Anthonys Textbook of Anatomy Physiology 21e Kevin Patton, Gary Thibodeau

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com
Anthony's Textbook of
Patton
Thibodeau
Get Complete eBook Download By email at student.support@hotmail.com

UNIT 1 The Body as a Whole, 1 UNIT 4 Transportation

and Defense, 604
CHAPTER 1 Organization of the Body, 2
CHAPTER 2 Homeostasis, 23 CHAPTER 27 Blood, 606
CHAPTER 3 Chemistry of Life, 38 CHAPTER 28 Heart,634
CHAPTER 4 Biomolecules, 55 CHAPTER 29 Blood Vessels, 663
CHAPTER 5 Cell Structure, 75 CHAPTER 30 Circulation of Blood, 697
CHAPTER 6 Cell Function, 98 CHAPTER 31 Lymphatic System, 725
CHAPTER 7 Cell Growth and Development, 120 CHAPTER 32 Innate Immunity, 746
CHAPTER 8 Introduction to Tissues, 137 CHAPTER 33 Adaptive Immunity, 759
CHAPTER 9 Tissue Types, 154 CHAPTER 34 Stress, 782
UNIT 2 Support and Movement, 178 UN IT 5 Respiration, Nutrition,

and Excretion, 798
CHAPTER 10 Skin, 180
CHAPTER 11 Skeletal Tissues, 209 CHAPTER 35 Respiratory Tract, 800
CHAPTER 12 Axial Skeleton, 233 CHAPTER 36 Ventilation, 823
CHAPTER 13 Appendicular Skeleton, 263 CHAPTER 37 Gas Exchange and Transport, 847
CHAPTER 14 Articulations, 281 CHAPTER 38 Upper Digestive Tract, 860
CHAPTER 15 Axial Muscles, 31 0 CHAPTER 39 Lower Digestive Tract, 881
CHAPTER 16 Appendicular Muscles, 333 CHAPTER 40 Digestion and Absorption, 900
CHAPTER 17 Muscle Contraction, 356 CHAPTER 41 Nutrition and Metabolism, 928
CHAPTER 42 Urinary System, 963
CHAPTER 43 Fluid and Electrolyte Balance, 996
UNIT 3 Communication, Control, CHAPTER 44 Acid-Base Balance, 1016
and Integration, 386
CHAPTER 18 Nervous System Cells, 388 UNIT 6 Reproduction and
CHAPTER 19 Nerve Signaling, 408
Development, 1034
CHAPTER 20 Central Nervous System, 432
CHAPTER 21 Peripheral Nervous System, 473 CHAPTER 45 Male Reproductive System, 1036
CHAPTER 22 Autonomic Nervous System, 47 4 CHAPTER 46 Female Reproductive System, 1054
CHAPTER 23 General Senses,498 CHAPTER 47 Growth, Development, and Aging, 1086
CHAPTER 24 Special Senses, 514 CHAPTER 48 Genetics and Heredity, 1121
CHAPTER 25 Endocrine Regulation, 526
CHAPTER 26 Endocrine Glands, 556 Glossary of Anatomy & Physiology, 1144
Index, 1198

21ST EDITION
KEVIN T. PATTON, PhD
Professor of Anatomy & Physiology Instruction
New York Chiropractic College
Seneca Falls, New York
Founding Professor of Life Sciences,
Emeritus Faculty
St. Charles Community College
Cottleville, Missouri
Assistant Professor Emeritus of Physiology
Course Director Emeritus in Human Physiology
St. Louis University Medical School
St. Louis, Missouri
AUTHOR EMERITUS
GARY A. THIBODEAU, PhD
Chancellor Emeritus
Professor Emeritus of Biology
University of Wisconsin- River Falls
River Falls, Wisconsin
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ANTHONY'S TEXTBOOK OF ANATOMY & PHYSIOLOGY, 21ST EDIT ION ISBN: 978-0-323-52880-1
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About the Author
Kevin T. Patton has ta ug ht anatomy :md physiol-

t>g}' (A&·P) to high sd10oal, community college. and
university shtdenb from \':trious backgrounds for more
th:m 3 (lc:c.:ulc:~-. Kevin found th:tt the wo rk tl1at led him
to:. PhD in verteln a te anatomy and ph~~iology instillc:<l
in him an :.ppreciation for t1H: ~ B ig Picture .. of human
struchtre :ut<l function. T'his cxpcricnce has IH:Ipcd him
prudu~ :1 text tl1at \\ill he e:.sier to m1<le rst.and for all studcnls.
He h:.s earned se\-er.~l citations for te:.ching A&: P, including the lvl is-
somi Cmrernor's Award for Excel len~ in Te:.ching.
"One tl1ing t·vc lcamcd," s.:ays Kc\~n. "'is that most of us learn scientific
concepts more easily \lll1c:n we c:.n see whafs going on.- His talent for using
imagery to teach is C\~dcnl tluougl10ut th is eclitiun, \\ith ib; extensive :m:.y of
visu:.l rc:sourcc:s. Kc:vin ·s stro ng interest in applying the principles of leaming
scic:nc:e to c:ffectivc:ly tc::.ehing A&P is also c:vi<le nt in the instructional clc:sign
o f th is texthuok, whid1 earned tl1e 1016 Tbthook Excdlenec: Award from the
textbook & Aeademic Authors A.;sociation (l i\.A).
Kevin's work in promoting excellence: in teaching A&P h 3s lc:d h im to take
an active role in tl1c: H um:.n Anatomy :.nd Physiology Society (HAPS). wl1c:re
he is 3 Presiclc:nt Emerihts. He w:.s the fmm<ling director o f the:
HAPS lmtitute ( H.Af>$.() and was :rw;mled the HA PS Presi·
<le nt's 2\•lc:d:.l for o utstanding contrilmtions in Jlromoting the To my family and friends. who
mission of e.xec:llc:nc:e in A&P tead1ing :.nd learning. nnl!r let me forget the joys ofdisrovery.
Kevin :.lr.o teaches gra<lu:.te courses to prospective and cur· adventure. and good humor.
rent A&:P professors. He h:.s sc:rvecl :.s 3 mentor to A&P profes. To the many teachers who taught
son across the continent and produces online resomees for me more by who they were than by
A&·P shtdc:nts and tead1c:n. including tlreAI'student.org :.nd what they said.
theAPprofessor.org. H is blog PaUorv\P.org provides insigl1ts To my tdudents who help me keep
and tc::.ching notes fur f:tculty using this textbook. the thrill of learning fresh and exciting.
Kel<in '1: l'aHou

v
ane
Rhonda Gamble, PhD Terry Thompson, MS, MS-HAPI EVOLVE WRITER
Professor of Physiological Sciences Professor of Biological Sciences and
Mineral Area College Phi Theta Kappa Advisor Daniel J. Matusiak, BS, MA, EdD
Park Hills, Missouri Wor-\iVic Community College Life Science Instructor
Salisbury, Maryland St. Dominic High School
Michael Greer, MA O'Fallon, Missouri
Instructor Peggie Williamson, MS, SPT Adjunct Professor
University of Arkansas at Little Rock Professor St. Charles Community College
Little Rock, Arkansas Central Texas College Cottleville, Missouri
Killeen, Texas
Suzanne Hembrough, MA
ONLINE COURSE WRITER
Instructor
Lindenwood University Linda Swisher, RN, EdD
Saint Charles, Missouri Retired
Saint Louis University Suncoast Technical College
Saint Louis, Missouri Sarasota, Florida
ers
Amanda May Boye-Ray Bhupinder Singh John Bagdade
AnMed Health School of Radiology Biztech College Northwestern University
Carolyn Bunde Kathy Smith-Stillson Mary K. Beals
Idaho State University Regis University Southern University and A&M College
Colorado Christian University
Teresa Cowan Rachel Venn Beecham
Baker College of Auburn Hills Luann Wilkinson Mississippi Valley State University
Marion Technical College
Debbie Gantz Brenda Blackwelder
Mississippi Delta Community College Peggie Williamson Central Piedmont Community College
Central Texas College
Robert S. Kellar Richard Blonna
Northern Arizona University Justin L. Wilson William Paterson College
Hampton University
Karen Kelly Claude Bouchei
Milligan College PAST EDITION REVIEWERS INSERM
Nick Pasquale Charles T. Brown
The Department of Physiology and The
UltraSound Institute/MUA: Medical Barton County Community College
Department of Anatomy & Structural
University of America
Biology Laurence Campbell
Kevin Pierce Otago School of Medical Sciences- Florida Southern College
East West College of Natural Medicine University of Otago
Patricia W. Campbell
Scott D. Schaeffer Mohammed Abbas Carolinas College of Health Sciences
Harford Community College Wayne County Community College
Geralyn M. Caplan
Kim Seigman Laura Anderson Owensboro Community and Technical
Covenant School of Radiology Elk County Catholic High School College
Paula Denise Silver Bert Atsma Roger Carroll
ECPI University- Medical Careers Institute Union County College University of Tennessee School of Medicine
•
VI

••
Reviewers VII
Melvin Chambliss Rebecca Halyard Melanie S. MacNeil

Alfred State College Clayton State College Brock University
SUNY College of Technology
Ann T. Harmer Susan Marshall
Pattie Clark Orange Coast College St. Louis University School of Medicine
Abraham Baldwin College
Linden C. Haynes Gary Massaglia
Richard Cohen Hinds Community College Elk County Christian High School
Union County College
Lois Jane Heller Bruce S. McEwan
Barbara A. Coles University of Minnesota School of Medicine The Rockefeller University
Wake Technical Community College
Lee E. Henderson Jeff Mellenthin
Harry W. Colvin, Jr. Prairie View A&M University The Methodist Debakey Heart Center
University of California - Davis
Angela R. Hess Lanette Meyer
Darwin Coy Bloomsburg University Regis University/Denver Children's
University of North Florida Hospital
Paula Holloway
Douglas M. Dearden Ohio University Donald Misumi
General College of University of Minnesota Los Angeles Trade- Technical Center
Julie Hotz-Siville
Cheryl Donlon Mt. San Jacinto College Susan Moore
Northeast Iowa Community College New Hampshire Community Technical
Gayle Dranch lnsler
College
J. Paul Ellis Adelphi University
St. Louis Community College Rose Morgan
Patrick Jackson
Minot State University
Frank G. Emanuele Canadian Memorial Chiropractic College
Mercyhurst University Jeremiah Morrissey
Carolyn Jaslow
Washington University School of Medicine
Cammie Emory Rhodes College
Bossier Parish Community College Greg Mullen
Gloria El Kammash
South Louisiana Community College/
Julie Fiez Wake Technical Community College
National EMS Academy
Washington University School of Medicine
Murray Kaplan
Robert Earl Olsen
Beth A. Forshee Iowa State University
Briar Cliff College
Lake Erie College of Osteopathic Medicine
Kathy Kath
Susan M. Caley Opsal
Laura Frost Henry Ford Hospital School of Radiologic
Illinois Valley Community College
Florida Gulf Coast University Technology
Juanelle Pearson
Debbie Gantz Brian H. Kipp
Spalding University
Mississippi Delta Community College Grand Valley State University
Nicole Pinaire
Christy Gee Johanna Krontiris-Litowitz
St. Charles Community College
South College - Asheville Youngstown State University
Wanda Ragland
Becky Gesler William Langley
Macomb Community College
Spalding University Butler County Community College
Saeed Rahmanian
Norman Goldstein Michael Levitzky
Roane State Community College
California State University- Hayward Louisiana State University School of
Medicine Robert S. Rawding
Zully Villanueva Gonzalez
Gannon University
Dona Ana Branch Community College Clifton Lewis
Wayne County Community College Carolyn Jean Rivard
John Goudie
Fanshawe College of Applied Arts and
Kalamazoo Area Mathematics & Science Jerri Lindsey
Technology
Center Tarrant County Junior College
Mary F. Ruh
Charles J. Grossman Eddie Lunsford
St. Louis University School of Medicine
Xavier University Southwestern Community College
Jenny Sarver
Monica L. Hall-Woods Bruce Luon
Sarver Chiropractic
St. Charles Community College University ofTexas Medical Branch

viii Reviewers
Henry M. Seidel* Aleta Sullivan Karin VanMeter

T he Johns Hopkins University School of Pearl River Community College Iowa State University/Des Moines Area
Medicine Community College
Kathleen Tatum
Gerry Silverstein Iowa State University Gordon Wardlaw
University ofVermont- Burlington Ohio State University
Reid Tatum
Charles Singhas St. Martin's Episcopal School AmyL. Way
East Carolina University Lock Haven University of Pennsylvania
Kent R. Thomas
Marci Slusser Wichita State University Anthony J. Weinhaus
Reading Area Community College University of Minnesota
Todd Thuma
Paul Keith Small Macon College Cheryl Wiley
Eureka College Andrews University
Stuart Tsubota
William G. Sproat, Jr. St. Louis University Clarence C. Wolfe
Walters State Community College Northern Virginia Community College
Judith B. Van Liew
Snez Stolic State University of New York College at
Griffith University Buffalo
· Deceased.

his textbook relates th e story of the human body's structure and function.
More than a simple collection of facts, it is both a teaching tool and a learn-
ing tool. It was written to help students unify information, stimulate critical
thinking, and acquire a taste for knowledge about th e wonders of th e human body.
The story related in th is textbook will h elp students avoid becoming lost in a maze 45°
of facts while navigating a complex learning environment. It will encourage th em to
explore, to question, and to look fo r relationships, not only between related facts in
a single disciplin e, but also between fields of academic inquiry and personal experience.
This new edition of the text has been carefully revised to better tell the story of the
human body. Essential, accurate, and current information continues to be presented in a
comfortable storytelling style. Emphasis is placed on concepts rath er than descriptions,
and the "connectedness" of th e human body- in which structure fits functi on - is repeat-
edly reinforced by unifying th emes.
UNIFYING THEMES
Anatomy and physiology encompasses a body of knowledge that is large and complex.
Students are fac ed with th e n eed to know and understand a multitude of individual struc-
tures and functions that constitute a bewildering array of seemingly disjointed informa-
tion. Ultimately, th e student of anatomy and physiology must be able to "pull togeth er"
this information to view th e body as a whole-to see the "Big Picture." If a textbook is
to be successful as a teaching tool in such a complex learning environment, it
must help unify information, stimulate critical thinking, and motivate students
to master a new vocabulary.
To accomplish th is synthesis of information, unifying themes are required to tell the story
of the human body effectively. In addition, a mechanism to position and implement these
themes must be an integral part of each chapter. Prior to Unit l is "Seeing the Big Picture,"
an overview that encourages students to place individual structures or functions into an in-
tegrated framework. T hen , a special "T he Big Picture" section wraps up th e story of each
chapter so that its significance in th e overall function of the body can easily be seen.
Anthony's Textbook of Anatomy 6 Physiology is dominated by two major unifying
themes: ( l ) structure fits function and (2) homeostasis. The student is shown, as the
story unfolds, how organized anatomical structures of a particular size, shape, form, or
placem ent serve unique adaptive functions. The in-
tegrating principle of homeostasis is used to show
how th e "normal" interaction of structure and func-
tion is achieved and maintained by counterbalanc-
ing forces with in the body. Repeated emphasis of
th ese principles encourages students to inte-
grate otherwise isolated factual information
into a cohesive and understandable whole.
"The Big Picture" summarizes th e larger
interaction between structures and func-
tions of the different body systems. As a
result, the story of anatomy and
physiology emerges as a living and
dynamic topic of personal interest
and importance to students.
•
IX

x Preface
• AIMS OF THE REVISION

As in p:.st editions, In)' re\'ision ellorts focused on identi~·ing tl1e nec:d for new o r revise<l informdlion
and for a<l<lition.al visual presc:ntdtions that clari~· important, yet sometimes d ifficuIt, c:onlc:nt :.reas.
In tl1is tc:ntl1 e<lition,l have include<l information on new concepU :.ml new perspectives in many
areas o f an:.tomy :.ml pl1p iology. Some: of the ferminology has been upd:.ted to reflec:t the most e m-
rent us:.gc: in the seic:ntihc community. The d iseuSllion of osmosis in Ch:.ptc:r 4 :.nd se\·eral o ther
chapters l1.as bc:en clarihc:d to reReet the latest seientihc understdnding while: still rc:t:~ining an "entry
level- treahnc:nt of this important eoncept The stress ch:.ptc:r (Ch:.pter H) h:.s heen reorganized and
p;trfi.:.Hr rewritten to hetter reflect current theories o f
stress in humans. Most of tl1e content ch:.nges :.re
subtle a<l justmenb> to our current un<lc:rst.anding of
hum:.n science; however, t11c: accumubtion of all o f
these ch.:.nges makes th is e<lition tl1e most up-to-tlate
textbook :t\'aibble.
'11lis e<lition .:.lso intro<lucc:s a uni<pte ne\v ledrning
fc::.turc: th:.t repbcc:s the: fonner "summ.:.ry" opc:nc:rs
to tl1c: six units o f tl1is ch:.ptc:r. Dc\·c:loped in colb l,.,
ration with cognitive texthook design expert lvlichael
Creer and .:.natmnr and physiologr professor 1C:rry
'11mmpson, each unit now opens with an illustr.ttc:d tool
th:.t jump-stdrb> student le.arning hr rc\'iC~.\ing JXlsf learning :.ml prc\'iC~.\ing nc:w lc:.:.rning yet
to come. 'l11is innov:tti\·c: strafe:~· is b:.sed on cunc:nt, evi<lc:nce·hasc:d leaming theories.
In :.n im~ting. illustr.tted layout, these ne\v interaeti\'e unit openers provide spaced
retrieval practice along \\ith pre-testing exercises proven to enhance shtdent
learning. Student:; wl10 usc: this nc:w fe.ah tre will en joy a more c:ffecti\'c:
learning experience :.s they mo\'e tluough tl1c: textbook.
A h:.llmdrk of this lexthook has bc:en its effecti\'e "chunking- of
m:.teri.:.l into man.age;tb)e b ite-size p ieces-.:.notl1er C\'i<lc:nce-basc:d
enh:.ncement of tl1c: ledrning process. This edition reflects
mr continuing commitment to that approach. In the pre\'i-
-==~~~ om edition, I undertook significant chunking o f long
~ chapters into sm.:.H, c::.sil)' rc::.d chapter.>, In this ne\v e<li-
tion, I continue the: process h)' carefully clari~~ng an<l
adding sullllc::.ding:o; to im pro\'e the telling o f the story of the
human bodr. Besides provi<ling graphic scaffolding to help sht-
dents construct a dc::.r umler.;tan<ling of concepts :.s the story un-
folds, these: subheadings .:.)so help stmlc:nU hnd rc:lc\'anl material as
thcr later "r.ti<l- their texthook for specific help in cbri~·ing d ifficult
concc:pb>-ur concepU thc:y missc:<l or forgot :.ftc:r their hrst red<ling. I h:.ve
also t.aken opportunities to reduce: cognitive load and impro\'C: rc::.ding com-
prehension b)· spliHing longer paragraphs into sm.:.llc:r p.:.ragrnphs.
Another .:.im of th is rc:\~sion has been the hne-tuning of tl1e usc: of online:
articles. FOnnerly called A 6 1) Connect, this feahtre is now called Con nect It!
Besi<lc:s JllU\'iding interesting :.sides t11.at hd1) sp:trk interest in a topic and
moti\'ate deeper le.:.ming, these articles provide an opportunity to inte-
grate diverse topics scattered throughout the book. For example:, the
rc:\~sed article The Human Microbionle is c:.lled out in m.lH)' different cl1dpters,
helping rc:a<lers sc:e the numerous connections that ch.:.r:tcterizc: human structure
and fun ction. Such "integrati\'e- use of the articles has bec:n c:xp.:.nded and im-
proved in tl1is c:<lition.
PrC~.·ious editions have featured wh.:.t is nuw our sjgnature page design
that makes the textbook easier to use by putting the illustrations,
graphs, and tables doser to the related text In tl1is edition, our prO<luc-
tion tc:.:.m l1.as worked h:.rd to make the page layout cvc:n more effective for

Preface x:i
telling tl1e story or tl1e human hody. The extensi\-e set of summary tables helps s.tuden~ visually org;t-
nize important concepb> :md complements the impm..-ed <lesign to provide a muhisc:nsory learning
tool. The art program has been enhance<! by moving descriptions of ..steps- from tl1e legend into
the (liagr.~m itselr. tlnu reducing cognitive lo:.d and imprO\-ing comprd1ension.
The effort.; in represen ting d iversity of the ht.man form continue in th is edition by
a(Ming a new set o r musde illustrations feahu ing a remale subject. Our :.rtish llaYe also re-
placed many illustr:ltions thro ugl1out tl1e book witl1 :.rt representing a more d iverse set of hu-
m:.n traib.
SC'\·eral new illustr:ltions also maintain the use of :. eonsistent Color Key (round on tl1e
Emh-e website at n'Ofl.-e.~lsevi~r. rom/PaHon/AN) for certain cell parb>, tissue types, :.nd hiomole-
eules to help ma~e learning easier ror beginning shulc:nts.
In this e(lition, I continue my effort to ma~e tl1is text :.ccessible to shulents whose fir.ot langua.ge
is not English. Arter consulting witl1 ESL speci:.lists :.nd £Sllearners. I have continued t o refine
chapter word lists and improve readability to make the concep ts o f h uman s tructure and
function more understandable for all studen ts.
As a te:.cher of :matomy :md physiology. I know that to he effective a text must be dear :.nd rea<l-
able, an<l it must c11allenge and excite the student. Th is text remains one that students will
read- o ne designed t o help the teacher t each and the student learn. 10 :.ccomplisl1 tl1is
end, I f:.cil itate(l the comprehension of (liflicult m:.teri:.l for shulc:nts with thorough, consistent, an<l
nonintimid:.ting expbnations that are free or unneeess:.ry terminology :.ml extr.meous infonnation.
'l'his easy access to complex i(lea.s remains tl1e single most striking l1allm:.rk or this texthool
• LEARNING AIDS
Anthony$ 'textbook ofAnatomy 6 Physiology is a student-oriented text. \ ¥ rinen in:. re:.dable style th:.t
tc:lls a col1erc:nt story, the text is <lesigne<l with many d ifferent pe(lagogical aids to moti..-ate :.ml main-
lain interest. T11e special re:.tures and leam ing :.ids listed below are intemled to faci litate learning and
retention of infonnation in the most effecti\·e and efficient manner.
No textbook c:.n replace tl1e direction and stimulation provided by an c:nthusi:.stic teacher to a
curious an<l in\'Oh-ed stm lc:nt. Howe\'er, :1 rull complement o r innovative pedagogical ai(ls that :.re
eardull)' planned and implemented can contribute:. great deal to tl1e success o f a text as:. le:.rning
tool. An excellent textboul: c:.n and should be enjoyable to re:.d an<l sl10uld be l1d pfu1 to both shJdent
and teacher. I l10pe you :.gree that the learning aids in Anthony's 'ff>xtbook ofAnatomy 6 l)hysiology
mec:t the h ig h expectations l l1a\'e set.
INTERACTIVE UNIT INTRODUCTIONS

E.aeh of the six m:.jur units of the tc:xt hegins with a bric:f, interactive le:.ming opportunity that reviews
JUSt learning:.nd "'primes the pump- ror nC'\V le:.m ing in the ch apters th:.t by:.hea<l. Based on mud-
ern le:.ming science, using this strategy "~11 c:nh:.nce yuur understanding :.s you re:.d the chapters o r
each unit. '11tis is rollmved ll}' :. dear o\·c:rviC~.v o r tl1e story told in the chapters or tl1e unit. E:.ch unit
h:.s:. color-coded tab at the outside edge of e\'c:ry )Xlge to help )'UU quickl)' find tl1c: infonnation )'UU
need.
CHAPTER LEARNING AIDS

Study Hints gi1--e specific suggestiom (or using many of th~ l~amiug aids found in ead1 chapter.
Because many readers l1a\·e never le:.m ed the speci:.l skills nee(le<l to make effective use of
the pe<l.agogic:.l resources fo und in science textbooks, hc:lpru l tips :.re em-
H nt
lle(Me<l within e:.ch Chapter Outline, L:mgu.age of Science & 2\•lc:dicine
list. Case: Shtd)', C l1apter Summary, RC'\·ic:w Questions sc:t, and C ritic:.l
.__..;;;;..._.-. 'l11in king section. Answers ror the Quicl: Checl: an<l Case Study (ptc:stions :.re
available ror shtdcnb on the E:mh·e website (n:olv~.elsn'ier.rom/PaltoniAPI). :.nd :.nswers for these
plus the ReviC'\\' and C ritic:. I Thin~ing E.xercises are :J\'aibhle for instm ctors in the TEACH Instruc-
tor's Resource.
'l'he Chapter Outline: summari;n the ronknU ofa chapin at a glance. An over\'ic:w outline intm·
<luces e:.ch chapter and c:nallles the student to prc:\-iew the content :.nd direction of tl1c: ch apter at the
m:.jur concept le\'c:l berore heginning a detailed rea<ling. P:tge references en:.ble students to quickl)'
locnte topics in tl1e chapter.

xii Preface
Language of Science introduces you to new scientific tf'mu in the chaptf'r. A compre-
hensive list of new terms is presc:ntecl :.t l11c: beginning of t11c: d1apter. f.:td1 term in the
list h:.s :.n eaS)'4t~I LSe pro nunciation guide: to help the Ieamer easily "'c1wn- the worcl by LANGUAGE OF SCIENCE
being :.llle to say it. literal tr:msb tiom o f c::.ch lc:nn's word pam are inc:ludecl to l1c:lp
Isometric contraction
s.tuden~ learn how to clc:<luce the mc::.ning of new lc:nns on their mm. l 1le listecl terms
(a)'e-soh·f.£T.fik kon·TRAK·shlll)
are clc:fined in the text lxxl}'. wl1c:re they :.ppe:.r in bolclf:.cc: type. and :.re also in the: C los- l.iso· equa~ -metr· meas~.n,
50ry at t11c: back o f the: bool The: boldface type feature: enables shulc:nU to scan tl1e lc:xt ·k relating to, c:oo- together,
for nc:w wor<ls hefore beginning their first clc:t:~ilc:d rea<ling of the: material, so the)' m:.y ·tmct· drag or lkaw. ·tilt~ process)
reacl without h:.ving to clisrupt the Row to gr:.pplc: witl1 new '"-urds o r phrases. T11e lan 4
Isotonic contraction
guagc: of Scien~ word list includes terms rc:latc:<l to the essential :.natom)' an<l physiology (aye·Soh·TON·ii< kon· TRAK·sl'ul)
presc:ntc:d in tl1c: chapter. Anotl1er word list nc:ar tl1e end of the chapter, :1 feature cle- l.iso· equa~ /IJII· stretdl or tension,
scribc:<l as the L:.nguage o f !vleclicine, is an in\'e ntory of all of the new clinic:.) tenns in 4
·k relating to, c:oo- together,
troc:lucecl in the: ehaplc:r. ·118Ct· drag or lkaw. ·tilt~ process)
Cnlor-cuded illustr.:ttions help Mginning 5tudf'nts appreciatE' thE' '"Big Picture" of hu· lactate (IAK· tly1)
man structure and {unction. A special fc::.ture of the illustr:ltions in th is tc:xt is the: eareful jAlct· rnJk., ·ate salt of 111 acidJ
and consistent use o f color to identify important stmchnes and subsbnces th:.t recur
throughout the book. Consistent me of :1 color ~e)' helps beginning shulc:nU apprc:ciafe
the "Big Picture" elf human stmctmc: an<l function c::.ch time the)' sec: a familiar structure
in a new illustr:~lion. For an explanation of the color scheme, see the Color Ker o n the
E\'Ulve wdlsite (c.11'0lve.elsettier.com/Patton!Ai>l).
Direction al rosettes help students lf'am thE' orientation of anatomical
5fructurrs.. Where: appropriate, small orientation c~agr.um and clirc:ctional
msettc:s are includecl as JXlrf o f an illustr.ltion to help stmlc:nb> locale: a stru~
lure with reference: to the boc:k as a whole or orient :1 small struchue in a
larger vic:w.
Qu ick Check tluestions test your knowledgE' of material you'vE' just
Quick C H E C K
read. Short objc:etive-type questions are locatecl immecli:.tc:ly follc)'l,\rlng
1. L.m the majOf subdivisions of the hu'nan nervous system.
m:.jor topic cliscussions thmughoul the: boclr of the text. '11lc:se ques-
2. What two organs make up the ceNral nervous system?
tions cover important infonnation presented in t11c: preceding section.
Shulc:nts un:.llle to answer the questions shoulcl rereacl that section
before JlfOcec:ding. This feature: therefore c:nhan~s reading cmnprc:-
.,....,,
3. Contrast the somatic nervous system with the autonomic oef'IIOus
hc:nsion. Quick Check items are numbered b)' chapter, and a numc:ri 4
cal listing of their answers ean he fo und o n the: £mlve website: (e-vob't".
elsn'ier.coml f>aUonJAPI). C ON N E CT I T ! @
Cnn nect It! fc-.ah ues call the readtr's atte-ntion to online articles that Tiny. barref.shaped organelles called vaults may
illudralf', clarify, and apply conupts f'ncoun lf'red in thE' lf'xl. £mheclclc:d a1so assm with transport ol molecules to and
within the text narrative, these: boxes connect you with intc:rc:s.ting, hrid from the nucleus. To learn more about these little
o nline: articles th at stimulate thinking. satis~· your curiosity, and help transport sh.rt1les.. check out Vsults oni'le at
Comect ttt
you appl}' important concepU. Connect It! articles also help you unclc:r 4
stan d connections among stmcturc:s and functions throughout the:

bcxly. integrating concepts into a .. Big Pichu e- of lmman function.
'11lc:y are olfen illustratc:<l \\rlth m icrographs, meclical im:.ges, and mc:<li·
cal ilhLslrations.
Cycle of Life describn major changes that OC"CUT on!r a person's lifetimE'. fonn and function. The: intent o f the Mechanisms
~'
In many hod}' srstc:ms, changes in struch1re and function are frequently re- of Disease section is to reinforce: understanding of
lated to a person's age o r state: of dC'I.·elopmc:nt. In appropriate: chapters of the tl1c: normal structures an<l mechanisms of the hody
text. these changes are hig hlighted in this special section. while: h ighligl1ting the gc:nernl causes of disorders
The Big (Jid u rc explains the interactions of the sy~tem discusU!d in a par· fur a )Xlrticular hod}' system. These: sections arc:
ticular chaptu with the body as a whole. 'l11is hc:lps sh1dc:nb> relate informa 4
heavily illustratc:<l with <liagrams and medical pho 4
lion about bod)· structures o r functions that are cliseussecl in the: chapter to tographs that hring pathology eoncc:pts to life.
the bcxly as a whole. '11lc: Big Picture feature: hc:lps you improve critical Lang u.:Jgc of M edic ine iulmducn )'OU to Uf'W
thin~ing h}' focusi ng on hm\' stmchnc:s and functions relate to one anotl1er clinical terms in the chapter. A hrid list o f clinical
o n :1 bcxh-.,,i de hasis. terms is presented near the c:nd o f each chapter. A<;
Mcch2nisrm of L>i~ca.'\C helps you understand the basic principles of hu· in the Language of Science: list at the lleginning of
0 man drudure and {unction by showing what hapfWns whf'n things go wrong. tl1c: chapter, each tc:nn has:. phonetic pronuncia 4
Examples of pat11ology. or <liseasc:, arc: includecl in man)' chapter.; of the hook tion g u ide and transbtions of \mrd JXII'fs. '11lc:
to stimulate student interest and to help shulc:nts umlc:rstand that the clisease listed terms are <ld i nc:d in tl1e text bod)'. where:
process is :1 <lismption in hmnc:ostasis, a llreakdown o f nonnal integration of ti1C:}' appear in holdfa~ type.
•••
Preface XIII
A Case Study challenges you with "real-life" clinical Audio Chapter Summaries allow you to listen and
or other practical situations so you can creatively apply learn wherever you may be. T hese summaries are avail-
what you have learned. Case studies precede the chapter able in MP3 fo rmat for download at th e Evolve website
summaries. T he case study consists of a description of a (evolve.elsevier.com/Patton/API).
real-life situation and a series of questions that requ ire Review Questions help you determine whether you have mastered
the student to use critical thinking skills to determine the important concepts of each chapter. Review questions at the end
the answers. of each chapter give students practice in using a narrative for mat to
The Chapter Summary outlines essential information in a way discuss the concepts presented in th e chapter.
that helps you organize your study. D etailed end-of-chapter summa- Critical Thinking Questions actively engage and challenge you
ries provide excellent guides for students as th ey review the text ma- to evaluate and synthesize the chapter content. C ritical th inking ques-
terials before examinations. Many students also find th e summaries tions require students to use th eir h igh er level reasoning skills and
to be useful as a chapter preview in conjunction with th e chapter demonstrate their u nderstanding of, not just their repetition of, com-
outline. plex concepts.
BOXED SIDEBARS Diagnostic Study keeps you abreast of developments

As always, I made every effort to update factual information and in- in diagnosing diseases and disorders. T h ese boxes deal
corporate the most current anatomy and physiology research find- with specific diagnostic tests used in clinical m edicine
ings in this edition. Although there continues to be an incredible or research . Lumbar puncture, angiography, and ante-
explosion of knowledge in th e life sciences, not all new info rmation natal diagnosis and treatment are exam ples.
is appropriate for inclusion in a fundamental-level textbook. T h ere- FYI gives you more in-depth information on interesting
fore I was selective in ch oosing new clinical, path ological, and topics mentioned in the text. Topics of current interest,
special-interest material to include in this edition . This text remains such as new advances in anatomy and physiology re-
foc used on normal anatom y and physiology. T h e addition of new search , are covered in these "for your information" boxes.
boxed content is intended to stim ulate stu dent interest and provide Sports and Fitness highlights sports-related topics.
examples that reinforce the immediate personal relevance of anat- Exercise physiology, sports injury, and physical educa-
omy and physiology as important disciplines for stu dy. tion applications are highlighted in these boxes.
General Interest Boxes provide an expanded expla- Career Choices highlights individuals in health-
nation of specific chapter content. Many chapters con- related careers. A Career C hoices box appears at the end of each unit.
0 tain boxed essays, occasionally clinical in nature, th at T hese boxes feature health professionals describing a few of the
expand on or relate to material covered in the text. Ex- diverse opportunities currently available in health-related occupations.
amples of subjects include th e Brainbow visualization T hey also demonstrate th e im portance of how an understanding of
of neural networks and the enteric nervous system . anatomy and physiology will be useful to students in their futures.
Health Matters presents current information on dis- Glossary
eases, disorders, clinical applications, and other health A compreh ensive glossary of terms is located at the end of the text.
issues related to normal structure and function . In some An expanded list of accurate, concise definitions and phonetic pro-
instances, examples of structural anomalies or path o- nu nciation guides is provided, along with word parts and th eir literal
physiology are presented. Information of th is type is of- translations. An audio glossary is also available on the expanded
ten useful in helping students un derstand th e mech anisms involved Evolve website (evolve.elsevier.com/Patton/AP/) with definitions and
in maintaining the "normal" interaction of structure and function . audio pronunciations for most of th e key terms in the text.
career choices Adult Nurse Practitioner

While going through nursing school, I had the opportunity to shadow involve the intrinsic conduction system of the heart,
during an open-heart surgery. The quadruple-bypass procedure took including dysrhythmias. Plumbing problems relate
11 hours, but I never moved from my spot beside the anesthesiologist. I was in to the coronary arteries that supply the blood flow
awe watching the patient's heart pumping blood through its chambers. My fasci- to the heart muscle, including all the blockage
nation with the cardiac system blossomed in that moment when the heart came problems of that system. The entire function of the
back to life and started functioning after a successful bypass. heart is to pump blood through the pulmonary and
More than 20 years later, I still recall that amazing sight. I use A&P every day systemic circulation. Any disease affecting muscle
in my role as an adult nurse practitioner in a cardiology practice. I see patients function can cause problems such as cardiomyop-
with a variety of cardiovascular diseases, and educating patients on their condi- athies, congestive heart failure, and valve disease.
tions is key to my practice. I strive to explain complex cardiac anatomy and phys- By educating my patients on the anatomy and Dena Kruse,
iology to my patients in simple terms so that they can understand their disease physiology of a healthy heart, I can explain cardio- APRN, MSN, ANP-BC
and treatment plans. I illustrate this complicated system by dividing cardiology vascular disease treatments aimed at improving
into three categories: electrical, "plumbing," and function. Electrical problems their health. •

xiv Preface
SURVIVAL GUIDE FOR ANATOMY

• LEARNING SUPPLEMENTS & PHYSIOLOGY
FOR STUDENTS ThE Survival Guide for Anatomy 6 Physiology (2nd edition), writ-
evolve ten by Kevin Patton, is an easy-to-read and easy-to-understand brief
handbook to help you achieve success in your anatomy and physiol-
EVOLVE.ELSEVIER.COM/PATTON/AP/ ogy course. Read with greater comprehension using the 12 survival
This new edition of Anthony's Textbook of Anatomy 6 Physiology is skills, study more effectively, prepare for tests and quizzes, and tap
supported by an expanded multimedia Evolve website, featuring: into all of the information resources at your disposal. The included
Maps, Charts, 6 Shortcuts section is filled with illustrations, tables,
• Audio Summaries for each chapter available for streaming analogies, and diagrams that convey all of the important facts and
or download in convenient MP3 form. concepts students need to know to succeed in an anatomy and physi-
• Answers to all of the Quick C heck and Case Study ques- ology course.
tions found in the textbook.
ANATOMY & PHYSIOLOGY
-
• Ouick access to all Connect It! articles cited in the
textbook. LABORATORY MANUAL
• An interactive audio glossary with definitions and pronun- ThE Anatomy 6 Physiology Laboratory Manual, authored by
ciations for more than 1000 key terms from the textbook. Kevin Patton with new contributions from Frank Bell, continues to
• The Body Spectrum E lectronic Anatomy Coloring Book, be an invaluable resource for students. This extensively illustrated,
which offers dozens of anatomy illustrations that can be full-color manual fea tures an extensively revised illustration program
colored online or printed out and colored by hand. that includes many new dissection photographs. This popular lab
manual contains 55 well-integrated exercises that provide hands-on
learning experience to help students acquire a thorough understand-
ing of the human body.
Exercises in cat and pig anatomy, along with cow and sheep or-
gans, are included to allow the flexi ble use of dissection specimens.
Other features are boxed hints on handling specimens and manag-
ing laboratory activities, safety tips, coloring exercises, and summa-
ries of landmark features used to distinguish microscopic specimens.
Each exercise concludes with a lab report that may also serve as a
homework assignment or self-test.
The lab manual includes eLabs for Anatomy 6 Physiology, an
online lab program designed to complement traditional lab exer-
• More than 500 Student Post-Test questions that allow you cises. The lab exercises, based on both anatomy and physiology, are
to get instant feedback on what you've learned in each separated into modules. The labs are designed so that students can
chapter. easily navigate between activities, allowing them the freedom to fo-
• State-of-the-art 3-D animations, which show and describe cus on the areas in which they need the most help.
physiological processes by body system.
• TEACHING SUPPLEMENTS
You can visit the Evolve site by pointing your browser to evolve.
FOR INSTRUCTORS
e!sevier. com/PattonlAPI.
INSTRUCTOR RESOURCES ON EVOLVE
ANATOMY AND PHYSIOLOGY ONLINE ThE T EACH Instructor's Resource was written and developed spe-
This 24-module online course brings anatomy and physiology to life cifically for this new edition of Anthony's Textbook of Anatomy 6
and helps you understand the most important concepts presented in Physiology. Available on Evolve, it provides critical thinking ques-
the book. Available for purchase, this online course includes instructions, learning objectives and activities, teaching tips for the text,
tionally sound learning modules with animations, interactive exer- synopses of difficult concepts, and clinical applications exercises. To
cises, and assessments. make lecture preparations a little easier, the TEACH Instructor's
Resource also includes lesson plans that allow you to hit the ground
.
runmng.

Preface xv
The Evolve website for instructors also includes: INSTRUCTOR'S GUIDE FOR THE
LABORATORY MANUAL
• Exam View Test Bank with more than 7000 multiple THE Instructor's Guide for the A6P Laboratory M anual on Evolve
choice, true/false, and challenge questions (which you can offers detailed information to help the instructor prepare for the
also import into your Classroom Performance System to laboratory exercises. Alternate activities, substitutions, student hand-
quickly assess student comprehension and monitor your outs, and other resources help instructors tailor the use of the A6P
classroom's response) Laboratory M anual to their own course. Answers for all questions
• A downloadable Image Collection featuring hundreds of on the lab reports in the A6P Laboratory Manual are also provided,
full-color illustrations and photographs, with labels and either to check student work or to provide for students who use lab
lead lines that you can turn off and on reports as self-tests.
• A detailed Update G uide, listing all significant revisions in
this edition
• PowerPoint Audience Response Q&A and much more!

ments
Over the years, many people have contributed to the development To those at Elsevier who put their best efforts into producing this
and success of Anatomy 6 Physiology. I extend my thanks and deep edition, I am indebted. This new edition, and its comprehensive li-
appreciation to all of the students and classroom instructors who brary of ancillary resources, would not have been possible without
have provided me with helpful suggestions. I also thank the many the efforts of Kellie White, Executive Content Strategist; Melissa
contributors and reviewers who have, over the last several editions, Rawe, Content Development Specialist; and Laura Goodrich, Se-
provided me with extraordinary insights and useful features that I nior Content Development Specialist. T heir expertise, support, and
have added to this textbook. hard work have been vital to the success of this revision. Further,
Thanks to Betsy Brantley, who contributed many of the case stud- where the rubber meets the road, I am fortunate to have a wonderful
ies found in this edition. T hanks also to those who provided their team of professionals working together to keep it all on track
insights in the Career Choices boxes. Dan Matusiak and Linda and moving along: Julie Eddy, Publishing Services Manager; and
Swisher have contributed in many ways to the last few editions. Clay Broeker, Pro ject Manager. I am also grateful to our friends at
For this edition, I am grateful for the contributions of Suzanne Graphic World, who helped us improve and execute the integrated
Hembrough and Rhonda Gamble, who helped me organize and design, layout, and art program.
update some chapter learning tools. Peggie Williamson's help in re- Finally, I want to recognize and thank my longtime writing part-
vising the stress chapter, as well as Bruce McEwan's advice, are ner Gary A. Thibodeau. For the many years we have worked to-
much appreciated. I'm thankful to Phil Tate for his suggestions for gether, Gary has been an insightful collaborator, a generous mentor,
improving the description and application of the concept of osmosis. and a supportive friend. Although he has retired from coauthoring,
I'm also grateful for Terry Thompson's work in creating the new in- I'm grateful for his continuing role as advisor for successive editions
teractive unit openers, as well as for Michael Greer's wise counsel. of this book.
Kevin T. Patton
xvi
Contents
UN IT 1 The Body as a Whole, 1 Set Point, 24
J\lfodel.s of Homeostasi,~>, 25
CHAPTER 1 Organization of the Body, 2 Homeostatic Control Mechanisms, 26
Science and Societv, 3 Feedback Loop,<, 26
Scientific Meti1od, 3 Basic Components of Control Systems, 26
Cultural Context, 3 Negative Feedback in Control S)wtems, 28
Anatomy and Ph~•iology, 4 Pos;ti)'e Feedl>atk in Control $)'stems, 28
Arwtomy, 4 Changing the Set Point, 29
Physiology, 4 Feed-FoMard in Control System,<, 30
Language of Science and Medicine, 4 Levels of Homeostatic Control, 31
Characteristics of Life, 5 Summary of Homeostasis, 3 I
Levels of Organization, 6 Cycle of Life: Life Span Considerations, 31
Chemic<JI Level, 6 The Big Picture: Homeostasis, 32
Organelle Le>•el, 7 Mechanisms of Disease, 32
Cellular Le>•el, 7 Case Studv, 36
'
Tissue Lew/, 7
Organ Lew?/, 7 CHAPTER 3 Chemistry of Ufe, 38
SJ•tem Lewd, 7 Units of Matter, 39
Organism um/, 8 Elements and Compounds, 39
Anatomical Position, 8 Atoms, 40
Anatomical Directions, 9 Atomic Structure, 40
Directional Tenus, 9 Cloud Model, 40
Tenn.<Related to Organs, 9 Atomic Number and J\1as,~; Number, .J I
Alwtomical Com(xlSs Rosette, 10 Energy Le>'els, 41
Body Planes and Sections, 10 Isotopes, 42
Sagittal Planes, 10 Attractions Between Atoms, 43
Coronal Plane,<, 10 Chemical Bonds, 43
Transverse Planes, I I Attractions Between Molecules, 44
Other Plane,~; and $el:tion.s, 11 H)'drogen Bonds, H
Body Cavities, 12 Chemical Reactions, 45
Dorsal Cavities, 12 Metabolism, 46
Ventral Cavitie.s, 12 Body Chemistry, 46
Body Regions, 15 Catal"'lism, 46
In teraction of Structure and Function, 16 Arwi><Jiism, .f6
Cycle of Life: Life Span Considerations, 17 Organic and Inorganic Compounds, 47
11>e Big Picture: Organization of the Body, 17 Inorganic Molecules, 47
Case Study, 19 \Vater, 47
Oxygen and Carbon Dioxide, 47
CHAPTER 2 Homeostasis, 23 Electrol)'tes, 48
Homeostasis, 24 The Big Picture: Chemistry of Life, 50
-n,e
lntl!mal Environment, 2'1 Mechanisms of Disease, 5 I
Relatiw Stal>ility, 24 Case Studv, SZ
'

xvii
xviii Contents
CHAPTER 4 Biomolecules, 55 CHAPTER 6 Cell Function, 98

Organic Molecules, 56 Membrane Transport, 99
Carbohydrates, 56 Overview of Membrane Transport, 99
Monosaccharides, 56 Passive Transport Processes, 99
Disaccharides and Polysaccharides, 57 Active Transport Processes, 105
Lipids, 58 Cell Metabolism, 108
Triglycerides or Fats, 58 Metabolism, 108
Phospholipids, 59 Role of Enzymes, 109
Steroids, 60 Catabolism, 112
Prostaglandins, 60 Anabolism, 115
Proteins, 61 The Big Picture: Cell Physiology and the \Vhole
Amino Acids, 63 Body, 115
Levels of Protein Structure, 64 Mechanisms of Disease, 116
Importance of Protein Shape, 65 Case Study, 117
Nucleic Acids and Related Molecules, 66
DNA and RNA, 66 CHAPTER 7 Cell Growth and Development, 120
Nucleotides and Related i\!Iolecules, 67 Protein Synthesis, 121
Combined Forms, 69 Deoxyribonucleic Acid (DNA), 121
The Big Picture: Biomolecules, 69 Ribonucleic Acid (RNA), 122
Mechanisms of Disease, 71 Transcription, 122
Case Study, 72 Editing the Transcript, 123
Translation, 124
CHAPTER 5 Cell Structure, 75 Post-Translation Processing, 125
Functional Anatomy of Cells, 76 Cell Growth, 126
The Typical Cell, 76 Production of Cytoplasm, 127
Cell Structures, 77 DNA Replication, 127
Cell Membranes, 79 Cell Reproduction, 128
Membrane Structure, 79 Mitosis, 128
Membrane Function, 81 Meiosis, 130
Cytoplasm and Organelles, 82 Regulating the Cell Life Cycle, 131
Endoplasmic Reticulum, 82 Cycle of Life: Cells, 13 1
Ribosomes, 83 The Big Picture: Cell Growth, Reproduction, and the
Golgi Apparatus, 83 Whole Body, 13 3
Lysosomes, 85 Mechanisms of Disease, 13 3
Proteasomes, 85 Case Study, 134
Peroxisomes, 86
Mitochondria, 86 CHAPTER 8 Introduction to Tissues, 137
Nucleus, 87 Introduction to Tissues, 138
Cytoskeleton, 88 Principal Types ofTissue, 138
Cell Fibers, 88 Development ofTissues, 138
Centrosome, 88 Extracellular Matrix, 139
Molecular Motors, 89 Fluid Environment of the Body, 140
Cell Extensions, 90 Components of the Extracellular Matrix, 140
Cell Connections, 92 Holding Tissues Together, 143
Desmosomes, 92 T issue Repair, 144
Gap Junctions, 92 Body Membranes, 144
Tight Junctions, 92 Epithelial Membranes, 145
The Big Picture: Cell Anatomy and the Whole Body, 93 Connective Tissue i\!Iembranes, 147
Mechanisms of Disease, 93 The Big Picture: T issues, Membranes, and the Whole
Case Study, 94 Body, 148
Mechanisms of Disease, 148
Case Study, 151

Contents xix
CHAPTER9 Tissue Types, 154 CHAPTER 11 Skeletal Tissues, 209

Epithelial Tissue, 15) Functions of Bone, 21 0
TyJ>e,<and Locntion< of Epithelial Ti$$ue, 155 C ross Structure of Bones, 210
Function< of Epithelial Tis,<ue, 155 T)'pes of Bones, 210
Ceneralizaaons About Epithelial Tissue, 155 Structure of Long Bone,<, 211
Classification of Epithelial Tissue, IS> Structure of Flat Bones, 212
Connective Tissue, 16 1 Microscopic $b'tJcture of Bones, 213
Functiow; o(Cormective 'lissue, 161 Bone Tissue, 213
Characteristics of Connective Tis,~;ue, 161 ComJ>act Bone, 215
Classification ofCormecti'!>-e Tis,~;ue, 163 Cancellou,<Bone, 21)
Fibrous Conneclil'e Ti,~>Sue, 163 T)'pes of Bone Cells, 216
Bone Tis,~;ue, 167 Bone J\1arrow, 2 I7
Cartilage Tissue, 168 Cartilage, 217
Blood Ti$$ue, 169 Regulation of Blood Calcium Le,•els, 219
Muscle Tissue, 169 Bone as a Calcium Depot, 219
Nervous Tissue, 171 tvfedwni,mu; of Calcium Homeostasis, 218
11>e Big Picture: Tissue Types and the Whole Body, 171 Development of Bone, 220
Case Study, 173 Osteogenesis, 220
Career Choices, 173 Intramembranous Ossification, 220
Endochondral Ossification, 221
Bone Remodeling, 224
UNIT 2 Support and Movement, 178 Repair of Bone Fractures, 225
C)de of Life: Skeletal Tissue<, 226
CHAPTER 10 Skin, 180 The Big Picture: Skeletal Tissues, 227
Stnocture of the Skin, lSI Case Stud)', 229
O>'el'lliew of Skin Structure, 181
Tl1in andTilick Skin, 181 CHAPTER 12 Axial Skeleton, 233
Epidermi,<, 183
Divisions of the Skeleton, 234
Dermoepidermal }unction, 185
Skul1,236
Dermi,<, 186
Cranial Bones, 248
Hypodennis, ISS
Facial Bones. 250
Skin Color, 189
Eye Orl>iu, 250
Melanin, 189
Fetal Skull, 250
Other Pigmen~<, 190
Hvoid Bone, 252
Functions of the Skin, 191
v;rtebral Column, 2)2
Di~wsityo{$kin Funcaons, 191
(h'en~ieu~ of the Spine, 252
Protection, 192
Vertebrae, 252
Sensation, 192
Flexibility, 192 Sacrum and Coccyx, 2 55
Spirwl Cun-•ature,~;, 2 55
Excretion, 192
Thorax, 2>8
Hormone (VUamin D) Production, 193
$temum, 258
Immunity, 193
Rib.<, 2>8
Homeo,~;tasis of Body Temperature, 193
Appendages of the Skin, 195
Case Study, 261
Hair, 195
Nails, 197 CHAPTER 13 Appendicular Skeleton, 263
Skin Clands, 198
Cycle of Life: Skin, 198 Upper Extremity, 264
11>e Big Picture: Skin and the Whole Body, 199 Shoulder Girdle, 264
Mechanisms of Disease, 200 Arm, 2M
c ase s.·tu dy, 70
_ >- Foreann, 264
Hand, 267

xx Contents
Lower Extremitv, 268 Tmnk Muscles, 323

Pelvic Cirdle, 268 Muscles of the Tlmax, 323
Thigh, 272 Muscles of the Abdomina/Wall, 324
Leg, 273 Muscles of the Back, 326
Foot, 273 Muscles of the Pel>oic Floor, 327
Skeletal Variations, 27) The Big Picture: A'ial Muscles and the Whole
Male-Female Skeletal Diffem!C~S, 275 Body, 329
Age Differences, 276 Case Study, BO
Environmental Factors. 276
Cycle of Life: Skeletal System, 277 CHAPTER 16 Appendicular Muscles, 333
111< Big Picture: Skeletal System, 277 Appendicular Muscles, 334
Mechanisms of Disease, 277 Upper Extremity Muscles, 334
Case Study, 278 Mu,<eles Acting on the Shoulder Cirdle, 3H
Mu,<eles Tlwt Mmoe tl>e Ann, 3H
CHAPTER 14 Articulations, 281 J\.fu,«:les Tlwt lvl(n>e tl1e Forearm. 337
Classification of joints, 282 Mu.<eles Tlwt Mmoe tl>e Wrist, Hand, and
Fibrous Joint.< (Synarthroses), 282 Fingers, l3 7
Cartilaginous Joints (Amphiarthroses), 282 Lower Extremity Muscles. 341
SrnoviaiJoints (Diarthroses), 284 Mu,<eles Tlwt Mm•e tl>e 'n•igl• and Leg, 341
Representative Synovial Joints, 286 Mu,<eles Tlwt Mm•e tl>e Ankle and Foot, 341
Humero..«:apular Joint, 286 Posture. 3S I
EIIJOw Join~ 287 How Po.~ture Is lvlaintained. 352
Forearm, \Vrist, Hand. and Finger Joints. 288 Cycle of Life: Muscular System, 353
Hip Joint, 290 The Big Pich1re: Appendicular Muscles and the \\~1ole
Knee Join~ 290 Body, 3)3
Ankle Joint, 293 Case Study, 3>4
Vertebra/Joints, 295
Movement at Synovial Joints, 295 CHAPTER 17 Muscle Contraction, 356
Range of Motion, 296 General Functions, 3S7
Angular J\.fm•ements. 296 Function of Skeletal Muscle Tissue. 3S7
Circular Nfovement.~. 296 Funt:tiorwl Characteristics of Nfusde, 357
Cliding lvltwements, 297 O>•erview of the Muscle Cell, 357
Special Mm.,ments, 297 M)'o/ilaments, 359
Examples ofJoint Mm•ements, 297 J\.fechanism o{Contra<:tion, 361
Cvc1e of Life: Articulations. 302 Energy Source,<for Muscle Contraction, 365
1i1e Big Picture: Articulations, 302 Function of Skeletal Muscle O rgans, 368
Mechanisms of Disease, 303 Motor Uni~ 368
Case Study, 306 M)•ogral>hy, 369
Tl1e Tulitd1 Contraction, 369
CHAPTER 15 Axial Muscles, 310 Treppe: -n,e StaircCJSe Phenomenon, 370
Skeletal Muscle StmchJre, 31 I Tetarw,<, 371
Connecth•e Tissue Components. 311 J\.fu,«:le Tone, 372
Size. Slwpe, and Fiber Arrangement. 311 Craded Strength Principle, 373
Attaclnnent of M usc/e.<, 313 Crades of Muscle Strengt/1, 373
Mu.«:le Action.~. 314 Mobilizing and Stabilizing Contractions, 374
Lew!r Systems, 31 5 Function of Cardiac and Smooth Muscle Tissue, 375
How Muscles Are Named, 3 I6 Cardiac Muscle, 375
Hints on How to Deduce Nfusde Actions, 319 Smooth Muscle, 377
A'ial Muscles, 32 I The Big Pich~re: Muscle Tissue and the Whole
Muscles of the Head and Neck, 32 I Body, 378
Muscles of Facial Expres,<ion, 321 Mechanisms of Disease: Major Muscular Disorders. 379
Muscles ofMastication, 322 Career Choices, 381
Mu.<eles Tlwt Move the Head, 323 Case Study, 38 I
Contents xxl

UNIT 3 Communication, Control, Case Srudv, 428
'
and Integration, 386
CHAPTER 20 Central Nervous System, 432
CHAPTER 18 Nervous System Cells, 388 Co\'erings of the Brain and Spinal Cord, H 3
Organi>.alton of the Nenou; S)>lcm, 3&9 Cerebrospinal fluid, H>
Ce11tral a11d Penpheral 1\'mous S1Tte11u, 3b9 Fluid Spacts, 4 3>
Affcront and Efferent DnntOIIS. 390 Fonnation arid Cirrulotion ofCerebmspmal
Somaltc and Aulouomtc l\~tn"'tts Sn,lems, 390 Fluid, 43)
Clia, 391 Spinal Cord, 438
O.'n>·i<>o· ofCita. 39 I Structurrof tlte Spinal Con/, 4l8
Cnttral Cl.,, 39 I Fundionrof tltt Spinal Con/, 4l9
Pnipheral Clta, 393 Brain, ++I
N'euron1, 39; Rtgiom of tlte Brain, 44 I
Structurr and FurtcltOtl o(i\'tutOII1. 39) Brain Dn-elopmenl, ++I
Clmst{J<allon of•'<turom. 397 Structurr of the Brainstnn, 442
Refle.\ .\re, 3% Functions of tlte Brainstem, ++-1
Nen. es rand Trac:h, 400 Structure of tltt Cer.b.llum, 4-14
Nen-n. -100 Functions of tlte Cerebellun~ 4-15
Tracts. 400 Dimctplralotl, 447
White a11d Gra1 Jllall<r. 4!10 Structure of tlte Cerebrum, ++9
Repair of Nene Ftben. 40 I FunclioiiS of tlte Cerebral Cortex, 4)2
Cycle of Ltfe: Ncnou< S)'lcm Cell;, 402 Somatic Sensory Pathwal'· 4 59
The Big Picture: Nenous S)'lcm Cell, and the \\'hole Somatic Motor Pathways, 460
BO<I). 402 Final Common Path, 460
Mech:lni. . ros of Disensc. 403 Pyramidal Tracts. 461
Case Sh1dy. 404 Extrapyramidal Tracts, 462
Fac:ilitatory and lniJil>ilory Tmtt.s, '162
CHAPTER 19 Nerve Signaling, 408 Cycle of Life: Central Nen•ous System. 463
Eleclrical Nature of Nemon .... 409 11>e Big Picture: 11>< Cenlrnl Nel\ous S)•tcm nnd the
tvfcmf)rant l'otcutials. 409 Whole Body, 463
Rc<ti11g ll lembrmre Potentials, 409 Mechanisms of Disease, 464
I.Jxnl Poter~tial<, 4 /() Case Srudy, 467
Actiot'l Potel'ltials, 4 11
,\ leclw11ism of tire Actro11 Potential. 4 I I
CHAPTER 21 Peripheral Nervous System, 473
Re{ract(ll'\• Period. 41l Spinal ~erYes, 47)
Co11duction of the Actro11 PotentiaL 4 I 4 Struclureo{Spinol 1\'m·-., 476
Splaplic Trammts.sion. 41 S Nen·e Pl.ruse<, 477
Structure of the S111apst. 4 I5 Dennatomes and A1mtome&, -f 81
T1pe.ofSmapses. 415 Craniall\en·es, 483
.\ltdtanums o(S•mapllc ·lran.smw•m•. i 16 Ol{actorv Nm·e (CN 1), 4&>
Summa/ton. -fib Op!ic 1\'m~ (CN 11), 4&6
Smap... a11d ,\lemon·. of 19 Oculomotor 1\'m~ (CN Ill}, 4&6
~eurotr:msm•Uers. -119 Trocltlear XenY (C.\' 1\'), 4&6
Fun<ltOti<JI ClaMJ{icatron of 1\:rorolratwmtten, ilO Trigeminal Xm~ (CN \'), 486
Structural Cla$St{icatron oft>.' rorolrarwrutten, il I Abducens l':m.. (CX \1}, 4~7
~eural :\'etuorb... 2-1 Faci<1l Nm~ (Ct-.' \11). ib~
Titt Nen.wl \lode/. 42i \ 'nlibulorochkar Nen-. (CN \'Ill}, iS~
Dn-elopment of Neural :>;en.mh. i15 Clossophanng&JI Nen·e (Ct\' IXl, iS!>
CompltXlh: m Neutol i"\'ttl.'Oth. -12; \'agus Nm~ (CN XI, 48!>
The Btg Pt<lurc: Nen c S.gnal111g and the Whole Accesson• NtnY (Ct\' Xl), 489
Bod). 426 Hypoglossal Nen~ (CN XII), i90

xxii Contents
Somatic Motor Nervous System, 490 CHAPTER 24 Special Senses, 514

Divisions of the Peripheral Nervous Systems, 490 Sense of Smell, 527
The Big Picture: Peripheral Nervous System and the Olfactory Receptors, 527
Whole Body, 492 Olfactory Pathway, 528
Case Study, 494 Sense of Taste, 528
Taste Buds, 528
CHAPTER 22 Autonomic Nervous System , 47 4 Neural Pathway for Taste, 530
Overview of the Autonomic Nervous System, 499 Senses of Hearing and Balance, 5 30
Role of the Autonomic Nervous System, 499 Structure of the Ear, 530
Divisions of the Autonomic Nervous System, 499 The Process of Hearing, 532
Structure of the Autonomic Nervous System, 500 Balance, 534
Basic Plan of Autonomic Pathways, 500 Sense ofVision, 536
Structure of the Sympathetic Pathways, 500 Structure of the Eye, 536
Structure of the Parasympathetic Pathways, 503 The Process of Seeing, 542
Autonomic eurotransmitters and Receptors, 504 C ycle of Life: Special Senses, 547
Norepinephrine and Its Receptors, 505 The Big Picture: Special Senses, 547
Acetylcholine and Its Receptors, 505 M echanisms of Disease, 548
Nonadrenergic-Noncholinergic Transmission, 506 Case Study, 5 50
Synaptic Complexity, 506
Pharmacology, 506 CHAPTER 25 Endocrine Regulation, 526
Functions of the Autonomic N ervous System , 507 Organization of the Endocrine System, 5 57
Overview of Autonomic Function, 507 C lassification of Hormones, 5 58
Functions of the Sympathetic Division, 509 Steroid Hormones, 558
Functions of the Parasympathetic Division, 510 Nonsteroid Hormones, 558
The Big Picture: Autonomic Nervous System and the How H ormones Work, 561
Whole Body, 510 General Principles of Hormone Action, 561
Case Study, 511 Mechanisms of Steroid Hormone Action, 561
Mechanisms of Nonsteroid Hormone Action, 562
CHAPTER 23 General Senses, 498 Regulation of Hormone Secretion, 564
Sensory Receptors, 515 Regulation of Target Cell Sensitivity, 566
Receptor Response, 515 Eicosanoids, 566
Distribution of Receptors, 515 Tissue Hormones, 566
C lassification of Receptors, 516 Prostaglandins, 567
Classification by Sensory Pathway, 516 Thromboxanes and Leukotrienes, 568
Classification by Location, 516 The Big Picture: Endocrine Regulation and the Whole
Classification by Stimulus Detected, 516 Body, 568
Classification by Structure, 517 Mechanisms of Disease, 569
Sense of Pain, 517
Sense of Temperature, 519 CHAPTER 26 Endocrine Glands, 556
Sense of Touch, 519 Pituitary Gland, 574
Skin Movement, 519 Structure of the Pituitary Gland, 574
Itch, 520 Adenohypophysis (Anterior Lobe of Pituitary), 574
Tickle, 520 Neurohypophysis (Posterior Lobe of Pituitary), 580
Light Touch, 52 1 Pineal Gland, 58 1
Deep Touch, 52 1 Thyroid Gland, 582
Sense of Proprioception, 52 1 Structure of the Thyroid Gland, 582
The Big Picture: General Senses, 522 Thyroid Hormone, 583
Case Study, 52 3 Calcitonin, 583

•••
Contents XXIII
Parathyroid Glands 584 7 Platelets 620 7
Structure of the Parathyroid Glands 584 7 Structure and Function of Platelets 620 7
Parathyroid Hormone 585 7 Formation and Life Span of Platelets 620 7
Adrenal Glands 586 7 Hemostasis 621 7
Structure of the Adrenal Glands 586 7 Vasoconstriction 621 7
Adrenal Cortex 587 7 Platelet Plug Formation 621 7
Adrenal Medulla 590 7 Blood Clotting (Coagulation) 622 7
Pancreatic Islets 590 7 Conditions That Oppose Clotting 624 7
Structure of the Pancreatic Islets 590 7 Conditions That Hasten Clotting 625 7
Pancreatic Hormones 591 7 Clot Dissolution 625 7
Gonads 591
7 The Big Picture: Blood and the Whole Body 626 7
Testes 592 7 Mechanisms of Disease 626 7
Ovaries 592 7 Case Study 630 7
Placenta 594 7
Thymus 594 7
CHAPTER 28 Heart, 634
Gastric and Intestinal Mucosa 594 7 Heart Structure 635 7
Heart 594
7 Location of the Heart 63 5 7
Adipose Tissue 594 7 Size and Shape of the Heart 635 7
Other Endocrine Glands and Hormones 59 5 7 Coverings of the Heart 639 7
Cycle of Life: Endocrine System 595 7 Structure of the Heart 640 7
The Big Picture: The Endocrine System and the Whole The Heart as a Pump 647 7
Body 595
7 Conduction System of the Heart 647 7
Mechanisms of Disease 596 7 Electrocardiogram 648 7
Case Study 599 7 Cardiac Cycle 650 7
Career Choices 599 7 Heart Sounds 653 7
Cycle of Life: Heart 6 53 7
The Big Picture: Heart 65 3 7
UN IT 4 Transportation Mechanisms of Disease 6 53 7
Case Study 659

and Defense, 604 7
CHAPTER 29 Blood Vessels, 663

CHAPTER 27 Blood , 606
Blood Vessel Types 664 7
Blood Composition 607 7 Arteries 664 7
Blood Tissue 607 7 Capillaries 664 7
Blood Plasma 608 7
Veins 667 7
Formed Elements 608 7 Structure of Blood Vessels 667 7
Hematopoiesis 608 7 Circulatory Routes 668 7
Blood Volume 609 7 Systemic Circulation 668 7
Hematocrit 610 7 Pulmonary Circulation 669 7
Red Blood Cells 610 7 Circulatory Bypasses 669 7
Structure of Red Blood Cells 610 7 Systemic Circulation 670 7
Function of Red Blood Cells 611 7 Systemic Arteries 670 7
Hemoglobin 611 7
Systemic Veins 679 7
Formation of Red B food Cells 613 7 Fetal Circulation 686 7
Life Cycle of Red Blood Cells 613 7 Organization of Fetal Circulation 686 7
Blood Types 614 7 Changes in Circulation at Birth 689 7
White Blood Cells 618 7 Cycle of Life: Blood Vessels 689 7
Granulocytes 618 7 The Big Picture: Blood Vessels and the Whole
Agranulocytes 619 7
Body 6907
White Blood Cell Numbers 619 7
Mechanisms of Disease 690 7
Formation of White Blood Cells 620 7 Case Study 694 7

xxiv Contents
CHAPTER 30 Circulation of Blood, 697 Mechanisms of Disease, 740

Hemodynamics, 698 Case Study, 742
Primary Principle of Circulation, 698
Arterial Blood Pressure, 699 CHAPTER 32 Innate Immunity, 746
Cardiac Output, 700 Organization of the Immune System, 747
Peripheral Resistance, 704 Defense of the Body, 747
Venous Return to the Heart, 709 Innate Immunity, 749
Venous Pumps, 709 Species Resistance, 749
Total Blood Volume, 711 Mechanical and Chemical Barriers, 749
Measuring Blood Pressure, 713 Inflammation and Fever, 750
Arterial Blood Pressure, 713 The Inflammatory Response, 750
Blood Pressure and Bleeding, 715 Fever, 750
Minute Volume of Blood, 715 Phagocytosis, 7 52
Velocity of Blood Flow, 716 Natural Killer Cells, 7 53
Pulse, 716 Interferon, 75 5
Mechanism, 716 Complement, 755
Pulse Wave, 717 Toll-Like Receptors, 756
Where the Pulse Can Be Felt, 718 The Big Picture: Innate Immunity and the Whole
Venous Pulse, 718 Body, 756
Cycle of Life: Cardiovascular Physiology, 719
The Big Picture: Blood Flow and the Whole Body, 719 CHAPTER 33 Adaptive Immunity, 759
Mechanisms of Disease, 719 Overview of Adaptive Immunity, 760
Case Study, 721 B Cells and Antibody-Mediated Immunity, 762
Development and Activation of B Cells, 762
CHAPTER 31 Lymphatic System, 725 Antibodies (Immunoglobulins), 763
Overview of the Lymphatic System, 726 Clonal Selection Theory, 766
Lymph and Interstitial Fluid, 727 T Cells and Cell-Mediated Immunity, 768
Lymphatic Vessels, 728 Development ofT Cells, 768
Distribution of Lymphatic Vessels, 728 Activation and Functions ofT Cells, 768
Structure of Lymphatic Vessels, 728 Types of Adaptive Immunity, 771
Functions of Lymphatic Vessels, 729 Summary of Adaptive Immunity, 772
Circulation of Lymph, 729 The Big Picture: Immune System and the Whole
Origin of Lymph, 729 Body, 775
The Lymphatic Pump, 730 Mechanisms of Disease, 775
Lymph Nodes, 731 Case Study, 779
Structure of Lymph Nodes, 731
Locations of Lymph Nodes, 732 CHAPTER 34 Stress, 782
Functions of Lymph Nodes, 734 Selye's Concept of Stress, 783
Lymphatic Drainage of the Breast, 734 Development of Selye's Stress Concept, 783
Distribution of Lymphatics in the Breast, 73 5 Definitions, 783
Lymph Nodes Associated With the Breast, 735 Stressors, 783
Tonsils, 736 General Adaptation Syndrome, 785
Thymus, 736 Mechanism of Stress, 787
Location and Appearance of the Thymus, 736 Some Current Concepts About Stress, 787
Structure of the Thymus, 737 Allostatic Load Model, 787
Function of the Thymus, 737 Stress Syndrome, 788
Spleen, 737 Role of the Brain in Stress, 789
Location of the Spleen, 737 Stress and Disease, 791
Structure of the Spleen, 737 Indicators of Stress, 791
Functions of the Spleen, 739 Effects of Intrauterine Stress, 792
Cycle of Life: Lymphatic System, 740 Summary of the Allostatic Model, 793
The Big Picture: Lymphatic System and the Whole The Big Picture: Stress and the Whole Body, 794
Body, 740

Contents xxv
Case Study, 79 5 The Big Picture: Gas Exchange and Transport and the
Career Choices, 795 Whole Body, 857
Case Study, 857
UN IT 5 Respiration, Nutrition, CHAPTER 38 Upper Digestive Tract, 860

Organization of the Digestive System, 86 1
and Excretion, 798 The Digestive Tract, 861
Wall of the Gastrointestinal Tract, 862
CHAPTER 35 Respiratory Tract, 800 Mouth, 863
Structural Organization, 80 1 Structure of the Oral Cavity, 863
Upper Respiratory Tract, 802 Salivary Glands, 866
Nose, 802 Teeth, 867
Pharynx, 804 Pharynx, 869
Larynx, 805 Esophagus, 869
Lower Respiratory Tract, 807 Overview of Esophagus, 869
Trachea, 807 Esophageal Sphincters, 870
Bronchi and Alveoli, 809 Gastroesophageal Refiux, 870
Lungs, 813 Stomach, 871
Thorax, 815 Size and Position of the Stomach, 871
Cycle of Life: Respiratory Tract, 815 Divisions of the Stomach, 872
The Big Picture: Respiratory Tract, 816 Curves of the Stomach, 872
Mechanisms of Disease, 816 Sphincter Muscles, 872
Case Study, 820 Stomach Wall, 872
Functions of the Stomach, 873
CHAPTER 36 Ventilation, 823 Cycle of Life: Upper Digestive Tract, 873
Respiratory Physiology, 824 Mechanisms of Disease, 874
Mechanism of Ventilation, 824 Case Study, 878
Primary Principle ofVentilation, 824
Inspiration, 825 CHAPTER 39 Lower Digestive Tract, 881
Expiration, 828 Small Intestine, 882
Pulmonary Volumes and Capacities, 832 Size and Position of the Small Intestine, 882
Pulmonary Volumes, 832 Divisions of the Small Intestine, 882
Pulmonary Capacities, 83 3 Wall of the Small Intestine, 882
Pulmonary Airflow, 834 Large Intestine, 884
Ventilation and Perfusion, 836 Size of the Large Intestine, 884
Regulation of Ventilation, 836 Divisions of the Large Intestine, 884
Homeostasis of Blood Gases and pH, 836 Wall of the Large Intestine, 886
Respiratory Control Centers, 836 Vermiform Appendix, 886
Feedback and Responses, 838 Peritoneum, 887
Other Infiuences on Ventilation, 840 Liver, 887
The Big Picture: Ventilation and the Whole Body, 841 Location and Size of the Liver, 887
Mechanisms of Disease, 841 Liver Lobes and Lobules, 888
Case Study, 844 Bile Ducts, 890
Functions of the Liver, 890
CHAPTER 37 Gas Exchange and Transport, 847 Gallbladder, 891
Pulmonary Gas Exchange, 848 Size and Location of the Gallbladder, 891
Partial Pressure, 848 Structure of the Gallbladder, 891
Exchange of Gases in the Lungs, 849 Functions of the Gallbladder, 891
How Blood Transports Gases, 85 1 Pancreas, 892
Hemoglobin, 851 Size and Location of the Pancreas, 892
Transport of Oxygen, 85 1 Structure of the Pancreas, 892
Transport of Carbon Dioxide, 852 Functions of the Pancreas, 892
Systemic Gas Exchange, 855 Cycle of Life: Lower Digestive Tract, 893

xxvi Contents
The Big Picture: The Digestive Tract 893 7 The Big Picture: Nutrition Metabolism and the Whole 7 7
Mechanisms of Disease 894 7 Body 955 7
Case Study 897 7 Mechanisms of Disease 95 5 7
Case Study 959 7
CHAPTER 40 Digestion and Absorption, 900

Overview of Digestive Function 90 1 7
CHAPTER 42 Urinary System, 963
Digestion 902 7 Anatomy of the Urinary System 964 7
Mechanical Digestion 902 7 Gross Structure 964 7
Chemical Digestion 906 7 Microscopic Structure 969 7
Secretion 912 7 Physiology of the Urinary System 974 7
Saliva 912 7 Overview of Kidney Function 974 7
Gastric Juice 912 7 Filtration 975 7
Pancreatic Juice 914 7 Reabsorption 977 7
Bile 914 7 Tubular Secretion 982 7
Intestinal Juice 915 7 Regulation of Urine Volume 983 7
Control of Digestive Gland Secretion 916 7 Urine Composition 985 7
Control of Salivary Secretion 916 7 Cycle of Life: Urinary System 986 7
Control of Gastric Secretion 916 7 The Big Picture: Urinary System and the Whole
Control of Pancreatic Secretion 918 7 Body 986 7
Control of Bile Secretion 918 7 Mechanisms of Disease 987 7
Control of Intestinal Secretion 918 7 Case Study 992 7
Absorption 919 7
Process of Absorption 919 7

CHAPTER 43 Fluid and Electrolyte Balance, 996
Mechanisms of Absorption 919 7 Fluid and Electrolyte Balance 997 7
Elimination 92 1 7 Total Body Water 997 7
The Big Picture: Digestion and the Whole Body 923 7 Body Fluid Compartments 997 7
Case Study 924 7 Electrolytes in Body Fluids 998 7
Extracellular vs. Intracellular Fluids 998 7

CHAPTER 41 Nutrition and Metabolism, 928 Measuring Electrolyte Reactivity 1000 7
Nutrition and Metabolism 929 7 Avenues of Water Entry and Exit 100 1 7
Overview 929 7 General Principles of Fluid Balance 1001 7
Nutrients 929 7 Homeostasis ofTotal Fluid Volume 1002 7
A Balanced Diet 930 7 Regulation of Fluid Intake 1002 7
Metabolic Pathways 931 7 Regulation of Urine Volume 1002 7
Carbohydrates 932 7 Factors That Alter Fluid Loss 1002 7
Dietary Sources of Carbohydrates 932 7 Regulation of Water and Electrolytes 1004 7

7
Carbohydrate Metabolism 932 7 Starling s Law of the Capillaries 1004 7
Lipids 942
7 Edema 1006 7
Dietary Sources of Lipids 942 7 Regulation of Water and Electrolytes in Intracellular

Transport of Lipids 942 7 Fluid 1007 7
Lipid Metabolism 942 7 Regulation of Sodium and Potassium 1008 7
Proteins 944
7 Cycle of Life: Fluid and Electrolyte Balance 1009 7
Sources of Proteins 944 7 The Big Picture: Fluid and Electrolyte Balance 10 10 7
Protein Metabolism 945 7 Mechanisms of Disease 1010 7
Vitamins and Minerals 946 7 Case Study 1013 7
Vitamins 946 7
Minerals 949 7
CHAPTER 44 Acid-Base Balance, 1016
Metabolic Rates 950 7 pH of Body Fluids 1017 7
Basal Metabolic Rate 950 7 Review of the pH Concept 1017 7
Total Metabolic Rate 952 7 Factors That Affect pH of Body Fluids 1018 7
Energy Balance and Body Weight 953 7 pH Control Mechanisms 1019 7
Mechanisms for Regulating Food lntake 953 7 Overview of pH Control Mechanisms 1019 7
Cycle of Life: Nutrition and Metabolism 95 5 7 Integration of pH Control 1019 7

••
Contents XXVII
Chemical Buffers, 1019 CHAPTER 46 Female Reproductive System, 1054

Buffers Defined, 1019 Overview of the Female Reproductive System, 105 5
Buffer Pairs, 1019 Function, 1055
Buffer Activity, 1020 Structure, 1055
Role of Buffers in pH Control, 1022 Perineum, 1056
Respiratory Mechanisms, 1022 Ovaries, 1057
Overview of Respiratory Mechanisms, 1022 Location of the Ovaries, 1057
Respiratory Adjustment of Blood pH, 1023 Microscopic Structure of the Ovaries, 1058
Principles Relating Respiration to pH, 1023 Functions of the Ovaries, 1059
Arterial Blood Gas Analysis, 1023 Uterus, 1059
Urinary Mechanisms, 1024 Structure of the Uterus, 1059
Overview of Urinary Mechanisms, 1024 Functions of the Uterus, 1061
Regulating pH of Urine and Blood, 1024 Uterine Tubes, 1061
The Big Picture: Acid-Base Balance, 1027 Location of the Uterine Tubes, 1061
Mechanisms of Disease, 1027 Structure of the Uterine Tubes, 1061
Case Study, 1030 Function of the Uterine Tubes, 1062
Career Choices, 1030 Vagina, 1062
Location of the Vagina, 1062
Structure of the Vagina, 1063
UNIT 6 Reproduction and Functions of the Vagina, 1063
Development, 1034 Vulva, 1063
Structure of the Vulva, 1063
Functions of the Vulva, 1065
CHAPTER 45 Male Reproductive System, 1036
Female Reproductive Cycles, 1065
Sexual Reproduction, 1037 Recurring Cycles, 1065
Male Reproductive Organs, 1037 Control of Female Reproductive Cycles, 1067
Male Reproductive Tract, 1037 Importance of Female Reproductive Cycles, 1070
Perineum, 1037 Infertility, 1072
Testes, 1038 Menarche and Menopause, 1072
Structure and Location, 1038 Breasts, 1072
Microscopic Anatomy of the Testis, 1038 Location and Size of the Breasts, 1072
Testes Functions, 1041 Structure of the Breasts, 1074
Spermatozoa, 1042 Function of the Breasts, 1074
Reproductive Ducts, 1043 Cycle of Life: Female Reproductive System, 1076
Epididymis, 104 3 The Big Picture: Female Reproductive System and the
Vas Deferens, 104 3 Whole Body, 1076
Ejaculatory Duct, 1044 Mechanisms of Disease, 1076
Urethra, 1044 Case Study, 1082
Accessory Reproductive Glands, 1045
Seminal Vesicles, 104 5 CHAPTER 47 Growth, Development, and Aging, 1086
Prostate Gland, 104 5
Human Reproduction, 1087
Bulbourethral Glands, 104 5
Production of Sex Cells, 1087
Supporting Structures, 1046
Ovulation and Insemination, 1092
Scrotum, 1046
Fertilization, 1092
Penis, 1046
Prenatal Period, 1093
Spermatic Cords, 104 7
Cleavage and Implantation, 1093
Composition and Course of Seminal Fluid, 1047
Placenta, 1096
Male Fertility, 1048
Periods of Development, 1097
Cycle of Life: Male Reproductive System, 1048
Stem Cells, 1098
The Big Picture: Male Reproductive System, 1048
Formation of the Primary Germ Layers, 1099
Histogenesis and Organogenesis, 1102
Case Study, 1051

xxviii Contents
Birth, 1104 Gene Expression, 1126

Stages of Labor, 1106 Hereditary Traits, 1126
Multiple Births, 1106 Sex-Linked Traits, 1128
Postnatal Period, 1107 Genetic Mutations, 1129
Growth, Development, and Aging, 1107 Medical Genetics, 1130
Infancy, 1108 Mechanisms of Genetic Diseases, 1130
Childhood, 1108 Single-Gene Diseases, 1132
Adolescence and Adulthood, 11 09 Multiple-Gene Diseases, 1134
Older Adulthood, 1109 Epigenetic Conditions, 1134
Aging, 1109 Chromosomal Diseases, 113 5
Mechanisms of Aging, 11 09 Genetic Basis of Cancer, 113 6
Effects of Aging, 1111 Prevention and Treatment of Genetic Diseases, 11 36
Causes of Death, 111 3 Genetic Counseling, 1136
The Big Picture: Growth, Development, Aging, and the Treating Genetic Diseases, 1138
Whole Body, 1114 The Big Picture: Genetics, Heredity, and the Whole
Mechanisms of Disease, 11 15 Body, 1139
Case Study, 111 7 Case Study, 1140
Career Choices, 1141
CHAPTER 48 Genetics and Heredity, 1121
The Science of Genetics, 11 22 Glossary of Anatomy & Physiology, 1144
Chromosomes and Genes, 1122
Mechanism of Gene Function, 1122 Index, 1198
The Human Genome, 1123
Distribution of Chromosomes to Offsp ring, 1125

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Illustration and Photograph Credits

UNIT 1 5 7. B, 5-12, B, -; . JS, B: Courtesy Charles Flickinger, University of
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dock: ils locali7.alion, fu nction, and rcseHing. Ad'' lnle-m 1'vled, lc:ukemi:., hypopl.astic :tnc:mi:. an<l myd<xl~:splastie syndrome, l>atJto-
38:8 1 106, 1993. In (rc:<lr:.wn From) Koeppen B, Stanton B: &me 6
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physiology, 13(4):217-225, 2006. 6-9, t\dapted from McCance K,
L.n.y phy~iology, ed 6, St. Louis, 2010, lvlo$by. 2-8, 2 9, B: Prom
4
Huether S: Pathophysiology, e<l -t, St. Louis, 2002, lvlosby. 6· 11
PaHon KT, '11lilxxle.au C: Human body in health 6 diseast', c:d 6, (d cctron micmgrnphs): Courtesy ).•J.:\•1. Perry and A B. Gilbert,
St Louis, 2014, Moshy. 2 9, A: F'mm Donne DC, Vile:$ JH, Crotl1 D,
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Melhorn 1: Stntchtre of tl1e recomllinant Full 1ength l1.amstc:r prion
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protein PRp (29.23 1): the N tc:nninm is highly Aexillle, Proc Nat/ Box 6· 1, S: Prom Coldm.an L. Ausie1lo D: Cecil textbook of medi·
Acad Sci USA, W, I H;2-l H57, 1997. Cuprrigl>t National Academy cine, ed ZZ, Philadelphia, lOCH, Saunders.
oFScic:nccs, USA.
Chapter 7
Chapter 3 7-1 (photo)' Cold Spring H•rbor l..oboratory. 7-t, Adapted from
3-J: from Patton Kf, Thihode.au C: Human body in health 6 dis· Poll.arcl T', E.:tm$h:tw \ V: Cell biology, revised reprint. intern:.tional
ease, c:<l 6, St Loui$, 20 14, ).•lusby. l _,: From Sugimoto Y, Pou P, e<lition, Phibddphia, lOCH, S:.undeD. 7-5: Prom P:tHon KT,
Abc: lvl, et al: Chemical identification of imli\'i<lual surface atoms by 'l11ilxxleau C : Human body in health 6 disetJ$C, ed 7, St. Louis, 20 18,
atomic Force: microscopy, Nature, 466:64...67, 2007. l~, C: lvlichad Mosh)'. 7-JO, J\.fo~: Dennis Stretc:. 7 12: Wikimeeli:. Commons.
4
CO<Iomsl:ifl<lm St.ack &: Associates. Case Study hox: Fmm Potter P,

Perry A: Basic nursing: eSSf'ntials (or practice, ed 6, St. Louis, 2006, Chapter 8
Mosln-. S.J: From Patton Kl ', l 11ilxldc::.u CA.: Mosby's handbook ofanatomy
6 physiology, ed 2, St. Louis, 20H, Elsevier. 8_, (hottom image):
Chapter 4 Modified from Pollard T D, f.:tmsl1.:tW \V: Cell biology, ed 2, Pl1ib 4
-t-13: F'mm P:.tton KT, l l tibcxleau CA.: Mosby's handbook of anal· <lclpl1ia, 2007, \VB Sam1<lcrs Company.&.-; , 8· 13: From Cartner LP,
amy 6 physiology, ed 2, St. Loui$, 20 14, Elsc:\-ier. 4· 14: Prom Hiatt JL: Color textbook of histology, ed 3, Ph i1a<lc:lph i:., 2007, Saun 4
PaHon K Thihode.au C, Dougla$ M: Essentials of anatomy and <lers. 8.6: From P:ttton Kl', Thihodeau C: Human body in health 6
physiology, St. Louis, 20 12, lvlo$by. 4 15, Box -t-t (photo): Prom
4
disease, eel 7, St. Louis, 2018, Moshy. 8 7: Prom C:tllen J, C reer K,
4
National Institute oF General Me<lic:tl Sciences, 'fhe structures o(life, Hood A, ct :.1: Color atlas ofdennatology, P11ibdclpl1ia, 1993, S:.un 4
July 2007, retriC~.·ed Nu..-ember 2008 from l1ttp://www.nigms.nih.gov/ <lers. S. IO, A, B: f rom Samudson DA: Textbook of \'eieriuary histol·
ne\\"'S/scienee_e<l/stm ct1ifc: /. Sox 4·2 (photo): Copyrigl1t Kevin ogy, \VB Saunders ComJXln)', 2007. S.JO, C : Will 2\1urr:ty (\Villscrit),
PaHon, Lion Den Inc, Weldon Spring, MO. http://wilmunaymc:di:..com. S. IZ: Reprinted witl1 permission From
Cregor Reid, Pl1D, l.:t\\'SOn Health Rc:se.arch lm lihtte.
Chapter 5
5·1, 8 : Courtesy A Arlan Hinchec:. 5 2, 5 9, 5· 10, 5·13, S-15 (dec
4 4 4 Chapter9
tron microgmphs), 5· 17: from Poll.ard T', E:amshaw \ V: Cell biology, 9-2, 9-t, 9-6, 9-7, 9-8,9-9, 9-H , 9-16,9-17,9-18,9-23,9-25, 9-26,
revise:<! reprint, intern:ttional eelition, Phila<lelphi:., 20<H, Satmders. 9-27, 9-29, 9-30, 9-31, 9-32, 9-33' Dennis Stretc. 9-3 (dmwing)'
JO(ix
xxx Illustration and Photograph Credits
Barbara Cousins. 9-3 (electron micrograph), 9-10, 9-15, B: From 2007, Saunders. 11-16: From Patton KT, Thibodeau G: Human
Erlandsen SL, Magney J: Color atlas of histology, St. Louis, 1992, body in health 6 disease, eel 7, St. Louis, 201 8, Mosby. 11-17: From
Mosby. 9-5: Ed Reschke 9-20, 9-28: From Gartner L, Hiatt J: Color Zitelli B, Davis H: Atlas of pediatric physical diagnosis, eel 4, Phila-
textbook of histology, eel 3, Philadelphia, 2007, Saunders. 9-21 , 9-24: delphia, 2002, Mosby. 11-18: Ed Reschke. 11-20: From Booher JM,
From Kerr J: Atlas of functional histology, London, 1999, Mosby. Thibodeau Ga: Athletic injury assessment, St. Louis, 1985, Mosby.
9-22: Courtesy Gary Thibodeau. Box 9-1: From Zitelli B, Davis H: 11-24, A, B: Courtesy of Dennis Strete. 11-24 C, 11-25: From
Atlas of pediatric physical diagnosis, eel 3, Philadelphia, 1997, Kumar V, Abbas A, Fausto N: Robbins and Cotran pathologic basis
Mosby. Career Choices box: Courtesy of Joanna McGaughey. of disease, eel 7, Philadelphia, 2005, Saunders.
UNIT 2 Chapter 12
Chapter 10 12-2 (photo), 12-3 (photo), 12-4 (photo), 12-5 (photo), Courtesy
10-1 (photo): Ed Reschke. 10-1 (drawing), 10-6, 10-29: Barbara Vidic B, Suarez FR: Photographic atlas of the human body, St. Louis,
Cousins. 10-3, 10-18, Case Study (figure): Copyright Kevin Patton, 1984, Mosby. 12-6 (photo), 12-11, 12-16, 12-13 (inset): From
Lion Den Inc, Weldon Spring, MO. 10-10: From Rouzaud F, Williams P: Gray's anatomy, eel 38, Philadelphia, 1996, Churchill
Kadekaro A, Abdel-Malek Za, Hearing VJ: MC1R and the response of Livingstone. 12-14, A-H: From Gosling J, Harris P, Whitmore I,
melanocytes to ultraviolet radiation, Mutat Res, 571:136,2005. 10-11: Willan P: Human anatomy, eel 4, Philadelphia, 2002, Mosby. 12-17:
From Regezi J, Sciubba JJ, Jordan RCK: Oral pathology: clinical Courtesy Dr. N. Blevins, ew England Medical Center, Boston.
pathologic correlations, eel 5, St. Louis, 2008, Saunders. 10-12: From
Epstein 0 , Perkin CD, Cookson J, de Bono 0: Clinical examination, Chapter 13
eel 3, St. Louis, 2003, Mosby. 10-13 (gradient): From McCance K, 13-2, D, 13-3, C, 13-4, C, 13-5, 13-6, 13-7, 13-8, D, E, 13-9, B
Huether S: Pathophysiology, eel 5, St. Louis, 2005, Mosby. 10-15, (photos): Courtesy Vidic B, Suarez FR: Photographic atlas of the
Box 10-6 (figure): From Patton KT, Thibodeau G: Human body in human body, St. Louis, 1984, Mosby. 13-7, 13-11, B, D: From
health 6 disease, eel 7, St. Louis, 2018, Mosby 10-17, C: Copyright © Abrahams P, Marks S, Hutchings R: McMinn's color atlas of human
by David Scharf, 1986, 1993. 10-20: Courtesy Christine Olekyk. anatomy, eel 5, Philadelphia, 2003 , Mosby. 13-10 (drawings): From
10-21, 10-24, 10-25: From Habif TP: Clinical demwtology, eel 4, Yvonne Wylie Walston. 13-10 (photo inset): From Seidel HM,
St. Louis, Mosby, 2004. 10-22: From HabifTP: Clinical dermatology, Ball JW, Dains JE, Benedict GW: Mosby's guide to physical examina-
eel 2, St. Louis, 1990, Mosby. 10-26: From Potter P, Perry A: Basic tion, eelS , St. Louis, 2003, Mosby.13-11, A, 13-12: From Patton KT,
nursing: essentials for practice, eel 5, St. Louis, 2003, Mosby. 10-27: Thibodeau G: Human body in health 6 disease, eel 7, St. Louis,
From James WD, Berger TG, Elston OM: Andrew's diseases of the 20 18, Mosby. Case Study box: From Browner B, Jupiter J, Trafton P:
skin: clinical dermatology, eel 10, London, 2000, Saunders. 10-28, A: Skeletal trauma: basic science, management, and reconstruction, eel 3,
From Goldman L, Ausiello 0: Cecil textbook of medicine, eel 23, Philadelphia, 2003, Saunders.
Philadelphia, 2008, Saunders. 10-28, B: From oble J: Textbook of
primary care medicine, eel 3, Philadelphia, 2001, Mosby. 10-28, C: Chapter 14
From Townsend C, Beauchamp RD, Evers BM, Mattox K: Sabiston 14-3, B, 14-6, 14-7, A, B, 14-8, 14-11: From Gosling J, Harris P,
textbook of surgery, eel 18, Philadelphia, 2008, Saunders. 10-28, D: Whitmore I, Willan PI: Human anatomy, eel 4, Philadelphia, 2002,
From Rakel R: Textbook of family medicine, eel 7, Philadelphia, 2007, Mosby. 14-5, B, D, 14-7, C, 14-9, B, D, 14-10, B, D: Courtesy
Saunders. Box 10-1: Courtesy James A. Ischen, MD, Baylor College Vidic B, Suarez FR: Photographic atlas of the human body, St. Louis,
of Medicine. Box 10-4: From Emond R: Color atlas of infectious dis- 1984, Mosby. 14-26: From Seidel HM, Ball JW, Dains JE,
eases, eel 4, Ph iladelphia, 2003, Mosby. Box 10-5 (figure): Courtesy Benedict GW: Mosby's guide to physical examination, eel 5, St. Louis,
Photo Researchers, Inc. http://images.sciencesource.com/search/ 2003 , Mosby. 14-27: From Swartz MH: Textbook of physical diagno-
SB1498. Box 10-7 (figure): From Callen JP et al: Color atlas of derma- sis, eel 4, Philadelphia, 2002, Saunders. 14-28, A, Box 14-1 (draw-
tology, eel 2, Philadelphia, 2000, Saunders. ing): From Patton KT, Thibodeau G: Human body in health 6
disease, eel 7, St. Louis, 2018, Mosby. Box 14-1 (photo): From
Chapter 11 Cummings N, Stanley-Green S, Higgs P: Perspectives in athletic
11-3, B: From White T: Human osteology, eel 2, Philadelphia, 2000, training, St. Louis, 2009, Mosby. Box 14-3: From Canale ST:
Academic Press. 11-4, B: From Moses K, Nava P, Banks J, Petersen 0: Campbell's operative orthopaedics, eel 9, St. Louis, 1998, Mosby.
Moses atlas of clinical gross anatomy, Philadelphia, 2005, Mosby. Case Study box: From Goldman L, Ausiello 0: Cecil textbook of
11-6, B, 11-24, A, B: Dennis Strete. 11-8: From Williams P: Gray's medicine, eel 23, Philadelphia, 2007, Saunders.
anatomy, eel 38, Philadelphia, 1996, Churchill Livingstone. 11-9, A:
From Muscolino J: Kinesiology, St. Louis, 2006, Mosby. 11-9, B: Chapter 15
From Erlandsen SL, Magney J: Color atlas of histology, St. Louis, 15-4: Adapted from Muscolino J: Kinesiology, St. Louis, 2006,
1992, Mosby. 11-10: Wikimedia Common. 11-1 1, A, B, C: From Mosby. 15-14: From Gosling J, Harris P, Whitmore I, Willan P: Hu-
Gartner, Leslie P: Color textbook of histology, eel 3, Philadelphia, man anatomy, eel 4, Philadelphia, 2002, Mosby. Box 15-1 (photo):
2006, Saunders. 11-13: From Patton K, Thibodeau G, Doublas M: From Harkreader H: Fundamentals of nursing: caring and clinical
Essentials of anatomy and physiology, St. Louis, 2012, Mosby. 11-14: judgment, eel 3, St. Louis, 2007, Saunders.
From Pollard TO, Earnshaw W: Cell biology, eel 2, Philadelphia,

•
Illustration and Photograph Credits XXXI
Chapter 16 University of Pennsylvania. 20-26: Courtesy D.N. Markand. Box 20-1

Box 16-1: Courtesy Aren Cummings, Ben Munson, and St. Charles (photos): From Forbes CD, Jackson WD: Color atlas and text of
Community College, Cottleville, MO. Box 16-3: From Patton KT, clinical medicine, ed 3, London, 2003, Mosby. Box 20-6 (photo):
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis, From Chipps EM, Clanin NJ, Campbell VG: Neurologic disorders,
2018, Mosby. St. Louis, 1992, Mosby-Year Book.
Chapter 17 Chapter 21
17-4, A: Courtesy Dr. J.H. Venable, Department of Anatomy, Colo- 21-1: From Drake RL, et al: Gray's atlas of anatomy, Philadelphia,
rado State University, Fort Collins, CO. 17-4, B, Courtesy Dr. H.E. 2008, Churchill Livingstone/Elsevier. Box 21-3 (photo): From
Huxley. 17-6: From Leeson CR, Leeson T, Paparo A: Text/atlas of Habif TP: Clinical dermatology, ed 2, St. Louis, 1990, Mosby.
histology, St. Louis, 1988, Saunders. 17-7, A: Courtesy of Don Box 21-4: From Perkin GO: Mosby's color atlas and text of neurol-
Fawcett, Harvard Medical School, Boston, MA. In Pollard TO: ogy, London, 1998, Times Mirror International Publishers. Box 21-5:
Earnshaw W: Cell biology, ed 2, St. Louis, 2007, Saunders. 17-10, From Beare P, Myers J: Adult health nursing, ed 3, St. Louis, 1998,
17-11, 17-15: From Lodish H: Molecular cell biology, ed 4, New Mosby.
York, 2000, WH Freeman. 17-12, B: Courtesy H.E. Huxley, Brandeis
University, Waltham, MA. 17-1 8, B: Courtesy Dr. Paul C. Chapter 22
Letourneau, Department of Anatomy, Medical School, University of Case Study box (photo): Courtesy Flickr, Photo Sharing.
Minnesota, MN. 17-22: Adapted from Pollard T, Earnshaw W: Cell
biology, ed 2, Philadelphia, 2008, Saunders. 17-30 (photos): Cour- Chapter 23
tesy Dr. Frederic S. Fay, Department of Physiology, University of 23-1: Adapted from Guyton A, Hall J: Textbook of medical physiol-
Massachusetts, Worcester, MA. 17-32 (photo): Courtesy Kellie ogy, ed 11, Philadelphia, 2006, Saunders. 23-3, A: From Seidel HM,
White. Box 17-6, A: From Kumar V, Abbas A, Fausto N: Robbins Ball JW, Dains JE, Benedict GW: Mosby's guide to physical examina-
and Cotran pathologic basis of disease, ed 7, Philadelphia, 2005, tion, ed 6, St. Louis, 2006, Mosby. 23-3 , B: From Swartz MH: Text-
Saunders. Box 17-7 (photo): From Fritz S: Mosby's fundamentals of book of physical diagnosis, ed 4, Philadelphia, 2002, Saunders. 23-4:
therapeutic massage, ed 5, St. Louis, 2013, Mosby. Career Choices Adapted from Boron W, Boulpaep E: Medical physiology, updated
box: Courtesy of Linda Carlson. version, Philadelphia, 2005, Saunders.
UNIT 3 Chapter 24
Chapter 18 24-3 , D: Omikron/Photo Researchers. 24-5, B: From Patton KT,
18-1: From Patton KT, Thibodeau G: Human body in health 6 dis- Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
ease, ed 6, St. Louis, 2014, Mosby. 18-13: Redrawn from FitzGerald 2018, Mosby. 24-8, B: Adapted from Guyton A, Hall J: Textbook of
MJT, Gruener G, Mtui E: Clinical neuroanatomy and neuroscience, medical physiology, ed 11, Philadelphia, 2006, Saunders. 24-11:
ed 6, Edinburgh, 201 1, Saunders. 18-14: From Feldman M, Copyright Kevin Patton, Lion Den Inc, Weldon Spring, MO. 24-13:
Friedman L, Brandt L: Sleisenger 6 Fordtran's gastrointestinal and From Newell FW: Ophthalmology: principles and concepts, ed 7,
liver disease, ed 8, Philadelphia, 2006, Saunders. Box 18-1 , A: Cour- St. Louis, 1992, Mosby. 24-18, C: Courtesy Dr. Scott Mittman,
tesy Marie Simar Couldwell, MD, and Maiken Nedergaard. Johns Hopkins Hospital, Baltimore, MD. 24-23: From Seidel HM,
Ball JW, Dains JE, Benedict GW: Mosby's guide to physical examina-
Chapter 19 tion, ed 3, St. Louis, 2003, Mosby. 24-25: Adapted from Boron W,
Box 19-1 (photo): From Christensen GJ: A consumer's guide to den- Boulpaep E: Medical physiology, updated version, Philadelphia,
tistry, ed 2, St. Louis, 2002, Mosby. Box 19-2: Copyright Kevin 2005, Saunders. 24-27: From Bingham BJG, Hawke M, Kwok P:
Patton, Lion Den Inc., Weldon Spring, MO. Box 19-3 (photo): Atlas of clinical otolaryngology, St. Louis, 1992, Mosby Year Book.
Courtesy Tamily Weissman, Jean Livet, and Jeff Lichtman, Harvard 24-29, 24-30, A: From Swartz MH: Textbook of physical diagnosis,
University. ed 4, Philadelphia, 2002, Saunders. Box 24-3 (figure): From
Ishihara's tests for colour deficiency, Tokyo, 1973, Kanehara Trading
Chapter 20 Co, Copyright lsshinkai Foundation.
20-2, B, 20-10, C , Box 20-3: From Abrahams P, Marks S,
Hutchings R: McMinn's color atlas of human anatomy, ed 5, Chapter 25
Philadelphia, 2003, Mosby. 20-5 , C , Table 20-3: Redrawn from 25-13: Adapted from Hinson J, Raven P: The endocrine system, Edin-
FitzGerald MJT, Gruener G, Mtui E: Clinical neuroanatomy and burgh, 2007, Churchill Livingstone.
neuroscience, ed 6, Philadelphia, 2011, Saunders. 20-7 (photo):
From Gosling J, Harris P, Whitmore I, Willan P: Human anatomy, Chapter 26
ed 4, Philadelphia, 2002, Mosby. 20-9, B: Courtesy Vidic B, 26-2: From Erlandsen SL, Magney J: Color atlas of histology,
Suarez FR: Photographic atlas of the human body, St. Louis, 1984, St. Louis, 1992, Mosby. 26-7: Adapted from Boron W, Boulpaep E:
Mosby. 20-16, C: From Gigandet X, et al: Estimating the confidence Medical physiology, updated version, Philadelphia, 2005, Saunders.
level of white matter connections obtained with MRI tractography, 26-9, B: From Jacob S: Atlas of human anatomy, Edinburgh, 2002,
PLoS ONE, 3(l2):e4006, 2008. 20-25: Courtesy Walter Schreider, Churchill Livingstone. 26-12, B: From Abrahams P, Marks S,

xxxii Illustration and Photograph Credits
Hutchings R: McMinn's color atlas of human anatomy, ed 3, Phila- Collins T: Robbins pathologic basis of disease, ed 6, Philadelphia,
delphia, 2003, Mosby. 26-13: Dennis Strete. 26-15: From Gosling J, 1999, Saunders. Box 28-1: From Goldman L, Ausiello D: Cecil text-
Harris P, Whitmore I, \i\Tillan P: Human anatomy, ed 4, Philadel- book of medicine, ed 23, Philadelphia, 2008, Saunders. Case Study
phia, 2002, Mosby. 26-1 7: From Kierszenbaum A: Histology and cell box: From Hicks GH: Cardiopulmonary anatomy and physiology,
biology, Philadelphia, 2002, Mosby. Box 26-4, A: From Swartz MH: Philadelphia, 2000, Saunders.
Textbook of physical diagnosis, ed 4, Philadelphia, 2002, Saunders.
Box 26-4, B: From Goldman L, Schafer AI: Goldman's Cecil medi- Chapter 29
cine, ed 24, vol. 2, Philadelphia, 2012, Saunders. Box 26-6 (figures): 29-5: Adapted from McCance K, Huether S: Pathophysiology, ed 5,
Courtesy Gower Medical Publishers. Box 26-1 (photo A): Courtesy St. Louis, 2006, Mosby. 29-9, C, 29-11, A, C, 29-13, B, C: From
Robert F. Gagel, MD and Ian McCutcheon, MD, University of Abrahams P, Marks S, Hutchings R: McMinn's color atlas of human
Texas MD Anderson Cancer Center, Houston, TX. In Black JM, anatomy, ed 5, Philadelphia, 2003, Mosby. 29-24: From Patton KT,
Hawks JH: Medical-surgical nursing: clinical management for posi- Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
tive outcomes, ed 8, St. Louis, 2009, Saunders. Box 26-1 (photo B): 2018, Mosby. 29-26 (photo): From Swartz MH: Textbook of physical
From Forbes C D, Jackson WF: Color atlas and text of clinical medi- diagnosis, ed 4, Philadelphia, 2002, Saunders. 29-29: From Cotran R,
cine, ed 3, London, 2003, Mosby, Elsevier Science Ltd. Box 26-4, C, Kumar V, Collins T: Robbins pathologic basis of disease, ed 6, Phila-
Box 26-6, C : From Patton KT, Thibodeau G: Human body in health delphia, 1999, Saunders. Box 29-1: Courtesy Simon C, Janner M:
6 disease, ed 7, St. Louis, 2018, Mosby. Career Choices box: Cour- Color atlas of pediatric diseases with differential diagnosis, ed 2,
tesy of Kim Musicante. Hamilton, Ontario, 1990, BC Decker. Case Study box: Courtesy
Dr. Daniel Simon and Mr. Paul Zambino
UNIT 4
Chapter 27 Chapter 30
27-3, D: From Zakus SM: Clinical procedures for medical assistants, 30-1: From Harvey W: The anatomical exercises, London, 1995,
ed 3, St. Louis, 1995, Mosby. 27-4: From Shiland BJ: Mastering Dover Publishing. 30-6: From Rhoades R, Pflanzer R: Human physi-
healthcare terminology, ed 3, St. Louis, 20 l 0, Mosby. 27-5: From ology, ed 3, Philadelphia, 1995, Perennial. 30-9: Adapted from
Patton KT, Thibodeau G: Human body in health 6 disease, ed 6, Guyton A, Hall J: Textbook of medical physiology, ed l l , Philadel-
St. Louis, 2014, Mosby. 27-8 (inset): From Carr J, Rodak B: Clinical phia, 2006, Saunders. 30-11, 30-19, B: Adapted from Boron W,
hematology atlas, St. Louis, 1999, Elsevier. 27-11 (inset): From Boulpaep E: Medical physiology, updated version, Philadelphia,
Belcher AE: Blood disorders, St. Louis 1993, Mosby. 27-13, 27-14, 2005, Saunders. 30-19, A: From Patton KT, Thibodeau G: Human
27-15 , 27-16, 27-17: Dennis Strete. 27-18: From Turgeon M: Linne body in health 6 disease, ed 7, St. Louis, 20 18, Mosby. 30-25:
6 Ringsud's clinical laboratory science, ed 5, St. Louis, 2007, Mosby. Adapted from Canobbio MM: Cardiovascular disorders, St. Louis,
27-19: From Carr JH, Rodak BF: Clinical hematology atlas, ed 2, 1990, Mosby. 30-28: Adapted from the National High Blood Pres-
St. Louis, 2004, Elsevier. 27-20, B: Copyright Dennis Kunkel Mi- sure Education Program.
croscopy Inc. 27-23: From Cotran R, Kumar V, Collins T: Robbins
pathologic basis of disease, ed 6, Philadelphia, 1999, Saunders. Chapter 31
27-24, 27-25: From Kumar V, Abbas A, Fausto N: Robbins and 31-2, 31-5,A: From Patton KT, Thibodeau G: Human body in health
Cotran pathologic basis of disease, ed 7, Philadelphia, 2005, 6 disease, ed 7, St. Louis, 2018, Mosby. 31-5B: Courtesy Ballinger P,
Saunders. Table 27-2: Adapted from Pagana KD, Pagana TJ: Frank E: Merrill's atlas of radiographic positions and radiologic pro-
Mosby's manual of diagnostic and laboratory tests, ed 5, St. Louis, cedures, ed 10, vol l, St. Louis, 2003, Mosby. 31-6: Adapted from
20 13, Mosby. Case Study box: From Stevens ML: Fundamentals of McCance K, Huether S: Pathophysiology, ed 4, St. Louis, 2002,
clinical hematology, Philadelphia, 1997, Saunders. Mosby. 31-7: Adapted from Boron W, Boulpaep E: Medical physiol-
ogy, updated version, Philadelphia, 2005, Saunders. 31-8, A: Adapted
Chapter 28 from Mathers L, Chase R, Dolph J, Glasgow E: CLASS clinical
28-1 : Courtesy Patricia Kane, Indiana University Medical School. anatomy principles, Philadelphia, 1996, Mosby. 31-8, B: From
28-9 (drawing): From Wilson SF, Giddens JF: Health assessment for Nielsen M: Human anatomy lab manual and workbook, ed 4,
nursing practice, ed 2, St. Louis, 200 l, Mosby. 28-9 (inset): From Dubuque, lA, 2002, Kendall/Hunt Publishing Company. 31-9, B,
Seidel HM, Ball JW, Dains JE, Benedict GW: Mosby's guide to 31-17, B: Dennis Strete. 31-14: From National Institute of Allergy
physical examination, ed 6, St. Louis, 2006, Mosby. 28-13 , A, 28-16, and Infectious Diseases, National Institutes of Health, Bethesda,
28-21: From Patton KT, Thibodeau G: Human body in health 6 MD. 31-15, 31-24: From Seidel HM, Ball JW, Dains JE,
disease, ed 7, St. Louis, 2018, Mosby. 28-1 7: From Noble A, Benedict GW: Mosby's guide to physical examination, ed 6, St. Louis,
Johnson R, Thomas A, Bass P: The cardiovascular system, Edinburgh, 2006, Mosby. 31-16, B: Courtesy Dr. Edward L. Applebaum, Head,
2005, Churchill Livingstone. 28-20: From Kumar V, Abbas A, Department of Otolaryngology, University of Illinois Medical Cen-
Fausto N: Robbins and Cotran pathologic basis of disease, ed 7, ter, Chicago. 31-18: Adapted from Rhoades R, Pflanzer R: Human
Philadelphia, 2005, Saunders. 28-24: Courtesy Guzzetta CE, physiology, ed 3, Philadelphia, 199 5, Perennial. 31-19: Courtesy
Dossey BM, Cardiovascular nursing: bodymind tapestry, St. Louis, Vidic B, Suarez FR: Photographic atlas of the human body, St. Louis,
1984, CV Mosby. 28-25: From Aehlert B: ACLS quick review study 1984, Mosby. 31-21: Courtesy Walter Tunnesen, MD, The Ameri-
cards, ed 2, St. Louis, 2004, Mosby. 28-26: From Cotran R, Kumar V, can Board of Pediatrics, Chapel Hill, NC. 31-22: From Goldstein B,

•••
Illustration and Photograph Credits XXXIII
editor: Practical dermatology, ed 2, St. Louis, 1997, Mosby. 31-23: Philadelphia, 2002, Mosby. 35-20, 35-21: From Kumar V, Abbas A,
Copyright Kevin Patton, Lion Den Inc, Weldon Spring, MO. Case Fausto N: Robbins and Cotran pathologic basis of disease, ed 7,
Study box: From Cohen J, Powderly WG: Infectious diseases, ed 2, Philadelphia, 2005, Saunders. Box 35-1: From Patton KT,
St. Louis, 2004, Mosby. Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
2018, Mosby.
Chapter 32
32-1, 32-8, Box 32-1, B: From Abbas A, Lichtman A: Cellular and Chapter 36
molecular immunology, ed 5, Philadelphia, 2003, Saunders. 32-4: 36-6: From Drake R, Vogl AW, Mitchell A: Gray's anatomy for stu-
From Roitt IM, Brostoff, Male DK: Immunology, ed 3, St. Louis, dents, Philadelphia, 2005, Churchill Livingstone. 36-9, A, 36-16:
1993, Mosby. 32-6: Adapted from McCance K, Huether, S: Patho- Adapted from Boron W, Boulpaep E: Medical physiology, updated
physiology, ed 5, St. Louis, 2006, Mosby. 32-10: From McCance K, version, Philadelphia, 2005, Saunders. 39-9, B: Antonia Reeve/Sci-
Huether S: Pathophysiology: the biologic basis for disease in adults ence Source. 36-12, Box 36-2: Adapted from Davies A, Moores C:
and children, ed 7, St. Louis, 2014, Mosby. Box 32-1 , A: From The respiratory system, Edinburgh, 2004, Churchill Livingstone.
Copstead-Kirkhorn L, Banasik J: Pathophysiology, ed 2, St. Louis, 36-14: From Patton KT, Thibodeau G: Human body in health 6
1999, Saunders. disease, ed 6, St. Louis, 2014, Mosby. Box 36-6: Copyright Kevin
Patton, Lion Den Inc, Weldon Spring, MO. Box 36-7: Adapted from
Chapter 33 Guyton A, Hall J: Textbook of medical physiology, ed 11, Philadel-
33-1: Copyright Dennis Kunkel Microscopy Inc. 33-3, 33-4, 33-5, phia, 2006, Saunders.
33-9, 33-14, 33-15, 33-16, 33-17, 33-18, 33-20, Box 32-1, B,
Box 33-6: From Abbas A, Lichtman A: Cellular and molecular im- Chapter 37
munology, ed 5, Philadelphia, 2003, Saunders. 33-13, 33-21: From 37-4, 37-13: Adapted from Boron W, Boulpaep E: Medical physiol-
Copstead-Kirkhorn L, Banasik J: Pathophysiology, ed 2, St. Louis, ogy, updated version, Philadelphia, 2005, Saunders. 37-5: From
1999, Saunders. Box 33-3: From Stinchcombe JC, Griffiths GM: Rhoades R, Pflanzer R: Human physiology, ed 3, Philadelphia, 1995,
The role of the secretory immunological synapse in killing by Perennial. 37-6: From Patton KT, Thibodeau G: Human body in
C D8+ CTL, Semin Immunol, 15(6):30 1-305, 2003. Box 33-5: health 6 disease, ed 6, St. Louis, 2014, Mosby.
Adapted from McCance K, Huether S: Pathophysiology, ed 4,
St. Louis, 2002, Elsevier. Case Study box: From Mason DJ, Leavitt J, Chapter 38
Chaffee M: Policy and politics in nursing and health care, ed 5, 38-5, B: Copyright Kevin Patton, Lion Den Inc, Weldon Spring,
St. Louis, 2007, Saunders. MO. 38-5: Dennis Strete. 38-6, B: From Zitelli B, Davis H: Atlas of
pediatric physical diagnosis, ed 3, Philadelphia, 1997, Mosby. 38-10
Chapter 34 (inset): From Weir J, Abrahams P: Imaging atlas of the human
34-1, A: Julie Dermansky/Science Source. 34-1, B: Ria Novosti/ anatomy, ed 2, Philadelphia, 1997, Mosby. 38-11 , 38-12, A, 38-16:
Science Source. 34-1, C : Mauro Fermariello/Science Source. From Patton KT, Thibodeau G: Human body in health 6 disease,
34-1, D: Global Warming Art. 34-1 , E: Stocktrek lmages!fhink- ed 7, St. Louis, 2018, Mosby. 38-12, B: From Stevens A, Lowe J:
stock. 34-6: Adapted from McEwan BS, Gianaros PJ: Stress- and al- Human histology, ed 3, Philadelphia, Mosby, 2005. 38-1 8, A: From
lostasis-induced brain plasticity, Annu Rev Med 62:5.1-5.15, 2011. Wilson SF, Giddens JF: Health assessment for nursing practice, ed 2,
Career Choices box: Courtesy of Dena Kruse. St. Louis, 2001, Mosby. 38-1 8, B: From Greig JD, Garden OJ: Color
atlas of surgical diagnosis, London, 1996, Times Mirror Interna-
UNIT 5 tional Publishers. 38-20, D: Courtesy Kevin Patton, Weldon Spring,
Chapter 35 MO. 38-21 , B, 38-22, Box 38-2: From Daffner DH: Clinical radiol-
35-4: From Stevens A, Lowe J: Human histology, ed 3, Philadelphia, ogy: the essentials, ed 3, Baltimore, 1992, Lippincott, Williams &
2005, Mosby. 35-8, B. C: From Cox JD: Radiation oncology, ed 9, Wilkins.
St. Louis, 2010, Mosby. 35-9: Adapted from Thompson JM,
Wilson SF: Health assessment for nursing practice, St. Louis, 1996, Chapter 39
Mosby. 35-13, B: From Erlandsen SL, Magney J: Color atlas of his- 39-2, B: From Abrahams P, Marks S, Hutchings R: McMinn's color
tology, St. Louis, 1992, Mosby. 35-12: From Hutchings RT, atlas of human anatomy, ed 5, Philadelphia, 2003, Saunders.
McMinn RM: McMinn's color atlas of human anatomy, ed 2, Chi- 39-4, B: From Erlandsen SL, Magney J: Color atlas of histology,
cago, 1988, Year Book Medical Publishers. 35-13 , A: From Patton KT, St. Louis, 1992, Mosby. 39-5: SPL/Photo Researchers. 39-10, A:
Thibodeau G: Structure 6 function, ed 15, St. Louis, 20 15, Mosby. Courtesy Baylor Regional Transplant Institute, Baylor University
35-14: From Epstein 0, Perkin C D, Cookson J, de Bono D: Clinical Medical Center, Dallas, TX. 39-14: Courtesy Thompson JM,
examination, ed 3, Philadelphia, 2003, Mosby. 35-15: From Wilson SF: Health assessment for nursing practice, St. Louis, 1996,
Patton KT, Thibodeau G: Human body in health 6 disease, ed 7, Mosby. 39-20: From Cotran R, Kumar V, Collins T: Robbins patho-
St. Louis, 2018, Mosby. 35-16: Courtesy Vidic B, Suarez RF: Photo- logic basis of disease, ed 6, Philadelphia, 1999, Saunders. 39-17:
graphic atlas of the human body, St. Louis, 1984, Mosby. 35-19: From Doughty DB, Jackson D: Gastrointestinal disorders, St. Louis,
From Zitelli B, Davis H: Atlas of pediatric physical diagnosis, ed 4, 1993, Mosby.

xxxiv Illustration and Photograph Credits
Chapter 40 Saunders. Table 42-2: From Bonewit-West K: Clinical procedures for

40-3, 40-5: From Patton KT, Thibodeau G: Human body in health medical assistants, ed 8, St. Louis, Saunders, 201 1.
6 disease, ed 7, St. Louis, 2018, Mosby. 40-4, Box 40-1: Adapted
from Boron W, Boulpaep E: Medical physiology, updated version, Chapter 43
Philadelphia, 2005, Saunders. 40-19, B: Courtesy Dr. Andrew Evan, 43-7: Copyright Kevin Patton, Lion Den Inc, Weldon Spring, MO.
Indiana University. Box 40-2, B: Adapted from Smith M, Morton D: 43-18: Modified from Goldman L, Schafer AI: Goldman's Cecil
The digestive system, Edinburgh, 2001, Churchill Livingstone. medicine, ed 24, Philadelphia, 2012, Saunders. 43-11: Courtesy
Box 40-4, B, C: From Stevens A, Lowe J: Human histology, ed 3, Kellie White.
Philadelphia, 2005, Mosby.
Chapter 44
Chapter 41 Box 44-1: Courtesy Kevin Patton, Lion Den Inc, Weldon Spring,
41-1 : From the United States Food and Drug Administration: Food MO. Career Choices box: Courtesy of Norma Cooper.
labeling guide, College Park, MD, 2013, Office of Nutrition, Label-
ing, and Dietary Supplements, HFS-800. 41-2, A: From the United UNIT 6
States Department of Agriculture: MyPlate 2013, Retrieved from Chapter 45
http://www.choosemyplate.gov/print-materials-ordering/graphic-re- 45-3, A, 45-8, E: Lennart Nilsson. 45-4, 45-8, F: From Stevens A,
sources.html. 41-2, B: From Health Canada, 2016. Eating well with Lowe J: Human histology, ed 3, Philadelphia, 2005, Mosby. 45-5:
Canada's food guide. Reproduced with permission from the Minister Courtesy Dr. Mark Ludvigson, US Army Medical Corps, St. Paul,
of Health, 2017. 41-14, B: Courtesy Brenda Russell, PhD, University MN. 45-9, 45-10, 45-13: From Erlandsen SL, Magney J: Color atlas
of Illinois at Chicago. 41-18, B: Adapted from Carroll R: Elsevier's of histology, St. Louis, 1992, Mosby. 45-11: Barbara Cousins. 45-12:
integrated physiology, Philadelphia, 2007, Mosby. 41-20: Adapted From Abrahams P, Marks S, Hutchings R: McMinn's color atlas of
from Report of the Expert Panel for Population Strategies for Blood human anatomy, ed 5, Philadelphia, 2003, Mosby. 45-14, B: Cour-
Cholesterol Reduction, Bethesda, MD, 1990, The National Choles- tesy Vidic B, Suarez RF: Photographic atlas of the human body,
terol Education Program, National Heart Lung and Blood Institute, St. Louis, 1984, Mosby. 45-15: Adapted from Guyton A, Hall J:
Public Health Service, US Department of Health and Human Ser- Textbook of medical physiology, ed 11, Philadelphia, 2006, Saunders.
vices, NIH Publication No. 90-3046. 41-25, 41-26, 41-29, 41-32, 45-16: Adapted from Boron W, Boulpaep E: Medical physiology,
Box 41-9, B: Adapted from Mahan LK, Escott-Stump S: Krause's updated version, Philadelphia, 2005, Saunders. 45-17, Box 45-1:
food, nutrition and diet therapy, ed 11, St. Louis, 2004, Saunders. From Seidel HM, Ball JW, Dains JE, Benedict GW: Mosby's guide
41-3 1: Adapted from Guyton A, Hall J: Textbook of medical physiol- to physical examination, ed 6, St. Louis, 2006, Mosby.
ogy, ed 11, Philadelphia, 2006, Saunders. 41-33: From Zitelli B,
Davis H: Atlas of pediatric physical diagnosis, ed 3, Philadelphia, Chapter 46
1997, Mosby. Box 41-2: Courtesy Bevelander G, Ramalay J: Essen- 46-1, B: From Moses K, Nava P, Banks J, Petersen D: Moses atlas of
tials of histology, ed 8, St. Louis, 1979, Mosby. Box 41-9, B: Adapted clinical gross anatomy, Philadelphia, 2005, Mosby. 46-3, B, 46-6,
from Mahan LK, Escott-Stump S: Krause's food, nutrition and diet 46-7: From Gosling J, Harris P, Whitmore I, Willan P: Human
therapy, ed 11, St. Louis, 2004, Saunders. anatomy, ed 4, Philadelphia, 2002, Mosby. 46-5, C: From Familiari G,
et al: Ultrastructural dynamics of human reproduction, from ovula-
Chapter 42 tion to fertilization and early embryo development, Int Rev Cytol,
42-1, A: Barbara Cousins. 42-1, B, 42-2, B: From Abrahams P, 249:53-141 , 2006. 46-10: From Stevens A, Lowe J: Human histology,
Marks S, Hutchings R: McMinn's color atlas of human anatomy, ed 3, Philadelphia, Mosby, 2005. 46-11: From McKee GT: Cytopa-
ed 5, Philadelphia, 2003, Mosby. 42-2, A, 42-10: Adapted from thology, London, 1997, Mosby-Wolfe. 46-12: Courtesy Dr. Richard
Brundage DJ: Renal disorders, Mosby's Clinical Nursing Series, Blandau, Department of Biological Structure, University of Wash-
St. Louis, 1992, Mosby. 42-3 , B: From Weir J, Abrahams P: Imaging ington School of Medicine, Seattle, WA, from his film Ovulation
atlas of the human anatomy, ed 2, Philadelphia, 1997, Mosby. 42-6: and egg transport in mammals, 1973. 46-18: Adapted from Boron W,
From Heylings D, Spence R, Kelly B: Integrated anatomy, Edin- Boulpaep E: Medical physiology, updated version, Philadelphia,
burgh, 2007, Churchill Livingstone. 42-7: From Telser A, Young J, 2005 , Saunders. 46-21, 46-23: From Mettler F: Essentials of radiol-
Baldwin K: Elsevier's integrated histology, Philadelphia, 2008, Mosby. ogy, ed 2, Philadelphia, 2005, Saunders. 46-22, A: From Abrahams P,
42-1 1, 42-16: From Stevens A, Lowe J: Human histology, ed 3, Phila- Marks S, Hutchings R: McMinn's color atlas of human anatomy,
delphia, 2005, Mosby. 42-8: From Gosling J, Harris P, Whitmore I, ed 5, Philadelphia, 2003, Saunders. 46-22, B: From Symonds EM,
Willan P: Human anatomy, ed 4, Philadelphia, 2002, Mosby. 42-9: MacPherson MB: Color atlas of obstetrics and gynecology, London,
Adapted from Guyton A, Hall J: Textbook of medical physiology, 1994, Mosby Wolfe. 46-24: From Kumar V, Abbas A, Fausto N:
ed 11, Philadelphia, 2006, Saunders. 42-14, 42-15, B: From Robbins and Cotran pathologic basis of disease, ed 7, Philadelphia,
Boron W, Boulpaep E: Medical physiology, updated version, Phila- 2005 , Saunders. 46-25, B, C, From Cotran R, Kumar V, Collins T:
delphia, 2005 , Saunders. 42-18, Box 42-6: From Patton KT, Robbins pathologic basis of disease, ed 6, Philadelphia, 1999,
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis, Saunders. Box 46-6 (photo): From Ferri FF: Ferri's color atlas and
2018, Mosby. 42-29: From Kumar V, Abbas A, Fausto N: Robbins text of clinical medicine, Philadelphia, 2009, Saunders/Elsevier.
and Cotran pathologic basis of disease, ed 7, Philadelphia, 2005, Box 46-7: Michael Donne, Science Photo Library, Science Source.

Illustration and Photograph Credits xxxv
Chapter 47 performance, Sci Am, 283(3):49-55, 2000. 47-3 1: From Goldman L,

47-5 (photo), 47-13: Lennart Nilsson. 47-7: Courtesy Lucinda L. Ausiello D, Cecil textbook of medicine, ed 23, Philadelphia, 2003,
Veeck, Jones Institute for Reproductive Medicine, Norfolk, VA. Saunders. Box 47-3 (photo): Courtesy of the Progeria Research
47-11, B: From Cotran R, Kumar V, Collins T: Robbins pathologic Foundation. Peabody, MA, http://www.progeriaresearch.org. Case
basis of disease, ed 6, Philadelphia, 1999, Saunders. 47-12, B: Study box: From Hagen-Ansert SL: Textbook of diagnostic ultraso-
Adapted from Hinson J, Raven P: The endocrine system, Edinburgh, nography, ed 6, vol 2, St. Louis, 2007, Mosby.
2007, Churchill Livingstone. 47-14: From Moore KL, Persand TV:
The developing human, ed 6, Philadelphia, 1998, Saunders. 46-17, Chapter 48
46-18, 47-25: Adapted from Boron W, Boulpaep E: Medical physiol- 48-1: Adapted from Boron W, Boulpaep E: Medical physiology, up-
ogy, updated version, Philadelphia, 2005, Saunders. 47-20: From dated version, Philadelphia, 2005, Saunders. 48-2: From Patton KT,
Patton KT, Thibodeau G: Human body in health 6 disease, ed 7, Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
St. Louis, 2018, Mosby. 47-23: From Hockenberry MJ, Wilson D: 2018, Mosby. 48-5: From Jorde L, Carey J, Bamshad M: Medical
Wong's essentials of pediatrics nursing, ed 8, St. Louis, 2009, Mosby. genetics, ed 3, Philadelphia, 2004, Saunders. 48-10: From
47-24, Box 47-2, B: Copyright Kevin Patton, Lion Den Inc, Weldon McCance K, Huether S: Pathophysiology, ed 4, St. Louis, 2002,
Spring, MO. 47-26: Adapted from Mahan LK, Escott-Stump S: Mosby. 48-13, B: From Kumar V, Abbas A, Fausto N: Robbins and
Krause's food, nutrition and diet therapy, ed 12, St. Louis, 2007, Cotran pathologic basis of disease, ed 7, Philadelphia, 2005, Saun-
Saunders. 47-27: Adapted from McCance K, Huether S: Pathophysi- ders. 48-14, A: Courtesy Lois McGavran, Denver Children's Hospi-
ology, ed 5, St. Louis, 2005, Mosby. 47-29, B: Adapted from tal. 48-14, B: From Zitelli: Atlas of pediatric physical diagnosis, ed 6,
lgnatavicius D, Bayne MY: Medical-surgical nursing: a nursing St. Louis, 2012, Mosby. 48-15 , 48-16, B, 48-17, B: Courtesy Nancy
process approach, Philadelphia, 1991, Saunders. 47-30: From S. Wexler, PhD, Columbia University. Career Choices box: Cour-
Andersen JL, Schjerling P, Saltin B: Muscle, genes, and athletic tesy of Andrea L. Mose.

the big picture I Seeing the BIG picture

Before reading this introduction, you probably spent a few minutes Many textbooks are written like reference books-dictionaries, for example.
flipping through this book. Naturally, you are curious about your They provide detailed descriptions of the structure and function of individual body
course in human anatomy and physiology, and you want to see what lies ahead. parts, often in logical groupings, while rarely stopping to step back and look at
It is more than that. You are curious about the human body-about yourself, the whole person. In this book, however, we have
really. We all have that desire to learn more about how our bodies are put incorporated the "whole body" aspect into the
together and how all the parts work. Unlike many other people, though, you now discussion of every major topic. In chapter
have the opportunity to gain an understanding of the underlying scientific princi- and unit introductions, in appropriate para-
ples of human structure and function. graphs within each section, and in specific
To truly understand the nature of the human body requires an ability to appre- sections near the end of each chapter, we
ciate "the parts" and "the whole" at the same time. As you flipped through this have stepped back from the topic at hand
book for the first time, you probably looked at many different body parts. Some and refocused attention to the broader
•
were microscopic-such as muscle cells-and some were very large-such as VIeW. •
arms and legs. In looking at these parts, however, you gained very little insight
about how they worked together to allow you to sit here, alive and breathing, and
read and comprehend these words.
Think about it for a moment. What does it take to be able to read these words
and understand them? You might begin by thinking about the eye. How do all of
its many intricate parts work together to form an image? The eye is not the only
organ you are using right now. What about the bones, joints, and muscles you
----- J
are using to hold the book, to turn the pages, and to move your eyes as they
scan this paragraph? Let's not forget the nervous system. The brain, spinal cord,
and nerves are receiving information from the eyes, evaluating it, and using it to
coordinate the muscle movements. The squiggles we call letters are being inter-
preted near the top of the brain to form complex ideas. In short, you are thinking
about what you are reading .
However, that does not cover everything. How are you
getting the energy to operate your eyes, muscles, brain,
and nerves? Energetic chemical reactions inside
each cell of these organs require oxygen and nutri-
ents captured by the lungs and digestive tract
and delivered by the heart and blood vessels.
These chemical reactions produce wastes that
are handled by the liver, kidneys, and other
organs. All of these functions must be coordi-
nated, a feat accomplished by regulation of body
organs by hormones, nerves, and other mechanisms.
Learning to name the various body parts, to describe
their detailed structure, and to explain the mecha-
nisms that produce their functions is an essential
step that leads to the goal of understanding the
human body. To actually reach that goal,
however, you must be able to draw together
isolated facts and concepts. In other words,
understanding the nature of individual body
parts becomes more meaningful when you
understand how the parts work together in a
living, whole person .
•
XXXVI

AWARD

At the organelle level within the living skin cells, you

probably think of the mitochondrion shown here as the Sweat glands in our skin are epithelial tissue exocrine glands that
"power plant" of the cell. In this unit you will learn more secrete substances onto the surface of
about the process of cellular respiration. the skin. You know they help cool off
1. What is the molecule produced by this cell part that your body when overheated, but they
transfers energy from nutrients to the chemical or also secrete wastes in that fluid.
metabolic processes of life? 2. What other organ system would
a) DNA b) RNA c) ATP •• a/so get rid of wastes as fluids?
~ :·--
•
•
••
•
•
•
•
•
••
At the biochemical level, the •
•
• •
• When you think
•• •
subcutaneous layer under our ••• about muscles in the
•••
skin has many fat cells. They •
• human body, you
•
provide insulation and energy probably focus on
..0
• reserves. those that attach to
1'-
. - 7. An abundance of which of f ••
E
Q.)
•• ·-·
~
• ••
il l and move the
...... these four major groups of
(/) ~ skeleton. However.
>.
(/)
organic substances would there are several
(/)
::::::l
0 be found in these cells? types of muscle tissue in humans. Shown
2: a) carbohydrates
Q)
c • here is smooth muscle that can make hair
• b) lipids •••
<D • • stand on end and form "goose bumps."
.(.)- c) proteins
•• ••
• : Diagram of 3. /s contraction of this tissue
l{)
• ••
•
.- d) nucleic acids ••• :• Skin Structure controlled voluntarily or involuntarily?
Q)
'"0 •• ••
>< ••• ••
0 ••
••• •
••
c ••• ••
0
..0 •• ••
••
:......
rn •
••
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c This receptor in the skin detects ••
ro •
•• If you have ever cut yourself or become
a5 stimuli that make it possible for ••
0> ••
>. the body to respond to changes occurring in flushed when overheated, you know that
><
0
•
••
• both the external and internal environments. •• our skin has a good blood supply. The
••
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23 6. This would be part of what body system larger vessels function for transport, but it
rn
......
c responsible for communication, control, is the small, microscopic vessels called
-::::::l
0 and integration? capillaries that transfer nutrients and vital
>
c substances between blood and tissue cells.
•
(")
.- 4. What are the two important inorganic
substances exchanged at capillaries
Some specialized cells in the skin
that are closely related to cellular
called melanocytes produce the pigment that gives our
respiration occurring in the
skin color. As you learn new terminology, such as the
mitochondrion shown above?
name of this cell, use clues in the name to help you
•
C\.1 remember its structure and function.
.(.)-
• 5 . What would you predict would be the name of the
pigment chemical this cell produces?
a) keratin b) elastin c) melanin

T he nine chapters in Unit 1 "set the stage" for the study of human anatomy and physiology. They
provide the unifying information required to understand the "connectedness" of human structure
and function . You will explore different levels of organization from chemical to tissue level. The first
organ you will study in the next unit w ill be the skin. Let's take a look ahead at its structure and
function and figure out what you already know from your own experiences as a human or have
learned before this at the foundational level. Watch for any ideas you have that are oversimplified
so you can add to your knowledge or any misconceptions you can correct based on the scientific
principles in this first unit. Try out these framework questions: •
Why a set of hard questions before you even begin

reading? The science of learning shows that it will
1 Organization of the Body, 2
go easier if you jump-start your brain with a few 2 Homeostasis, 23

questions that get you thinking about concepts to be
3 Chemistry of Life, 38
explored in this unit, even if you have to guess! Try
answering (or guessing at) each item, moving clock-
4 Biomolecules, 55
wise around the facing page, then check your an- 5 Cell Structure, 75
swer at the side of the page. It is okay if you do not
6 Cell Function , 98
answer them correctly; the goal here is simply to get
you thinking before you read. Even though it seems
7 Cell Growth and Development, 120
odd, and maybe a bit discouraging the first time, it 8 Introduction to Tissues, 137
does work! • 9 Tissue Types, 154

Organization
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2
ou have just begun the study of one of nature's most wondrous structures-the human
body. Anatomy and physiology are branches of biology that are concerned w ith the
form and functions of the body. Anatomy is the study of body structure, whereas physiol-
ogy deals with body function. As you learn about the complex interdependence of structure and
function in the human body, you become, in a very real sense, the subject of your own study.
Regardless of your field of study or your future career goals, acquiring and using information
about your body structure and functions will enable you to live a more knowledgeable, involved,
and healthy life in this science-conscious age. Your study of anatomy and physiology provides
a unique and fascinating understanding of self, and this knowledge allows for more active and
informed participation in your own personal health care decisions. If you are pursuing a health-,
science-, or athletic-related career, your study of anatomy and physiology takes on added sig-
nificance. It provides the necessary concepts you will need to understand your professional
courses and succeed in clinical experiences . •
SCIENCE AND SOCIETY tion, but cultural influences now are pulling scientists in other ex-
Before we get to the details, we should emphasize that everything perimental directions they otherwise may not have taken.
you will read in this book is in the context of a broad field of inquiry Similarly, science affects culture. Recent advances in understand-
called science. Science is a style of inquiry that attempts to under- ing human genes and technological advances in our ability to use
stand nature in a rational, logical manner. so-called stem cells and other tissues from h uman embryos, human
cadavers, and living donors to treat devastating diseases have sparked
SCIENTIFIC METHOD
Using detailed observations and vigorous tests, or experiments, sci-
entists winnow out each element of an idea or h ypoth esis until a
reasonable conclusion about its validity can be made. Rigorous ex- Observations and previous experiments
periments that eliminate any influences or biases not being directly
tested are called controlled experiments.
If the results of observations and experiments are repeatable, they '
Propose hypothesis
may verify a hypothesis and eventually lead to enough confidence in

the concept to call it a th eory. T h eories in which scientists have an
unusually h igh level of confidence are sometimes called laws. Ex-
'
Design experiment
periments may disprove a hypothesis, a result that often leads to the

formation of new hypotheses to be tested.
Figure 1-1 summarizes some of the basic concepts of how new
'
Collect and analyze data Yes
scientific principles are developed. As you can see, science is a dy-

namic process of getting closer and closer to the truth about nature, '
Determine if data are biased
including the nature of the human body. Science is definitely not a

set of unchanging facts as many people in our culture often
' NO
Refine hypothesis
assume.
CULTURAL CONTEXT
We should point out the social and cultural context of the science
'
Repeat experiments
' If results are consistent

presented in this book. Scientists drive the process of science, but our
Accept as theory
culture drives the kinds of questions we ask about nature and how we
attempt to answer them. For example, cutting apart h uman cadavers ' If unusually high level of confidence
(dead bodies) for the purpose of studying th em has not always been Accept as law
an acceptable activity in all cultures. Today a debate faced by our
culture concerns the acceptability of using live animals in scientific FIGURE 1 -1 Scientific method. This flowchart summarizes the classic ideal
experiments. Because our culture does not condone most experi- of how new principles of science are developed. Initial observations or results from
ments involving living humans, we have until now often conducted other experiments may lead to the formation of a new hypothesis. As more testing is
testing on animals that are similar to humans. In fact, most of the performed to eliminate outside influences or biases and ensure consistent results,
theories presented in this book are based on animal experimenta- scientists begin to have more confidence in the principle and call it a theory or law.

4 UNIT 1 The Bo dy as a W hole
new debates concerning how our culture defines what it means to be PHYSIOLOGY
a human being. Physiology is the science that deals with the functions of the living
As you study the concepts presented in this book, keep in mind organism and its parts. The term physiology is a combination of two
that they are not set in stone. Science is a rapidly changing set of Greek words (physis, "nature," and logos, "words or study"). Simply
ideas and processes that not only is influenced by our cultural biases stated, it is the study of physiology that helps us understand how the
but also affects our cultural awareness of who we are. body works. Physiologists attempt to discover and understand the
intricate control systems that permit the body to operate and survive
in changing and often hostile environments.
CONNECT IT ! @
As a scientific discipline, physiology can be subdivided according
For a quick peek at the major scientific breakthroug hs t hat have changed
to ( l ) the type of organism involved, such as human physiology or
our lives - and serve as t he core concepts of this book - check out The
Nobel Legacy online at Connect It! plant physiology; (2) the organizational level studied, such as mo-
lecular or cellular physiology; or (3) a specific or systemic function
being studied, such as neurophysiology, respiratory physiology, or
cardiovascular physiology.
• ANATOMY AND PHYSIOLOGY In the chapters that follow, you will see again and again that ana-
ANATOMY tomical parts have structures exactly suited to perform specific func-
Anatomy is often defined as study of the structure of an organism and tions. Each has a particular size, shape, form, or position in the body
the relationships of its parts. T he word anatomy is derived from related directly to its ability to perform a unique and specialized ac-
Greek word parts that mean "to cut apart." Students of anatomy still tivity. This principle- that structure fits function - explains why
learn about the structure of the human body by literally cutting it studying anatomy and physiology together is the key to understand-
apart. T his process, called dissection, remains a principal technique ing the human body.
used to isolate and study the structural components or parts of the
human body.
Quick CHECK
Biology is defined as the scientific study of life. Both anatomy and
1. Describe how science develops new principles.
physiology are subdivisions of this very broad area of inquiry. Each of
these subdivisions can be further divided into smaller areas of study. 2. Define anatomy and physiology.
3. List the three ways in which physiology can be subdivided as a scien-
For example, the term gross anatomy is used to describe the study of
t ific discipline.
body parts visible to the naked eye. Before invention of the micro-
4. What name is used to describe the study of the body that focuses on
scope, anatomists had to study human structure by relying only on groups of organs t hat have a common function?
the eye during dissection. These early anatomists could make only a
gross, or whole, examination, as you can see in Figure 1-2. With the
use of modern microscopes, many anatomists now specialize in
microscopic anatomy, including the study of cells, called cytology
LANGUAGE OF SCIENCE
(sye-TOL-oh-jee), and tissues, called histology (his-T OL-oh-jee) . AND MEDICINE
Other branches of anatomy include the study of human growth You may have noticed by now that many scientific terms, such as
and development (developmental anatomy) and the study of diseased anatomy and physiology, are made up of non-English word parts.
body structures (pathological anatomy) . In the chapters that follow, Many such terms make up the core of the language used to com-
you will study the body by systems-a process called systemic anat- municate ideas in science and medicine. Learning in science thus
omy. Systems are groups of organs that have a common function, begins with learning a new vocabulary, just as when you learn a new
such as the bones in the skeletal system and the muscles in the mus- language to help you understand and communicate in a region of
cular system. the world other than the one you call home.
To help you learn the vocabulary of anatomy and physiology, we
have provided several helpful tools for you. Within each chapter,
lists of new terms titled Language of Science and Language of Medi-
cine give you each new key (boldface) term that you will be learning
in that chapter. Each term in the list has a pronunciation guide and
an explanation (or meaning) of each of the word parts that make up
FIGURE 1-2 Gross anatomy. the term.
This famous woodcut of a gross dissection
We have also included a separate compact reference called
appeared in the world's first modern
QuiCK GuiDE TO THE LANGUAGE OF SCIENCE AND MEDICINE with
anatomy textbook, De Humani Corporis
Fabrica (On the Structure of the Human
this textbook. Take a moment now to locate it. After you have fin-
Body), in 1543. This woodcut features the ished reading this chapter, quickly review the tips for learning scien-
book's author, Andreas Vesalius, who is tific language. Then keep it nearby so that you will have a handy list
considered to be the founder of modern of commonly used word parts at your fingertips.
anatomy. The body being dissected is You will see that most scientific terms are made up of word parts
called a cadaver. from Latin or Greek. Most Western scientists first began corresponding

Chapter 1 Organizat ion of the Body 5
with one another in these languages, because they were commonly the CHARACTERISTICS OF LIFE
first written languages learned by educated people. Other languages Anatomy and physiology are important disciplines in biology-the
such as German, French, and Japanese are also sources of some scien- study of life. But what is life? What is the quality that distinguishes a
tific word parts. vital and functional being from a dead body? We know that a living
As with any language, scientific language changes constantly. organism is endowed with certain characteristics not associated with
T his is useful because we often need to fine-tune our terminology to inorganic matter. However, it is sometimes hard to find a single cri-
reflect changes in our understanding of science and to accommo- terion to define life.
date new discoveries. But it also sometimes leads to confusion. One could say that living organisms are self-organizing or self-
In an attempt to clear up some of the confusion, the International maintaining and nonliving structures are not. This concept is called
Federation of Associations of Anatomists (IFM) formed a worldwide autopoiesis, which literally means "self-making." Another idea, called
committee to publish a list of "universal" or standard anatomical the cell theory, states that any independent structure made up of one or
terminology. The list for gross anatomy, the structure we can see more microscopic units called cells is a living organism.
without magnification, was published in 1998 as Terminologia Ana- Instead of trying to find a single difference that separates living
tomica (TA). In 2008 Terminologia Histologica (TH) was published and nonliving things, scientists sometimes define life by listing what
for microscopic anatomy- the study of body structure requiring sig- are often called characteristics of life. Lists of characteristics of life
nificant magnification for the purpose of visualization. may differ from one physiologist to the next, depending on the type
Although there remain some alternate (and newer) terms used in of organism being studied and the way in which life functions are
anatomy, the lists are useful standard references. The lists show each grouped and defined. Attributes that characterize life in bacteria,
term in Latin and English (based on the Latin form), along with a plants, or animals may vary. Characteristics of life that are consid-
reference number. In this textbook we use the English terms from ered most important in humans are described in Table 1-1 .
the published lists as our standard reference, but we do occasionally Each characteristic of life is related to the sum total of all the
refer to the pure Latin form or an alternate term when appropriate physical and chemical reactions occurring in the body. T he term
for beginning students. metabolism is used to describe these various processes. T hey in-
One of the basic principles of the standardized terminology is the clude the steps involved in the breakdown of nutrient materials to
avoidance of eponyms, or terms that are based on a person's name. produce energy and the transformation of one material into another.
Instead, a more descriptive Latin-based term is always preferred. For example, if we eat and absorb more sugar than needed for the
T hus the term eustachian tube (tube connected to the middle ear, body's immediate energy requirements, it is converted into an alter-
named after the famed Italian anatomist Eustachius) is now replaced nate form, such as fat, that can be stored in the body.
with the more descriptive auditory tube. Likewise, the islets of Lang- Metabolic reactions are also required for making complex com-
erhans (in the pancreas) are now simply pancreatic islets. pounds out of simpler ones, as in tissue growth, wound repair, or
In the rare cases where eponyms do appear in a standard list, we manufacture of body secretions.
now avoid the possessive form . Thus Bowman's capsule (in kidney Each characteristic of life- its functional manifestation in the
tissue) is now either glomerular capsule or Bowman capsule. body, its integration with other body functions and structures, and its
There are no such standard lists of physi-
ological terms. However, many principles TABLE 1-1 Characteristics of Human Life
used in anatomical terminology are used in CHARACTERISTIC DESCRIPTION
physiology. For example, most terms have
Responsiveness Ability of an organism to sense, monitor, and respond to changes in both its
an English spelling but are based on Latin
external and internal environments
or Greek word parts. And, as in anatomy,
eponyms are less favored than descriptive Conductivity Capacity of living cells to transmit a wave of electrical d isturbance from one
point to another within the body
terms.
A QuiCK GuiDE TO THE LANGUAGE OF Growth Organized increase in the size and number of cells and therefore an increase in
size of the individual or a particular organ or part
SCIENCE AND MEDICINE accompanies this
book. It offers a handy summary of the ba- Respiration Exchange of respiratory gases (oxygen and carbon d ioxide) between an
sic principles of using your new "A&P lan- organism and its environment
guage." The quick guide also lists common Digestion Process by which complex food products are broken down into simpler
roots, prefixes, and suffixes- along with substances that can be absorbed and used by individual body cells
acronyms, abbreviations, Greek letters, Ro- Absorption Movement of molecules, such as respiratory gases or d igested nutrients,
man numerals, and much more. throug h a membrane and into the body fluids for transport to cells for use
This may all seem like a lot more than Secretion Production and release of important substances, such as digestive juices and
you want to know right now. However, if you hormones, for diverse body functions
focus on learning the new words as you begin Excretion Removal of waste products from the body
each new topic, as though you are in a for-
Circulation Movement of body flu ids containing many substances from one body area to
eign land and need to pick up a few phrases another in a continuous, circular route through hollow vessels
to get by, you will find your study of anatomy
Reproduction Formation of new individual offspring
and physiology easy and enjoyable.

6 UNIT 1 The Body as a Whole
mechanism of control - is th e subject of study in subsequent chap- function effectively. Because you already know that structure fits
ters of the text. functi on, it sh ou ld not surprise you that the h ighly complex and
coordinated functions of th e whole body can be understood by dis-
covering th e many basic processes that occu r in th e smaller parts,
Quick CHECK
such as organs, tissu es, and cells. These differing levels of organiza-
5. What is an eponym?
tion th at help us better understand th e body are illustrated in
6. What single criterion might be used to define life?
Figure 1-3.
7. Define t he term metabolism as it applies to the characterist ics of life.
CHEMICAL LEVEL
Note that organization of th e body begins at th e chemical level (see
• LEVELS OF ORGANIZATION Figure 1-3). There are more than 100 different chemical building
Before you begin the study of the structure and function of the hu- blocks of nature called atoms- tiny spheres of matter so small they
man body and its many parts, it is important to th ink about how the are invisible. Every material thing in our universe, including th e
parts are organized and how th ey might logically fit together and human body, is composed of atoms.
Combinations of atoms form larger chemical groupings,
called m olecules. Molecules, in turn, often combine with
Atom
Molecule oth er atoms and molecules to form larger and more
Vesicles
Neuron complex chemicals, called m acrom olecules.
T he unique and complex relationships that exist
among atoms, molecules, and macromolecules
in living material form a gel-like material made
-tnQ) of fluids, particles, and m embranes called
>
-(.)
Q)
cytoplasm - the essential material of human life.
·-c. Unless proper relationsh ips
0
(.)
tn Chemical level Group of neurons among chemical elem ents are
...0(.) (Chapters 3-4) and support cells maintained, death results.
·-
:?! Maintaining the type of chem-
•
Organelle level · . ical organization in cytoplasm
(Chapters 5-7)
required for life requires th e
Cellular level expenditure of energy. In
(Chapters 5-7) C hapters 3 and 4, important
information related to th e
Integumentary Tissue level
chemistry of life is discussed
(Chapters 8-9) in more detail.
Skeletal
Muscular Organ level
Organ system level (Chapter 20) ~-...:-- Brain
(Chapters 10-46) Cardiovascular ' rj
Endocrine
-tn
Q)
>
-tn
Q)
tn
...0
~
FIGURE 1 -3 Levels of organization. The
smallest parts of the body are the atoms that make up
the chemicals, or molecules, of the body. Molecules, in
turn, make up microscopic parts called organelles that fit
together to form each cell of the body. Groups of similar
Reproductive cells are called tissues, which combine with other
tissues to form individual organs. Groups of organs that
Uri nary work together are called systems. All the systems of the
body together make up an individual organism. Knowl-
Digestive Nervous
edge of the different levels of organization will help you
Respiratory
understand the basic concepts of human anatomy and
Organism level Lymphatic/ Immune physiology.

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UNIT 1 The Body as a Whole, 1 UNIT 4 Transportation

UNIT 2 Support and Movement, 178 UN IT 5 Respiration, Nutrition,

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ELSEVIER 32 51 Riverport Lane

C opyright © 2019 by Elsevier Inc. All rights reserved.

International Standard Book Number: 978-0-323-52880-1

Executive Content Strategist: Kellie vVhite

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About the Author

Kevin T. Patton has ta ug ht anatomy :md physiol-

Kel<in '1: l'aHou

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Melvin Chambliss Rebecca Halyard Melanie S. MacNeil

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Henry M. Seidel* Aleta Sullivan Karin VanMeter

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• AIMS OF THE REVISION

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INTERACTIVE UNIT INTRODUCTIONS

CHAPTER LEARNING AIDS

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stan d connections among stmcturc:s and functions throughout the:

BOXED SIDEBARS Diagnostic Study keeps you abreast of developments

career choices Adult Nurse Practitioner

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SURVIVAL GUIDE FOR ANATOMY

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CHAPTER 4 Biomolecules, 55 CHAPTER 6 Cell Function, 98

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CHAPTER9 Tissue Types, 154 CHAPTER 11 Skeletal Tissues, 209

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Lower Extremitv, 268 Tmnk Muscles, 323

Mechanisms of Disease, 426

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Somatic Motor Nervous System, 490 CHAPTER 24 Special Senses, 514

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Parathyroid Glands 584 7 Platelets 620 7

Parathyroid Hormone 585 7 Formation and Life Span of Platelets 620 7

Adrenal Glands 586 7 Hemostasis 621 7

Structure of the Adrenal Glands 586 7 Vasoconstriction 621 7

Adrenal Cortex 587 7 Platelet Plug Formation 621 7

Adrenal Medulla 590 7 Blood Clotting (Coagulation) 622 7

Pancreatic Islets 590 7 Conditions That Oppose Clotting 624 7

Pancreatic Hormones 591 7 Clot Dissolution 625 7

Testes 592 7 Mechanisms of Disease 626 7

Ovaries 592 7 Case Study 630 7

Adipose Tissue 594 7 Size and Shape of the Heart 635 7

Other Endocrine Glands and Hormones 59 5 7 Coverings of the Heart 639 7

Cycle of Life: Endocrine System 595 7 Structure of the Heart 640 7

Mechanisms of Disease 596 7 Electrocardiogram 648 7

Case Study 599 7 Cardiac Cycle 650 7

Career Choices 599 7 Heart Sounds 653 7

Cycle of Life: Heart 6 53 7