ELSEVIER SAUNDERS Elsevier lnc. 1600 John F Kennedy Blvd. Suite 1800 Philadelphia, Pennsylvania 19103-2899 TEXTBOOK OF MEDICAL PHYSIOLOGY ISBN0-7216-0240-1 International Edition Isbn 0-8089-2317-X 6,1991,1986,1981,1976,1971,196,1961,1956 by elsevier Inc. All rights reserved. No part of this publication duced or transmitted in any form or by any means, electronic or mechanical, including ng, recording, or any information stor publisher. Permissions may be sought Philadelphia, PA, USA: Phone: (+1) 152393804,fax(+1) 9 3805.e-mail: healt @elsevier.com.Youmayalsocomplete yourrequeston-lineviatheElsevierhomepage(http://www.elsevier.com),byselecting"custome Support"and then"Obtaining Permissions NOTICE our knowledge, changes in practice, treatment and drug therapy may become experienc Ige and best practice in this field are constantly changing. As new research an essary or appropriate. Readers are advised to check the most current information provided (i)on ocedures featured or(ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula. the method and duration of administration. and contraindications. g eIr patient, to make diagnoses, to determine dosages and the best treatment for each individual tient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book. Library of Congress Cataloging-in-Publication Data Guyton, Arthur C. Textbook of medical physiology Arthur C Guyton, John E. Hall-1lth ed. Includes bibliographical references and index. ISBN07216-0240-1 DNLM: 1. Physiological Processes. QT 104 G992t 2006 oP34.5G92006 612dc22 004051421 Publishing Director: Linda belfus Managing Editor: Rebecca Gruliow Publishing Services Mi Tina Rebane Project Manager: Mary Anne Folcher Design Manager: Steven Stave Marketing Manager: John Gore Cover illustration is a detail from Opus 1972 by Virgil Cantini, Ph. D, with permission of the artist and Mansfield State College. Mansfield, Pennsylvania Chapter opener credits: Chapter 43, modified from Getty Images 21000058038: Chapter 44, modified from Getty Images 21000044598: Chapter 84, modified from Corbis ng toget grow libraries in developing countries Printed in China www.elsevicr.comIwww.bookaid.orgIwww.sabre.org Last digit is the umber:98765432 El SEVIER BOOK AID Sabre FoundatiElsevier Inc. 1600 John F. Kennedy Blvd., Suite 1800 Philadelphia, Pennsylvania 19103-2899 TEXTBOOK OF MEDICAL PHYSIOLOGY ISBN 0-7216-0240-1 International Edition ISBN 0-8089-2317-X Copyright © 2006, 2000, 1996, 1991, 1986, 1981, 1976, 1971, 1966, 1961, 1956 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting “Customer Support” and then “Obtaining Permissions”. NOTICE Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book. Library of Congress Cataloging-in-Publication Data Guyton, Arthur C. Textbook of medical physiology / Arthur C. Guyton, John E. Hall.—11th ed. p. ; cm. Includes bibliographical references and index. ISBN 0-7216-0240-1 1. Human physiology. 2. Physiology, Pathological. I. Title: Medical physiology. II. Hall, John E. (John Edward) III. Title. [DNLM: 1. Physiological Processes. QT 104 G992t 2006] QP34.5.G9 2006 612—dc22 2004051421 Publishing Director: Linda Belfus Acquisitions Editor: William Schmitt Managing Editor: Rebecca Gruliow Publishing Services Manager: Tina Rebane Project Manager: Mary Anne Folcher Design Manager: Steven Stave Marketing Manager: John Gore Cover illustration is a detail from Opus 1972 by Virgil Cantini, Ph.D., with permission of the artist and Mansfield State College, Mansfield, Pennsylvania. Chapter opener credits: Chapter 43, modified from © Getty Images 21000058038; Chapter 44, modified from © Getty Images 21000044598; Chapter 84, modified from © Corbis. 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