Eighth Edition

L Prakasam Reddy MD
Former Associate Professor
Department of Physiology
Kamineni Institute of Medical Sciences
Nalgonda, Telangana, India

Contributors
L Gowri Sankar Reddy
Vidya Reddy
L Dhanalakshmi
Naren Prakash Reddy
 PREFACE TO THE EIGHTH EDITION
It is a pleasure to bring out the eighth edition of LPR Fundamentals of Medical Physiology in a completely revised and
student-friendly format. This edition has been thoroughly updated based on the latest Competency-Based Medical Education
(CBME) curriculum. The entire subject of Physiology is divided into competencies and sub-competencies. Scenario-based
and task-based questions are given at the end of each section to enable the students to do the self-assessment test and appear
confidently for the exams.

What is Competency?
Competency is defined as “the ability to do something successfully and efficiently.” CBME is an approach to ensure that the
graduates develop the competencies required to fulfill the patients’ needs in the society. Teaching of Physiology to the medical
graduates is as per the CBME-2019.

I. Goal
The broad goal of the teaching of undergraduate students in physiology is to provide the student with comprehensive knowledge
of the normal functions of the organ systems of the body to facilitate an understand the physiological basis of health and disease.

II. Objectives
A. Knowledge: At the end of the course the student will be able to:
1. Explain the normal functioning of all organ systems and their interactions for well-coordinated total body
functioning.
2. Assess the relative contribution of each organ system to the maintenance of the milieu interior.
3. Elucidate the physiological aspects of normal growth and development.
4. Describe the physiological response and adaptations to environmental stress.
5. List the physiological principles underlying pathogenesis and treatment of the disease.
B. Skills: At the end of the course the student will be able to:
1. Conduct experiments designed for study of physiological phenomenon.
2. Interpret experimental/investigative data.
3. Distinguish between normal and abnormal data derived as a result of the tests which he/she has performed and
observed in the laboratory.
C. Attitude and communication skills: At the end of the course the student will be able to:
1. Show due respect to the persons who volunteer to be examined for the purpose of learning clinical examination.
2. Communicate effectively with peers and teachers.
3. Demonstrate the ability of team work.
D. Integration: At the end of the first year integrated teaching, the student should acquire an integrated knowledge of
organ structure and function and the regulatory mechanisms and tests to assess the functional status of organ systems.
The student should know the basic features of clinical conditions explained at the end of each chapter. This helps the
student in getting ready with the clinical knowledge before he/she enters the portals of hospital.

L Prakasam Reddy
 EARLY CLINICAL EXPOSURE (ECE)
Concept
Early clinical exposure (ECE) to the first professional medical undergraduates is a method adapted by medical educationists to
expose the undergraduate students directly to the patients during their first year course.
It is highly challenging to introduce clinical subjects to first-year undergraduates who are supposed to learn basics in
Physiology, Anatomy and Biochemistry. It is believed that this Early Clinical Exposure will make them appreciate the importance
of first-year subjects as a part of clinical medicine in their medical career.

Methods in Early Clinical Exposure

ECE can be performed by:
1. OPD visits: Students observe how doctor–patient interaction takes place.
2. Visit to the wards: Students observe how doctors, paramedical staff and nursing sisters deal with the inpatients.
3. Case presentation: The students will be given a case presentation about a system-based module.
4. Case discussion: The in charge doctor would explain and discuss the relevant case with the students. For this purpose the
students are taken to the wards.
5. Problem-based learning: A clinical case scenario on a specific topic is created and a discussion may be initiated with the
student active participation.
6. Demonstrating the clinical-based investigations: Investigations recorded from the patients should be explained about
their recording analysis and significance of their variations.

Advantages
1. It creates interest in the undergraduate students and motivates them to think beyond the first year subjects as they read the
disease process.
2. It helps the students to remember the features of the disease, the investigations and the drugs used for the management of
a disease.

Probable ECE Modules as per CBME-2019

1. Acute Myocardial Infarction (STEMI, Non STEMI)
2. Parkinsons Disease (PD)
3. Spinal Injury
4. Type 2-Diabetes Mellitus
5. Acid-Base Disorders
6. Obesity
7. Ascites
8. Chronic Obstructive Pulmonary Disease (COPD)
9. Thyrotoxicosis
10. Acid-peptic Disease
11. Hypertension
12. Jaundice
13. Anemia
14. Cushing Syndrome
 CONTENTS
Preface to the Eighth Edition ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������� vii

Acknowledgments ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ix

Early Clinical Exposure (ECE) ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������� xi

Competencies ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� xxvii

Abbreviations ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ xxxiii

VOLUME 1
Active Transport Processes 37
SECTION I GENERAL PHYSIOLOGY Gibbs-Donnan Equilibrium 41

CHAPTER 1 Introduction to Physiology������������������� 3–10 CHAPTER 5 Bioelectric Potentials������������������������43–52

Introduction 3 Introduction 43
Need for Learning Physiology 3 Significance of Bioelectric Potentials 43
Utility of Physiology 3 Origin 44
Scientists’ Contribution to Physiology 4 Terms Used 44
Resting Membrane Potential 46
CHAPTER 2 Organization of the Body: Cell Structure Local Potential or Graded Potential 47
and Function��������������������������������������������11–26 Action Potential 48
Organization of the Body 11
Cell 12 CHAPTER 6 Body Fluids and Body Water – pH���������53–58
Structure and Functions of a Mammalian Cell 12 Introduction 53
Deoxyribonucleic Acid 20 Body Fluid Compartments 53
Ribonucleic Acid 22 Determination of Body Fluid Volumes 54
Gene Expression 22 Water Balance 55
Cell Junctions 23 Intercompartmental Movement of Water 55
Intercellular Communication 25 Regulation of Tonicity and Volume of Extracellular Fluid 55
ph and Acid-Base Homeostasis 55
CHAPTER 3 Cell Division–Growth–Cell Aging Units for Measuring Concentration of Solutes 56
Necrosis–Apoptosis������������������������������������27–32 Buffer Systems in the Body 57
Introduction 27 Dehydration 57
Cell Division 27 Edema 58
Cell Growth—Differentiation and Maturation 29
Cell Adaptation 29 CHAPTER 7 Homeostasis����������������������������������59–72
Cell Death—Necrosis and Apoptosis 30 Introduction 59
Stem Cells 32 Importance of Homeostasis 59
Body Systems that Participate in Homeostasis 60
CHAPTER 4 Transport Mechanism Across Factors of the Internal Environment to be
Cell Membrane�����������������������������������������33–42 Maintained Homeostatically 60
Introduction 33 Components of Homeostatic System 60
Passive Transport Processes 33 Homeostatic Regulatory Mechanisms 61
xiv Fundamentals of Medical Physiology

Molecular Basis of Muscular Relaxation 116

SECTION II NERVE PHYSIOLOGY Types of Muscular Contractions 116
Gradation of Muscular Activity Factors that
CHAPTER 8 Structure and Function of Neuron����������75–81 Influence Force of Contraction 118
Introduction 75
Recruitment of Motor Units During Muscular Contraction 118
Structure of Neuron 76
Rigor Mortis 119
General Functions of Neurons 78
Heat Rigor 119
Types of Neurons 78
Neuroglia 80 CHAPTER 14 Energy Source for Muscular
Neurotrophins 81
Contraction�������������������������������������������120–122
CHAPTER 9 Properties of a Nerve Fiber – Axon��������82–86 Introduction 120
Properties of a Nerve Fiber 82 O2 Debt 121
Excitability of Nerve During Different Phases of AP 85 Heat Production in the Muscle 121
Metabolism in the Nerve Fibers 85
Heat Production 86 CHAPTER 15 Properties of Skeletal Muscle
and Disorders—Electromyography���������������123–130
CHAPTER 10 Peripheral Nerve – Classification of Properties of Skeletal Muscle 123
Nerve Fibers���������������������������������������������87–89 Velocity of Contraction and Load 125
Structure of Peripheral Nerve Fiber 87 Length-Tension Relation 125
General Features of Nerve Fibers 88 Fatigue 126
Properties of Mixed Nerve Fibers 88 Disorders of Muscles 127
Classification of Nerve Fibers 89 Muscular Dystrophy-Myopathies 128
Effects of Denervation on Skeletal Muscle 129
CHAPTER 11A Nerve Injuries – Degeneration and Electromyography (EMG) 129
Regeneration of Peripheral Nerve�������������������90–93
Introduction 90 CHAPTER 16 Smooth Muscles�������������������������131–142
Types of Nerve Injuries 90 Structure of Smooth Muscle 131
Degeneration in the Neuron 91 Mechanism of Contraction and Relaxation 131
Nerve Regeneration 92 Nerve Supply 132
Transneuronal Degeneration 93 Types of Smooth Muscles 133
Neurogenesis in the CNS 93 Factors that Influence Smooth Muscle 135
Nerve Grafts 93 Denervation Hypersensitivity 136
Complications of Nerve Injuries 93 Cardiac Muscles 136
Peripheral Neuropathy 93

CHAPTER 11B Neuromuscular Junction and Neuromuscular SECTION IV CENTRAL NERVOUS SYSTEM
Blocking Drugs���������������������������������������� 94–104
Neuromuscular Junction (NMJ) 94 CHAPTER 17 Organization of Nervous System������145–151
Mechanism of Transmission at NMJ 95 Introduction 145
Drugs that Influence the Transmission at NMJ 96 Divisions of Nervous System 145
Disorders of Neuromuscular Junction 98 Brain 146
Organization of Brain and Spinal Cord 147
SECTION III MUSCLE PHYSIOLOGY Peripheral Nervous System 150

CHAPTER 18 Synapse�����������������������������������152–160
CHAPTER 12 The Skeletal Muscle���������������������107–113
Introduction 152
Introduction 107
Classification of Synapse 152
Functions of Muscles 107
Structure of a Synapse—Axodendritic 153
Structure of Skeletal Muscle 108
Functions of Synapse 154
Muscle Fiber 108
Sarcotubular System 110 Mechanism of Transmission of Impulse at
Types of Muscle Fibers 111 Synapse (Excitatory) 154
Motor Unit 112 Inhibition of the Transmission at Synapse 155
Chemistry of Skeletal Muscle 112 Excitatory Postsynaptic Potential (EPSP) 155
Inhibitory Postsynaptic Potential (IPSP) 155
CHAPTER 13 Mechanism of Muscular Contraction Fate of Released Neurotransmitter 156
and Relaxation—Molecular Basis����������������114–119 Synaptic Inhibitions 156
Introduction 114 Presynaptic Facilitation 157
Muscular Contraction 114 Properties of Synapse 157
Molecular Basis of Muscular Contraction 115 Synaptic Plasticity 159
 Contents xv

CHAPTER 19 Chemical Transmission in the Spinotectal Tract 206

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Nervous System (Neurotransmitters)������������161–166 Lissauer’s Tract 206
Definitions 161 Spinovestibular Tract 206
Criteria for Neurotransmitter 161 Comma Tract 206
Transport, Release and Mechanism of Action 162 Spinopontine Tract 206
Inactivation of Neurotransmitter 162 Spinoreticular Tracts 206
Classification of Neurotransmitters 162 Spino-olivary Tract 206
Acetylcholine 162 The Lemnisci 206
Biogenic Amines 163
Amino Acid Neurotransmitters 164 CHAPTER 26 Thalamus—A Great Relay Station
Peptide Neurotransmitters 165 for Sensory and Motor Impulses������������������208–212
Purinergic Neurotransmitters 166 Thalamus 208
Other Neurotransmitters 166 Classification of Thalamic Nuclei 209
Functions of Thalamus 211
CHAPTER 20 Reflexes�����������������������������������167–173 Disorders of Thalamus 212
Introduction 167
Reflex Arc 167 CHAPTER 27 Sensory Cortex (Feeling Brain)��������213–215
Classification of Reflexes 168 Introduction 213
Important Reflexes 170 Somatosensory Area I 214
Properties of Reflexes 172 Somatosensory Area II 214
Posterior Parietal Cortex 215
CHAPTER 21 Organization of the Spinal Cord�������174–178 Tests for Sensory Function 215
Introduction 174
Spinal Segments and Spinal Roots 174 CHAPTER 28 Motor Nervous System (Movement
Internal Structure of the Spinal Cord 175 Controlling System) – Corticospinal Tract�������216–222
Arterial Blood Supply 178 Introduction 216
Functions of Spinal Cord 178 Components and Functions of the Motor System 216
Motor Neurons 217
CHAPTER 22 Sensory Receptors�����������������������179–187 Motor Cortex 218
Sensory Nervous System 179 Disorders of Motor Nervous System 222
Sensory Receptors 180
Cutaneous Receptors 181 CHAPTER 29 Extrapyramidal System
Study of Function of a Receptor 185 (Medial Motor System)�����������������������������223–226
Properties of Sensory Receptors 186 Introduction 223
Extrapyramidal Tracts 223
CHAPTER 23 Sensations��������������������������������188–191 General Functions of Extrapyramidal System 225
Introduction 188 Features of Extrapyramidal Lesion 225
Classification of Sensations 188
Coding of Primary Sensations 191 CHAPTER 30 Basal Nuclei������������������������������227–234
Introduction 227
CHAPTER 24 Physiology of Pain�����������������������192–199 Components of Basal Nuclei 227
Introduction 192 Connections of Basal Nuclei 228
Types of Pain 192 Functions of Basal Ganglia 230
Mechanism of Pain Sensation 193 Disorders of Basal Ganglia 232
Benefits of Pain 193
Modulation of Pain Perception 193 CHAPTER 31 Cerebellum�������������������������������235–244
Pathway for Pain Sensation 195 Introduction 235
Centers for Pain Sensation 196 Anatomical Divisions of Cerebellum 235
Pain from Viscera and Face 197 Phylogenetic Divisions 236
Disorders of Pain 198 Functional Divisions 236
Management of Pain 198 Structure of Cerebellum 236
Connections of Cerebellum 240
CHAPTER 25 Ascending Tracts�������������������������200–207 Functions of Cerebellum 241
Introduction 200 Cerebellar Disorders 243
Type of Tracts 200 Tests for Cerebellar Function 244
Dorsal Columns (Tracts of Gracilis and Cuneatus) 201
Spinothalamic Tracts (Anterolateral System) 202 CHAPTER 32 Motor Control – Stretch Reflex –
Trigeminal Pathway 204 Muscle Tone – Gait���������������������������������245–250
Great Ascending Sensory Pathway 205 Introduction 245
Spinocerebellar Tracts—Dorsal and Types of Movements 245
Ventral Spinocerebellar Tracts 205 Levels of Motor Control 246
xvi Fundamentals of Medical Physiology

Stretch Reflex 246 CHAPTER 40 Electroencephalography����������������294–298

Muscle Tone 248 Introduction 294
Gait or Walking 249 Normal EEG Pattern 294
Source of EEG 295
CHAPTER 33 Vestibular Apparatus��������������������251–257 Factors that Influence EEG Waves 297
Introduction 251 Abnormal EEG 297
Vestibular Apparatus 251 Significance of EEG 297
Innervation and Connections of Vestibular Apparatus 255 Evoked Cortical Potentials 297
Functions of Vestibular Apparatus 255 Epilepsy 298
Disorders of Vestibular Apparatus 256
Tests of Vestibular Function 257 CHAPTER 41 Cerebral Hemisphere�������������������299–302
Introduction 299
CHAPTER 34 Posture and Equilibrium����������������258–263 Cerebral Hemispheres 299
Posture 258 Structure of Cerebrum 300
Postural Reflexes 260 Cerebral Cortex 300
White Matter of Cerebrum 300
CHAPTER 35 Experimental and Clinical Conditions Internal Capsule 301
of Spinal Lesions������������������������������������264–273
Hemiplegia 264 CHAPTER 42 Lobes of Cerebrum – Functions��������303–309
Spinal Cord Lesions 265 and Disorders
Paraplegia 268 Parietal Lobe 303
Tabes Dorsalis 269 Temporal Lobe 305
Syringomyelia 270 Occipital Lobe 306
Subacute Combined Degeneration of Spinal Cord 270 Frontal Lobe 307
Effects of Section of Anterior Nerve Roots 271 Prefrontal Lobe 308
Effects of Section of Posterior Nerve Roots 271
Upper and Lower Motor Neuron Lesions 272 CHAPTER 43 Higher Functions of
Disseminated – Multiple Sclerosis (MS) 273 the Nervous System���������������������������������310–317
Spinal Muscular Atrophy 273 Introduction 310
Methods of Study 310
CHAPTER 36 Hypothalamus����������������������������274–280 Learning – Conditioned Reflexes 311
Introduction 274 Memory 311
Functions of Hypothalamus 275 Drugs that Facilitate Memory 314
Disorders of Hypothalamic Function 280 Disorders of Memory 314
Speech – Language 314
CHAPTER 37 Limbic System���������������������������281–284 Expression of Speech 316
Introduction 281 Disorders of Speech 316
Components 281
Important Connections 282 CHAPTER 44 Autonomic Nervous System������������318–326
Functions of the Limbic System 282 Introduction 318
Addiction 284 Divisions of Autonomic Nervous System 318
Sympathetic Nervous System (SNS) 320
CHAPTER 38 Reticular Formation���������������������285–288 Parasympathetic Nervous System – Craniosacral System 322
Introduction 285 Comparison of SNS and PSNS 324
Characteristics of Reticular Formation 285 Enteric Nervous System 324
Components of Reticular Formation 286 Central Control of the Autonomic Nervous System 325
Connections of Reticular Formation 286 Functions of Autonomic Nervous System 325
Neurotransmitters of the Reticular Formation 287 Bedside Tests for ANS 325
Functions of Descending Reticular Formation 287 Features in Autonomic Insufficiency 326
Functions of Ascending Reticular Activation System 288
CHAPTER 45 Brain – Extracellular Fluid and
CHAPTER 39 Sleep���������������������������������������289–293 Cerebrospinal Fluid���������������������������������327–331
Introduction 289 Functional Anatomy 327
Physiological Changes During Sleep 289 Types of Fluids in Brain and Spinal Cord 328
Theories of Sleep 290
Mechanism of Sleep – NREM 291 CHAPTER 46 Blood-Brain Barrier, Blood-CSF
Genesis of REM Sleep 291 Barrier and Circumventricular Organs�����������332–369
Sleep-Wakeful Cycle 292 Introduction 332
Distribution of NREM and REM Sleep 292 Blood-Brain Barrier 332
Sleep Resembling Conditions 292 Blood-Csf Barrier 333
Sleep Disorders 292 Circumventricular Organs 333
 Contents xvii

Variations in Total Leukocyte Count 405

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

SECTION V BLOOD Granulocytes 406
Agranulocytes 409
CHAPTER 47 Composition and Functions of Blood��373–375 Variations in Agranulocytes 412
Introduction 373 Leukemia 412
Composition of Blood 373
Functions of Blood 375 CHAPTER 55 Monocyte – Macrophage System –
Spleen (Reticuloendothelial System)������������413–415
CHAPTER 48 Hemopoiesis������������������������������376–379 Introduction 413
Introduction 376
Origin of Macrophages 413
Sites of Hemopoiesis 376
Spleen 414
Theories of Hemopoiesis 377
Main Phases of Hemopoiesis 377 CHAPTER 56 Immunity and Allergy�������������������416–431
Regulation of Hemopoiesis 377 Introduction 416
Bone Marrow 378 Immune System 416
Innate Immunity 417
CHAPTER 49 Erythrocytes�������������������������������380–383 Acquired Immunity 418
Introduction 380 Humoral Immunity 418
Morphology of RBC 380 Antibodies 420
RBC Count 381 Cell-Mediated Immunity 422
Variations in Morphology of RBCs 382 Complement System 424
Functions of RBCs 382 Cytokines 426
Lifespan of RBC 383 Self-Recognition of Cells 427
Site of RBC Destruction 383 Immune Disorders 427
Fragility of RBC 383 Applications 427
Hemolysis 383 Tissue Grafting and Transplantation 428
Hypersensitivity or Allergy 429
CHAPTER 50 Erythropoiesis����������������������������384–388
Definition 384 CHAPTER 57 Plasma Proteins�������������������������432–436
Site of Erythropoiesis 384 Introduction 432
Stages in RBC Development 385 Origin 433
Changes During Maturation 386 Separation of Plasma Proteins 433
Regulation of Erythropoiesis 386 Functions of Plasma Proteins 434
Plasmapheresis 435
CHAPTER 51 Hemoglobin and Different Types
Changes in Plasma Protein Levels 435
of Jaundice�������������������������������������������389–394
Introduction 389 CHAPTER 58 Platelets – Thrombocytes���������������437–440
Hemoglobin 389 Platelets 437
Fate of RBC and Hemoglobin 391 Thrombopoiesis 437
Jaundice 392 Structure and Chemistry of Platelets 438
Jaundice of Newborn – Physiological Jaundice 393 Properties 438
Van den Bergh Reaction 394 Functions 439
Platelet Disorders 439
CHAPTER 52 Iron Metabolism and Anemia����������395–399
Iron Metabolism 395 CHAPTER 59 Hemostasis�������������������������������441–446
Anemia 397 Introduction 441
Mechanism of Hemostasis 442
CHAPTER 53 Packed Cell Volume or Importance of Blood Coagulation 446
Hematocrit-Blood Indices-Erythrocyte
Sedimentation Rate���������������������������������400–403 CHAPTER 60 Anticoagulants – Hemostatic Agents –
Packed Cell Volume 400 Hemostatic Disorders – Tests���������������������447–453
Blood Indices 401 Introduction 447
Red Cell Distribution Width (RDW) 401 Classification of Anticoagulants 447
Erythrocyte Sedimentation Rate 402 Fibrinolytic System – Clot Lysis 449
Hemostatic Agents in Clinical Practice 449
CHAPTER 54 White Blood Corpuscles Hemophilia 451
(Leukocytes)�����������������������������������������404–412 Tests to Analyze Defects in Blood Clotting and Bleeding 452
Introduction 404
Classification 404 CHAPTER 61 Blood Groups and Transfusion���������454–460
General Features 405 Introduction 454
Leukopoiesis 405 Landsteiner Law 454
xviii Fundamentals of Medical Physiology

Classical ABO System 455 Ventricular Cycle 520

Rh Group System 455 Events during Each Cardiac Cycle 521
MNS System 457 Pressure Changes During Cardiac Cycle 522
Bombay Blood Group 457 Volume Changes of Ventricle 524
Importance of Blood Groups 457 Pressure-Volume Curve 525
Blood Transfusion 457 Arterial Pulse 525
Jugular Venous Pulse 527
CHAPTER 62 Lymphoid Organs and Lymph����������461–465 Apical Impulse (Apex Beat) 527
Lymphatic System – Lymphoid Organs and Lymph 461 Heart Sounds (Phonocardiogram) 527
Lymphoid Organs 461 Stenosis 529
Lymph 463 Incompetence or Insufficiency 529
Lymphatic Duct System 464
CHAPTER 69 Cardiac Output���������������������������530–537
CHAPTER 63 Blood Volume����������������������������466–489 Introduction 530
Introduction 466 Definitions 530
Physiological Variation 466 Distribution 531
Determination 467 Determination 531
Blood Volume Regulation 467 Variations in Cardiac Output 533
Pathological Variation 468 Regulation of Cardiac Output 533
Frank-Starling’s Law 536
SECTION VI CARDIOVASCULAR SYSTEM Cardiac Function Curves 537
Regulation of Cardiac Output 537
CHAPTER 64 Functional Anatomy of the Heart������493–499 CHAPTER 70 Heart Rate – Venous Return –
Introduction 493
Cardiac Reserve�������������������������������������538–542
General Scheme of Circulation 493
Heart Rate 538
Functions of CVS 494
Venous Return (VR) 541
Heart 494
Cardiac Reserve 542
Mechanism of Contraction and Relaxation 499

CHAPTER 65 Properties of Cardiac Muscle����������500–504 CHAPTER 71 Regulatory Mechanisms of

Introduction 500 Heart and Vascular Function����������������������543–553
Excitability 500 Introduction 543
Conductivity 502 Local Autoregulatory Mechanisms 544
Contractility 502 Systemic Regulatory Mechanisms 545
Auto Rhythmicity 502 Cardiovascular Reflexes 548
Refractory Period (RP) 503 Summary - Regulatory Mechanisms of Heart
Fatiguability 504 and Vascular Function 553
Length-Tension Relation 504
CHAPTER 72 Vascular System and
CHAPTER 66 Conducting System of the Heart�������505–508 Hemodynamics��������������������������������������554–560
Introduction 505 Circulation of Blood in the Vascular System 554
Components of Conducting System 505 General Structure of Blood Vessels 554
Origin of Cardiac Impulse 507 Functional Classification of Vessels 555
Spread of Cardiac Impulse 508 Hemodynamics 555
Disorders of Conducting System 508
CHAPTER 73 Capillary Circulation
CHAPTER 67 Electrocardiogram�����������������������509–518 (Microcirculation)�����������������������������������561–564
Introduction 509 Introduction 561
ECG Leads 510 Capillaries 561
ECG Paper 511 Transcapillary Exchange 563
Normal ECG 511 Tissue Fluid 564
Clinical Applications of ECG 513
Electrocardiographic Changes in Clinical Conditions 513 CHAPTER 74 Arterial Blood Pressure�����������������565–570
His Bundle Electrogram 515 Significance of Blood Pressure 565
Cardiac Arrhythmias 515 Definitions 565
Recording of BP 566
CHAPTER 68 Cardiac Cycles���������������������������519–529 Factors Maintaining Arterial Blood
Introduction 519 Pressure-Determinants 567
Atrial Cycle 520 Physiological Variations 569
 Contents xix

CHAPTER 75 Regulation of Arterial Blood Determination of Cerebral Blood Flow 588

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Pressure����������������������������������������������571–579
Introduction 571
Short-term or Rapid-Acting or
Neural Regulatory Mechanisms 571
Intermediate Arterial Blood Pressure
Regulatory Mechanisms 574
Long-Term Arterial Blood Pressure Regulatory Mechanism or
Renal Regulation 574
Hormonal Regulation of Arterial Blood Pressure 576
Disorders of Blood Pressure 576
Venous Pressure 578
CHAPTER 76 Regional Circulations
(Coronary Circulation)������������������������������580–586
Introduction 580
Arterial Supply to the Heart 580
Venous Drainage of the Heart 581
Special Features of Coronary Circulation 581
Determination of Coronary Blood Flow (CBF) 582
Determinants of Coronary Blood Flow 582
Regulation of Coronary Blood Flow 584
Factors that Affect Coronary Blood Flow 585
CHAPTER 77 Regional Circulations
(Cerebral Blood Flow)������������������������������587–590
Introduction 587
Arterial Blood Supply to the Brain 587
Venous Drainage of the Brain 587
Nerve Supply of Brain 588
Regulation of Cerebral Circulation 588
Regional Blood Flow in Brain 589
CHAPTER 78 Regional Circulations
(Cutaneous Circulation)����������������������������591–593
Introduction 591
Special Features 591
Measurement of Cutaneous Blood Flow 592
Regulation of Cutaneous Blood Flow 592
Response of the Skin to Mechanical Trauma 592
CHAPTER 79 Regional Circulations—
Fetal Circulation and Splanchnic Circulation���594–597
Fetal Circulation 594
Neonatal Circulation and Respiration 596
Splanchnic Circulation 596
CHAPTER 80 Cardiac Function Tests������������������598–599
Introduction 598
CHAPTER 81 Moderate Hemorrhage������������������600–603
Introduction 600
Compensatory Reactions 601
CHAPTER 82 Heart Failure and Shock –
Effects of Gravity������������������������������������604–634
Heart Failure 604
Circulatory Shock 605
Effect of Gravity 609

VOLUME 2
Regulation of Gastric Secretion 655
SECTION VII GASTROINTESTINAL SYSTEM Gastric Mucosal Barrier 658
Tests for Gastric Function 659
CHAPTER 83 Functional Anatomy of
Gastrointestinal Tract�������������������������������637–641 CHAPTER 86 Pancreas����������������������������������663–669
Parts of Human Digestive Canal 637 Introduction 663
Functions of Alimentary Canal 638 Structure of Pancreas 663
General Structure of Alimentary Canal 638 Pancreatic Juice 664
Nerve Supply 639 Tests for Pancreatic Function 668
General Regulatory Mechanisms of GIT Secretions 641
CHAPTER 87 Liver, Bile and Gallbladder������������670–678
CHAPTER 84 Mouth – Esophagus – Liver 670
Salivary Glands��������������������������������������642–647 Bile 672
Gallbladder 675
Mouth 642
Liver Transplant 677
Esophagus 642
Liver Function Tests 677
Salivary Glands 642
Saliva Secretion – Saliva 645 CHAPTER 88 Small Intestine���������������������������679–682
Functional Anatomy 679
CHAPTER 85 Stomach�����������������������������������648–662 Succus Entericus – Intestinal Juice 680
Structure 648 Functions of Small Intestine 682
Gastric Glands 649
Functions of Stomach 651 CHAPTER 89 Large Intestine���������������������������683–688
Composition and Functions of Gastric Juice 651 Functional Anatomy 683
Methods of Study of Gastric Secretion 653 Functions 684
xx Fundamentals of Medical Physiology

Movements of Large Intestine 684 Work of Breathing 742

Diarrhea 688 Stability of Alveoli 745
Laxatives 688
Gas in the GIT 688 CHAPTER 95 Ventilation��������������������������������748–752
Rectal Administration of Drugs 688 Introduction 748
Appendix 688 Types of Ventilation 748
Lung Volumes and Capacities 750
CHAPTER 90 Digestion and Absorption of Foods����689–697 Sampling of Alveolar Air 750
Introduction 689 Uniformity of Alveolar Ventilation 750
Digestion and Absorption of Carbohydrates 689 Perfusion of Lungs 751
Digestion and Absorption of Proteins 692 Ventilation-Perfusion Ratio 751
Digestion and Absorption of Fats 693
Absorption of Vitamins, Water and Electrolytes 696 CHAPTER 96 Diffusion of Gases in
the Lung and Tissues�������������������������������753–756
CHAPTER 91 Gastrointestinal Motility����������������698–708 Diffusion of Gases in the Lungs 753
Overview 698 Diffusion Capacity of Lungs (DC) 755
Mechanisms Influencing GIT Motility 698 Diffusion of Gases at Tissue Level 755
Chewing 699 Respiratory Quotient (RQ) 756
Deglutition or Swallowing 699 COVID-19 756
Gastric Motility 702
Small Intestine Movements 705 CHAPTER 97 Pulmonary Function Tests��������������757–763
Ileocecal Valve 707 Introduction 757
Gut-Brain Axis 707 Importance of Pulmonary Function Tests 757
Classification 758
CHAPTER 92 Gastrointestinal Hormones�������������709–728
Introduction 709 CHAPTER 98 Transport of Oxygen (O2)����������������764–768
Gastrin 710 Introduction 764
Cholecystokinin-Pancreozymin (CCK-PZ) 710 Uptake of O2 by the Blood in the Lungs 764
Secretin 711 Transport of O2 in the Blood 765
Ghrelin (GH-REL-IN) (Growth Hormone-Releasing-Incretin) 711 Delivery of O2 to the Tissue 765
Gastric Inhibitory Polypeptide (GIP) 711 Dissociation Curves of HBO2, HBFO2 MYGO2 and HBCO 767
Vasoactive Intestinal Polypeptide (VIP) 711 O2 Transport during Exercise 768
Motilin 711
Chymodenin 713 CHAPTER 99 Transport of Carbon Dioxide�����������769–772
P Substance 713 Introduction 769
Bombesin 713 Uptake of CO2 by the Blood 769
Somatostatin 713 Transport of CO2 in the Blood 770
Gastrin Releasing Peptide (GRP) 713 Delivery of CO2 to the Lungs 770
Neurotensin 713 CO2 Dissociation Curve 771
Pancreatic Polypeptide 714
GLP-1 (Glucagon-Like Peptide-1) 714 CHAPTER 100 Neural Regulation of Respiration����773–778
Guanylin 714 Introduction 773
Neural Regulation of Respiration 773
Genesis of Respiratory Rhythm 776
SECTION VIII RESPIRATION Factors Affecting Respiratory Center 776
Reflexes that Modify Respiratory Process 778
CHAPTER 93 Functional Anatomy of Respiratory System –
Blood Supply – Functions��������������������������731–737 CHAPTER 101 Chemical Regulatory Mechanisms��779–784
Introduction 731 Introduction 779
Functional Anatomy 731 Peripheral Chemoreceptors 779
Respiratory Parenchyma 733 Central Chemoreceptors 780
Pulmonary Circulation 734 Ventilatory Responses to O2, CO2 and H+ Ion 781
Pulmonary Capillary Wedge Pressure 735 Effect of Interaction of Hypoxia (↓PO2) and
Functions of Respiratory System 736 Hypercapnia (↑PCO2) on Ventilation 783
Regulation of Respiration during Exercise 783
CHAPTER 94 Mechanics of Breathing�����������������738–747 Respiration during Sleep 784
Introduction – Breathing 738 Disorders Associated with the Regulation of Respiration 784
Mechanism of Inspiration 738
Mechanism of Expiration 740 CHAPTER 102 Hypoxia����������������������������������785–788
Types of Breathing 740 Introduction 785
Pressure Changes during Breathing 741 Hypoxic Hypoxia 785
 Contents xxi

Anemic Hypoxia 786

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Stagnant Hypoxia (Ischemic Hypoxia) 786
SECTION IX RENAL PHYSIOLOGY
Histotoxic Hypoxia 786
Effects of Hypoxia 787 CHAPTER 107 Urinary System—
Oxygen Therapy in Different Types of Structure of Kidney—Nephron��������������������827–832
Hypoxia 787 Introduction 827
Toxic Effects of 100% O2 Therapy 787 Urinary System 827
Functions of Kidney or Nephron 828
CHAPTER 103 Pathophysiological States������������789–795 Structure of the Kidney 828
Asphyxia 789 Nephron 829
Cyanosis 790 Types of Nephrons 832
Periodic Breathing 790
CHAPTER 108 Renal Blood Flow (RBF)���������������833–836
Kussmaul Breathing 791
Arterial Blood Supply 833
Gasping 791
Venous Drainage 833
Abnormal Respiratory Breathing 791 Measurement of Renal Blood Flow 834
Pneumothorax 793 Renal Clearance 834
Hydrothorax 793 Special Features of Renal Circulation 835
Pleural Effusion 793 Regulation of Renal Blood Flow 836
Chylothorax 793
Hemothorax 793 CHAPTER 109 Urine Formation –
Bronchiectasis 793 Glomerular Filtration�������������������������������837–842
Atelectasis 793 Urine Formation 837
Emphysema 793 Formation of Glomerular Filtrate 837
Cystic Fibrosis 793 Determinants of GFR (Factors that Influence GFR) 838
Apnea 793 Regulation of GFR 839
Hyperventilation 794 Determination of GFR 840
Breath Holding 794 Regulation of Renal Blood Flow (RBF) and
Hypoventilation 794 Glomerular Filtration Rate (GFR) 841
Hypercapnia (Hypercarbia) 794
Hypocapnia (Hypocarbia) 794 CHAPTER 110 Reabsorption of Substances from
Dyspnea 794 Filtrate and Secretion�������������������������������843–849
Orthopnea 795 Introduction 843
Bronchial Asthma 795 Methods of Study of Tubular Function 843
Carbon Monoxide Poisoning 795 Modes of Reabsorption 844
Idiopathic Pulmonary Fibrosis 795 Regulation of Tubular Reabsorption 844
Effects of Chronic Smoking on Reabsorption from Proximal Convoluted Tubule (PCT) 844
Reabsorption from Loop of Henle (LH) 846
Respiratory Efficiency 795
Reabsorption from Distal Nephron (DCT and CD) 847
CHAPTER 104 High Altitude Physiology��������������796–799 Hormones that Influence Reabsorption from Tubules 848
Introduction 796 Secretion of Substances into Urine 849
Low Atmospheric Pressure 796
CHAPTER 111 Acidification of Urine������������������850–853
Cold and Dry Weather 797
Introduction 850
UV Light Rays and Other Light Rays 797
Reabsorption of HCO3– 850
Effects of Hypoxia on Body Systems 797 Secretion of H+ Ion 850
Acclimatization to High Altitude 798 Role of Kidney in Acidosis and Alkalosis 853
Clinical Conditions Associated
with High Altitude 798 CHAPTER 112 Concentrating and Diluting
Mechanisms of Urine�������������������������������854–858
CHAPTER 105 Deep Sea Physiology������������������800–802 Introduction 854
Introduction 800 Production of Concentrated Urine 854
Hazards of Deep Sea Diving 800 Production of Dilute Urine 858
SCUBA 802
Diving Reflex 802 CHAPTER 113 Regulation of Water by Kidney�������559–862
Drowning 802 Introduction 859
Water Handling by the Kidney 859
CHAPTER 106 Artificial Ventilation and Obligatory Type of Absorption 860
Cardiopulmonary Resuscitation�������������������803–824 Facultative Type of Absorption 860
Artificial Ventilation and CPR 803 Factors that Influence H2O Absorption 861
Methods of CPR 803 Diuresis 861
Cardiopulmonary Resuscitation (CPR) 805 Diuretics 862
xxii Fundamentals of Medical Physiology

CHAPTER 114 Regulation of Electrolytes�������������863–865 Assay of Hormones 915

Na+ Regulation 863 Endocrine Glands 915
Regulation of K+ 864
Regulation of Chloride 865 CHAPTER 120 Hypothalamus—Pituitary Gland�����919–935
Hypothalamus 919
CHAPTER 115 Endocrinal Role of Kidneys�����������866–870 Importance of Hypothalamico­hypophyseal Portal System 920
Introduction 866 Pituitary Gland-Hypophysis 920
Renal Erythropoietin 866 Anterior Pituitary Gland-Adenohypophysis 921
Renin (Renin-Angiotensin system – RAS) 867 Hormones 921
1,25-(OH)2 Cholecalciferol (Calciferol) 869 Growth Hormone—Somatotrophic Hormone 927
Thrombopoietin 870 Physiology of Growth 929
Prostaglandins 870 Neurohypophysis—Posterior Pituitary Gland 929
Kallikrein-Bradykinin System 870 Disorders of Pituitary and Hypothalamus 932
Other Hormones 870
CHAPTER 121 Thyroid Gland���������������������������936–947
CHAPTER 116 Renal Function Tests – Introduction 936
Renal Failure – Artificial Kidney������������������871–875 Structure 936
Biosynthesis and Secretion of Thyroid Hormones 937
Renal Function Tests 871
Regulation of Thyroid Hormone Secretion 939
Renal Failure 873
Mechanism of Action at Cellular Level 940
Abnormal Substances of Urine 873
Actions (Functions) of Thyroid Hormones 940
Dialysis 874
Tests for Thyroid Function 943
Hemodialysis (Artificial Kidney) 874
Disorders of Thyroid Function 943
Kidney Transplant 875
Management of Thyroid Disorders 947
CHAPTER 117 Urinary Tract—Micturition������������876–895
CHAPTER 122 Bone Physiology—
Functional Anatomy of Urinary Tract 876
Nerve Supply 877
Parathyroid Hormone�������������������������������948–959
Bone Physiology 948
Physiology of Micturition 878
Functions of Bones 950
Bone Disorders 951
SECTION X SKIN Parathyroid Gland 951
Disorders of Parathyroid Hormone 954
CHAPTER 118 Structure and Functions of Skin������899–904 Calcitonin (Thyrocalcitonin) 954
Introduction 899 Calcium and PO4 Homeostasis 954
Structure of Skin 899 Relation between Plasma Ca+ and PO43– 956
Nerve Fibers 901 Disorders of Calcium and PO43– Homeostasis 958
Blood Supply 901 Paget’s Disease (Osteitis Deformans) 959
Glands of the Skin 901
CHAPTER 123 Suprarenal Gland—Adrenal Cortex��960–970
Problems of Skin 902
Introduction 960
Functions of Skin 902 Adrenal Cortex 960
Color of the Skin 903 Glucocorticoids 961
Psoriasis 904 Mineralocorticoids 966
Burns 904 Disorders of Adrenal Cortex 967
Sunburn 904 Adrenal Cortex Function Tests 970
Skin Graft 904
CHAPTER 124 Adrenal Medulla—
SECTION XI ENDOCRINE PHYSIOLOGY General Adaptation Syndrome��������������������971–977
Adrenal Medulla 971
Biosynthesis of Catecholamines 972
CHAPTER 119 General Introduction to Regulation of Adrenal Medullary Secretion 975
Endocrine Glands������������������������������������907–918 Disorders of Catecholamine Secretion 975
Introduction 907 Tests for Sympatheticoadrenal System 976
Endocrines 908 Stress and General Adaptation Syndrome (GAS) 976
Hormones 908
Relation Between Endocrines and CNS 909 CHAPTER 125 Endocrine—Pancreas������������������978–983
Regulation of Hormone Secretion 909 Introduction 978
Methods of Study of Endocrines 910 Insulin 979
Hormonal Actions 911 Glucagon 982
Hormones used for Therapeutic Purposes 914 Pancreatic Polypeptide 983
General Functions of Hormones 914 Somatostatin 983
Basic Causes of Endocrine Disorders 915 Amylin 983
 Contents xxiii

CHAPTER 126 Blood Glucose Homeostasis����������984–989 CHAPTER 134 Menstrual Cycle

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Introduction 984 (Endometrial Cycle)—Fertilization������������1048–1053
Blood Sugar Level 984 Introduction 1048
Role of Hormones in the Homeostasis of Blood Glucose 985 Definition 1048
Nervous Regulation of Blood Glucose Level 986 Phases of Menstrual Cycle 1049
Disorders 986 Hormonal Cycle 1050
Glucose Tolerance Test (GTT) 989 Fertilization 1051
Implantation of the Zygote (Nidation) 1052
CHAPTER 127 Other Endocrine Glands— Ectopic Pregnancies 1052
Local Hormones����������������������������������� 990–1016 Perimenopause and Menopause 1053
Thymus 990 Menopausal Syndrome 1053
Pineal Gland 990
Hormones of the Heart (Natriuretic Peptides) 991 CHAPTER 135 Pregnancy and Pregnancy
Hormones of Kidney 992 Diagnostic Tests����������������������������������1054–1058
Local Hormones 992 Pregnancy 1054
Pregnancy Diagnostic Tests 1056
SECTION XII REPRODUCTION Pregnancy—Psychological and Psychiatric Disorders 1058

CHAPTER 136 Parturition—Placenta��������������1059–1063

CHAPTER 128 Development of Gonads— Introduction 1059
Puberty���������������������������������������������1019–1025 Stages of Parturition 1059
Introduction 1019 Initiation of Labor 1060
Sex Determination 1019 Mechanism of Parturition 1060
Human Chromosomes—Karyotyping 1020 Placenta 1061
Development of Gonads 1021
Onset of Puberty 1023 CHAPTER 137 Lactation������������������������������1064–1067
Introduction 1064
CHAPTER 129 Male Reproductive System— Structure of Mammary Gland 1064
Functional Anatomy������������������������������1026–1029 Development of Breast Gland 1064
Organs 1026 Lactation 1065
Primary Sex Organ 1026 Importance of Lactation 1067
Accessory Sex Organs 1028 Composition of Milk 1067
Psychological and Psychosocial Changes During Puberty 1029
CHAPTER 138 Contraception������������������������1068–1072
CHAPTER 130 Spermatogenesis��������������������1030–1034 Introduction 1068
Introduction 1030 Need for Contraception 1068
Stages in the Spermatogenesis 1030 Principles in Contraception 1069
Spermatozoa 1031 Methods of Contraception 1069
Regulation of Spermatogenesis 1032
Semen 1033 CHAPTER 139 Sex Hormones�����������������������1073–1080
Estrogen 1073
CHAPTER 131 Male and Female Sexual Act������1035–1037 Progesterone 1076
Male Sexual Act 1035 Testosterone 1077
Female Sexual Act 1036 Other Ovarian and Testicular Hormones 1079
Male Sexual Disorders 1036 Gonadotropins 1080
Contraception in Male 1037
CHAPTER 140 Fetoplacental Unit – Infertility –
CHAPTER 132 Female Reproductive System— Cloning of Mammal – Test Tube Baby��������1081–1098
Functional Anatomy������������������������������1038–1041 Fetoplacental Unit 1081
Introduction 1038 Infertility 1082
Female Sex Organs 1038 Tests to Assess Fertility Status 1082
Primary Sex Organ 1040 Cloning of a Mammal 1082
Technique of Making a Baby (Test Tube Baby – IVF) 1083
CHAPTER 133 Oogenesis—Ovarian Cycle��������1042–1047
Introduction 1042
Changes in the Fetal Ovary up to Birth 1042 SECTION XIII PHYSIOLOGY OF SPECIAL SENSES
Changes from Postnatal to Puberty 1043
Postpubertal Changes 1043 CHAPTER 141 Gustation (Taste)��������������������1101–1104
Sexual Cycles in Female 1043 Introduction 1101
Cyclical Changes in Cervix and Vagina 1046 Functional Anatomy 1102
xxiv Fundamentals of Medical Physiology

Taste Pathway 1102 CHAPTER 150 Basic Optics and Image Forming
Physiology of Taste Sensation 1103 Mechanism—Visual Acuity—Defects���������1142–1148
Disorders of Taste 1104 Principles of Optics 1142
Types of Lenses 1142
CHAPTER 142 Olfaction (Smell)��������������������1105–1108 Image Formation by a Convex Lens 1143
Functional Anatomy of Olfactory System 1105
Formation of Image on the Retina 1144
Smell Pathway 1106
Visual Acuity 1144
Tests for Olfaction 1107
Defects of Image Formation Mechanism 1145
Special Features of Smell Pathway 1107
Optical Aberrations 1148
Importance of Olfaction 1107
Physiology of Smell Sensation 1107 CHAPTER 151 Retina—Visual Receptors���������1149–1153
Disorders of Smell 1108 Retina 1149
Electroretinogram (ERG) 1152
CHAPTER 143 Audition—External and
Visual Receptors 1152
Middle Ear�����������������������������������������1109–1112
Audition 1109 CHAPTER 152 Visual Pathway—Field of Vision��1154–1159
External Ear 1109 Visual Pathway 1154
Middle Ear (Tympanic Cavity) 1110 Visual Centers 1155
Connections of Visual Pathway 1156
CHAPTER 144 Inner Ear—Organ of Corti����������1113–1117
Field of Vision 1156
Inner Ear 1113
Effect of Lesion on Visual Pathway at
Organ of Corti 1115
Different Levels 1157
Mechanism of Activation of Hair Cells 1116
Effect of Lesion on Visual Cortical Areas 1159
Function of Hair Cells 1116

CHAPTER 145 Auditory Pathway— CHAPTER 153 Mechanism of Visual Processing��1160–1163

Response of Receptors 1160
Electrical Potentials from Cochlea������������1118–1121
Response of Bipolar Cells 1161
Auditory Pathway 1118
Processing at LGN 1162
Electrical Potentials from Cochlea 1120
Processing by Visual Cortex 1162
CHAPTER 146 Physical Properties of Sound – Depth (Distance) Perception (Stereopsis) 1163
Mechanism of Hearing��������������������������1122–1126
CHAPTER 154 Adaptation of the Eye to
Introduction 1122
Characteristics of Sound 1122 Dark and Light Environment��������������������1164–1166
Mechanism of Hearing 1123 Introduction 1164
Masking 1126 Dark Adaptation 1164
Auditory Cortex 1126 Light Adaptation 1165
Critical Fusion Frequency (CFF) 1166
CHAPTER 147 Disorders of Hearing—
Hearing Tests�������������������������������������1127–1130 CHAPTER 155 Color Vision��������������������������1167–1171
Introduction 1127 Introduction 1167
Hypoacusis 1127 Characteristics of Light 1167
Syndromes 1128 Laws of Color Vision 1168
Hearing Tests 1128 Theories of Color Vision 1168
Treatment of Deafness 1129 Physiological Basis of Color Vision 1169
Lateral Geniculate Nucleus (LGN) 1169
CHAPTER 148 Vision—Functional Anatomy of Color Blindness 1169
the Eye���������������������������������������������1131–1137 Tests for Color Vision 1170
Introduction 1131 Importance of Color Vision 1171
Functional Anatomy of Eyeball 1132
Lacrimal Apparatus 1136 CHAPTER 156 Movements of the Eyeball—
Tests for Visual Function������������������������1172–1188
CHAPTER 149 Pupillary Reflexes— Introduction 1172
Accommodation����������������������������������1138–1141 Muscles of the Eyeball 1172
Introduction 1138 Conjugate Eye Movements 1173
Light Reflex 1138 Control of Eye Movements 1173
Pupillary Dilatation 1139 Blind Sight 1174
Accommodation 1139 Cortical Blindness 1174
Abnormal Pupillary Reflexes 1141 Tests for Visual Function 1174

SECTION XIV INTEGRATED PHYSIOLOGY
CHAPTER 1 Regulation of Body Temperature –
Adaptation to Hot and Cold Environment –
Fever – Hypothermia – Frostbite –
Heat Stroke����������������������������������������1191–1198
Introduction 1191
Normal Body Temperature 1192
Physiological Variations 1192
Heat Balance 1192
Regulation of Body Temperature 1194
Temperature Regulation in the Newborn 1196
CHAPTER 2 Cardiorespiratory Changes
During Exercise – Benefits of Regular
Exercise – Cardiovascular Changes�����������1199–1207
Introduction 1199
Acute or Immediate Changes 1200
Long-term (Training) Effects of Exercise 1203
Exercise Under Hot and Cold Environment 1203
Effects of Isometric Exercise on
Cardiorespiratory Adjustments 1204
Respiratory Changes in Muscular Exercise 1204
Other Changes in the Body 1205
Benefits of Regular Exercise on the Body (Training) 1206
Long-term Benefits of Regular Exercise on
the Body (Training) 1207
Benefits of Exercise During Pregnancy and
Post-Pregnancy 1207
CHAPTER 3 Physiological Consequences of
Sedentary Lifestyle – Obesity – Nutrition�����1208–1217
What is Sedentary Lifestyle? 1208
Obesity 1209
Fitness – Different – Easy 1211
Management of Obesity 1212
Obesity – Mental Health Problems 1212
Six Super Principles for Burning Calories and
Maintaining Body Weight 1213
Nutrition 1213
Nutrients 1214
Milk 1216
CHAPTER 4 Physiology of Aging –
Free Radicals – Antioxidants�������������������1218–1222
Introduction 1218
Theories of Aging 1218
Common Diseases of Old Age 1220
Congenital Aging Disorders 1221
Free Radicals 1221
Antioxidants 1222
CHAPTER 5 Concept of Brain Death –
Implications���������������������������������������1223–1224
Concept of Brain Death 1223
CHAPTER 6 Physiological Effects of
Yoga and Meditation�����������������������������1225–1231
Introduction 1225
Contents xxv
Yoga 1225
FUNDAMENTALS OF MEDICAL PHYSIOLOGY
Types of Yogic Practices 1226
Benefits of Yoga Practice 1230
Yoga in Health and Disease 1231
CHAPTER 7 Fetal and Neonatal Physiology�������1232–1236
Developmental Stages of a Fetus 1232
Fetal Growth 1232
Fetal Circulation 1233
Neonatal Physiology 1233
CHAPTER 8 Physiology of Acid-Base
Homeostasis��������������������������������������1237–1241
Concept of pH and H+ Concentration 1237
Henderson-Hasselbalch Equation (1908) 1237
Blood Buffers 1238
Source of Acids 1238
Source of Alkali 1238
Defence Against Changes in H+ Ion Concentration 1238
Disturbances of Acid-Base Status 1239
Clinical Evaluation of Disturbances in
Acid-Base Status – Anion Gap 1241
CHAPTER 9 Regulation of Composition Osmolality
and Volume of Body Fluids (ECF)��������������1242–1246
Introduction 1242
Regulation of Composition 1242
Regulation of Osmolality (Tonicity) of ECF 1243
Role of Osmoreceptors 1243
Role of Aldosterone 1244
Regulation of Body Fluid Volume of ECF 1244
Disorders of Volume and Osmolality of Body Fluid 1246
CHAPTER 10 Artificial Respiration –
Basic Life Support – Cardiopulmonary –
Resuscitation (CPR)�����������������������������1247–1250
Cardiopulmonary Arrest 1247
Methods of CPR 1248
CHAPTER 11 Physiology of Growth –
Growth Curves������������������������������������1251–1256
Growth 1251
Behavioral Development 1254
Hyperfunction of Anterior Pituitary 1254
Growth Disorders 1254
CHAPTER 12 Cytological Methods and their
Applications in Clinical Care and Research��1257–1260
Cytological Methods 1257
CHAPTER 13 COVID-19�������������������������������1261–1262
Introduction 1261
CHAPTER 14 Acquired Human Immunodeficiency
Syndrome������������������������������������������1263–1266
Acquired Immunodeficiency Syndrome 1263
Virology of HIV 1264
Pathogenesis of HIV 1264
Clinical Course of AIDS 1265
Diagnosis of AIDS 1266
xxvi Fundamentals of Medical Physiology

APPENDIX III Physiological Problems and

APPENDICES
Solutions�������������������������������������������1279–1282

APPENDIX I Clinical Case Scenario and

INDEX���������������������������������������������������������������������1283–1322
Solution��������������������������������������������1269–1275

APPENDIX II Numerical Formulas for

Quick Review��������������������������������������1276–1278
 COMPETENCIES
Competency-Based Undergraduate Curriculum for the Indian Medical Graduate

CODE COMPETENCY CHAPTER

General Physiology
PY1.1 Describe the structure and functions of a mammalian cell 2 and 63 (Vol. 1)

PY1.2 Describe and discuss the principles of homeostasis 7 (Vol. 1)

PY1.3 Describe intercellular communication 2 (Vol. 1)

PY1.4 Describe apoptosis – programmed cell death 3 (Vol. 1)

PY1.5 Describe and discuss transport mechanisms across cell membranes 4 (Vol. 1)

PY1.6 Describe the fluid compartments of the body, its ionic composition and measurements 6 (Vol. 1), 9 (Vol. 2–Int. Phy.)

PY1.7 Describe the concept of pH and Buffer systems in the body 6 (Vol. 1), 9 (Vol. 2–Int. Phy.)

PY1.8 Describe and discuss the molecular basis of resting membrane potential and action 5 (Vol. 1)
potential in excitable tissue
PY1.9 Demonstrate the ability to describe and discuss the methods used to demonstrate the 12 (Vol. 2–Int. Phy.)
functions of the cells and its products, its communications and their applications in Clinical
care and research.
Hematology
PY2.1 Describe the composition and functions of blood components 47 (Vol. 1)

PY2.2 Discuss the origin, forms, variations and functions of plasma proteins 57 (Vol. 1)

PY2.3 Describe and discuss the synthesis and functions of Hemoglobin and explain its breakdown. 51 (Vol. 1)
Describe variants of hemoglobin
PY2.4 Describe RBC formation (erythropoiesis and its regulation) and its functions 48, 49 and 50 (Vol. 1)

PY2.5 Describe different types of anemias and Jaundice 52 (Vol. 1)

PY2.6 Describe WBC formation (granulopoiesis) and its regulation 54 and 55 (Vol. 1)

PY2.7 Describe the formation of platelets, functions and variations. 58 (Vol. 1)

PY2.8 Describe the physiological basis of hemostasis and, anticoagulants. Describe bleeding and 59 and 60 (Vol. 1)
clotting disorders (Hemophilia, purpura)
PY2.9 Describe different blood groups and discuss the clinical importance of blood grouping, 61 (Vol. 1)
blood banking and transfusion
PY2.10 Define and classify different types of immunity. Describe the development of immunity and 56 (Vol. 1)
its regulation
PY2.11 Estimate Hb, RBC, TLC, RBC indices, DLC, Blood groups, BT/CT Topic for Practicals
 ABBREVIATIONS
1, 25(OH)2 CCF 1,25–dihydroxy cholecalciferol cAMP Cyclic AMP
2,3-DPG 2,3-diphosphoglycerate Cb Carotid body
5HT 5-hydroxytryptamine CBG Corticosteroid binding globulin
ABP Androgen binding protein CCK-PZ Cholecystokinin pancreozymin
AC Apneustic center CCM Counter current mechanism
ACE Angiotensin converting enzyme CFU (E) Colony forming unit (erythrocytic)
Ach Acetylcholine CIC Cardioinhibitory center
Ache Acetylcholinesterase CL Corpus luteum
ACTH Adrenocorticotrophic hormone CLIP Corticotrophin like intermediate lobe peptide
ADH Antidiuretic hormone CN Caudate nucleus
ADP Adenosine diphosphate CO Cardiac output
Adre Adrenaline COHb Carboxyhemoglobin
AHC Anterior horn cell COMT Catechol-O-methyl transferase
ANP Atrial natriuretic polypeptide CP Creatine phosphate
ANS Autonomic nervous system CPK (cK) Creatine phosphokinase
AP Action potential CRH Corticotrophin releasing hormone
APC Antigen presenting cells CRO Cathode ray oscilloscope
APUD cells Amino precursor uptake and decarboxylation CS syndrome Carotid sinus syndrome
ARAS Ascending reticular activating system CS Conditioned stimulus
ARDS Adult respiratory distress syndrome CSF Cerebrospinal fluid
ARP Absolute refractory period CVC Cardiovagal center
ARP Argyll-Robertson pupil DAG Diacylglycerol
ATP Adenosine triphosphate DBP Diastolic blood pressure
AV block Atrioventricular block DC Diffusion capacity
AV node Atrioventricular node DCN Dorsal cochlear nucleus
BAO Basal acid output DCT Distal convoluted tubule
BBB Blood brain barrier DE Diffusion co-efficient
BBB Bundle branch block DHCC Dihydroxy cholecalciferol
BER Basal electric rhythm DHEA Dehydroepiandrosterone
BFU (E) Burst forming unit (erythrocytic) DI Dyspneic index
BMI Body mass index DN Dentate nucleus
BMR Basal metabolic rate DNA Deoxyribonucleic acid
CA Carbonic anhydrase DNV Dorsal nucleus of vagus
CAC Cardioacceleratory center DOPA Dihydroxyphenyl alanine
CAM Cell adhesion molecules DRG Dorsal respiratory group
 S E CT I O N I

General Physiology

Cell says, “I am the real worker. All the body activities are the outcome of my hard work.”
Living things consist of one or more cells. Each cell can live independently of the rest.
Cells can arise only from the other cells.

SECTION OUTLINE
Chapter 1 
Introduction to Physiology Chapter 4 Transport Mechanism Across
Chapter 2 
Organization of the Body: Cell Membrane
Cell Structure and Function Chapter 5 Bioelectric Potentials
Chapter 3 
Cell Division–Growth–Cell Aging Chapter 6 Body Fluids and Body Water – pH
Necrosis–Apoptosis Chapter 7 Homeostasis
 Eighth Edition

L Prakasam Reddy MD
Former Associate Professor
Department of Physiology
Kamineni Institute of Medical Sciences
Nalgonda, Telangana, India

Contributors
L Gowri Sankar Reddy
Vidya Reddy
L Dhanalakshmi
Naren Prakash Reddy
 PREFACE TO THE EIGHTH EDITION
It is a pleasure to bring out the eighth edition of LPR Fundamentals of Medical Physiology in a completely revised and
student-friendly format. This edition has been thoroughly updated based on the latest Competency-Based Medical Education
(CBME) curriculum. The entire subject of Physiology is divided into competencies and sub-competencies. Scenario-based
and task-based questions are given at the end of each section to enable the students to do the self-assessment test and appear
confidently for the exams.

What is Competency?
Competency is defined as “the ability to do something successfully and efficiently.” CBME is an approach to ensure that the
graduates develop the competencies required to fulfill the patients’ needs in the society. Teaching of Physiology to the medical
graduates is as per the CBME-2019.

I. Goal
The broad goal of the teaching of undergraduate students in physiology is to provide the student with comprehensive knowledge
of the normal functions of the organ systems of the body to facilitate an understand the physiological basis of health and disease.

II. Objectives
A. Knowledge: At the end of the course the student will be able to:
1. Explain the normal functioning of all organ systems and their interactions for well-coordinated total body
functioning.
2. Assess the relative contribution of each organ system to the maintenance of the milieu interior.
3. Elucidate the physiological aspects of normal growth and development.
4. Describe the physiological response and adaptations to environmental stress.
5. List the physiological principles underlying pathogenesis and treatment of the disease.
B. Skills: At the end of the course the student will be able to:
1. Conduct experiments designed for study of physiological phenomenon.
2. Interpret experimental/investigative data.
3. Distinguish between normal and abnormal data derived as a result of the tests which he/she has performed and
observed in the laboratory.
C. Attitude and communication skills: At the end of the course the student will be able to:
1. Show due respect to the persons who volunteer to be examined for the purpose of learning clinical examination.
2. Communicate effectively with peers and teachers.
3. Demonstrate the ability of team work.
D. Integration: At the end of the first year integrated teaching, the student should acquire an integrated knowledge of
organ structure and function and the regulatory mechanisms and tests to assess the functional status of organ systems.
The student should know the basic features of clinical conditions explained at the end of each chapter. This helps the
student in getting ready with the clinical knowledge before he/she enters the portals of hospital.

L Prakasam Reddy
 CONTENTS
Preface to the Eighth Edition ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������� vii

Acknowledgments ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ix

Early Clinical Exposure (ECE) ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������� xi

Competencies ����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� xxvii

Abbreviations ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ xxxiii

VOLUME 1
Active Transport Processes 37
SECTION I GENERAL PHYSIOLOGY Gibbs-Donnan Equilibrium 41

CHAPTER 1 Introduction to Physiology������������������� 3–10 CHAPTER 5 Bioelectric Potentials������������������������43–52

Introduction 3 Introduction 43
Need for Learning Physiology 3 Significance of Bioelectric Potentials 43
Utility of Physiology 3 Origin 44
Scientists’ Contribution to Physiology 4 Terms Used 44
Resting Membrane Potential 46
CHAPTER 2 Organization of the Body: Cell Structure Local Potential or Graded Potential 47
and Function��������������������������������������������11–26 Action Potential 48
Organization of the Body 11
Cell 12 CHAPTER 6 Body Fluids and Body Water – pH���������53–58
Structure and Functions of a Mammalian Cell 12 Introduction 53
Deoxyribonucleic Acid 20 Body Fluid Compartments 53
Ribonucleic Acid 22 Determination of Body Fluid Volumes 54
Gene Expression 22 Water Balance 55
Cell Junctions 23 Intercompartmental Movement of Water 55
Intercellular Communication 25 Regulation of Tonicity and Volume of Extracellular Fluid 55
ph and Acid-Base Homeostasis 55
CHAPTER 3 Cell Division–Growth–Cell Aging Units for Measuring Concentration of Solutes 56
Necrosis–Apoptosis������������������������������������27–32 Buffer Systems in the Body 57
Introduction 27 Dehydration 57
Cell Division 27 Edema 58
Cell Growth—Differentiation and Maturation 29
Cell Adaptation 29 CHAPTER 7 Homeostasis����������������������������������59–72
Cell Death—Necrosis and Apoptosis 30 Introduction 59
Stem Cells 32 Importance of Homeostasis 59
Body Systems that Participate in Homeostasis 60
CHAPTER 4 Transport Mechanism Across Factors of the Internal Environment to be
Cell Membrane�����������������������������������������33–42 Maintained Homeostatically 60
Introduction 33 Components of Homeostatic System 60
Passive Transport Processes 33 Homeostatic Regulatory Mechanisms 61
xiv Fundamentals of Medical Physiology

Molecular Basis of Muscular Relaxation 116

SECTION II NERVE PHYSIOLOGY Types of Muscular Contractions 116
Gradation of Muscular Activity Factors that
CHAPTER 8 Structure and Function of Neuron����������75–81 Influence Force of Contraction 118
Introduction 75
Recruitment of Motor Units During Muscular Contraction 118
Structure of Neuron 76
Rigor Mortis 119
General Functions of Neurons 78
Heat Rigor 119
Types of Neurons 78
Neuroglia 80 CHAPTER 14 Energy Source for Muscular
Neurotrophins 81
Contraction�������������������������������������������120–122
CHAPTER 9 Properties of a Nerve Fiber – Axon��������82–86 Introduction 120
Properties of a Nerve Fiber 82 O2 Debt 121
Excitability of Nerve During Different Phases of AP 85 Heat Production in the Muscle 121
Metabolism in the Nerve Fibers 85
Heat Production 86 CHAPTER 15 Properties of Skeletal Muscle
and Disorders—Electromyography���������������123–130
CHAPTER 10 Peripheral Nerve – Classification of Properties of Skeletal Muscle 123
Nerve Fibers���������������������������������������������87–89 Velocity of Contraction and Load 125
Structure of Peripheral Nerve Fiber 87 Length-Tension Relation 125
General Features of Nerve Fibers 88 Fatigue 126
Properties of Mixed Nerve Fibers 88 Disorders of Muscles 127
Classification of Nerve Fibers 89 Muscular Dystrophy-Myopathies 128
Effects of Denervation on Skeletal Muscle 129
CHAPTER 11A Nerve Injuries – Degeneration and Electromyography (EMG) 129
Regeneration of Peripheral Nerve�������������������90–93
Introduction 90 CHAPTER 16 Smooth Muscles�������������������������131–142
Types of Nerve Injuries 90 Structure of Smooth Muscle 131
Degeneration in the Neuron 91 Mechanism of Contraction and Relaxation 131
Nerve Regeneration 92 Nerve Supply 132
Transneuronal Degeneration 93 Types of Smooth Muscles 133
Neurogenesis in the CNS 93 Factors that Influence Smooth Muscle 135
Nerve Grafts 93 Denervation Hypersensitivity 136
Complications of Nerve Injuries 93 Cardiac Muscles 136
Peripheral Neuropathy 93

CHAPTER 11B Neuromuscular Junction and Neuromuscular SECTION IV CENTRAL NERVOUS SYSTEM
Blocking Drugs���������������������������������������� 94–104
Neuromuscular Junction (NMJ) 94 CHAPTER 17 Organization of Nervous System������145–151
Mechanism of Transmission at NMJ 95 Introduction 145
Drugs that Influence the Transmission at NMJ 96 Divisions of Nervous System 145
Disorders of Neuromuscular Junction 98 Brain 146
Organization of Brain and Spinal Cord 147
SECTION III MUSCLE PHYSIOLOGY Peripheral Nervous System 150

CHAPTER 18 Synapse�����������������������������������152–160
CHAPTER 12 The Skeletal Muscle���������������������107–113
Introduction 152
Introduction 107
Classification of Synapse 152
Functions of Muscles 107
Structure of a Synapse—Axodendritic 153
Structure of Skeletal Muscle 108
Functions of Synapse 154
Muscle Fiber 108
Sarcotubular System 110 Mechanism of Transmission of Impulse at
Types of Muscle Fibers 111 Synapse (Excitatory) 154
Motor Unit 112 Inhibition of the Transmission at Synapse 155
Chemistry of Skeletal Muscle 112 Excitatory Postsynaptic Potential (EPSP) 155
Inhibitory Postsynaptic Potential (IPSP) 155
CHAPTER 13 Mechanism of Muscular Contraction Fate of Released Neurotransmitter 156
and Relaxation—Molecular Basis����������������114–119 Synaptic Inhibitions 156
Introduction 114 Presynaptic Facilitation 157
Muscular Contraction 114 Properties of Synapse 157
Molecular Basis of Muscular Contraction 115 Synaptic Plasticity 159
 Contents xv

CHAPTER 19 Chemical Transmission in the Spinotectal Tract 206

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Nervous System (Neurotransmitters)������������161–166 Lissauer’s Tract 206
Definitions 161 Spinovestibular Tract 206
Criteria for Neurotransmitter 161 Comma Tract 206
Transport, Release and Mechanism of Action 162 Spinopontine Tract 206
Inactivation of Neurotransmitter 162 Spinoreticular Tracts 206
Classification of Neurotransmitters 162 Spino-olivary Tract 206
Acetylcholine 162 The Lemnisci 206
Biogenic Amines 163
Amino Acid Neurotransmitters 164 CHAPTER 26 Thalamus—A Great Relay Station
Peptide Neurotransmitters 165 for Sensory and Motor Impulses������������������208–212
Purinergic Neurotransmitters 166 Thalamus 208
Other Neurotransmitters 166 Classification of Thalamic Nuclei 209
Functions of Thalamus 211
CHAPTER 20 Reflexes�����������������������������������167–173 Disorders of Thalamus 212
Introduction 167
Reflex Arc 167 CHAPTER 27 Sensory Cortex (Feeling Brain)��������213–215
Classification of Reflexes 168 Introduction 213
Important Reflexes 170 Somatosensory Area I 214
Properties of Reflexes 172 Somatosensory Area II 214
Posterior Parietal Cortex 215
CHAPTER 21 Organization of the Spinal Cord�������174–178 Tests for Sensory Function 215
Introduction 174
Spinal Segments and Spinal Roots 174 CHAPTER 28 Motor Nervous System (Movement
Internal Structure of the Spinal Cord 175 Controlling System) – Corticospinal Tract�������216–222
Arterial Blood Supply 178 Introduction 216
Functions of Spinal Cord 178 Components and Functions of the Motor System 216
Motor Neurons 217
CHAPTER 22 Sensory Receptors�����������������������179–187 Motor Cortex 218
Sensory Nervous System 179 Disorders of Motor Nervous System 222
Sensory Receptors 180
Cutaneous Receptors 181 CHAPTER 29 Extrapyramidal System
Study of Function of a Receptor 185 (Medial Motor System)�����������������������������223–226
Properties of Sensory Receptors 186 Introduction 223
Extrapyramidal Tracts 223
CHAPTER 23 Sensations��������������������������������188–191 General Functions of Extrapyramidal System 225
Introduction 188 Features of Extrapyramidal Lesion 225
Classification of Sensations 188
Coding of Primary Sensations 191 CHAPTER 30 Basal Nuclei������������������������������227–234
Introduction 227
CHAPTER 24 Physiology of Pain�����������������������192–199 Components of Basal Nuclei 227
Introduction 192 Connections of Basal Nuclei 228
Types of Pain 192 Functions of Basal Ganglia 230
Mechanism of Pain Sensation 193 Disorders of Basal Ganglia 232
Benefits of Pain 193
Modulation of Pain Perception 193 CHAPTER 31 Cerebellum�������������������������������235–244
Pathway for Pain Sensation 195 Introduction 235
Centers for Pain Sensation 196 Anatomical Divisions of Cerebellum 235
Pain from Viscera and Face 197 Phylogenetic Divisions 236
Disorders of Pain 198 Functional Divisions 236
Management of Pain 198 Structure of Cerebellum 236
Connections of Cerebellum 240
CHAPTER 25 Ascending Tracts�������������������������200–207 Functions of Cerebellum 241
Introduction 200 Cerebellar Disorders 243
Type of Tracts 200 Tests for Cerebellar Function 244
Dorsal Columns (Tracts of Gracilis and Cuneatus) 201
Spinothalamic Tracts (Anterolateral System) 202 CHAPTER 32 Motor Control – Stretch Reflex –
Trigeminal Pathway 204 Muscle Tone – Gait���������������������������������245–250
Great Ascending Sensory Pathway 205 Introduction 245
Spinocerebellar Tracts—Dorsal and Types of Movements 245
Ventral Spinocerebellar Tracts 205 Levels of Motor Control 246
xvi Fundamentals of Medical Physiology

Stretch Reflex 246 CHAPTER 40 Electroencephalography����������������294–298

Muscle Tone 248 Introduction 294
Gait or Walking 249 Normal EEG Pattern 294
Source of EEG 295
CHAPTER 33 Vestibular Apparatus��������������������251–257 Factors that Influence EEG Waves 297
Introduction 251 Abnormal EEG 297
Vestibular Apparatus 251 Significance of EEG 297
Innervation and Connections of Vestibular Apparatus 255 Evoked Cortical Potentials 297
Functions of Vestibular Apparatus 255 Epilepsy 298
Disorders of Vestibular Apparatus 256
Tests of Vestibular Function 257 CHAPTER 41 Cerebral Hemisphere�������������������299–302
Introduction 299
CHAPTER 34 Posture and Equilibrium����������������258–263 Cerebral Hemispheres 299
Posture 258 Structure of Cerebrum 300
Postural Reflexes 260 Cerebral Cortex 300
White Matter of Cerebrum 300
CHAPTER 35 Experimental and Clinical Conditions Internal Capsule 301
of Spinal Lesions������������������������������������264–273
Hemiplegia 264 CHAPTER 42 Lobes of Cerebrum – Functions��������303–309
Spinal Cord Lesions 265 and Disorders
Paraplegia 268 Parietal Lobe 303
Tabes Dorsalis 269 Temporal Lobe 305
Syringomyelia 270 Occipital Lobe 306
Subacute Combined Degeneration of Spinal Cord 270 Frontal Lobe 307
Effects of Section of Anterior Nerve Roots 271 Prefrontal Lobe 308
Effects of Section of Posterior Nerve Roots 271
Upper and Lower Motor Neuron Lesions 272 CHAPTER 43 Higher Functions of
Disseminated – Multiple Sclerosis (MS) 273 the Nervous System���������������������������������310–317
Spinal Muscular Atrophy 273 Introduction 310
Methods of Study 310
CHAPTER 36 Hypothalamus����������������������������274–280 Learning – Conditioned Reflexes 311
Introduction 274 Memory 311
Functions of Hypothalamus 275 Drugs that Facilitate Memory 314
Disorders of Hypothalamic Function 280 Disorders of Memory 314
Speech – Language 314
CHAPTER 37 Limbic System���������������������������281–284 Expression of Speech 316
Introduction 281 Disorders of Speech 316
Components 281
Important Connections 282 CHAPTER 44 Autonomic Nervous System������������318–326
Functions of the Limbic System 282 Introduction 318
Addiction 284 Divisions of Autonomic Nervous System 318
Sympathetic Nervous System (SNS) 320
CHAPTER 38 Reticular Formation���������������������285–288 Parasympathetic Nervous System – Craniosacral System 322
Introduction 285 Comparison of SNS and PSNS 324
Characteristics of Reticular Formation 285 Enteric Nervous System 324
Components of Reticular Formation 286 Central Control of the Autonomic Nervous System 325
Connections of Reticular Formation 286 Functions of Autonomic Nervous System 325
Neurotransmitters of the Reticular Formation 287 Bedside Tests for ANS 325
Functions of Descending Reticular Formation 287 Features in Autonomic Insufficiency 326
Functions of Ascending Reticular Activation System 288
CHAPTER 45 Brain – Extracellular Fluid and
CHAPTER 39 Sleep���������������������������������������289–293 Cerebrospinal Fluid���������������������������������327–331
Introduction 289 Functional Anatomy 327
Physiological Changes During Sleep 289 Types of Fluids in Brain and Spinal Cord 328
Theories of Sleep 290
Mechanism of Sleep – NREM 291 CHAPTER 46 Blood-Brain Barrier, Blood-CSF
Genesis of REM Sleep 291 Barrier and Circumventricular Organs�����������332–369
Sleep-Wakeful Cycle 292 Introduction 332
Distribution of NREM and REM Sleep 292 Blood-Brain Barrier 332
Sleep Resembling Conditions 292 Blood-Csf Barrier 333
Sleep Disorders 292 Circumventricular Organs 333
 Contents xvii

Variations in Total Leukocyte Count 405

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

SECTION V BLOOD Granulocytes 406
Agranulocytes 409
CHAPTER 47 Composition and Functions of Blood��373–375 Variations in Agranulocytes 412
Introduction 373 Leukemia 412
Composition of Blood 373
Functions of Blood 375 CHAPTER 55 Monocyte – Macrophage System –
Spleen (Reticuloendothelial System)������������413–415
CHAPTER 48 Hemopoiesis������������������������������376–379 Introduction 413
Introduction 376
Origin of Macrophages 413
Sites of Hemopoiesis 376
Spleen 414
Theories of Hemopoiesis 377
Main Phases of Hemopoiesis 377 CHAPTER 56 Immunity and Allergy�������������������416–431
Regulation of Hemopoiesis 377 Introduction 416
Bone Marrow 378 Immune System 416
Innate Immunity 417
CHAPTER 49 Erythrocytes�������������������������������380–383 Acquired Immunity 418
Introduction 380 Humoral Immunity 418
Morphology of RBC 380 Antibodies 420
RBC Count 381 Cell-Mediated Immunity 422
Variations in Morphology of RBCs 382 Complement System 424
Functions of RBCs 382 Cytokines 426
Lifespan of RBC 383 Self-Recognition of Cells 427
Site of RBC Destruction 383 Immune Disorders 427
Fragility of RBC 383 Applications 427
Hemolysis 383 Tissue Grafting and Transplantation 428
Hypersensitivity or Allergy 429
CHAPTER 50 Erythropoiesis����������������������������384–388
Definition 384 CHAPTER 57 Plasma Proteins�������������������������432–436
Site of Erythropoiesis 384 Introduction 432
Stages in RBC Development 385 Origin 433
Changes During Maturation 386 Separation of Plasma Proteins 433
Regulation of Erythropoiesis 386 Functions of Plasma Proteins 434
Plasmapheresis 435
CHAPTER 51 Hemoglobin and Different Types
Changes in Plasma Protein Levels 435
of Jaundice�������������������������������������������389–394
Introduction 389 CHAPTER 58 Platelets – Thrombocytes���������������437–440
Hemoglobin 389 Platelets 437
Fate of RBC and Hemoglobin 391 Thrombopoiesis 437
Jaundice 392 Structure and Chemistry of Platelets 438
Jaundice of Newborn – Physiological Jaundice 393 Properties 438
Van den Bergh Reaction 394 Functions 439
Platelet Disorders 439
CHAPTER 52 Iron Metabolism and Anemia����������395–399
Iron Metabolism 395 CHAPTER 59 Hemostasis�������������������������������441–446
Anemia 397 Introduction 441
Mechanism of Hemostasis 442
CHAPTER 53 Packed Cell Volume or Importance of Blood Coagulation 446
Hematocrit-Blood Indices-Erythrocyte
Sedimentation Rate���������������������������������400–403 CHAPTER 60 Anticoagulants – Hemostatic Agents –
Packed Cell Volume 400 Hemostatic Disorders – Tests���������������������447–453
Blood Indices 401 Introduction 447
Red Cell Distribution Width (RDW) 401 Classification of Anticoagulants 447
Erythrocyte Sedimentation Rate 402 Fibrinolytic System – Clot Lysis 449
Hemostatic Agents in Clinical Practice 449
CHAPTER 54 White Blood Corpuscles Hemophilia 451
(Leukocytes)�����������������������������������������404–412 Tests to Analyze Defects in Blood Clotting and Bleeding 452
Introduction 404
Classification 404 CHAPTER 61 Blood Groups and Transfusion���������454–460
General Features 405 Introduction 454
Leukopoiesis 405 Landsteiner Law 454
xviii Fundamentals of Medical Physiology

Classical ABO System 455 Ventricular Cycle 520

Rh Group System 455 Events during Each Cardiac Cycle 521
MNS System 457 Pressure Changes During Cardiac Cycle 522
Bombay Blood Group 457 Volume Changes of Ventricle 524
Importance of Blood Groups 457 Pressure-Volume Curve 525
Blood Transfusion 457 Arterial Pulse 525
Jugular Venous Pulse 527
CHAPTER 62 Lymphoid Organs and Lymph����������461–465 Apical Impulse (Apex Beat) 527
Lymphatic System – Lymphoid Organs and Lymph 461 Heart Sounds (Phonocardiogram) 527
Lymphoid Organs 461 Stenosis 529
Lymph 463 Incompetence or Insufficiency 529
Lymphatic Duct System 464
CHAPTER 69 Cardiac Output���������������������������530–537
CHAPTER 63 Blood Volume����������������������������466–489 Introduction 530
Introduction 466 Definitions 530
Physiological Variation 466 Distribution 531
Determination 467 Determination 531
Blood Volume Regulation 467 Variations in Cardiac Output 533
Pathological Variation 468 Regulation of Cardiac Output 533
Frank-Starling’s Law 536
SECTION VI CARDIOVASCULAR SYSTEM Cardiac Function Curves 537
Regulation of Cardiac Output 537
CHAPTER 64 Functional Anatomy of the Heart������493–499 CHAPTER 70 Heart Rate – Venous Return –
Introduction 493
Cardiac Reserve�������������������������������������538–542
General Scheme of Circulation 493
Heart Rate 538
Functions of CVS 494
Venous Return (VR) 541
Heart 494
Cardiac Reserve 542
Mechanism of Contraction and Relaxation 499

CHAPTER 65 Properties of Cardiac Muscle����������500–504 CHAPTER 71 Regulatory Mechanisms of

Introduction 500 Heart and Vascular Function����������������������543–553
Excitability 500 Introduction 543
Conductivity 502 Local Autoregulatory Mechanisms 544
Contractility 502 Systemic Regulatory Mechanisms 545
Auto Rhythmicity 502 Cardiovascular Reflexes 548
Refractory Period (RP) 503 Summary - Regulatory Mechanisms of Heart
Fatiguability 504 and Vascular Function 553
Length-Tension Relation 504
CHAPTER 72 Vascular System and
CHAPTER 66 Conducting System of the Heart�������505–508 Hemodynamics��������������������������������������554–560
Introduction 505 Circulation of Blood in the Vascular System 554
Components of Conducting System 505 General Structure of Blood Vessels 554
Origin of Cardiac Impulse 507 Functional Classification of Vessels 555
Spread of Cardiac Impulse 508 Hemodynamics 555
Disorders of Conducting System 508
CHAPTER 73 Capillary Circulation
CHAPTER 67 Electrocardiogram�����������������������509–518 (Microcirculation)�����������������������������������561–564
Introduction 509 Introduction 561
ECG Leads 510 Capillaries 561
ECG Paper 511 Transcapillary Exchange 563
Normal ECG 511 Tissue Fluid 564
Clinical Applications of ECG 513
Electrocardiographic Changes in Clinical Conditions 513 CHAPTER 74 Arterial Blood Pressure�����������������565–570
His Bundle Electrogram 515 Significance of Blood Pressure 565
Cardiac Arrhythmias 515 Definitions 565
Recording of BP 566
CHAPTER 68 Cardiac Cycles���������������������������519–529 Factors Maintaining Arterial Blood
Introduction 519 Pressure-Determinants 567
Atrial Cycle 520 Physiological Variations 569
 Contents xix

CHAPTER 75 Regulation of Arterial Blood Determination of Cerebral Blood Flow 588

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Pressure����������������������������������������������571–579
Introduction 571
Short-term or Rapid-Acting or
Neural Regulatory Mechanisms 571
Intermediate Arterial Blood Pressure
Regulatory Mechanisms 574
Long-Term Arterial Blood Pressure Regulatory Mechanism or
Renal Regulation 574
Hormonal Regulation of Arterial Blood Pressure 576
Disorders of Blood Pressure 576
Venous Pressure 578
CHAPTER 76 Regional Circulations
(Coronary Circulation)������������������������������580–586
Introduction 580
Arterial Supply to the Heart 580
Venous Drainage of the Heart 581
Special Features of Coronary Circulation 581
Determination of Coronary Blood Flow (CBF) 582
Determinants of Coronary Blood Flow 582
Regulation of Coronary Blood Flow 584
Factors that Affect Coronary Blood Flow 585
CHAPTER 77 Regional Circulations
(Cerebral Blood Flow)������������������������������587–590
Introduction 587
Arterial Blood Supply to the Brain 587
Venous Drainage of the Brain 587
Nerve Supply of Brain 588
Regulation of Cerebral Circulation 588
Regional Blood Flow in Brain 589
CHAPTER 78 Regional Circulations
(Cutaneous Circulation)����������������������������591–593
Introduction 591
Special Features 591
Measurement of Cutaneous Blood Flow 592
Regulation of Cutaneous Blood Flow 592
Response of the Skin to Mechanical Trauma 592
CHAPTER 79 Regional Circulations—
Fetal Circulation and Splanchnic Circulation���594–597
Fetal Circulation 594
Neonatal Circulation and Respiration 596
Splanchnic Circulation 596
CHAPTER 80 Cardiac Function Tests������������������598–599
Introduction 598
CHAPTER 81 Moderate Hemorrhage������������������600–603
Introduction 600
Compensatory Reactions 601
CHAPTER 82 Heart Failure and Shock –
Effects of Gravity������������������������������������604–634
Heart Failure 604
Circulatory Shock 605
Effect of Gravity 609

VOLUME 2
Regulation of Gastric Secretion 655
SECTION VII GASTROINTESTINAL SYSTEM Gastric Mucosal Barrier 658
Tests for Gastric Function 659
CHAPTER 83 Functional Anatomy of
Gastrointestinal Tract�������������������������������637–641 CHAPTER 86 Pancreas����������������������������������663–669
Parts of Human Digestive Canal 637 Introduction 663
Functions of Alimentary Canal 638 Structure of Pancreas 663
General Structure of Alimentary Canal 638 Pancreatic Juice 664
Nerve Supply 639 Tests for Pancreatic Function 668
General Regulatory Mechanisms of GIT Secretions 641
CHAPTER 87 Liver, Bile and Gallbladder������������670–678
CHAPTER 84 Mouth – Esophagus – Liver 670
Salivary Glands��������������������������������������642–647 Bile 672
Gallbladder 675
Mouth 642
Liver Transplant 677
Esophagus 642
Liver Function Tests 677
Salivary Glands 642
Saliva Secretion – Saliva 645 CHAPTER 88 Small Intestine���������������������������679–682
Functional Anatomy 679
CHAPTER 85 Stomach�����������������������������������648–662 Succus Entericus – Intestinal Juice 680
Structure 648 Functions of Small Intestine 682
Gastric Glands 649
Functions of Stomach 651 CHAPTER 89 Large Intestine���������������������������683–688
Composition and Functions of Gastric Juice 651 Functional Anatomy 683
Methods of Study of Gastric Secretion 653 Functions 684
xx Fundamentals of Medical Physiology

Movements of Large Intestine 684 Work of Breathing 742

Diarrhea 688 Stability of Alveoli 745
Laxatives 688
Gas in the GIT 688 CHAPTER 95 Ventilation��������������������������������748–752
Rectal Administration of Drugs 688 Introduction 748
Appendix 688 Types of Ventilation 748
Lung Volumes and Capacities 750
CHAPTER 90 Digestion and Absorption of Foods����689–697 Sampling of Alveolar Air 750
Introduction 689 Uniformity of Alveolar Ventilation 750
Digestion and Absorption of Carbohydrates 689 Perfusion of Lungs 751
Digestion and Absorption of Proteins 692 Ventilation-Perfusion Ratio 751
Digestion and Absorption of Fats 693
Absorption of Vitamins, Water and Electrolytes 696 CHAPTER 96 Diffusion of Gases in
the Lung and Tissues�������������������������������753–756
CHAPTER 91 Gastrointestinal Motility����������������698–708 Diffusion of Gases in the Lungs 753
Overview 698 Diffusion Capacity of Lungs (DC) 755
Mechanisms Influencing GIT Motility 698 Diffusion of Gases at Tissue Level 755
Chewing 699 Respiratory Quotient (RQ) 756
Deglutition or Swallowing 699 COVID-19 756
Gastric Motility 702
Small Intestine Movements 705 CHAPTER 97 Pulmonary Function Tests��������������757–763
Ileocecal Valve 707 Introduction 757
Gut-Brain Axis 707 Importance of Pulmonary Function Tests 757
Classification 758
CHAPTER 92 Gastrointestinal Hormones�������������709–728
Introduction 709 CHAPTER 98 Transport of Oxygen (O2)����������������764–768
Gastrin 710 Introduction 764
Cholecystokinin-Pancreozymin (CCK-PZ) 710 Uptake of O2 by the Blood in the Lungs 764
Secretin 711 Transport of O2 in the Blood 765
Ghrelin (GH-REL-IN) (Growth Hormone-Releasing-Incretin) 711 Delivery of O2 to the Tissue 765
Gastric Inhibitory Polypeptide (GIP) 711 Dissociation Curves of HBO2, HBFO2 MYGO2 and HBCO 767
Vasoactive Intestinal Polypeptide (VIP) 711 O2 Transport during Exercise 768
Motilin 711
Chymodenin 713 CHAPTER 99 Transport of Carbon Dioxide�����������769–772
P Substance 713 Introduction 769
Bombesin 713 Uptake of CO2 by the Blood 769
Somatostatin 713 Transport of CO2 in the Blood 770
Gastrin Releasing Peptide (GRP) 713 Delivery of CO2 to the Lungs 770
Neurotensin 713 CO2 Dissociation Curve 771
Pancreatic Polypeptide 714
GLP-1 (Glucagon-Like Peptide-1) 714 CHAPTER 100 Neural Regulation of Respiration����773–778
Guanylin 714 Introduction 773
Neural Regulation of Respiration 773
Genesis of Respiratory Rhythm 776
SECTION VIII RESPIRATION Factors Affecting Respiratory Center 776
Reflexes that Modify Respiratory Process 778
CHAPTER 93 Functional Anatomy of Respiratory System –
Blood Supply – Functions��������������������������731–737 CHAPTER 101 Chemical Regulatory Mechanisms��779–784
Introduction 731 Introduction 779
Functional Anatomy 731 Peripheral Chemoreceptors 779
Respiratory Parenchyma 733 Central Chemoreceptors 780
Pulmonary Circulation 734 Ventilatory Responses to O2, CO2 and H+ Ion 781
Pulmonary Capillary Wedge Pressure 735 Effect of Interaction of Hypoxia (↓PO2) and
Functions of Respiratory System 736 Hypercapnia (↑PCO2) on Ventilation 783
Regulation of Respiration during Exercise 783
CHAPTER 94 Mechanics of Breathing�����������������738–747 Respiration during Sleep 784
Introduction – Breathing 738 Disorders Associated with the Regulation of Respiration 784
Mechanism of Inspiration 738
Mechanism of Expiration 740 CHAPTER 102 Hypoxia����������������������������������785–788
Types of Breathing 740 Introduction 785
Pressure Changes during Breathing 741 Hypoxic Hypoxia 785
 Contents xxi

Anemic Hypoxia 786

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Stagnant Hypoxia (Ischemic Hypoxia) 786
SECTION IX RENAL PHYSIOLOGY
Histotoxic Hypoxia 786
Effects of Hypoxia 787 CHAPTER 107 Urinary System—
Oxygen Therapy in Different Types of Structure of Kidney—Nephron��������������������827–832
Hypoxia 787 Introduction 827
Toxic Effects of 100% O2 Therapy 787 Urinary System 827
Functions of Kidney or Nephron 828
CHAPTER 103 Pathophysiological States������������789–795 Structure of the Kidney 828
Asphyxia 789 Nephron 829
Cyanosis 790 Types of Nephrons 832
Periodic Breathing 790
CHAPTER 108 Renal Blood Flow (RBF)���������������833–836
Kussmaul Breathing 791
Arterial Blood Supply 833
Gasping 791
Venous Drainage 833
Abnormal Respiratory Breathing 791 Measurement of Renal Blood Flow 834
Pneumothorax 793 Renal Clearance 834
Hydrothorax 793 Special Features of Renal Circulation 835
Pleural Effusion 793 Regulation of Renal Blood Flow 836
Chylothorax 793
Hemothorax 793 CHAPTER 109 Urine Formation –
Bronchiectasis 793 Glomerular Filtration�������������������������������837–842
Atelectasis 793 Urine Formation 837
Emphysema 793 Formation of Glomerular Filtrate 837
Cystic Fibrosis 793 Determinants of GFR (Factors that Influence GFR) 838
Apnea 793 Regulation of GFR 839
Hyperventilation 794 Determination of GFR 840
Breath Holding 794 Regulation of Renal Blood Flow (RBF) and
Hypoventilation 794 Glomerular Filtration Rate (GFR) 841
Hypercapnia (Hypercarbia) 794
Hypocapnia (Hypocarbia) 794 CHAPTER 110 Reabsorption of Substances from
Dyspnea 794 Filtrate and Secretion�������������������������������843–849
Orthopnea 795 Introduction 843
Bronchial Asthma 795 Methods of Study of Tubular Function 843
Carbon Monoxide Poisoning 795 Modes of Reabsorption 844
Idiopathic Pulmonary Fibrosis 795 Regulation of Tubular Reabsorption 844
Effects of Chronic Smoking on Reabsorption from Proximal Convoluted Tubule (PCT) 844
Reabsorption from Loop of Henle (LH) 846
Respiratory Efficiency 795
Reabsorption from Distal Nephron (DCT and CD) 847
CHAPTER 104 High Altitude Physiology��������������796–799 Hormones that Influence Reabsorption from Tubules 848
Introduction 796 Secretion of Substances into Urine 849
Low Atmospheric Pressure 796
CHAPTER 111 Acidification of Urine������������������850–853
Cold and Dry Weather 797
Introduction 850
UV Light Rays and Other Light Rays 797
Reabsorption of HCO3– 850
Effects of Hypoxia on Body Systems 797 Secretion of H+ Ion 850
Acclimatization to High Altitude 798 Role of Kidney in Acidosis and Alkalosis 853
Clinical Conditions Associated
with High Altitude 798 CHAPTER 112 Concentrating and Diluting
Mechanisms of Urine�������������������������������854–858
CHAPTER 105 Deep Sea Physiology������������������800–802 Introduction 854
Introduction 800 Production of Concentrated Urine 854
Hazards of Deep Sea Diving 800 Production of Dilute Urine 858
SCUBA 802
Diving Reflex 802 CHAPTER 113 Regulation of Water by Kidney�������559–862
Drowning 802 Introduction 859
Water Handling by the Kidney 859
CHAPTER 106 Artificial Ventilation and Obligatory Type of Absorption 860
Cardiopulmonary Resuscitation�������������������803–824 Facultative Type of Absorption 860
Artificial Ventilation and CPR 803 Factors that Influence H2O Absorption 861
Methods of CPR 803 Diuresis 861
Cardiopulmonary Resuscitation (CPR) 805 Diuretics 862
xxii Fundamentals of Medical Physiology

CHAPTER 114 Regulation of Electrolytes�������������863–865 Assay of Hormones 915

Na+ Regulation 863 Endocrine Glands 915
Regulation of K+ 864
Regulation of Chloride 865 CHAPTER 120 Hypothalamus—Pituitary Gland�����919–935
Hypothalamus 919
CHAPTER 115 Endocrinal Role of Kidneys�����������866–870 Importance of Hypothalamico­hypophyseal Portal System 920
Introduction 866 Pituitary Gland-Hypophysis 920
Renal Erythropoietin 866 Anterior Pituitary Gland-Adenohypophysis 921
Renin (Renin-Angiotensin system – RAS) 867 Hormones 921
1,25-(OH)2 Cholecalciferol (Calciferol) 869 Growth Hormone—Somatotrophic Hormone 927
Thrombopoietin 870 Physiology of Growth 929
Prostaglandins 870 Neurohypophysis—Posterior Pituitary Gland 929
Kallikrein-Bradykinin System 870 Disorders of Pituitary and Hypothalamus 932
Other Hormones 870
CHAPTER 121 Thyroid Gland���������������������������936–947
CHAPTER 116 Renal Function Tests – Introduction 936
Renal Failure – Artificial Kidney������������������871–875 Structure 936
Biosynthesis and Secretion of Thyroid Hormones 937
Renal Function Tests 871
Regulation of Thyroid Hormone Secretion 939
Renal Failure 873
Mechanism of Action at Cellular Level 940
Abnormal Substances of Urine 873
Actions (Functions) of Thyroid Hormones 940
Dialysis 874
Tests for Thyroid Function 943
Hemodialysis (Artificial Kidney) 874
Disorders of Thyroid Function 943
Kidney Transplant 875
Management of Thyroid Disorders 947
CHAPTER 117 Urinary Tract—Micturition������������876–895
CHAPTER 122 Bone Physiology—
Functional Anatomy of Urinary Tract 876
Nerve Supply 877
Parathyroid Hormone�������������������������������948–959
Bone Physiology 948
Physiology of Micturition 878
Functions of Bones 950
Bone Disorders 951
SECTION X SKIN Parathyroid Gland 951
Disorders of Parathyroid Hormone 954
CHAPTER 118 Structure and Functions of Skin������899–904 Calcitonin (Thyrocalcitonin) 954
Introduction 899 Calcium and PO4 Homeostasis 954
Structure of Skin 899 Relation between Plasma Ca+ and PO43– 956
Nerve Fibers 901 Disorders of Calcium and PO43– Homeostasis 958
Blood Supply 901 Paget’s Disease (Osteitis Deformans) 959
Glands of the Skin 901
CHAPTER 123 Suprarenal Gland—Adrenal Cortex��960–970
Problems of Skin 902
Introduction 960
Functions of Skin 902 Adrenal Cortex 960
Color of the Skin 903 Glucocorticoids 961
Psoriasis 904 Mineralocorticoids 966
Burns 904 Disorders of Adrenal Cortex 967
Sunburn 904 Adrenal Cortex Function Tests 970
Skin Graft 904
CHAPTER 124 Adrenal Medulla—
SECTION XI ENDOCRINE PHYSIOLOGY General Adaptation Syndrome��������������������971–977
Adrenal Medulla 971
Biosynthesis of Catecholamines 972
CHAPTER 119 General Introduction to Regulation of Adrenal Medullary Secretion 975
Endocrine Glands������������������������������������907–918 Disorders of Catecholamine Secretion 975
Introduction 907 Tests for Sympatheticoadrenal System 976
Endocrines 908 Stress and General Adaptation Syndrome (GAS) 976
Hormones 908
Relation Between Endocrines and CNS 909 CHAPTER 125 Endocrine—Pancreas������������������978–983
Regulation of Hormone Secretion 909 Introduction 978
Methods of Study of Endocrines 910 Insulin 979
Hormonal Actions 911 Glucagon 982
Hormones used for Therapeutic Purposes 914 Pancreatic Polypeptide 983
General Functions of Hormones 914 Somatostatin 983
Basic Causes of Endocrine Disorders 915 Amylin 983
 Contents xxiii

CHAPTER 126 Blood Glucose Homeostasis����������984–989 CHAPTER 134 Menstrual Cycle

FUNDAMENTALS OF MEDICAL PHYSIOLOGY

Introduction 984 (Endometrial Cycle)—Fertilization������������1048–1053
Blood Sugar Level 984 Introduction 1048
Role of Hormones in the Homeostasis of Blood Glucose 985 Definition 1048
Nervous Regulation of Blood Glucose Level 986 Phases of Menstrual Cycle 1049
Disorders 986 Hormonal Cycle 1050
Glucose Tolerance Test (GTT) 989 Fertilization 1051
Implantation of the Zygote (Nidation) 1052
CHAPTER 127 Other Endocrine Glands— Ectopic Pregnancies 1052
Local Hormones����������������������������������� 990–1016 Perimenopause and Menopause 1053
Thymus 990 Menopausal Syndrome 1053
Pineal Gland 990
Hormones of the Heart (Natriuretic Peptides) 991 CHAPTER 135 Pregnancy and Pregnancy
Hormones of Kidney 992 Diagnostic Tests����������������������������������1054–1058
Local Hormones 992 Pregnancy 1054
Pregnancy Diagnostic Tests 1056
SECTION XII REPRODUCTION Pregnancy—Psychological and Psychiatric Disorders 1058

CHAPTER 136 Parturition—Placenta��������������1059–1063

CHAPTER 128 Development of Gonads— Introduction 1059
Puberty���������������������������������������������1019–1025 Stages of Parturition 1059
Introduction 1019 Initiation of Labor 1060
Sex Determination 1019 Mechanism of Parturition 1060
Human Chromosomes—Karyotyping 1020 Placenta 1061
Development of Gonads 1021
Onset of Puberty 1023 CHAPTER 137 Lactation������������������������������1064–1067
Introduction 1064
CHAPTER 129 Male Reproductive System— Structure of Mammary Gland 1064
Functional Anatomy������������������������������1026–1029 Development of Breast Gland 1064
Organs 1026 Lactation 1065
Primary Sex Organ 1026 Importance of Lactation 1067
Accessory Sex Organs 1028 Composition of Milk 1067
Psychological and Psychosocial Changes During Puberty 1029
CHAPTER 138 Contraception������������������������1068–1072
CHAPTER 130 Spermatogenesis��������������������1030–1034 Introduction 1068
Introduction 1030 Need for Contraception 1068
Stages in the Spermatogenesis 1030 Principles in Contraception 1069
Spermatozoa 1031 Methods of Contraception 1069
Regulation of Spermatogenesis 1032
Semen 1033 CHAPTER 139 Sex Hormones�����������������������1073–1080
Estrogen 1073
CHAPTER 131 Male and Female Sexual Act������1035–1037 Progesterone 1076
Male Sexual Act 1035 Testosterone 1077
Female Sexual Act 1036 Other Ovarian and Testicular Hormones 1079
Male Sexual Disorders 1036 Gonadotropins 1080
Contraception in Male 1037
CHAPTER 140 Fetoplacental Unit – Infertility –
CHAPTER 132 Female Reproductive System— Cloning of Mammal – Test Tube Baby��������1081–1098
Functional Anatomy������������������������������1038–1041 Fetoplacental Unit 1081
Introduction 1038 Infertility 1082
Female Sex Organs 1038 Tests to Assess Fertility Status 1082
Primary Sex Organ 1040 Cloning of a Mammal 1082
Technique of Making a Baby (Test Tube Baby – IVF) 1083
CHAPTER 133 Oogenesis—Ovarian Cycle��������1042–1047
Introduction 1042
Changes in the Fetal Ovary up to Birth 1042 SECTION XIII PHYSIOLOGY OF SPECIAL SENSES
Changes from Postnatal to Puberty 1043
Postpubertal Changes 1043 CHAPTER 141 Gustation (Taste)��������������������1101–1104
Sexual Cycles in Female 1043 Introduction 1101
Cyclical Changes in Cervix and Vagina 1046 Functional Anatomy 1102
xxiv Fundamentals of Medical Physiology

Taste Pathway 1102 CHAPTER 150 Basic Optics and Image Forming
Physiology of Taste Sensation 1103 Mechanism—Visual Acuity—Defects���������1142–1148
Disorders of Taste 1104 Principles of Optics 1142
Types of Lenses 1142
CHAPTER 142 Olfaction (Smell)��������������������1105–1108 Image Formation by a Convex Lens 1143
Functional Anatomy of Olfactory System 1105
Formation of Image on the Retina 1144
Smell Pathway 1106
Visual Acuity 1144
Tests for Olfaction 1107
Defects of Image Formation Mechanism 1145
Special Features of Smell Pathway 1107
Optical Aberrations 1148
Importance of Olfaction 1107
Physiology of Smell Sensation 1107 CHAPTER 151 Retina—Visual Receptors���������1149–1153
Disorders of Smell 1108 Retina 1149
Electroretinogram (ERG) 1152
CHAPTER 143 Audition—External and
Visual Receptors 1152
Middle Ear�����������������������������������������1109–1112
Audition 1109 CHAPTER 152 Visual Pathway—Field of Vision��1154–1159
External Ear 1109 Visual Pathway 1154
Middle Ear (Tympanic Cavity) 1110 Visual Centers 1155
Connections of Visual Pathway 1156
CHAPTER 144 Inner Ear—Organ of Corti����������1113–1117
Field of Vision 1156
Inner Ear 1113
Effect of Lesion on Visual Pathway at
Organ of Corti 1115
Different Levels 1157
Mechanism of Activation of Hair Cells 1116
Effect of Lesion on Visual Cortical Areas 1159
Function of Hair Cells 1116

CHAPTER 145 Auditory Pathway— CHAPTER 153 Mechanism of Visual Processing��1160–1163

Response of Receptors 1160
Electrical Potentials from Cochlea������������1118–1121
Response of Bipolar Cells 1161
Auditory Pathway 1118
Processing at LGN 1162
Electrical Potentials from Cochlea 1120
Processing by Visual Cortex 1162
CHAPTER 146 Physical Properties of Sound – Depth (Distance) Perception (Stereopsis) 1163
Mechanism of Hearing��������������������������1122–1126
CHAPTER 154 Adaptation of the Eye to
Introduction 1122
Characteristics of Sound 1122 Dark and Light Environment��������������������1164–1166
Mechanism of Hearing 1123 Introduction 1164
Masking 1126 Dark Adaptation 1164
Auditory Cortex 1126 Light Adaptation 1165
Critical Fusion Frequency (CFF) 1166
CHAPTER 147 Disorders of Hearing—
Hearing Tests�������������������������������������1127–1130 CHAPTER 155 Color Vision��������������������������1167–1171
Introduction 1127 Introduction 1167
Hypoacusis 1127 Characteristics of Light 1167
Syndromes 1128 Laws of Color Vision 1168
Hearing Tests 1128 Theories of Color Vision 1168
Treatment of Deafness 1129 Physiological Basis of Color Vision 1169
Lateral Geniculate Nucleus (LGN) 1169
CHAPTER 148 Vision—Functional Anatomy of Color Blindness 1169
the Eye���������������������������������������������1131–1137 Tests for Color Vision 1170
Introduction 1131 Importance of Color Vision 1171
Functional Anatomy of Eyeball 1132
Lacrimal Apparatus 1136 CHAPTER 156 Movements of the Eyeball—
Tests for Visual Function������������������������1172–1188
CHAPTER 149 Pupillary Reflexes— Introduction 1172
Accommodation����������������������������������1138–1141 Muscles of the Eyeball 1172
Introduction 1138 Conjugate Eye Movements 1173
Light Reflex 1138 Control of Eye Movements 1173
Pupillary Dilatation 1139 Blind Sight 1174
Accommodation 1139 Cortical Blindness 1174
Abnormal Pupillary Reflexes 1141 Tests for Visual Function 1174

SECTION XIV INTEGRATED PHYSIOLOGY
CHAPTER 1 Regulation of Body Temperature –
Adaptation to Hot and Cold Environment –
Fever – Hypothermia – Frostbite –
Heat Stroke����������������������������������������1191–1198
Introduction 1191
Normal Body Temperature 1192
Physiological Variations 1192
Heat Balance 1192
Regulation of Body Temperature 1194
Temperature Regulation in the Newborn 1196
CHAPTER 2 Cardiorespiratory Changes
During Exercise – Benefits of Regular
Exercise – Cardiovascular Changes�����������1199–1207
Introduction 1199
Acute or Immediate Changes 1200
Long-term (Training) Effects of Exercise 1203
Exercise Under Hot and Cold Environment 1203
Effects of Isometric Exercise on
Cardiorespiratory Adjustments 1204
Respiratory Changes in Muscular Exercise 1204
Other Changes in the Body 1205
Benefits of Regular Exercise on the Body (Training) 1206
Long-term Benefits of Regular Exercise on
the Body (Training) 1207
Benefits of Exercise During Pregnancy and
Post-Pregnancy 1207
CHAPTER 3 Physiological Consequences of
Sedentary Lifestyle – Obesity – Nutrition�����1208–1217
What is Sedentary Lifestyle? 1208
Obesity 1209
Fitness – Different – Easy 1211
Management of Obesity 1212
Obesity – Mental Health Problems 1212
Six Super Principles for Burning Calories and
Maintaining Body Weight 1213
Nutrition 1213
Nutrients 1214
Milk 1216
CHAPTER 4 Physiology of Aging –
Free Radicals – Antioxidants�������������������1218–1222
Introduction 1218
Theories of Aging 1218
Common Diseases of Old Age 1220
Congenital Aging Disorders 1221
Free Radicals 1221
Antioxidants 1222
CHAPTER 5 Concept of Brain Death –
Implications���������������������������������������1223–1224
Concept of Brain Death 1223
CHAPTER 6 Physiological Effects of
Yoga and Meditation�����������������������������1225–1231
Introduction 1225
Contents xxv
Yoga 1225
FUNDAMENTALS OF MEDICAL PHYSIOLOGY
Types of Yogic Practices 1226
Benefits of Yoga Practice 1230
Yoga in Health and Disease 1231
CHAPTER 7 Fetal and Neonatal Physiology�������1232–1236
Developmental Stages of a Fetus 1232
Fetal Growth 1232
Fetal Circulation 1233
Neonatal Physiology 1233
CHAPTER 8 Physiology of Acid-Base
Homeostasis��������������������������������������1237–1241
Concept of pH and H+ Concentration 1237
Henderson-Hasselbalch Equation (1908) 1237
Blood Buffers 1238
Source of Acids 1238
Source of Alkali 1238
Defence Against Changes in H+ Ion Concentration 1238
Disturbances of Acid-Base Status 1239
Clinical Evaluation of Disturbances in
Acid-Base Status – Anion Gap 1241
CHAPTER 9 Regulation of Composition Osmolality
and Volume of Body Fluids (ECF)��������������1242–1246
Introduction 1242
Regulation of Composition 1242
Regulation of Osmolality (Tonicity) of ECF 1243
Role of Osmoreceptors 1243
Role of Aldosterone 1244
Regulation of Body Fluid Volume of ECF 1244
Disorders of Volume and Osmolality of Body Fluid 1246
CHAPTER 10 Artificial Respiration –
Basic Life Support – Cardiopulmonary –
Resuscitation (CPR)�����������������������������1247–1250
Cardiopulmonary Arrest 1247
Methods of CPR 1248
CHAPTER 11 Physiology of Growth –
Growth Curves������������������������������������1251–1256
Growth 1251
Behavioral Development 1254
Hyperfunction of Anterior Pituitary 1254
Growth Disorders 1254
CHAPTER 12 Cytological Methods and their
Applications in Clinical Care and Research��1257–1260
Cytological Methods 1257
CHAPTER 13 COVID-19�������������������������������1261–1262
Introduction 1261
CHAPTER 14 Acquired Human Immunodeficiency
Syndrome������������������������������������������1263–1266
Acquired Immunodeficiency Syndrome 1263
Virology of HIV 1264
Pathogenesis of HIV 1264
Clinical Course of AIDS 1265
Diagnosis of AIDS 1266
xxvi Fundamentals of Medical Physiology

APPENDIX III Physiological Problems and

APPENDICES
Solutions�������������������������������������������1279–1282

APPENDIX I Clinical Case Scenario and

INDEX���������������������������������������������������������������������1283–1322
Solution��������������������������������������������1269–1275

APPENDIX II Numerical Formulas for

Quick Review��������������������������������������1276–1278
 COMPETENCIES
Competency-Based Undergraduate Curriculum for the Indian Medical Graduate

CODE COMPETENCY CHAPTER

General Physiology
PY1.1 Describe the structure and functions of a mammalian cell 2 and 63 (Vol. 1)

PY1.2 Describe and discuss the principles of homeostasis 7 (Vol. 1)

PY1.3 Describe intercellular communication 2 (Vol. 1)

PY1.4 Describe apoptosis – programmed cell death 3 (Vol. 1)

PY1.5 Describe and discuss transport mechanisms across cell membranes 4 (Vol. 1)

PY1.6 Describe the fluid compartments of the body, its ionic composition and measurements 6 (Vol. 1), 9 (Vol. 2–Int. Phy.)

PY1.7 Describe the concept of pH and Buffer systems in the body 6 (Vol. 1), 9 (Vol. 2–Int. Phy.)

PY1.8 Describe and discuss the molecular basis of resting membrane potential and action 5 (Vol. 1)
potential in excitable tissue
PY1.9 Demonstrate the ability to describe and discuss the methods used to demonstrate the 12 (Vol. 2–Int. Phy.)
functions of the cells and its products, its communications and their applications in Clinical
care and research.
Hematology
PY2.1 Describe the composition and functions of blood components 47 (Vol. 1)

PY2.2 Discuss the origin, forms, variations and functions of plasma proteins 57 (Vol. 1)

PY2.3 Describe and discuss the synthesis and functions of Hemoglobin and explain its breakdown. 51 (Vol. 1)
Describe variants of hemoglobin
PY2.4 Describe RBC formation (erythropoiesis and its regulation) and its functions 48, 49 and 50 (Vol. 1)

PY2.5 Describe different types of anemias and Jaundice 52 (Vol. 1)

PY2.6 Describe WBC formation (granulopoiesis) and its regulation 54 and 55 (Vol. 1)

PY2.7 Describe the formation of platelets, functions and variations. 58 (Vol. 1)

PY2.8 Describe the physiological basis of hemostasis and, anticoagulants. Describe bleeding and 59 and 60 (Vol. 1)
clotting disorders (Hemophilia, purpura)
PY2.9 Describe different blood groups and discuss the clinical importance of blood grouping, 61 (Vol. 1)
blood banking and transfusion
PY2.10 Define and classify different types of immunity. Describe the development of immunity and 56 (Vol. 1)
its regulation
PY2.11 Estimate Hb, RBC, TLC, RBC indices, DLC, Blood groups, BT/CT Topic for Practicals
 ABBREVIATIONS
1, 25(OH)2 CCF 1,25–dihydroxy cholecalciferol cAMP Cyclic AMP
2,3-DPG 2,3-diphosphoglycerate Cb Carotid body
5HT 5-hydroxytryptamine CBG Corticosteroid binding globulin
ABP Androgen binding protein CCK-PZ Cholecystokinin pancreozymin
AC Apneustic center CCM Counter current mechanism
ACE Angiotensin converting enzyme CFU (E) Colony forming unit (erythrocytic)
Ach Acetylcholine CIC Cardioinhibitory center
Ache Acetylcholinesterase CL Corpus luteum
ACTH Adrenocorticotrophic hormone CLIP Corticotrophin like intermediate lobe peptide
ADH Antidiuretic hormone CN Caudate nucleus
ADP Adenosine diphosphate CO Cardiac output
Adre Adrenaline COHb Carboxyhemoglobin
AHC Anterior horn cell COMT Catechol-O-methyl transferase
ANP Atrial natriuretic polypeptide CP Creatine phosphate
ANS Autonomic nervous system CPK (cK) Creatine phosphokinase
AP Action potential CRH Corticotrophin releasing hormone
APC Antigen presenting cells CRO Cathode ray oscilloscope
APUD cells Amino precursor uptake and decarboxylation CS syndrome Carotid sinus syndrome
ARAS Ascending reticular activating system CS Conditioned stimulus
ARDS Adult respiratory distress syndrome CSF Cerebrospinal fluid
ARP Absolute refractory period CVC Cardiovagal center
ARP Argyll-Robertson pupil DAG Diacylglycerol
ATP Adenosine triphosphate DBP Diastolic blood pressure
AV block Atrioventricular block DC Diffusion capacity
AV node Atrioventricular node DCN Dorsal cochlear nucleus
BAO Basal acid output DCT Distal convoluted tubule
BBB Blood brain barrier DE Diffusion co-efficient
BBB Bundle branch block DHCC Dihydroxy cholecalciferol
BER Basal electric rhythm DHEA Dehydroepiandrosterone
BFU (E) Burst forming unit (erythrocytic) DI Dyspneic index
BMI Body mass index DN Dentate nucleus
BMR Basal metabolic rate DNA Deoxyribonucleic acid
CA Carbonic anhydrase DNV Dorsal nucleus of vagus
CAC Cardioacceleratory center DOPA Dihydroxyphenyl alanine
CAM Cell adhesion molecules DRG Dorsal respiratory group
 S E C T I O N VII

Gastrointestinal
System

Gastrointestinal System, “I pulverize the food and supply the same for energy generation and body growth.
But greedy eaters abuse me only to become obese and sick.”
“Simple diet is best for many dishes bring many diseases.”
“Eat slowly and moderately, without drinking during meals,
thoroughly chewing food and rising from the table with
the sense of being able to eat more.”

SECTION OUTLINE
Chapter 83 Functional Anatomy of Chapter 87 Liver, Bile and Gallbladder
Gastrointestinal Tract Chapter 88 Small Intestine
Chapter 84  Mouth – Esophagus – Salivary Chapter 89 Large Intestine
Glands Chapter 90 Digestion and Absorption of Foods
Chapter 85 Stomach Chapter 91 Gastrointestinal Motility
Chapter 86 Pancreas Chapter 92 Gastrointestinal Hormones