Color Atlas of Physiology Stefan Silbernagl Agamemnon Despopoulos 6th edition basic sciences 孿 Thieme
At a glance 1 Fundamentals and Cell Physiology 2 Nerve and Muscle, Physical Work 3 Autonomic Nervous System(ANS) 6 Acid-Base homeostasis 138 7 Kidneys, Salt, and Water 8 Cardiovascular System 9 Thermal Balance and Thermoreg 10 Nutrition and Digestion 228 11 Hormones and Reproduction 268 12 Central Nervous System and Ser 312 37 Further Reading Index
I At a Glance 1 Fundamentals and Cell Physiology 2 2 Nerve and Muscle, Physical Work 42 3 Autonomic Nervous System (ANS) 78 4 Blood 88 5 Respiration 106 6 Acid–Base Homeostasis 138 7 Kidneys, Salt, and Water Balance 148 8 Cardiovascular System 188 9 Thermal Balance and Thermoregulation 224 10 Nutrition and Digestion 228 11 Hormones and Reproduction 268 12 Central Nervous System and Senses 312 13 Appendix 378 Further Reading 397 Index 399
Color atlas of Physiology Stefan Silbernagl, MD of Wurzburg Agamemnon Despopoulos, MD Formerly: Ciba Geigy 189 color plates by Astried Rothenburger Thieme Stuttgart· New york
III Color Atlas of Physiology 6th edition Stefan Silbernagl, MD Professor Institute of Physiology University of Würzburg Würzburg, Germany Agamemnon Despopoulos, MD Professor Formerly: Ciba Geigy Basel 189 color plates by Ruediger Gay and Astried Rothenburger Thieme Stuttgart · New York
Library of Congress Catalogitg-in-Ptblicntion Data Important Note: Medicine is an ever-changing [ Taschenatlas der Physiologie. English esearch and dinical experience are continua ng our kn thenburger translator, Suzyon O'Neal WandreyL. knowledge of proper treatment and drug the apy. Insofar as this book mentions any dosage bibliographical references and index anslation of: Taschenatlas der Physiologie. 5th German ed the authors, editors, and publishers have made very effort to ensure that such references ar LSBN978-3-13-545005-3(alk. puper) in accordance with the state of knowledge at cases L. Sulberngl, Stefan. I Title. the time of production of the book. NLM: L Phrysiology-Atlases QT 17 D471c 2009] P345553132009 Nevertheless, this does not involve, imply or express any guarantee or responsibility on 2008042538 the part of the publishers in respect to any do age instructions and forms of applications amine carefully the manufacturers' leaflets Ist spanish e mpanying each drug and to check, if nece rd spanish edition 1994 4th German ediTion 1991 list, whether the dosage schedules mentioned therein or the contraindications stated by the nd Czech edition manufacturers differ from the statements made in the present book. Such examination is 2nd frenchedition 19g2 either rarely used or have been newly released n the market. Every dosage schedule or every 5th English edition 2003 form of application used is entirely at the user's 1989 publishers request every user to report to the Ist Chinese edition 1991 publishers any discrepancies or inaccuracies noticed If errors in this work are found after 2nd Italian edition 2002 st polish ed publicationerratawillbepostedatwww.thie- st Portuguese edition 200 me. com on the product description page. nd Hungarian edition 1996 Some of the product names, patents, and registered designs referred to in this book are Ist Serbian onesion eton 4uou in fact registered trademarks or proprietary ames even though specific reference to this act is not always made in the text. Therefo the appearance of a name without designation ated by Suryon ONeal Wandrey and Ra proprietary is not to be construed as a repre- ad by Atelier Gay Rothenburger, erma sentation by the publisher that it is in the udigerstraBe 14, 70469 Stuttgart, Germany This book, including all parts thereof, is le- gally protected by copyright. Any t 3 Seventh Avenue tion, or commercialization outside the narrow York. NY 10001. USA limits set by copyright legislation, without the over design: Thieme Publishing Group reproduction, copying, mimeographing or Anderson Nexo Zwenkau duplication of any kind, translating, prepara- ion of microfilms, and electronic data pr 1 2345 cessing and storage
IV Library of Congress Cataloging-in-Publication Data Despopoulos, Agamemnon. [Taschenatlas der Physiologie. English] Color atlas of physiology / Agamemnon Despopoulos, Stefan Silbernagl; color plates by Ruediger Gay and Astried Rothenburger ; [translator, Suzyon O’Neal Wandrey]. – 6th ed., completely rev. and expanded. p. ; cm Includes bibliographical references and index. Translation of: Taschenatlas der Physiologie. 5th German ed. c2001. ISBN 978-3-13-545006-3 (alk. paper) 1. Human physiology–Atlases. I. Silbernagl, Stefan. II. Title. [DNLM: 1. Physiology–Atlases. QT 17 D471c 2009a] QP34.5.S5313 2009 612–dc22 2008042538 1st German edition 1979 2nd German edition 1983 3rd German edition 1988 4th German edition 1991 5th German edition 2001 6th German edition 2003 7th German edition 2007 1st English edition 1981 2nd English edition 1984 3rd English edition 1986 4th English edition 1991 5th English edition 2003 1st Dutch edition 1981 2nd Dutch edition 2001 3rd Dutch edition 2008 1st Italian edition 1981 2nd Italian edition 2002 1st Japanese edition 1982 2nd Japanese edition 1992 3rd Japanese edition 2005 1st Serbian edition 2006 1st Spanish edition 1982 2nd Spanish edition 1985 3rd Spanish edition 1994 4th Spanish edition 2001 1st Czech edition 1984 2nd Czech edition 1994 3rd Czech edition 2004 1st French edition 1985 2nd French edition 1992 3rd French edition 2001 1st Turkish edition 1986 2nd Turkish edition 1997 1st Greek edition 1989 1st Chinese edition 1991 1st Polish edition 1994 1st Portuguese edition 2003 1st Hungarian edition 1994 2nd Hungarian edition 1996 1st Indonesion edition 2000 Translated by Suzyon O’Neal Wandrey and Rachel Swift Illustrated by Atelier Gay + Rothenburger, Sternenfels, Germany 1981, 2009 Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany http://www.thieme.de Thieme New York, 333 Seventh Avenue, New York, NY 10001, USA http://www.thieme.com Cover design: Thieme Publishing Group Typesetting by: Druckhaus Götz GmbH, Ludwigsburg, Germany Printed in Germany by: Offizin Anderson Nexö, Zwenkau ISBN 978-3-13-545006-3 12345 Important Note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book. Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage
Preface to the sixth Edition The base of knowledge in many sectors of I am very grateful for the many helpful com- hysiology has again grown considerably in ments from attentive readers and for the th since the last edition of come feedback from my peers, this time this book was published. Many advances, es- pecially from Prof R Renate LiilImann-Rauch cially the successful application of the Kiel, Prof Gerhardt Burckhardt, Gottingen, Prof. methods of molecular biology and gene tech- Detlev Drenckhahn, Wurzburg, and Dr Michael ology brought completely new insight into Fischer, Mainz as well as from my colleagues cell signalling and communication as well as and staff at the department of Physiology in into many integrative functions of the body. Wurzburg. It was again a great pleasure to This made it necessary to edit and, in some work with Riidiger Gay and Astried Rothen- cases, enlarge some parts of the book, es- burger, to whom I am deeply indebted for cially the chapters on blood clotting, wate illustrations in the book and for homeostasis, regulation of body weight, in esigning a number of new color plates To etabolism, sleep-wake cycle, memory and them I extent my sincere thanks. I am also in- publishing staff, Rachel Swift. In recent years, etent editor and Elisabeth Kurz. for and clinical examples have been adde to the curricula of medical physiology. To make like to thank Katharina Volker for her ever ob- for this development also in this servant and conscientious assistance in olor atlas, the numerous references to clinical paring the index. dicine are marked by blue margin bars, and hope that also the 6th Edition of the Color and clinical key-words are Atlas of Physiology will prove to be a valuable attached at the bottom of each text page. They tool for helping students better understand should make it easier to recognize the rele- physiological correlates, and that it will be a vance of the physiological facts for clinical valuable reference for practicing physicians ce,and to find quickly more and scientists, to help them recall previously ormation on these topics in textbooks of learned information and gain new insights in thophysiology (e.g. in our Color Atlas of physiology. hysiology )and clinical medicine urzburg. September 2008 e-mail: stefan silbernagl@mail. uni-wuerzburg d
V Preface to the Sixth Edition The base of knowledge in many sectors of physiology has again grown considerably in magnitude and depth since the last edition of this book was published. Many advances, especially the successful application of the methods of molecular biology and gene technology brought completely new insight into cell signalling and communication as well as into many integrative functions of the body. This made it necessary to edit and, in some cases, enlarge some parts of the book, especially the chapters on blood clotting, water homeostasis, regulation of body weight, iron metabolism, sleep-wake cycle, memory and sound reception. In recent years, more pathophysiological aspects and clinical examples have been added to the curricula of medical physiology. To make allowance for this development also in this color atlas, the numerous references to clinical medicine are marked by blue margin bars, and pathophysiological and clinical key-words are attached at the bottom of each text page. They should make it easier to recognize the relevance of the physiological facts for clinical medicine at a glance, and to find quickly more information on these topics in textbooks of pathophysiology (e. g. in our Color Atlas of Pathophysiology) and clinical medicine. I am very grateful for the many helpful comments from attentive readers and for the welcome feedback from my peers, this time especially from Prof. R. Renate Lüllmann-Rauch, Kiel, Prof. Gerhardt Burckhardt, Göttingen, Prof. Detlev Drenckhahn, Würzburg, and Dr. Michael Fischer, Mainz as well as from my colleagues and staff at the Department of Physiology in Würzburg. It was again a great pleasure to work with Rüdiger Gay and Astried Rothenburger, to whom I am deeply indebted for revising many illustrations in the book and for designing a number of new color plates. To them I extent my sincere thanks. I am also indebted to the publishing staff, Rachel Swift, a very competent editor, and Elisabeth Kurz, for invaluable production assistance. I would also like to thank Katharina Völker for her ever observant and conscientious assistance in preparing the index. I hope that also the 6th Edition of the Color Atlas of Physiology will prove to be a valuable tool for helping students better understand physiological correlates, and that it will be a valuable reference for practicing physicians and scientists, to help them recall previously learned information and gain new insights in physiology. Würzburg, September 2008 Stefan Silbernagl* * e-mail: stefan.silbernagl@mail.uni-wuerzburg.de
Preface to the first edition In the modern world, visual pathways have A book of this nature is inevitably deriva- utdistanced other avenues for informational tive, but many of the representations are new aput. This book takes advantage of the eco and, we hope, innovative. A number of people my of visual representation to indicate the si- have contributed directly and indirectly to the lultaneity and multiplicity of physiological completion of this volume, but none more phenomena. Although some subjects lend than Sarah Jones, who gave much more than hemselves more readily than others to this editorial assistance. Acknowledgement criticism and advice is due also to drs overage of the key elements of physiology has R Greger, A. Ratner, J. Weiss, and S. Wood, and Prof. H Seller. We are grateful to Joy wieser for Clearly, this book of little more than 300 her help in checking the proofs. Wolf-Ruidige ges, only half of which are textual, cannot be and Barbara Gay are especially recognized, not considered as a primary source for the serious only for their art work, but for their conceptu udent of physiology. Nevertheless, it does contributions as well. The publishers, ontain most of the basic principles and facts Thieme Verlag and Deutscher Taschenbuch taught in a medical school introductory Verlag, contributed valuable assistance based urse. Each unit of text and illustration can on extensive experience: an author could wish serve initially as an overview for introduction for no better relationship. Finally, special to the subject and subsequently as a concise recognition to Dr Walter Kumpmann for in- eview of the material. The contents are as cur- spiring the project and for his unquestioning nt as the publishing art permits and include confidence in the authors. both classical information for the beginning as recent details and trends Basel and Innsbruck, Summer 1979 or the advanced
VI Preface to the First Edition In the modern world, visual pathways have outdistanced other avenues for informational input. This book takes advantage of the economy of visual representation to indicate the simultaneity and multiplicity of physiological phenomena. Although some subjects lend themselves more readily than others to this treatment, inclusive rather than selective coverage of the key elements of physiology has been attempted. Clearly, this book of little more than 300 pages, only half of which are textual, cannot be considered as a primary source for the serious student of physiology. Nevertheless, it does contain most of the basic principles and facts taught in a medical school introductory course. Each unit of text and illustration can serve initially as an overview for introduction to the subject and subsequently as a concise review of the material. The contents are as current as the publishing art permits and include both classical information for the beginning students as well as recent details and trends for the advanced student. A book of this nature is inevitably derivative, but many of the representations are new and, we hope, innovative. A number of people have contributed directly and indirectly to the completion of this volume, but none more than Sarah Jones, who gave much more than editorial assistance. Acknowledgement of helpful criticism and advice is due also to Drs. R. Greger, A. Ratner, J. Weiss, and S. Wood, and Prof. H. Seller. We are grateful to Joy Wieser for her help in checking the proofs. Wolf-Rüdiger and Barbara Gay are especially recognized, not only for their art work, but for their conceptual contributions as well. The publishers, Georg Thieme Verlag and Deutscher Taschenbuch Verlag, contributed valuable assistance based on extensive experience; an author could wish for no better relationship. Finally, special recognition to Dr. Walter Kumpmann for inspiring the project and for his unquestioning confidence in the authors. Basel and Innsbruck, Summer 1979 Agamemnon Despopoulos Stefan Silbernagl
VIl From the preface to the third edition The first German edition of this book was al- Their intention was to cross the atlantic in their sailing boat. This was the last that wa ever heard of them and we have had to aban- Without the creative enthusiasm of Aga- menon Despopoulos, it is doubtful whether this book would have been possible; without his personal support it has not been easy to continue with the project. whilst keeping in mind our original aims, I have completely re vised the book, incorporating the latest adval in the field of physiology as well as the wel- edition, to whom I extend my thanks for their active interest in New York: Professor of Physiology at the buquerque, USA, until 1971: Wurzburg, Fall 1985 scientific adviser to CIBA-GEIGY. Basel
VII From the Preface to the Third Edition The first German edition of this book was already in press when, on November 2nd, 1979, Agamennon Despopoulos and his wife, Sarah Jones-Despopoulos put to sea from Bizerta, Tunisia. Their intention was to cross the Atlantic in their sailing boat. This was the last that was ever heard of them and we have had to abandon all hope of seeing them again. Without the creative enthusiasm of Agamennon Despopoulos, it is doubtful whether this book would have been possible; without his personal support it has not been easy to continue with the project. Whilst keeping in mind our original aims, I have completely revised the book, incorporating the latest advances in the field of physiology as well as the welcome suggestions provided by readers of the earlier edition, to whom I extend my thanks for their active interest. Würzburg, Fall 1985 Stefan Silbernagl Dr. Agamemnon Despopoulos Born 1924 in New York; Professor of Physiology at the University of New Mexico. Albuquerque, USA, until 1971; thereafter scientific adviser to CIBA-GEIGY, Basel
Table of contents 1 Fundamentals and Cell Physiology The Body: an Open System with an Internal Environment ontrol and Regulation..4 Transport In, Through and Between Cells..16 Transport by Means of Diffu Osmosis Filtration and Convection.. 24 Active Transport…26 Electrical Membrane potentials and lon Channels. 3 tole of Ca2 in Cell Regulation..36 Energy Production and Metabolism.. 38 2 Nerve and Muscle, Physical Work Neuron Structure and Function .. 4 Resting Membrane potential .. 44 Action potential….46 Propagation of Action Potentials in Nerve Fiber..48 ficial Stimulation of Nerve Cells .. 50 Synaptic Transmission. 50 Motor end.- plate…56 Motility and Muscle Types..58 Motor unit of skeletal muscle .. 58 Contractile Apparatus of Striated Muscle..60 Contraction of Striated Muscle .. 62 Mechanical Features of skeletal muscle .. 66 Energy Supply for Muscle Contraction..7. Physical Fitness and Training..76 3 Autonomic Nervous System(ANS) Organization of the Autonomic Nervous System(ANS) Acetylcholine and Cholinergic Transmission..82 Catecholamines, Adrenergic Transmission and Adrenoceptors..84 Adrenal Medulla…86 lon-cholinergic, Non-adrenergic Transmitters..86 Composition and Function of Blood..88 Iron Metabolism and Erythropoiesis..90 Flow Properties of Blood..92 Plasma. lon Distribution
IX Table of Contents 1 Fundamentals and Cell Physiology 2 The Body: an Open System with an Internal Environment · · · 2 Control and Regulation · · · 4 The Cell · · · 8 Transport In, Through and Between Cells · · · 16 Passive Transport by Means of Diffusion · · · 20 Osmosis, Filtration and Convection · · · 24 Active Transport · · · 26 Cell Migration · · · 30 Electrical Membrane Potentials and Ion Channels · · · 32 Role of Ca2+ in Cell Regulation · · · 36 Energy Production and Metabolism · · · 38 2 Nerve and Muscle, Physical Work 42 Neuron Structure and Function · · · 42 Resting Membrane Potential · · · 44 Action Potential · · · 46 Propagation of Action Potentials in Nerve Fiber · · · 48 Artificial Stimulation of Nerve Cells · · · 50 Synaptic Transmission · · · 50 Motor End-plate · · · 56 Motility and Muscle Types · · · 58 Motor Unit of Skeletal Muscle · · · 58 Contractile Apparatus of Striated Muscle · · · 60 Contraction of Striated Muscle · · · 62 Mechanical Features of Skeletal Muscle · · · 66 Smooth Muscle · · · 70 Energy Supply for Muscle Contraction · · · 72 Physical Work · · · 74 Physical Fitness and Training · · · 76 3 Autonomic Nervous System (ANS) 78 Organization of the Autonomic Nervous System (ANS) · · · 78 Acetylcholines and Cholinergic Transmission · · · 82 Catecholamines, Adrenergic Transmission and Adrenoceptors · · · 84 Adrenal Medulla · · · 86 Non-cholinergic, Non-adrenergic Transmitters · · · 86 4 Blood 88 Composition and Function of Blood · · · 88 Iron Metabolism and Erythropoiesis · · · 90 Flow Properties of Blood · · · 92 Plasma, Ion Distribution · · · 92
able of contents Immune Systen…94 Hypersensitivity Reactions(Allergies)..100 Fibrinolysis and Thromboprotection.. 104 Purification of Respiratory Air... 110 Artificial Respiration.. 110 Lung volumes and their Measurement.. 112 Dead Space, Residual Volume, Airway Resistance.. 114 Dynamic Lung Function Tests.. 118 ulmonary Gas Exchange Pulmonary Blood Flow, Ventilation-Perfusion Ratio.. 122 Blood, cO in CSF CO2 in Cerebrospinal Fluid ternal(Tissue)Respiration, Hypoxia.. 130 spiratory Control and Stimulation..132 Effects of Diving on Respiration.. 134 Effects of High Altitude on Respiration.. 136 gen Toxicity…136 pH, pH Buffers, Acid-E lance……138 Acidosis and alkalosis Assessment of Acid-Base Status . 146 7 Kidneys, Salt, and Water Balance Kidney Structure and Function..148 Glomerular Filtration and Clearance .. 152 Transport Processes at the Nephron.. 154 Reabsorption of Organic Substances..158 Reabsorption of Na* and CI-..162 Reabsorption of Water, Formation of Concentrated Urine.. 164 is…168 alt and Water 170 Diuresis and Diuretics The Kidney and Acid-Base Balance..176
X Immune System · · · 94 Hypersensitivity Reactions (Allergies) · · · 100 Blood Groups · · · 100 Hemostasis · · · 102 Fibrinolysis and Thromboprotection · · · 104 5 Respiration 106 Lung Function, Respiration · · · 106 Mechanics of Breathing · · · 108 Purification of Respiratory Air · · · 110 Artificial Respiration · · · 110 Pneumothorax · · · 110 Lung Volumes and their Measurement · · · 112 Dead Space, Residual Volume, Airway Resistance · · · 114 Pressure–Volume Curve, Respiratory Work · · · 116 Surface Tension, Surfactant · · · 118 Dynamic Lung Function Tests · · · 118 Pulmonary Gas Exchange · · · 120 Pulmonary Blood Flow, Ventilation–Perfusion Ratio · · · 122 CO2 Transport in Blood · · · 124 CO2 Binding in Blood, CO2 in CSF · · · 126 CO2 in Cerebrospinal Fluid · · · 126 Binding and Transport of O2 in Blood · · · 128 Internal (Tissue) Respiration, Hypoxia · · · 130 Respiratory Control and Stimulation · · · 132 Effects of Diving on Respiration · · · 134 Effects of High Altitude on Respiration · · · 136 Oxygen Toxicity · · · 136 6 Acid–Base Homeostasis 138 pH, pH Buffers, Acid–Base Balance · · · 138 Bicarbonate/Carbon Dioxide Buffer · · · 140 Acidosis and Alkalosis · · · 142 Assessment of Acid–Base Status · · · 146 7 Kidneys, Salt, and Water Balance 148 Kidney Structure and Function · · · 148 Renal Circulation · · · 150 Glomerular Filtration and Clearance · · · 152 Transport Processes at the Nephron · · · 154 Reabsorption of Organic Substances · · · 158 Excretion of Organic Substances · · · 160 Reabsorption of Na+ and Cl– ··· 162 Reabsorption of Water, Formation of Concentrated Urine · · · 164 Body Fluid Homeostasis · · · 168 Salt and Water Regulation · · · 170 Diuresis and Diuretics · · · 174 The Kidney and Acid–Base Balance · · · 176 Table of Contents
Table of cont on of Phosphate, Ca2 and Mg2+ Potassium balance…182 Tubuloglomerular Feedback, Renin-Angiotensin System.. 186 8 Cardiovascul 188 Overview…188 Blood Vessels and Blood Flow .. 190 Excitation in Electrolyte Disturbances..200 cardiac Arrhythmia Ventricular Pressure-Volume Relationships..204 Cardiac Work and Cardiac Power. 204 Arterial Blood pressure .. 208 Endothelial Exchange Processes.. 210 212 regulation of the Circulation.. 214 Fetal and Neonatal Circulation .. 222 9 Thermal Balance and Thermoregulation Thermal Balance…224 2 10 Nutrition and Digestion Nutrition Energy Metabolism and Calorimetry..230 Energy Homeostasis and body Weight.. 232 astrointestinal (Gl)Tract: Overview, Immune Defense, Blood Flow..234 eural and Hormonal Integration..236 Saliva ., 238 Deglutition…240 Vomiting…240 Stomach Structure and Motility ... Small Intestinal Function .. 246 Pancreas . 248 Excretory Liver Function, Bilirubin..252 Lipid Digestion…254 Lipid Distribution and Storag 256 Digestion and Absorption of Carbohydrates and Protein..260 Vitamin Absorption.. 262 Vater and Mineral Absorption..264 Large Intestine, Defecation, Feces..266
XI Reabsorption and Excretion of Phosphate, Ca2+ and Mg2+ ··· 180 Potassium Balance · · · 182 Tubuloglomerular Feedback, Renin–Angiotensin System · · · 186 8 Cardiovascular System 188 Overview · · · 188 Blood Vessels and Blood Flow · · · 190 Cardiac Cycle · · · 192 Cardiac Impulse Generation and Conduction · · · 194 Electrocardiogram (ECG) · · · 198 Excitation in Electrolyte Disturbances · · · 200 Cardiac Arrhythmias · · · 202 Ventricular Pressure–Volume Relationships · · · 204 Cardiac Work and Cardiac Power · · · 204 Regulation of Stroke Volume · · · 206 Venous Return · · · 206 Arterial Blood Pressure · · · 208 Endothelial Exchange Processes · · · 210 Myocardial Oxygen Supply · · · 212 Regulation of the Circulation · · · 214 Circulatory Shock · · · 220 Fetal and Neonatal Circulation · · · 222 9 Thermal Balance and Thermoregulation 224 Thermal Balance · · · 224 Thermoregulation · · · 226 10 Nutrition and Digestion 228 Nutrition · · · 228 Energy Metabolism and Calorimetry · · · 230 Energy Homeostasis and Body Weight · · · 232 Gastrointestinal (GI) Tract: Overview, Immune Defense, Blood Flow · · · 234 Neural and Hormonal Integration · · · 236 Saliva · · · 238 Deglutition · · · 240 Vomiting · · · 240 Stomach Structure and Motility · · · 242 Gastric Juice · · · 244 Small Intestinal Function · · · 246 Pancreas · · · 248 Bile · · · 250 Excretory Liver Function, Bilirubin · · · 252 Lipid Digestion · · · 254 Lipid Distribution and Storage · · · 256 Digestion and Absorption of Carbohydrates and Protein · · · 260 Vitamin Absorption · · · 262 Water and Mineral Absorption · · · 264 Large Intestine, Defecation, Feces · · · 266 Table of Contents