Essentials of

MEDICAL PHYSIOLOGY
Seventh Edition

K Sembulingam PiD
Madha Med €lCo ele & Research nstlule
KundralhurMainRoad,Kovur'lhandalEm
Chenna Tam Nad!, nda
Famedy al
MR [,led *l Kaaburaq Karnataka lndia
Col ege,
Sri Ramachandra Medcal Colegernd Research nstl!te, Chenna, Iami Nadu, nda
School of Heallr Sciences Universli Sans Maaysa, Keanlan Malaysia
Sr Lakshm Na6yana lnsttuteofMenica Sclences, Puducherry lnda
Sr Manaku a Vnryagar Medi.a coleqe.nd Hospiial, Pudu.herry lnd a

Shr Salhya Sa Medi.a Coleqo and Research lnsllute Nelikuppam, Tami Nadu, ndla
and

Prema Sembulingam P,D

Farnerly at
t',lR Medicatco ege, Kalab!ragi Karnataka, ndi€
sriRamachandra Mcdcalcolege a.d Researclr nstilule, chenna Tahl Nad!,lnda
Schoolof HealthScien.es UnvercllSansMaaysa,K€anlan,iralaysa
Sri Lakshmi NaEyana nstlule of Medcal Scen@s. Pudlcherry lndia
Sathyabama Unvercly DenlalColeg6 and Hospital, chenna Tami Nadu, nda
s Manakula viiayaoar IMed cal col eqe a.d Hospital, Pudlcherry lndia
Shri Salhya Sai M€d cal Col ege and Research nsttule, Nelikuppam Tami Nadu, ida
and
Madha M€d ca colege& Research lnslitute Chen.ai, Tam I Nadu lndia

,iftl
rEr
aM rhe Healrh Sciences Publisher
lPhiladelpha Panama
Contents

section 2- Blood and Bodv Fluids

:].:g! alrcn ol B ood

sE Flu'd a.d rd€a5 ... ... 157

Section 3 - Muscle
t Cl6dielion ot Muscles . . ... ..... . 165
Z grdue of Skelelal Musc e ...........167
,a48e.t6o1skeerdMusc] .......... .....................,.......174
a oEE6 o-'ng VuscJlar. onraclion . . ... ... .. ..
xviii

re
Essentials ol Medical PhyslolosY

oi Digestive Srslem .,...,,.,...... . 219

iecel]on...............................,, 223
rcreton,.,,,...,,.,,....................... 231
c S€cr61ion................................
Biliary System................,,,.,.... , ,, ., ,, ,, .,, .,249
and secellons of small lnlestl , ,, ,, ,, , ,. ',261
end Sec@uons of La€e lnl€sl . 266
ts of Gastroinlcstinal Tract....... . 270
:slinal Hormones....,,..,,.,,.........
, Ab$rption and Mstabollsm of . 249
, AbeDrion and MerabolBm ol
, AbsDlion and Melabolism ot

Section 5 Renal and Skin

303
Nephron

315
318
51 Concent:lbn ol Ur ne
52. Acid'base Balance... .. ... .. .. .. .. ... .. .. 334
... ... ...
Acidifcaton oflrine and RoleofKdneyinAcld-base Baanc€..... ....... ... .. .. .. .. ......341
54. Renz Fui.rdn Tesrs .. 344
55 Rena Fa LE
56 Micluriton .. .. .. .. .. .. .. . .351
D alysis and Artfc alKidney .. 358
53 360
,, ', 363
..369
Section 6 -
Endocrne Syslem.. . .. 379
Homones .. .. .. .. .. . .. .334
Piluilarycland.. ... . .. .. .. .. .. .. ..389
Thyrodcand .. .. .. ...403
65 Pa€thyroid c ands and Physlorogy of Bone.. 415
Endocrine Functions of Pancrea ..... .......... ..431
Adrenalcorl€x. ... ......... ..442
6S AdrenalMedlla 456
69 Endocrlne Funclions orolher Orlans 46r
 Section 7 -
(rareReprcductvesyslem... ....... '"473
72 semna vesicLes.. 446
Prostate G and .... ..437
Semen . .. . .. '439
FemaeReproduclvesystem. . ... . "' 442
ovary .. 495
Meistrua cyce .... - _' ' 501
ovu aton '512
79 Menopause . .. 514
30 lnfert lty ' 516
31. Pregna;cyandPanurion ''"'513
a2 Paceila .. 526
33. Pregnancy Tesls. '530
Mamma.ycandsandlactaton --. 533
Ferli tyconlrol.. .. .. .. .. . ' 536

se.tion 8 - Cardiovascu,ar
6v;toi;w or cardiovascular syslem. .. ... ''" s43
Properlesolca.dac Musce... .- -.. . 550
Carda.Cyce ..... ........ .. ..... . ' ""558
Hean Sounds .. .. .. . . ...... ... ........ 570
CardiacMumur. " " 575
Eecfocardogram (EcG) .. ...... ..... ... . "517
re(lo.--...585
:: Arhythma ..,... ... . . ""' 53S
Effect of Changes ln E e.trolyle Concenlraton on He.d . " 597
Cardiacoutput. ""' ' 599
Heart-ung Preparaton .. .. ... . . .. . . """' 609
cardacEunctoncuryes . ... .. "'611
HeanRale.... -"""614
Hemodynamcs .. . .. .. .. . " 621
Arter alBlood Pressure... ...... --^--""" 624
Venols B ood Pressure. '643
Caplary Bood Pressure .. '- ' " 647
AderiaLPulse... ....... ' '649
Venous Pulse .. . ... . ... ... . .. " " "' 654
: coroiary C rculalion .. . "657
Cereb€ Crcualion '"" "663
sp anchn c c rculauoi .. ...... .... .. ..
. .. .. .. 667
CapiaryCrculalon...... ----- -""" 66S
c rcu alion Through Ske elall,lusce .. ... " 673
110 Cutaneous Circu aiion .. .. ... ....... 675
]11 Feia circoation and Respiralion . .. .. ..67j
112 Hemorhase . 68.l
113CrculaloryshockandlleaftFalure.... ......... ...6a4
114 EfieclofExercseonCardovascuarSystem. .. ..... ... ..... 694
and EnvironmentalPhv
115. Ovetuiew of Respiralory Syslem . .. .. .. 703
116 P! monary C rculallon.. .709
117 rvlechan cs of R€spna on. .- ..713
113 Pumonary FuncloiTests ... .721
1]9 Venl ation:nd D€ad Spac 731
120 lnspredAr AlveolarArandExpredAr ._ _ _. .. __ . .. .. .T34
121 Exchange of Resp ratory G ..... ... .. .736
122 Transpon oi Resp ratory Gases __ .. .. .. . .... 742
123 Regulation of Resp raton 747
124. Ds6asesand oisorders ofRespraton ...... .._._._ _. .......754
125 HlhAitiludeand Space physoogy .. .. .. ......,.. Z6a
126. Deep Sea Physorogy.. .........774
127 Eflects ofExposureto Cold and Heal. .. .. 777
123 AnficialResp raton.. .......... 780
129 Eifects of Exerc se on Respi€lon .. .. .. -
Section 10 - Nervous
130 Ovetoiew olNeruous Syst .. .707
131. Neuron .. .. .. . .. .. .. . .. ... 790
]32. CrassricationorNerueFb ..... ... ..........Ts6
133 Propenes ol Netoe F berc ....... ....798
134 oegeneralon and Regeneration of NeNe Fibe6 ..802
135 Neurogla .. . .. .. . .. .. .. ..805
136 Receplors. .. . . .. .. .. .. , OOo
137. Synapse ... .... .. .. ..8i3
138 Neurotransmifte6 A2a
]39 ReiexActvity.. .. . _..... ......... ....A27
'140. Spina cord. ... .. .. .. .. A3s
141 Somalose.sory Syslem and Somatomotor Sys(eh .. . .. ... 861
142 Pain
Physiology ol .. .. .. .. .. .. A72
143 B6instem __ _. .. .... .. .. .. ... A7A
144 Thalamus. .. .. .. .. .. .. .. .. 8O.l
145 lnterna Capsule . .. .. .. BO7
146 Hypothaamus ego
147 Ce.ebelum ...... ..... ... ..399
143 Basa Gangla . .. .. ...... .. . .. 914
149. Cerebm Conex
 I c"**,G
5 l5O. LimbicSyslom..
'51 Re (ularFo trarcl . 937
I ', P,epdako-c o'Arrasfo'E.pe_' -nld SL.des ,, ', 941
'53 Prop_o!ep'o.b. 943
':a Poslu e a'd Eq.ilb'ui
'5 Ve\'ib ra Appar.ru\
I 'S. E€Joe-ip'aos'ar (EEG) ..
3 5 PhF o o9) of S eep
"S EPltP"y. ..
3 "g tlghe' 'nlel .clal Fln.lio
l ldl CqEbo-prdl-l d(CSF). .. ..
1 tr Anono. ,c Ne1o,s Sr'- re1 rA\S). ..... ..
1r-s
999
=. .1412
ri:r'Vis.n 1421
:i !. Palhway... .. ... ..1024
: : : ar_r Reflexes 1030
:::_. son . .. 1035
': :-::ciReir.cton . .. . .. .. .1040
, :. ..1043
- :::-; Parhway 1049
:::_smofllearng. 1452
- :::1 D€fe.ls 1053
:: ::rrnolTasle.. . .. .. 1060
. :i_:?:trnofsmer 1064
1069

t.