Textbook of Medical Physiology (second revised edition)

Textbook of Medical Physiologyby A.P. Krishna (Author)

The author has a vast teaching experience of three decades. He taught physiology to various groups of students like MBBS, BDS, B.Sc. Nursing, BPT, B. Pharm. and other related courses. This book in its second edition is especially prepared for MBBS students with simple and easy to understand language.

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For current medical students, this is a great way to reinforce the material you are learning and another incentive to know the information well. For professionals in the field, this is an opportunity to stay up to date with the most current research and data. Medical Physiology hopes to accomplish the first in what are many other books in the basic sciences to allow greater access to those in the field of medicine and those who wish to understand these topics at a greater level. All the chapters of the book have been discussed in detail that students can grasp the matter easily.

Chapter 1
Introduction and General Physiology 1—16 Introduction to Physiology 1–6 Homeostasis—Definition, Negative and Positive feedback mechanisms Cell Physiology—Structure and functions of cellular organelles 6–10 Junctional complexes Cellular receptors, intercellular and intracellular communication Transport across cell membrane—Active and Passive transport 11–16 Vesicular transport process Resting membrane potential, Action potential—Phases, Ionic basis, Properties Osmolarity, Osmolality, Nernst equation, Gibbs-Donnan membrane equilibrium Dehydration, Overhydration, Apoptosis 16

Chapter 2
Blood and Body Fluids 17—70 Introduction—Properties, composition and functions of blood 19–22 Plasma Proteins—Types, plasma level, functions 22–23 Red Blood Cells: Morphology, normal count, physiological variation, and functions 23–27 Erythropoiesis: Definition, sites, hemopoietic stem cells, stages of erythropoiesis Factors influencing erythropoiesis Regulation of erythropoiesis—erythropoietin and other hemopoietic factors Hemoglobin: Normal level, Physiological variations 27–30 Structure, Types, Compounds of hemoglobin, Fate of Hb White Blood Cells: Classification of WBC, normal values, morphology,
functions, variations 30–36 Leukopoiesis, Leukaemia Platelet: Platelet structure, normal value, production, functions 36–42 Purpura and Bleeding Time Hemostasis: Major steps—Primary and Secondary, Coagulation factors Extrinsic and intrinsic mechanisms of coagulation Physiological mechanisms preventing intravascular coagulation— Endogenous anticoagulant systems 43–47 Endogenous fibrinolytic systems, Intravascular blood coagulation, Disseminated Intravascular coagulation Anticoagulants—Types, mechanism of action and uses Bleeding and Clotting disorders—von Willebrand disease, Hemophilia, Vitamin K deficiency Clotting time, Bleeding time, Prothrombin time Blood Group: Physiological basis for blood groups 47–53 The ABO system The Rh system—Hemolytic Disease of Newborn (HDN) Other minor blood group systems x Contents Blood transfusion: Indications, collection, precautions to be taken – cross matching, screening for infections, Consequences of mismatched transfusion, Hazards of blood transfusion, Blood bank Significance of blood grouping, Coomb’s test Anemia: Definition, etiological and morphological classification 53–65 Effects of anemia on physiological systems, Signs and symptoms Common types of anemia—Iron deficiency anemia, pernicious anemia, sickle cell anemia, and thalassemia—their causes and salient features Polycythemia—Primary and secondary, physiological effects ESR, PCV, Blood Indices, Osmotic fragility Blood volume: Normal value, physiological variation, principles of measurement, regulation Body Fluids and Compartments Distribution of Total Body Water (TBW) Principles of measurement of body fluids Reticulo endothelial system 65–70 Odema
Immunity: Definition and types of immunity Mechanisms (i) Cell mediated immunity (ii) Humoral immunity Physiological basis of immunization Autoimmune disease, AIDS, Graft rejection

Chapter 3
Cardio Vascular System 71—119 Physiological anatomy of heart 73–77 Greater and lesser circulation Structure and properties of cardiac muscle Functional tissues of heart—Origin and spread of cardiac impulses 77–80 Heart block Cardiac cycle—Definition, mechanical events during different phases of systole and diastole 80–83 Pressure volume changes inside heart chambers and aorta Innervation of heart 83–84 Heart Rate—Normal value, physiological variation, Regulation of heart rate 84–87 Cardiac output—Definition, normal values, Physiological variation, factors affecting, cardiac index, 87–89 cardiac reserve Regulation of cardiac output Principles of measurement of cardiac output Electrocardiogram—Principles of electrocardiography, Normal ECG 89–91 Characteristics of waves, Einthoven’s triangle and law Significance of ECG Heart sounds—Causes, characteristics, significance, phonocardiogram, Murmurs 91–93 Blood Pressure—Arterial blood pressure—Definition, normal values, physiological variations, 93–103 factors affecting Regulation of BP, Measurement of BP Hypertension and Hypotension
Arterial pulse, venous pulse, triple response, circulation time, apex beat, Central venous pressure 103–107 Contents xi Haemodynamics—Peripheral resistance, blood viscosity, laminar blood flow, turbulent blood flow, 107–109 velocity of blood flow Poiseuille’s Law Microcirculation—Capillary circulation, Starling forces Local and humoral control of blood flow—Autoregulation of blood flow and hyperemia Regional circulation—Coronary circulation and coronary artery disease, pulmonary, splanchnic, 109–111 cutaneous, cerebral and foetal circulation Circulatory shock and Syncope 112–117 Cardiac failure, Cardiopulmonary resuscitation (CPR) Cardio vascular changes during exercise and effect of gravity on CVS, Echocardiography, Cardiac arrythmia Lymphatic system: Lymph-, formation, composition, circulation and functions, lymphatic organs, 117–119 Disorders of lymphatic obstruction

Chapter 4
Respiratory System 121—154 Functional anatomy, Functions of respiratory system—Respiratory and non respiratory functions 123–125 Physiological anatomy Respiratory membrane Mechanism of breathing—Respiratory muscles and their action 125–128 Intrapleural and intrapulmonary pressure changes during respiratory cycle, Forces acting on respiratory membrane Pressure—Volume relationships 128–130 Compliance—chest and lungs, values, total compliance Surfactant, Hyaline membrane disease Spirometry—Lung volumes and lung capacities, Normal values, significance 130–137 Vital capacity and timed vital capacity—factors affecting and
significance of vital capacity Minute repiratory volume Maximum Voluntary Ventilation Breathing Reserve Respiratory dead space-Anatomical and physiological—Defintion and normal value Principle of measurement Pulmonory ventilation and alveolar ventiliation Ventilation purfusion ratio Airway resistance Pulmonary gas exchange—Composition of inspired air, expired air, Partial pressures Factors affecting gas exchange across the respiratory membrane Transportation of oxygen in the blood 137–140 Oxygen-Hb dissociation curve Transportation of carbondioxide in the blood Chloride shift, Haldane effect Respiratory Quotient Regulation of Respiration – Neural Regulation – Respiratory centres 141–142 Hering-Bruer’s Inflation and deflation reflexes Chemical regulation of respiration Peripheral and central chemoreceptors 142–145 Effect of H+ conc, PCO2 and PO2 on respiration Hypoxia—Types and effects 145–151 Cyanosis, Asphyxia, Dyspnoea, Periodic breathing, Acclimitization to high altitude, mountain sickness Dysbarism Asthma, Emphysema, Apnoea, Periodic Breathing xii Contents Artificial respiration—Manual methods 151–154 Holger-Neilson method and mouth to mouth breathing Respiratory changes during exercise

Chapter 5
Excretory System 155—182 Kidney: Functional anatomy Functions of kidney, types of nephrons 157–162 Renal blood flow and its peculiarities Juxta Glomerular Apparatus
Mechanism of urine formation, Glomerular filtration—GFR 162–165 Mechanism, factors affecting and measurement Tubular reabsorption—Sodium, water and glucose—Tmg and renal threshold Tubular secretion of H+ Mechanism of concentration of urine – Counter current mechanism 165–166 Role of urea, action of ADH Micturition—Innervation of bladder, Cystometrogram 166–170 Micturition reflex, abnormalities of micturition Properties and composition of normal urine 170–171 Abnormal constituents of urine Non excretory functions of Kidneys 171–178 Acid base balance Regulation of plasma osmalality, ECF volume Endocrine functions Hormones acting on kidneys Renal Function Tests—Clearance tests 178–179 Diuresis Applied aspects—Renal failure, Artificial kidney, Nephrotic syndrome 179– 182 Skin & its Appendages—Structure and function

Chapter 6
Digestive System 183—214 Introduction, functional anatomy of gastro intestinal tract and its innervations 185–187 Secretory functions of GIT Saliva-properties, composition 188–190 Functions and regulation of secretion and applied aspects Stomach- functional anatomy 190–194 Gastric juice—properties, composition, functions, mechanisms and regulation of secretion, Experimental evidences of gastric secretion (Sham feeding and Pavlov’s pouch) Applied aspects—Gastritis, Peptic ulcer, Zollinger-Ellison Syndrome Exocrine Pancreas—Pancreatic juice—properties, composition, functions and regulation of secretion 195–196 Applied aspects—Pancreatitis Liver—Functions of liver 196–199 Bile—composition, functions and
regulation of secretion Functions of Gall bladder Enterohepatic circulation—Gall stones Contents xiii Small intestine—Functional anatomy—Succus entericus—properties, composition, functions and 199–201 regulation of secretion Functions of large intestine Applied aspects Motor functions of GIT Mastication, Deglutition—stages—Achalasia 201–207 Gastric emptying, Movements of stomach, Vomiting Small intestine—movements Large intestine—functions and movements, Defecation Applied aspects—Diarrhea, Constipation Jaundice, appendicitis, Steatorrhea, Irritable bowel syndrome (IBS) Inflammatory bowel disease 207–210 (IBD), Hirschpurng’s disease, Gastro Esophageal Reflux Disorder (GERD) Digestion and absorption of Carbohydrates, Proteins and Lipids 210–214 Applied aspects—Malabsoption syndrome Dietary fibres

Chapter 7
Endocrine System 215—271 Introduction—Types of chemical messengers General properties of hormones 217–221 Classification of hormones and mechanism of action Major endocrine glands Anterior Pituitary—Hypothalamic control of pituitary secretion 221–227 Physiological functions of growth hormone (GH), role of somatomedians on growth, regulation of GH secretion Abnormalities of GH secretion—Dwarfism, gigantism, acromegaly Functions and regulation of secretion of prolactin, TSH, ACTH, Gonadotropins
Posterior Pituitary 227–230 Antidiuretic hormone—Function and regulation of secretion Diabetes insipidus and SIADH Oxytocin—Functions and regulation of secretion Thyroid gland—Synthesis, secretion, functions and regulation of secretion of thyroid hormones 230–237 Disorders of thyroid—Goitre, Cretinism, Myxoedema, Grave’s disease, Thyroid function tests, Antithyroid substances Adrenal Cortex Synthesis and secretion of adrenocortical hormones, Functions of the mineralocorticoids-aldosterone 237–245 Regulation of secretion of aldosterone Conn’s syndrome Functions and regulation of secretion of glucocorticoids—cortisol, disordersAddison’s disease, Cushing’s syndrome Adrenal androgens Adrenogential syndrome Adrenal medulla—Biosyntheis of catecholamines Functions of adrenal medullary hormones Alarm reaction, Pheochromocytoma Endocrine Pancreas—Physiological functions of insulin 246–255 Mechanism of action—Insulin receptors Regulation of insulin secretion Diabetes mellitus—types and pathophysiology Glucagon—Functions and regulation of secretion Somatostatin—Pancreatic polypeptide Hormonal regulation of blood glucose Hypoglycemia Parathyroid Gland—functions and regulation of secretion of PTH 255–261 Actions of PTH on regulation of plasma calcium and phosphate concentration, Tetany Calcitonin—Functions and regulation of secretion Calcium metabolism—Hormonal regulation of plasma calcium level Other endocrine glands—Pineal gland, thymus 261–264 Local hormones— Histamine, Serotonin, Prostaglandins, Acetyl choline, Bradykinin
GIT hormones Growth, development and ageing 265–271

Chapter 8
Nervous System 273—357 Organization and overview of functions of Nervous system 275–277 Neuron —Structure, classification and properties 277–278 Resting membrane potential, Action potential, strength-duration curve Nervefibre—Classification, conduction of impulses in myelinated & nonmyelinated nerve fibers 279–280 Velocity of conduction of nerve impulse Degeneration and regeneration of nervefibre, Neurotrophins 281–283 Neuroglia—Types and functions Sensory Receptors—Definition, Classification and Properties 283–285 Synapse—Structure, transmission, properties, synaptic inhibition Neurotransmitters – Definition, 285–291 types and examples Organization of spinal cord 291–293 Reflex Action, Reflex arc, Classification of reflexes 293–299 Properties of reflexes Ascending Tracts—Sensory pathways—Dorsal column, lateral column 299– 304 (Name of important tracts, explanation of lateral spinothalamic tract) Anterior column Pathway for fine touch, crude touch, pressure pain, and temperature Physiology of Pain—Definition of pain, Pain receptors, Classification of pain 304–309 Pain pathways—fast and slow Modulation of pain at spinal cord level Central pain analgesic mechanisms Referred pain, Phantom pain, Projected pain, analgesia Principles of pain management Descending tracts—Pyramidal and extra pyramidal pathways Origin, course, termination and functions 309–316 Upper motor neuron lesion and lower motor neuron lesion Lesions of spinal cord—Complete and Hemisection of spinal cord Gross structure and functions of—Medula and Pons 316–317 Cerebellum—Structure, connections and functions 317–322 Cerebellar
disorders Posture and equilibrium, muscle spindle and postural reflexes Decerebrate rigidity Contents xv Hypothalamus—Structure, connections and functions 322–329 Thalamus— Structure, connections and functions 329–331 Thalamic syndrome Basal ganglia—Connections and functions 331–334 Disorders— Parkinsonism, Wilson’s disease, Chorea Reticular formation 334–335 Cerebral cortex, cytoarchitecture,lobes and functions Dominant hemisphere, Disorders-Cerebral 335–340 palcy, Plegia, Epilepsy Limbic system, organization, connections and functions Disorders 340–342 Electroencephalogram: EEG pattern, Clinical uses of EEG 342–343 Cerebrospinal fluid, Formation, circulation, composition and functions, Hydrocephalus-lumbar 343–346 puncture Blood Brain Barrier Physiology of Sleep 346–350 Speech and speech disorders Learning & Memory—Definition, types of memory 350–352 Biochemical and physiological basis of memory Amnesia, Alzheimer’s disease Autonomic Nervous System , Organization and functions 352–355 Cranial nerves 356–357

Chapter 9
Special Senses 359—384 Vision—Functional anatomy Structure of retina Rods and cones 361–363 Mechanism of formation of image—Basic optics 363 Mechanism of processing of image—Phototransduction 363–365 Refractive errors with correction Aqueous humour, Vitreous humour, Intraoccular pressure 366 Pupillary reflexes with pathways—Light reflexes and Accommodation reflex
Argyl Robertsons 366–372 Pupil Strabismus or squint Movements of eye Physiology of color vision and color blindness Visual-Adaptation—light and dark, Cateract, Critical Fusion Frequency Visual pathway with lesions at various levels, Visual acuity and Field of vision 372–375 Audition—Structure and function of external and middle ear 375–376 Structure of organ of Corti, Cochlear fluids, Cochlear potential Mechanism of hearing, Activation of hair cell, Auditory pathway, Electrical potentials from cochlea, 376–377 Theories of hearing Frequency and intensity discrimination Auditory pathway 377–379 Applied aspect: Hearing tests, Deafness, Audiometry Vestibular apparatus: functions 379–381 Olfaction—Olfactory receptors, mechanism of stimulation, Olfactory pathway 381–384 Gustation—Modalities of taste, Taste buds Mechanism of stimulation and taste pathway

Chapter 10
Muscle Physiology and Exercise Physiology 385—408 Muscle—Types 387–391 Comparison between skeletal, cardiac and smooth muscles, Motor unit Physiological anatomy of skeletal muscle, sarcomere, contractile muscle proteins, Sarcoplasmic reticulum Properties of skeletal muscle Neuromuscular junction—Structure, neuromuscular transmission, Neuromuscular blockers, 391–398 Myasthenia gravis Excitation contraction coupling, molecular basis of muscle contraction Experiments on properties of muscles Chemical changes during contraction Types of contraction—isometric and isotonic, Fast and slow muscle Muscle dystrophy, rigor mortis Smooth muscle—structure, types and functions, Mechanism of smooth muscle contraction 398–399
Exercise Physiology—Isotonic and isometric exercise, gradation of exercise 400–401 Changes during exercise—Cardiovascular, respiratory, metabolic, endocrine and nervous 401–406 Effect of training on muscular performance, health benefits of exercise 406– 408

Chapter 11
Reproductive System 409—440 Introduction 411–412 Puberty—Pubertal changes in male and female Male reproductive system—Functional anatomy 412–417 Spermatogenesis— steps and factors influencing Abnormal spermatogenesis, semen, Sertoli cells Functions and regulation of secretion of testosterone Cryptorchidism, Hypogonadism Infertility Female reproductive system—Functional anatomy 417–425 Oogenesis- steps and factors influencing Menstrual cycle—Ovarian and uterine changes Tests for ovulation Hormonal control of menstrual cycle Female sex hormones, oestrogen, progesterone, relaxin Physiology of pregnancy—Fertilization, implantation 425–432 Placenta, hormones of placenta and functions Pregnancy diagnostic tests Maternal changes during pregnancy Parturition: initiation and onset of labor Lactation—Role of estrogen and progesterone in development of breast Role of prolactin and oxytocin in milk ejection process Menopause Family planning, Physiology of contraception—Physiological basis of different methods of 432–435 contraception in males and females Sex determination, Sex differentiation 435–439 Chromosomal aberrations of sexual development
Question Bank 441–454
Bibliography 455
Index 457

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