Guyton and Hall Textbook of Medical Physiology
THIRD SOUTH ASIA EDITION
John E. Hall, PhD
Arthur C. Guyton Professor and Chair, Department of Physiology and Biophysics, Associate Vice Chancellor for Research, University of Mississippi Medical Center, Jackson, MS, United States
Michael E. Hall, MD, MS
Associate Professor, Department of Medicine, Division of Cardiovascular Diseases, Associate Vice Chair for Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
Adaptation Editors Mario Vaz, MD
Professor, Department of Physiology, St. John’s Medical College, Bangalore, India
Anura Kurpad, MD, PhD
Professor, Department of Physiology, St. John’s Medical College, Bangalore, India
Tony Raj, MD
Professor, Department of Physiology, St. John’s Medical College, Bangalore, India
Table of Contents
Cover image
Title page
Copyright
Dedication
Preface to the third South Asia edition
Preface to the second South Asia edition
Preface to the first South Asia edition
Preface to the 14th edition
Videos
Competency map
SECTION I. General Physiology
1. Functional organization of the human body and control of the “internal environment”
Cells are the living units of the body
Extracellular fluid the “internal environment”
Homeostasis—maintenance of a nearly constant internal environment PY1.2
Control systems of the body
Summary automaticity of the body
Further readings
2. The cell and its functions
Organization of the cell
Physical structure of the cell PY1.1
Functional systems of the cell PY1 1
Further readings
3. Genetic control of protein synthesis, cell function, and cell reproduction PY1.1
Genes in the cell nucleus control protein synthesis
The DNA code in the cell nucleus is transferred to RNA code in the cell cytoplasm the process of transcription
Control of gene function and biochemical activity in cells
Genetic testing
The DNA–genetic system controls cell reproduction
Cell differentiation
Apoptosis PY1.4
Further readings
4. Transport of substances through cell membranes
Diffusion PY1.5
“Active transport” of substances through membranes PY1.5
Further readings
5. The body fluid compartments
Fluid intake and output are balanced during steady-state conditions
Body fluid compartments PY1.6
Blood volume
Constituents of extracellular and intracellular fluids PY1.6
Measurement of fluid volumes in the different body fluid compartments the indicator–dilution principle PY1.6
Determination of volumes of specific body fluid compartments
Further readings
6. Intracellular and extracellular
fluid compartments and edema PY1.6
Basic principles of osmosis
and osmotic pressure
Osmotic equilibrium is maintained between intracellular and extracellular fluids
Volume and osmolality of extracellular and intracellular
fluids in abnormal states
Clinical abnormalities of fluid volume regulation: Hyponatremia and hypernatremia
Edema: Excess fluid in the tissues
Fluids in the “potential spaces”
of the body
Further readings
7. Resting membrane potential
Basic physics of membrane potentials PY1.8
Measuring the membrane potential
Resting membrane potential of neurons
Impermeant anions (the Gibbs–Donnan phenomenon)
Further readings
SECTION II. Nerve and Muscle Physiology
8. The neuron: Stimulus and excitability
Characteristics of a stimulus PY1.8
Excitation—the process of eliciting the action potential
Further readings
9. Action potential of the nerve PY1.8
Voltage-gated sodium and potassium channels
Summary of the events that cause the action potential
Roles of other ions during the action potential
Local potentials
Refractory period
Further readings
10. Propagation of the nerve impulse PY3.2
Special characteristics of signal transmission in nerve trunks
Further readings
11. Peripheral nerve damage
The nature and causes if peripheral neuropathy
Nerve injury
Wallerian degeneration PY3.3
Functional assessment of nerve damage using the strength–duration curve PY3.17
Nerve regeneration PY3.3
Further readings
12. Neuromuscular transmission PY3.4
Secretion of acetylcholine by the nerve terminals
Molecular biology of acetylcholine formation and release
Drugs that enhance or block transmission at the neuromuscular junction PY3.5
Myasthenia gravis PY3.6
Lambert-Eaton syndrome
Muscle action potential—comparison with nerve action potential
Further readings
13. Excitation–contraction coupling PY3.4; PY3.8
Transverse tubule–sarcoplasmic reticulum system
Release of calcium ions by the sarcoplasmic reticulum
Further readings
14. Molecular basis of skeletal muscle contraction PY3.4; PY3.9
Physiological anatomy of skeletal muscle
General mechanism of muscle contraction
Molecular mechanism of muscle contraction
Further readings
15. Chemical changes during skeletal muscle contraction PY3.11
Energetics of muscle contraction
Further readings
16. Characteristics of skeletal muscle contraction PY3.8, 3.10, 3.12
The amount of actin and myosin filament overlap determines tension developed by the contracting muscle
Relation of velocity of contraction to load
Mechanics of skeletal muscle contraction
Muscular dystrophy PY3.13
Further readings
17. Applied skeletal muscle physiology
Blood flow regulation in skeletal muscle at rest and during exercise PY3.11
Muscles in exercise PY3.11
Gender differences in athletic performance PY11.4
Drugs and athletes
Further readings
SECTION III. Blood and Its Constituents
18. Introduction to blood and plasma proteins PY2.1
Functional roles of the plasma proteins PY2.2
Separation of plasma proteins
Plasmapheresis
Further readings
19. Red blood cells (erythrocytes) PY2.3
Shape and size of red blood cells
Concentration of red blood cells in the blood
Quantity of hemoglobin in the cells
Life span of red blood cells is about 120 days
Erythrocyte sedimentation rate
Further readings
20. Erythropoiesis PY2.4
Areas of the body that produce red blood cells
Genesis of blood cells
Stages of differentiation of red blood cells
Erythropoietin regulates red blood cell production
Maturation of red blood cells requirement for vitamin B12 (cyanocobalamin) and folic acid
Further readings
21. Hemoglobin
Formation of hemoglobin PY2.3
Iron metabolism
Further readings
22. Anemia and polycythemia PY2.5
Anemia
RBC indices in anemia
Polycythemia
Further readings
23. Jaundice
Hemolytic jaundice is caused by hemolysis of red blood cells PY2.5
Obstructive jaundice is caused by obstruction of bile ducts or liver disease
Diagnostic differences between hemolytic and obstructive jaundice
Further readings
24. White blood cells PY2.6
Leukocytes (white blood cells)
Neutrophils and macrophages defend against infections
Monocyte–macrophage cell system (reticuloendothelial system)
Eosinophils
Basophils
Leukopenia
Leukemias
Further readings
25. Immunity and allergy
Acquired (adaptive) immunity PY2.10
Allergy and hypersensitivity
Further readings
26. Platelets
Thrombopoiesis PY2.7
Hemostasis events PY2.7
Vascular constriction
Thrombocytopenia
Thromboembolic conditions
Bleeding time
Further readings
27. Blood coagulation PY2.8
Conversion of prothrombin to thrombin
Conversion of fibrinogen to fibrin—formation of the clot
Positive feedback of clot formation
Initiation of coagulation: Formation of prothrombin activator
Intravascular anticoagulants prevent blood clotting in the normal vascular system
Plasmin causes lysis of blood clots
Conditions that cause excessive bleeding in humans
Anticoagulants for clinical use
Blood coagulation tests
Further readings
28. Blood groups PY2.9
Multiplicity of antigens in the blood cells
O–A–B blood types
Rh blood types
Further readings
SECTION IV. Cardiovascular Physiology
29. Organization of the cardiovascular system PY5.7, 5.8
Physical characteristics of the circulation
Basic principles of circulatory function
Further readings
30. Properties of cardiac muscle PY5.2
Anatomical characteristics of cardiac muscle
Physiological characteristics of cardiac muscle
Further readings
31. Cardiac action potentials PY5.4
Membrane potentials for the SA node and muscle fibers
Control of cardiac action potentials by the sympathetic and parasympathetic nerves
Effect of drugs on the cardiac action potential
Further readings
32. Origin and conduction of the cardiac impulse PY5.4
Specialized excitatory and conductive system of the heart
Control of excitation and conduction in the heart PY5.1
Further readings
33. The normal electrocardiogram
Characteristics of the normal electrocardiogram PY5.5
Flow of current around the heart during the cardiac cycle
Electrocardiographic leads
34. Clinical applications of the electrocardiogram
Abnormal sinus rhythms PY5.6
Abnormal rhythms that result from block of heart signals within the intracardiac conduction pathways
Premature contractions
Paroxysmal tachycardia
Ventricular fibrillation
Atrial fibrillation
Atrial flutter
Cardiac arrest
Vectorial analysis of the ECG and its application to ventricular hypertrophy
Vectorial analysis of the normal electrocardiogram
Mean electrical axis of the ventricular QRS and its significance
Coronary ischemia
Further readings
35. Cardiac cycle
Diastole and systole
Oxygen utilization by the heart
Efficiency of cardiac contraction
Further readings
36. Cardiac output and venous return PY5.8, 5.9
Normal values for cardiac output at rest and during activity
Control of cardiac output by venous return the Frank–Starling mechanism of the heart
Venous return curves
Analysis of cardiac output and right atrial pressure using simultaneous cardiac output and venous return curves
Methods for measuring cardiac output
Further readings
37. Regulation of cardiac output PY5.8, 5.9
Intrinsic regulation of heart pumping—the Frank–Starling mechanism
Effect of potassium and calcium ions on heart function
Effect of temperature on heart function
Increasing the arterial pressure load (up to a limit) does not decrease the cardiac output
Further readings
38. Hemodynamics PY5.7
Interrelationships of pressure, flow, and resistance
Further readings
39. Microcirculation PY5.10
Structure of the microcirculation and capillary system
Flow of blood in the capillaries vasomotion
Exchange of water, nutrients, and other substances between the blood and interstitial fluid
Interstitium and interstitial fluid
Fluid filtration across capillaries
Further readings
40. The lymphatic system PY5.10
Formation of lymph
Rate of lymph flow
The lymphatic system plays a key role in controlling interstitial fluid protein concentration, volume, and pressure
Further readings
41. The venous system PY5.7
Right atrial pressure (central venous pressure) and its regulation PY5.8
Peripheral venous pressure and its determinants
Blood reservoir function of the veins
Further readings
42. Determinants of arterial blood pressure
Arterial pressure pulsations
Vascular distensibility PY5.9
Clinical methods for measuring systolic and diastolic pressures
Further readings
43. Short-term regulation of
arterial blood pressure PY5.8, 5.9
Autonomic nervous system
Role of the nervous system in rapid control of arterial pressure
Special features of nervous control of arterial pressure
Further readings
44. Long-term regulation of
arterial blood pressure PY5.8, 5.9
Quantification of pressure diuresis as a basis for arterial pressure control
The renin–angiotensin system: Its role in arterial pressure control
Further readings
45. Local and humoral control of blood flow
Variations in blood flow in different tissues and organs PY5.8. 5.10
Mechanisms of blood flow control
Humoral control of the circulation
Further readings
46. Coronary circulation
Physiological anatomy of the
coronary blood supply PY5.10
Normal coronary blood flow averages 5% of cardiac output
Control of coronary blood flow
Special features of cardiac muscle metabolism
Ischemic heart disease
Causes of death after acute coronary occlusion
Stages of recovery from acute myocardial infarction
Function of the heart after recovery from myocardial infarction
Pain in coronary heart disease
Surgical treatment of coronary artery disease
Further readings
47. Cerebral circulation
Anatomy of cerebral blood flow
Regulation of cerebral
blood flow PY5.10
Cerebral microcirculation
“Cerebral stroke” occurs when cerebral blood vessels are blocked
Further readings
48. Splanchnic circulation
Anatomy of the gastrointestinal blood supply PY5.10
Effect of gut activity and metabolic factors on gastrointestinal blood flow
Nervous control of gastrointestinal blood flow.
Further readings
49. Fetal and neonatal circulation
Circulatory readjustments at birth PY5.10
Special functional problems in the circulation of the neonate
Abnormal circulatory dynamics in congenital heart defects
Further readings
50. Valvular heart disease
Causes of heart sounds
Valvular lesions
Abnormal circulatory dynamics
in valvular heart disease
PY5.11
Hypertrophy of the heart in valvular heart disease
Further readings
51. Cardiac failure
Circulatory dynamics in cardiac
failure PY5.11
Unilateral left heart failure
Low-output cardiac failure cardiogenic shock
Edema in patients with cardiac failure
Cardiac reserve
Further readings
52. Circulatory shock
Physiological causes of shock PY5.11
Causes of shock
Physiology of treatment in shock
Circulatory arrest
Further readings
SECTION V. Respiratory
Physiology
53. Organization of the respiratory system
Anatomical organization of the lungs and airways PY6.1
Physical laws applicable in respiratory physiology
Nonrespiratory functions of the lungs
Further readings
54. Mechanics of breathing
Mechanics of pulmonary ventilation PY6.2
Minute respiratory volume
Alveolar ventilation
Further readings
55. Lung volumes and capacities
Lung function tests PY6.7
Pulmonary volumes and
capacities PY6.2
Mucus lining the respiratory passageways, and cilia action to clear the passageways
Flow–volume curves
Further readings
56. Ventilation
Minute respiratory volume (minute ventilation)
Alveolar ventilation PY6.2
Maximum voluntary ventilation
Breathing reserve
Gas pressures in a mixture of gases ”partial pressures” of individual gases
Pressures of gases dissolved in water and tissues
Relationship between alveolar ventilation and partial pressures of oxygen and carbon dioxide
Causes of hypoventilation and hyperventilation
Further readings
57. Pulmonary circulation
Physiological anatomy of the pulmonary circulatory system
PY6.1
Pressures in the pulmonary system
Pulmonary vascular resistance
Blood volume of the lungs
Blood flow through the lungs and its distribution
Effect of hydrostatic pressure gradients in the lungs on regional pulmonary blood flow
Pulmonary capillary dynamics
Further readings
58. Diffusion of gases
Physics of gas diffusion and gas partial pressures
Diffusion of gases through the respiratory membrane PY6.2
Diffusion and perfusion limitations of gas transfer
Further readings
59. Oxygen transport
Compositions of alveolar air and atmospheric air are different
Methods of oxygen transport PY6.3
Hypoxia and oxygen therapy PY6.6, 6.5
Further readings
60. Carbon dioxide transport
Transport of CO2 in the blood PY6.3
Respiratory exchange ratio
Further readings
61. Chemical regulation of respiration
Chemical control of respiration PY6.3
Peripheral chemoreceptor system role of oxygen in respiratory control
Regulation of respiration during exercise
Further readings
62. Neural regulation of respiration
Respiratory center PY6.3
Other factors that affect
respiration PY6.6
Further readings
63. Respiration in unusual environments
Effects of low oxygen pressure
on the body PY6.4
Physiology of deep-sea diving and other hyperbaric conditions
PY6.4
Changes that occur with
deep-sea diving PY6.5
Self-contained underwater breathing apparatus (SCUBA) diving
Further readings
64. Applied respiratory physiology
Respiratory disorders PY6.6
Hypercapnia excess carbon dioxide in the body fluids PY6.6
Artificial respiration PY6.5
Oxygen therapy
Hyperbaric oxygen therapy
Further readings
