Preface to the first edition In the modern world, visual pathways have A book of this nature is inevitably deriva- utdistanced other avenues for informational tive, but many of the representations are new aput. This book takes advantage of the eco and, we hope, innovative. A number of people my of visual representation to indicate the si- have contributed directly and indirectly to the lultaneity and multiplicity of physiological completion of this volume, but none more phenomena. Although some subjects lend than Sarah Jones, who gave much more than hemselves more readily than others to this editorial assistance. Acknowledgement criticism and advice is due also to drs overage of the key elements of physiology has R Greger, A. Ratner, J. Weiss, and S. Wood, and Prof. H Seller. We are grateful to Joy wieser for Clearly, this book of little more than 300 her help in checking the proofs. Wolf-Ruidige ges, only half of which are textual, cannot be and Barbara Gay are especially recognized, not considered as a primary source for the serious only for their art work, but for their conceptu udent of physiology. Nevertheless, it does contributions as well. The publishers, ontain most of the basic principles and facts Thieme Verlag and Deutscher Taschenbuch taught in a medical school introductory Verlag, contributed valuable assistance based urse. Each unit of text and illustration can on extensive experience: an author could wish serve initially as an overview for introduction for no better relationship. Finally, special to the subject and subsequently as a concise recognition to Dr Walter Kumpmann for in- eview of the material. The contents are as cur- spiring the project and for his unquestioning nt as the publishing art permits and include confidence in the authors. both classical information for the beginning as recent details and trends Basel and Innsbruck, Summer 1979 or the advanced
VI Preface to the First Edition In the modern world, visual pathways have outdistanced other avenues for informational input. This book takes advantage of the economy of visual representation to indicate the simultaneity and multiplicity of physiological phenomena. Although some subjects lend themselves more readily than others to this treatment, inclusive rather than selective coverage of the key elements of physiology has been attempted. Clearly, this book of little more than 300 pages, only half of which are textual, cannot be considered as a primary source for the serious student of physiology. Nevertheless, it does contain most of the basic principles and facts taught in a medical school introductory course. Each unit of text and illustration can serve initially as an overview for introduction to the subject and subsequently as a concise review of the material. The contents are as current as the publishing art permits and include both classical information for the beginning students as well as recent details and trends for the advanced student. A book of this nature is inevitably derivative, but many of the representations are new and, we hope, innovative. A number of people have contributed directly and indirectly to the completion of this volume, but none more than Sarah Jones, who gave much more than editorial assistance. Acknowledgement of helpful criticism and advice is due also to Drs. R. Greger, A. Ratner, J. Weiss, and S. Wood, and Prof. H. Seller. We are grateful to Joy Wieser for her help in checking the proofs. Wolf-Rüdiger and Barbara Gay are especially recognized, not only for their art work, but for their conceptual contributions as well. The publishers, Georg Thieme Verlag and Deutscher Taschenbuch Verlag, contributed valuable assistance based on extensive experience; an author could wish for no better relationship. Finally, special recognition to Dr. Walter Kumpmann for inspiring the project and for his unquestioning confidence in the authors. Basel and Innsbruck, Summer 1979 Agamemnon Despopoulos Stefan Silbernagl
VIl From the preface to the third edition The first German edition of this book was al- Their intention was to cross the atlantic in their sailing boat. This was the last that wa ever heard of them and we have had to aban- Without the creative enthusiasm of Aga- menon Despopoulos, it is doubtful whether this book would have been possible; without his personal support it has not been easy to continue with the project. whilst keeping in mind our original aims, I have completely re vised the book, incorporating the latest adval in the field of physiology as well as the wel- edition, to whom I extend my thanks for their active interest in New York: Professor of Physiology at the buquerque, USA, until 1971: Wurzburg, Fall 1985 scientific adviser to CIBA-GEIGY. Basel
VII From the Preface to the Third Edition The first German edition of this book was already in press when, on November 2nd, 1979, Agamennon Despopoulos and his wife, Sarah Jones-Despopoulos put to sea from Bizerta, Tunisia. Their intention was to cross the Atlantic in their sailing boat. This was the last that was ever heard of them and we have had to abandon all hope of seeing them again. Without the creative enthusiasm of Agamennon Despopoulos, it is doubtful whether this book would have been possible; without his personal support it has not been easy to continue with the project. Whilst keeping in mind our original aims, I have completely revised the book, incorporating the latest advances in the field of physiology as well as the welcome suggestions provided by readers of the earlier edition, to whom I extend my thanks for their active interest. Würzburg, Fall 1985 Stefan Silbernagl Dr. Agamemnon Despopoulos Born 1924 in New York; Professor of Physiology at the University of New Mexico. Albuquerque, USA, until 1971; thereafter scientific adviser to CIBA-GEIGY, Basel
Table of contents 1 Fundamentals and Cell Physiology The Body: an Open System with an Internal Environment ontrol and Regulation..4 Transport In, Through and Between Cells..16 Transport by Means of Diffu Osmosis Filtration and Convection.. 24 Active Transport…26 Electrical Membrane potentials and lon Channels. 3 tole of Ca2 in Cell Regulation..36 Energy Production and Metabolism.. 38 2 Nerve and Muscle, Physical Work Neuron Structure and Function .. 4 Resting Membrane potential .. 44 Action potential….46 Propagation of Action Potentials in Nerve Fiber..48 ficial Stimulation of Nerve Cells .. 50 Synaptic Transmission. 50 Motor end.- plate…56 Motility and Muscle Types..58 Motor unit of skeletal muscle .. 58 Contractile Apparatus of Striated Muscle..60 Contraction of Striated Muscle .. 62 Mechanical Features of skeletal muscle .. 66 Energy Supply for Muscle Contraction..7. Physical Fitness and Training..76 3 Autonomic Nervous System(ANS) Organization of the Autonomic Nervous System(ANS) Acetylcholine and Cholinergic Transmission..82 Catecholamines, Adrenergic Transmission and Adrenoceptors..84 Adrenal Medulla…86 lon-cholinergic, Non-adrenergic Transmitters..86 Composition and Function of Blood..88 Iron Metabolism and Erythropoiesis..90 Flow Properties of Blood..92 Plasma. lon Distribution
IX Table of Contents 1 Fundamentals and Cell Physiology 2 The Body: an Open System with an Internal Environment · · · 2 Control and Regulation · · · 4 The Cell · · · 8 Transport In, Through and Between Cells · · · 16 Passive Transport by Means of Diffusion · · · 20 Osmosis, Filtration and Convection · · · 24 Active Transport · · · 26 Cell Migration · · · 30 Electrical Membrane Potentials and Ion Channels · · · 32 Role of Ca2+ in Cell Regulation · · · 36 Energy Production and Metabolism · · · 38 2 Nerve and Muscle, Physical Work 42 Neuron Structure and Function · · · 42 Resting Membrane Potential · · · 44 Action Potential · · · 46 Propagation of Action Potentials in Nerve Fiber · · · 48 Artificial Stimulation of Nerve Cells · · · 50 Synaptic Transmission · · · 50 Motor End-plate · · · 56 Motility and Muscle Types · · · 58 Motor Unit of Skeletal Muscle · · · 58 Contractile Apparatus of Striated Muscle · · · 60 Contraction of Striated Muscle · · · 62 Mechanical Features of Skeletal Muscle · · · 66 Smooth Muscle · · · 70 Energy Supply for Muscle Contraction · · · 72 Physical Work · · · 74 Physical Fitness and Training · · · 76 3 Autonomic Nervous System (ANS) 78 Organization of the Autonomic Nervous System (ANS) · · · 78 Acetylcholines and Cholinergic Transmission · · · 82 Catecholamines, Adrenergic Transmission and Adrenoceptors · · · 84 Adrenal Medulla · · · 86 Non-cholinergic, Non-adrenergic Transmitters · · · 86 4 Blood 88 Composition and Function of Blood · · · 88 Iron Metabolism and Erythropoiesis · · · 90 Flow Properties of Blood · · · 92 Plasma, Ion Distribution · · · 92
able of contents Immune Systen…94 Hypersensitivity Reactions(Allergies)..100 Fibrinolysis and Thromboprotection.. 104 Purification of Respiratory Air... 110 Artificial Respiration.. 110 Lung volumes and their Measurement.. 112 Dead Space, Residual Volume, Airway Resistance.. 114 Dynamic Lung Function Tests.. 118 ulmonary Gas Exchange Pulmonary Blood Flow, Ventilation-Perfusion Ratio.. 122 Blood, cO in CSF CO2 in Cerebrospinal Fluid ternal(Tissue)Respiration, Hypoxia.. 130 spiratory Control and Stimulation..132 Effects of Diving on Respiration.. 134 Effects of High Altitude on Respiration.. 136 gen Toxicity…136 pH, pH Buffers, Acid-E lance……138 Acidosis and alkalosis Assessment of Acid-Base Status . 146 7 Kidneys, Salt, and Water Balance Kidney Structure and Function..148 Glomerular Filtration and Clearance .. 152 Transport Processes at the Nephron.. 154 Reabsorption of Organic Substances..158 Reabsorption of Na* and CI-..162 Reabsorption of Water, Formation of Concentrated Urine.. 164 is…168 alt and Water 170 Diuresis and Diuretics The Kidney and Acid-Base Balance..176
X Immune System · · · 94 Hypersensitivity Reactions (Allergies) · · · 100 Blood Groups · · · 100 Hemostasis · · · 102 Fibrinolysis and Thromboprotection · · · 104 5 Respiration 106 Lung Function, Respiration · · · 106 Mechanics of Breathing · · · 108 Purification of Respiratory Air · · · 110 Artificial Respiration · · · 110 Pneumothorax · · · 110 Lung Volumes and their Measurement · · · 112 Dead Space, Residual Volume, Airway Resistance · · · 114 Pressure–Volume Curve, Respiratory Work · · · 116 Surface Tension, Surfactant · · · 118 Dynamic Lung Function Tests · · · 118 Pulmonary Gas Exchange · · · 120 Pulmonary Blood Flow, Ventilation–Perfusion Ratio · · · 122 CO2 Transport in Blood · · · 124 CO2 Binding in Blood, CO2 in CSF · · · 126 CO2 in Cerebrospinal Fluid · · · 126 Binding and Transport of O2 in Blood · · · 128 Internal (Tissue) Respiration, Hypoxia · · · 130 Respiratory Control and Stimulation · · · 132 Effects of Diving on Respiration · · · 134 Effects of High Altitude on Respiration · · · 136 Oxygen Toxicity · · · 136 6 Acid–Base Homeostasis 138 pH, pH Buffers, Acid–Base Balance · · · 138 Bicarbonate/Carbon Dioxide Buffer · · · 140 Acidosis and Alkalosis · · · 142 Assessment of Acid–Base Status · · · 146 7 Kidneys, Salt, and Water Balance 148 Kidney Structure and Function · · · 148 Renal Circulation · · · 150 Glomerular Filtration and Clearance · · · 152 Transport Processes at the Nephron · · · 154 Reabsorption of Organic Substances · · · 158 Excretion of Organic Substances · · · 160 Reabsorption of Na+ and Cl– ··· 162 Reabsorption of Water, Formation of Concentrated Urine · · · 164 Body Fluid Homeostasis · · · 168 Salt and Water Regulation · · · 170 Diuresis and Diuretics · · · 174 The Kidney and Acid–Base Balance · · · 176 Table of Contents
Table of cont on of Phosphate, Ca2 and Mg2+ Potassium balance…182 Tubuloglomerular Feedback, Renin-Angiotensin System.. 186 8 Cardiovascul 188 Overview…188 Blood Vessels and Blood Flow .. 190 Excitation in Electrolyte Disturbances..200 cardiac Arrhythmia Ventricular Pressure-Volume Relationships..204 Cardiac Work and Cardiac Power. 204 Arterial Blood pressure .. 208 Endothelial Exchange Processes.. 210 212 regulation of the Circulation.. 214 Fetal and Neonatal Circulation .. 222 9 Thermal Balance and Thermoregulation Thermal Balance…224 2 10 Nutrition and Digestion Nutrition Energy Metabolism and Calorimetry..230 Energy Homeostasis and body Weight.. 232 astrointestinal (Gl)Tract: Overview, Immune Defense, Blood Flow..234 eural and Hormonal Integration..236 Saliva ., 238 Deglutition…240 Vomiting…240 Stomach Structure and Motility ... Small Intestinal Function .. 246 Pancreas . 248 Excretory Liver Function, Bilirubin..252 Lipid Digestion…254 Lipid Distribution and Storag 256 Digestion and Absorption of Carbohydrates and Protein..260 Vitamin Absorption.. 262 Vater and Mineral Absorption..264 Large Intestine, Defecation, Feces..266
XI Reabsorption and Excretion of Phosphate, Ca2+ and Mg2+ ··· 180 Potassium Balance · · · 182 Tubuloglomerular Feedback, Renin–Angiotensin System · · · 186 8 Cardiovascular System 188 Overview · · · 188 Blood Vessels and Blood Flow · · · 190 Cardiac Cycle · · · 192 Cardiac Impulse Generation and Conduction · · · 194 Electrocardiogram (ECG) · · · 198 Excitation in Electrolyte Disturbances · · · 200 Cardiac Arrhythmias · · · 202 Ventricular Pressure–Volume Relationships · · · 204 Cardiac Work and Cardiac Power · · · 204 Regulation of Stroke Volume · · · 206 Venous Return · · · 206 Arterial Blood Pressure · · · 208 Endothelial Exchange Processes · · · 210 Myocardial Oxygen Supply · · · 212 Regulation of the Circulation · · · 214 Circulatory Shock · · · 220 Fetal and Neonatal Circulation · · · 222 9 Thermal Balance and Thermoregulation 224 Thermal Balance · · · 224 Thermoregulation · · · 226 10 Nutrition and Digestion 228 Nutrition · · · 228 Energy Metabolism and Calorimetry · · · 230 Energy Homeostasis and Body Weight · · · 232 Gastrointestinal (GI) Tract: Overview, Immune Defense, Blood Flow · · · 234 Neural and Hormonal Integration · · · 236 Saliva · · · 238 Deglutition · · · 240 Vomiting · · · 240 Stomach Structure and Motility · · · 242 Gastric Juice · · · 244 Small Intestinal Function · · · 246 Pancreas · · · 248 Bile · · · 250 Excretory Liver Function, Bilirubin · · · 252 Lipid Digestion · · · 254 Lipid Distribution and Storage · · · 256 Digestion and Absorption of Carbohydrates and Protein · · · 260 Vitamin Absorption · · · 262 Water and Mineral Absorption · · · 264 Large Intestine, Defecation, Feces · · · 266 Table of Contents