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REVIEW OF MEDICAL PHYSIOLOGY 20th Ed 2001,Front Matter. Title Page,a LANGE medical book,Review of Medical Physiology. twentieth edition,William F Ganong MD, Jack and DeLoris Lange Professor of Physiology Emeritus. University of California,San Francisco,Lange Medical Books McGraw Hill. Medical Publishing Division, New York Chicago San Francisco Lisbon London Madrid Mexico City Milan.
New Delhi San Juan Seoul Singapore Sydney Toronto,Copyright Page. Review of Medical Physiology Twentieth Edition, Copyright 2001 by The McGraw Hill Companies Inc All rights reserved Printed in the United States. of America Except as permitted under the United States Copyright Act of 1976 no part of this publication. may be reproduced or distributed in any form or by any means or stored in a data base or retrieval. system without the prior written permission of the publisher. Previous editions copyright 1999 1997 1995 1993 1991 by Appleton Lange copyright 1963. through 1989 by Lange Medical Publications,1 2 3 4 5 6 7 8 9 0 DOW DOW 0 9 8 7 6 5 4 3 2 1. ISBN 0 8385 8282 6,ISSN 0892 1253, Notice Medicine is an ever changing science As new research and clinical experience broaden our. knowledge changes in treatment and drug therapy are required The author and the publisher of this. work have checked with sources believed to be reliable in their efforts to provide information that is. complete and generally in accord with the standards accepted at the time of publication However in view. of the possibility of human error or changes in medical sciences neither the author nor the publisher nor. any other party who has been involved in the preparation or publication of this work warrants that the. information contained herein is in every respect accurate or complete and they disclaim all responsibility. for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources For example. and in particular readers are advised to check the product information sheet included in the package of. each drug they plan to administer to be certain that the information contained in this work is accurate and. that changes have not been made in the recommended dose or in the contraindications for. administration This recommendation is of particular importance in connection with new or infrequently. used drugs, The book was set in Times Roman by Rainbow Graphics.
The editors were Janet Foltin Isabel Nogueira Jim Ransom and Lester A Sheinis. The production supervisor was Phil Galea,The production service was Rainbow Graphics. The cover designer was Mary McKeon,The art manager was Charissa Baker. The art coordinator was Becky Hainz Baxter, The illustrators were Linda F Harris Shirley Bortoli and Teshin Associates. The indexer was Katherine Pitcoff,R R Donnelley Sons Company was printer and binder. This book is printed on acid free paper,INTERNATIONAL EDITION ISBN 0 07 112064 5.
Copyright 2001 Exclusive rights by The McGraw Hill Companies Inc for manufacture and export. This book cannot be re exported from the country to which it is consigned by McGraw Hill The. International Edition is not available in North America. Preface ix,SECTION I INTRODUCTION 1, 1 The General Cellular Basis of Medical Physiology 1. Introduction 1,General Principles 1,Functional Morphology of the Cell 8. Structure Function of DNA RNA 17,Transport Across Cell Membranes 27. The Capillary Wall 35,Intercellular Communication 35. Homeostasis 46,Section I References 47,SECTION II PHYSIOLOGY OF NERVE MUSCLE CELLS 47.
2 Excitable Tissue Nerve 49,Introduction 49,Nerve Cells 49. Excitation Conduction 51,Ionic Basis of Excitation Conduction 56. Properties of Mixed Nerves 58,Nerve Fiber Types Function 58. Neurotrophins 58,3 Excitable Tissue Muscle 62,Introduction 62. Skeletal Muscle 62,Morphology 62,Electrical Phenomena Ionic Fluxes 65.
Contractile Responses 65,Energy Sources Metabolism 70. Properties of Muscles in the Intact Organism 72,Cardiac Muscle 74. Morphology 74,Electrical Properties 74,Mechanical Properties 75. Metabolism 77,Pacemaker Tissue 78,Smooth Muscle 78. Morphology 78,Visceral Smooth Muscle 78,Multi Unit Smooth Muscle 80.
4 Synaptic Junctional Transmission 81,Introduction 81. Synaptic Transmission 81,Functional Anatomy 81,Electrical Events in Postsynaptic Neurons 84. Inhibition Facilitation at Synapses 88,Chemical Transmission of Synaptic Activity 90. Principal Neurotransmitter Systems 93,Synaptic Plasticity Learning 110. Neuromuscular Transmission 110,Neuromuscular Junction 110.
Nerve Endings in Smooth Cardiac Muscle 112,Denervation Hypersensitivity 113. 5 Initiation of Impulses in Sense Organs 115,Introduction 115. Sense Organs Receptors 115,The Senses 115,Electrical Chemical Events in Receptors 117. Ionic Basis of Excitation 118,Coding of Sensory Information 119. Section II References 121,SECTION III FUNCTIONS OF THE NERVOUS SYSTEM 123.
6 Reflexes 123,Introduction 123,Monosynaptic Reflexes The Stretch Reflex 123. Polysynaptic Reflexes The Withdrawal Reflex 129,General Properties of Reflexes 130. 7 Cutaneous Deep Visceral Sensation 132,Introduction 132. Pathways 132,Proprioception 136,Temperature 136,Other Sensations 142. 8 Vision 144,Introduction 144,Anatomic Considerations 144.
The Image Forming Mechanism 149,The Photoreceptor Mechanism 152. Responses in the Visual Pathways Cortex 155,Color Vision 159. Other Aspects of Visual Function 161,Eye Movements 163. 9 Hearing Equilibrium 166,Introduction 166,Anatomic Considerations 166. Hair Cells 170,Hearing 172,Vestibular Function 178.
10 Smell Taste 180,Introduction 180,Receptor Organs Pathways 183. 11 Alert Behavior Sleep the Electrical Activity of the Brain 187. Introduction 187,The Thalamus the Cerebral Cortex 187. The Reticular Formation the Reticular Activating System 187. Evoked Cortical Potentials 188,The Electroencephalogram 189. Physiologic Basis of the EEG Consciousness Sleep 191. 12 Control of Posture Movement 197,Introduction 197. General Principles 197,Corticospinal Corticobulbar System 198.
Anatomy Function 198,Posture Regulating Systems 201. Spinal Integration 203,Medullary Components 204,Midbrain Components 206. Cortical Components 207,Basal Ganglia 207,Cerebellum 211. 13 The Autonomic Nervous System 217,Introduction 217. Anatomic Organization of Autonomic Outflow 217,Chemical Transmission at Autonomic Junctions 219.
Responses of Effector Organs to Autonomic Nerve Impulses 221. 14 Central Regulation of Visceral Function 224,Introduction 224. Medulla Oblongata 224,Hypothalamus 225,Anatomic Considerations 225. Hypothalamic Function 226,Relation to Autonomic Function 226. Relation to Sleep 227,Relation to Cyclic Phenomena 227. Hunger 228,Thirst 232,Control of Posterior Pituitary Secretion 233.
Control of Anterior Pituitary Secretion 239,Temperature Regulation 242. 15 Neural Basis of Instinctual Behavior Emotions 248. Introduction 248,Anatomic Considerations 248,Limbic Functions 249. Sexual Behavior 249,Fear Rage 252,Motivation Addiction 253. Brain Chemistry Behavior 254, 16 Higher Functions of the Nervous System Conditioned Reflexes Learning Related. Phenomena 259,Introduction 259,Methods 259,Learning Memory 259.
Functions of the Neocortex 264,Section III References 264. SECTION IV ENDOCRINOLOGY METABOLISM REPRODUCTIVE FUNCTION 267. 17 Energy Balance Metabolism Nutrition 271,Introduction 271. Energy Metabolism 271,Intermediary Metabolism 274,Carbohydrate Metabolism 278. Protein Metabolism 284,Fat Metabolism 290,Nutrition 302. 18 The Thyroid Gland 307,Introduction 307,Anatomic Considerations 307.
Formation Secretion of Thyroid Hormones 308,Transport Metabolism of Thyroid Hormones 311. Effects of Thyroid Hormones 313,Regulation of Thyroid Secretion 316. Clinical Correlates 317, 19 Endocrine Functions of the Pancreas Regulation of Carbohydrate Metabolism 322. Introduction 322,Islet Cell Structure 322,Structure Biosynthesis Secretion of Insulin 323. Fate of Secreted Insulin 324,Effects of Insulin 324.
Mechanism of Action 327,Consequences of Insulin Deficiency 328. Insulin Excess 333,Regulation of Insulin Secretion 334. Glucagon 337,Other Islet Cell Hormones 339, Effects of Other Hormones Exercise on Carbohydrate Metabolism 340. Hypoglycemia Diabetes Mellitus in Humans 341,20 The Adrenal Medulla Adrenal Cortex 344. Introduction 344,Adrenal Morphology 344,Adrenal Medulla 346.
Structure Function of Medullary Hormones 346,Regulation of Adrenal Medullary Secretion 348. Adrenal Cortex 349, Structure Biosynthesis of Adrenocortical Hormones 349. Transport Metabolism Excretion of Adrenocortical Hormones 354. Effects of Adrenal Androgens Estrogens 356,Physiologic Effects of Glucocorticoids 356. Pharmacologic Pathologic Effects of Glucocorticoids 358. Regulation of Glucocorticoid Secretion 359,Effects of Mineralocorticoids 362. Regulation of Aldosterone Secretion 364, Role of Mineralocorticoids in the Regulation of Salt Balance 366.
Summary of the Effects of Adrenocortical Hyper Hypofunction in Humans 366. 21 Hormonal Control of Calcium Metabolism the Physiology of Bone 369. Introduction 369,Calcium Phosphorus Metabolism 369. Bone Physiology 370,Vitamin D the Hydroxycholecalciferols 375. The Parathyroid Glands 377,Calcitonin 380, Effects of Other Hormones Humoral Agents on Calcium Metabolism 382. 22 The Pituitary Gland 383,Introduction 383,Morphology 381. Intermediate Lobe Hormones 384,Growth Hormone 386,Physiology of Growth 392.
Pituitary Insufficiency 395,Pituitary Hyperfunction in Humans 396. 23 The Gonads Development Function of the Reproductive System 398. Introduction 398,Sex Differentiation Development 398. Chromosomal Sex 398,Embryology of the Human Reproductive System 400. Aberrant Sexual Differentiation 401,Puberty 405,Precocious Delayed Puberty 407. Menopause 408,Pituitary Gonadotropins Prolactin 408.
The Male Reproductive System 410,Structure 410,Gametogenesis Ejaculation 411. Endocrine Function of the Testes 415,Control of Testicular Function 418. Abnormalities of Testicular Function 419,The Female Reproductive System 419. The Menstrual Cycle 419,Ovarian Hormones 425,Control of Ovarian Function 430. Abnormalities of Ovarian Function 433,Pregnancy 433.
Lactation 436, 24 Endocrine Functions of the Kidneys Heart Pineal Gland 439. Introduction 439,The Renin Angiotensin System 439,Erythropoietin 444. Hormones of the Heart Other Natriuretic Factors 445. Pineal Gland 447,Section IV References 449,SECTION V GASTROINTESTINAL FUNCTION 453. 25 Digestion Absorption 453,Introduction 453,Carbohydrates 453. Proteins Nucleic Acids 456,Lipids 458,Absorption of Water Electrolytes 459.
Absorption of Vitamins Minerals 462,26 Regulation of Gastrointestinal Function 464. Introduction 464,General Considerations 464,Gastrointestinal Hormones 466. Mouth Esophagus 472,Stomach 475,Exocrine Portion of the Pancreas 481. Liver Biliary System 483,Small Intestine 489,Section V References 496. SECTION VI CIRCULATION 499,27 Circulating Body Fluids 499.
Introduction 499,Bone Marrow 499,White Blood Cells 500. Immunity 504,Platelets 514,Red Blood Cells 515,Blood Types 519. Plasma 522,Hemostasis 524, 28 Origin of the Heartbeat the Electrical Activity of the Heart 528. Introduction 528,Origin Spread of Cardiac Excitation 528. The Electrocardiogram 530,Cardiac Arrhythmias 535, Electrocardiographic Findings in Other Cardiac Systemic Diseases 541.
29 The Heart as a Pump 545,Introduction 545,Mechanical Events of the Cardiac Cycle 545. Cardiac Output 550,30 Dynamics of Blood Lymph Flow 556. Introduction 556,Anatomic Considerations 556,Biophysical Considerations 560. Arterial Arteriolar Circulation 565,Capillary Circulation 568. Lymphatic Circulation Interstitial Fluid Volume 570. Venous Circulation 572,31 Cardiovascular Regulatory Mechanisms 574.
Introduction 574,Local Regulatory Mechanisms 574,Substances Secreted by the Endothelium 575. Systemic Regulation by Hormones 577,Systemic Regulation by the Nervous System 579. 32 Circulation Through Special Regions 588,Introduction 588. Cerebral Circulation 588,Anatomic Considerations 588. Cerebrospinal Fluid 589,The Blood Brain Barrier 591.
Cerebral Blood Flow 593,Regulation of Cerebral Circulation 595. Brain Metabolism Oxygen Requirements 596,Coronary Circulation 597. Splanchnic Circulation 601,Circulation of the Skin 602. Placental Fetal Circulation 603, 33 Cardiovascular Homeostasis in Health Disease 607. Introduction 607,Compensations for Gravitational Effects 607.
Exercise 609,Inflammation Wound Healing 612,Hypertension 618. Heart Failure 620,Section VI References 622,SECTION VII RESPIRATION 625. 34 Pulmonary Function 625,Introduction 625,Properties of Gases 625. Anatomy of the Lungs 626,Mechanics of Respiration 627. Gas Exchange in the Lungs 637,Pulmonary Circulation 639.
Other Functions of the Respiratory System 642, 35 Gas Transport Between the Lungs the Tissues 644. Introduction 644,Oxygen Transport 644,Carbon Dioxide Transport 647. 36 Regulation of Respiration 649,Introduction 649,Neural Control of Breathing 649. Regulation of Respiratory Activity 650,Chemical Control of Breathing 651. Nonchemical Influences on Respiration 656,37 Respiratory Adjustments in Health Disease 658.
Introduction 658,Effects of Exercise 658,Hypoxia 660. Hypoxic Hypoxia 661,Other Forms of Hypoxia 667,Oxygen Treatment 668. Hypercapnia Hypocapnia 668,Other Respiratory Abnormalities 669. Effects of Increased Barometric Pressure 670,Artificial Respiration 672. Section VII References 673,SECTION VIII FORMATION AND EXCRETION OF URINE 675.
38 Renal Function Micturition 675,Introduction 675. Functional Anatomy 675,Renal Circulation 679,Glomerular Filtration 681. Tubular Function 684,Water Excretion 689, Acidification of the Urine Bicarbonate Excretion 694. Regulation of Na Cl Excretion 697,Regulation of K Excretion 699. Diuretics 699,Effects of Disordered Renal Function 700.
Filling of the Bladder 701,Emptying of the Bladder 701. 39 Regulation of Extracellular Fluid Composition Volume 704. Introduction 704,Defense of Tonicity 704,Defense of Volume 704. Defense of Specific Ionic Composition 705,Defense of H Concentration 705. Section VIII References 713,Appendix 714,General References 714. Normal Values the Statistical Evaluation of Data 714. Abbreviations Symbols Commonly Used in Physiology 716. Some Standard Respiratory Symbols 722, Equivalents of Metric United States English Measures 723.
Greek Alphabet 723, Self Study Objectives Essay Questions Multiple Choice Questions 725. Answers to Quantitative Multiple Choice Questions 775. Standard Atomic Weights 1995 Inside Front Cover, Ranges of Normal Values in Human Whole Blood Plasma or Serum Inside Back Cover. This book is designed to provide a concise summary of mammalian and particularly of human. physiology that medical students and others can use by itself or can supplement with readings in current. texts monographs and reviews Pertinent aspects of general and comparative physiology are also. included Summaries of relevant anatomic considerations will be found in each section but this book is. written primarily for those who have some knowledge of anatomy chemistry and biochemistry Examples. from clinical medicine are given where pertinent to illustrate physiologic points In many of the chapters. physicians desiring to use this book as a review will find short discussions of important symptoms. produced by disordered function, Review of Medical Physiology also includes a self study section to help students review for Board and. other examinations and an appendix that contains general references a discussion of statistical methods. a glossary of abbreviations acronyms and symbols commonly used in physiology and several useful. tables The index is comprehensive and specifically designed for ease in locating important terms topics. and concepts, In writing this book the author has not been able to be complete and concise without also being. dogmatic I believe however that the conclusions presented without detailed discussion of the. experimental data on which they are based are supported by the bulk of the currently available evidence. Much of this evidence can be found in the papers cited in the credit lines accompanying the illustrations. Further discussions of particular subjects and information on subjects not considered in detail can be. found in the references listed at the end of each section Information about serial review publications that. provide up to date discussions of various physiologic subjects is included in the note on general. references in the appendix In the interest of brevity and clarity I have in most instances omitted the. names of the many investigators whose work made possible the views of physiology presented here This. omission is in no way intended to slight their contributions but including their names and specific. references to original papers would greatly increase the length of the book. In this twentieth edition as in previous editions the entire book has been thoroughly revised with a view. to eliminating errors incorporating suggestions of readers updating concepts and discarding material. that is no longer relevant In this way the book has been kept as up to date and accurate as possible. Since the last edition there has continued to be rapid expansion of knowledge about how extracellular. signals initiate changes in gene expression and about the genetic basis of disease Material on these. topics has been updated The section on immunology has been rewritten again for clarity and to expand. consideration of the relation between innate and acquired immunity The sections on the cerebral cortex. in relation to vision audition and olfaction have been revised and the chapter on sleep and waking. states has been rewritten to emphasize the importance of thalamocortical oscillations New information. has been provided on many topics including molecular motors hormones of the heart motilin and. gastrointestinal motility acute phase proteins sleep apnea and addiction. The self study section has been updated and more emphasis has been placed on physiology in relation. to disease in keeping with the current trend in the United States Medical Licensing Examinations. I am greatly indebted to the many individuals who helped with the preparation of this book Those to. whom I express special thanks for their help with the twentieth edition include Dr Walter Miller Dr Melvin. Grumbach Dr Stephen McPhee and Dr Dolores Shoback Jesse Loesberg provided invaluable. secretarial assistance and as always my wife made numerous contributions Jim Ransom who edited. the first edition of this book 40 years ago came back again and did an excellent job of editing this edition. Many associates and friends provided unpublished illustrative materials and numerous authors and. publishers generously granted permission to reproduce illustrations from other books and journals I also. thank all the students and others who took the time to write to me offering helpful criticisms and. suggestions Such comments are always welcome and I solicit additional corrections and criticisms. which may be addressed to me at,Department of Physiology.
University of California,San Francisco CA 94143 0444 USA. Since this book was first published in 1963 the following translations have been published Bulgarian. Chinese two independent translations Czech two editions French German four editions Greek two. editions Hungarian Indonesian three editions Italian seven editions Japanese fifteen editions. Korean Malaysian Polish two editions Portuguese seven editions Serbo Croatian Spanish sixteen. editions and Turkish two editions Various foreign English language editions have been published and. the book has been recorded in English on tape for use by the blind The tape recording is available from. Recording for the Blind Inc 20 Rozsel Road Princeton NJ 08540 USA For computer users the book. is now available along with several other titles in the Lange Medical Books series in STAT Ref a. searchable CD ROM from Teton Data Systems 211 East Broadway Jackson WY 83001 USA More. information about this and other Lange and McGraw Hill books including addresses of the publisher s. international offices is available on McGraw Hill s Web site www mghmedical com. Copyright c 2001 The McGraw Hill Companies Inc All rights reserved. To all fellow medical colleagues, This book is not intended to be a substitution for the one made of paper This is a. brilliant book and the only way to show appreciation for the authors and the publisher is. Please inform if there are any errors or if there are any improvements you would. wish to see in the text Hope you enjoy the book, The purpose of the doctor To cure sometimes To relieve often To comfort. always Socrates,Section I Introduction, 1 The General Cellular Basis of Medical Physiology. Section II Physiology of Nerve Muscle Cells,2 Excitable Tissue Nerve.
3 Excitable Tissue Muscle,4 Synaptic Junctional Transmission.


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