Late Distal Tubule and Cortical Collecting Tubules. In the late distal tubule and cortical collecting tubules, the osmolarity of...
        • Inner Medullary Collecting Ducts. The concentration of fluid in the inner medullary collecting ducts also depends on the followi...
  • Control of Extracellular Fluid Osmolarity and Sodium Concentration
  • Osmoreceptor-­ADH Feedback System
    • Other Stimuli for ADH Secretion
  • Importance of Thirst in Controlling Extracellular Fluid Osmolarity and Sodium Concentration
    • Stimuli for Thirst
• 30 - Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium; Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume
  • Regulation of Extracellular Fluid Potassium Concentration and Potassium Excretion
    • Insulin Stimulates Potassium Uptake Into Cells. ­Insulin stimulates sodium-­potassium adenosine triphosphatase (ATPase) activity...
      • Aldosterone Increases Potassium Uptake Into Cells. Increased potassium intake also stimulates secretion of aldosterone, which in...
        • β-­Adrenergic Stimulation Increases Cellular Uptake of Potassium. Increased secretion of catecholamines, especially epinephrine,...
        • Acid–Base Abnormalities Can Cause Changes in Potassium Distribution. Metabolic acidosis increases extracellular potassium concen...
        • Cell Lysis Causes Increased Extracellular Potassium Concentration. As cells are destroyed, the large amounts of potassium contai...
        • Strenuous Exercise Can Cause Hyperkalemia by Releasing Potassium From Skeletal Muscle. During prolonged exercise, potassium is r...
        • Increased Extracellular Fluid Osmolarity Causes Redistribution of Potassium From Cells to Extracellular Fluid. Increased extrace...
        • Variable Potassium Secretion in Distal and Collecting Tubules Mediates Most Daily Changes in Potassium Excretion. The most impor...
        • Control of Potassium Secretion by Principal Cells. The primary factors that control potassium secretion by the principal cells o...
        • Intercalated Cells Can Reabsorb or Secrete Potassium. In circumstances associated with severe potassium depletion, there is a ce...
        • Increased Extracellular Fluid Potassium Concentration Stimulates Potassium Secretion. The rate of potassium secretion in the lat...
        • Aldosterone Stimulates Potassium Secretion. Aldosterone stimulates active reabsorption of sodium ions by the principal cells of ...
        • Increased Extracellular Potassium Ion Concentration Stimulates Aldosterone Secretion. In negative feedback control systems, the ...
        • Blockade of Aldosterone Feedback System Greatly Impairs Potassium Regulation. In the absence of aldosterone secretion, as occurs...
        • Increased Distal Tubular Flow Rate Stimulates Potassium Secretion. A rise in distal tubular flow rate, as occurs with volume exp...
        • Acute Acidosis Decreases Potassium Secretion. Acute increases in extracellular fluid hydrogen ion concentration (acidosis) reduc...
  • Regulation of Renal Calcium Excretion and Extracellular Calcium Ion Concentration
    • Proximal Tubular Calcium Reabsorption. Most of the calcium reabsorption in the proximal tubule occurs through the paracellular p...
      • Loop of Henle and Distal Tubule Calcium Reabsorption. In the loop of Henle, calcium reabsorption is restricted to the thick asce...
        • Regulation of Tubular Calcium Reabsorption. One of the primary controllers of renal tubular calcium reabsorption is PTH. Increas...
  • Regulation of Renal Phosphate Excretion
  • Regulation of Renal Magnesium Excretion and Extracellular Magnesium Ion Concentration
  • Integration of Renal Mechanisms for Control of Extracellular Fluid
  • Importance of Pressure Natriuresis and Pressure Diuresis in Maintaining Body Sodium and Fluid Balance
    • Pressure Natriuresis and Diuresis: Key Components of A Renal–Body Fluid Feedback for Regulating Body Fluid Volumes and Arterial ...
  • Distribution of Extracellular Fluid Between Interstitial Spaces and Vascular System
  • Nervous and Hormonal Factors Increase Effectiveness of Renal–Body Fluid Feedback Control
  • Integrated Responses to Changes in Sodium Intake
  • Conditions That Cause Large Increases in Blood Volume and Extracellular Fluid Volume
  • Conditions That Cause Large Increases in Extracellular Fluid Volume With Normal or Reduced Blood Volume
• 31 - Acid–Base Regulation
  • Hydrogen Ion Concentration is Precisely Regulated
  • Acids and Bases—Definitions and Meanings
    • Strong and Weak Acids and Bases. A strong acid, such as HCl, rapidly dissociates and releases especially large amounts of H+ in ...
  • 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
    • Feedback Control of H+ Concentration by the Respiratory System. Because increased H+ concentration stimulates respiration and be...
      • Efficiency of Respiratory Control of H+ Concentration. Respiratory control cannot return the H+ concentration all the way back t...
        • Buffering Power of the Respiratory System. Respiratory regulation of acid–base balance is a physiological type of buffer system ...
        • Impairment of Lung Function Can Cause Respiratory Acidosis. We have discussed thus far the role of the normal respiratory mechan...
  • 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−
  • Quantifying Renal Acid–Base Excretion
  • 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−
• 32 - Diuretics and Kidney Diseases
• 33 - Red Blood Cells, Anemia, and Polycythemia
  • Red Blood Cells (Erythrocytes)
    • Shape and Size of Red Blood Cells. Normal RBCs, shown in Figure 33-­3, are biconcave discs having a mean diameter of about 7.8 m...
      • Concentration of Red Blood Cells in the Blood. In healthy men, the average number of RBCs per cubic millimeter is 5,200,000 (±30...
        • Quantity of Hemoglobin in the Cells. RBCs can concentrate hemoglobin in the cell fluid up to about 34 g/100 ml of cells. The con...
  • Production of Red Blood Cells
    • Areas of the Body That Produce Red Blood Cells. In the early weeks of embryonic life, primitive nucleated RBCs are produced in t...
      • Stages of Differentiation of Red Blood Cells
      • Erythropoietin Regulates Red Blood Cell Production
        • Tissue Oxygenation—Essential Regulator of Red Blood Cell Production. Conditions that decrease the quantity of oxygen transported...
        • Hypoxia Increases Formation of Erythropoietin Which Stimulates Red Blood Cell Production. The principal stimulus for RBC product...
        • Erythropoietin Is Formed Mainly in the Kidneys. Normally, about 90% of all erythropoietin is formed in the kidneys, and the rema...
        • Erythropoietin Stimulates Production of Proerythroblasts From Hematopoietic Stem Cells. When an animal or person is placed in an...
      • Maturation of Red Blood Cells Requires Vitamin B12 (Cyanocobalamin) and Folic Acid
        • Maturation Failure Anemia Caused by Poor Absorption of Vitamin B12 From the Gastrointestinal Tract—Pernicious Anemia. A common c...
        • Maturation Failure Anemia Caused by Folic Acid (Pteroylglutamic Acid) Deficiency. Folic acid is a normal constituent of green ve...
    • Hemoglobin Formation
    • Iron Metabolism
      • Transport and Storage of Iron. Transport, storage, and metabolism of iron in the body are diagrammed in Figure 33-­7 and can be ...
        • Daily Loss of Iron. An average man excretes about 0.6 mg of iron each day, mainly into the feces. Additional quantities of iron ...
      • Absorption of Iron From the Intestinal Tract
        • Regulation of Total Body Iron by Controlling Absorption Rate. When the body becomes saturated with iron so that essentially all ...
        • Destruction of Hemoglobin by Macrophages. When RBCs burst and release their hemoglobin, the hemoglobin is phagocytized almost im...
  • Anemias
    • Blood Loss Anemia. After rapid hemorrhage, the body replaces the fluid portion of the plasma in 1 to 3 days, but this response r...
      • Aplastic Anemia Due to Bone Marrow Dysfunction. Bone marrow aplasia means lack of functioning bone marrow. For example, exposure...
        • Megaloblastic Anemia. Based on the earlier discussions of vitamin B12, folic acid, and intrinsic factor from the stomach mucosa,...
        • Hemolytic Anemia. Different abnormalities of the RBCs, many of which are acquired through hereditary, make the cells fragile, so...
  • Polycythemia
    • Secondary Polycythemia. Whenever the tissues become hypoxic because of too little oxygen in the breathed air, such as at high al...
• 34 - Resistance of the Body to Infection: I. Leukocytes, Granulocytes, the Monocyte-­Macrophage System, and Inflammation
  • Leukocytes (White Blood Cells)
    • Genesis of White Blood Cells
    • Life Span of White Blood Cells
  • Neutrophils and Macrophages Defend Against Infections
    • White Blood Cells Enter the Tissue Spaces by Diapedesis. Neutrophils and monocytes can squeeze through gaps between endothelial ...
      • White Blood Cells Move Through Tissue Spaces by Ameboid Motion. Both neutrophils and macrophages can move through the tissues by...
        • White Blood Cells Are Attracted to Inflamed Tissue Areas by Chemotaxis. Many different chemical substances in the tissues cause ...
    • Phagocytosis
      • Phagocytosis by Neutrophils. The neutrophils entering the tissues are already mature cells that can immediately begin phagocytos...
        • Phagocytosis by Macrophages. Macrophages are the end-­stage product of monocytes that enter the tissues from the blood. When act...
        • Once Phagocytized, Most Particles Are Digested by Intracellular Enzymes. Once a foreign particle has been phagocytized, lysosome...
        • Neutrophils and Macrophages Can Kill Bacteria.In addition to the digestion of ingested bacteria in phagosomes, neutrophils and m...
  • Monocyte-­Macrophage Cell System (Reticuloendothelial System)
    • Tissue Macrophages in Skin and Subcutaneous Tissues (Histiocytes). The skin is mainly impregnable to infectious agents, except w...
      • Macrophages in Lymph Nodes. Essentially no particulate matter that enters the tissues, such as bacteria, can be absorbed directl...
        • Alveolar Macrophages in Lungs. Another route whereby invading organisms frequently enter the body is through the lungs. Large nu...
        • Macrophages (Kupffer Cells) in Liver Sinusoids. Another route whereby bacteria invade the body is through the gastrointestinal t...
        • Macrophages of Spleen and Bone Marrow. If an invading organism succeeds in entering the general circulation, there are other lin...
    • Inflammation
  • Macrophage and Neutrophil Responses During Inflammation
    • Tissue Macrophages Provide First Line of Defense Against Infection. Within minutes after inflammation begins, the macrophages al...
      • Neutrophil Invasion of the Inflamed Area Is a Second Line of Defense. Within the first hour or so after inflammation begins, lar...
        • Acute Increase in the Number of Neutrophils in Blood—Neutrophilia. Also, within a few hours after the onset of acute severe infl...
        • Second Macrophage Invasion Into the Inflamed Tissue Is a Third Line of Defense. Along with the invasion of neutrophils, monocyte...
        • Increased Production of Granulocytes and Monocytes by Bone Marrow Is a Fourth Line of Defense. The fourth line of defense is gre...
      • Feedback Control of Macrophage and Neutrophil Responses
      • Formation of Pus
  • Eosinophils
  • Basophils
  • Leukopenia
  • Leukemias
• 35 - Resistance of the Body to Infection: II. Immunity and Allergy
  • Acquired (Adaptive) Immunity
    • T and B Lymphocytes Promote Cell-­Mediated and ­Humoral Immunity. Although most lymphocytes in normal lymphoid tissue look alike...
      • Thymus Gland Preprocesses T Lymphocytes. The T lymphocytes, after origination in the bone marrow, first migrate to the thymus gl...
        • Liver and Bone Marrow Preprocess B Lymphocytes. In humans, B lymphocytes are preprocessed in the liver during midfetal life and ...
        • Millions of Specific Types of Lymphocytes Are Stored in Lymphoid Tissue. Millions of different types of preformed B lymphocytes ...
        • Role of Macrophages in the Activation Process. Aside from the lymphocytes in lymphoid tissue, literally millions of macrophages ...
        • Role of T Cells in Activation of B Lymphocytes. Most antigens activate both T lymphocytes and B lymphocytes at the same time. So...
    • Specific Attributes of The B-­Lymphocyte System—Humoral Immunity and Antibodies
      • Antibody Formation by Plasma Cells. Before exposure to a specific antigen, the clones of B lymphocytes remain dormant in the lym...
        • Formation of Memory Cells Enhances Antibody Response to Subsequent Antigen Exposure. A few of the lymphoblasts formed by activat...
        • Generation of Lifelong Immunity by Plasma Cells. When naïve B lymphocytes encounter their associated antigens, become activated,...
      • Nature of Antibodies
        • Specificity of Antibodies. Each antibody is specific for a particular antigen; this characteristic is a result of the unique str...
        • Five General Classes of Antibodies. There are five general classes of antibodies, respectively named IgM, IgG, IgA, IgD, and IgE...
      • Mechanisms of Action of Antibodies
        • Direct Action of Antibodies on Invading Agents. Figure 35-­5 shows antibodies (designated by the red Y-­shaped bars) reacting wi...
        • Classical Pathway. The classical pathway is initiated by an antigen-­antibody reaction. That is, when an antibody binds with an ...
    • Special Attributes of T-­Lymphocyte System—Activated T Cells and Cell-­Mediated Immunity
      • Release of Activated T Cells From Lymphoid Tissue and Formation of Memory Cells. On exposure to the proper antigen, as presented...
        • Antigen-­Presenting Cells, Major Histocompatibility Complex Proteins, and Antigen Receptors on T Lymphocytes. T-­cell responses ...
    • Different Types of T Cells and Their Functions
      • T-­Helper Cells Are the Most NumerousT Cells
        • Specific Regulatory Functions of Lymphokines. In the absence of the lymphokines from the T-­helper cells, the remainder of the i...
        • Stimulation of Growth and Proliferation of Cytotoxic T Cells and Regulatory T Cells. In the absence of T-­helper cells, the clon...
        • Stimulation of B-­Cell Growth and Differentiation to Form Plasma Cells and Antibodies. The direct actions of antigens to cause B...
        • Activation of the Macrophage System. The lymphokines also affect the macrophages. First, they slow or stop the migration of the ...
        • Feedback Stimulatory Effect on T-­Helper Cells. Some of the lymphokines, especially interleukin-­2, have a direct positive feedb...
      • Cytotoxic T Cells Are Killer Cells
      • Regulatory T Cells
        • Most Tolerance Results From Clone Selection During Preprocessing. Most tolerance is believed to develop during the preprocessing...
        • Failure of the Tolerance Mechanism Causes Autoimmune Diseases. Sometimes, people lose immune tolerance of their own tissues. Thi...
    • Passive Immunity
  • Allergy and Hypersensitivity
    • Anaphylaxis—Widespread Allergic Reaction. When a specific allergen is injected directly into the circulation, the allergen can r...
      • Urticaria—Localized Anaphylactoid Reactions. ­Urticaria results from antigen entering specific skin areas and causing localized ...
        • Hay Fever. In hay fever, the allergen-­reagin reaction occurs in the nose. Histamine released in response to the reaction causes...
        • Asthma. Asthma often occurs in the hypersensitive allergic person. In these individuals, the allergen-­reagin reaction occurs in...
• 36 - Blood Types; Transfusion; and Tissue and Organ Transplantation
  • Antigenicity Causes Immune Reactions of Blood
  • O-­A-­B Blood Types
    • A and B Antigens—Agglutinogens
    • Agglutinins
    • Blood Typing
  • Rh Blood Types
  • Rh Immune Response
  • Transfusion Reactions Resulting From Mismatched Blood Types
  • Transplantation of Tissues and Organs
• 37 - Hemostasis and Blood Coagulation
  • HEMOSTASIS EVENTS
    • VASCULAR CONSTRICTION
    • FORMATION OF THE PLATELET PLUG
      • Physical and Chemical Characteristics
      • Mechanism of Platelet Plug Formation
  • MECHANISM OF BLOOD COAGULATION
    • GENERAL MECHANISM
  • CONVERSION OF FIBRINOGEN TO FIBRIN—FORMATION OF THE CLOT
    • Extrinsic Pathway for Initiating Clotting
      • Intrinsic Pathway for Initiating Clotting
      • Role of Calcium Ions in the Intrinsic and Extrinsic Pathways
      • Interaction Between Extrinsic and Intrinsic Pathways—Summary of Blood-­Clotting Initiation
    • PLASMIN CAUSES LYSIS OF BLOOD CLOTS
  • CONDITIONS THAT CAUSE EXCESSIVE BLEEDING IN HUMANS
    • HEMOPHILIA
    • THROMBOCYTOPENIA
  • THROMBOEMBOLIC CONDITIONS
  • ANTICOAGULANTS FOR CLINICAL USE
    • COUMARINS AS ANTICOAGULANTS
  • BLOOD COAGULATION TESTS
    • BLEEDING TIME
    • CLOTTING TIME
• 38 - Pulmonary Ventilation
• 39 - Pulmonary Circulation, Pulmonary Edema, and Pleural Fluid
• 40 - Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory Membrane
  • Compositions of Alveolar Air and Atmospheric Air are Different
    • Air Is Humidified in the Respiratory Passages
      • Alveolar Air Is Slowly Renewed by Atmospheric Air
        • Slow Replacement of Alveolar Air Helps Stabilize Respiratory Control. The slow replacement of alveolar air is of particular impo...
      • Oxygen Concentration and Partial Pressure in Alveoli
      • CO2 Concentration and Partial Pressure in Alveoli
        • Respiratory Membrane. Figure 40-­9 shows the ultrastructure of the respiratory membrane drawn in cross section on the left and a...
      • Factors Affecting Rate of Gas Diffusion Through the Respiratory Membrane
      • Diffusing Capacity of the Respiratory Membrane
        • Diffusing Capacity for Oxygen. In the average young man, the diffusing capacity for O2 under resting conditions averages 21 ml/m...
        • Increased Oxygen Diffusing Capacity During Exercise. During strenuous exercise or other conditions that greatly increase pulmona...
        • Diffusing Capacity for Carbon Dioxide. The diffusing capacity for CO2 has never been measured because CO2 diffuses through the r...
• 41 - Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids
  • Uptake of Oxygen by the Pulmonary Blood During Exercise. During strenuous exercise, a person’s body may require as much as 20 ti...
    • Increasing Blood Flow Raises Interstitial Fluid Po2. If the blood flow through a particular tissue is increased, greater quantit...
      • Reversible Combination of O2 With Hemoglobin
        • Oxygen-­Hemoglobin Dissociation Curve. Figure 41-8 shows the O2-­hemoglobin dissociation curve, which demonstrates a progressive...
        • Maximum Amount of Oxygen That Can Combine With the Hemoglobin of the Blood. The blood of a normal person contains about 15 grams...
        • Amount of Oxygen Released From Hemoglobin When Systemic Arterial Blood Flows Through Tissues. The total quantity of O2 bound wit...
        • Transport of Oxygen Is Markedly Increased During Strenuous Exercise. During heavy exercise, the muscle cells use O2 at a rapid r...
        • Utilization Coefficient. The percentage of the blood that gives up its O2 as it passes through the tissue capillaries is called ...
      • Hemoglobin “Buffers” Tissue Po2
        • Hemoglobin Helps Maintain Nearly Constant Po2 in the Tissues. Under basal conditions, the tissues require about 5 ml of O2 from ...
        • When Atmospheric Oxygen Concentration Changes Markedly, the Buffer Effect of Hemoglobin Still Maintains Almost Constant Tissue P...
      • Factors That Shift the Oxygen-­Hemoglobin Dissociation Curve—Their Importance for Oxygen Transport
      • Increased Delivery of Oxygen to Tissues When CO2 and H+ Shift the Oxygen-­Hemoglobin Dissociation Curve—the Bohr Effect
      • Effect of BPG to Cause Rightward Shift of the Oxygen-­Hemoglobin Dissociation Curve
      • Rightward Shift of the Oxygen-­Hemoglobin Dissociation Curve During Exercise
  • Metabolic Use of Oxygen by Cells
    • Effect of Intracellular Po2 on Oxygen Usage Rate. Only a minute level of O2 pressure is required in the cells for normal intrace...
      • Effect of Diffusion Distance From the Capillary to the Cell on Oxygen Usage. Tissue cells are seldom more than 50 micrometers aw...
        • Effect of Blood Flow on Metabolic Use of Oxygen. The total amount of O2 available each minute for use in any given tissue is det...
  • Transport of Co2 in Blood
    • Transport of CO2 in a Dissolved State
    • Carbon Dioxide Dissociation Curve
      • When Oxygen Binds With Hemoglobin, CO2 Is Released (the Haldane Effect) to Increase CO2 Transport
  • Respiratory Exchange Ratio
• 42 - Regulation of Respiration
  • Respiratory Center
    • Rhythmical Inspiratory Discharges From the Dorsal Respiratory Group. The basic rhythm of respiration is generated mainly in the ...
  • Chemical Control of Respiration
  • Direct Control of Respiratory Center Activity by Co2 and H+
    • Chemosensitive Area of the Respiratory Center Beneath the Medulla’s Ventral Surface. We have mainly discussed three areas of the...
      • Excitation of the Chemosensitive Neurons by H+ Is Likely the Primary Stimulus. The sensor neurons in the chemosensitive area are...
        • CO2 Indirectly Stimulates the Chemosensitive Neurons. Although CO2 has little direct effect in stimulating the neurons in the ch...
        • Attenuated Stimulatory Effect of CO2 After the First 1 to 2 Days. Excitation of the respiratory center by CO2 is great the first...
        • Quantitative Effects of Blood Pco2 and H+ Concentration on Alveolar Ventilation. Figure 42-­3 shows quantitatively the approxima...
        • Changes in O2 Have Little Direct Effect on Control of the Respiratory Center. Changes in O2 concentration have virtually no dire...
  • Peripheral Chemoreceptor System—Role of Oxygen in Respiratory Control
    • Decreased Arterial Oxygen Stimulates the Chemoreceptors. When the oxygen concentration in the arterial blood falls below normal,...
      • Basic Mechanism of Stimulation of the Chemoreceptors by O2 Deficiency. The exact means whereby low Po2 excites the nerve endings...
        • Increased CO2 and H+ Concentration Stimulates the Chemoreceptors. An increase in CO2 or H+ concentration also excites the chemor...
      • Effect of Low Arterial Po2 to Stimulate Alveolar Ventilation When Arterial CO2 and H+ Concentrations Remain Normal
      • Chronic Breathing of Low O2 Stimulates Respiration Even More—The Phenomenon of “Acclimatization”
      • Composite Effects of Pco2, pH, and Po2 on Alveolar Ventilation
  • Regulation of Respiration During Exercise
    • Interrelationship Between Chemical and Nervous Factors in Controlling Respiration During Exercise. When a person exercises, dire...
• 43 - Respiratory Insufficiency—Pathophysiology, Diagnosis, Oxygen Therapy
  • Useful Methods for Studying Respiratory Abnormalities
    • Study of Blood Gases and Blood ph
      • Determination of Blood pH. Blood pH is measured using a glass pH electrode of the type commonly used in chemical laboratories. H...
        • Determination of Blood CO2. A glass electrode pH meter can also be used to determine blood CO2. When a weak solution of sodium b...
        • Determination of Blood Po2. The concentration of O2 in a fluid can be measured by a technique called polarography. Electric curr...
        • Abnormalities of the Maximum Expiratory Flow-­Volume Curve. Figure 43-­2 shows the normal maximum expiratory flow-­volume curve,...
    • Chronic Pulmonary Emphysema
    • Atelectasis—Collapse of the Alveoli
      • Airway Obstruction Causes Lung Collapse. The airway obstruction type of atelectasis usually results from the following: (1) bloc...
        • Lack of “Surfactant” as a Cause of Lung Collapse. The secretion and function of surfactant in the alveoli were discussed in Chap...
    • Tuberculosis
  • Hypoxia and Oxygen Therapy
    • Inadequate Tissue Capability to Use Oxygen. The classic cause of inability of the tissues to use O2 is cyanide poisoning, in whi...
    • Cyanosis
  • Hypercapnia—Excess Carbon Dioxide in the Body Fluids
    • Dyspnea
  • Artificial Respiration
    • Resuscitator. Many types of respiratory resuscitators are available, and each has its own characteristic principles of operation...
      • Tank Respirator (the “Iron Lung”). Figure 43-­9B shows the tank respirator with a patient’s body inside the tank and the head pr...
        • Effect of the Resuscitator and the Tank Respirator on Venous Return. When air is forced into the lungs under positive pressure b...
• 44 - Aviation, High Altitude, and Space Physiology
  • Alveolar Po2 at Different Elevations
    • Carbon Dioxide and Water Vapor Decrease the Alveolar Oxygen. Even at high altitudes, carbon dioxide (CO2) is continually excrete...
      • Alveolar Po2 at Different Altitudes. The fifth column of Table 44-­1 shows the approximate Po2 values in the alveoli at differen...
        • Saturation of Hemoglobin With Oxygen at Different Altitudes. Figure 44-­1 shows arterial blood O2 saturation at different altitu...
        • The “Ceiling” When Breathing Air and When Breathing Oxygen in an Unpressurized Airplane. When comparing the two arterial blood O...
    • Acute Effects of Hypoxia
    • Acclimatization to Low Po2
      • Increased Pulmonary Ventilation—Role of Arterial Chemoreceptors. Immediate exposure to low Po2 stimulates the arterial chemorece...
        • Increase in Red Blood Cells and Hemoglobin Concentration During Acclimatization. As discussed in Chapter 33, hypoxia is a major ...
        • Increased Diffusing Capacity After Acclimatization. The normal diffusing capacity for O2 through the pulmonary membrane is about...
        • Peripheral Circulatory System Changes During Acclimatization—Increased Tissue Capillarity. The cardiac output often increases as...
        • Cellular Acclimatization. In animals native to altitudes of 13,000 to 17,000 feet, cell mitochondria and cellular oxidative enzy...
    • Chronic Mountain Sickness
• 45 - Physiology of Deep-­Sea Diving and Other Hyperbaric Conditions
  • Relationship of Pressure to Sea Depth. A column of seawater 33 feet (10.1 meters) deep exerts the same pressure at its bottom as...
  • Effect of High Partial Pressures of Individual Gases on the Body
  • Oxygen Toxicity at High Pressures
    • Effect of Very High Po2 on Blood Oxygen Transport. When the Po2 in the blood rises above 100 mm Hg, the amount of O2 dissolved i...
      • Effect of High Alveolar Po2 on Tissue Po2. Let us assume that the Po2 in the lungs is about 3000 mm Hg (4 atm pressure). Referri...
        • Acute Oxygen Poisoning. The extremely high tissue Po2 that occurs when O2 is breathed at a very high alveolar O2 pressure can be...
        • Excessive Intracellular Oxidation as a Cause of Nervous System Oxygen Toxicity—Oxidizing Free Radicals. Molecular O2 has little ...
        • Chronic Oxygen Poisoning Causes Pulmonary Disability. A person can be exposed to only 1 atm pressure of O2 almost indefinitely w...
    • Carbon Dioxide Toxicity at Great Depths in the Sea
    • Decompression of the Diver After Excess Exposure to High Pressure
      • Symptoms of Decompression Sickness (“Bends”). The symptoms of decompression sickness are caused by gas bubbles blocking many blo...
        • Nitrogen Elimination From the Body; Decompression Tables. If a diver is brought to the surface slowly, enough of the dissolved n...
        • Tank Decompression and Treatment of Decompression Sickness. Another procedure widely used for decompression of professional dive...
  • Self-­Contained Underwater Breathing Apparatus (Scuba) Diving
• 46 - Organization of the Nervous System, Basic Functions of Synapses, and Neurotransmitters
  • Central Nervous System Neuron: The Basic Functional Unit
    • Storage of Information—Memory
  • Major Levels of Central Nervous System Function
    • Spinal Cord Level
    • Lower Brain or Subcortical Level
    • Higher Brain or Cortical Level
  • Comparison of the Nervous System to A Computer
  • Central Nervous System Synapses
    • “One-­Way” Conduction at Chemical Synapses. Chemical synapses have one exceedingly important characteristic that makes them high...
      • Transmitter Release From Presynaptic Terminals—Role of Calcium Ions
      • Transmitter Actions on Postsynaptic Neurons—Function of Receptor Proteins
        • Ion Channels. The ion channels in the postsynaptic neuronal membrane are usually of two types: (1) cation channels, which usuall...
        • “Second Messenger” System in the Postsynaptic Neuron. Many functions of the nervous system—for example, the process of memory—re...
      • Excitatory or Inhibitory Receptors in the Postsynaptic Membrane
        • Excitation
        • Inhibition
      • Small-­Molecule, Rapidly Acting Transmitters
        • Recycling of Small-­Molecule Types of Vesicles. Vesicles that store and release small-­molecule transmitters are continually rec...
        • Characteristics of Some Important Small-­Molecule Transmitters. Acetylcholine is secreted by neurons in many areas of the nervou...
      • Neuropeptides
        • Neuropeptide and Small-­Molecule Transmitters May Coexist in the Same Neurons. Slowly acting neuropeptide transmitters and rapid...
        • Resting Membrane Potential of the Neuronal Soma. Figure 46-­9 shows the soma of a spinal motor neuron, indicating a resting memb...
        • Concentration Differences of Ions Across the Neuronal Somal Membrane. Figure 46-­9 also shows the concentration differences acro...
        • Uniform Distribution of Electrical Potential Inside the Neuronal Soma. The interior of the neuronal soma contains a highly condu...
        • Effect of Synaptic Excitation on the Postsynaptic Membrane—Excitatory Postsynaptic Potential. Figure 46-­10A shows the resting n...
        • Generation of Action Potentials in the Initial Segment of the Axon Leaving the Neuron—Threshold for Excitation. When the EPSP ri...
  • Electrical Events During Neuronal Inhibition
    • Effect of Inhibitory Synapses on the Postsynaptic Membrane—Inhibitory Postsynaptic Potential. The inhibitory synapses mainly ope...
      • Presynaptic Inhibition
      • Time Course of Postsynaptic Potentials
      • “Spatial Summation” in Neurons—Threshold for Firing
      • “Temporal Summation” Caused by Successive Discharges of a Presynaptic Terminal
        • Simultaneous Summation of Inhibitory and Excitatory Postsynaptic Potentials. If an IPSP tends to decrease the membrane potential...
      • Facilitation of Neurons
  • Special Functions of Dendrites for Exciting Neurons
    • Large Spatial Field of Excitation of Dendrites. The dendrites of the anterior motor neurons often extend 500 to 1000 micrometers...
      • Most Dendrites Cannot Transmit Action Potentials—But They Can Transmit Signals Within the Same Neuron by Electrotonic Conduction...
        • Decrement of Electrotonic Conduction in the Dendrites—Greater Excitatory (or Inhibitory) Effect by Synapses Located Near the Som...
        • Summation of Excitation and Inhibition in Dendrites. The uppermost dendrite of Figure 46-­12 is shown to be stimulated by both e...
  • Excitation State of the Neuron and Rate of Firing
    • “Excitatory State” Is the Summated Degree of Excitatory Drive to the Neuron. If there is a higher degree of excitation than inhi...
      • Fatigue of Synaptic Transmission. When excitatory synapses are repetitively stimulated at a rapid rate, the number of discharges...
        • Effect of Acidosis or Alkalosis on Synaptic Transmission. Most neurons are highly responsive to changes in pH of the surrounding...
        • Effect of Hypoxia on Synaptic Transmission. Neuronal excitability is also highly dependent on an adequate supply of oxygen. Cess...
        • Effect of Drugs on Synaptic Transmission. Many drugs are known to increase the excitability of neurons, and others are known to ...
        • Synaptic Delay. During transmission of a neuronal signal from a presynaptic neuron to a postsynaptic neuron, a certain amount of...
• 47 - Sensory Receptors, Neuronal Circuits for Processing Information
  • Types of Sensory Receptors and the Stimuli they Detect
    • Differential Sensitivity of Receptors
      • Modality of Sensation—The “Labeled Line” Principle
    • Local Electrical Currents at Nerve Endings—Receptor Potentials
      • Mechanisms of Receptor Potentials. Different receptors can be excited in one of several ways to cause receptor potentials: (1) b...
        • Maximum Receptor Potential Amplitude. The maximum amplitude of most sensory receptor potentials is about 100 mV, but this level ...
        • Relation of the Receptor Potential to Action Potentials. When the receptor potential rises above the threshold for eliciting act...
      • Receptor Potential of the Pacinian Corpuscle—an Example of Receptor Function
        • Relation Between Stimulus Intensity and the Receptor Potential. Figure 47-­4 shows the changing amplitude of the receptor potent...
    • Adaptation of Receptors
      • Mechanisms by Which Receptors Adapt. The mechanism of receptor adaptation is different for each type of receptor in much the sam...
        • Slowly Adapting Receptors Detect Continuous Stimulus Strength—the “Tonic” Receptors. Slowly adapting receptors continue to trans...
        • Rapidly Adapting Receptors Detect Change in Stimulus Strength—the “Rate Receptors,” “Movement Receptors,” or “Phasic Receptors.”...
        • Predictive Function of the Rate Receptors. If the rate at which some change in the body’s status is taking place is known, the s...
  • Signal Intensity Transmission in Nerve Tracts—Spatial and Temporal Summation
    • Spatial Summation. Figure 47-­7 shows the phenomenon of spatial summation, whereby increasing signal strength is transmitted by ...
  • Transmission and Processing of Signals in Neuronal Pools
  • Relaying of Signals Through Neuronal Pools
    • Organization of Neurons for Relaying Signals. ­Figure 47-­9 is a schematic diagram of several neurons in a neuronal pool, showin...
      • Threshold and Subthreshold Stimuli—Excitation or Facilitation. As discussed in Chapter 46, discharge of a single excitatory pres...
        • Inhibition of a Neuronal Pool. Some incoming fibers inhibit neurons, rather than exciting them. This mechanism is the opposite o...
      • Divergence of Signals Passing Through Neuronal Pools
      • Convergence of Signals
      • Neuronal Circuit With Both Excitatory and Inhibitory Output Signals
        • Synaptic Afterdischarge. When excitatory synapses discharge on the surfaces of dendrites or soma of a neuron, a postsynaptic ele...
        • Reverberatory (Oscillatory) Circuit as a Cause of Signal Prolongation. One of the most important of all circuits in the entire n...
        • Signal Prolongation Characteristics of a Reverberatory Circuit. Figure 47-­15 shows output signals from a typical reverberatory ...
      • Continuous Signal Output From Some Neuronal Circuits
        • Continuous Discharge Caused by Intrinsic Neuronal Excitability. Neurons, like other excitable tissues, discharge repetitively if...
        • Continuous Signals Emitted From Reverberating Circuits as a Means for Transmitting Information. A reverberating circuit that doe...
      • Rhythmical Signal Output
  • Instability and Stability of Neuronal Circuits
    • Automatic Short-­Term Adjustment of Pathway Sensitivity by the Fatigue Mechanism. Those neuronal pathways that are overused usua...
• 48 - Somatic Sensations: I. General Organization, Tactile and Position Senses
  • Classification of Somatic Senses
  • Detection and Transmission of Tactile Sensations
    • Interrelations Among the Tactile Sensations of Touch, Pressure, and Vibration. Although touch, pressure, and vibration are frequ...
      • Tactile Receptors. There are at least six entirely different types of tactile receptors, but many more similar to these also exi...
        • Transmission of Tactile Signals in Peripheral Nerve Fibers. Almost all specialized sensory receptors, such as Meissner’s corpusc...
        • Detection of Vibration. All tactile receptors are involved in detection of vibration, although different receptors detect differ...
        • Detection of Tickle and Itch by Mechanoreceptive Free Nerve Endings. Neurophysiological studies have demonstrated the existence ...
  • Sensory Pathways for Transmitting Somatic Signals Into the Central Nervous System
    • Anatomy of the Dorsal Column–Medial Lemniscal System
      • Spatial Orientation of the Nerve Fibers in the Dorsal Column–Medial Lemniscal System
    • Somatosensory Cortex
      • Somatosensory Areas I and II. Figure 48-­6 shows two separate sensory areas in the anterior parietal lobe called somatosensory a...
        • Spatial Orientation of Signals From Different Parts of the Body in Somatosensory Area I. Somatosensory area I lies immediately b...
      • Layers of the Somatosensory Cortex and Their Function
      • The Sensory Cortex Is Organized in Vertical Columns of Neurons; Each Column Detects a Different Sensory Spot on the Body With a ...
      • Functions of Somatosensory Area I
    • Somatosensory Association Areas
  • Characteristics of Dorsal Column–Medial Lemniscal Signal Transmission and Analysis
    • Basic Neuronal Circuit in the Dorsal Column–Medial Lemniscal System. The lower part of Figure 48-­9 shows the basic organization...
      • Two-­Point Discrimination. A method frequently used to test tactile discrimination is to determine a person’s so-­called “two-­p...
        • Effect of Lateral Inhibition to Increase the Degree of Contrast in the Perceived Spatial Pattern. As noted in Chapter 47, virtua...
        • Transmission of Rapidly Changing and Repetitive Sensations. The dorsal column system is also of particular importance in apprisi...
        • Vibratory Sensation. Vibratory signals are rapidly repetitive and can be detected as vibration up to 700 cycles/sec. The higher ...
    • Position Senses
      • Position Sensory Receptors. Knowledge of position, both static and dynamic, depends on knowing the degrees of angulation of all ...
        • Processing of Position Sense Information in the ­Dorsal Column–Medial Lemniscal Pathway. Referring to ­Figure 48-­12, one sees t...
  • Transmission of Sensory Signals in the Anterolateral Pathway
• 49 - Somatic Sensations: II. Pain, Headache, and Thermal Sensations
  • Fast Pain and Slow Pain and Their Qualities
    • Pain Receptors Are Free Nerve Endings. The pain receptors in the skin and other tissues are all free nerve endings. They are wid...
      • Mechanical, Thermal, and Chemical Stimuli Excite Pain Receptors. Pain can be elicited by multiple types of stimuli, classified a...
        • Nonadapting Nature of Pain Receptors. In contrast to most other sensory receptors of the body, pain receptors adapt very little ...
        • Rate of Tissue Damage as a Stimulus for Pain. The average person begins to perceive pain when the skin is heated above 45°C, as ...
        • Special Importance of Chemical Pain Stimuli During Tissue Damage. Extracts from damaged tissue cause intense pain when injected ...
        • Tissue Ischemia as a Cause of Pain. When blood flow to a tissue is blocked, the tissue often becomes very painful within a few m...
        • Muscle Spasm as a Cause of Pain. Muscle spasm is also a common cause of pain and is the basis of many clinical pain syndromes. T...
  • Dual Pathways for Transmission of Pain Signals Into the Central Nervous System
    • Neospinothalamic Tract for Fast Pain
      • Termination of the Neospinothalamic Tract in the Brain Stem and Thalamus. A few fibers of the neospinothalamic tract terminate i...
        • The Nervous System Can Localize Fast Pain in the Body. The fast-­sharp type of pain can be localized much more exactly in the di...
        • Glutamate, the Probable Neurotransmitter of the Type Aδ Fast Pain Fibers. It is believed that glutamate is the neurotransmitter ...
      • Paleospinothalamic Pathway for Transmitting Slow-­Chronic Pain
        • Substance P, the Probable Slow-­Chronic Neurotransmitter of Type C Nerve Endings. Type C pain fiber terminals entering the spina...
        • Projection of Paleospinothalamic Pathway (Slow-­Chronic Pain Signals) Into the Brain Stem and Thalamus. The slow-­chronic paleos...
        • Poor Capability of the Nervous System to Localize Precisely the Source of Pain Transmitted in the Slow-­Chronic Pathway. Localiz...
        • Function of the Reticular Formation, Thalamus, and Cerebral Cortex in the Appreciation of Pain. Complete removal of the somatic ...
        • Special Capability of Pain Signals to Arouse Overall Brain Excitability. Electrical stimulation in the reticular areas of the br...
        • Surgical Interruption of Pain Pathways. When a person has severe and intractable pain (sometimes resulting from rapidly spreadin...
  • Pain Suppression (Analgesia) System in the Brain and Spinal Cord
    • The Brain’s Opiate System—Endorphins and Enkephalins
  • Referred Pain
  • Visceral Pain
    • Localization of Referred Pain Transmitted via Visceral Pathways. When visceral pain is referred to the surface of the body, the ...
  • Thermal Sensations
    • Thermal Receptors and Their Excitation
      • Stimulation of Thermal Receptors—Sensations of Cold, Cool, Indifferent, Warm, and Hot. Figure 49-­10 shows the effects of differ...
        • Stimulatory Effects of Rising and Falling Temperature—Adaptation of Thermal Receptors. When a cold receptor is suddenly subjecte...
        • Spatial Summation of Thermal Sensations. Because the number of cold or warmth endings in any one surface area of the body is sli...
• 50 - The Eye: I. Optics of Vision
  • Physical Principles of Optics
  • Optics of the Eye
    • Consideration of All Refractive Surfaces of the Eye as a Single Lens—The “Reduced” Eye. If all the refractive surfaces of the ey...
    • Mechanism of “accommodation”
      • Accommodation Is Controlled by Parasympathetic Nerves. Ciliary muscle is controlled almost entirely by parasympathetic nerve sig...
        • Presbyopia—Loss of Accommodation by the Lens. As a person grows older, the lens grows larger and thicker and becomes far less el...
    • Pupillary Diameter
    • Visual Acuity
      • Clinical Method for Stating Visual Acuity. The chart for testing eyes usually consists of letters of different sizes placed 20 f...
        • Determination of Distance by Sizes of Retinal Images of Known Objects. If one knows that a person being viewed is 6 feet tall, o...
        • Determination of Distance by Moving Parallax. Another important means whereby the eyes determine distance is that of moving para...
        • Determination of Distance by Stereopsis—Binocular Vision. Another method whereby one perceives parallax is that of binocular vis...
  • Fluid System of the Eye—Intraocular Fluid
    • Intraocular Pressure
• 51 - The Eye: II. Receptor and Neural Function of the Retina
  • Anatomy and Function of the Structural Elements of the Retina
    • The Retina Is Composed of Ten Layers or Boundaries. Figure 51-­1 shows the functional components of the retina, which are arrang...
      • Foveal Region of the Retina and Its Importance in Acute Vision. The fovea is a minute area in the center of the retina, shown in...
        • Rods and Cones Are Essential Components of Photoreceptors. Figure 51-­3 is a diagrammatic representation of the essential compon...
        • Pigment Layer of the Retina. The black pigment melanin in the pigment layer prevents light reflection throughout the globe of th...
  • Photochemistry of Vision
  • Rhodopsin-­Retinal Visual Cycle and Excitation of the Rods
    • Rhodopsin and Its Decomposition by Light Energy. The outer segment of the rod that projects into the pigment layer of the retina...
      • Re-­Formation of Rhodopsin. The first stage in re-­formation of rhodopsin, as shown in Figure 51-­5, is to reconvert the all-­tr...
        • Role of Vitamin A for Formation of Rhodopsin. Note in Figure 51-­5 that there is a second chemical route whereby all-­trans reti...
        • Duration of the Receptor Potential, and Logarithmic Relation of the Receptor Potential to Light Intensity. When a sudden pulse o...
        • Mechanism Whereby Rhodopsin Decomposition Decreases Membrane Sodium Conductance—The Excitation “Cascade.” Under optimal conditio...
      • Photochemistry of Color Vision by the Cones
        • Value of Light and Dark Adaptation in Vision. Between the limits of maximal dark adaptation and maximal light adaptation, the ey...
  • Color Vision
    • Spectral Sensitivities of the Three Types of Cones. On the basis of color vision tests, the spectral sensitivities of the three ...
      • Interpretation of Color in the Nervous System. In Figure 51-­10, one can see that an orange monochromatic light with a wavelengt...
        • Perception of White Light. About equal stimulation of all the red, green, and blue cones gives one the sensation of seeing white...
  • Neural Function of the Retina
    • The Visual Pathway From the Cones to the Ganglion Cells Functions Differently From the Rod Pathway. As is true for many of our o...
      • Neurotransmitters Released by Retinal Neurons. Not all the neurotransmitter chemical substances used for synaptic transmission i...
        • Transmission of Most Signals Occurs in the Retinal Neurons by Electrotonic Conduction, Not by Action Potentials. The only retina...
      • Lateral Inhibition to Enhance Visual Contrast—Function of the Horizontal Cells
      • Depolarizing and Hyperpolarizing Bipolar Cells
      • Amacrine Cells and Their Functions
        • P and M Cells. In primates, a different classification of retinal ganglion cells is used, and as many as 20 types of retinal gan...
  • Excitation of the Ganglion Cells
    • Spontaneous, Continuous Action Potentials in the Ganglion Cells. It is from the ganglion cells that the long fibers of the optic...
      • Transmission of Signals Depicting Contrasts in the Visual Scene—The Role of Lateral Inhibition
      • Transmission of Color Signals by the Ganglion Cells
• 52 - The Eye: III. Central Neurophysiology of Vision
  • Visual Pathways
  • Organization and Function of the Visual Cortex
    • Primary Visual Cortex. The primary visual cortex (see Figure 52-­2) lies in the calcarine fissure area, extending forward from t...
    • The Primary Visual Cortex has six Major Layers
      • Vertical Neuronal Columns in the Visual Cortex. The visual cortex is organized structurally into several million vertical column...
        • “Color Blobs” in the Visual Cortex. Interspersed among the primary visual columns, as well as among the columns of some of the s...
        • Interaction of Visual Signals From the Two Separate Eyes. Recall that visual signals from the two separate eyes are relayed thro...
        • Two Major Pathways for Analysis of Visual Information: (1) The Fast “Position” and “Motion” Pathway and (2) the Accurate Color P...
        • Analysis of Contrasts in Visual Images. If a person looks at a blank wall, only a few neurons in the primary visual cortex will ...
        • Visual Cortex Also Detects Orientation of Lines and Borders—“Simple” Cells. The visual cortex detects not only the existence of ...
        • “Complex” Cells Detect Line Orientation When a Line Is Displaced Laterally or Vertically in the Visual Field. As the visual sign...
        • Detection of Lines of Specific Lengths, Angles, or Other Shapes. Some neurons in the outer layers of the primary visual columns,...
    • Detection of Color
  • Eye Movements and Their Control
    • Muscular Control of Eye Movements. The eye movements are controlled by three pairs of muscles, shown in Figure 52-­7: (1) the me...
    • Fixation Movements of the Eyes
      • Mechanism of Involuntary Locking Fixation—Role of the Superior Colliculi. The involuntary locking type of fixation discussed in ...
        • Saccadic Movement of the Eyes—A Mechanism of Successive Fixation Points. When a visual scene is moving continually before the ey...
        • Saccadic Movements During Reading. During the process of reading, a person usually makes several saccadic movements of the eyes ...
        • Fixation on Moving Objects—“Pursuit Movement.” The eyes can also remain fixed on a moving object, which is called pursuit moveme...
        • Superior Colliculi Are Mainly Responsible for Turning the Eyes and Head Toward a Visual Disturbance. Even after the visual corte...
      • Neural Mechanism of Stereopsis for Judging Distances of Visual Objects
    • Autonomic Nerves to the Eyes
    • Control of Pupillary Diameter
• 53 - The Sense of Hearing
• 54 - The Chemical Senses—Taste and Smell
  • Sense of Taste
    • Primary Taste Sensations
      • Sour Taste. The sour taste is caused by acids—that is, by the hydrogen ion concentration—and the intensity of this taste sensati...
        • Salty Taste. The salty taste is elicited by ionized salts, mainly by the sodium ion concentration. The quality of the taste vari...
        • Sweet Taste. The sweet taste is not caused by any single class of chemicals. Some of the types of chemicals that cause this tast...
        • Bitter Taste. The bitter taste, like the sweet taste, is not caused by any single type of chemical agent. Here again, the substa...
        • Umami Taste. Umami, a Japanese word meaning “delicious,” designates a pleasant taste sensation that is qualitatively different f...
    • Threshold for Taste
    • Taste Buds and Their Function
      • Location of the Taste Buds. The taste buds are found on three types of papillae of the tongue, as follows (see Figure 54-­1A): (...
        • Specificity of Taste Buds for a Primary Taste ­Stimulus. Microelectrode studies from single taste buds show that each taste bud ...
        • Generation of Nerve Impulses by the Taste Bud. On first application of the taste stimulus, the rate of discharge of the nerve fi...
        • Taste Reflexes Are Integrated in the Brain Stem. From the tractus solitarius, many taste signals are transmitted within the brai...
        • Rapid Adaptation of Taste. Everyone is familiar with the fact that taste sensations adapt rapidly, often almost completely, with...
  • Sense of Smell
    • Olfactory Membrane
  • Stimulation of the Olfactory Cells
    • Mechanism of Excitation of the Olfactory Cells. The portion of each olfactory cell that responds to the olfactory chemical stimu...
      • Membrane Potentials and Action Potentials in ­Olfactory Cells. The membrane potential inside unstimulated olfactory cells, as me...
        • Rapid Adaptation of Olfactory Sensations. The olfactory receptors adapt about 50% in the first second or so after stimulation. T...
      • Search for the Primary Sensations of Smell
        • Affective Nature of Smell. Smell, even more so than taste, has the affective quality of either pleasantness or unpleasantness, a...
        • Threshold for Smell. One of the principal characteristics of smell is the minute quantity of stimulating agent in the air that c...
        • Gradations of Smell Intensities. Although the threshold concentrations of substances that evoke smell are extremely slight, for ...
        • Transmission of Olfactory Signals Into the Olfactory Bulb. The olfactory bulb is shown in Figure 54-­5. The olfactory nerve fibe...
      • Primitive and Newer Olfactory Pathways Into the Central Nervous System
        • The Primitive Olfactory System—The Medial ­Olfactory Area. The medial olfactory area consists of a group of nuclei located in th...
        • The Less Old Olfactory System—The Lateral ­Olfactory Area. The lateral olfactory area is composed mainly of the prepyriform and ...
        • The Newer Pathway. A newer olfactory pathway that passes through the thalamus, passing to the dorsomedial thalamic nucleus and t...
        • Summary. Thus, there appear to be a primitive olfactory system that subserves the basic olfactory reflexes, a less old system th...
        • Centrifugal Control of Activity in the Olfactory Bulb by the Central Nervous System. Many nerve fibers that originate in the olf...
• 55 - Spinal Cord Motor Functions; the Cord Reflexes
  • Organization of the Spinal Cord for Motor Functions
    • Anterior Motor Neurons. Located in each segment of the anterior horns of the cord gray matter are several thousand neurons that ...
      • Alpha Motor Neurons. The alpha motor neurons give rise to large type A alpha (Aα) motor nerve fibers, averaging 14 micrometers i...
        • Gamma Motor Neurons. Along with the alpha motor neurons, which excite contraction of the skeletal muscle fibers, about one-half ...
        • Interneurons. Interneurons are present in all areas of the cord gray matter—in the dorsal horns, the anterior horns, and the int...
  • Muscle Sensory Receptors—Muscle Spindles and Golgi Tendon Organs—and Their Roles in Muscle Control
  • Receptor Function of the Muscle Spindle
    • Structure and Motor Innervation of the Muscle ­Spindle. The organization of the muscle spindle is shown in Figure 55-­3. Each sp...
      • Sensory Innervation of the Muscle Spindle. The receptor portion of the muscle spindle is its central portion. As shown in Figure...
        • Primary Ending. In the center of the receptor area, a large sensory nerve fiber encircles the central portion of each intrafusal...
        • Secondary Ending. Usually one but sometimes two smaller sensory nerve fibers—type II fibers with an average diameter of 8 microm...
        • Division of the Intrafusal Fibers Into Nuclear Bag and Nuclear Chain Fibers—Dynamic and Static Responses of the Muscle Spindle. ...
        • The Primary and the Secondary Endings Both Respond to the Length of the Receptor—“Static” Response. When the receptor portion of...
        • The Primary Ending (but Not the Secondary Ending) Responds to Rate of Change of Receptor Length—“Dynamic” Response. When the len...
        • Control of Intensity of the Static and Dynamic ­Responses by the Gamma Motor Nerves. The gamma motor nerves to the muscle spindl...
        • Continuous Discharge of the Muscle Spindles Under Normal Conditions. Normally, when there is some degree of gamma nerve excitati...
    • Muscle Stretch Reflex
      • Neuronal Circuitry of the Stretch Reflex. Figure 55-­5 demonstrates the basic circuit of the muscle spindle stretch reflex, show...
        • Dynamic Stretch Reflex and Static Stretch Reflexes. The stretch reflex can be divided into two components: the dynamic stretch r...
        • “Damping” Function of the Dynamic and Static Stretch Reflexes in Smoothing Muscle Contraction. An especially important function ...
      • Brain Areas for Control of the Gamma Motor System
        • The Muscle Spindle System Stabilizes Body Position During Tense Action. One of the most important functions of the muscle spindl...
  • Golgi Tendon Reflex
    • Golgi Tendon Organ Helps Control Muscle Tension. The Golgi tendon organ, shown in Figure 55-­8, is an encapsulated sensory recep...
      • Transmission of Impulses From the Tendon Organ Into the Central Nervous System. Signals from the tendon organ are transmitted th...
        • The Tendon Reflex Prevents Excessive Tension on the Muscle. When the Golgi tendon organs of a muscle tendon are stimulated by in...
        • Possible Role of the Tendon Reflex to Equalize ­Contractile Force Among the Muscle Fibers. Another likely function of the Golgi ...
      • Function of the Muscle Spindles and Golgi Tendon Organs in Motor Control by Higher Levels of the Brain
  • Flexor Reflex and the Withdrawal Reflexes
    • Neuronal Mechanism of the Flexor Reflex. The left-­hand portion of Figure 55-­9 shows the neuronal pathways for the flexor refle...
  • Crossed Extensor Reflex
  • Reciprocal Inhibition and Reciprocal Innervation
    • Postural and Locomotive Reflexes of the Cord
      • Positive Supportive Reaction. Pressure on the footpad of a decerebrate animal causes the limb to extend against the pressure app...
        • Cord “Righting” Reflexes. When a spinal animal is laid on its side, it will make uncoordinated movements to try to raise itself ...
  • Stepping and Walking Movements
    • Rhythmical Stepping Movements of a Single Limb. Rhythmical stepping movements are frequently observed in the limbs of spinal ani...
      • Reciprocal Stepping of Opposite Limbs. If the lumbar spinal cord is not split down its center, every time stepping occurs in the...
        • Diagonal Stepping of All Four Limbs—“Mark Time” Reflex. If a well-­healed spinal animal (with spinal transection in the neck abo...
• 56 - Cortical and Brain Stem Control of Motor Function
  • Motor Cortex and Corticospinal Tract
    • Primary Motor Cortex
    • Premotor Area
    • Supplementary Motor Area
      • Broca’s Area (Motor Speech Area). Figure 56-­3 shows a premotor area labeled “word formation” lying immediately anterior to the ...
        • “Voluntary” Eye Movement Field. In the premotor area immediately above Broca’s area is a locus for controlling voluntary eye mov...
        • Head Rotation Area. Slightly higher in the motor association area, electrical stimulation elicits head rotation. This area is cl...
        • Area for Hand Skills. In the premotor area immediately anterior to the primary motor cortex for the hands and fingers is a regio...
      • Corticospinal (Pyramidal) Tract
        • The Corticorubrospinal System Is an Accessory Pathway for Transmitting Relatively Discrete Signals From the Motor Cortex to the ...
        • Each Column of Neurons Functions as an Integrative Processing System. The neurons of each column operate as an integrative proce...
        • Dynamic and Static Signals Are Transmitted by the Pyramidal Neurons. If a strong signal is sent to a muscle to cause initial rap...
      • Somatosensory Feedback to the Motor Cortex Helps Control Precision of Muscle Contraction
      • Stimulation of the Spinal Motor Neurons
        • Patterns of Movement Elicited by Spinal Cord Centers. From Chapter 55, recall that the spinal cord can provide certain specific ...
  • Control of Motor Functions by the Brain Stem
    • Excitatory-­Inhibitory Antagonism Between Pontine and Medullary Reticular Nuclei
      • Pontine Reticular System Transmits Excitatory Signals. The pontine reticular nuclei transmit excitatory signals downward into th...
        • Medullary Reticular System Transmit Inhibitory Signals. The medullary reticular nuclei transmit inhibitory signals to the same a...
      • Role of the Vestibular Nuclei to Excite the Antigravity Muscles
        • The Decerebrate Animal Develops Spastic Rigidity. When the brain stem of an animal is sectioned below the midlevel of the mesenc...
    • Vestibular Apparatus
      • “Maculae”—Sensory Organs of the Utricle and Saccule for Detecting Orientation of the Head With Respect to Gravity. Located on th...
        • Directional Sensitivity of the Hair Cells—Kinocilium. Each hair cell has about 100 small cilia called stereocilia, plus one larg...
        • Semicircular Ducts. The three semicircular ducts in each vestibular apparatus, known as the anterior, posterior, and lateral (ho...
    • Function of the Utricle and Saccule in the Maintenance of Static Equilibrium
    • Detection of Head Rotation by the Semicircular Ducts
• 57 - Cerebellum and Basal Ganglia Contributions to Overall Motor Control
  • The Cerebellum and its Motor Functions
    • Neuronal Circuit of the Functional Unit. Also shown in the left half of Figure 57-­7 is the neuronal circuit of the functional u...
      • Purkinje Cells and Deep Nuclear Cells Fire Continuously Under Normal Resting Conditions. One characteristic of both Purkinje cel...
        • Balance Between Excitation and Inhibition at the Deep Cerebellar Nuclei. Referring again to the circuit of Figure 57-­7, note th...
        • Basket Cells and Stellate Cells Cause Lateral Inhibition of Purkinje Cells in the Cerebellum. In addition to the deep nuclear ce...
      • Turn-­On/Turn-­Off and Turn-­Off/Turn-­On Output Signals From the Cerebellum
      • The Purkinje Cells “Learn” to Correct Motor Errors—Role of the Climbing Fibers
      • The Vestibulocerebellum Functions in Association With the Brain Stem and Spinal Cord to Control Equilibrium and Postural Movemen...
      • Spinocerebellum—Feedback Control of Distal Limb Movements via the Intermediate Cerebellar Cortex and the Interposed Nucleus
        • Function of the Cerebellum to Prevent Overshoot and to “Damp” Movements. Almost all movements of the body are “pendular.” For ex...
        • Cerebellar Control of Ballistic Movements. Most rapid movements of the body, such as the movements of the fingers in typing, occ...
      • Cerebrocerebellum—Function of the Large Lateral Zone of the Cerebellar Hemisphere to Plan, Sequence, and Time Complex Movements
        • Planning of Sequential Movements. The planning of sequential movements requires that the lateral zones of the hemispheres commun...
        • Timing Function for Sequential Movements. Another important function of the lateral zones of the cerebellar hemispheres is to pr...
        • Extramotor Predictive Functions of the Cerebrocerebellum. The cerebrocerebellum (the large lateral lobes) also helps to “time” e...
  • The Basal Ganglia and Their Motor Functions
    • Neural Pathways of the Putamen Circuit. Figure 57-­11 shows the principal pathways through the basal ganglia for executing learn...
  • Integration of the Many Parts of the Total Motor Control System
    • Spinal Level
    • Hindbrain Level
    • Motor Cortex Level
      • Associated Functions of the Cerebellum. The cerebellum functions with all levels of muscle control. It functions with the spinal...
        • Associated Functions of the Basal Ganglia. The basal ganglia are essential to motor control in ways entirely different from thos...
    • What drives us to action
• 58 - Cerebral Cortex, Intellectual Functions of the Brain, Learning, and Memory
  • Physiologic Anatomy of the Cerebral Cortex
  • Functions of Specific Cortical Areas
    • Association Areas
      • Parieto-­Occipitotemporal Association Area
        • Analysis of the Spatial Coordinates of the Body. An area beginning in the posterior parietal cortex and extending into the super...
        • Wernicke’s Area Is Important for Language Comprehension. The major area for language comprehension, called Wernicke’s area, lies...
        • The Angular Gyrus Area Is Needed for Initial Processing of Visual Language (Reading). Posterior to the language comprehension ar...
        • Area for Naming Objects. In the most lateral portions of the anterior occipital lobe and posterior temporal lobe is an area for ...
      • Prefrontal Association Area
        • Broca’s Area Provides the Neural Circuitry for Word Formation. Broca’s area, shown in Figure 58-­5, is located partly in the pos...
      • Limbic Association Area
      • Area for Recognition of Faces
        • Angular Gyrus—Interpretation of Visual Information. The angular gyrus is the most inferior portion of the posterior parietal lob...
      • Concept of the Dominant Hemisphere
      • Role of Language in the Function of Wernicke’s Area and in Intellectual Functions
        • Decreased Aggressiveness and Inappropriate Social Responses. Decreased aggressiveness and inappropriate social responses probabl...
        • Inability to Progress Toward Goals or to Carry Through Sequential Thoughts. We learned earlier in this chapter that the prefront...
        • Elaboration of Thought, Prognostication, and Performance of Higher Intellectual Functions by the Prefrontal Areas—Concept of a “...
  • Thoughts, Consciousness, and Memory
    • Positive and Negative Memory—“Sensitization” or “Habituation” of Synaptic Transmission. Although we often think of memories as b...
    • Short-­Term Memory
    • Intermediate Long-­Term Memory
      • Memory Based on Chemical Changes in Presynaptic Terminals or Postsynaptic Neuronal Membranes
        • Mechanism for Facilitation. In the case of facilitation, at least part of the molecular mechanism is believed to be the followin...
    • Long-­Term Memory
      • Structural Changes Occur in Synapses During Development of Long-­Term Memory
      • Number of Neurons and Their Connectivities Often Change Significantly During Learning
    • Consolidation of Memory
      • Rehearsal Enhances the Transference of Short-­Term Memory Into Long-­Term Memory. Studies have shown that rehearsal of the same ...
        • New Memories Are Codified During Consolidation. One of the most important features of consolidation is that new memories are cod...
        • Retrograde Amnesia—Inability to Recall Memories From the Past After Hippocampal or Thalmic Lesions. When retrograde amnesia occu...
        • Hippocampi Are Not Important in Reflexive Learning. People with hippocampal lesions usually do not have difficulty in learning p...
• 59 - The Limbic System and the Hypothalamus—Behavioral and Motivational Mechanisms of the Brain
  • Activating—Driving Systems Of The Brain
  • Control Of Cerebral Activity By Continuous Excitatory Signals From The Brain Stem
    • Reticular Excitatory Area of the Brain Stem—a Driver of Brain Activity
      • Excitation of the Reticular Excitatory Area by Peripheral Sensory Signals. The level of activity of the reticular excitatory are...
        • Increased Activity of the Excitatory Area Causedby Feedback Signals Returning From the Cerebral Cortex. Not only do excitatory s...
        • The Thalamus Is a Distribution Center That Controls Activity in Specific Regions of the Cortex. As pointed out in Chapter 58, al...
      • A Reticular Inhibitory Area Is Located in the Lower Brain Stem
        • Neurohormonal Systems in the Human Brain. Figure 59-­3 shows the brain stem areas in the human brain for activating four neuroho...
        • Other Neurotransmitters and Neurohormonal Substances Secreted in the Brain. Without describing their function, the following is ...
  • Limbic System
  • The Hypothalamus, a Major Control Headquarters for the Limbic System
    • Cardiovascular Regulation. Stimulation of different areas throughout the hypothalamus can cause many neurogenic effects on the c...
      • Body Temperature Regulation. The anterior portion of the hypothalamus, especially the preoptic area, is concerned with regulatio...
        • Body Water Regulation. The hypothalamus regulates body water in two ways: (1) by creating the sensation of thirst, which drives ...
        • Regulation of Uterine Contractility and Milk Ejection from the Breasts. Stimulation of the paraventricular nuclei causes their n...
        • Gastrointestinal and Feeding Regulation. Stimulation of several areas of the hypothalamus causes an animal to experience extreme...
        • Hypothalamic Control of Endocrine Hormone Secretion by the Anterior Pituitary Gland. Stimulation of certain areas of the hypotha...
        • Hypothalamic Control of Circadian Rhythms—The Suprachiasmatic Nucleus. The suprachiasmatic nucleus (SCN) of the hypothalamus con...
        • Summary. Several areas of the hypothalamus control specific vegetative and endocrine functions. The functions of these areas are...
  • Behavioral Functions of the Hypothalamus and Associated Limbic Structures
    • Effects Caused by Stimulation of the Hypothalamus. In addition to the vegetative and endocrine functions of the hypothalamus, st...
      • Reward Centers
      • Punishment Centers
      • Association of Rage With Punishment Centers
        • Placidity and Tameness. Exactly the opposite emotional behavior patterns occur when the reward centers are stimulated—placidity ...
        • Effect of Tranquilizers on the Reward or Punishment Centers. Administration of a tranquilizer, such as chlorpromazine, usually i...
      • Importance of Reward or Punishment in Learning and Memory—Habituation Versus Reinforcement
    • Functions Of The Hippocampus
• 60 - States of Brain Activity—Sleep, Brain Waves, Epilepsy, Psychoses, and Dementia
  • Sleep
    • REM (Paradoxical, Desynchronized) Sleep
      • Slow-­Wave Sleep
  • Basic Theories of Sleep
    • Sleep Is Caused by an Active Inhibitory Process. An earlier theory of sleep was that the excitatory areas of the upper brain ste...
      • Neuronal Centers, Neurohumoral Substances, and Mechanisms That Can Cause Sleep—Possible Role for Serotonin
        • Lesions in Sleep-­Promoting Centers Can Cause Intense Wakefulness. Discrete lesions in the raphe nuclei lead to a high state of ...
        • Other Possible Transmitter Substances Related to Sleep. Experiments have shown that the cerebrospinal fluid and the blood or uri...
        • Possible Cause of REM Sleep. It is not understood why slow-­wave sleep is broken periodically by REM sleep. However, drugs that ...
      • Cycle Between Sleep and Wakefulness
• 61 - The Autonomic Nervous System and the Adrenal Medulla
  • General Organization of the Autonomic Nervous System
    • Cholinergic and Adrenergic Fibers—Secretion of Acetylcholine or Norepinephrine
      • Mechanisms of Transmitter Secretion and Removal at Postganglionic Endings
        • Secretion of Acetylcholine and Norepinephrine by Postganglionic Nerve Endings. A few of the postganglionic autonomic nerve endin...
        • Synthesis of Acetylcholine, Its Destruction After Secretion, and Its Duration of Action. Acetylcholine is synthesized in the ter...
        • Synthesis of Norepinephrine, Its Removal, and Its Duration of Action. Synthesis of norepinephrine begins in the axoplasm of the ...
    • Receptors on the Effector Organs
      • Excitation or Inhibition of the Effector Cell by Changing Its Membrane Permeability. Because the receptor protein is an integral...
        • Receptor Action by Altering Intracellular “Second Messenger” Enzymes. Another way a receptor often functions is to activate or i...
      • Two Principal Types of Acetylcholine Receptors—Muscarinic and Nicotinic Receptors
      • Alpha and Beta Adrenergic Receptors
    • Function of the Adrenal Medullae
      • The Adrenal Medullae Support Sympathetic Nervous System Functions. Epinephrine and norepinephrine are almost always released by ...
        • Tone Caused by Basal Secretion of Epinephrine and Norepinephrine by the Adrenal Medullae. The normal resting rate of secretion b...
        • Effect of Loss of Sympathetic or Parasympathetic Tone After Denervation. Immediately after a sympathetic or parasympathetic nerv...
  • Selective Stimulation of Target Organs by Sympathetic and Parasympathetic Systems or “Mass Discharge”
    • The Sympathetic System Sometimes Responds by Mass Discharge. In some cases, almost all portions of the sympathetic nervous syste...
      • The Parasympathetic System Usually Causes Specific Localized Responses. Control functions by the parasympathetic system are ofte...
        • Control of Brain Stem Autonomic Centers by Higher Areas. Signals from the hypothalamus and even from the cerebrum can affect act...
• 62 - Cerebral Blood Flow, Cerebrospinal Fluid, and Brain Metabolism
  • Cerebral Blood Flow
    • Regulation of Cerebral Blood Flow
      • Excesses of CO2 or H+ Concentration Increase Cerebral Blood Flow. An increase in CO2 concentration in the arterial blood perfusi...
        • Importance of Cerebral Blood Flow Control by CO2 and H+. Increased H+ concentration greatly depresses neuronal activity. Therefo...
        • Oxygen Deficiency as a Regulator of Cerebral Blood Flow. Except during periods of intense brain activity, the rate of O2 utiliza...
    • Cerebral Microcirculation
  • Cerebrospinal Fluid System
    • Secretion by the Choroid Plexus. The choroid plexus, a section of which is shown in Figure 62-­6, is a cauliflower-­like growth ...
      • Absorption of Cerebrospinal Fluid Through the Arachnoidal Villi. The arachnoidal villi are microscopic fingerlike inward project...
        • Perivascular Spaces and Cerebrospinal Fluid. The large arteries and veins of the brain lie on the surface of the brain but their...
        • Lymphatic Function of the Perivascular Spaces. As is true elsewhere in the body, a small amount of protein leaks out of the brai...
  • Brain Metabolism
    • Total Brain Metabolic Rate and Metabolic Rate of Neurons. Under resting but awake conditions, brain metabolism accounts for abou...
      • Special Requirement of the Brain for Oxygen—Lack of Significant Anaerobic Metabolism. Most tissues of the body can live without ...
        • Under Normal Conditions, Most Brain Energy Is Supplied by Glucose. Under normal conditions, almost all the energy used by the br...
• 63 - General Principles of Gastrointestinal Function—Motility, Nervous Control, and Blood Circulation
  • Physiologic Anatomy of the Gastrointestinal Wall
    • Gastrointestinal Smooth Muscle Functions as a Syncytium. The individual smooth muscle fibers in the gastrointestinal tract are 2...
      • Electrical Activity of Gastrointestinal Smooth Muscle
        • “Slow Waves” Caused by Undulating Changes in Resting Membrane Potential. Most gastrointestinal contractions occur rhythmically, ...
        • Spike Potentials. The spike potentials are true action potentials. They occur automatically when the resting membrane potential ...
        • Changes in Voltage of the Resting Membrane Potential. In addition to the slow waves and spike potentials, the baseline voltage l...
        • Entry of Calcium Ions Causes Smooth Muscle Contraction. Smooth muscle contraction occurs in response to entry of calcium ions in...
        • Tonic Contraction of Some Gastrointestinal Smooth Muscle. Some smooth muscle of the gastrointestinal tract exhibits tonic contra...
  • Neural Control of Gastrointestinal Function—Enteric Nervous System
  • Autonomic Control of the Gastrointestinal Tract
    • Parasympathetic Stimulation Increases Activity of the Enteric Nervous System. The parasympathetic supply to the gut is divided i...
      • Afferent Sensory Nerve Fibers From the Gut
      • Gastrointestinal Reflexes
  • Hormonal Control of Gastrointestinal Motility
  • Functional Movements in the Gastrointestinal Tract
    • PROPULSIVE MOVEMENTS—PERISTALSIS
      • Function of the Myenteric Plexus in Peristalsis. Peristalsis occurs only weakly or not at all in any portion of the gastrointest...
        • Peristaltic Waves Move Toward the Anus With Downstream Receptive Relaxation—“Law of the Gut.” Peristalsis, theoretically, can oc...
  • Gastrointestinal Blood Flow—Splanchnic Circulation
    • Mechanisms of Increased Blood Flow During Gastrointestinal Activity. Although the precise causes of the increased blood flow dur...
      • “Countercurrent” Blood Flow in the Villi. Note in Figure 63-­8 that the arterial flow into the villus and the venous flow out of...
        • Importance of Nervous Depression of Gastrointestinal Blood Flow When Other Parts of the Body Need Extra Blood Flow. A major valu...
• 64 - Propulsion and Mixing of Food in the Alimentary Tract
  • Ingestion of Food
    • Mastication (Chewing)
    • Swallowing (Deglutition)
      • Voluntary Stage of Swallowing. When the food is ready for swallowing, it is “voluntarily” squeezed or rolled posteriorly into th...
        • Involuntary Pharyngeal Stage of Swallowing. As the bolus of food enters the posterior mouth and pharynx, it stimulates epithelia...
        • Nervous Initiation of the Pharyngeal Stage of Swallowing. The most sensitive tactile areas of the posterior mouth and pharynx fo...
        • The Pharyngeal Stage of Swallowing Momentarily Interrupts Respiration. The entire pharyngeal stage of swallowing usually occurs ...
        • The Esophageal Stage of Swallowing Involves Two Types of Peristalsis. The esophagus functions primarily to conduct food rapidly ...
        • Receptive Relaxation of the Stomach. When the esophageal peristaltic wave approaches the stomach, a wave of relaxation, transmit...
        • Function of the Lower Esophageal Sphincter (Gastroesophageal Sphincter). At the lower end of the esophagus, extending upward abo...
        • Prevention of Esophageal Reflux by Valvelike Closure of the Distal End of the Esophagus. Another factor that helps prevent reflu...
  • Motor Functions of the Stomach
    • Storage Function of the Stomach
      • Chyme. After food in the stomach has become thoroughly mixed with the stomach secretions, the resulting mixture that passes down...
        • Hunger Contractions. Besides the peristaltic contractions that occur when food is present in the stomach, another type of intens...
    • Stomach Emptying
      • Intense Antral Peristaltic Contractions During Stomach Emptying—“Pyloric Pump.” Most of the time, the rhythmic stomach contracti...
        • Role of the Pylorus in Controlling Stomach Emptying. The distal opening of the stomach is the pylorus. Here the thickness of the...
    • Regulation of Stomach Emptying
      • The Hormone Gastrin Promotes Stomach Emptying. In Chapter 65, we discuss how stretching of the stomach wall and the presence of ...
        • Hormonal Feedback From the Duodenum Inhibits Gastric Emptying—Role of Fats and the Hormone Cholecystokinin. Hormones released fr...
      • Summary of the Control of Stomach Emptying
  • Movements of the Small Intestine
  • Propulsive Movements
    • Peristalsis in the Small Intestine. Chyme is propelled through the small intestine by peristaltic waves, as discussed in Chapter...
      • Control of Peristalsis by Nervous and Hormonal Signals. Peristaltic activity of the small intestine increases markedly after a m...
        • Propulsive Effect of the Segmentation Movements. The segmentation movements, although lasting for only a few seconds at a time, ...
        • Powerful, Rapid Peristalsis—“Peristaltic Rush.” Although peristalsis in the small intestine is normally weak, intense irritation...
        • Feedback Control of the Ileocecal Sphincter by Reflexes From the Cecum. The degree of contraction of the ileocecal sphincter and...
  • Movements of the Colon
    • Mixing Movements—“Haustrations.” In the same manner that segmentation movements occur in the small intestine, large circular con...
      • Propulsive Movements—“Mass Movements.” Much of the propulsion in the cecum and ascending colon results from the slow but persist...
        • Initiation of Mass Movements by Gastrocolic and Duodenocolic Reflexes. The appearance of mass movements after meals is facilitat...
    • Defecation
  • Other Autonomic Reflexes That Affect Bowel Activity
• 65 - Secretory Functions of the Alimentary Tract
  • Basic Mechanisms of Stimulation of the Alimentary Tract Glands
    • Contact of Food With Gut Epithelium Activates the Enteric Nervous System and Stimulates Secretion
      • Sympathetic Stimulation Has a Dual Effect on Alimentary Tract Glandular Secretion Rate. Stimulation of the sympathetic nerves go...
        • Regulation of Glandular Secretion by Hormones. In the stomach and intestine, several different gastrointestinal hormones help re...
  • Basic Mechanism of Secretion by Glandular Cells
    • Secretion of Organic Substances. Although all the basic mechanisms by which glandular cells function are not known, experimental...
  • Secretion of Saliva
    • Saliva Contains a Serous Secretion and a Mucus Secretion. The principal glands of salivation are the parotid, submandibular, and...
  • Gastric Secretion
    • Secretions From the Gastric (Oxyntic) Glands
      • Basic Mechanism of Hydrochloric Acid Secretion. When stimulated, the parietal cells secrete an acid solution that contains about...
        • The Basic Factors That Stimulate Gastric Secretion Are Acetylcholine, Gastrin, and Histamine. Acetylcholine released by parasymp...
        • Secretion and Activation of Pepsinogen. Several slightly different types of pepsinogen are secreted by the peptic and mucous cel...
        • Secretion of Intrinsic Factor by Parietal Cells. The substance intrinsic factor, which is essential for vitamin B12 absorption i...
    • Surface Mucous Cells
  • Stimulation of Gastric Acid Secretion
    • Parietal Cells of the Oxyntic Glands Are the Only Cells That Secrete Hydrochloric Acid. As noted earlier in the chapter, the aci...
    • Regulation of Pepsinogen Secretion
  • Pancreatic Secretion
    • Pancreatic Digestive Enzymes
    • Secretion of Bicarbonate Ions
  • Regulation of Pancreatic Secretion
    • Basic Stimuli That Cause Pancreatic Secretion
      • Phases of Pancreatic Secretion
        • Cephalic and Gastric Phases. During the cephalic phase of pancreatic secretion, the same nervous signals from the brain that cau...
        • Intestinal Phase. After chyme leaves the stomach and enters the small intestine, pancreatic secretion becomes copious, mainly in...
        • Secretin Stimulates Copious Secretion of Bicarbonate Ions, Which Neutralizes Acidic Stomach Chyme. Secretin is a polypeptide con...
        • Cholecystokinin Contributes to Control of Digestive Enzyme Secretion by the Pancreas. The presence of food in the upper small in...
  • Bile Secretion by the Liver
    • The Gallbladder Stores and Concentrates Bile. Bile is secreted continually by the liver cells, but most of it is normally stored...
      • Composition of Bile. Table 65-­2 lists the composition of bile when it is first secreted by the liver and then after it has been...
        • Cholecystokinin Stimulates Gallbladder Emptying. When food begins to be digested in the upper gastrointestinal tract, the gallbl...
  • Secretions of the Small Intestine
    • Secretion of Mucus by Brunner's Glands in the Duodenum
      • Mechanism of Secretion of the Watery Fluid. The exact mechanism that controls the marked secretion of watery fluid by the crypts...
        • Digestive Enzymes in the Small Intestinal Secretion. When secretions of the small intestine are collected without cellular debri...
  • Secretion of Mucus by The Large Intestine
• 66 - Digestion and Absorption in the Gastrointestinal Tract
  • Hydrolysis of Carbohydrates. Almost all the carbohydrates of the diet are either large polysaccharides or disaccharides, which a...
    • Hydrolysis of Fats. Almost the entire fat portion of the diet consists of triglycerides (neutral fats), which are combinations o...
  • Digestion of Carbohydrates
    • Carbohydrate Foods of the Diet. Only three major sources of carbohydrates exist in the normal human diet. They are sucrose, whic...
  • Digestion of Carbohydrates in the Small Intestine
    • Digestion by Pancreatic Amylase. Pancreatic secretion, like saliva, contains a large quantity of α-­amylase that is almost ident...
  • Digestion of Proteins
    • Proteins of the Diet. Dietary proteins are chemically long chains of amino acids bound together by peptide linkages. A typical l...
      • Digestion of Proteins in the Stomach. Pepsin, an important peptic enzyme of the stomach, is most active at a pH of 2.0 to 3.0 an...
        • Most Protein Digestion Results From Actions of Pancreatic Proteolytic Enzymes. Most protein digestion occurs in the upper small ...
        • Digestion of Peptides by Peptidases in the Enterocytes That Line the Small Intestinal Villi. The last digestive stage of protein...
  • Digestion of Fats
    • Fats of the Diet. By far the most abundant fats of the diet are the neutral fats, also known as triglycerides, each molecule of ...
      • Digestion of Fats Occurs Mainly in the Small Intestine. A small amount of triglycerides is digested in the stomach by lingual li...
        • The First Step in Fat Digestion Is Emulsification by Bile Acids and Lecithin. The first step in fat digestion is to physically b...
        • Triglycerides Are Digested by Pancreatic Lipase. By far the most important enzyme for digestion of the triglycerides is pancreat...
        • End Products of Fat Digestion Are Free Fatty Acids. Most of the triglycerides of the diet are split by pancreatic lipase into fr...
        • Bile Salts Form Micelles That Accelerate Fat Digestion. The hydrolysis of triglycerides is a highly reversible process; therefor...
        • Digestion of Cholesterol Esters and Phospholipids. Most cholesterol in the diet is in the form of cholesterol esters, which are ...
  • Basic Principles of Gastrointestinal Absorption
    • Anatomical Basis of Absorption
  • Absorption in the Small Intestine
    • Isosmotic Absorption of Water
  • Absorption of Ions
    • Sodium Is Actively Transported Through the Intestinal Membrane. Twenty to 30 grams of sodium are secreted in the intestinal secr...
      • Osmosis of the Water. The next step in the transport process is osmosis of water by transcellular and paracellular pathways. Thi...
        • Aldosterone Greatly Enhances Sodium Absorption. When a person becomes dehydrated, large amounts of aldosterone are secreted by t...
        • Absorption of Chloride Ions in the Small Intestine. In the upper part of the small intestine, chloride ion absorption is rapid a...
        • Absorption of Bicarbonate Ions in the Duodenum and Jejunum. Often large quantities of bicarbonate ions (HCO3−) must be reabsorbe...
        • Secretion of Bicarbonate and Absorption of Chloride Ions in the Ileum and Large Intestine. The epithelial cells on the surfaces ...
        • Active Absorption of Calcium, Iron, Potassium, Magnesium, and Phosphate. Calcium ions are actively absorbed into the blood, espe...
  • Absorption of Nutrients
    • Carbohydrates Are Mainly Absorbed as Monosaccharides
      • Glucose Is Transported by a Sodium Co-­Transport Mechanism. In the absence of sodium transport through the intestinal membrane, ...
        • Absorption of Other Monosaccharides. Galactose is transported by almost exactly the same mechanism as glucose, using the SGLT1 a...
      • Absorption of Proteins as Dipeptides, Tripeptides, or Amino Acids
      • Absorption of Fats
        • Direct Absorption of Fatty Acids Into the Portal Blood. Small quantities of short-­ and medium-­chain fatty acids, such as those...
  • Absorption in the Large Intestine: Formation of Feces
    • Absorption and Secretion of Electrolytes and Water. The mucosa of the large intestine, like that of the small intestine, has a h...
      • Maximum Absorption Capacity of the Large Intestine. The large intestine can absorb a maximum of 5 to 8 liters of fluid and elect...
        • Composition of the Feces. The feces normally are about three-­fourths water and one-­fourth solid matter that is composed of abo...
• 67 - Physiology of Gastrointestinal Disorders
• 68 - Metabolism of Carbohydrates and Formation of Adenosine Triphosphate
• 69 - Lipid Metabolism
  • Basic Chemical Structure of Triglycerides (Neutral Fat)
    • Transport of Triglycerides and Other Lipids From the Gastrointestinal Tract by Lymph—the Chylomicrons
• 70 - Protein Metabolism
• 71 - The Liver
• 72 - Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and Minerals
  • ENERGY INTAKE AND OUTPUT BALANCED UNDER STEADY-­STATE CONDITIONS
  • REGULATION OF FOOD INTAKE AND ENERGY STORAGE
    • The Hypothalamus Contains Hunger and Satiety Centers. Several neuronal centers of the hypothalamus participate in the control of...
      • Neurons and Neurotransmitters in the ­Hypothalamus That Stimulate or Inhibit Feeding. Two distinct types of neurons in the arcua...
        • Neural Centers That Influence the Mechanical Process of Feeding. Another aspect of feeding is the mechanical act of the feeding ...
    • Short-­Term Regulation of Food Intake
      • Gastrointestinal Filling Inhibits Feeding. When the gastrointestinal tract becomes distended, especially the stomach and the duo...
      • Gastrointestinal Hormonal Factors Suppress Feeding. CCK, which is released mainly in response to fat and proteins entering the d...
      • Ghrelin, a Gastrointestinal Hormone, Increases ­Feeding. Ghrelin is a hormone released mainly by the oxyntic cells of the stomac...
      • Oral Receptors Meter Food Intake. When an animal with an esophageal fistula is fed large quantities of food, even though this fo...
    • Intermediate-­ and Long-­Term Regulation of Food Intake
      • Effect of Blood Concentrations of Glucose, Amino Acids, and Lipids on Hunger and Feeding.
      • Temperature Regulation and Food Intake
      • Feedback Signals From Adipose Tissue Regulate Food Intake.
    • Importance of Having Both Long-­ and Short-­Term Regulatory Systems for Feeding
• 73 - Energetics and Metabolic Rate
• 74 - Body Temperature Regulation and Fever
  • Normal Body Temperatures
    • Body Core Temperature and Skin Temperature. The temperature of the deep tissues of the body—the “core” of the body—usually remai...
  • Body Temperature is Controlled by Balancing Heat Production and Heat Loss
    • Heat Production
    • Heat Loss
      • Insulator System of the Body
      • Blood Flow to the Skin From the Body Core Provides Heat Transfer
        • Control of Heat Conduction to the Skin by the Sympathetic Nervous System. Heat conduction to the skin by the blood is controlled...
      • Basic Physics of Heat Loss From the Skin Surface
        • Radiation Causes Heat Loss in the Form of Infrared Rays. As shown in Figure 74-­4, in a nude person sitting inside at normal roo...
        • Conductive Heat Loss Occurs by Direct Contact With an Object. As shown in Figure 74-­4, only minute quantities of heat, about 3%...
        • Convective Heat Loss Results From Air Movement. Heat from the skin is first conducted to the air and then carried away by the co...
        • Cooling Effect of Wind. When the body is exposed to wind, the layer of air immediately adjacent to the skin is replaced by new a...
        • Conduction and Convection of Heat From a Person Suspended in Water. Water has a specific heat several thousand times as great as...
      • Evaporation
        • Evaporation is a Necessary Cooling Mechanism at Very High Air Temperatures. As long as skin temperature is greater than the temp...
        • Clothing Reduces Conductive and Convective Heat Loss. Clothing entraps air next to the skin in the weave of the cloth, thereby i...
      • Sweating and Its Regulation by the Autonomic Nervous System
        • Mechanism of Sweat Secretion. In Figure 74-­5, the sweat gland is shown to be a tubular structure consisting of two parts: (1) a...
        • Acclimatization of the Sweating Mechanism to Heat—The Role of Aldosterone. Although a normal, unacclimatized person seldom produ...
  • Regulation of Body Temperature—Role of the Hypothalamus
    • Temperature-­Decreasing Mechanisms When the Body Is Too Hot
      • Temperature-­Increasing Mechanisms When the Body Is Too Cold
        • Hypothalamic Stimulation of Shivering. Located in the dorsomedial portion of the posterior hypothalamus near the wall of the thi...
        • Sympathetic “Chemical” Excitation of Heat Production. As noted in Chapter 73, an increase in either sympathetic stimulation or c...
        • Increased Thyroxine Output as a Long-­Term Cause of Increased Heat Production. Cooling the anterior hypothalamic-­preoptic area ...
        • Feedback Gain for Body Temperature Control. As discussed in Chapter 1, feedback gain is a measure of the effectiveness of a cont...
      • Skin Temperature Can Slightly Alter the Set Point for Core Temperature Control
    • Fever
      • Resetting the Hypothalamic Temperature-­Regulating Center in Febrile Diseases—Effect of Pyrogens
        • Mechanism of Action of Pyrogens in Causing Fever—Role of Cytokines. Experiments in animals have shown that some pyrogens, when i...
        • Fever Caused by Brain Lesions. When a brain surgeon operates in the region of the hypothalamus, severe fever almost always occur...
• 75 - Introduction to Endocrinology
  • Coordination of Body Functions by Chemical Messengers
  • Chemical Structure and Synthesis of Hormones
    • Polypeptide and Protein Hormones Are Stored in Secretory Vesicles Until Needed. Most of the hormones in the body are polypeptide...
      • Steroid Hormones Are Usually Synthesized From Cholesterol and Are Not Stored. Steroid hormones have a chemical structure that is...
        • Amine Hormones Are Derived From Tyrosine. The two groups of hormones derived from tyrosine, the thyroid and the adrenal medullar...
        • Hormone Secretion After a Stimulus and Duration of Action of Different Hormones. Some hormones, such as norepinephrine and epine...
        • Concentrations of Hormones in the Circulating Blood and Hormonal Secretion Rates. The concentrations of hormones required to con...
  • Feedback Control of Hormone Secretion
    • Negative Feedback Prevents Overactivity of Horm­one Systems. Although the plasma concentrations of many hormones fluctuate in re...
      • Surges of Hormones Can Occur With Positive Feedback. In a few cases, positive feedback occurs when the biological action of the ...
        • Cyclical Variations Occur in Hormone Release. Superimposed on the negative and positive feedback control of hormone secretion ar...
        • “Clearance” of Hormones From the Blood. Two factors can increase or decrease the concentration of a hormone in the blood: (1) th...
    • Hormone Receptors and their Activation
      • The Number and Sensitivity of Hormone Receptors Are Regulated. The number of receptors in a target cell usually does not remain ...
        • Ion Channel–Linked Receptors. Virtually all the neurotransmitter substances, such as acetylcholine and norepinephrine, combine w...
        • G Protein–Linked Hormone Receptors. Many hormones activate receptors that indirectly regulate the activity of target proteins (e...
        • Enzyme-­Linked Hormone Receptors. Some receptors, when activated, function directly as enzymes or are closely associated with en...
        • Intracellular Hormone Receptors and Activation of Genes. Several hormones, including adrenal and gonadal steroid hormones, thyro...
      • Adenylyl Cyclase–cAMP Second Messenger System
      • Cell Membrane Phospholipid Second Messenger System
      • Calcium-­Calmodulin Second Messenger System
  • Hormones that Act Mainly on the Genetic Machinery of the Cell
    • Steroid Hormones Increase Protein Synthesis
      • Thyroid Hormones Increase Gene Transcription in the Cell Nucleus
• 76 - Pituitary Hormones and Their Control by the Hypothalamus
  • Hypothalamus Controls Pituitary Secretion
  • Physiological Functions of Growth Hormone
    • Growth Hormone Promotes Protein Deposition in Tissues
      • Growth Hormone Enhances Fat Utilization for Energy
      • Growth Hormone Decreases Carbohydrate Utilization
      • Necessity of Insulin and Carbohydrate for the Growth-­Promoting Action of Growth Hormone
      • Hypothalamic Growth Hormone–Releasing Hormone Stimulates, and Somatostatin Inhibits Growth Hormone Secretion
  • Posterior Pituitary Gland and its Relation to the Hypothalamus
  • Regulation of Antidiuretic Hormone Production
  • Physiological Functions of Oxytocin
• 77 - Thyroid Metabolic Hormones
  • Synthesis and Secretion of the Thyroid Metabolic Hormones
  • Thyroglobulin and Formation of Thyroxine and Triiodothyronine
    • Formation and Secretion of Thyroglobulin by the Thyroid Cells. The thyroid cells are typical protein-­secreting glandular cells,...
      • Oxidation of the Iodide Ion.The first essential step in thyroid hormone formation is conversion of iodide ions to an oxidized fo...
        • Iodination of Tyrosine and Thyroid Hormone Formation—“Organification” of Thyroglobulin. The binding of iodine with the thyroglob...
        • Storage of Thyroglobulin.The thyroid gland is unusual among the endocrine glands in its ability to store large amounts of hormon...
        • Daily Rate of Secretion of Thyroxine and Triiodothyronine.About 93% of the thyroid hormone released from the thyroid gland is no...
  • Transport of Thyroxine and Triiodothyronine to Tissues
    • Thyroxine and Triiodothyronine Are Bound to Plasma Proteins.Upon entering the blood, more than 99% of the thyroxine and triiodot...
      • Thyroxine and Triiodothyronine Are Released Slowly to Tissue Cells. Because of high affinity of the plasma-­binding proteins for...
        • Thyroid Hormones Have Slow Onset and Long Duration of Action.After injection of a large quantity of thyroxine into a human being...
    • Thyroid Hormones Increase Transcription of Many Genes
      • Most of the Thyroxine Secreted by the Thyroid Is Converted to Triiodothyronine. Before acting on the genes to increase genetic t...
        • Thyroid Hormones Activate Nuclear Receptors. Thyroid hormone receptors are either attached to the DNA genetic strands or located...
        • Thyroid Hormones Increase the Number and Activity of Mitochondria. When thyroxine or triiodothyronine is given to an animal, the...
        • Thyroid Hormones Increase Active Transport of Ions Through Cell Membranes. One of the enzymes that increases its activity in res...
  • Effects of Thyroid Hormone on Specific Body Functions
    • Stimulation of Carbohydrate Metabolism.Thyroid hormone stimulates almost all aspects of carbohydrate metabolism, including rapid...
      • Stimulation of Fat Metabolism. Essentially all aspects of fat metabolism are also enhanced by thyroid hormone. In particular, li...
        • Effect on Plasma and Liver Fats. Increased thyroid hormone decreases the concentrations of cholesterol, phospholipids, and trigl...
        • Increased Requirement for Vitamins. Because thyroid hormone increases the quantities of many bodily enzymes and because vitamins...
        • Increased Basal Metabolic Rate. Because thyroid hormone increases metabolism in almost all cells of the body, excessive quantiti...
        • Decreased Body Weight.A greatly increased amount of thyroid hormone almost always decreases body weight, and a greatly decreased...
        • Increased Blood Flow and Cardiac Output. Increased metabolism in the tissues causes more rapid utilization of oxygen than normal...
        • Increased Heart Rate.The heart rate increases considerably more under the influence of thyroid hormone than would be expected fr...
        • Increased Heart Strength.A slight excess of thyroid hormone can increase the strength of the heart. This effect is analogous to ...
        • Normal Arterial Pressure. The mean arterial pressure usually remains about normal after administration of thyroid hormone. Becau...
        • Increased Respiration. The increased rate of metabolism increases oxygen utilization and carbon dioxide formation; these effects...
        • Increased Gastrointestinal Motility. In addition to increased appetite and food intake, which has been discussed, thyroid hormon...
        • Excitatory Effects on the Central Nervous System.In general, thyroid hormone increases the rapidity of cerebration, although tho...
        • Effect on the Function of the Muscles.A slight increase in thyroid hormone usually makes the muscles react with vigor but, with ...
        • Muscle Tremor.One of the most characteristic signs of hyperthyroidism is a fine muscle tremor. This symptom is not the coarse tr...
        • Effect on Sleep. Because of the exhausting effect of thyroid hormone on the musculature and on the central nervous system, perso...
        • Effect on Other Endocrine Glands. Increased thyroid hormone increases the secretion rates of several other endocrine glands, but...
        • Effect of Thyroid Hormone on Sexual Function. For normal sexual function, thyroid secretion needs to be approximately normal. In...
  • Regulation of Thyroid Hormone Secretion
    • Cyclic Adenosine Monophosphate Mediates the Stimulatory Effect of TSH. Most of the varied effects of TSH on the thyroid cell res...
• 78 - Adrenocortical Hormones
  • Corticosteroids: Mineralocorticoids, Glucocorticoids, and Androgens
    • The Adrenal Cortex has Three Distinct Layers
      • Mineralocorticoid Deficiency Causes Severe Renal Sodium Chloride Wasting and Hyperkalemia. Total loss of adrenocortical secretio...
        • Aldosterone Is the Major Mineralocorticoid Secreted by the Adrenals. In humans, aldosterone exerts nearly 90% of the mineralocor...
  • Renal and Circulatory Effects of Aldosterone
    • Aldosterone Increases Renal Tubular Reabsorption of Sodium and Secretion of Potassium. As discussed in Chapter 28, aldosterone i...
      • Excess Aldosterone Increases Extracellular Fluid Volume and Arterial Pressure But Has Only a Small Effect on Plasma Sodium Conce...
        • Excess Aldosterone Causes Hypokalemia and Muscle Weakness; Aldosterone Deficiency Causes Hyperkalemia and Cardiac Toxicity. Exce...
        • Excess Aldosterone Increases Tubular Hydrogen Ion Secretion and Causes Alkalosis. Aldosterone not only causes potassium to be se...
  • Functions of Glucocorticoids
  • Effects of Cortisol on Carbohydrate Metabolism
    • Stimulation of Gluconeogenesis. The best-­known metabolic effect of cortisol and other glucocorticoids on metabolism is the abil...
      • Decreased Glucose Utilization by Cells. Cortisol also causes a moderate decrease in glucose utilization by most cells in the bod...
        • Elevated Blood Glucose Concentration and “Adrenal Diabetes.” Both the increased gluconeogenesis and moderate reduction in glucos...
  • Effects of Cortisol on Protein Metabolism
    • Reduction in Cellular Protein. One of the principal effects of cortisol on the metabolic systems of the body is reduction of pro...
      • Cortisol Increases Liver and Plasma Proteins. Coincidentally with the effect of glucocorticoids to reduce proteins elsewhere in ...
        • Increased Blood Amino Acids, Diminished Transport of Amino Acids Into Extrahepatic Cells, and Enhanced Transport Into Hepatic Ce...
  • Effects of Cortisol on Fat Metabolism
    • Mobilization of Fatty Acids. In much the same manner that cortisol promotes amino acid mobilization from muscle, it also promote...
      • Anti-­inflammatory Effects of High Levels of Cortisol
        • Cortisol Prevents the Development of Inflammation by Stabilizing Lysosomes and by Other Effects. Cortisol has the following effe...
        • Cortisol Causes Resolution of Inflammation. Even after inflammation has become well established, administration of cortisol can ...
  • Regulation of Cortisol Secretion by Adrenocorticotropic Hormone from the Pituitary Gland
    • ACTH Stimulates Cortisol Secretion. Unlike aldosterone secretion by the zona glomerulosa, which is controlled mainly by potassiu...
      • Chemistry of ACTH. ACTH has been isolated in pure form from the anterior pituitary. It is a large polypeptide, having a chain le...
        • ACTH Secretion Is Controlled by Corticotropin-­Releasing Factor From the Hypothalamus. In the same way that other pituitary horm...
        • ACTH Activates Adrenocortical Cells to Produce Steroids by Increasing cAMP. The principal effect of ACTH on the adrenocortical c...
        • Physiological Stress Increases ACTH and Adrenocortical Secretion. As pointed out earlier in the chapter, almost any type of phys...
        • Inhibitory Effect of Cortisol on the Hypothalamus and Anterior Pituitary to Decrease ACTH Secretion. Cortisol has direct negativ...
      • Summary of the Cortisol Control System
      • Synthesis and Secretion of ACTH in Association With Melanocyte-­Stimulating Hormone, Lipotropin, and Endorphin
• 79 - Insulin, Glucagon, and Diabetes Mellitus
  • Insulin and its Metabolic Effects
    • Insulin Promotes Muscle Glucose Uptake and Metabolism
      • Quantitative Effect of Insulin to Facilitate Glucose Transport Through the Muscle Cell Membrane
      • Insulin Promotes Liver Uptake, Storage, and Use of Glucose
        • Glucose Is Released From the Liver Between Meals. When the blood glucose level begins to fall to a low level between meals, seve...
        • Insulin Promotes Conversion of Excess Glucose Into Fatty Acids and Inhibits Gluconeogenesis in the Liver. When the quantity of g...
      • Lack of Effect of Insulin on Glucose Uptake and Usage by the Brain
      • Effect of Insulin on Carbohydrate Metabolism in Other Cells
    • Effect of Insulin on Fat Metabolism
      • Insulin Promotes Fat Synthesis and Storage
        • Role of Insulin in Storage of Fat in the Adipose Cells. Insulin has two other essential effects that are required for fat storag...
      • Insulin Deficiency Increases Use of Fat for Energy
        • Insulin Deficiency Causes Lipolysis of Storage Fat and Release of Free Fatty Acids. In the absence of insulin, all the effects o...
        • Insulin Deficiency Increases Plasma Cholesterol and Phospholipid Concentrations. The excess of fatty acids in the plasma associa...
        • Excess Usage of Fats During Insulin Deficiency Causes Ketosis and Acidosis. Insulin deficiency also causes excessive amounts of ...
  • Effect of Insulin on Protein Metabolism and Growth
    • Insulin Promotes Protein Synthesis and Storage
      • Insulin Deficiency Causes Protein Depletion and Increased Plasma Amino Acids
      • Insulin and Growth Hormone Interact Synergistically to Promote Growth
    • Mechanisms of Insulin Secretion
    • Control of Insulin Secretion
      • Increased Blood Glucose Stimulates Insulin Secretion. At the normal fasting level of blood glucose of 80 to 90 mg/100 ml, the ra...
        • Feedback Relation Between Blood Glucose Concentration and the Insulin Secretion Rate. As blood glucose concentration rises above...
  • Glucagon and its Functions
    • Effects on Glucose Metabolism
      • Glucagon Causes Glycogenolysis and Increased Blood Glucose Concentration
      • Glucagon Increases Gluconeogenesis
      • Other Effects of Glucagon
  • Regulation of Glucagon Secretion
    • Increased Blood Glucose Inhibits Glucagon Secretion. Blood glucose concentration is by far the most potent factor that controls ...
      • Increased Blood Amino Acids Stimulate Secretion of Glucagon. High concentrations of amino acids, such as those that occur in the...
        • Exercise Stimulates Secretion of Glucagon. During exhaustive exercise, blood glucagon concentration often increases fourfold to ...
  • Summary of Blood Glucose Regulation
• 80 - Parathyroid Hormone, Calcitonin, ­Calcium and Phosphate Metabolism, ­Vitamin D, Bone, and Teeth
  • Overview of Calcium and Phosphate Regulation in Extracellular Fluid and Plasma
    • Hypocalcemia Causes Nervous System Excitement and Tetany. When the extracellular fluid concentration of calcium ions falls below...
  • Absorption and Excretion of Calcium and Phosphate
    • Intestinal Absorption and Fecal Excretion of Calcium and Phosphate. The usual rates of intake are approximately 1000 mg/day each...
  • Bone and its Relationship to Extracellular Calcium and Phosphate
    • Organic Matrix of Bone. The organic matrix of bone is 90% to 95% collagen fibers, and the remainder is a homogeneous gelatinous ...
      • Bone Salts. The crystalline salts deposited in the organic matrix of bone are composed principally of calcium and phosphate. The...
        • Tensile and Compressional Strength of Bone. Each collagen fiber of cortical (compact) bone is composed of repeating periodic seg...
  • Precipitation and Absorption of Calcium and Phosphate in Bone—Equilibrium With the Extracellular Fluids
    • Hydroxyapatite Does Not Precipitate in Extracellular Fluid Despite Supersaturation of Calcium and Phosphate Ions. The concentrat...
      • Mechanism of Bone Calcification. The initial stage in bone production is secretion of collagen molecules (called collagen monome...
        • Precipitation of Calcium in Nonosseous Tissues Under Abnormal Conditions. Although calcium salts usually do not precipitate in n...
  • Deposition and Resorption of Bone—Remodeling of Bone
    • Deposition of Bone by the Osteoblasts. Bone is continually being deposited by osteoblasts, and it is continually being resorbed ...
      • Resorption of Bone—Function of the Osteoclasts. Bone is also being continually resorbed in the presence of osteoclasts, which ar...
        • Bone Deposition and Resorption Are Normally in Equilibrium. Except in growing bones, the rates of bone deposition and resorption...
        • Value of Continual Bone Remodeling. The continual deposition and resorption of bone have several important functions. First, bon...
        • Control of the Rate of Bone Deposition by Bone “Stress” Bone is deposited in proportion to the compressional load that the bone ...
  • Vitamin D
    • Cholecalciferol (Vitamin D3) Is Formed in the Skin. Several compounds derived from sterols belong to the vitamin D family, and t...
      • Cholecalciferol Is Converted to 25-­Hydroxycholecal­ciferol in the Liver. The first step in the activation of cholecalciferol is...
        • Formation of 1,25-­Dihydroxycholecalciferol in the Kidneys and Its Control by Parathyroid Hormone. Figure 80-­8 also shows the c...
        • Calcium Ion Concentration Controls the Formation of 1,25-­Dihydroxycholecalciferol. Figure 80-­10 demonstrates that plasma conce...
    • Actions of Vitamin D
      • “Hormonal” Effect of Vitamin D to Promote ­Intestinal Calcium Absorption. 1,25-­Dihydroxycholecal- ciferol functions as a type o...
        • Vitamin D Promotes Phosphate Absorption by the Intestines. Although phosphate is usually absorbed easily, phosphate flux through...
        • Vitamin D Decreases Renal Calcium and Phosphate Excretion. Vitamin D also increases calcium and phosphate reabsorption by the ep...
        • Effect of Vitamin D on Bone and Its Relation to Parathyroid Hormone Activity. Vitamin D plays important roles in bone resorption...
  • Parathyroid Hormone
    • Parathyroid Hormone Mobilizes Calcium and Phosphate From Bone
      • Rapid Phase of Calcium and Phosphate Mobilization From Bone—Osteolysis. When large quantities of PTH are injected, calcium ion c...
        • Slow Phase of Bone Resorption and Calcium Phosphate Release—Activation of the Osteoclasts. A much better known effect of PTH and...
      • Parathyroid Hormone Decreases Calcium Excretion and Increases Phosphate Excretion by the Kidneys
      • Parathyroid Hormone Increases Intestinal Absorption of Calcium and Phosphate
        • Cyclic Adenosine Monophosphate Mediates the Effects of Parathyroid Hormone. A large share of the effect of PTH on its target org...
  • Calcitonin
    • Increased Plasma Calcium Concentration Stimulates Calcitonin Secretion. The primary stimulus for calcitonin secretion is increas...
      • Calcitonin Decreases Plasma Calcium Concentration. In some young animals, calcitonin decreases blood calcium ion concentration r...
        • Calcitonin Has a Weak Effect on Plasma Calcium Concentration in Adult Humans. The reason for the weak effect of calcitonin on pl...
  • Summary of Control of Calcium ion Concentration
    • Buffer Function of the Exchangeable Calcium in Bones—The First Line of Defense. The exchangeable calcium salts in the bones, dis...
  • Physiology of the Teeth
    • Enamel. The outer surface of the tooth is covered by a layer of enamel that is formed before eruption of the tooth by special ep...
      • Dentin. The main body of the tooth is composed of dentin, which has a strong bony structure. Dentin is made up principally of hy...
        • Cementum. Cementum is a bony substance secreted by cells of the periodontal membrane, which lines the tooth socket. Many collage...
        • Pulp. The pulp cavity of each tooth is filled with pulp, which is composed of connective tissue with an abundant supply of nerve...
        • Dentition. Humans and most other mammals develop two sets of teeth during a lifetime. The first teeth are called deciduous teeth...
        • Formation of the Teeth. Figure 80-­16 shows the formation and eruption of teeth. Figure 80-­16A shows invagination of the oral e...
        • Eruption of Teeth. During early childhood, the teeth begin to protrude outward from the bone through the oral epithelium into th...
        • Development of the Permanent Teeth. During embryonic life, a tooth-­forming organ also develops in the deeper dental lamina for ...
        • Metabolic Factors Influence Development of the Teeth. The rate of development and the speed of eruption of teeth can be accelera...
        • Mineral Exchange in Teeth. The salts of teeth, like those of bone, are composed of hydroxyapatite with adsorbed carbonates and v...
• 81 - Reproductive and Hormonal Functions of the Male (and Function of the Pineal Gland)
  • Spermatogenesis
    • Steps of Spermatogenesis
      • Meiosis. Spermatogonia that cross the barrier into the Sertoli cell layer become progressively modified and enlarged to form lar...
        • Sex Chromosomes. In each spermatogonium, one of the 23 pairs of chromosomes carries the genetic information that determines the ...
        • Formation of Sperm. When the spermatids are first formed, they still have the usual characteristics of epithelioid cells, but so...
      • Hormonal Factors That Stimulate Spermatogenesis
      • Maturation of Sperm in the Epididymis
        • Storage of Sperm in the Testes. The two testes of the human adult form up to 120 million sperm each day. Most of these sperm are...
        • Physiology of the Mature Sperm. The normal motile, fertile sperm are capable of flagellated movement through the fluid medium at...
    • Function of the Seminal Vesicles
    • Function of the Prostate Gland
    • Semen
      • “Capacitation” of Spermatozoa Is Required for Fertilization of the Ovum
      • Acrosome Enzymes, the “Acrosome Reaction,” and Penetration of the Ovum
        • Why Does Only One Sperm Enter the Oocyte With as many sperm as there are, why does only one enter the oocyte The reason is not e...
  • Male Sexual Act
    • Neuronal Stimulus for Performance of the Male Sexual Act
      • Psychic Element of Male Sexual Stimulation. Appropriate psychic stimuli can greatly enhance the ability of a person to perform t...
        • Integration of the Male Sexual Act in the Spinal Cord. Although psychic factors usually play an important part in the male sexua...
  • Stages of the Male Sexual Act
    • Penile Erection—Role of the Parasympathetic Nerves. Penile erection is the first effect of male sexual stimulation, and the degr...
      • Lubrication Is a Parasympathetic Function. During sexual stimulation, the parasympathetic impulses, in addition to promoting ere...
        • Emission and Ejaculation Are Functions of the Sympathetic Nerves. Emission and ejaculation are the culmination of the male sexua...
    • Secretion, Metabolism, and Chemistry of the Male Sex Hormones
    • Functions of Testosterone
      • Functions of Testosterone During Fetal Development
        • Effect of Testosterone to Cause Descent of the Testes. The testes usually descend into the scrotum during the last 2 to 3 months...
      • Effect of Testosterone on Development of Adult Primary and Secondary Sexual Characteristics
        • Effect on the Distribution of Body Hair. Testosterone causes growth of hair (1) over the pubis, (2) upward along the linea alba ...
        • Male Pattern Baldness. Testosterone decreases the growth of hair on the top of the head; a man who does not have functional test...
        • Effect on the Voice. Testosterone secreted by the testes or injected into the body causes hypertrophy of the laryngeal mucosa an...
        • Testosterone Increases Thickness of the Skin and Can Contribute to Development of Acne. Testosterone increases the thickness of ...
        • Testosterone Increases Protein Formation and Muscle Development. One of the most important male characteristics is development o...
        • Testosterone Increases Bone Matrix and Causes Calcium Retention. After the great increase in circulating testosterone that occur...
        • Testosterone Increases the Basal Metabolic Rate. Injection of large quantities of testosterone can increase the basal metabolic ...
        • Testosterone Increases Red Blood Cells. When normal quantities of testosterone are injected into a castrated adult, the number o...
        • Effect on Electrolyte and Water Balance. As pointed out in Chapter 78, many steroid hormones can increase the reabsorption of so...
      • Gonadotropin-­Releasing Hormone Increases Secretion of Luteinizing Hormone and Follicle-­Stimulating Hormone
      • Gonadotropic Hormones: Luteinizing Hormone and Follicle-­Stimulating Hormone
        • Regulation of Testosterone Production by Luteinizing Hormone. Testosterone is secreted by the interstitial cells of Leydig in th...
        • Inhibition of Anterior Pituitary Secretion of Luteinizing and Follicle-­Stimulating Hormones by Testosterone—Negative Feedback C...
      • Regulation of Spermatogenesis by Follicle-­Stimulating Hormone and Testosterone
        • Role of Inhibin in Negative Feedback Control of Seminiferous Tubule Activity. When the seminiferous tubules fail to produce sper...
      • Human Chorionic Gonadotropin Secreted by the Placenta During Pregnancy Stimulates Testosterone Secretion by the Fetal Testes
      • Puberty and Regulation of Its Onset
• 82 - Female Physiology Before Pregnancy and Female Hormones
  • Physiologic Anatomy of the Female Sexual Organs
  • Oogenesis and Follicular Development in the Ovaries
  • Female Hormonal System
  • Monthly Ovarian Cycle and Function of Gonadotropic Hormones
    • Development of Antral and Vesicular Follicles. During the first few days of each monthly female sexual cycle, the concentrations...
      • Ovulation
        • A Surge of Luteinizing Hormone Is Necessary for Ovulation. LH is necessary for final follicular growth and ovulation. Without th...
        • Initiation of Ovulation. Figure 82-­6 provides a schema for the initiation of ovulation, showing the role of the large quantity ...
        • Luteinizing Function of Luteinizing Hormone. The change of granulosa and theca interna cells into lutein cells depends mainly on...
        • Secretion by the Corpus Luteum: An Additional Function of Luteinizing Hormone. The corpus luteum is a highly secretory organ, se...
        • Involution of the Corpus Luteum and Onset of the Next Ovarian Cycle. Estrogen in particular and progesterone to a lesser extent,...
    • Summary
  • Functions of Ovarian Hormones—Estradiol and Progesterone
  • Chemistry of the Sex Hormones
    • Estrogens. In the normal nonpregnant female, estrogens are secreted in significant quantities only by the ovaries, although minu...
      • Progestins. By far the most important of the progestins is progesterone. However, small amounts of another progestin, 17α-­hydro...
        • Synthesis of the Estrogens and Progestins. Note from the chemical formulas of the estrogens and progesterone in Figure 82-­7 tha...
        • Estrogens and Progesterone Are Transported in the Blood Bound to Plasma Proteins. Both estrogens and progesterone are transporte...
        • Functions of the Liver in Estrogen Degradation. The liver conjugates estrogens to form glucuronides and sulfates, and about one-...
        • Fate of Progesterone. Within a few minutes after secretion, almost all the progesterone is degraded to other steroids that have ...
        • Effect of Estrogens on the Uterus and External Female Sex Organs. During childhood, estrogens are secreted only in minute quanti...
        • Effect of Estrogens on the Fallopian Tubes. The estrogens’ effects on the mucosal lining of the fallopian tubes are similar to t...
        • Effect of Estrogens on the Breasts. The primordial breasts of females and males are exactly alike. In fact, under the influence ...
        • Effect of Estrogens on the Skeleton. Estrogens inhibit osteoclastic activity in the bones and therefore stimulate bone growth. A...
        • Osteoporosis of the Bones Caused by Estrogen Deficiency in Old Age. After menopause, almost no estrogens are secreted by the ova...
        • Estrogens Slightly Increase Protein Deposition. Estrogens cause a slight increase in total body protein, which is evidenced by a...
        • Estrogens Increase Body Metabolism and Fat Deposition. Estrogens increase the whole-­body metabolic rate slightly, but only abou...
        • Estrogens Have Little Effect on Hair Distribution. Estrogens do not greatly affect hair distribution. However, hair does develop...
        • Effect of Estrogens on the Skin. Estrogens cause the skin to develop a texture that is soft and usually smooth, but even so, the...
        • Effect of Estrogens on Electrolyte Balance. The chemical similarity of estrogenic hormones to adrenocortical hormones has been d...
  • Functions of Progesterone
    • Progesterone Promotes Secretory Changes in the Uterus. A major function of progesterone is to promote secretory changes in the u...
      • Progesterone Promotes Secretion by the Fallopian Tubes. Progesterone also promotes increased secretion by the mucosal lining of ...
        • Progesterone Promotes Development of the Breasts. Progesterone promotes development of the lobules and alveoli of the breasts, c...
        • Proliferative Phase (Estrogen Phase) of the Endometrial Cycle Occurs Before Ovulation. At the beginning of each monthly cycle, m...
        • Secretory Phase (Progestational Phase) of the Endometrial Cycle Occurs After Ovulation. During most of the latter half of the mo...
        • Menstruation. If the ovum is not fertilized, about 2 days before the end of the monthly cycle, the corpus luteum in the ovary in...
        • Leukorrhea During Menstruation. During menstruation, large numbers of leukocytes are released, along with the necrotic material ...
  • Regulation of Female Monthly Rhythm—Interplay Between Ovarian and Hypothalamic-­Pituitary Hormones
    • Intermittent, Pulsatile Secretion of GnRH by the Hypothalamus Stimulates Pulsatile Release of LH From the Anterior Pituitary Gla...
      • Hypothalamic Centers for Release of Gonadotropin-­Releasing Hormone. The neuronal activity that causes pulsatile release of GnRH...
        • Inhibin From the Corpus Luteum Inhibits FSH and LH Secretion. In addition to the feedback effects of estrogen and progesterone, ...
      • Anovulatory Cycles—Sexual Cycles at Puberty
    • Puberty and Menarche
    • Menopause
  • Female Sexual Act
    • Stimulation of the Female Sexual Act. As is true in the male sexual act, successful performance of the female sexual act depends...
      • Female Erection and Lubrication. Located around the introitus and extending into the clitoris is erectile tissue almost identica...
        • Female Orgasm. When local sexual stimulation reaches maximum intensity, and especially when the local sensations are supported b...
• 83 - Pregnancy and Lactation
  • Maturation and Fertilization of the Ovum
    • Entry of the Ovum Into the Fallopian Tube (Uterine Tube). When ovulation occurs, the ovum, along with a hundred or more attached...
  • Early Nutrition of the Embryo
  • Anatomy and Function of the Placenta
    • Diffusion of Oxygen Through the Placental Membrane. Almost the same principles for diffusion of oxygen through the pulmonary mem...
      • Diffusion of Carbon Dioxide Through the Placental Membrane. Carbon dioxide is continually formed in the fetal tissues in the sam...
        • Diffusion of Foodstuffs Through the Placental Membrane. Other metabolic substrates needed by the fetus diffuse into the fetal bl...
        • Excretion of Waste Products Through the Placental Membrane. In the same manner that carbon dioxide diffuses from the fetal blood...
  • Hormonal Factors in Pregnancy
    • Function of Human Chorionic Gonadotropin. Human chorionic gonadotropin is a glycoprotein having a molecular weight of about 39,0...
      • Human Chorionic Gonadotropin Stimulates the Male Fetal Testes to Produce Testosterone. Human chorionic gonadotropin also exerts ...
        • Function of Estrogen in Pregnancy. In Chapter 82, we pointed out that estrogens exert mainly a proliferative function on most re...
  • Parturition
    • Increased Uterine Excitability Near Term
  • Hormonal Factors That Increase Uterine Contractility
    • Increased Ratio of Estrogens to Progesterone. Progesterone inhibits uterine contractility during pregnancy, thereby helping to p...
      • Oxytocin Causes Contraction of the Uterus. Oxytocin, a hormone secreted by the neurohypophysis, specifically causes uterine cont...
        • Effect of Fetal Hormones on the Uterus. The fetus’s pituitary gland secretes increasing quantities of oxytocin, which might play...
        • Stretch or Irritation of the Cervix. There is reason to believe that stretching or irritating the uterine cervix is particularly...
  • Lactation
    • Development of the Breasts
      • Estrogens Stimulate Growth of the Ductal System of the Breasts. All through pregnancy, the large quantities of estrogens secrete...
        • Progesterone Is Required for Full Development of the Lobule-­Alveolar System. Final development of the breasts into milk-­secret...
    • Prolactin Promotes Lactation
      • The Hypothalamus Secretes Prolactin Inhibitory Hormone. The hypothalamus plays an essential role in controlling prolactin secret...
        • Suppression of the Female Ovarian Cycles in Nursing Mothers for Many Months After Delivery. In most nursing mothers, the ovarian...
        • Inhibition of Milk Ejection. A particular problem in nursing a baby comes from the fact that many psychogenic factors or even ge...
        • Antibodies and Other Anti-­infectious Agents in Milk. Not only does milk provide the newborn baby with needed nutrients, but it ...
• 84 - Fetal and Neonatal Physiology
• 85 - Sports Physiology
• Normal Values for Selected Common Laboratory Measurements

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