By John E. Hall and Michael E. Hall
Brief Contents:
1. Functional Organization of the Human Body and Control of the “Internal Environment”
2. The Cell and Its Functions
3. Genetic Control of Protein Synthesis, cell function, and cell reproduction
UNIT II – Membrane Physiology, Nerve, and Muscle
4. Transport of Substances Through Cell Membranes
5. Membrane Potentials and Action Potentials
6. Contraction of Skeletal Muscle
7. Excitation of Skeletal Muscle: Neuromuscular Transmission and Excitation-Contraction Coupling
8. Excitation and Contraction of Smooth Muscle
UNIT III – The Heart
9. Cardiac Muscle; The Heart as a Pump and Function of the Heart Valves
10. Rhythmical Excitation of the Heart
11. The Normal Electrocardiogram
12. Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities:
Vectorial Analysis
13.Cardiac Arrhythmias and Their Electrocardiographic Interpretation
UNIT IV – The Circulation
14. Overview of the Circulation; Biophysics of Pressure, Flow, and Resistance
15. Vascular Distensibility and Functions of the Arterial and Venous Systems
16. The Microcirculation and Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph
Flow
17. Local and Humoral Control of Tissue Blood Flow
18. Nervous Regulation of the Circulation and Rapid Control of Arterial Pressure
19. Role of the Kidneys in Long-Term Control of Arterial Pressure and in Hypertension: The Integrated
System for Aterial Pressure Regulation
20. Cardiac Output, Venous Return, and Their Regulation
21. Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart
Disease
22. Cardiac Failure
23. Heart Valves and Heart Sounds; Valvular and Congenital Heart Defects
24. Circulatory Shock and Its Treatment
UNIT V – The Body Fluids and Kidneys
25. The Body Fluid Compartments: Extracellular and Intracellular Fluids; Edema
26. The Urinary System: Functional Anatomy and Urine Formation by the Kidneys
27. Glomerular Filtration, Renal Blood Flow, and Their Control
28. Renal Tubular Reabsorption and Secretion
29. Urine Concentration and Dilution; Regulation of Extracellular Fluid Osmolarity and Sodium
Concentration
30. Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium; Integration of Renal
Mechanisms for Control of Blood Volume and Extracellular Fluid Volume
31. Acid-Base Regulation
32. Diuretics, Kidney Diseases
UNIT VI – Blood Cells, Immunity, and Blood Coagulation
33. Red Blood Cells, Anemia, and Polycythemia
34. Resistance of the Body to Infection: I. Leukocytes, Granulocytes, the Monocyte-Macrophage System,
and Inflammation
35. Resistance of the Body to Infection: II. Immunity and Allergy
36. Blood Types; Transfusion; Tissue and Organ Transplantation
37. Hemostasis and Blood Coagulation
UNIT VII – Respiration
38. Pulmonary Ventilation
39. Pulmonary Circulation, Pulmonary Edema, Pleural Fluid
40. Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory
Membrane
41. Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids
42. Regulation of Respiration
43. Respiratory Insufficiency – Pathophysiology, Diagnosis, Oxygen Therapy
UNIT VIII – Aviation, Space, and Deep-Sea Diving Physiology
44. Aviation, High Altitude, and Space Physiology
45. Physiology of Deep-Sea Diving and Other Hyperbaric Conditions
UNIT IX – The Nervous System: A. General Principles and Sensory Physiology
46. Organization of the Nervous System, Basic Functions of Synapses, and Neurotransmitters
47. Sensory Receptors, Neuronal Circuits for Processing Information
48. Somatic Sensations: I. General Organization, the Tactile and Position Senses
49. Somatic sensations: II. Pain, Headache, and Thermal Sensations
UNIT X – The Nervous System: B. The Special Senses
50. The Eye: I. Optics of Vision
51. The Eye: II. Receptor and Neural Function of the Retina
52. The Eye: III. Central Neurophysiology of Vision
53. The Sense of Hearing
54. The Chemical Senses – Taste and Smell
UNIT XI – The Nervous System: C. Motor and Integrative Neurophysiology
55. Motor Functions of the Spinal Cord; the Cord Reflexes
56. Cortical and Brain Stem Control of Motor Function
57. Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control
58. Cerebral Cortex, Intellectual Functions of the Brain, Learning, and Memory
59. Behavioral and Motivational Mechanisms of the Brain – The Limbic System and the Hypothalamus
60. States of Brain Activity – Sleep, Brain Waves, Epilepsy, Psychoses, and Dementia
61. The Autonomic Nervous System and the Adrenal Medulla
62. Cerebral Blood Flow, Cerebrospinal Fluid, and Brain Metabolism
UNIT XII – Gastrointestinal Physiology
63. General Principles of Gastrointestinal Function – Motility, Nervous Control, and Blood Circulation
64. Propulsion and Mixing of Food in the Alimentary Tract
65. Secretory Functions of the Alimentary Tract
66. Digestion and Absorption in the Gastrointestinal Tract
67. Physiology of Gastrointestinal Disorders
UNIT XIII – Metabolism and Temperature Regulation
68. Metabolism of Carbohydrates and Formation of Adenosine Triphosphate
69. Lipid Metabolism
70. Protein Metabolism
71. The Liver as an Organ
72. Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and Minerals
73. Energetics and Metabolic Rate
74. Body Temperature Regulation and Fever
UNIT XIV – Endocrinology and Reproduction
75. Introduction to Endocrinology
76. Pituitary Hormones and Their Control by the Hypopthalamus
77. Thyroid Metabolic Hormones
78. Adenocortical Hormones
79. Insulin, Glucagon, and Diabetes Mellitus
80. Parathyroid Hormone, Calcitonin, Calcium and Phosphate Metabolism, Vitamin D, Bone, and Teeth
81. Reproductive and Hormonal Functions of the Male (and Function of the Pineal Gland)
82. Female Physiology Before Pregnancy and Female Hormones
83. Pregnancy and Lactation
84. Fetal and Neonatal Physiology
UNIT XV – Sports Physiology
85. Sports Physiology
Preface
The first edition of the Textbook of Medical Physiology was written by Arthur C. Guyton almost 65 years ago. Unlike most major medical textbooks, which often have 20 or more authors, the first eight editions of the Textbook of Medical Physiology were written entirely by Dr. Guyton. He had a gift for communicating complex ideas in a clear and interesting manner that made studying physiology fun. He wrote the book to help students learn physiology, not to impress his professional colleagues.
Dr. John Hall worked closely with Dr. Guyton for almost 30 years and had the privilege of writing parts of the 9th and 10th editions and of assuming sole responsibility for completing the subsequent editions. Dr. Michael Hall has joined in the preparation of the 14th edition of the Textbook of Medical Physiology. He is a physician trained in internal medicine, cardiology, and physiology and has brought new insights that have helped greatly to achieve the same goal as for previous editions— to explain, in language easily understood by students, how the different cells, tissues, and organs of the human body work together to maintain life.
This task has been challenging and fun because researchers continue to unravel new mysteries of body functions. Advances in molecular and cellular physiology have made it possible to explain some physiology principles in the terminology of molecular and physical sciences rather than in merely a series of separate and unexplained biological phenomena. However, the molecular events that underpin the functions of the body’s cells provide only a partial explanation of human physiology. The total function of the human body requires complex control systems that communicate with each other and coordinate the molecular functions of the body’s cells, tissues, and organs in health and disease.
The Textbook of Medical Physiology is not a reference book that attempts to provide a compendium of the most recent advances in physiology. It is a book that continues the tradition of being written for students. It focuses on the basic principles of physiology needed to begin a career in the health care professions, such as medicine, dentistry, and nursing, as well as graduate studies in the biological and health sciences. It should also be useful to physicians and health care professionals who wish to review the basic principles needed for understanding the pathophysiology of human disease. We have attempted to maintain the same unified organization of the text that has been useful to students in the past and to ensure that the book is comprehensive enough that students will continue to use it during their professional careers.
Our hope is that the Textbook of Medical Physiology conveys the majesty of the human body and its many functions and that it stimulates students to study physiology throughout their careers. Physiology links the basic sciences and medicine. The great beauty of physiology is that it integrates the individual functions of all the body’s different cells, tissues, and organs into a functional whole, the human body. Indeed, the human body is much more than the sum of its parts, and life relies upon this total function, not just on the function of individual body parts in isolation from the others.
This brings us to an important question: How are the separate organs and systems coordinated to maintain proper function of the entire body? Fortunately, our bodies are endowed with a vast network of feedback controls that achieve the necessary balances without which we would be unable to live. Physiologists call this high level of internal bodily control homeostasis. In disease states, functional balances are often seriously disturbed, and homeostasis is impaired. When even a single disturbance reaches a limit, the whole body can no longer live. One of the goals of this text is to emphasize the effectiveness and beauty of the body’s homeostasis mechanisms as well as to present their abnormal functions in disease.
Another objective is to be as accurate as possible. Suggestions and critiques from many students, physiologists, and clinicians throughout the world have checked factual accuracy as well as balance in the text. Even so, because of the likelihood of error in sorting through many thousands of bits of information, we issue a further request for all readers to send notations of error or inaccuracy to us. Physiologists understand the importance of feedback for proper function of the human body; feedback is also important for progressive improvement of a textbook of physiology. To the many persons who have already helped, we express sincere thanks. Your feedback has helped to improve the text.
A brief explanation is needed about several features of the 14th edition. Although many of the chapters have been revised to include new principles of physiology and new figures to illustrate these principles, the text length has been closely monitored to limit the book’s size so that it can be used effectively in physiology courses for medical students and health care professionals. New references have been chosen primarily for their presentation of physiological principles, for the quality of their own references, and for their easy accessibility. The selected bibliography at the end of the chapters lists mainly review papers from recently published scientific journals that can be freely accessed from the PubMed site at https://www.ncbi.nlm.nih.gov/pubmed/. Use of these references, as well as cross-references from them, provides much more extensive coverage of the entire field of physiology.
Our effort to be as concise as possible has, unfortunately, necessitated a more simplified and dogmatic presentation of many physiological principles than we normally would have desired. However, the bibliography can be used to learn more about the controversies and unanswered questions that remain in understanding the complex functions of the human body in health and disease.
Another feature of the book is that the print is set in two sizes. The material in large print constitutes the fundamental physiological information that students will require in virtually all of their medical studies. The material in small print and highlighted with a pale lavender background (or identified by beginning and ending double gray arrowheads in the ebook version) is of several different kinds: (1) anatomic, chemical, and other information that is needed for immediate discussion but that most students will learn in more detail in other courses; (2) physiological information of special importance to certain fields of clinical medicine; and (3) information that will be of value to those students who wish to study specific physiological mechanisms more deeply. The ebook version provides links to additional content including video animations and self-assessment questions that can be accessed with computers, smart phones, and electronic tablets. For additional self-assessment beyond these textbook supplements, the reader may consider using a copy of Guyton and Hall Physiology Review, which includes more than 1000 practice questions referenced to the textbook. We hope that these ancillary materials will assist readers in testing their understanding of basic principles of physiology.
We express sincere thanks to many persons who have helped to prepare this book, including our colleagues in the Department of Physiology and Biophysics at the University of Mississippi Medical Center who provided valuable suggestions. The members of our faculty and a brief description of the research and educational activities of the department can be found at http://physiology.umc.edu/.
We are especially grateful to Stephanie Lucas for excellent assistance and to James Perkins for excellent illustrations. We also thank Elyse O’Grady, Jennifer Shreiner, Grace Onderlinde, Rebecca Gruliow, and the entire Elsevier team for continued editorial and production excellence. Finally, we thank the many readers who continue to help us improve the Textbook of Medical Physiology. We hope that you enjoy the current edition and find it even more useful than previous editions.