PHYSIOLOGY nee made Stephen Goldberg, M.D. McGRAW-HILL INTERNATIONAL EDITIONS Medical SeriesCONTENTS Preface... PART I: CARDIO-PULMONARY- RENAL-ELECTROLYTE- ACID-BASE-BALANCE CHAPTER 1. CELL FUNCTION CHAPTER 2. BLOOD PRESSURE ....... CHAPTER 8. ELECTROLYTES AND ACID-BASE METABOLISM. CHAPTER 4, EVALUATION OF RENAL FUNCTION . CHAPTER 5. CARDIAC FUNCTION ..... CHAPTER 6. THE RESPIRATORY SYSTEM. PART II: EVERYTHING ELSE CHAPTER 7, RED BLOOD CELLS AND BLOOD COAGULATION CHAPTER 8, THE IMMUNE SYSTEM... CHAPTER 9, NEUROPHYSIOLOGY .. CHAPTER 10 THE DIGESTIVE SYSTEM... CHAPTER 11 THE ENDOCRINE SYSTEM. ..PART I CARDIO-PULMONARY-RENAL- ELECTROLYTE-ACID-BASE-BALANCE CHAPTER 1. CELL FUNCTION Certain functions occur in all cells, whereas others oc- cur only in specialized cells in particular organs. Fig. 1-1. The intracellular localization of biochemical reactions, mtegoneeres, Sa sera ono moran or fo) Ee Er Re . The organ localization of some key biochemi- cal reactions, ‘The cell membrane accounts for some of the major dif- ferences between cells. Many cells contain specialized cell surface receptors that enable selective recognition of those cells by hormones and other cells, For instance, thyroid stimulating hormone (TSH) affects thyroid cells, because thyroid cells contain receptors for TSH, A very important part of cell function that relates to cell physiology is the mechanism that controls the entry into cells of simple molecules, like sodium and potas: sium ions. If such molecules entered cells only by sim: ple diffusion, then the intra-and extracellular milieu ‘would contain the same concentrations of these mole- cules, whereas radically different intra- and extracellu- lar concentrations are necessary for life. Fig. 13. The major mechanisms of transport of chem- icals across cell membranes: 1) Simple diffusion along the molecule's electro- chemical concentration gradient. That is, molecules tend to move from a zone in which their concentration is higher toa zone in which their concentration is lower. Similar reasoning applies when there is a charge im balance between two zones, in which case an ion will tend to move s0 as to equalize the charges. Increased pressure on the molecules that are to diffuse across a membrane will also increase the tendency to diffuse, by increasing the concentration and/or the kinetic energy of the diffusing molecule. Simple diffusion, however, depends in large part on the permeability of the membrane across which the mol- ecules diffuse, Regardless of the electrochemical gradi- ent, diffusion will not occur if the membrane is nonpermeable to the molecule in question. Lipid-soluble (nonpolar) substances more readily diffuse aeross cell plasma membranes, whereas polar substances diffuse more readily through water-filled channels (e.g. Na+ ‘and K+ channels) within the plasma membrane. 2) Simple facilitated diffusion. The molecule moves along its electrochemical concentration gradient, but it is attached to some other “carrier” protein mole- cule that facilitates its passage. For instance, a polar molecule may have difficulty passing through a lipid cell membrane, but it will do so more readily if attached to another molecule that passes easily. Whereas simple diffusion inereases in proportion to the concentration of the diffusing molecule, simple facilitated diffusion reaches a maximum that depends on the concentration of the carrier molecule. Simple facilitated diffusion does not move against an electrochemical gradient, and no special energy input is necessary to drive it. (The process of simple facilitated diffusion does, however, re- lease energy, which may dissipate as heat or be used for other purposes.) 3) Primary active transport. The molecule moves, against its electrochemical concentration gradient, and the energy supplied for this comes from ATP, which is the “energy curreney” of the body. For instance, the pumping of sodium against its gradient, out of a renal tubular cell and into the peritubular capillaries, re- quires a Na/K ATPase, an enzyme that converts ATP to ADP to release energy. 4) Secondary active transport. As in primary ac- tive transport, the molecule moves against its electro-