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To the Instructor
I would like to present another edition that is older and semester (or even two) allows. This text focuses on the
wiser with the help of your comments and sugges- physiology that is basic and most clinically relevant.
tions. Even after minor surgery, a few transplants, and Pathophysiology is introduced primarily to clarify
some trimming and plumping, the fifth edition of The physiological function. For instance, the different types
Human Body in Health and Illness has emerged with the of anemias illustrate the various steps in the making
same sense of humor! of the red blood cell. A second concern has to do with
The Human Body in Health and Illness tells the story the recognition that we are not preparing physiolo-
of the human body with all its parts and the way these gists; instead, we want the student to be able to use the
parts work together. It is a story that we have told physiology to understand clinically relevant content
many times in our classes. It is also a story that gets such as pathophysiology, physical assessment, diag-
better with each telling as the body continues to reveal nostics, and pharmacology. An understanding of phys-
its mysteries and how marvelously it has been created. iology is crucial for advancement in the medically
I hope that you enjoy telling the story as much as I do. related sciences.
The Human Body in Health and Illness is a basic
anatomy and physiology text addressed to the student
TEXTBOOK STRENGTHS
preparing for a career in the health professions. It is
written for students with minimal preparation in the • Anatomy and physiology are clearly and simply
sciences; no prior knowledge of biology, chemistry, or explained. A meticulously prepared set of
physics is required. The text provides all the back- illustrations—complete with amusing cartoons—
ground science information needed for an understand- supports the text. In fact, the story of the body is
ing of anatomy and physiology. told as much through the art as through the written
The basic principles of chemistry and biochemistry word.
are presented in Chapters 2 and 4, and they set the • The text truly integrates pathophysiology; it is not
stage for an understanding of cellular function, fluid merely boxed in or tacked on at the end. The inte-
and electrolyte balance, endocrine function, and diges- grated pathophysiology is used primarily to amplify
tion. Chapter 5, Microbiology Basics, presents clini- the normal anatomy and physiology. The expanded
cally relevant microbiological topics. Check out the Medical Terminology and Disorders tables and fre-
stories “Rick, Nick, and the Sick Tick” and “Dr. Sem- quent references to common medical terminology
melweis Screams: ‘Wash Those Mitts!’ ” The latter is an allow the text to be used for an introductory course
amusing presentation of a sad tale in the history of in pathophysiology and medical terminology.
medicine and corresponds to the current emphasis on • In addition to the pathophysiology, other topics
hand hygiene and healthcare-associated infection. are liberally integrated throughout the text. These
The anatomy and physiology content is presented include common diagnostic procedures such as
in a traditional order, from simple to complex. The text blood count, lumbar puncture, urinalysis, and elec-
begins with a description of a single cell and progresses trocardiography. Pharmacological topics are also
through the various organ systems. There are two introduced and, like the pathophysiology, are used
key themes that run throughout the text: (1) the to amplify the normal anatomy and physiology. For
relationship between structure and function—the instance, the discussion of the neuromuscular junc-
student must understand that an organ is anatomically tion is enhanced by a description of the effects of
designed to perform a specific physiological function, the neuromuscular-blocking agents. Because of the
and (2) homeostasis—the role that each organ system effort of the text to make clinical correlations, it sets
plays in sustaining life and what happens when that the stage for the more advanced health science
delicate balance is disturbed. courses, including pharmacology and medical-
The text addresses two concerns about the selection surgical nursing.
of content. The first has to do with the amount • Re-Think boxes are liberally distributed through-
of content. The field of anatomy and physiology is out each chapter and encourage students to master
huge; therefore, there must be a selection of content that content before progressing through the chapter.
that can be mastered in the short period of time that a New Ramp It Up boxes develop selected clinically
vi
To the Instructor vii
homework assignments for each lesson are pro- • Assessment Plan To ensure that your students
vided here along with an overall estimated comple- have mastered all the objectives, the new TEACH
tion time. includes a separate Assessment Plan section. An
• The 50-Minute Lesson Plan A lecture outline that easy-to-use table maps each assessment tool to the
reflects the chapter lecture slides that come as part lesson plans and chapter objectives so you can see
of TEACH is included, as well as classroom activi- all your assessment options—by chapter, by lesson,
ties and online activities, one or more critical think- and by objective—and choose accordingly.
ing questions, and time estimates for the classroom
lecture and activities.
To the Student
This book will take you on an amazing journey through MEDICAL TERMINOLGY AND
the human body. You will learn many body parts, and DISORDERS TABLES
more importantly, how they work in an integrated These tables describe medical terms and specific dis-
manner to keep you going. You will use this informa- orders related to individual body systems, with a focus
tion in your clinical practice when patients become on developing a strong working vocabulary, which is
ill with disorders of those structures. The following necessary for a career in the health professions.
special features were created to help make learning
enjoyable and fun. END-OF-CHAPTER FEATURES
Summary Outline
TEXTBOOK FEATURES A detailed outline at the end of each chapter summa-
rizes key concepts and serves as an excellent review of
KEY TERMS the chapter content. Use it as a study tool to review
Key terms are listed at the beginning of each chapter your reading and prepare for exams.
along with a page reference. Each is (1) presented in
the text in blue print, (2) accompanied by a pronuncia- Review Your Knowledge
tion guide, (3) thoroughly explained within the chapter, The matching and multiple-choice questions in this
and (4) defined in the glossary. section cover the major points of the chapter and allow
you to test your comprehension.
OBJECTIVES
Numbered objectives identify the goals for each Go Figure
chapter. This review section asks you to reflect on the figures
in the chapter and reinforces the importance of the
ILLUSTRATIONS concepts presented.
Original illustrations and full-color cartoons help you
make sense of anatomy and physiology using humor, ANSWERS TO REVIEW YOUR KNOWLEDGE AND
clarity, and insight. GO FIGURE QUESTIONS
The Appendix contains answers to all Review Your
DO YOU KNOW… Knowledge and Go Figure questions found in the
Most of these boxed vignettes refer to clinical situa- textbook.
tions; others relate to interesting and amusing histori-
cal events related to anatomy and physiology. GLOSSARY
The glossary includes a pronunciation guide and a
RAMP IT UP! brief definition of all key terms and many other words
These features challenge you with more advanced in the text.
anatomy and physiology topics.
SUM IT UP!
These features appear regularly throughout the chap-
ters and help the student synthesize key concepts.
ix
Contents
The Heart’s Chambers and Great Vessels, 311 Blood Vessels Act as Exchange Vessels, 364
Right Atrium, 311 What Is an Exchange Vessel?, 364
Right Ventricle, 312 Why Capillaries Are Good Exchange Vessels, 365
Left Atrium, 312 Capillary Forces: Exchange, 365
Left Ventricle, 312 Blood Vessels Distribute Blood, 367
Great Vessels of the Heart, 313 Blood Vessels Regulate Body Temperature, 367
Heart Valves, 313
Atrioventricular Valves, 313 20 Lymphatic System, 373
Semilunar Valves, 314
Heart Sounds, 315 The Lymphatic System, 373
Pathway of Blood Flow through the Heart, 315 Lymph: What It Is, Where It Comes From, 373
Blood Flow and Shunts, 315 Lymphatic Vessels, 373
Blood Supply to the Myocardium, 316 Movement through the Lymphatic Vessels, 374
Ischemia and Infarction, 317 Lymphoid Organs, 374
Cardiac Enzymes and Leaky Cells, 318 Lymph Nodes, 375
Cardiac Conduction System, 318 Tonsils, 376
Parts of the Cardiac Conduction System, 318 Thymus Gland, 376
Automaticity and Rhythmicity, 320 Spleen, 378
Electrocardiogram, 320
21 Immune System, 382
17 Function of the Heart, 325 Classification of the Immune System, 382
The Coordinated and Adaptable Pump, 325 Nonspecific Immunity, 382
Cardiac Cycle, 325 Specific Immunity: Third Line of Defense, 386
Autonomic Control of the Heart, 326 Types of Immunity, 390
Heart Talk, 330 Genetic Immunity, 391
Heart Talk: Clinical Terms, 330 Acquired Immunity, 391
Heart Talk: Receptor Language, 331 Other Immune Responses, 392
The Failing Heart: When the Heart Can’t Allergic Reactions, 392
Pump, 332 Autoimmune Disease, 393
Left Heart Failure, 332 Organ Rejection, 393
Right Heart Failure, 333
22 Respiratory System, 399
18 Anatomy of the Blood Vessels, 340 Structure: Organs of the Respiratory System, 399
Circles, Circuits, and Circulations, 340 Upper and Lower Respiratory Tracts, 399
Blood Vessels, 341 Nose and Nasal Cavities, 399
Naming the Blood Vessels, 341 Pharynx, 401
Blood Vessel Walls: The Layered Look, 341 Larynx, 401
Blood Vessels: What They Do, 342 Trachea, 404
Major Arteries of the Systemic Circulation, 343 Bronchial Tree: Bronchi, Bronchioles, and
Aorta, 343 Alveoli, 404
Branches of the Aorta, 344 Lungs, 406
Major Veins of the Systemic Circulation, 346 Pleural Membranes, 407
Venae Cavae, 346 Collapsed and Expanded Lungs, 407
Special Circulations, 348 Why Lungs Collapse, 408
Blood Supply to the Head and Brain, 348 Why Lungs Expand, 409
Blood Supply to the Liver and the Hepatic Portal Saying It Another Way: Compliance, 410
Circulation, 350 Respiratory Function, 411
Fetal Circulation, 351 Three Steps in Respiration, 411
Pulse, 353 Amounts of Air, 416
What Is a Pulse?, 353 Control of Breathing, 418
What Can You Learn About a Patient by Feeling the
Pulse?, 353
23 Digestive System, 428
19 Functions of the Blood Vessels, 357 Overview of the Digestive System, 428
Digestion and Absorption, 429
Blood Vessels Deliver, 357 Layers, Nerves, and Membranes, 429
Blood Vessels Regulate Blood Pressure, 357 Structures and Organs, 431
Measurement of Blood Pressure, 357 Mouth, 431
Blood Pressure in Different Blood Vessels, 359 Pharynx, 433
What Determines Blood Pressure?, 360 Esophagus, 434
How Blood Pressure Stays within Normal Limits, 362 Stomach, 434
xiv Contents
Key Terms
abdominopelvic cavity (p. 10) homeostasis (p. 6) sagittal plane (p. 7)
anatomical position (p. 6) mediastinum (p. 10) spinal (vertebral) cavity (p. 9)
anatomy (p. 1) organs (p. 2) thoracic cavity (p. 10)
cranial cavity (p. 9) pericardial cavity (p. 10) transverse plane (p. 7)
dorsal cavity (p. 9) physiology (p. 1) ventral cavity (p. 9)
frontal plane (p. 7) pleural cavities (p. 10) viscera (p. 9)
Objectives
1. Define the terms anatomy and physiology. 6. List common terms used for relative positions of the body.
2. List the levels of organization of the human body. 7. Describe the three major planes of the body.
3. Describe the 12 major organ systems. 8. List anatomical terms for quadrants and regions of the
4. Define homeostasis. body.
5. Describe the anatomical position. 9. Describe the major cavities of the body.
The human body is a wonderful creation. Millions of describes what the heart looks like, how big it is, what
microscopic parts work together in a coordinated it is made of, how it is organized, and where it is
fashion to keep you going for about 75 years. Most of located. The word anatomy comes from the Greek word
us are curious about our bodies—how they work, why meaning to dissect. The science of anatomy arose from
they do not work, what makes us tick, and what makes observations made by scientists centuries ago as they
us sick. As you learn more about the body, you will dissected bodies that were usually stolen from the
sometimes feel like this cartoon character: “What is local graveyard.
this? Why do I need it? How does it work? Why don’t Physiology (fiz-ee-OL-o-jee) is the branch of science
I have one?” As you study anatomy and physiology, that describes how the body functions. For example,
you will learn the answers to these questions. physiology describes how the heart pumps blood and
why the pumping of blood is essential for life. Patho-
physiology (path-o-fiz-ee-OL-o-jee) is the branch of
science that describes the consequences of the improper
functioning of the body—that is, how a body part
functions when a person has a disease. Pathophysiol-
ogy describes what happens during a heart attack,
when the heart functions poorly, or not at all.
Re-Think
Using any household item, explain what is meant by “structure
and function are related.”
Do You Know…
Why This Grave Is Being Robbed, and Why the Grave Robber
Is in Big, Big Trouble?
Dissection of the human body during medieval times was not
allowed. Thus, the only way that the early anatomists had for
obtaining human bodies for dissection was to rob graves.
Medieval scientists hired people to rob graves. Punishment for
robbing graves was swift and severe. This lad will be in big,
big trouble if he is caught, and it looks as if he will be. Surpris-
ingly, grave robbing was common early in this century and in
this country. Many a medical student who enrolled in the most
prestigious medical schools had to “get” his own cadaver.
Atoms
Molecules
Cells
Tissue
Organ
Organism
system
Organ
and relaxation of these muscles help the organ and in the defense of the body against pathogens
systems carry out their functions. and other foreign material.
• The nervous system is made up of the brain, spinal • The immune system is an elaborate defense system
cord, nerves, and sense organs. Sensory nerves that protects the body not only from pathogens, but
receive information from the environment and also from allergens, such as pollens, bee venom, and
bring it to the spinal cord and brain, where it is some of our own cells that have gone awry (cancer
interpreted. Decisions made by the brain and spinal cells). The immune system is widely distributed
cord are transmitted along motor nerves to various throughout the body (it is not shown in Figure 1-3).
body structures. • The respiratory system contains the lungs and other
• The endocrine (EN-doh-krin) system contains structures that conduct air to and from the lungs.
numerous glands that secrete hormones and chemi- Oxygen-rich air moves into the lungs; the oxygen is
cal substances that regulate body activities such as picked up by the blood and distributed throughout
growth, reproduction, metabolism, and water the body. Carbon dioxide–rich air moves out of the
balance. lungs, thereby ridding the body of waste.
• The circulatory (SER-kyoo-lah-tor-ee) system con- • The digestive system is comprised of organs
sists of the blood, heart, and blood vessels. This designed to ingest food and break it down into sub-
system pumps (heart) and transports (blood vessels) stances that can be absorbed by the body. Food that
blood throughout the body. Blood carries nutrients is not absorbed is eliminated as waste.
and oxygen to all the body’s cells and also carries • The urinary system contains the kidneys and other
the waste away from the cells to the organs of structures that help excrete waste products from the
excretion. body through the urine. More importantly, the
• The lymphatic (lim-FAT-ik) system is made up of urinary system helps control water, electrolyte, and
the lymph nodes, lymphatic vessels, lymph, and acid–base balance in the body.
other lymphoid organs. Lymph and lymphoid • The reproductive system is made up of organs and
structures play an important role in fluid balance structures that enable humans to reproduce.
4 CHAPTER 1 Introduction to the Human Body
Sum It Up!
Anatomy and physiology describes the structure and function
of the body. The body is constructed from simple to complex
(atoms to molecules to cells to tissues to organs to organ
systems to the human organism). The 12 major organ systems
are shown in Figure 1-3. Homeostatic mechanisms enable the
body to “stay the same” despite changing internal and external FIGURE 1-4 Anatomical position.
environments.
in pairs. Note that the two terms in each pair are gener-
ANATOMICAL TERMS: TALKING ABOUT
ally opposites. Remember, the references are valid only
THE BODY
for the body in its anatomical position.
Special terms describe the location, position, and • Superior and inferior. Superior means that a part is
regions of body parts. Because these terms are used above another part or is closer to the head. For
frequently, you should become familiar with them example, the head is superior to the chest. Inferior
now. People in the medical field are often accused of means that a part is located below another part or
speaking their own language. Indeed, we do! We is closer to the feet. The chest, for example, is infe-
always use these terms as if the body were standing in rior to the head.
its anatomical position. • Anterior and posterior. Anterior means toward the
front surface (the belly surface). Posterior means
toward the back surface. For example, the heart is
ANATOMICAL POSITION anterior to the spinal cord, but the heart is posterior
In its anatomical position, the body is standing erect, to the breastbone. Another word for anterior is
with the face forward, the arms at the sides, and ventral, and another word for posterior is dorsal.
the toes and palms of the hands directed forward Consider the dorsal fin of a fish. It is the dorsal part
(Figure 1-4). of the shark that can be seen moving effortlessly and
very quickly toward your surfboard!
• Medial and lateral. Imagine a line drawn through the
RELATIVE POSITIONS middle of your body, dividing it into right and left
Specific terms describe the position of one body part halves. This is the midline. Medial means toward the
in relation to another body part. These are directional midline of the body. The nose, for example is medial
terms. They are like the more familiar directions of to the ears. Lateral means away from the midline of
north, south, east, and west; however, whereas describ- the body. For example, the ears are lateral to the
ing Canada as being located north of the United States nose. In the anatomical position, the hand is closer
would be correct, describing the head as “north of the to the lateral thigh than to the medial thigh.
chest” would sound strange. Therefore, in locating • Proximal and distal. Proximal means that the struc-
body parts, we use other terminology. The terms come ture is nearer the point of attachment, often the
Introduction to the Human Body CHAPTER 1 7
A B C
FIGURE 1-5 Planes of the body. A, Sagittal. B, Frontal (coronal). C, Transverse.
trunk of the body. Because the elbow is closer to the PLANES OF THE BODY
point of attachment than is the wrist, the elbow is
described as proximal to the wrist. The wrist is When we refer to the left side of the body, the top
proximal to the fingers, meaning that the wrist half of the body, or the front of the body, we are
is closer to the trunk than are the fingers. Distal referring to the planes of the body. Each plane divides
means that a part is farther away from the point of the body with an imaginary line in one direction.
attachment than another part. For example, the Figure 1-5 shows the following three important
wrist is distal to the elbow and the fingers are distal planes:
to the wrist. 1. Sagittal plane (see Figure 1-5, A). The sagittal plane
• Superficial and deep. Superficial means that a part is divides the body lengthwise into right and left por-
located on or near the surface of the body. The skin tions. If the cut is made exactly down the midline
is superficial to the muscles. Deep means that the of the body, the right and left halves of the body are
body part is away from the surface of the body. The equal. This division is a midsagittal section.
bones, for example, are deep to the skin. 2. Frontal plane (see Figure 1-5, B). The frontal plane
• Central and peripheral. Central means that the part is divides the body into anterior (ventral) and poste-
located in the center. Peripheral means away from rior (dorsal) portions. This plane creates the front
the center. The heart, for example, is located cen- part of the body and the back part of the body. The
trally, whereas the blood vessels are located periph- frontal plane is also called the coronal plane. Coronal
erally (away from the center and extending toward means “crown,” so the imaginary line for the coronal
the limbs). The brain and spinal cord are called the plane is made across the part of the head where
central nervous system and the nerves are called the a crown would sit and then downward through
peripheral nervous system. the body.
3. Transverse plane (see Figure 1-5, C). The transverse
Re-Think plane divides the body horizontally, creating an
upper (superior) and a lower (inferior) body. When
Use the terms medial and lateral in describing the parts of the
the body or an organ is cut horizontally or trans-
thigh. Do the same with the eye.
versely, it is called a cross section.
8 CHAPTER 1 Introduction to the Human Body
Cranial
Cephalic
Orbital
Occipital
Buccal Oral
Cervical
Deltoid
Sternal Scapular
Abdominal
Axillary
Brachial Lumbar
Antecubital
Flank
Caudal
Inguinal
Umbilical
Digital
Gluteal
Pubic
Femoral
Patellar
Popliteal
Pedal
Plantar
A B
FIGURE 1-6 Regional terms. A, Anterior view. B, Posterior view.
Mediastinum
Pleural cavities
Cranial cavity
Spinal cavity
Dorsal
Thoracic cavity cavity
Diaphragm
Ventral
cavity
Abdominal
cavity
Abdomino–
pelvic cavity
Pelvic cavity
Gluteal: buttocks
Lumbar: area of the back between the ribs and the hips
Re-Think
Occipital: back of the head Of the following terms, which can be seen only on the posterior
Popliteal: behind, or back of, the knee area view of the body: umbilical, antecubital, gluteal, lumbar, sternal,
Scapular: shoulder blade area patellar, and popliteal?
5 juillet.
9 juillet.
13 juillet.
Coire, 15 juillet.
Tout d’une traite, j’ai filé jusqu’à Coire, où je vais coucher, afin de
faire, en plein jour, la sauvage montée de l’Albula.
Le crépuscule est tout rose. De ma chambre qui donne sur la
grande place, je vois des cimes d’arbres ondulant sous un ciel
nacré, où déjà brille une étoile ; j’aperçois des perspectives de
petites vieilles rues, aux maisons basses, des passants qui circulent
sans hâte, le visage calme. De rares voitures avancent, paisibles
parmi les groupes que rassemble la belle fin de jour, lumineuse et
chaude. Une brume, diaprée par le couchant, voile un peu les
lointains du cirque de montagnes, à l’ombre desquelles s’épanouit la
ville souriante. Tantôt, je me suis amusée à suivre au hasard le
dédale des rues inconnues qui serpentent, étroites et proprettes,
escaladent les belles pentes boisées, ou descendent vers la Plessur
écumeuse avec une allure de petit torrent sur un lit de pierres
luisantes.
J’adore m’en aller ainsi, au gré de mon caprice, dans une ville
étrangère que je découvre avec des ravissements et des
désillusions d’« explorateur »… Je m’y sens bien moins seule que
dans mon Paris où, parmi tant d’êtres que je connais, je ne suis
qu’une épave errante dont nul n’a souci.
En voyage, oh ! délice, j’oublie… Je ne suis plus qu’une
insatiable curieuse, jamais lasse, que rien n’effraie ; un cerveau qui
jouit ; des yeux avides de contempler… La solitude ne m’est plus un
fruit amer, elle me devient un trésor, car elle me permet de
vagabonder à ma guise, de m’arrêter, de partir, de rêvasser ainsi
qu’il me plaît…
Et cette impression de pleine indépendance jette en moi une
griserie dont je goûte la saveur d’autant plus que j’ai le souvenir
d’odieux voyages, en compagnie de mon casanier mari qui ne
concevait que Paris ; voyages où chaque occasion amenait le heurt
de nos goûts, des natures trop différentes que l’amour ne fondait
plus…
Ah ! que c’est exquis de voyager à sa guise !
Aussi, déjà le charme opère… Et je m’y abandonne toute, corps,
âme, pensée ; consciente qu’il est excellent pour moi d’être loin de
Paris, distraite de tout ce qui n’est pas l’imprévu du voyage.
Ainsi, je vais retrouver un bienfaisant je m’en fichisme, le seul
état d’âme qui puisse désormais me convenir.
Tout à l’heure, avant de rentrer à l’hôtel, je me suis arrêtée un
instant à mi-côte du sentier de chèvre que je redescendais. Et j’ai
regardé la féerie du couchant se voiler derrière les crêtes, nimbées
de flamme. Sous l’éblouissante lueur la ville était toute rose, alors
que déjà les bois bleuissaient, saisis par le crépuscule. A peine, une
rumeur lointaine montait des rues claires, allongées devant la
montagne : aboi d’un chien, bruit vague de quelque voix ; roulement
sourd des roues sur le pavé. Nul passant.
Mais près de moi, hélas ! arrêtés sur un banc voisin, des
touristes ; une famille allemande qui m’observait, plutôt curieuse,
surtout la fillette, — quatorze à quinze ans, — dont la lourde
silhouette se couronnait d’un délicieux visage de petite vierge grave.
J’entendais les rudes sonorités de leur langue.
Je regardais, à mes pieds, ces demeures où vivaient des êtres
qui tous m’étaient inconnus ; ces rues à travers lesquelles j’étais la
passante étrangère qui traverse et ne revient pas.
Ah ! que Paris me semblait loin !… Et bien lointaine aussi, cette
Viva que troublait si profondément, il y a deux jours, l’adieu d’un
ami ; la Viva qui, toute la nuit, dans son wagon, avait aimé la senteur
des œillets se fanant à son corsage, reçus à la dernière heure de cet
ami…
Et curieusement, les yeux un peu sévères et un peu moqueurs,
je la contemplais, cette Viva qui avait été moi quelques heures et
que je ne comprenais plus bien, gagnée par l’indifférente sérénité
des choses.
Saint-Moritz, 18 juillet.
22 juillet.
25 juillet.