Physiology

Reference
Guyton and Hall Textbook of Medical Physiology,
Thirteenth Edition
Copyright © 2016 by Elsevier, Inc.
 Course Outline
• C h a p t e r 1: Functional Organization of the Human Body
and Control of the “Internal Environment.
• C h a p t e r 2: The Cell and Its Functions.
• C h a p t e r 3: Transport of Substances Through Cell
Membranes.
• C h a p t e r 4: Membrane Potentials and Action Potentials.
• C h a p t e r 5: Contraction of Skeletal Muscle.
• C h a p t e r 6: Excitation of Skeletal Muscle: Neuromuscular
Transmission and Excitation-Contraction Coupling
• C h a p t e r 7: Organization of the Nervous System, Basic
Functions of Synapses, and Neurotransmitters
 Course Outline
• C h a p t e r 8: Red Blood Cells, Anemia, and Polycythemia.
• C h a p t e r 9: Leukocytes, Granulocytes, the Monocyte-
Macrophage System, and Inflammation.
• C h a p t e r 10: Blood Types; Transfusion; Tissue and Organ
Transplantation.
• C h a p t e r 11: Hemostasis and Blood Coagulation.
 Physiology
• Physiology: is the science that seeks to explain
the physical and chemical mechanisms that are
responsible for the origin, development, and
progression of life.
• Human Physiology: The science of human
physiology attempts to explain the specific
characteristics and mechanisms of the human
body that make it a living being.
 Cells are the Living Units
of the Body
• The basic living unit of the body is the cell.
Each organ is an aggregate of many different
cells held together by intercellular supporting
structures.
• Each type of cell is specially adapted to
perform one or a few particular functions. For
instance, the red blood cells transport oxygen
from the lungs to the tissues.
• All cells have certain basic characteristics that are
alike. For instance, oxygen reacts with
carbohydrate, fat, and protein to release energy
required for all cells to function. Further, the
general chemical mechanisms for changing
nutrients into energy are basically the same in all
cells, and all cells deliver products of their chemical
reactions into surrounding fluids.

• Almost all cells also have the ability to reproduce

additional cells of their own kind except neurons.
 ”Extracellular Fluid - “The Internal Environment
• About 60% of adult human body is fluid, mainly a
water solution of ions and other substances.
• Intracellular fluid: fluid inside cells and is about two
thirds.
• Extracellular fluid: fluid outside cells and is about one
third. It constitutes blood and intercellualr fluid
(Interstitial fluid). In extracellular fluid are ions and
nutrients needed by cells to maintain life. Thus, all
cells live in the same environment - the extracellular
fluid. Therefore, extracellular fluid is also called
internal environment of the body.
 Differences Between Extracellular and
Intracellular Fluids
• The extracellular fluid contains larger amounts of
sodium, chloride, and bicarbonate ions plus
nutrients, such as oxygen, glucose, fatty acids, and
amino acids. It also contains carbon dioxide that is
being transported from the cells to the lungs to be
excreted.

• The intracellular fluid contains larger amounts of

potassium, magnesium, and phosphate ions.
 Homeostasis
• Homeostasis: maintenance of nearly constant
conditions in the internal environment.

• All organs of the body perform functions that help

maintain relatively constant conditions. For instance:
• Lungs provide oxygen to extracellular fluid to
replenish oxygen used by the cells
• Kidneys maintain constant ion concentrations
• Gastrointestinal system provides nutrients.
 Some body’s constituents are normally regulated
within narrow range
• Variations in blood hydrogen ion concentration, for
example, are normally less than 5 nanommoles/L
(0.000000005) moles/L.

• Blood sodium concentration is normally varying only

a few millimoles/L even with large changes in sodium
intake.

• Variations of sodium concentration are at least 1

million times greater than for hydrogen ions.
• Normal body functions require the integrated actions
of cells, tissues, organs, and the multiple nervous,
hormonal, and local control systems that together
contribute to homeostasis.
• Disease is often considered to be a state of disrupted
homeostasis. However, even in the presence of
disease, homeostatic mechanisms continue to
maintain vital functions through multiple
compensations.
• In some cases, these compensations may lead to
deviations of body’s functions from normal range.
• For example, diseases that impair the kidneys’ ability
to excrete salt and water may lead to hypertension,
which helps return excretion to normal. Over long
periods hypertension can damage various organs,
including kidneys, causing even greater increases in
blood pressure and more renal damage.

• Pathophysiology explains how various physiological

processes are altered in diseases or injury.
 Extracellular Fluid Transport and Mixing System -
Blood Circulatory System

• Extracellular fluid is
transported through the
body in two stages:
The first stage: is movement
of blood through the body in
the blood vessels.
• The second stage: is movement of fluid between blood
capillaries and intercellular spaces.
•As blood passes through blood capillaries, continual
exchange occurs between plasma portion of blood and
interstitial fluid.
•Walls of capillaries are permeable to most molecules except
plasma proteins which are too large to pass through
capillaries. Therefore, large amounts of fluid and its dissolved
constituents diffuse back and forth (by kinetic motion)
between blood and interstitial fluid (shown by arrows).
•Few cells are located more than 50 micrometers from a
capillary, which ensures diffusion of substances from the
capillary to the cell within a few seconds. Thus, the
extracellular fluid is continually being mixed and maintains
its homogeneity throughout the body.
 Origin of Nutrients in Extracellular Fluid
1. Respiratory System: Blood picks up oxygen in the alveoli
of the lung by simple diffusion through very thin alveolar
membrane which is only 0.4 to 2.0 micrometers thick.
2. Gastrointestinal Tract: Glucose, fatty acids and amino
acids are absorbed from the ingested food into blood.
3. Liver and Other Organs: Liver changes chemical
compositions of many substances absorbed from
gastrointestinal tract to more usable forms. Other tissues
including fat cells, gastrointestinal mucosa, kidneys and
endocrine glands help modify absorbed substances or store
them until they are needed. The liver also eliminates certain
waste products and toxic substances.
 Removal of Metabolic End Products
1. Removal of Carbon Dioxide by the Lungs: Carbon
dioxide is released from blood into lung alveoli and then
to the atmosphere by expiration. Carbon dioxide is the
most abundant metabolic product.
2. Kidneys: Kidneys remove waste products from the
plasma such as urea and uric acid. Nephrons of Kidneys
perform their function by first filtering large quantities of
plasma through the glomerular capillaries into the
tubules and then reabsorbing into the blood the
substances needed by the body. Glucose and amino acids
are completely reabsorbed whereas water and many ions
are partially reabsorbed .
Afferent arteriole
Efferent arteriole

Glomerulus

Nephron of the Kidney

3. Gastrointestinal Tract: Undigested materials and
some waste products of metabolism are eliminated in
feces.

4. Liver: Liver detoxifies or removes many drugs and

chemicals, and secretes them into bile to be eliminated
in feces.
 Regulation of Body Functions
1. Nervous System: It is composed of three major parts:
A. Sensory input portion: Sensory receptors detect the state of
the body or the state of the surroundings. For instance,
receptors in the skin alert us whenever an object touches the
skin.
B. Central nervous system (Integrative portion): It is composed
of brain and spinal cord. The brain can store information,
generate thoughts, create ambition, and determine reactions
that the body performs in response to the sensations. An
important segment of nervous system is called autonomic
system. It operates at a subconscious level and controls
functions of internal organs such as pumping activity of the
heart, movements of gastrointestinal tract and secretion of
glands.
C. Motor output portion: Appropriate signals are then transmitted
through the motor output portion of the nervous system to carry
out one’s desires.
The three major parts of nervous system is presented by Reflex Arc.
2. Hormone Systems: Hormones are secreted directly into
blood by endocrine glands to regulate cellular function. For
instance:
* Thyroid hormones: triiodothyronine (T3) and
tetraiodothyronine (thyroxine or T4) increase cellular metabolic
rate.
* Parathyroid hormones: Parathormone increases blood calcium
and decreases blood phosphate.
* Pancreatic hormones: Insulin lowers blood glucose and
glucagon increases blood glucose.
* Adrenal gland hormones
- Adrenal medulla: Adrenaline and noradrenaline which have metabolic
effects.
- Adrenal cortex: Glucocorticoids e.g. Cortisol which has metabolic,
anti-inflammatory and anti-stress effects. Mineralocorticoids e.g.
Aldosterone which increases sodium reabsorption and potassium
secretion in the nephron of the kidney.
 Protection of the Body
Immune System: Consists mainly of white blood cells and
provides a mechanism for the body to:
1. Distinguish its own cells from foreign cells
2. Destroy the invader by phagocytosis or by producing
sensitized lymphocytes (B and T cells) or antibodies that either
destroy or neutralize the invader.
Integumentary System: Consists of skin and its appendages
e.g. hair, nails and glands:
1. Covers, cushions, and protects deeper tissues and organs of
the body and provides a boundary between body’s internal
environment and outside world.
2. Regulates temperature and excretes wastes.
3. Provides a sensory interface between the body and the
external environment.
 Control systems of the Body
1. Regulation of Oxygen and Carbon dioxide Concentrations
in the Extracellular Fluid.
A. Regulation of Oxygen: Hemoglobin combines with oxygen
as blood passes through lungs. In tissue, hemoglobin, because
of its own strong chemical affinity for oxygen, does not release
oxygen into tissue fluid if too much oxygen is already there.
However, if oxygen concentration in the tissue fluid is too low,
sufficient oxygen is released to re-establish an adequate
concentration. Thus regulation of oxygen concentration in the
tissue depends principally on the chemical characteristics of
hemoglobin. This regulation is called oxygen-buffering
function of hemoglobin.
B. Regulation of Carbon dioxide: Carbon dioxide is the
most abundant metabolic product. Accumulation of carbon
dioxide in the blood excites the respiratory center in
medulla oblongata, causing a person to breathe rapidly and
deeply. This deep, rapid breathing increases expiration of
carbon dioxide and, therefore, removes excess carbon
dioxide from the blood and tissue fluids until returns to
normal. Carbon dioxide regulation is a negative feedback
control.
2. Regulation of Arterial Blood Pressure - Baroreceptor
system: Baroreceptors (Stretch receptors) are located in the
walls of bifurcation region of carotid arteries in the neck
(carotid sinus) and in aortic arch. Increase arterial blood
pressure stretches arterial wall and stimulates baroreceptors
which send inhibitory nerve impulses through
glossopharyngeal and vagus nerves to vasomotor center in
medulla oblongata of the brain. This in turn decreases the
number of impulses transmitted from the vasomotor center
through the sympathetic nervous system to the heart and
blood vessels. Lack of these impulses decreases pumping
activity of the heart and causes vasodilation of peripheral
blood vessels. Both of these effects decrease arterial pressure,
moving it back toward normal. Therefore, arterial Blood
Pressure is regulated by negative feedback mechanism.
Conversely, a decrease in arterial pressure relaxes stretch receptors,
allowing the vasomotor center to become more active, causing
vasoconstriction and increased heart pumping. This raises arterial
pressure, moving it back toward normal.
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Normal values and ranges of important extracellular
fluid constituents
Constituent Normal value Normal range Unit
Oxygen (venous) 40 35-45 mm Hg
Carbon dioxide (venous) 45 35-45 mm Hg
Sodium ion 142 138-146 mmol/L
Potassium ion 4.2 3.8-5.0 mmol/L
Calcium ion 1.2 1.0-1.4 mmol/L
Chloride ion 106 103-112 mmol/L
Bicarbonate ion 24 24-32 mmol/L
Glucose 90 75-95 mg/dl
Body temperature 37 37 oC
Acid-base 7.4 7.3-7.5 pH
* An increase in body temperature of only 7°C above normal can
lead to a vicious cycle of increasing cellular metabolism that
destroys the cells.
* An increase or decrease in pH value by only 0.5 is lethal.
* Decreases in potassium ion concentration to less than one-
third normal causes paralysis as a result of inability of nerves to
carry signals. Alternatively, if potassium increases to two or more
times normal, the heart muscle is likely to be severely depressed.
* Decrease in calcium ion concentration below about one-half
normal causes tetanic contraction of muscles because of
spontaneous generation of excess nerve impulses in peripheral
nerves.
* Decrease in glucose concentration below one-half normal
causes mental irritability and sometimes convulsions.
 Characteristics of Control Systems
1. Negative Feedback Nature of Most Control Systems
Examples:
A. Regulation of Carbon dioxide Concentrations in the
Extracellular Fluid (previously discussed).
B. Regulation of Arterial Blood Pressure - Baroreceptor system
(previously discussed).
2. Gain of a Control System
* Gain is the degree of effectiveness with which a control system
maintains constant conditions. For instance:
* Assume that a large volume of blood is transfused into a
person whose baroreceptors are not functioning, and arterial
pressure rises from the normal level of 100 mm Hg up to 175 mm
Hg.
* Assume that the same volume of blood is injected into the
same person when baroreceptors are functioning, and
pressure rises to 125 mm Hg.
* Thus the feedback control system has caused a “correction”
of −50 mm Hg (175 − 125 mm Hg) and there remains an
increase in pressure of +25 mm Hg called the “error”.
* Gain of the system = Correction/Error
= −50 / + 25 = − 2

* Gain of the system controlling body temperature when a

person is exposed to cold weather is about −33.

* Therefore, temperature control system is much more

effective than baroreceptor pressure control system.
3. Positive Feedback mechanism
A. Positive Feedback Can Sometimes Cause Vicious Cycles and
Death, For instance:
* If the person is suddenly bled 2 liters decrease amount of
blood to such a low level that not enough blood is available for
heart to pump effectively decrease arterial pressure
decrease blood flow to heart muscle through coronary arteries
weakening of the heart further decrease pumping
further decrease in coronary blood flow more weakness
of the heart the cycle repeats itself again and again (vicious
cycle) until death occurs.
* if the person is bled only 1 liter, the normal negative feedback
mechanisms for controlling cardiac output and arterial pressure
can counterbalance the positive feedback and the person can
recover.
B. Positive Feedback Can Sometimes Be Useful
Examples:
1. Blood clotting: Ruptured of blood vessel clot begins to form by
activation of clotting factors (enzymes) Some of these enzymes
act on other unactivated enzymes of the immediately adjacent
blood more blood clotting continues until vessel is plugged
and bleeding stops.
If this mechanism get out of hand formation of unwanted clots
like coronary artery clot heart attack.
2. Childbirth: Uterine contractions stretch uterine cervix
signals through uterine muscle back to uterus more
stronger contractions powerful enough baby is born.
3. generation of nerve signals:
Stimulation of a nerve fiber slight leakage of sodium
ions through sodium channels into fiber’s interior change of
membrane potential more opening of channels more
change of potential more opening of channels.