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(BQ) Part 2 book Elsevier''s integrated physiology presents the following contents: Pulmonary system, renal system and urinary tract, gastrointestinal system, endocrine system, female reproductive system, male reproductive system, life span, integration.
Pulmonary System CONTENTS PULMONARY SYSTEM PHYSIOLOGY MAP STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM Upper Airways and Larynx Lower Airways Pleura Muscular Structure VENTILATION Lung Volumes and Compliance SURFACTANT AND PULMONARY COMPLIANCE Alveoli WORK OF RESPIRATION GAS EXCHANGE Air–Alveolar Gas Mixing Alveolar–Blood Gas Exchange PULMONARY CIRCULATION VENTILATION-PERFUSION BALANCE BLOOD TRANSPORT OF OXYGEN AND CARBON DIOXIDE REGULATION OF PULMONARY FUNCTION Regulation of Blood Oxygen Regulation of Blood Carbon Dioxide Integrated Control of Respiration Pulmonary Mechanisms in Acid-Base Regulation TOP TAKE-HOME POINTS Lungs facilitate exchange of O2 and CO2 between tissues and the atmosphere O2 uptake is necessary to support aerobic (oxidative) metabolism, and CO2 is eliminated as a metabolic waste product Inspiration brings atmospheric air into the alveoli for exchange Diffusion drives O2 from the alveoli into the blood and CO2 from the blood into the alveoli After exchange, the arteries transport oxygenated blood from the heart to the tissues Oxygen diffuses from tissue capillaries through interstitial fluid, cell membranes, cytoplasm, and finally reaches the mitochondria Carbon dioxide follows the reverse path, entering blood at the tissue capillaries.The veins bring CO2-rich blood back to the heart and lungs for elimination in the expired air 10 The lungs fill the thoracic cavity, and although they are not physically attached, the lungs and chest wall move together during respiration The interpleural space is a thin region between the pleura lining the lungs and the pleura lining the interior of the chest wall This pleural fluid effectively couples the movement of the lungs to the movement of the chest wall Within the thorax, the elastic recoil of the lungs pulls the lungs away from the chest wall Conversely, the recoil of the thorax pulls the chest wall away from the lungs These opposing forces cause the interpleural pressure to be negative, about −4 mm Hg at rest, and even more negative during inspiration Alveoli must remain open to participate in gas exchange The alveoli are interconnected with elastic tissue, so inflation of one alveolus helps expand the adjacent alveoli (interdependence) Surfactant reduces surface tension generated by the air-water interface The surfactant-mediated decreases in surface tension are greater in uninflated alveoli, again preventing collapse and closure Ventilation and perfusion are matched to facilitate gas exchange Alveolar hypoxia causes pulmonary vascular smooth muscle to vasoconstrict and to direct pulmonary blood flow away from areas of poor ventilation Low CO2 in the airways causes constriction of the bronchiole smooth muscle, directing ventilation to alveoli that are better perfused Control of respiration involves a basic rhythm generated by the brainstem that is modified by multiple neural inputs Respiration is controlled by both central CO2 sensors and peripheral CO2 and O2 sensors Pulmonary stretch receptors reflexly inhibit inspiration and prevent overinflation of the lungs There is no hormonal control of respiration Hormones do, however, control constriction of bronchiole smooth muscle Histamine and acetylcholine constrict the bronchioles, important in anaphylactic shock Epinephrine and norepinephrine dilate the bronchioles Descending input from higher central nervous system (CNS) structures provides additional respiratory control, particularly during exercise The lungs are not a classical endocrine organ, but participate in two important endocrine actions Angiotensin converting enzyme is localized on the pulmonary capillary endothelium, and catalyzes the formation of the vasoconstrictor peptide, angiotensin II Histamine is released from mast cells in the lung during anaphylactic shock 100 PULMONARY SYSTEM ●●● PULMONARY SYSTEM PHYSIOLOGY MAP The physiologic map of the pulmonary system is complex, reflecting the various factors involved in exchanging gas between the outside air and the tissues (Fig 10-1).The central point of pulmonary function is the exchange across the barrier that separates the alveolar air and the pulmonary capillary blood This process is driven by diffusion and consequently determined by the components of Fick’s law of diffusion: the diffusion coefficient reflecting solubility, the surface area available for exchange, the concentration gradient, and the distance over which the compound must move In Figure 10-1A, the focus is on alveolar partial pressure (1) and the movement of air between the alveoli and the atmosphere This movement is determined by the partial pressure (composition) of the gas entering the alveoli (2), and the alveolar minute ventilation (3), the rate at which air enters the alveoli Air movement within the respiratory system is complicated because air flow is achieved by a “pushpull exchange” process rather than by a “flow-through” process In this exchange process, the inspired air mixes with air already within the body (4), and the volume of new air flowing into the mouth is greater than the volume of new air that flows into the alveoli Pulmonary ventilation has to account for dead space ventilation of airways that not participate in gas exchange These events contribute to the drop in oxygen partial pressure (PO2) as air flows toward the alveoli The maximal inspired volume is determined by the physical size of the lungs and the compliance of the lungs Normal ventilation is less than the maximum and is determined by airway resistance and by the pressure gradient between the atmosphere and the alveoli The map in Figure 10-1B begins at alveolar partial pressure, but the focus shifts to the transport of O2 and CO2 in the blood and the exchange at the tissue level Oxygen transport in the blood is accomplished primarily through the red blood cell (RBC) protein hemoglobin, with a very small amount of O2 being carried dissolved in the plasma Blood CO2 transport is primarily in the form of bicarbonate, with smaller amounts being carried on the hemoglobin protein and dissolved in the plasma Gas exchange between the mitochondria in the tissues and the blood in the systemic capillaries is again accomplished by diffusion and described by the components of Fick’s law of diffusion: the diffusion coefficient reflecting solubility, the Figure 10-1 Map of the respiratory system Gas exchange across the alveolar/pulmonary capillary barrier is the focal point for pulmonary function A, Gas composition and the volume of air exchange determine the alveolar gas composition CNS Respiratory muscles Respiratory effort Chest wall compliance Lung compliance % Composition Atmospheric pressure Pleural pressure Alveolar gas volume Alveolar pressure Atmospheric pressure Pressure gradient Inspired gas partial pressure Humidified partial pressure Water vapor Airway resistance Vital capacity Flow Respiratory rate Inspired volume Minute ventilation Alveolar partial pressure Mix with air already in alveoli Dead space A Alveolar minute ventilation r rrie li eo Alv ba STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM Alveolar partial pressure Barrier D conc D distance Arterial chemoreceptors Cardiovascular system J=:DA Arterial blood content Pulmonary capillary partial pressure Figure 10-1 Continued B, The focus shifts to blood flow (pink shaded area) and blood-carrying capacity The two points of homeostatic regulation, the arterial chemoreceptors and the CNS chemoreceptors, are shown in shaded boxes Dissolved Bound Carrying capacity Pulmonary blood flow Venous blood flow Venous blood content Dissolved Cardiac output Other tissues Tissue blood flow Systemic capillary delivery Bound Barrier D conc J=:DA D distance B CNS chemoreceptors Interstitial fluid Cell surface area available for exchange, the concentration gradient, and the distance over which the compound must move There are three regulated variables controlled by a negative feedback system in the pulmonary system: arterial blood partial pressure of O2 (PaO2), arterial blood partial pressure of CO2 (PaCO2), and CNS tissue pH The gas composition of arterial blood is monitored by chemoreceptors located at the carotid bodies and the aortic bodies Afferent nerves from these chemoreceptors synapse in the respiratory centers of the pons and the medulla The CNS chemoreceptors monitor brain pH as a measure of CO2 levels Any increase in CO2 in the CNS or arterial plasma will cause an increase in ventilation A pronounced drop in arterial O2 partial pressure also can cause an increase in ventilation The increase in ventilation should facilitate pulmonary uptake of O2 and elimination of CO2, returning the body gas levels to their normal values ●●● STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM The lungs lie within the thoracic cavity on either side of the heart They are cone shaped, with the apex rising above the first rib and the base resting on the diaphragm The right lung is divided into three lobes, and the left lung into two lobes Mitochondria The mediastinum separates the two lobes from each other and from the heart, thoracic blood vessels, esophagus, and part of the trachea and bronchi (Fig 10-2) Air travels progressively through the nose and pharynx, then the trachea, bronchi, and bronchioles before entering the alveoli The airways branch into progressively smaller airways, and each dividing point is called a “generation.” Alveoli are reached after 20 to 25 generations Larger airways are kept open by cartilage, and small airways and alveoli are kept open by transpulmonary pressures and by connections to adjacent alveoli Goblet cells line the airways and secrete mucus Mucus helps keep the airways moist and traps inspired particulate matter Ciliated epithelia propel mucus toward the pharynx Mucus and trapped particles are either expelled by coughing or swallowed The trachea and bronchi contain smooth muscle Airway smooth muscle normally is relaxed Hormones released from pulmonary mast cells can cause a strong contraction, particularly histamine and the slow reactive substance of anaphylaxis This release is characteristic of allergic reactions.The presence of irritants also causes release of constrictor hormones Vagal parasympathetic stimulation (acetylcholine) contracts airway smooth muscle Sympathetic nerves and the circulating catecholamine hormones epinephrine and norepinephrine relax airway smooth muscle This airway dilation 101 102 PULMONARY SYSTEM Nasal cavity Upper respiratory system Tongue Pharynx Larynx Vocal cords Esophagus Trachea Left bronchus Right bronchus Left lung Right lung Figure 10-2 Functional anatomy of the pulmonary system A, Air entering the lungs passes first through the upper airways and then through the trachea and the lower airways before reaching the alveoli B, Progressive branching of the tracheobronchial tree ends in the alveoli C, Pulmonary vascular supply includes the bronchial circulation, which originates from the aorta, and the pulmonary circulation, which originates from the pulmonary artery Lower respiratory system Diaphragm A Bronchiole Larynx Smooth muscle Trachea Left primary bronchus Bronchial artery, vein, and nerve Elastic fibers Capillary beds Branch of pulmonary artery Lymphatic vessel Alveoli Secondary bronchus Bronchiole Alveoli Branch of pulmonary vein B C assists the increase in ventilation that accompanies a sympathetic “fight or flight” response Upper Airways and Larynx The upper airways include nasal cavities, the pharynx, and the larynx The mouth can be considered part of the upper airway because it is a secondary route for air to pass to the trachea Inspired air is warmed and humidified while passing through the nose Particulate matter is filtered while passing through the nose Turbulent air flow causes precipitation of particles as they contact the mucous layer In addition, nose hairs help filter larger particles Inspired particles smaller than μm can pass through the nose These particles can precipitate in bronchioles or alveoli or remain suspended and be expired (e.g., 60% of cigarette smoke is expired) The sneeze reflex is initiated by irritation of the nasal passages and helps clear the nasal passages of foreign matter The mouth is less effective in warming, filtering, and humidifying air during high-volume breathing Consequently, a larger percentage of particulate matter enters the lower airways and becomes trapped in the mucous layer during mouth breathing STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM The pharynx is a cone-shaped passageway extending from the nose to the larynx It is a common pathway for both the respiratory and the digestive systems.The epiglottis forms the barrier between the pharynx and the larynx When food or liquids are swallowed, the epiglottis seals the larynx and prevents aspiration of food and liquid into the lower airways Speech is a combination of phonation, pitch, articulation, and resonance Phonation is accomplished by vibration of the vocal cords of the larynx Pitch of sound is altered by stretching or relaxing the vocal cords Pitch of sound is also altered by changing the shape and mass of the vocal cord edges Articulation of sound is accomplished by the lips, tongue, and soft palate of the mouth Resonance of sound is controlled by the mouth, nose, nasal sinuses, pharynx, and thoracic cavity Lower Airways The lower airways, or tracheobronchial tree, connect the larynx and the alveoli Gas exchange between the inspired air in the pulmonary capillaries occurs in the respiratory bronchioles, the alveolar ducts, and the alveolar sacs The trachea is a flexible, muscular air passage held open by cartilaginous rings Although the trachea is primarily a passageway, air entering the body is further humidified and warmed during its passage through the trachea The trachea ends at the branching point leading to the left to the left primary bronchus and to the right to mainstem bronchi The mainstem bronchi undergo series of branchings into progressively smaller airways The small bronchioles not possess cartilage and can collapse and trap air in the smaller airways when intrapleural pressure is high The terminal bronchioles are the last airways of the conducting system The remaining airways are the respiratory zone, which participates in gas exchange Alveoli are the functional components of the lung The total surface of the alveolus is approximately 800 square feet, or about the size of a tennis court Alveoli are specialized for gas exchange.The epithelia of the alveoli consist of type I and type II pneumocytes The inner wall of the alveoli is lined with surfactant secreted by type II pneumocytes Oxygen passing from alveolar air into the pulmonary capillary passes sequentially through a fluid and surfactant layer lining the alveoli, alveolar epithelia, epithelial basement membrane, interstitial space, capillary basement membrane, and finally capillary endothelium Pleura Pleurae are serous membranes that separate the lungs and the wall of the thoracic cavity The visceral pleura covers the surface of the lungs, and the parietal pleura covers the inside of the thorax, mediastinum, and diaphragm A thin film of serous fluid fills the space between the two pleurae This pleural fluid couples the movement of the lungs and chest wall, so that changes in chest wall shape cause a corresponding change in lung shape Normally the pressure in the interpleural space is negative and keeps the lungs inflated so that they fill the thoracic space Entry of air into the interpleural space (pneumothorax) allows the lung to collapse and the chest wall to expand Lungs can be “reinflated” by removing pleural air The mediastinum usually limits lung collapse to one side Muscular Structure Ventilation results from the action of skeletal muscles to alter the thoracic space Normal breathing uses the diaphragm for inspiration, and expiration is accomplished passively by recoil of elastic tissue of the lung The diaphragm is a dome-shaped muscle that makes up the base of the thoracic cage.The dome of the diaphragm extends upward into the thoracic space During inspiration, the diaphragm contracts and flattens, expanding the volume of the thoracic space The subsequent drop in interpleural pressure causes the lungs to expand, pulling the lungs downward toward the abdominal space Forced breathing is facilitated by a variety of accessory muscles (Table 10-1) Forced inspiration causes a further increase in the volume of the thoracic space by pulling the ribs upward and outward Forced expiration reverses the direction and decreases the thoracic space by pulling the ribs downward and inward PATHOLOGY PATHOLOGY Infant Respiratory Distress Syndrome Fetal production of surfactant occurs early in the third trimester Babies born before 28 weeks of gestation not have sufficient surfactant to allow the airway to remain open, and infant respiratory distress syndrome develops The lack of surfactant greatly increases the work of breathing and increases the probability that the alveoli will collapse from increased surface tension Pneumothorax An opening in the thoracic cage, combined with the negative intrapleural pressure, allows air to enter the pleural space The lungs will collapse because of their elastic recoil, and the chest wall will expand outward Contraction of the diaphragm then causes air to enter the intrapleural space rather than to inflate the lungs A puncture of the trachea or tearing of the bronchi allows air to enter the intrapleural space during inspiration, but the air cannot be expelled during expiration, creating a tension pneumothorax 103 104 PULMONARY SYSTEM TABLE 10-1 Accessory Muscles of Respiration Forced Inspiration Forced Expiration External intercostals Internal intercostals Sternocleidomastoids Abdominals Scalenes Anterior serrati ANATOMY Intercostal Muscles The internal intercostal muscles and the external intercostal muscles are arranged at right angles to each other Contraction of the internal intercostals elevates the ribs away from the thoracic cavity Contraction of the external intercostal muscles pulls the ribs into the thoracic cavity ●●● VENTILATION Air movement during both inspiration and expiration requires the creation of a pressure gradient The initial event in inspiration is contraction of the diaphragm, which causes an increase in the volume of the thoracic space and a decrease in the interpleural pressure (B1 to B2 in Fig 10-3) The expansion of the lungs causes alveolar pressure to drop below atmospheric pressure (A2), creating a pressure gradient that is diminished (A3) as air flows into the alveoli (C1 to C2) Inspiration (air flow) ends when intra-alveolar pressure equals atmospheric pressure By the end of inspiration, interpleural pressure is at its most negative, but alveolar pressure has returned to atmospheric pressure because of the increase in lung volume The sequence is reversed during expiration as air moves from the alveoli to the atmosphere Relaxation of the diaphragm causes a decrease in the volume of the thoracic cage, and interpleural pressure becomes less negative Compression of the lungs causes alveolar pressure to become positive (1 cm H2O) relative to the atmosphere Again, air moves down the pressure gradient, now exiting the lungs Expiration ends when intra-alveolar pressure equals atmospheric pressure Lung Volumes and Compliance Pulmonary ventilation is divided into four volumes and four capacities, as illustrated in Figure 10-4 The volumes are (1) inspiratory reserve volume—the difference between a normal and a maximal inspiration, (2) tidal volume—the amount of air moved during a normal, quiet respiration, (3) expiratory reserve volume—the difference between a normal and a maximal expiration, and (4) residual volume—the amount of air remaining in the lungs after a maximal expiration.The first three volumes can be measured by spirometry Residual volume cannot be determined by spirometry but can be measured by helium dilution or determined by plethysmography Capacities are the sum of two or more respiratory volumes The normal resting point of the lung is at the end of a normal, quiet expiration Functional residual capacity is the volume of air remaining in the lungs after this normal, quiet expiration and is equal to (expiratory reserve volume + residual volume) Inspiratory capacity is the volume of air that can be inspired following a normal, quiet expiration and is equal to tidal volume + inspiratory reserve volume Vital capacity is the volume of air under voluntary control, equal to (inspiratory reserve volume + tidal volume + expiratory reserve volume) Vital capacity measurement requires maximal effort on the part of the patient and is often called forced vital capacity Total lung capacity is the amount of air contained within a maximally inflated lung (all four volumes combined) Spirometry measures all volumes and derived capacities except residual volume and the two capacities that include residual volume—total lung capacity and functional residual capacity (see Fig 10-4) Normal values are a function of height, sex, age, and, to a lesser degree, ethnic group Changes in volumes and capacities are indicative of pulmonary dysfunction Timed vital capacity, obtained during a forced expiration following a maximal inspiration, is also an important clinical test FEV1 (forced expiratory volume in second) usually is 80% of vital capacity FEV3 (forced expiratory volume in seconds) usually is 95% of vital capacity Equivalent diagnostic information is obtained from measurement of peak expiratory flow rates (Fig 10-5) Clinical assessment of pulmonary function commonly uses flow-volume loops to illustrate simultaneously the patient data obtained by spirometry and FEV Flow-volume loops plot the spirometry data on the x-axis, with the residual volume at the far right and the total lung capacity at the far left.The velocity of air flow is plotted on the y-axis, with zero air flow plotted in the middle of the y-axis, inspiratory flow being downward from zero and expiratory flow being upward from zero The expiratory portion of the loop provides the peak expiratory flow, and the slope of the right side of the expiratory flow loop provides an effort-independent flow rate This portion of the loop is effort independent because the increase in intrathoracic pressure during forced expiration will collapse bronchi that lack cartilaginous support Pulmonary function tests help distinguish between two major classes of pulmonary disease: restrictive and obstructive The flow-volume tracings for these two types of disease are shown in Figure 10-6 Restrictive diseases limit expansion of the lungs, because of either damage to the lungs (fibrosis) or limitation in thoracic expansion (musculoskeletal) Patients with restrictive disease have low total lung capacities and low vital capacities The peak velocity of flow and the FEV are low, but the FEV1 VENTILATION Expiration Alveolar pressure (mm Hg) A4 A1 A3 Bronchi C ;2 ;1 A5 :1 A2 A Lung B3 Intrapleural pressure (mm Hg) B1 B :2 :3 :4 Pressure (cm H20) Trachea Inspiration Figure 10-3 Interpleural and alveolar pressure changes during the respiratory cycle During inspiration, interpleural pressure decreases due to expansion of the thoracic cage Lung expansion causes alveolar pressure to become negative relative to the atmosphere, and air enters the lungs Inspiration stops when the entering air causes alveolar pressure to rise to atmospheric pressure During expiration, the cycle is reversed, with the decrease in lung size causing an increase in alveolar pressure As air flows out of the lungs, alveolar pressure returns to atmospheric pressure :5 :6 B2 Diaphragm C2 500 250 C1 C3 6000 Volume (mL) 750 Volume of air moved (mL) Time (sec) Figure 10-4 Spirometry allows measurement of lung volumes Spirometry allows determination of three lung volumes and their associated capacities Spirometry cannot determine residual volume or any capacitycontaining residual volume Maximal inspiration Lung volume (mL) 5000 4000 Inspiratory reserve volume 3000 Tidal volume 2000 Inspiratory capacity Residual volume Total lung capacity Normal resting point of the lungs Expiratory reserve volume 1000 Vital capacity Maximal expiration Functional residual capacity Time is normal Patients with restrictive disease can move only a small volume of air but can move that small volume fairly well These patients often breathe with lower tidal volumes but higher frequencies in order to maintain adequate minute alveolar ventilation Obstructive diseases limit airflow, either because of narrowing of the airways themselves (asthma) or because of obstruction by a tumor or foreign body Patients with obstructive disease have high total lung capacity but low vital capacity Inspiration may be normal, but expiration is 105 PULMONARY SYSTEM impaired This causes air to become “trapped” in the lungs and increases the residual volume Peak velocity is low because of the airway obstruction, and impairment of exhalation causes a “scooped” slope of the second half of the expiratory flow-volume loop Attempts to increase exhalation only cause a further increase in intrathoracic pressure, collapsing the small bronchioles Patients with obstructive disease often breathe with higher tidal volumes and lower frequencies in order to maintain adequate alveolar minute ventilation 15 Expiration Peak expiratory flow Air flow (L/s) Inspiration Maximal curve Effort independent 10 Effort dependent TLC RV ●●● SURFACTANT AND PULMONARY COMPLIANCE 10 Maximal curve 15 Volume (L) Figure 10-5 The flow-volume curve plots the spirometry values against the velocity of air flow Peak expiratory air flow occurs early during the expiratory cycle, with the later portions of the curve being independent of effort The effortindependent portion of the curve reflects elastic recoil of the lung and the critical closing pressures 15 Obstructive disease Normal Restrictive disease 9 Lung volume (L) Compliance is the change in volume divided by the change in pressure For the lungs, measured compliance is due to both compliance of the lungs and compliance of the thorax Hysteresis, or wandering, is a change in measured compliance during inspiration and expiration Hysteresis is due to the viscous properties of the lungs and surface tension within the alveoli Surfactants act like a detergent to reduce the surface tension of the fluid lining the alveoli Surfactants are secreted by type II granular pneumocytes Surfactant contains a variety of phospholipids, particularly dipalmitoyl lecithin and sphingomyelin Reduced surface tension is essential to allowing a functional air-water interface on the surface of the alveoli (Fig 10-7) Diseases can alter compliance Compliance is reduced in disease states such as fibrosis and surfactant deficiency For these individuals, a much larger inspiratory effort is required to inflate the lungs At the other extreme, compliance is increased is disease states such as emphysema For these individuals, inflation of the lungs is relatively easy, but elastic recoil is less effective in assisting expiration Alveoli 12 Air flow (L/s) 106 Figure 10-6 Obstructive pulmonary disease and restrictive pulmonary disease cause characteristic shifts in the flowvolume relationship Obstructive diseases are characterized by elevated lung volume due primarily to the elevated residual volume Restrictive diseases are characterized by reduced lung volume due primarily to reduced vital capacity Both diseases show a decrease in the peak velocity of air flow Minute ventilation is the tidal volume times the respiratory rate, usually, 500 mL × 12 breaths/min = 6000 mL/min Increasing respiratory rate or tidal volume will increase minute ventilation Dead space refers to airway volumes not participating in gas exchange Anatomic dead space includes air in the mouth, trachea, and all but the smallest bronchioles, usually about 150 mL Physiologic dead space also includes alveoli that are ventilated but not exchange gas because of low blood flow (usually, mL in normal humans) Tidal volume must exceed dead space or functional alveoli will not be ventilated with fresh air Only air delivered to the terminal bronchioles and alveoli is available for gas exchange Alveolar minute ventilation is less than minute ventilation and is calculated as ([tidal volume − dead space] × respiratory rate) or ([500 mL − 150 mL] × 12 breaths/min) = 4200 mL/min Increasing tidal volume increases alveolar ventilation more effectively than does increasing respiratory rate (see the earlier discussion of restrictive and obstructive disease) GAS EXCHANGE Normal surfactant production 100 Abnormal surfactant production 100 Volume (% TLC) A 75 75 50 50 FRC 25 B 25 Figure 10-7 Surfactant causes hysteresis during the respiratory cycle Surfactant reduces surface tension in the inflated alveoli, delaying closure during the expiratory portion of the respiratory cycle In the absence of surfactant (e.g., respiratory distress syndrome), a greater increase in pressure is needed to move a normal volume of air, the functional residual capacity is decreased, and hysteresis is not as evident FRC 0 10 20 Translung pressure (mm Hg) 10 20 Translung pressure (mm Hg) ●●● WORK OF RESPIRATION ●●● GAS EXCHANGE Gas exchange is driven by diffusion Consequently, movement of gas is always down a concentration (partial pressure) gradient Oxygen is less soluble than CO2, and consequently oxygen diffusion requires a higher pressure gradient in both the lungs and the tissues The effectiveness of diffusion diminishes as the distance to be traveled increases Normally, the distance between alveolar air and blood is small, and O2 and CO2 diffuse with little trouble However, diseases such as 500 Work=DP!DV Lung volume (mL) The movement of air requires work, defined for the respiratory system as pressure times volume (Fig 10-8) Respiratory work has three components: resistance to air flow, expansion of the elastic tissue of the lung, and expansion of the chest wall.Work due to resistance to air flow is increased by bronchiole constriction, increased by turbulent flow when flow velocity is high, and decreased by reducing air viscosity (e.g., helium use in SCUBA diving) Work due to expansion of the elastic tissue of the lungs is increased in fibrosis.Work due to expansion of the chest wall is also increased in fibrosis Expiration normally is passive and requires no additional work.Active expiration requires additional work and involves the accessory muscles of breathing Active expiration also increases the possibility of the increase in intrathoracic pressure collapsing the small bronchi, so the additional muscular effort yields only a small improvement in ventilation The metabolic costs of respiration are considerable Normal breathing can account for up to 5% of total body O2 consumption During exercise, the proportion can increase to up to 30% Importantly, in disease states, the metabolic costs of respiration can become unsustainable In these cases, patients may be placed on a respirator to reduce the total body metabolic load while the underlying cause of the increased respiratory work is corrected :3 :6 Pressure (cm H2O) Expiration Inspiration Obstructive disease Restrictive disease Work to overcome elastic recoil Stored work from inspiration Active work to overcome resistance and surface tension Figure 10-8 Respiratory work has multiple components The work of breathing includes work against the elastic recoil of the lung, work to overcome airway resistance, and work to overcome surface tension The work of breathing is increased in restrictive disease because of the necessity to overcome elastic recoil The work of breathing is increased in obstructive disease because of the necessity to overcome airway resistance In severe obstructive disease, additional work may be needed for expiration PATHOLOGY Pulmonary Edema Normally there is little fluid in the interstitial space between alveoli in the pulmonary capillaries An increase in pulmonary venous pressure or an increase in pulmonary capillary permeability can cause the accumulation of fluid in the interstitial space In addition, the elevated interstitial fluid pressure can cause fluid to leak into the alveoli This pulmonary edema decreases the efficiency of oxygen exchange and can cause arterial hypoxia 107 PULMONARY SYSTEM pulmonary edema increase the distance between alveolar air and blood and can impede gas movement Air–Alveolar Gas Mixing Inspired air has a total pressure of 760 mm Hg at sea level (1 atmosphere) Nitrogen accounts for 79% of the air, or about 597 mm Hg partial pressure Oxygen accounts for 21% of the air, or a partial pressure of 159 mm Hg Water vapor accounts for 0.5% of the air, or a partial pressure of mm Hg Carbon dioxide accounts for 0.04% of the air, or a partial pressure of 0.3 mm Hg (Fig 10-9) Air enters lungs PO2=159 mm Hg PCO2=0.3 mm Hg PN2=597 mm Hg PH2O=4 mm Hg Alveolar–Blood Gas Exchange Air mixes with dead-space air, alveolar air, and is humidified Alveolar unit PAO2=104 mm Hg PACO2=40 mm Hg PAH2O=47 mm Hg PAN2=596 mm Hg PvO2=40 mm Hg PvCO2=46 mm Hg Mixed venous blood The alveolus–capillary exchange surface area is large, facilitating diffusion Gas exchange occurs in the terminal portions of the pulmonary air spaces, the respiratory bronchiole, alveolar ducts, and alveoli Alveolar gases must diffuse through a series of barriers (Fig 10-11): Fluid lining the alveoli, including surfactant Alveolar epithelial cells Epithelial basement membrane PaO2=97 mm Hg PaCO2=40 mm Hg CO2 O2 CO2 Air entering the trachea is humidified, increasing the water vapor partial pressure but not changing the total atmospheric pressure Consequently, the partial pressure of the other gases is decreased In humidified air in the larger airways, water vapor partial pressure increases to 47 mm Hg, and O2 partial pressure decreases to 150 mm Hg When entering the alveoli, inspired humidified air mixes with CO2-rich humidified air already present in the alveolus, so the partial pressure of the other gases is further diluted Oxygen partial pressure decreases to 104 mm Hg, and CO2 partial pressure (PCO2) is 40 mm Hg.Water vapor partial pressure remains at 47 mm Hg Expired air is a mixture of dead space air and alveolar air (Fig 10-10) Dead space air exits first, so gas pressures represent those listed above for the trachea End tidal air samples more closely represent the values of alveolar air Consequently, end tidal air sampling is used to estimate mixed venous blood CO2 levels O2 VD =PaCO2-PECO2 VT PaCO2 Arterial blood Pulmonary capillary 50 End-tidal 40 CO2 transport 70% HCO323% bound to hemoglobin 7% dissolved O2 transport >98% bound to hemoglobin < 2% dissolved PCO2 (mm Hg) 108 30 20 10 O2 CO2 Systemic capillary Tissue Figure 10-9 Inspired air is humidified and mixed with deadspace air before reaching the alveolus Arterial blood gas values are slightly less than those in the alveolar air because of the small amount of shunt blood flow Mixed venous blood gas values reflect the gas partial pressure in the tissues a, arterial; A, alveolar; v, venous Expiration starts Inspiration starts Time (s) Figure 10-10 During expiration, the first gas leaving the body is dead space that has not participated in gas exchange and consequently contains no CO2 The remainder of the gas leaving the body reflects air that originated in the alveoli End-tidal CO2 partial pressure is normally a good measure of alveolar CO2 and therefore of arterial PCO2.VD, dead space volume; VT, tidal volume; PE–CO2, average expired gas CO2 pressure CASE STUDY ANSWERS (glucose and galactose) are transported by apical sodiumcoupled transport and basolateral GLUT2-facilitated diffusion transport Normally, carbohydrates are digested into one of three monosaccharides: glucose, galactose, and fructose In the absence of lactase, lactose remains a nonabsorbable disaccharide The lactose remains in the lumen of the GI tract and enters the colon Within the colon, the colonic microflora digest the lactose and metabolize it, producing intestinal gas Newborn mammals use lactase to break down the lactose consumed while nursing After weaning, most mammals lose the ability to metabolize lactose Some human populations, including individuals of northern European descent, inherit a dominant gene that provides lactase activity into adulthood This gene is very rare in individuals of Chinese descent The definitive test is an intestinal biopsy and analysis for the presence of the brush border enzyme More frequently, lactose is removed from the diet If the symptoms disappear, lactose is reintroduced to the diet, and the patient is monitored for the return of symptoms Chapter 13: Subacute Granulomatous Thyroiditis The increased size of the thyroid gland was not caused by TSH TSH levels were low and physiologically appropriate for the elevated thyroid hormone levels The increase in thyroid gland size is due to inflammation and an immune response The bacterial inflammation resulted from the earlier respiratory infection and by the continuing elevated body core temperature The patient’s problem is the enhanced immune response rather than a true thyroid problem The NSAIDs diminished the immune response and relieved the symptoms The bacterial infection damaged the thyroid gland cells The initial elevation in thyroid hormone is due to thyroid hormone release from the damaged tissue After that initial release, the ability of the thyroid gland to synthesize thyroid hormone is impaired This results in the drop in circulating thyroid hormone and elevation in TSH Chapter 14: Endometriosis The patient’s symptoms are caused by endometrial tissue that is located in the pelvic peritoneum In spite of the extrauterine location, the endometrial tissue responds to estrogen and progesterone just as does the normal uterine endometrium Estrogen stimulates proliferation and growth of the tissue during the first half of the menstrual cycle Progesterone from the corpus luteum causes vascular congestion in the tissue during the second half of the menstrual cycle As the corpus luteum involutes and progesterone levels fall, the endometrial tissue undergoes necrosis and inflammation, causing pain The onset of pain occurs during the onset of normal menstruation Menstruation results in the loss of the outer layer of the uterine endometrium and expulsion through the vagina as menses The extrauterine endometrial tissue does not have a route through which it can easily be expelled from the body Consequently, the necrotic extrauterine endometrial tissue serves as a site of inflammation Danazol inhibits hypothalamic GnRH release and consequently diminishes anterior pituitary FSH and LH release In the absence of FSH and LH, the ovaries not produce sufficient estrogen or progesterone to support the menstrual cycle This ovarian suppression results in the cessation of menstruation The extrauterine endometrial tissue similarly is no longer subjected to hormone-induced growth or necrosis Endometriosis often causes scarring and inflammation at the extrauterine site The fallopian tubes are fragile structures that often are destroyed by the scarring Chapter 15: Benign Prostatic Hyperplasia The urethra passes through the center of the prostate gland shortly after exiting the urinary bladder Enlargement of the prostate gland decreases the lumen of the urethra, impairing the flow of urine exiting the bladder Prostatic enlargement can result from numerous causes The tumor of the prostate would not cause symmetric enlargement of the gland Prostatic infection is associated with symmetric enlargement, but it causes discomfort on palpation Enlargement of the prostate is stimulated by the testosterone metabolite dihydrotestosterone Within the target tissue, testosterone is converted to dihydrotestosterone by the enzyme 5α-reductase Dihydrotestosterone has a much stronger biological activity than does testosterone Inhibition of 5α-reductase prevents the conversion of testosterone to a more biologically active form α1-Adrenergic blockers relax the smooth muscle of the prostate, bladder neck, and proximal urethra Relaxation of the smooth muscle diminishes the resistance to urine flow through the prostate and reduces the symptoms associated with impaired urination Chapter 16: Patent Ductus Arteriosus The ductus arteriosus allows blood pumped by the right ventricle to bypass the fetal pulmonary circulation The 225 226 CASE STUDY ANSWERS ductus arteriosus carries blood from the pulmonary artery into the aorta after the arch of the aorta The fetal pulmonary arterial blood is poorly oxygenated In the aorta, the pulmonary arterial blood mixes with O2-rich blood pumped by the fetal left ventricle In the adult, cardiac murmurs associated with valvular disorders are usually limited to only a portion of cardiac cycle The narrowed, or stenotic, valves generate a murmur during the portion of the cardiac cycle when the valve is normally open Valves that fail to seal properly on closure generate a murmur from the retrograde flow of blood during the portion of the cardiac cycle when they are normally closed In the neonate, aortic blood pressure is always higher than pulmonary artery blood pressure Consequently, the murmur is continuous throughout the cardiac cycle The intensity of the murmur increases during ventricular ejection, because the pressure gradient between the aorta and the pulmonary artery is greatest during this time A patent ductus arteriosus represents a left-to-right shunt This brings oxygenated blood into the pulmonary artery Cyanosis results from a right-to-left shunt, in which poorly oxygenated blood enters the systemic circulation Patients with a patent ductus arteriosus not exhibit cyanosis but can exhibit right-sided heart failure In utero, the ductus arteriosus remains open because of the production of prostaglandin E Prostaglandin E is a vasodilator The presence of oxygenated blood in the ductus arteriosus inhibits the production of prostaglandin E In this patient, prostaglandin E production is continuing despite the presence of oxygenated blood Indomethacin is used to biochemically inhibit prostaglandin production Interruption of the synthesis of the vasodilator should result in constriction of the ductus, closing the connection between the aorta and pulmonary artery In the adult, the remnants of the ductus arteriosus persist as the ligamentum arteriosum Chapter 17: Salicylate Overdose Acid-Base Disturbance There is a mild alkalosis Based on the algorithm, it was caused by a low CO2, so it is at least a respiratory alkalosis The predicted HCO3– is 22 mEq/L (normal 24 mEq) diminished to mEq/L because of the decrease in PCO2 The actual HCO3– is lower, so it is a partially compensated respiratory alkalosis Salicylates stimulate the respiratory center directly, increasing alveolar minute ventilation This causes a decrease in PCO2, and respiratory alkalosis is an early finding in salicylate overdose The drop in HCO3– is a result of metabolic compensation of the respiratory alkalosis Toxic doses of salicylates cause a drop in renal function and an accumulation of acids normally excreted by the kidney Salicylates also alter carbohydrate metabolism, causing the production of lactic and pyruvic acids Finally, salicylates are themselves acids, but the amount of salicylates in the blood during salicylate poisoning is sufficient to drop HCO3– by only to mEq The metabolic acidosis will proceed and become more pronounced The respiratory depression will cause an accumulation of CO2, which in the presence of an already depressed HCO3–, will cause a combined metabolic acidosis and respiratory acidosis 227 Index Note: Page numbers followed by f indicate figures; those followed by t indicate tables; and those followed by b indicate boxed material A A band, 43, 46f, 51, 51f A wave, 72, 73f ABO system, 61, 62t Absolute refractory period (ARP), 37, 37f in cardiac muscle, 71f Absorption, gastrointestinal, 139–143, 142f, 152–156, 154f Acceleration, and cardiovascular function, 96 ACE (angiotensin-converting enzyme) inhibitors, 71b Acetylcholine (ACh) in autonomic nervous system, and heart rate, 67, 68f, 74 in neuromuscular transmission, 43, 45, 47–48, 47f, 48f in respiratory control, 99, 101 in smooth muscle contraction, 54 Acetylcholine (ACh) receptors in myasthenia gravis, 48b in neuromuscular transmission, 47 toxins and drugs affecting, 48–49 Acetylcholinesterase, in neuromuscular transmission, 45, 48 ACh See Acetylcholine (ACh) Achalasia, 145 Acid-base disturbance(s), 210–212, 210f, 211f due to salicylate overdose, 219, 226 Acid-base regulation, 209–210, 209f, 209t pulmonary mechanisms in, 113–115 Acidosis, 210 hyperchloremic, 212b metabolic, 210–211, 210f, 211f and potassium balance, 25 respiratory, 210, 210f, 211f Actin, 43, 46f in excitation-contraction coupling, 49, 49f, 50f in muscle contraction, 51 Actin filaments, 43–45, 46f in excitation-contraction coupling, 49–50, 49f, 50f in muscle contraction, 51, 51f, 52f in smooth muscle, 53, 53f Action potential, 35f–37f, 36–38, 37b myocardial, 67, 67f, 70, 70f, 71f in neuromuscular transmission, 43, 45 Activation m-gate, 36, 37, 37f Active diffusion, 12f Active hyperemia, 84 Active transport across cell membrane, 32, 33f primary, 20, 32 secondary, 20, 32 Active zone, of presynaptic membrane, 45, 47 Addison’s disease, 25 Adenohypophysis, 158f, 159t, 160–161, 161f hormones of, 161, 162f, 162t Adenosine triphosphate (ATP), in muscle contraction, 49–50, 50f ADH See Antidiuretic hormone (ADH) Adipocytes, 15 Adipose tissue endocrine function of, 159t insulin and, 169 Adrenal cortex, 158f, 159t, 165–168, 166b, 166f Adrenal gland, 165–168, 166f–168f Adrenal medulla, 158f, 159t, 165, 166f α1-Adrenergic blockers, for benign prostatic hypertrophy, 218–219, 225 Adrenergic receptor(s), 85b, 86, 166b α-, 7, 7b, 166b α1-, 7b α2-, 7b β-, 7, 7b, 166b signaling by, 40f β1-, 7b β2-, 7b β3-, 7b subtypes of, 7, 7b Adrenocortical hormones, 165–168, 167f–169f Adrenocorticotropic hormone (ACTH), 162t and aldosterone release, 166, 168f during pregnancy, 199 secretion of, 160, 168, 169f Aerobic exercise, 212–214, 212f–214f Afterload, 52f cardiac, 71, 71t, 72f, 91, 93 Agonists, 38, 39b, 41 Air, components of, 108 Air–alveolar gas mixing, 108, 108f Albumin, in arterial blood, 61t Aldosterone, 159t, 165–166 actions of, 165–166 biosynthesis of, 166f–167f in intestinal ion and water balance, 155 in potassium balance, 25, 26 during pregnancy, 199 in renal regulation, 135 secretion of, 165, 166, 166f, 168f Alkalosis, 210 metabolic, 210f, 211, 211f respiratory, 210, 210f, 211f α-cells, 168 Altitude, and regulation of blood oxygen, 113 Alveolar hypoxia, 99 Alveolar minute ventilation, 100, 106 Alveolar oxygen partial pressure, 108 Alveolar partial pressure, 100, 100f Alveolar partial pressure of CO2 (PACO2), 108, 108f Alveolar partial pressure of O2 (PAO2), 108, 108f Alveolar pressure and pulmonary blood flow, 110, 110f during respiratory cycle, 104, 105f Alveolar ventilation during exercise, 213 during pregnancy, 199 Alveolar–blood gas exchange, 108–109, 109f Alveolus(i), 99, 101, 102f, 103, 106 Alveolus–capillary exchange, 108–109, 109f Amino acids, reabsorption of, 125, 126 Ammonia (NH3), 133–134 Ammonium (NH4+), 133–134 Amnion, 199f Amniotic fluid, 199f Amylases, 142f, 148 pancreatic, 152 salivary, 148, 152 Amylopectin, 152 Amylose, 152 Anal sphincter external, 142f, 147 internal, 147 Anaphase, 29 Anaphylactic shock, 94 Anatomic dead space, 106 Androgen(s), 159t biosynthesis of, 166f–167f, 189–190 and growth, 204, 204f Androgen-binding protein, 193f Andropause, 195 Androstenediol, 182f Androstenedione, 182f, 190 Androsterone, 182f Anemia causes of, 59, 59b iron deficiency, 59, 59b pernicious, 156 Angiogenesis, 79, 79b, 84 Angiogenesis inhibitors, 84, 84b Angiotensin, 174–175 Angiotensin I, 174, 174f Angiotensin II and aldosterone release, 166, 168f in malignant hypertension, 124b in renal regulation, 134, 134f, 135 in renin-angiotensin system, 174, 174f and vascular smooth muscle, 175 as vasoconstrictor, 86 Angiotensin-converting enzyme (ACE) inhibitors, 71b Angiotensinogen, 159t, 174, 174f Anion gap, 211–212 ANP (atrial natriuretic peptide), 159t, 174, 175 in renal regulation, 135 in sodium balance, 25 ANS See Autonomic nervous system (ANS) Antagonists, 38, 39b, 41 Antiarrhythmic drugs, 67b Anticoagulants, 62f, 63 for atrial fibrillation, 217, 223 Anticodon, 29f Antidiuretic hormone (ADH), 159t in collecting duct, 128, 133 syndrome of inappropriate, 23, 25 synthesis of, 161 Antidiuretic hormone (ADH) defect, diabetes insipidus due to, 25 Antigen presentation, 17b Antiports, 32 Antrum, systolic contraction of, 145 Aorta, 66f Aortic body, 87 Aortic pressure, 72, 73f Aortic valve calcification, 206b Apical membrane, 11, 11f Apical membrane potential, 13f Apocrine glands, 14f, 15 Apomorphine, 146b Aquaporin(s), 128 Aquaporin water channels, 19 Arachidonic acid, 175, 175f 228 INDEX Arcuate artery, 119f Arcuate vein, 119f Areola, 180 ARP (absolute refractory period), 37, 37f in cardiac muscle, 71f Arrector pili muscle, 14f Arterial baroreceptors, 4, 85, 86f, 87 Arterial blood gas composition of, 101 laboratory values for, 61t Arterial blood pressure, 81–82, 82t cardiac output and, 91, 92f cyclic changes in, 81, 81f with exercise, 213, 214 increase in, 91–92, 92f mean, 81 measurement of, 81–82, 82f over life span, 205, 206t regulation of, 80, 85, 85f, 93, 96 feedback control in, 4, 4t systolic and diastolic, 81 Arterial hypotension, 93–94 Arterial partial pressure of CO2 (PaCO2), 4t, 61t, 101, 108f Arterial partial pressure of O2 (PaO2), 4t, 61t, 101, 108f, 113 Arterial pulse pressure, 81 Arterioles, 78, 78f Arteriovenous bypass, 79f Arteriovenous shunts, cutaneous, 87f Artery(ies), 78, 78f, 79f Articular disks, 54 Articulation, of sound, 103 Ascites, 88 Aspirin, as anticoagulant, 63 Aspirin overdose, acid-base disturbance due to, 219, 226 ATP (adenosine triphosphate), in muscle contraction, 49–50, 50f Atrial fibrillation, 216–217, 223 Atrial natriuretic peptide (ANP), 159t, 174, 175 in renal regulation, 135 in sodium balance, 25 Atrial pressure, 72, 73f Atrial systole, 71, 73f Atrioventricular (AV) node, 67, 68, 69f Atrioventricular (AV) valve, 66f Atrium(ia), 65, 66f Auerbach’s plexus, 143 Autocrine signaling, 30, 30f Automaticity, 65 Autonomic nervous system (ANS), 6–7, 7b in gastrointestinal regulation, 143 and heart rate, 67, 68f, 74 in vascular smooth muscle tone, 86 Autoregulation, of blood flow, 84, 86f AV (atrioventricular) node, 67, 68, 69f AV (atrioventricular) valve, 66f Axillary nodes, 181f B Bar graphs, 6, 6f Barbiturates, 210b Baroreceptor reflex, 4, 85, 86f, 87 Barrett’s esophagus, 145 Barriers, movement across, 2, 2t Basal acid secretion rate, 149 Basal body metabolism, 15 Basal body temperature, 184f, 186f Basolateral membrane, 11, 11f Basolateral membrane potential, 13f Bed rest, and cardiovascular function, 96 Benign prostatic hyperplasia, 218–219, 225 Bernard, Claude, β-cells, 168 Bicarbonate (HCO3–) absorption of, 155 in arterial blood, 61t reabsorption of, 125–126 in renal tubules, 133–134 Bicarbonate (HCO3–) buffer, 209–210, 209f Bile, 151–152, 151b Bile acids, 142f, 151, 152 Biliary secretions, 139, 151–153, 153f Bilirubin, 151–152 Birth, 197, 202–203, 203f cardiovascular adjustments to, 201f Bladder, 117, 118f, 119–120 in urine excretion, 135–136, 136f Blastocyst, 198f Bleeding time, 64t Blockers, 38 Blood components of, 59–61, 60f, 61t, 62f functions of, 57 oxygen and carbon dioxide transport in, 99, 100, 110–112, 111f, 112f viscosity of, 80–81 Blood carbon dioxide, regulation of, 113, 114f Blood cells, synthesis of, 57–59, 58f fetal, 200 Blood clotting, 57, 58f, 61–63, 62f, 63t Blood flow autoregulation of, 84, 86f functions of, 87 high-velocity, 80 laminar vs turbulent, 80 local control of, 83–84, 85f, 86f in microcirculation, 83 neural and hormonal regulation of, 77, 85–87, 86f, 87f resistance to, 80, 81f in thermoregulation, 15, 16f, 17b Blood gases, and cardiac function, 75 Blood groups, 61 Blood oxygen, regulation of, 113 Blood pressure arterial, 81–82, 82t cardiac output and, 91, 92f cyclic changes in, 81, 81f with exercise, 213, 214 increase in, 91–92, 92f mean, 81 measurement of, 81–82, 82f over life span, 205, 206t regulation of, 80, 85, 85f, 93, 96 feedback control in, 4, 4t systolic and diastolic, 81 feedback control of, 4, 4t neural and hormonal regulation of, 80, 85–87, 86f, 87f normal values for, 82t renal regulation of, 96, 97f venous, 91, 92f, 93 Blood typing, 61, 62t Blood urea nitrogen (BUN), 61t Blood vessel(s) compliance of, 81 histology of, 77–78, 78f Blood vessel radius, 80 Blood volume, 19, 57 during pregnancy, 198–199 regulation of, 93 Blood-brain barrier, 77 CO2 diffusion across, 113, 114f Blood-testis barrier, 192 BMI (body mass index), 205, 206f Body fluid(s) volume depletion of, 21–23, 22f, 22t volume expansion of, 22f, 22t, 23 Body fluid balance, 23–24, 23t, 24f Body fluid compartments barriers between, 19, 20f measurement of, 19 Body fluid distribution, 19–26 Body fluid movement, across barriers, 19–23 via capillary filtration, 21, 21f cell membrane permeability and, 21b via diffusion, 19–20 via osmosis, 20, 21f Body fluid volume disturbances in, 21–23, 22f, 22t, 23b feedback control of, 4t renal regulation of, 135t Body mass, 205, 205f Body mass index (BMI), 205, 206f Body temperature, regulation of, 4f, 7–9, 8b, 9f skin in, 15–16, 16f Bohr shift, 112 Bolus, of food, 144–145, 144f Bone(s), 43, 54, 54b, 165b over life span, 207, 207b Bone density, 207, 207b, 208 Bone marrow, 54, 57 Bone remodeling, 54, 164, 165 Bowman’s capsule, 117, 119f oncotic pressure in, 124 Bradykinin, 86 Brain, growth of, 205, 205f Brainstem, in respiratory control, 112, 112f Braxton-Hicks contractions, 202 Breast(s), 180–181, 181b, 181f during pregnancy and lactation, 199, 203 Breast cancer, 181b Breathing, work of, 107, 107f Bronchial circulation, 110 Bronchioles, 101, 102f, 103 Bronchus(i), 101, 102f, 103 Brunner’s glands, 151 Brush border, 141f Bulbogastrone, 149 Bulbourethral gland, 192f, 194f BUN (blood urea nitrogen), 61t Bundle branches, 65 Bundle of His, 65, 68 α-Bungarotoxin, 49 C C peptide, 168 Calciferol, 159t Calcitonin (CT), 159t, 164 Calcium (Ca++) in excitation-contraction coupling cardiac muscle, 70, 70f skeletal muscle, 49–50, 49f, 50f smooth muscle, 53, 53f and muscle strength, 51–53 in neuromuscular transmission, 45, 47f plasma free, 164, 164f regulation of, 164–165, 164f serum, 61t in signal transduction, 38, 39f, 40f Calcium (Ca++) absorption, 155 during pregnancy, 199 Calcium (Ca++) balance, 26, 26f integrated, 165 Calcium (Ca++) channel(s), 34t Calcium (Ca++) channel blocker for atrial fibrillation, 217, 223 toxicity of, 216, 222 INDEX Calcium chloride, for calcium channel blocker toxicity, 216, 222 Calcium (Ca++) pump, 33f Calmodulin, in smooth muscle contraction, 53, 53f Calponin, in smooth muscle contraction, 53, 53f cAMP (cyclic adenosine monophosphate), in signal transduction, 40f Capillary(ies), 78, 78f, 79f Capillary filtration, 2t, 21, 21f Capillary pressure, 82t Carbohydrate(s), digestion and absorption of, 152 Carbohydrate malabsorption, 152, 155 Carbohydrate metabolism, integrated regulation of, 170–174, 172f–173f Carbon dioxide (CO2) blood, regulation of, 113, 114f CSF, 113 in respiratory regulation, 112, 113, 113f–114f Carbon dioxide (CO2) diffusion, 107–108 Carbon dioxide partial pressure (PCO2), 108, 108f in respiratory control, 112, 113f Carbon dioxide (CO2) transport, 99, 100, 111–112 Carbon monoxide (CO), in signal transduction, 38, 41f Carbon monoxide (CO) poisoning, 217, 224 Carbonic anhydrase in red blood cells, 59–60 in renal tubules, 133 Cardiac cycle, 71–74, 73f, 74f Cardiac electrical activity, coordination of, 67–68 Cardiac electrophysiology, 65–69, 67b, 67f–69f, 69t Cardiac function curves, 94, 94f, 95f Cardiac glycosides, 33b Cardiac index, 74 Cardiac mechanical activity, 71–74, 71t, 72f–74f Cardiac murmurs, 73, 73b, 81b Cardiac muscle, 43, 44t, 54 exercise and, 214 physiology of, 69–71, 70f, 71f structure of, 65, 66f Cardiac output, 74, 91 determinants of, 93 exercise and, 97, 212, 212f during pregnancy, 199 and venous pressure, 93, 94–96, 94f, 95f Cardiopulmonary volume receptors, 87 Cardiovascular adjustments to birth, 201f, 202, 203f to exercise, 96, 97–98 Cardiovascular control, integration and redundancy of, 96, 97f Cardiovascular function with arterial hypotension and shock, 93–94 conceptual model of, 91–93, 92f effects of acceleration and gravity on, 96 effects of respiration on, 96 integrated, 91–98 Cardiovascular system, 65, 66f fetal, 199–201, 200f, 201f map of, 91, 92f over life span, 205–206, 206t regulation of, 93 Cardioversion, for atrial fibrillation, 217, 223 Carotid body, 87 Carrier proteins, 12 Carrier-mediated transport, 32 Catecholamine(s) and heart rate, 74–75 and myocardial contractility, 70–71 pattern of action of, 157, 160f secretion of, 165 CCK (cholecystokinin), 142f, 143t, 151, 152, 159t Cell(s) development of, 29–30 electrical activity of, 35–41 action potential as, 35f–37f, 36–38, 37b lipid-soluble signal transduction in, 38–41, 41f local currents in, 35, 35f membrane receptor signal transduction in, 38, 39b, 39f–41f, 39t eukaryotic, 27 growth of, 27–29, 30f structure of, 27, 28f, 29f Cell cycle, 29, 30f Cell membrane(s), 31–35 functions of, 31 membrane potential of, 34–35, 35f movement across, 19–23, 31–35, 32f via active transport, 32, 33f via capillary filtration, 21, 21f cell membrane permeability and, 21b via diffusion, 19–20, 31–32 via electrochemical gradient, 32–34, 33t, 34f, 34t via osmosis, 20, 21f permeability of, 21b signal transduction across lipid-soluble, 38–41, 41f membrane receptor, 38, 39b, 39f–41f, 39t overview of, 39f structure of, 28f, 31, 31b, 31f Cell membrane receptors, binding to, 38, 39t, 40f, 41f Cell-to-cell communication, 30–31, 30f, 31f Cellular function, 27–42 cell development and, 29–30 cell electrical activity in, 35–41 cell growth and, 27–29, 30f cell membrane in, 31–35 cell structure and, 27, 28f, 29f in cell-to-cell communication, 30–31, 30f, 31f modulation of tissue response to ligand in, 41–42, 42f Cellular processes, 28f Cellulose, 152 Central axillary nodes, 181f Central diabetes insipidus, 25 Central nervous system (CNS) neonatal, 204 in vascular regulation, 87, 87f Central venous pressure, 92f cardiac output and, 94–96, 94f, 95f Centrifugation, of blood, 59, 60f Centrioles, 28f Cephalic stage, of gastric acid secretion, 149 Cerebral circulation, 88 Cerebrospinal fluid (CSF), 19 CO2 in, 113 Cervical mucus, 184, 184f Cervix, 179f during menstrual cycle, 184, 184f Chemoreceptor trigger zone (CTZ), 146b Chemotherapy, 17b Chenodeoxycholic acid, 151 Chief cells, 127, 142f, 148, 149, 150f Chloride (Cl–), in arterial blood, 61t Chloride (Cl–) channels, 34t in cystic fibrosis, 12, 12b Chloride (Cl–) diarrhea, congenital, 155 Chloride (Cl–) reabsorption, 126, 132, 132f, 155 Cholecystokinin (CCK), 142f, 143t, 151, 152, 159t Cholera, 155 Cholesterol, 152 serum, 61t and steroid hormones, 166b, 167f, 182f Cholesterol esterase, 152 Cholic acid, 151 Chord conductance equation, 34–35, 35f Chordae tendineae, 65, 66f Chorion, 199f Chorionic gonadotropin, 197, 198 Chorionic villi, 199f Chromatin threads, 27, 29 Chromosomes, 29 Chylomicrons, 154, 154f Chyme in colon, 147 in small intestine, 139, 143, 146, 149 in stomach, 145 Circulation, in specific vascular beds, 87–89, 87f–89f Cl– See Chloride (Cl–) Clitoris, 179f Clot formation, 57, 58f, 61–63, 62f, 63t Clot lysis, 63 Clot retraction, 64 Clotting cascade, 62, 62f Clotting factors, 58f, 62–63, 63t CNS (central nervous system) neonatal, 204 in vascular regulation, 87, 87f CO (carbon monoxide), in signal transduction, 38, 41f CO (carbon monoxide) poisoning, 217, 224 CO2 See Carbon dioxide (CO2) Coagulation, functional tests of, 63, 64t Coagulation factors, 58f, 62–63, 63t Codons, 29b Colipase, 142f pancreatic, 154f Collecting duct anatomy of, 119f cortical, 126f, 127–128 handling of water and electrolytes in, 129–132, 130f–132f medullary, 126f transport via, 126f, 127–128, 128f, 129, 129t urine concentration and dilution in, 133, 133f in urine excretion, 135 Colloid osmotic pressure, 21, 21f Colocolonic reflex, 147 Colon, 142f Colonic motility, 147, 147f Colostrum, 203 Competitive antagonists, 39b Complementary DNA, 29 Concentration calculation of, 2, 3f change in, 3, 3f Concentration gradient, 2, 6, 31 Conception, 198f Conductance, 34 Congestive heart failure, 71b Connective tissue sheath, 14f Connexons, 30b Constipation, 147 Contact dermatitis, 215, 221 Contractility, myocardial, 70–71, 71t, 72f and cardiac output, 93 Copper absorption, 155 229 230 INDEX Coronary blood flow, 88, 89f Corpora cavernosa, 194f Corpus albicans, 183f Corpus luteum, 178f, 179–180 in menstrual cycle, 183, 183f, 185, 186f in pregnancy, 198 Corpus spongiosum, 190, 194f Cortical collecting duct, 119f, 126f, 127–128 Corticosterone, 165, 167f Corticotropin, 161 in lactation, 181 Corticotropin-releasing hormone (CRH), 160, 162t, 168, 169f Cortisol, 159t, 166–168 actions of, 168 biosynthesis of, 166f–167f and plasma glucose, 171 secretion of, 165, 166 control of, 161, 168, 169f Cortisol-binding globulin, 168 Co-transporters, 32 COX (cyclooxygenase), 175, 175f, 176b Creatinine plasma, 122, 123f serum, 61t Creatinine kinase, elevated, 216, 222 Crenation, 20 CRH (corticotropin-releasing hormone), 160, 162t, 168, 169f Crypt, 139, 142f Crypts of Lieberkühn, 151 CSF (cerebrospinal fluid), 19 CO2 in, 113 CT (calcitonin), 159t, 164 CTZ (chemoreceptor trigger zone), 146b Curare, 49 Cushing reflex, 88, 88b Cushing’s syndrome, 169b Cutaneous microcirculation, 87, 87f, 213b Cyclic adenosine monophosphate (cAMP), in signal transduction, 40f Cyclooxygenase (COX), 175, 175f, 176b Cystic fibrosis, 12, 12b Cytoskeleton proteins, 27 Cytosol, 28f D D (diffusion coefficient), 6, 19–20, 100 D antigen, 61 DAG (diacylglycerol), in signal transduction, 38 Danazol, for endometriosis, 218, 225 Darrow-Yannet diagrams, 22f Dartos muscle, 191 Daughter cells, 29 Davenport diagram, 210f D-cells, 150f Dead space, 106 Dead-space unit, 110, 111f Defecation, 147 Dehydroepiandrosterone (DHEA), 167f, 182f δ-cells, 168 Deoxycholic acid, 151 Deoxycorticosterone, 165 11-Deoxycorticosterone, 167f 11-Deoxycortisol, 167f Depolarization, 36, 36f, 37f, 38 in neuromuscular transmission, 45, 47, 47f, 48, 49f slow-wave, 53 Dermatitis, contact, 215, 221 Dermis, 14f, 15, 16f immune function of, 17 Dermoepithelial junction, 15 Descending limb, of nephron, 119f Desmolase, 167f 17,20-Desmolase, 166f–167f, 182f Desmosomes, 11, 14f α-Dextrinase, 153 DHEA (dehydroepiandrosterone), 167f, 182f Diabetes insipidus, 25 Diabetes mellitus, 127b, 171b, 171f Diacylglycerol (DAG), in signal transduction, 38 Diaphragm, 102f, 103 Diarrhea, 147 congenital Cl–, 155 volume depletion due to, 21 Diastole, 73f Diffusion, 2t, 19–20, 31–32 active, 12f facilitated, 20, 32 Fick’s law of, 6, 19–20, 83, 100 in gas exchange, 107, 108–109, 109f passive, 12f in transcapillary exchange, 83, 83f Diffusion coefficient (D), 6, 19–20, 100 Digestion, 139, 142f, 152–156, 154f Digestive hormones, 139, 143t Digitalis and myocardial contractility, 70 and Na+/K+-ATPase, 33f Digoxin, 33b Dihydropyridine receptors, 49, 49f Dihydrotestosterone, 165, 182f, 190 1,25-Dihydroxyvitamin D3, 159t Diiodinated tyrosine (DIT), 163, 163f Distal tubule anatomy of, 119f handling of water and electrolytes in, 129–132, 130f–132f transport via, 126f, 127, 128f, 129, 129t in tubuloglomerular feedback, 134, 134f in urinary acid-base regulation, 134 urine concentration and dilution in, 132–133, 133f DIT (diiodinated tyrosine), 163, 163f Diuretics, 135b potassium-sparing, 127b DNA, complementary, 29 DNA codons, 29b Dopamine, 160 Doppler flowmeter, 74 Duchenne’s muscular dystrophy, 216, 222–223 Ductus arteriosus at birth, 201f, 202, 203f in fetal circulation, 200, 200f, 201f patent, 219, 225–226 Ductus venosus, 200 Duodenal acidity, 146 Duodenal hypertonicity, 146 Duodenum, 142f, 143, 145–146 Dwarfism, 162b Dystrophin, 222 E E1 (estrone), 182f E2 (estradiol) biosynthesis of, 182f in female reproductive system, 177, 178 in male reproductive system, 190 E3 (estriol), 182f Eccrine sweat glands, 15 ECF See Extracellular fluid (ECF) ECG (electrocardiogram), 68–69, 68f, 69f, 69t of cardiac cycle, 71–72, 73f ECL (enterochromaffin-like) cells, 149, 150f ED (erectile dysfunction), 195b Edema, 83, 85b, 86b pulmonary, 107b EDRF (endothelial-derived relaxing factor), 77 Effort-independent flow rate, 104, 106f Ejaculation, 189, 190f, 195 Ejaculatory duct, 191, 191f, 192f Ejection fraction, 73 Elastic recoil, of lungs, 99 Elderly cardiovascular system in, 205–206 colonic motility in, 206–207 renal system in, 207 respiratory system in, 206 skeletal system in, 207, 207b skin of, 207 Electrocardiogram (ECG), 68–69, 68f, 69f, 69t of cardiac cycle, 71–72, 73f Electrochemical gradients, 32–34, 33t, 34f Electrochemical movement, 2t Electrolyte(s) digestion and absorption of, 155 renal handling of, 129–132, 130f–132f Electrolyte balance, 23–26, 24t, 25f, 26f hormonal control of, 158 Electrotonic conductance, 35 Embolus, 63 Emetics, 146, 146b Emission, 195 End plate potential (EPP), 48, 48f End-diastolic pressure, 74f End-diastolic volume, 72, 74f, 91 Endocardium, 65 Endocrine, defined, 157 Endocrine control, of growth, 204, 204f Endocrine events, during menstrual cycle, 178f, 185, 185f, 186f Endocrine function, renal, 136–137, 159t Endocrine secretions, 11 Endocrine signaling, 30, 30f Endocrine system, 157–176 adrenal gland in, 165–168, 166f–168f function of, 157–158 hormones of, 157, 159t synthesis of, 157, 160f trophic, 159t, 161, 162t, 163t hypothalamus and pituitary in, 158–161, 161f, 162f, 162t organs of, 157, 158f over life span, 207 pancreas in, 168–174, 170f–173f parathyroid hormone and calcitonin in, 164–165, 164f regulation of, 158, 160f renin-angiotensin system and atrial natriuretic peptide in, 174–176, 174f, 175f thyroid in, 161–163, 163f, 164f Endometriosis, 184b, 218, 225 Endometrium, 179f, 180 during menstrual cycle, 184, 184f, 186f Endoplasmic reticulum rough, 28f smooth, 28f Endorphins, 176 Endothelial-derived relaxing factor (EDRF), 77 End-systolic volume, 72, 74t, 91 Endurance training, 214 Enkephalins, 176 Enteric nervous system, 143, 144 Enterochromaffin-like (ECL) cells, 149, 150f Enterohepatic circulation, 151 Enzyme kinetics, hormone-receptor interactions and, 33b Epicardium, 65 Epidermal glands, 14–15, 14f INDEX Epidermis, 13–15, 14b, 14f, 16f immune function of, 17 in vitamin D production, 17 Epididymis, 192, 192f, 194 Epiglottis, 103, 144, 144f Epinephrine, 159t actions of, 165 and heart rate, 74–75 and plasma glucose, 171, 173f in respiratory control, 99, 101 secretion of, 165, 166f in vascular smooth muscle tone, 86 Epiphyseal plate, 54b Epithelia, 11–12, 11f–13f, 12b Epithelial cells, 11, 14f growth and replacement of, 17 Epithelial membranes, 11–12 EPO (erythropoietin), 58f, 59, 137, 159t Epoetin alfa, 59b EPP (end plate potential), 48, 48f Equations, Equilibrium potentials, 33t, 34f Erectile dysfunction (ED), 195b Erection, 191 Erythrocyte count, 60, 64t Erythropoiesis, 57–59, 58f Erythropoietin (EPO), 58f, 59, 137, 159t Esophageal motility, 144–145, 144f Esophageal phase, of swallowing, 144–145, 144f Esophagitis, 145 Esophagus, 140f, 142f, 144 Barrett’s, 145 Estradiol (E2) biosynthesis of, 182f in female reproductive system, 177, 178 in male reproductive system, 190 Estriol (E3), 182f Estrogen(s), 159t, 166f biosynthesis of, 181, 182f in female reproductive system, 178f, 181 after menopause, 186 during menstrual cycle, 185, 185f, 186f in puberty, 178, 181 in sex differentiation, 177 and growth, 204, 204f placental, 198, 199b during pregnancy, 199, 202 replacement therapy, 186b Estrone (E1), 182f Ethanol intoxification, 215, 221–222 Eukaryotic cells, 27 Evans blue dye, and plasma volume, Exchangers, 32 Excitation-contraction coupling in cardiac muscle, 70–71, 70f, 71f in skeletal muscle, 49–50, 49f, 50b, 50f in smooth muscle, 53–54, 53f Exercise, 212–214 adaptations to, 213–214, 214f aerobic, 212–214, 212f–214f cardiovascular adjustment to, 96, 97–98 over life span, 207–208 ventilation during, Exercise performance, peak, 214 Exocrine secretions, 11 Expiration, 104, 105f active, 107 forced, 103, 104f Expiratory reserve volume, 104, 105f Expired air, 108, 108f External anal sphincter, 142f, 147 Extracellular fluid (ECF), 19, 20f Extracellular fluid (ECF) osmolality and body fluid volume, 22t changes in, 20f Extracellular fluid (ECF) volume, 20f Extrathoracic veins, blood pressure in, 82t F Facilitated diffusion, 20, 32 Facilitation, 48 Fallopian tube, 179f, 180, 197, 198f Fast Na+ channel, 36, 37f Fast twitch fibers, 45, 47t Fasting, and glucose, 171–174, 173f Fat malabsorption, 154, 155 Feedback control, 4–5, 4f, 4t Feedforward regulation, Female reproductive system, 177–187 anatomy of, 178–180, 179f, 180b breasts in, 180–181, 181b, 181f hormones in, 181, 182f maturation of, 177, 178f menarche in, 178, 181–183 menopause in, 185–186, 186b menstrual cycle in, 178f, 183–185, 183f–186f ovaries in, 177, 178f during puberty, 177–178, 178f secondary sexual characteristics, 178 sexual differentiation in utero in, 177, 191f Fertilization, 189, 194, 197, 198f Fetal blood cell formation, 200 Fetal circulation, 199–201, 200f, 201f Fetal development, 199–202, 200f, 201f Fetal growth, 204 Fetal hemoglobin, 198, 201b FEV1 (forced expiratory volume in second), 104 FEV3 (forced expiratory volume in seconds), 104 Fibrin, 62, 62f Fibrin mesh, 62, 62f Fibrinogen, 61, 62, 62f, 63t Fibrinolysis, 63 Fibrinolytic agents, 62f, 63 Fick equation, 213 Fick principle, 74 Fick’s law of diffusion, 6, 19–20, 83, 100 Figures, Filtration, in transcapillary exchange, 83, 84f Filtration coefficient, 124 Filtration force, 83, 84f Fimbriae, 179f, 180 Fingernails, 13 First heart sound, 73 Flow(s), 2t calculation of, 3, 3f Flow-volume loops, 104, 106f Fluid and electrolyte balance, 23–26, 23t, 24f–26f, 24t Fluid intake, control of, 24, 24f Fluid loss, 24, 24f Flux, 6, 19 Folic acid absorption, 155 Follicle-stimulating hormone (FSH) in female reproductive system, 178f, 181 following birth, 177 after menopause, 186 in menstrual cycle, 183, 185, 185f, 186f during puberty, 178 in male reproductive system, 193, 193f, 194 release of, 160, 161, 162t Foramen ovale at birth, 201f, 202, 203f in fetal circulation, 200, 200f, 201f Forced expiration, 103, 104f Forced expiratory volume in second (FEV1), 104 Forced expiratory volume in seconds (FEV3), 104 Forced inspiration, 103, 104f Foreskin, 190, 194f Fourth heart sound, 73 Frame-shift error, 30b Frank-Starling relationship, 71, 72f, 94 Free water clearance, 122–123 FSH See Follicle-stimulating hormone (FSH) Functional residual capacity, 104, 105f G G cells, 148, 149, 150f G proteins, in signal transduction, 38, 39t, 40f G0 phase, 29, 30f G1 phase, 29, 30f G2 phase, 30f G-actin molecule, 46f Gallamine, 49 Gallbladder, 140f, 142f, 152 Gallstones, 152–153 Gametogenesis, 29 Gap junctions, 30, 30b Gas exchange, 100–101, 100f–101f, 107–109, 108f, 109f Gastric acid, 148 Gastric acid secretion, 148–149, 150f inhibition of, 151b Gastric emptying, 143, 145, 145f feedback control of, 4t Gastric glands, 141f, 148b Gastric inhibitory peptide, 143t Gastric motility, 145–146, 145f Gastric phase, of gastric acid secretion, 149 Gastric reflux, 145 Gastric secretions, 139, 148–149, 150f Gastrin, 142f, 143t, 148, 150f, 159t Gastrocolic reflex, 146 Gastroileal reflex, 146 Gastrointestinal (GI) hormones, 139, 143t Gastrointestinal (GI) motility, 142f, 143–147 colonic, 147, 147f and defecation, 147 gastric, 145–146, 145f oral and esophageal, 144–145, 144f small intestinal, 146–147, 147f and vomiting, 146 Gastrointestinal (GI) secretion(s), 147–153 functional role of, 139 gastric, 139, 148–149, 150f hepatic and biliary, 139, 151–153, 153f intestinal, 139, 151 pancreatic, 139, 149–151, 151f saliva as, 139, 148, 148f Gastrointestinal (GI) smooth muscle, 143 Gastrointestinal (GI) system, 139–156 anatomy of, 139, 140f–141f blood supply of, 139 digestion and absorption by, 139–143, 142f, 152–156, 154f embryology of, 201 hormones of, 139, 143t over life span, 206–207 physiology of, 139–143, 142f regulation of, 143, 144 “Generation,” of airway, 101 Genome, 27 Germ cells, 189 Gestational period, 197 GFR See Glomerular filtration rate (GFR) GH (growth hormone), 160–161, 162t, 204, 204f and plasma glucose, 171, 173f release of, 162f 231 232 INDEX GHIH (growth hormone–inhibiting hormone) See Somatostatin (SS) GHRH (growth hormone–releasing hormone), 160, 162f, 162t GI See Gastrointestinal (GI) Glans penis, 190, 194f Globulins, in arterial blood, 61t Glomerular blood flow, 124 Glomerular capillaries, 119f Glomerular capillary blood pressure, 123, 124f, 124t Glomerular capillary filtration, 124f Glomerular capillary hydrostatic pressure, 124, 124f Glomerular capillary oncotic pressure, 124, 124f Glomerular filtrate, 117, 120 osmolarity of, 132–133, 133f Glomerular filtration barrier, 125f Glomerular filtration rate (GFR) estimation of, 122, 123f factors determining, 123–124, 124f feedback control of, 4t, 134–135, 134f over life span, 207 Glomerular tuft, 117, 119f Glomerulonephrosis, poststreptococcal, 125b Glomerulotubular balance, 134–135 Glomerulus, 117, 119f Glucagon, 159t, 170, 171, 172f for calcium channel blocker toxicity, 216, 222 Glucagon-like peptide 1, 143t Glucoamylase, 152 Glucocorticoids, 165 biosynthesis of, 166f–167f and plasma glucose, 171, 172f during pregnancy, 199 secretion of, 168 Gluconeogenesis, 171, 172f–173f Glucose blood fasting, 171 neonatal, 203 carbohydrate metabolism and, 170–174, 172f–173f insulin and, 169b, 170f–172f, 171 plasma feedback control of, 4t, hormonal regulation of, 158, 170–174, 172f–173f serum, 61t Glucose consumption, 171 Glucose reabsorption, 125, 126, 127f Glucose tolerance test, 171f Glucose uptake, 171 GLUT4 transporter, 169, 170f Glycogen synthesis, 171, 172f–173f Glycogenolysis, 171, 172f–173f Glycolysis, 214b in muscle contraction, 50 GnRH See Gonadotropin-releasing hormone (GnRH) Goblet cells, 101, 141f, 151 Golgi apparatus, 28f Gonadal differentiation, 177, 189, 191f Gonadotropin-releasing hormone (GnRH), 160, 162t in female reproductive system, 178f, 181 during menstrual cycle, 185, 185f during puberty, 177–178 in male reproductive system, 190, 193, 193f Graafian follicle, 179–180, 180b, 183, 183f, 186f Gradient, movement against, Granulosa cells, 183, 185, 185f Graphs, 5–6, 6f Gravity and cardiovascular function, 96 and pulmonary blood flow, 110, 110f Growth, 204–208 in body mass, 205, 205f, 206f of cardiovascular system, 205–206, 206t endocrine control of, 204, 204f of endocrine system, 207 of gastrointestinal system, 206–207 in height, 204, 204f of integument, 207 organ, 205, 205f of renal system, 207 of respiratory system, 206 of skeletal system, 207–208, 207b, 208b Growth hormone (GH), 160–161, 162t, 204, 204f and plasma glucose, 171, 173f release of, 162f Growth hormone–inhibiting hormone (GHIH) See Somatostatin (SS) Growth hormone–releasing hormone (GHRH), 160, 162f, 162t H H+ (hydrogen), plasma, and potassium balance, 25 H+ (hydrogen) concentration, 209 H zone, 46f, 51f H2O See Water (H2O) Hair, 13–14 Hair bulb, 13 Hair follicles, 13, 14, 14b, 14f, 15 Haldane effect, 111–112 Haptocorrin, 142f, 155 Haptoglobin, 61 Hard palate, 144f HCl (hydrochloric acid), 148, 150f HCO3– See Bicarbonate (HCO3–) Heart, 65–75 blood flow through, 65, 66f electrophysiology of, 65–69, 67b, 67f–69f, 69t endocrine function of, 159t mechanical activity of, 71–74, 71t, 72f–74f myocardial physiology of, 69–71, 70f, 71f neural and hormonal regulation of, 74–75 structure of, 65, 66f Heart failure, congestive, 71b Heart murmurs, 73, 73b, 81b Heart rate control of, 67, 68f, 74–75, 91 during exercise, 212, 212f, 214 Heart sounds, 73 Heartburn, 145 Heat conservation, Heat gain, mechanisms of, 8b Heat loss, mechanisms of, 8, 8b Heat-shock proteins (HSPs), in signal transduction, 41f Height, 204, 204f Helicobacter pylori, 149b Hematocrit, 60, 60f, 64t Hematopoiesis, 57–59, 58f fetal, 200 Hematopoietic stem cells, 57, 58f Hemodynamics, 79–82, 81f, 82f, 82t Hemoglobin, 59, 111b fetal, 198, 201b in O2 and CO2 transport, 110–112, 111f, 112f total, 64t Hemoglobin affinity, of oxygen, 111–112, 112f Hemoglobin concentration, 60 Hemopexin, 61 Hemorrhage, volume depletion due to, 22 Hemorrhagic shock, 23b, 93, 217, 223–224 Hemostasis, 57, 58f, 61–63, 62f, 63t Heparin, 63 Hepatic acinus, 151b Hepatic artery, 88, 89f Hepatic circulation, 88, 89f Hepatic function, neonatal, 204 Hepatic secretions, 139, 151–152, 153f Hepatic vein, 88, 89f Hering-Breuer reflex, 112 Heterometric G protein target kinases, 39t HIF-1 (hypoxia-inducible factor 1), 79b Hirschsprung’s disease, 147 Histamine, 86 in gastric secretion, 149, 150f in respiratory control, 99 Homeostasis, Hormone(s), 157, 159t See also Endocrine system synthesis of, 157, 160f trophic, 159t, 161, 162t, 163t Hormone response elements, 41b Hormone signaling pathways, modulation of, 41–42, 42f Hormone-receptor interactions, and enzyme kinetics, 33b Hot tub hyperthermia, 215, 221 HSPs (heat-shock proteins), in signal transduction, 41f Human somatomammotropin, 198 Hydrochloric acid (HCl), 148, 150f Hydrogen (H+), plasma, and potassium balance, 25 Hydrogen (H+) concentration, 209 17α-Hydroxylase, 166f–167f, 181f 18-Hydroxylase, 166f–167f 21-Hydroxylase, 166f–167f 17-Hydroxypregnenolone, 167f 17α-Hydroxypregnenolone, 182f 17-Hydroxyprogesterone, 167f 17α-Hydroxyprogesterone, 182f 17β-Hydroxysteroid dehydrogenase, 182f Hymen, 179f Hyperaldosteronism, 25 Hypercalcemia, 165 Hypercapnia and cardiac function, 75 and ventilation, 113, 114f Hyperchloremic acidosis, 212b Hyperemia active, 84 reactive, 84, 85f Hyperglycemia, 171 Hyperkalemia, 25, 26 Hypernatremia, 25 Hyperplasia, 29 Hyperpolarization, 36f, 37f Hypertension, malignant, 124b Hyperthermia, hot tub, 215, 221 Hypertonic fluid depletion, 22f, 23 Hypertonic fluid gain, 22f Hypertonic saline, intravenous infusion of, 23 Hypertrophy, 27 Hypocalcemia, 165 Hypodermis, 14f, 15 Hypogastric artery, 180 Hypoglycemia, 171 Hypokalemia, 26 Hyponatremia, 25 Hypophyseal stalk, 158, 161f Hypophysis, 158–161, 161f INDEX Hypotension, 93–94 orthostatic, 96 Hypothalamic hormones, 160, 162t Hypothalamic hypophyseal portal system, 158–159 Hypothalamic temperature control, 8, 8b, 16f Hypothalamus, 158–160, 158f, 159t, 161f Hypothermia, Hypotonic fluid gain, 22f Hypotonic fluid loss, 22–23, 22f Hypoxia and cardiac function, 75 and ventilation, 113, 114f Hypoxia-inducible factor (HIF-1), 79b Hysteresis, 106, 107f I I band, 43, 46f, 51f ICF (intracellular fluid), 19 ICF (intracellular fluid) volume, 20f Idiopathic thrombocytopenia purpura, 216, 223 IGFs (insulin-like growth factors), 159t, 161, 162f, 204, 204f Ileocecal valve, 142f, 147f Ileogastric reflex, 146 Ileum, 142f Iliac artery, internal, 180 Immune function of blood, 57 of skin, 17 Implantation, 197, 198, 198f Inactivation h-gate, 36, 37, 37f Inamrinone, for calcium channel blocker toxicity, 216, 222 Indicator dilution technique, 2–3, 3f, 3t, 74 Indomethacin, for patent ductus arteriosus, 219, 226 Infant respiratory distress syndrome (IRDS), 103b, 202, 203b Inferior vena cava, 66f Influenza, 8b thermoregulation alterations due to, 8–9, 9f Infraclavicular nodes, 181f Inhibin, 159t in male reproductive system, 193, 193f ovarian, 159t Inositol 1,4,5-triphosphate (IP3), in signal transduction, 38, 40f Inotropic effect, positive vs negative, 94 Inspiration, 104, 105f forced, 103, 104f Inspiratory capacity, 104, 105f Inspiratory reserve volume, 104, 105f Inspired air, 108, 108f Insulin, 159t, 168–169 actions of, 169 and adipose tissue, 169 and glucose, 169b, 170f–172f, 171 and growth, 204, 204f and growth hormone, 161 and protein metabolism, 169 secretion of, 169 Insulin-like growth factors (IGFs), 159t, 161, 162f, 204, 204f Integration, Integrative physiology, Integument, 11–17 endocrine function of, 159t epithelia of, 11–12, 11f–13f, 12b growth and regeneration of, 16–17 in immune function, 17 layers of, 12–15, 14b, 14f over life span, 207 specialized structures in, 13, 14f Integument (cont’d) in thermoregulation, 15–16, 16f in vitamin D production, 17 Intercalated cell, 127–128 Intercalated disks, 65, 66f Intercostal muscles, 104b Intercourse, 194–195, 197 Internal anal sphincter, 147 Internal iliac artery, 180 Internal mammary nodes, 181f Interpleural pressure, 99 during respiratory cycle, 104, 105f Interpleural space, 99 Interstitial fluid, 19 pressure and volume of, 83, 85b Interstitial fluid osmolarity, renal, 120 Interstitial fluid volume, 20f Intestinal blood flow, 88 Intestinal divalent ion regulation, 154, 155 Intestinal ion and water balance, regulation of, 154, 155 Intestinal motility, 146–147, 147f Intestinal phase, of gastric acid secretion, 149 Intestinal secretions, 139, 151 Intestinal villi, 140f, 141f Intestinointestinal reflex, 146 Intracellular fluid (ICF), 19 Intracellular fluid (ICF) volume, 20f Intrathoracic pressure, and cardiovascular function, 96 Intrathoracic veins, blood pressure in, 82t Intravenous infusion, volume expansion due to, 23 Intrinsic factor, 142f, 148, 150f, 155 Inulin clearance rate, 122, 123f Iodine, in thyroid hormone synthesis, 163, 163f Ion balance, 23–26, 24t, 25f, 26f Ion channels, 34, 34t Ion permeability, and membrane potential, 34–35, 35f, 38 IP3 (inositol 1,4,5-triphosphate), in signal transduction, 38, 40f Ipecac, 146b IRDS (infant respiratory distress syndrome), 103b, 202, 203b Iron deficiency anemia, 59, 59b Iron reabsorption, 155 Islets of Langerhans, 168 Isometric contraction, 51, 52f Isotonic contraction, 51, 52f Isotonic fluid gain, 22f Isotonic fluid loss, 21–22, 22f Isotonic saline, intravenous infusion of, 23 J J receptors, 112 Jaundice, neonatal, 204 Jejunum, 142f Joints, 43, 54 Juxtaglomerular apparatus, 120b, 134f K K+ See Potassium (K+) Keratin, 13 Keratinocytes, 13, 14f Ketones, 169 Ketosis, 169 Kidney(s) function of, 120–125, 121f–125f, 124t endocrine, 136–137, 159t metabolic, 137 metanephric, 191f structure of, 117–119, 118f–119f Kidney stones, 217–218, 224 Korotkoff sounds, 82, 82f L Labium majora, 179f Labium minora, 179f Labor and delivery, 202, 202f Lactase, 152 Lactase deficiency, 218, 224–225 Lactate threshold, 214, 214f Lactation, 181, 203 Lactose intolerance, 218, 224–225 Laminar flow, 80 Langerhans cells, 17, 17b Laplace’s law, 81 Large intestine, 140f Larynx, 102, 102f, 144f Lateral axillary nodes, 181f Lateral mammary artery, 180 Lateral thoracic artery, 180 Left atrial pressure, 72, 82t Left ventricular blood flow, 88, 89f Left ventricular pressure, 72, 82t Leptin, 159t Leukotrienes, 175, 175f Levels of organization, 1, 2f Leydig cells anatomy of, 191, 192f in puberty, 190 in sexual development, 189 in spermatogenesis, 194 testosterone pro duction by, 193, 193f LH See Luteinizing hormone (LH) Lidocaine, and action potentials, 37b Life span, 197–208, 197f growth during, 204–208, 204f–206f of cardiovascular system, 205–206, 206t of endocrine system, 207 of gastrointestinal system, 206–207 of integument, 207 of renal system, 207 of respiratory system, 206 of skeletal system, 207–208, 207b, 208b neonatal physiology in, 197, 203–204 pregnancy in, 197–203 and birth, 202–203, 203f fertilization in, 197, 198f fetal development during, 199–202, 200f, 201f fetal hemoglobin in, 198, 201b gestational diabetes during, 200b and lactation, 203 maternal adjustments to, 198–199 and parturition, 202, 202f placenta in, 198, 199b, 199f, 200b Ligaments, 54 Ligamentum arteriosus, 66f Ligand(s) defined, 38 modulation of tissue response to, 41–42, 42f Ligand-gated channel, 34 Line graphs, 5, 6f Lipases, 142f, 148 gastric, 150f pancreatic, 153, 154f Lipid(s), digestion and absorption of, 153–154, 154f Lipid malabsorption, 154, 155 Lipid-soluble signal transduction, 38–41, 39f, 41f Lithocholic acid, 151 Liver, 140f endocrine function of, 159t Local currents, 35, 35f Local potentials, 35, 35f 233 234 INDEX Loop of Henle anatomy of, 119f ascending limb of, 129t thick, 119f, 126, 126f, 128–129, 128f thin, 127 descending limb of, 129t thin, 127, 128, 128f handling of water and electrolytes in, 129–132, 130f–132f transport via, 126–127, 126f, 128f, 129t in urinary acid-base regulation, 134 urine concentration and dilution in, 132, 133f Lower airways, 102f, 103 Lower esophageal sphincter, 142f, 144, 145, 145b Lower respiratory system, 102f Lung(s) elastic recoil of, 99 endocrine actions of, 99 fetal, 201 neonatal, 202, 203b structure and function of, 99, 101, 102f, 103 Lung capacities, 104, 105f Lung compliance, 104, 106 Lung volumes, 104, 105f Luteinizing hormone (LH) in female reproductive system, 178f, 181 following birth, 177 after menopause, 186 in menstrual cycle, 183, 185, 185f, 186f during puberty, 178 in male reproductive system, 193, 193f, 194 release of, 160, 161, 162t Lymph, 79, 80f Lymph flow, 83 Lymph nodes, 79, 80f Lymphatic(s), 79, 80f Lymphatic drainage, of breast, 180, 181f Lysis, 20 Lysosomes, 28f M M line, 46f, 49f, 51f Macula densa, 120b Magnesium absorption, 155 Male reproductive system, 189–195, 190f androgen biosynthesis in, 189–190 development of, 189, 191f intercourse and orgasm in, 194–195, 194f, 195f in puberty, 190 sexual differentiation in utero in, 189 structures of, 190–194, 192f, 193f Malignant hypertension, 124b Mammary artery, lateral, 180 Mammary nodes, internal, 181f Mastication, 144 Maximal expiration, 105f Maximal inspired volume, 100, 105f Mean arterial pressure (MAP), 81 Mean electrical axis, 69, 70b Mechanically gated channel, 34 Meconium, 201 Medulla, in respiratory control, 112, 112f Medullary collecting duct, 119f, 126f Meiosis, 29 Meissner corpuscles, 15 Meissner’s plexus, 143 Melanin, 13 Melanocytes, 13 Melanocyte-stimulating hormone (MSH), 13 Melatonin, 159t Membrane permeability, 21b Membrane potential, 34–35, 35f ion permeability and, 34–35, 35f, 38 in neuromuscular transmission, 47–48 resting, 36f Membrane receptor signal transduction, 38, 39b, 39f–41f, 39t Menarche, 178, 181–183 Menopause, 185–186, 186b Menstrual cycle, 183–185 endocrine events during, 178f, 185, 185f, 186f length of, 183 ovarian changes during, 183, 183f proliferative and secretory phases of, 186f uterine and vaginal changes during, 184–185, 184f MEPP (miniature end plate potential), 48 Merkel cells, 15 Mesentery, 140f Mesonephric duct, 177, 189, 191f Messenger RNA (mRNA), 27, 29b, 29f Metabolic acidosis, 210–211, 210f, 211f Metabolic alkalosis, 210f, 211, 211f Metabolic function, renal, 137 Metabolic supposition, of autoregulation, 84 Metanephric kidneys, 191f Metaphase, 29 Metarterioles, 78, 79f Micelles, 152, 153 Microcirculation, 78, 79f, 83–84, 83f–86f, 85b cutaneous, 87, 87f, 213b Microcirculation blood flow, feedback control of, 4t Microfilaments, 28f Microtubules, 28f Microvilli, 28f, 139, 141f Micturition, 135–136, 136f Micturition reflex, 135–136 Migrating myoelectric complex, 146–147 Mineralocorticoids, 165 biosynthesis of, 166f–167f Miniature end plate potential (MEPP), 48 Minute ventilation, 106 alveolar, 100, 106 Mitochondrion, 28f Mitosis, 29, 30f Mitral valve, 66f Mittelschmerz, 183 Monoiodinated tyrosine (MIT), 163, 163f Motilin, 143t, 146 Motor end plate, 45 α-Motor neuron, 43, 45, 47f, 49f Mouth, in gastrointestinal system, 140f, 142f, 144, 144b, 144f Movement across barriers, 2, 2t skeletal muscle in, 43, 44f, 54 mRNA (messenger RNA), 27, 29b, 29f MSH (melanocyte-stimulating hormone), 13 Mucins, 148 Mucous neck cells, 149, 150f Mucus cervical, 184, 184f respiratory, 101, 149, 150f Müllerian duct, 177, 189, 191f Murmurs, 73, 73b, 81b Muscle(s) cardiac, 43, 44t, 54 skeletal, 43–53 blood flow to, 87–88, 88f during exercise, 213 characteristics of, 44t excitation-contraction coupling in, 49–50, 49f, 50b, 50f Muscle(s) (cont’d) fast twitch and slow twitch fibers in, 45, 47t functions of, 43 heat production by, 54 mechanics of, 50–53, 51f, 52f in movement, 43, 44f, 54 naming of, 45b neuromuscular transmission in, 45–49, 47b, 47f, 48b, 48f remodeling of, 53 structure of, 43–45, 46f smooth, 43, 44t, 53–54, 53f of airway, 101–102 Muscle atrophy, 208 Muscle contraction excitation-contraction coupling in, 49–50, 49f, 50f mechanics of, 50–53, 51f, 52f and movement, 54 neuromuscular transmission in, 45–49, 46f–48f of smooth muscle, 53, 53f strength of, 51–53 Muscle end plate, 47, 47f Muscle fascicle, 43, 46f Muscle fibers, 43, 46f fast twitch and slow twitch, 45, 47t Muscle stretch, feedback control of, 4t Muscle tension, 50–51, 52f Muscular dystrophy, Duchenne’s, 216, 222–223 Musculoskeletal system, 43–55 bones and joints in, 43, 54, 54b cardiac muscle in, 44t, 54 in life span, 207–208, 207b muscle types in, 43, 44t skeletal muscle(s) in, 43–53 characteristics of, 44t excitation-contraction coupling in, 49–50, 49f, 50b, 50f fast twitch and slow twitch fibers in, 45, 47t functions of, 43 heat production by, 54 mechanics of, 50–53, 51f, 52f in movement, 43, 44f, 54 naming of, 45b neuromuscular transmission in, 45–49, 47b, 47f, 48b, 48f remodeling of, 53 structure of, 43–45, 46f smooth muscle in, 44t, 53–54, 53f Mutations, 29, 30b Myasthenia gravis, 48b Myenteric plexus, 143 Myocardial cells, 65, 66f, 69 Myocardial infarction, 89b, 93–94, 94b, 95–96 Myocardial mechanics, 70–71, 70f, 71f Myocardial physiology, 69–71, 70f, 71f Myocardium, 54, 65, 66f Myofibrils, 43, 46f Myogenic premise, of autoregulation, 84 Myometrium, 179f, 180 Myosin, 43, 46f in excitation-contraction coupling, 49, 49f, 50f Myosin filaments, 43–45, 46f in excitation-contraction coupling, 49–50, 49f, 50f in muscle contraction, 51, 51f, 52f in smooth muscle, 53, 53f Myosin heads, 46f, 49, 49f, 50f in muscle contraction, 51 INDEX N Na+ See Sodium (Na+) Nail(s), 13 Nail bed, 13 Nail matrix, 13 Nasal cavity, 101, 102, 102f Negative feedback control, 4, 4f, 4t Negative inotropic effect, 94 Neonatal physiology, 197, 203–204 Nephrogenic diabetes insipidus, 25 Nephron, 117, 118f–119f, 120 Nernst equation, 33, 34f Nernst equilibrium potentials, 33–34, 33t, 34f, 38 Nernst equilibrium value, 67 Neurohypophysis, 158f, 159t, 161, 161f Neuromuscular junction in skeletal muscle, 45 in smooth muscle, 54 Neuromuscular transmission, 45–49, 47b, 47f, 48b, 48f Neurotensin, 147 Neurotransmitter signaling, 30–31, 30f, 31f NH3 (ammonia), 133–134 NH4+ (ammonium), 133–134 Nicotinic acid absorption, 155 Nipple, 180 Nitric oxide (NO) in signal transduction, 38, 41f in vascular endothelium, 77 Noncompetitive antagonists, 39b Norepinephrine, 159t actions of, 165 in autonomic nervous system, in cell-to-cell communication, 30–31, 31f and heart rate, 67, 68f, 74–75 in respiratory control, 99, 101 secretion of, 165, 166f Nuclear envelope, 27 Nucleolus, 28f Nucleus, 27, 28f Nutrition, and renal function, 137 O O2 See Oxygen (O2) Obstructive pulmonary disease, 105–106, 106f 3β-OH-dehydrogenase, 167f 18-OH-dehydrogenase, 167f Oncotic pressure, 21, 21f plasma, 123, 124f Oral cavity, in gastrointestinal system, 140f, 142f, 144, 144b, 144f Oral contraceptives, 198b Oral phase, of swallowing, 144, 144f Organelles, 27, 28f Organization, levels of, 1, 2f Orgasm, male, 191, 195 Orthostatic hypotension, 96 Osmolality, 21f serum, 61t Osmolarity, 20 Osmosis, 2t, 12, 12f water movement between body fluid compartments via, 20, 21f Osmotic gradients, 19 Osmotic pressure, 20 Osteoblasts, 54, 165 Osteoclasts, 54, 165 Osteocytes, 54, 165 Osteoporosis, 207, 207b OT See Oxytocin (OT) Ovarian artery, 180 Ovarian changes, during menstrual cycle, 183, 183f Ovarian follicle, 179–180, 180b, 183, 183f, 186f Ovarian inhibin, 159t Ovaries, 177, 178f, 179–180, 179f endocrine function of, 159t Oviduct, 191f Ovulation, 183, 183f, 184, 184f, 186f, 198f Ovulatory cycle See Menstrual cycle Ovum, 177, 178f, 180, 189, 197 Oxidative phosphorylation, 50b in muscle contraction, 50 Oxygen (O2) blood, regulation of, 113 hemoglobin affinity of, 111–112, 112f Oxygen (O2) administration, for carbon monoxide poisoning, 217, 224 Oxygen (O2)-binding capacity, 111f Oxygen (O2) consumption, during exercise, 214 Oxygen (O2) content, 110 in cardiovascular system, 82t Oxygen (O2) delivery, during exercise, 213, 213f Oxygen (O2) diffusion, 107–108 Oxygen partial pressure (PO2), 108, 108f Oxygen (O2) transport, 99, 100, 110–112, 111f, 112f Oxyhemoglobin dissociation curve, shift to right of, 111, 112f Oxyntic cells, 148 Oxytocin (OT), 159t in lactation, 181, 202f, 203 synthesis of, 161 and uterine contractions, 5, 202, 202f P P wave, 68, 69f, 71, 73f Pacemaker activity, 67 Pacemaker potential, 65 Pacinian corpuscles, 15 Packed RBC volume, 60f PACO2 (alveolar partial pressure of CO2), 108, 108f PaCO2 (arterial partial pressure of CO2), 4t, 61t, 101, 108f PAH (para-aminohippuric acid) clearance, 122, 123f PAH (para-aminohippuric acid) secretion, 132, 132f Pain perception, 15–16 Pancreas endocrine, 158f, 159t, 168–174 in carbohydrate metabolism, 170–174, 172f–173f glucagon release by, 170 insulin release by, 168–169, 170f, 171f somatostatin release by, 170 structure of, 168 exocrine, 140f, 142f Pancreatic duct, 150 Pancreatic enzymes, 149–151, 151f Pancreatic polypeptide, 159t Pancreatic secretions, 139, 149–151, 151f PAO2 (alveolar partial pressure of O2), 108, 108f PaO2 (arterial partial pressure of O2), 4t, 61t, 101, 108f, 113 Papillary dermis, 15 Papillary muscles, 66f Para-aminohippuric acid (PAH) clearance, 122, 123f Para-aminohippuric acid (PAH) secretion, 132, 132f Paracellular pathway, 12, 12f Paracrine signaling, 30, 30f Paramesonephric duct, 177, 189, 191f Parametrium, 179f, 180 Parasympathetic nervous system (PNS), 7, 7b in colonic motility, 147 in gastrointestinal regulation, 143 and heart rate, 67, 68f, 74 in vascular smooth muscle tone, 86 Parathyroid, 158f, 159t Parathyroid hormone (PTH), 159t, 164, 164f and calcium balance, 26, 26f during pregnancy, 199 Parietal cells, 142f, 148, 150f Parietal pleura, 103 Partial agonists, 39b Partial thromboplastin time, 64t Parturition, 202, 202f Passive diffusion, 12f Patent ductus arteriosus, 219, 225–226 PCO2 (carbon dioxide partial pressure), 108, 108f in respiratory control, 112, 113f Peak exercise performance, 214 Peak expiratory flow, 104, 106f Peak systolic pressure, 74f Pectoral nodes, 181f Pelvic blood supply, 180 Penis, 190–191, 192f during intercourse, 194–195, 194f Pepsin, 142f, 149, 150f, 152 Pepsinogen, 142f, 148, 149, 150f Peptic cells, 148 Peptidases, 152 Peptide hormones, 157, 160f Perfusion pressure, 80 Pericardial tamponade, 71, 93, 217, 224 Pericarditis, 71 Pericardium, 65, 71 Peristalsis, 139, 142f, 143–145, 144f, 146 Peritubular capillaries, 117, 119f Peritubular capillary blood pressure, 123, 124t Peritubular reabsorption, 124t Permeability, of cell membrane, 20, 21b Pernicious anemia, 156 Peroxisomes, 28f Petechiae, in idiopathic thrombocytopenia purpura, 216, 223 Peyer’s patch, 141f PGs (prostaglandins), 137, 175–176, 175f pH, 209 arterial blood, 61t calculation of, 210 plasma, 209t of urine, 133–134 pH buffering systems, 209–210, 209f Pharyngeal phase, of swallowing, 144, 144f Pharynx, 101, 102f, 103, 144, 144f Pheromones, 15 Phonation, 103 Phonocardiogram, 73f Phosphate (PO4) metabolism, 155, 164, 165 Phosphocreatinine, in muscle contraction, 50 Phospholipase A2, 153 Phospholipase C (PLC), in signal transduction, 38, 40f Physiologic dead space, 106, 110, 111f Physiologic shunt, 110, 111f Physiology, 1–9 autonomic nervous system in, 6–7, 7b common themes in, 2–7 application of, 7–9, 8b, 9f defined, feedback control in, 4–5, 4f, 4t graphs, figures, and equations in, 5–6, 6f indicator dilution in, 2–3, 3f, 3t integrative, 1, levels of organization in, 1, 2f 235 236 INDEX Physiology (cont’d) movement across barriers in, 2, 2t redundant control in, research in, of thermoregulation, 7–9, 8b, 9f Pie charts, 6, 6f PIH (prolactin inhibitory hormone), 160, 162t Pilosebaceous unit, 14b Pineal gland, 158f, 159t Pinocytosis, 83 Pitch, of sound, 103 Pituitary gland, 158–161, 161f anterior, 158f, 159t, 160–161, 161f hormones of, 161, 162f, 162t posterior, 158f, 159t, 161, 161f Pituitary hormones, 160, 162t during pregnancy, 199 Placenta, 198, 199b, 199f, 200b Plasma, 19, 59, 60f normal values for, 61t Plasma oncotic pressure, 123, 124f Plasma osmolality, feedback control of, 4t Plasma osmolarity, feedback control of, 4t Plasma volume, 20f changes in, 20f estimation of, Plasmin, 62f, 63 Plasminogen, 62f, 63 Platelet(s), 61 production of, 58f, 61 Platelet count, 61, 64t Platelet plug, 58f, 61–62, 62f PLC (phospholipase C), in signal transduction, 38, 40f Pleura(e), 103 Pleural fluid, 103 Pluripotent hematopoietic stem cells, 57, 58f Pneumocytes, 103, 106 Pneumotaxic center, of pons, 112 Pneumothorax, 103, 103b PNS See Parasympathetic nervous system (PNS) PO2 (oxygen partial pressure), 108, 108f PO4 (phosphate) metabolism, 155, 164, 165 Poiseuille’s law, 80 Poison ivy contact dermatitis, 215, 221 Polypeptide hormones, 157 Pons, in respiratory control, 112, 112f Portal vein, 88, 89f Positive feedback, Positive inotropic effect, 94 Postovulatory phase, of menstrual cycle, 185 Poststreptococcal glomerulonephrosis, 125b Postsynaptic cell, 45 Postsynaptic events, 47–49, 48f Posttetanic potentiation, 48 Potassium (K+) in arterial blood, 61t plasma and aldosterone release, 166, 168f feedback control of, 4t renal regulation of, 135t Potassium (K+) balance, 24t, 25–26, 25f Potassium (K+) channels, 34t voltage-gated, 36 Potassium (K+) reabsorption, 126, 129, 131f, 132, 132f, 155 Potassium (K+) secretion, 127 Potassium-sparing diuretics, 127b Power stroke, 49, 50f PR interval, 69f Precapillary sphincters, 78, 79f Pregnancy, 197–203 and birth, 202–203, 203f fertilization in, 197, 198f Pregnancy (cont’d) fetal development during, 199–202, 200f, 201f fetal hemoglobin in, 198, 201b gestational diabetes during, 200b and lactation, 203 maternal adjustments to, 198–199 and parturition, 202, 202f placenta in, 198, 199b, 199f, 200b Pregnenolone, 167f, 182f Preload, 52f cardiac, 71, 71t, 72f, 91, 93 Preovulatory phase, of menstrual cycle, 185 Prepuce, 190, 194f Pressure-volume curves, for blood vessel compliance, 81 Presynaptic cell, 45, 47f Presynaptic events, 47 Presynaptic membrane, 45 PRH (prolactin-releasing hormone), 161, 162t Progesterone, 159t biosynthesis of, 167f, 181, 182f in female reproductive system, 178f, 181 during menstrual cycle, 185, 185f, 186f in puberty, 178 in sexual differentiation, 177 placental, 198 during pregnancy, 199 Progestin, in female reproductive system, 178 Prolactin, 160, 161, 162t in lactation, 181, 203 during pregnancy, 199 Prolactin inhibitory hormone (PIH), 160, 162t Prolactin-releasing hormone (PRH), 161, 162t Proliferative phase, of menstrual cycle, 186f Prophase, 29 Prostacyclins, 175, 175f, 176 Prostaglandins (PGs), 137, 175–176, 175f Prostate gland, 191f, 192–193, 192f, 193b, 194f secretions of, 194 Prostatic hyperplasia, benign, 218–219, 225 Proteases, 142f, 148 pancreatic, 150, 153 Protein(s) digestion and absorption of, 152, 153f total, 61t Protein hormones, 157 Protein kinase(s), in signal transduction, 38, 39f, 42 Protein kinase C, in signal transduction, 38 Protein metabolism, insulin and, 169 Protein synthesis, 29f Proteinuria, 124–125 Prothrombin, 62, 63t Prothrombin time, 64t Proximal convoluted tubule anatomy of, 119f handling of water and electrolytes in, 129–132, 130f–132f transport via, 125–126, 126f–128f, 128, 129t in urinary acid-base regulation, 133–134 urine concentration and dilution in, 132, 133f Pseudohypertrophy, 222 PTH (parathyroid hormone), 159t, 164, 164f and calcium balance, 26, 26f during pregnancy, 199 Puberty female, 177–178, 178f and growth, 204, 204f male, 190 Pudendum, 178–179, 179f Pulmonary arteries, 65, 66f Pulmonary artery pressure, 72, 82t, 109, 109f fetal, 201 Pulmonary blood flow, gravity and, 110, 110f Pulmonary capillary pressure, 82t Pulmonary capillary transit time, 109 Pulmonary circulation, 89, 109–110, 109f, 110f Pulmonary compliance, 104, 106 Pulmonary edema, 107b Pulmonary function, regulation of, 99, 112–115, 112f–114f Pulmonary function tests, 104, 106f Pulmonary semilunar valve, 66f Pulmonary stretch receptors, 99 Pulmonary system, 99–115 in acid-base regulation, 113–115 at birth, 202–203 blood transport of oxygen and carbon dioxide in, 99, 100, 110–112, 111f, 112f fetal, 201–202 gas exchange in, 100–101, 100f–101f, 107–109, 108f, 109f over life span, 206 physiologic map of, 100–101, 100f–101f structure and function of, 99, 101–103, 102f, 104t surfactant and pulmonary compliance in, 99, 106, 107f ventilation in, 104–106, 105f, 106f ventilation-perfusion balance in, 99, 110, 111f work of respiration in, 107, 107f Pulmonary vascular resistance, 109–110 Pulmonary venous pressure, 82t, 109, 109f Pulse pressure, 81 Purkinje fibers, 68, 69f Purpura, idiopathic thrombocytopenia, 216, 223 Pyloric sphincter, 140f Pylorus, 142f, 143, 145, 146 Q Q-Q interval, in atrial fibrillation, 217, 223 QRS complex, 68–69, 69f, 72, 73f R R protein, 142f, 155 Reabsorption, renal, 120, 122f Reactive hyperemia, 84, 85f Recruitment, 50–51 Rectum, 140f, 142f, 147 Red blood cell(s) (RBCs), 59–61 centrifugation of, 60f components of, 59–60 deformation of, 60–61 life span of, 60 lysis of, 61 morphology of, 59 production of, 57–59, 58f sequestration of, 60 Red blood cell (RBC) count, 60, 64t Red blood cell (RBC) volume, packed, 60f 5α-Reductase, 182f Redundant control, Refractory period absolute, 37, 37f in cardiac muscle, 71f relative, 37, 37f in cardiac muscle, 71f Regurgitation, cardiac, 73b Relative refractory period (RRP), 37, 37f in cardiac muscle, 71f Relaxin, 159t, 202 Renal artery, 118f INDEX Renal blood flow, 120–122, 122f, 124f, 124t Renal blood vessels, 117 Renal capsule, 118f Renal clearance, 122–123, 123f Renal cortex, 117, 118f–119f Renal excretion, 120, 122f Renal filtrate, 117, 120 osmolarity of, 132–133, 133f Renal filtration, 120, 122f Renal function neonatal, 204 nutrition and, 137 regulation of, 134–135, 134f, 135t Renal medulla, 117, 118f–119f Renal pelvis, 118f Renal perfusion pressure, 135 Renal plasma flow (RPF), estimation of, 122, 123f Renal reabsorption, 120, 122f Renal regulation, of blood pressure, 96, 97f Renal secretion, 120, 122f Renal sympathetic nerves, 135 Renal system, 117–137 endocrine function of, 136–137, 159t fetal, 202 function of, 120–125 handling of water and electrolytes by, 129–132, 130f–132f metabolic function of, 137 over life span, 207 physiologic map of, 120, 121f structures of, 117–120, 118f–119f transcapillary fluid exchange in, 123–125, 124f, 124t, 125f tubular secretion and absorption in, 125 urinary acid-base regulation in, 133–134 urine concentration and dilution in, 132–133, 133f urine excretion by, 135–136, 136f urine formation in, 120, 122f Renal tubule(s) blood vessels and, 117–119, 119f distal, 119f, 126f, 127, 128f, 129, 129t handling of water and electrolytes in, 129–132, 130f–132f loop of Henle as, 119f, 126–127, 126f, 128f, 129t proximal convoluted, 119f, 125–126, 126f–128f, 128, 129t transport via, 125–129, 128f, 129t Renal vein, 118f Renin, 136–137, 159t, 174, 174f Renin-angiotensin system, 174–175, 174f Replication errors, 29, 30b Repolarization, 36, 36f, 37f Reproductive system See Female reproductive system; Male reproductive system Research, physiologic, Residual volume, 104, 105f Resonance, of sound, 103 Respiration accessory muscles of, 103, 104t at birth, 202 and cardiovascular function, 96 control of, 99, 112–115, 112f–114f during exercise, metabolic costs of, 107 work of, 107, 107f Respiratory acidosis, 210, 210f, 211f Respiratory alkalosis, 210, 210f, 211f Respiratory control, 99, 112–115, 112f–114f Respiratory cycle, 104, 105f Respiratory distress syndrome, infant, 103b, 202, 203b Respiratory muscles, 103, 104t Respiratory system See Pulmonary system Respiratory work, 107, 107f Resting membrane potential, 36f Restrictive pulmonary disease, 104–105, 106f Retching, 146 Reticular dermis, 15 Reticulocyte(s), 58f, 59, 60 Reticulocyte count, 64t Retropulsion, 145 Rh blood groups, 61 Rh0(D) immune globulin (RhoGAM), 61 Rh-negative, 61 Rh-positive, 61 Ribosomal subunits, 29f Ribosomes, 28f, 29f Right atrial pressure, 82t, 92f cardiac output and, 94, 94f Right ventricular pressure, 82t RNA messenger, 27, 29b, 29f transfer, 29f RNA polymerase, 29b, 29f Rough endoplasmic reticulum, 28f RPF (renal plasma flow), estimation of, 122, 123f RRP (relative refractory period), 37, 37f in cardiac muscle, 71f Ruffini endings, 15 Rugae gastric, 140f vaginal, 180 S S phase, 30f SA (sinoatrial) node, 65, 67, 67f, 68, 69f Salicylate overdose, acid-base disturbance due to, 219, 226 Saline, normal (isotonic), 20 Saliva, 139, 142f, 148, 148f Salivary glands, 140f, 148 Sarcolemma, 46f Sarcomere, 43–45, 46f in muscle contraction, 51, 51f, 52f Sarcoplasmic reticulum (SR), 46f, 49, 49f in cardiac muscle, 70, 70f Scrotum, 191, 192f Sebaceous glands, 14–15, 14b, 14f Sebum, 15 Second heart sound, 73 Second messengers, 38, 39f–42f, 42 Secondary sexual characteristics, female, 178 Secretin, 142f, 143t, 149, 151, 151f Secretory phase, of menstrual cycle, 186f Semen, 193, 194 Seminal vesicles, 191f, 193, 194f Seminiferous tubules, 191, 192f Semipermeable barrier, in osmotic movement of water, 20 Sensory receptors, in skin, 14f, 15–16 SERCA, 50 Serotonin, 86 Sertoli cells, 191–192, 192f, 193, 193f Serum, 59 Set point, 4, 4f Sex chromosomes, 177, 189 Sexual arousal female, 180 male, 191, 194–195 Sexual differentiation female, 177, 191f male, 189, 191f Sexual intercourse, 194–195, 197 Shock, 93–94, 93b anaphylactic, 94 hemorrhagic, 23b, 93, 217, 223–224 Shunt unit, 110, 111f SIADH (syndrome of inappropriate antidiuretic hormone), 23, 25 Signal transduction lipid-soluble, 38–41, 39f, 41f membrane receptor, 38, 39b, 39f–41f, 39t overview of, 39f Sildenafil, 195b Sinoatrial (SA) node, 65, 67, 67f, 68, 69f Sinus arrhythmia, normal, 96 Skeletal muscle(s), 43–53 blood flow to, 87–88, 88f during exercise, 213 characteristics of, 44t excitation-contraction coupling in, 49–50, 49f, 50b, 50f fast twitch and slow twitch fibers in, 45, 47t functions of, 43 heat production by, 54 mechanics of, 50–53, 51f, 52f in movement, 43, 44f, 54 naming of, 45b neuromuscular transmission in, 45–49, 47b, 47f, 48b, 48f remodeling of, 53 structure of, 43–45, 46f Skeletal system, 54, 54b over life span, 207, 207b Skin, 11–17 coloration of, 13 endocrine function of, 159t epithelia of, 11–12, 11f–13f, 12b growth and regeneration of, 16–17 in immune function, 17 layers of, 12–15, 14b, 14f over life span, 207 specialized structures in, 13, 14f in thermoregulation, 15–16, 16f in vitamin D production, 17 Sliding filament mechanism, 49, 50f Slow twitch fibers, 45, 47t Slow-wave depolarization, 53 Small intestinal motility, 146–147, 147f Small intestine, 140f endocrine function of, 159t Smooth endoplasmic reticulum, 28f Smooth muscle, 43, 44t, 53–54, 53f of airway, 101–102 gastrointestinal, 143 vascular, 77 Snake venoms, 49 SNAP-SNARE mechanism, 47 Sneeze reflex, 102 SNS See Sympathetic nervous system (SNS) Sodium (Na+) in arterial blood, 61t renal regulation of, 135t Sodium (Na+) absorption, 155 Sodium (Na+) balance, 24–25, 24t, 25f Sodium (Na+) channels, 34t fast, 36, 37, 37f on myocardial cells, 67 Sodium (Na+) reabsorption, 25, 125, 126, 129, 130f, 132, 132f Sodium/calcium (Na+-Ca++) exchanger, 33b, 33f Sodium/potassium (Na+-K+) pump, 33f Sodium/potassium-adenosine triphosphatase (Na+/K+-ATPase), 32, 33b, 33f Soft palate, 144, 144f Solute movement, water movement and, 12 Solvent drag, 12 Somatomammotropin, 198 Somatomedins, 161 237 238 INDEX Somatostatin (SS), 159t, 162t, 170 and gastric acid secretion, 150f and growth hormone, 160, 162f and migrating myoelectric complex, 147 Somatotropin, 160–161, 162f, 162t Spatial summation, 35 Speech, 103 Sperm, 177, 189, 193–194, 198b Spermatids, 192f, 193 Spermatocytes, 192f, 193 Spermatogenesis, 193–194, 193f Spermatogonium(ia), 192f, 193 Spermatozoa, 192f Sphincter of Oddi, 152 Sphygmomanometer, 82, 82f Spirometry, 104, 105f, 106f Splanchnic blood vessels, 88 SR (sarcoplasmic reticulum), 46f, 49, 49f in cardiac muscle, 70, 70f SS See Somatostatin (SS) ST segment, 69f Staircase effect, 51–53 Starling hypothesis, 21, 83, 84f Stem cells, 29, 30f, 57, 58f Stenosis, cardiac, 73b Steroid hormones, 98b, 157, 160f biosynthesis of, 167f cholesterol and, 166b, 167f in signal transduction, 38–41, 41f Stomach, 140f, 142f, 143, 145 endocrine function of, 159t Stress-relaxation response, 86 Stretch-sensitive channels, 53 Stroke volume, 72–73, 91 during exercise, 212, 212f Subacute granulomatous thyroiditis, 218, 225 Subcutaneous fat layer, 15 Submucosal plexus, 143 Subscapular nodes, 181f Substance P, 147 Succinylcholine, 49 Sucrase, 152 Supraclavicular nodes, 181f Surfactant, 99, 106, 107f, 201–202, 203b Swallowing, 144, 144f Swallowing center, 144 Swallowing reflex, 144 abnormalities of, 145 Swan-Ganz catheter, 109, 109f Sweat, 15 volume depletion due to, 22–23 Sweat glands, 14f, 15, 87 in thermoregulation, 16f Sympathetic nervous system (SNS), 7, 7b in gastrointestinal regulation, 143 and heart rate, 67, 68f, 74 in vascular smooth muscle tone, 86 Sympathetic vasomotor tone, 86 Symports, 32 Synaptic cleft, 43, 44f, 45, 47f Synaptic fatigue, 48 Synaptic gap, 45 Synaptic trough, 45 Synaptic vesicles, in neuromuscular transmission, 45, 47, 48 Syndrome of inappropriate antidiuretic hormone (SIADH), 23, 25 Systole, 71, 72, 73f T T tubules, 46f, 49, 49f T wave, 69, 69f, 72, 73f T3 (triiodothyronine), 159t, 161–162 synthesis and release of, 163, 163f, 164f T4 (thyroxine), 159t, 161–162 synthesis and release of, 163, 163f, 164f Tachycardia, 71 Telophase, 29 Temporal summation, 35, 50–51 Tendons, 54 Testicles See Testis(es) Testis(es) anatomy of, 191–192, 192f descent of, 189 endocrine function of, 159t enlargement of, 190 regulation of function of, 193, 193f Testosterone biosynthesis of, 182f, 189–190 in male reproductive system, 189, 190, 193, 195, 195f Tetanic stimulation, 48 Tetany, 48 Theca cells, 183, 185, 185f Thermal dilution, 74 Thermoreceptors, 15 Thermoregulation, 4, 7–9, 8b, 9f, 87 neonatal, 204 skin in, 15–16, 16f Thick filaments, 43–45, 46f in excitation-contraction coupling, 49–50, 49f, 50f in muscle contraction, 51, 51f, 52f Thin filaments, 43–45, 46f in excitation-contraction coupling, 49–50, 49f, 50f in muscle contraction, 51, 51f, 52f Third heart sound, 73 Thoracic artery, lateral, 180 Thoracic duct, 79 Thoroughfare channel, 79f Threshold voltage, 36 Thrombin, 62, 62f Thrombin time, 64t Thrombocytopenia, 63 Thrombocytopenia purpura, idiopathic, 216, 223 Thromboplastin, 62, 63t Thromboplastin time, partial, 64t Thrombopoietin, 58f Thrombosis, 63 Thromboxanes, 175, 175f, 176 Thymopoietin, 159t Thymosin, 159t Thymus, 158f, 159t Thyroglobulin, 163, 163f Thyroid gland, 158f, 159t Thyroid hormone, 157, 161–163 action of, 160f, 161–163 and growth, 204, 204f during pregnancy, 199 in signal transduction, 38–41 synthesis and release of, 161 regulation of, 163, 163f, 164f Thyroid hormone–releasing hormone (TRH), 160, 162t, 163, 164f Thyroiditis, subacute granulomatous, 218, 225 Thyroid-releasing hormone (TRH), 160, 162t, 163, 164f Thyroid-stimulating hormone (TSH), 160, 161, 162t, 163, 164f Thyrotropin-releasing hormone, 163 Thyroxine (T4), 159t, 161–162 synthesis and release of, 163, 163f, 164f Tidal volume, 104, 105f, 106 Tight junctions, 11, 11f, 12b and paracellular movement, 12 Timed vital capacity, 104 Tissue blood flow, control of, 77 Tissue pressure hypothesis, of autoregulation, 84 Titin, 43, 46f Toenails, 13 Total lung capacity, 104, 105f Total peripheral resistance (TPR), 91, 92f, 93 and vascular function curve, 95 Total urinary acid excretion, 133 Trachea, 101, 102f, 103 Tracheobronchial tree, 103 Transcapillary exchange, 83, 83f, 84f Transcapillary fluid exchange, 123–125, 124f, 124t, 125f Transcellular pathway, 12, 12f Transcortin, 168 Transcription, 27, 28f, 29f Transepithelial potential, 12, 13f Transfer RNA (tRNA), 29f Transference, 34 Transferrin, 61 Transition voltage, 36 Translation, 27, 28f, 29f Transport, 2t Transport proteins, 11–12 Treppe effect, 51–53 TRH (thyroid hormone–releasing hormone), 160, 162t, 163, 164f Triglycerides, 153 Triiodothyronine (T3), 159t, 161–162 synthesis and release of, 163, 163f, 164f tRNA (transfer RNA), 29f Trophic hormones, 159t, 161, 162t, 163t Tropomyosin, 43, 46f, 49f Troponin, 43, 46f, 49f Troponin C, in excitation-contraction coupling, 49 Trypsinogen, pancreatic, 150 TSH (thyroid-stimulating hormone), 160, 161, 162t, 163, 164f d-Tubocurarine, 49 Tubular reabsorption, 125 Tubular secretion, 125 Tubule fluid, 117 Tubuloglomerular feedback, 134–135, 134f Tunica adventitia, 78, 78f Tunica dartos, 191 Tunica intima, 77, 78f Tunica media, 78, 78f Turbulence, cardiac, 73b Turbulent flow, 80 Turner’s syndrome, 191b Two-point discrimination, 15 Tyrosine kinase, in signal transduction, 38, 41f U Umbilical arteries, 199, 199f, 200, 200f, 202, 203f Umbilical cord, 199f, 202 Umbilical vein, 199, 199f–201f, 200, 202, 203f Uniports, 32 Upper airways, 102–103, 102f Upper esophageal sphincter, 142f, 144 Upper respiratory system, 102f Urea, reabsorption of, 129–132, 131f Urea nitrogen, serum, 61t Ureter(s), 118f, 119 in urine excretion, 135 Ureterorenal reflex, 135 Urethra, 120 Uric acid, serum, 61t Urinary acid excretion, total, 133 Urinary calculi, 217–218, 224 Urinary system, 118f–119f Urine acid-base regulation of, 133–134 concentration and dilution of, 132–133, 133f excretion of, 135–136, 136f formation of, 120, 122f Urine osmolarity, 132–133, 133f INDEX Urodilatin, 25 Urogenital sinus, 191f Urushiol, 221 Uterine arteries, 180, 199 Uterine changes, during menstrual cycle, 184–185, 184f Uterine contractions, 202 oxytocin and, Uterine veins, 199–200 Uterus, 178f, 179f, 180, 180b, 191f during pregnancy, 199 V Vagina, 179f, 180, 191f Vaginal changes, during menstrual cycle, 184–185, 184f Valsalva maneuver, 96 Varicose veins, 79 Vas deferens, 189, 191, 191f, 192f, 194, 194f Vasa recta, 119f, 120 Vascular beds, circulation in specific, 87–89, 87f–89f Vascular compliance, 81 Vascular endothelial growth factor (VEGF), 79b Vascular function curves, 94–96, 95f Vascular injury, 57, 61–63, 62f, 64 Vascular resistance, 80, 81f Vascular smooth muscle, 77 Vascular smooth muscle tone, 85–86 Vascular system, 77–89 circulation in specific vascular beds of, 87–89, 87f–89f hemodynamics of, 79–82, 81f, 82f, 82t histology of blood vessels in, 77–78, 78f microcirculation in, 78, 79f, 83–84, 83f–86f, 85b neural and hormonal regulation of, 77, 85–87, 86f, 87f segments of, 78–79, 79f, 80f take-home points on, 89 Vasoconstriction, 86 Vasodilation, 83–84, 86 Vasopressin See Antidiuretic hormone (ADH) VEGF (vascular endothelial growth factor), 79b Vein(s), 78f, 79, 79f varicose, 79 Venous blood pressure, 91, 92f, 93 cardiac output and, 93, 94–96, 94f, 95f Venous blood volume, 93 Venous reservoir, 91, 92f Venous return, during exercise, 213 Ventilation, 104–106, 105f, 106f during exercise, Ventilation-perfusion balance, 99, 110, 111f Ventilation-perfusion (V/Q) ratio, 110, 111f Ventricle(s), 65, 66f Ventricular diastole, 72, 73f Ventricular fibrillation, 95, 95b Ventricular filling pressure, 91 Ventricular pressure, 72, 73f Ventricular pressure-volume loop, 73–74, 74f Ventricular systole, 72, 73f Venule(s), 78, 79, 79f Verapamil overdose, 216, 222 Vesicular movement, 12 Vessel injury, 57, 61–63, 62f, 64 Villi, 140f, 141f Visceral pleura, 103 Viscosity, of blood, 80–81 Vital capacity, 104, 105f timed, 104 Vital signs, normal values for, Vitamin(s), digestion and absorption of, 155–156 Vitamin B12 absorption, 155–156 Vitamin C absorption, 155 Vitamin D production, epidermis in, 17 Vitamin D3, 159t, 165 Vocal cords, 144f Voltage-gated channel, 34 Voltage-gated K+ channels, 36 Voltage-gated Na+ channel, 36, 37, 37f Volume calculation of, 2, 3f change in, 3, 3f Volume contraction, 21–23, 22f, 22t Volume depletion, 21–23, 22f, 22t Volume disturbances, 21–23, 22f, 22t, 23b Volume expansion, 22f, 22t, 23 Vomiting, 146 Vomiting center, 146 Vomiting reflex, 146 V/Q (ventilation-perfusion) ratio, 110, 111f Vulva, 178–179, 179f W Warfarin, 63 Water (H2O) digestion and absorption of, 154–155 intravenous infusion of, 23 osmotic shift of, 21f reabsorption of colonic, 147, 147f renal, 129, 130f, 132, 132f renal handling of, 129, 130f, 132, 132f transepithelial movement of, 12 Water balance daily, 23t hormonal control of, 158 Water gain, daily, 23t Water loss, daily, 23t White blood cells (WBCs), production of, 58f Wolffian duct, 177, 189, 191f Work of respiration, 107, 107f X x axis, 5, 6f X chromosome, 177, 189 x-y graph, 5, 6f Y y axis, 5, 6f Y chromosome, 177, 189 Yolk sac, 199f Z Z disk (Z line), 43, 46f, 49f in muscle contraction, 51, 51f Zona fasciculata, 165, 166f Zona glomerulosa, 165, 166f Zona reticularis, 165, 166f Zygote, 197, 198f 239 ... CO2 levels O2 VD =PaCO2-PECO2 VT PaCO2 Arterial blood Pulmonary capillary 50 End-tidal 40 CO2 transport 70% HCO 323 % bound to hemoglobin 7% dissolved O2 transport >98% bound to hemoglobin < 2% ... control pH PCO2 Temperature 2, 3-DPG Mixed venous PO2 Arterial PO2 CO2 O2 and pH Medullary chemoreceptors Carotid and aortic chemoreceptors 100 90 Shift to the left 80 O2 saturation (%) 1 12 70 Central... CNS CO2 and acidosis both can stimulate ventilation CSF Blood-brain barrier Blood-brain barrier Venous blood CO2 CO2 Metabolic CO2 production CO2 Central chemoreceptor H; CO2 H; CO2 CO2 HCO3