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Ganong's Review of Medical Physiology

727 Pages · 2009 · 16.03 MB · English

  • Ganong's Review of Medical Physiology


    Ranges of Normal Values in Human Whole Blood (B), Plasma (P), or Serum (S)a


    Normal Value (Varies with Procedure Used) Determination Traditional Units SI Units


    Normal Value (Varies with Procedure Used)


    Determination Traditional Units SI Units


    Acetoacetate plus acetone (S) 0.3–2.0 mg/dL 3–20 mg/L


    Aldosterone (supine) (P) 3.0–10 ng/dL 83–227 pmol/L


    Alpha-amino nitrogen (P) 3.0–5.5 mg/dL 2.1–3.9 mmol/L


    Aminotransferases


    Alanine aminotransferase 3–48 units/L


    Aspartate aminotransferase 0–55 units/L


    Ammonia (B) 12–55 μmol/L 12–55 μmol/L


    Amylase (S) 53–123 units/L 884–2050 nmol s–1/L


    Ascorbic acid (B) 0.4–1.5 mg/dL (fasting) 23–85 μmol/L


    Bilirubin (S) Conjugated (direct): up to 0.4 mg/dL Up to 7 μmol/L


    Total (conjugated plus free): up to 1.0 mg/dL Up to 17 μmol/L


    Calcium (S) 8.5–10.5 mg/dL; 4.3–5.3 meq/L 2.1–2.6 mmol/L


    Carbon dioxide content (S) 24–30 meq/L 24–30 mmol/L


    Carotenoids (S) 0.8–4.0 μg/mL 1.5–7.4 μmol/L


    Ceruloplasmin (S) 23–43 mg/dL 240–430 mg/L


    Chloride (S) 100–108 meq/L 100–108 mmol/L


    Cholesterol (S) < 200 mg/dL < 5.17 mmol/L


    Cholesteryl esters (S) 60–70% of total cholesterol


    Copper (total) (S) 70–155 μg/dL 11.0–24.4 μmol/L


    Cortisol (P) (AM, fasting) 5–25 μg/dL 0.14–0.69 μmol/L


    Creatinine (P) 0.6–1.5 mg/dL 53–133 μmol/L


    Glucose, fasting (P) 70–110 mg/dL 3.9–6.1 mmol/L


    Iron (S) 50–150 μg/dL 9.0–26.9 μmol/L


    Lactic acid (B) 0.5–2.2 meq/L 0.5–2.2 mmol/L


    Lipase (S) 3–19 units/L


    Lipids, total (S) 450–1000 mg/dL 4.5–10 g/L


    Magnesium (S) 1.4–2.0 meq/L 0.7–1.0 mmol/L


    Osmolality (S) 280–296 mosm/kg H2O 280–296 mmol/kg H2O


    PCO2 (arterial) (B) 35–45 mm Hg 4.7–6.0 kPa


    Pepsinogen (P) 200–425 units/mL pH (B) 7.35–7.45


    Phenylalanine (S) 0–2 mg/dL 0–120 μmol/L


    Phosphatase, acid (S) Males: 0–0.8 sigma unit/mL


    Females: 0.01–0.56 sigma unit/mL


    Phosphatase, alkaline (S) 13–39 units/L (adults) 0.22–0.65 μmol s–1/L


    Phospholipids (S) 9–16 mg/dL as lipid phosphorus 2.9–5.2 mmol/L


    Phosphorus, inorganic (S) 2.6–4.5 mg/dL (infants in first year: up to 6.0 mg/dL) 0.84–1.45 mmol/L


    PO2 (arterial) (B) 75–100 mm Hg 10.0–13.3 kPa


    Potassium (S) 3.5–5.0 meq/L 3.5–5.0 mmol/L


    Protein


    Total (S) 6.0–8.0 g/dL 60–80 g/L


    Albumin (S) 3.1–4.3 g/dL 31–43 g/L


    Globulin (S) 2.6–4.1 g/dL 26–41 g/L


    Pyruvic acid (P) 0–0.11 meq/L 0–110 μmol/L


    Sodium (S) 135–145 meq/L 135–145 mmol/L


    Urea nitrogen (S) 8–25 mg/dL 2.9–8.9 mmol/L


    Uric acid (S)


    Women 2.3–6.6 mg/dL 137–393 μmol/L


    Men 3.6–8.5 mg/dL 214–506 μmol/L


    aBased in part on Kratz A, et al. Laboratory reference values. N Engl J Med 2004;351:1548. Ranges vary somewhat from one laboratory to another depending on the details of


    the methods used, and specific values should be considered in the context of the range of values for the laboratory that made the determination.





    a LANGE medical book


    Ganong’s


    Review of


    Medical Physiology


    Twenty-Third Edition


    Kim E. Barrett, PhD Scott Boitano, PhD


    Professor Associate Professor, Physiology


    Department of Medicine Arizona Respiratory Center


    Dean of Graduate Studies Bio5 Collaborative Research Institute


    University of California, San Diego University of Arizona


    La Jolla, California Tucson, Arizona


    Susan M. Barman, PhD Heddwen L. Brooks, PhD


    Professor Associate Professor


    Department of Pharmacology/Toxicology Department of Physiology


    Michigan State University College of Medicine


    East Lansing, Michigan University of Arizona


    Tucson, Arizona


    New York Chicago San Francisco Lisbon London Madrid Mexico City


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    Dedication to


    WILLIAM FRANCIS GANONG


    William Francis (“Fran”) Ganong was an outstanding scien- among physiologists. He was an excellent writer and far ahead


    tist, educator, and writer. He was completely dedicated to the of his time with his objective of distilling a complex subject into


    field of physiology and medical education in general. Chair- a concise presentation. Like his good friend, Dr. Jack Lange,


    man of the Department of Physiology at the University of Cal- founder of the Lange series of books, Fran took great pride in


    ifornia, San Francisco, for many years, he received numerous the many different translations of the Review of Medical Physi-


    teaching awards and loved working with medical students. ology and was always delighted to receive a copy of the new edi-


    Over the course of 40 years and some 22 editions, he was the tion in any language.


    sole author of the best selling Review of Medical Physiology, and He was a model author, organized, dedicated, and enthusias-


    a co-author of 5 editions of Pathophysiology of Disease: An tic. His book was his pride and joy and like other best-selling


    Introduction to Clinical Medicine. He was one of the “deans” of authors, he would work on the next edition seemingly every


    the Lange group of authors who produced concise medical text day, updating references, rewriting as needed, and always ready


    and review books that to this day remain extraordinarily popu- and on time when the next edition was due to the publisher. He


    lar in print and now in digital formats. Dr. Ganong made a did the same with his other book, Pathophysiology of Disease:


    gigantic impact on the education of countless medical students An Introduction to Clinical Medicine, a book that he worked on


    and clinicians. meticulously in the years following his formal retirement and


    A general physiologist par excellence and a neuroendocrine appointment as an emeritus professor at UCSF.


    physiologist by subspecialty, Fran developed and maintained a Fran Ganong will always have a seat at the head table of the


    rare understanding of the entire field of physiology. This greats of the art of medical science education and communi-


    allowed him to write each new edition (every 2 years!) of the cation. He died on December 23, 2007. All of us who knew


    Review of Medical Physiology as a sole author, a feat remarked him and worked with him miss him greatly.


    on and admired whenever the book came up for discussion


    iii


    Key Features of the 23rd Edition of


    Ganong’s Review of


    Medical Physiology


    •Thoroughly updatedto reflect the latest research and developments in important areas such as the


    cellular basis of neurophysiology


    •Incorporates examples from clinical medicinethroughout the chapters to illustrate important


    physiologic concepts


    •Delivers more detailed, clinically-relevant, high-yield information per pagethan any similar text


    or review


    •NEW full-color illustrations—the authors have worked with an outstanding team of medical


    illustrators, photographers, educators, and students to provide an unmatched collection of 600


    illustrations and tables


    •NEW boxed clinical cases—featuring examples of diseases that illustrate important physiologic


    principles


    •NEW high-yield board reviewquestions at the end of each chapter


    •NEW larger 8½ X 11” trim-sizeenhances the rich visual content


    •NEW companion online learning center (LangeTextbooks.com) offers a wealth of innovative


    learning tools and illustrations


    NEW iPod-compatible


    review—Medical PodClass


    offers audio and text for


    study on the go


    Full-color illustrations


    enrich the text


    iv


    KEY FEATURES v


    Clinical Cases illustrate essential


    physiologic principles


    Summary tables and charts


    encapsulate important information


    Chapters conclude with Chapter


    Summaries and review questions




    About the Authors


    KIM E. BARRETT American Physiological Society (APS) and recently served on its


    council. She has also served as Chair of the Central Nervous


    Kim Barrett received her PhD in biological


    System Section of APS as well as Chair of both the Women in


    chemistry from University College London


    Physiology and Section Advisory Committees of APS. In her


    in 1982. Following postdoctoral training at


    spare time, she enjoys daily walks, aerobic exercising, and


    the National Institutes of Health, she joined


    mind-challenging activities like puzzles of various sorts.


    the faculty at the University of California,


    San Diego, School of Medicine in 1985, rising


    SCOTT BOITANO


    to her current rank of Professor of Medicine


    in 1996. Since 2006, she has also served the Scott Boitano received his PhD in


    University as Dean of Graduate Studies. Her genetics and cell biology from


    research interests focus on the physiology and pathophysiology Washington State University in


    of the intestinal epithelium, and how its function is altered by Pullman, Washington, where he


    commensal, probiotics, and pathogenic bacteria as well as in acquired an interest in cellular signaling.


    specific disease states, such as inflammatory bowel diseases. She He fostered this interest at University


    has published almost 200 articles, chapters, and reviews, and has of California, Los Angeles, where


    received several honors for her research accomplishments he focused his research on second


    including the Bowditch and Davenport Lectureships from the messengers and cellular physiology of the lung epithelium. He


    American Physiological Society and the degree of Doctor of continued to foster these research interests at the University of


    Medical Sciences, honoris causa, from Queens University, Belfast. Wyoming and at his current positions with the Department of


    She is also a dedicated and award-winning instructor of medical, Physiology and the Arizona Respiratory Center, both at the


    pharmacy, and graduate students, and has taught various topics University of Arizona.


    in medical and systems physiology to these groups for more than


    20 years. Her teaching experiences led her to author a prior


    HEDDWEN L. BROOKS


    volume (Gastrointestinal Physiology, McGraw-Hill, 2005) and


    she is honored to have been invited to take over the helm of Heddwen Brooks received her PhD from


    Ganong. Imperial College, University of London


    and is an Associate Professor in the


    Department of Physiology at the University


    SUSAN M. BARMAN


    of Arizona (UA). Dr Brooks is a renal


    Susan Barman received her PhD in physiologist and is best known for her


    physiology from Loyola University School development of microarray technology


    of Medicine in Maywood, Illinois. Afterward to address in vivo signaling pathways


    she went to Michigan State University involved in the hormonal regulation of


    (MSU) where she is currently a Professor renal function. Dr Brooks’ many awards include the American


    in the Department of Pharmacology/ Physiological Society (APS) Lazaro J. Mandel Young Investigator


    Toxicology and the Neuroscience Program. Award, which is for an individual demonstrating outstanding


    Dr Barman has had a career-long interest in promise in epithelial or renal physiology. She will receive the


    neural control of cardiorespiratory function APS Renal Young Investigator Award at the 2009 annual


    with an emphasis on the characterization meeting of the Federation of American Societies for


    and origin of the naturally occurring discharges of sympathetic Experimental Biology. Dr Brooks is a member of the APS


    and phrenic nerves. She was a recipient of a prestigious National Renal Steering Section and the APS Committee of


    Institutes of Health MERIT (Method to Extend Research in Committees. She is on the Editorial Board of the American


    Time) Award. She is also a recipient of an Outstanding University Journal of Physiology-Renal Physiology (since 2001), and she


    Woman Faculty Award from the MSU Faculty Professional has also served on study sections of the National Institutes of


    Women's Association and an MSU College of Human Medicine Health and the American Heart Association.


    Distinguished Faculty Award. She has been very active in the


    vi




    Contents


    Preface ix


    I


    S E C T I O N 15. Electrical Activity of the Brain, Sleep–Wake


    CELLULAR & MOLECULAR BASIS FOR States, & Circadian Rhythms 229


    MEDICAL PHYSIOLOGY 1


    16. Control of Posture & Movement 241


    17. The Autonomic Nervous System 261


    1. General Principles & Energy


    Production in Medical Physiology 1 18. Hypothalamic Regulation of


    Hormonal Functions 273


    2. Overview of Cellular Physiology


    in Medical Physiology 31 19. Learning, Memory, Language,


    & Speech 289


    3. Immunity, Infection, & Inflammation 63


    IV


    II S E C T I O N


    S E C T I O N


    ENDOCRINE & REPRODUCTIVE


    PHYSIOLOGY OF NERVE


    PHYSIOLOGY 301


    & MUSCLE CELLS 79


    20. The Thyroid Gland 301


    4. Excitable Tissue: Nerve 79


    21. Endocrine Functions of the


    Pancreas & Regulation of


    5. Excitable Tissue: Muscle 93


    Carbohydrate Metabolism 315


    6. Synaptic & Junctional Transmission 115


    22. The Adrenal Medulla &


    7. Neurotransmitters & Neuromodulators 129 Adrenal Cortex 337


    8. Properties of Sensory Receptors 149 23. Hormonal Control of Calcium


    and Phosphate Metabolism &


    9. Reflexes 157


    the Physiology of Bone 363


    III


    24. The Pituitary Gland 377


    S E C T I O N


    CENTRAL & PERIPHERAL 25. The Gonads: Development & Function


    NEUROPHYSIOLOGY 167 of the Reproductive System 391


    V


    10. Pain & Temperature 167 S E C T I O N


    GASTROINTESTINAL


    11. Somatosensory Pathways 173


    PHYSIOLOGY 429


    12. Vision 181


    26. Overview of Gastrointestinal


    13. Hearing & Equilibrium 203 Function & Regulation 429


    14. Smell & Taste 219


    vii



    viii CONTENTS


    VII


    27. Digestion, Absorption, & S E C T I O N


    Nutritional Principles 451 RESPIRATORY PHYSIOLOGY 587


    28. Gastrointestinal Motility 469


    35. Pulmonary Function 587


    29. Transport & Metabolic


    36. Gas Transport & pH in the Lung 609


    Functions of the Liver 479


    37. Regulation of Respiration 625


    VI


    S E C T I O N


    VIII


    CARDIOVASCULAR S E C T I O N


    PHYSIOLOGY 489 RENAL PHYSIOLOGY 639


    30. Origin of the Heartbeat & the 38. Renal Function & Micturition 639


    Electrical Activity of the Heart 489


    39. Regulation of Extracellular Fluid


    31. The Heart as a Pump 507 Composition & Volume 665


    32. Blood as a Circulatory Fluid & the 40. Acidification of the Urine &


    Dynamics of Blood & Lymph Flow 521 Bicarbonate Excretion 679


    33. Cardiovascular Regulatory Mechanisms 555


    Answers to Multiple Choice Questions 687


    34. Circulation Through Special Regions 569 Index 689


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