1625915643-5d53d156c9525bd62bd0d3434ecdc231 (Netters - Essential Physiology (на английском))

This page intentionally left blankThis page intentionally left blankNETTER’SESSENTIAL PHYSIOLOGYSusan E. Mulroney, PhDProfessor of Physiology & BiophysicsDirector, Special Master’s ProgramGeorgetown University Medical CenterAdam K. Myers, PhDProfessor of Physiology & BiophysicsAssociate Dean for Graduate EducationGeorgetown University Medical CenterIllustrations byFrank H. Netter, MDContributing IllustratorsCarlos A.G.

Machado, MDJohn A. Craig, MDJames A. Perkins, MS, MFA1600 John F. Kennedy Blvd.Ste 1800Philadelphia, PA 19103-2899NETTER’S ESSENTIAL PHYSIOLOGYCopyright © 2009 by Saunders, an imprint of Elsevier Inc.ISBN: 978-1-4160-4196-2All rights reserved. No part of this book may be produced 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 publishers.

Permissions for Netter Art figures may be sought directlyfrom Elsevier’s Health Science Licensing Department in Philadelphia PA, USA: phone 1-800-523-1649,ext. 3276 or (215) 239-3276; or email H.Licensing@elsevier.com.NoticeNeither the Publisher nor the Authors assume any responsibility for any loss or injury and/or damage topersons or property arising out of or related to any use of the material contained in this book. It is theresponsibility of the treating practitioner, relying on independent expertise and knowledge of the patient,to determine the best treatment and method of application for the patient.The PublisherLibrary of Congress Cataloging-in-Publication DataMulroney, Susan E.Netter’s essential physiology / Susan E. Mulroney, Adam K.

Myers ;illustrations by Frank H. Netter ; contributing illustrators, CarlosA.G. Machado, John A. Craig, James A. Perkins.—1st ed.p. ; cm.ISBN 978-1-4160-4196-21. Human physiology. I. Myers, Adam K. II. Netter, Frank H. (FrankHenry), 1906-1991. III. Title. IV. Title: Essential physiology.[DNLM: 1. Cell Physiology—Atlases. QU 17 M961n 2009]QP34.5.M85 2009612—dc222008027016Editor: Elyse O’GradyDevelopmental Editor: Marybeth ThielProject Manager: David SaltzbergDesign Direction: Lou ForgioneIllustrations Manager: Karen GiacomucciMarketing Manager: Jason OberackerEditorial Assistant: Julie GoolsbyWorking together to growlibraries in developing countriesPrinted in ChinaLast digit is the print number: 9 8 7 6 5 4 3 2 1www.elsevier.com | www.bookaid.org | www.sabre.orgWe dedicate this book to our families, for their love andsupport and for their patience during the preparation of this book.We dedicate it also to the students of Georgetown University, whoare exceptional in their character and their love of learning.This page intentionally left blankPREFACEHuman physiology is the study of the functions of our bodies at all levels: wholeorganism, systems, organs, tissues, cells, and physical and chemical processes.

Physiology is a complex science, incorporating concepts and principles from biology,chemistry, biochemistry, and physics; and often, a true appreciation of physiologicalconcepts requires multiple learning modalities, beyond standard texts or lectures.This book, Netter’s Essential Physiology, has been prepared with this in mind. Itsgenerous illustrations and concise, bulleted, and highlighted text are designed todraw the student in, to focus the student’s efforts on understanding the essentialaspects of difficult concepts.

It is intended not to be a detailed reference book, butrather a guide to learning the essentials of the field, in conjunction with classroomwork and other texts when necessary.This book is organized in the classical order in which subdisciplines of physiologyare taught.

Beginning with fluid compartments, transport mechanisms, and cellphysiology, it progresses through neurophysiology, cardiovascular physiology, therespiratory system, renal physiology, the gastrointestinal system, and endocrinology.It is ideal for the visual learner. Each section is thoroughly illustrated with the greatdrawings of the late Frank Netter as well as the more recent, beautiful work of CarlosMachado, John Craig, and James Perkins.Recognizing that physiology, cell biology, and anatomy go hand in hand in themodern, integrated curriculum of many institutions, we have included more thanthe usual number of illustrations relevant to anatomy and histology. By reading thetext, studying the illustrations, and taking advantage of the review questions, thestudent will become familiar with the important concepts in each subdiscipline andgain the essential knowledge required in medical, dental, upper level undergraduate,or nursing courses in human physiology.Too many textbooks, although very useful reference works, go for the most partunread by students.

It is our hope that students will find this book enriching andstimulating and that it will inspire them to thoroughly learn this fascinating field.Susan E. Mulroney, PhDAdam K. Myers, PhDviiThis page intentionally left blankAcknowledgmentsThe preparation of this textbook has benefited from the efforts of numerous colleagues and students who reviewed various sections of the work and offered valuablecriticisms and suggestions. We especially wish to thank Charles Read, Henry Prange,Stefano Vicini, Jagmeet Kanwal, Peter Kot, Edward Inscho, Jennifer Rogers, AdamMitchell, Milica Simpson, Lawrence Bellmore, and Joseph Garman for their criticalreviews. In addition, we express our appreciation to Adriane Fugh-Berman, whoseinsights and advice helped us avert many potential nightmares; Amy Richards, forher constant good humor and willingness to help; and all our colleagues and coworkers for their friendship, collegiality, and encouragement during this project.Our special thanks go to the dedicated team at Elsevier, particularly MarybethThiel and Elyse O’Grady.

We also acknowledge Jim Perkins for his talented work onthe new illustrations in this volume, which gracefully complement the original drawings of the master illustrator, Frank Netter.Finally, we acknowledge the role of our students in this project, for their encouragement and for their enthusiasm in learning, which is the greatest inspiration forour work.ixThis page intentionally left blankAbout the AuthorsSUSAN E. MULRONEY, PhD, is an award-winning teacher and researcherat Georgetown University Medical Center, where she is Professor of Physiology andBiophysics and Director of the highly acclaimed Physiology Special Master’s Program.Dr. Mulroney directed the Medical Human Physiology course for the first-yearmedical students at the School of Medicine and now is Director of the MedicalGastrointestinal module in the new systems-based medical curriculum.

She alsodirects the Medical Physiology course for the Georgetown Summer Medical Institute.Dr. Mulroney lectures to medical and graduate students in multiple areas of humanphysiology, including renal, gastrointestinal, and endocrine physiology, and is recognized for her expertise in curricular innovation in medical education. Dr. Mulroney is a well-known researcher in renal and endocrine physiology, has publishedextensively in these areas, and was director of the Physiology PhD program for12 years. She is also coeditor of RNA Binding Proteins: New Concepts in GeneRegulation.ADAM K.

MYERS, PhD, is Professor of Physiology and Biophysics andAssociate Dean for Graduate Education at Georgetown University Medical Center.Dr. Myers was director of the Special Master’s Program at Georgetown for 12 yearsand developed and co-directed the M.S. program in Complementary and AlternativeMedicine.

He also founded and directs the Georgetown Summer Medical Institute.He has won numerous teaching awards from the students and faculty of GeorgetownUniversity School of Medicine, where he teaches extensively in several medical andgraduate courses in various areas of human physiology. Dr. Myers is recognized forhis extensive experience in educational program development and administration.His ongoing research in platelet and vascular biology has resulted in numerouspublications.

He is also author of the textbook Crash Course: Respiratory System andcoeditor of Alcohol and Heart Disease.xiThis page intentionally left blankAbout the ArtistsFRANK H. NETTER, MD, was born in 1906 in New York City. He studiedart at the Art Student’s League and the National Academy of Design before enteringmedical school at New York University, where he received his MD degree in 1931.During his student years, Dr. Netter’s notebook sketches attracted the attention ofthe medical faculty and other physicians, allowing him to augment his income byillustrating articles and textbooks.

He continued illustrating as a sideline after establishing a surgical practice in 1933, but he ultimately opted to give up his practice infavor of a full-time commitment to art. After service in the United States Army duringWorld War II, Dr. Netter began his long collaboration with the CIBA PharmaceuticalCompany (now Novartis Pharmaceuticals). This 45-year partnership resulted in theproduction of the extraordinary collection of medical art so familiar to physiciansand other medical professionals worldwide.In 2005, Elsevier Inc.

purchased the Netter Collection and all publications fromIcon Learning Systems. There are now more than 50 publications featuring theart of Dr. Netter available through Elsevier Inc. (in the United States: www.us.elsevierhealth.com/Netter and outside the United States: www.elsevierhealth.com).Dr. Netter’s works are among the finest examples of the use of illustration in theteaching of medical concepts. The 13-book Netter Collection of Medical Illustrations,which includes the greater part of the more than 20,000 paintings created by Dr.Netter, became and remains one of the most famous medical works ever published.The Netter Atlas of Human Anatomy, first published in 1989, presents the anatomicalpaintings from the Netter Collection.