Anatomy & Physiology

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ANATOMY & PHYSIOLOGY, 8th EDITION ISBN: 978-0-323-08357-7

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Library of Congress Cataloging-in-Publication Data

Patton, Kevin T.
Anatomy & physiology / Kevin T. Patton, Gary A. Thibodeau.—8th ed.
p. ; cm.
Anatomy and physiology
Includes bibliographical references and index.
ISBN 978-0-323-08357-7 (hardcover : alk. paper)
I. Thibodeau, Gary A., 1938- II. Title. III. Title: Anatomy and physiology.
[DNLM: 1. Anatomy. 2. Physiology. QS 4]

612--dc23
2011051161

Content Strategist: Kellie White

Content Manager: Rebecca Swisher
Content Coordinator: Emily Thomson
Publishing Services Manager: Deborah L. Vogel
Project Manager: John W. Gabbert
Cover Designer: Jessica Williams

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 About the Authors

Kevin Patton has taught anatomy and physiology to high Gary Thibodeau has been teaching anatomy and physiolo-
school, community college, and university students from various gy for more than three decades. Since 1975, Anatomy & Physiology
backgrounds for three decades. Kevin found that the work that led has been a logical extension of his interest and commitment to
him to a PhD in vertebrate anatomy and physiology instilled in education. Gary’s teaching style encourages active interaction with
him an appreciation for the “Big Picture” of human structure and students, and he uses a wide variety of teaching methodologies—a
function. This experience has helped him produce a text that will style that has been incorporated into every aspect of this edition.
be easier to understand for all students. He has earned several cita- He is considered a pioneer in the introduction of collaborative
tions for teaching anatomy and physiology, including the Mis- learning strategies to the teaching of anatomy and physiology. Re-
souri Governor’s Award for Excellence in Teaching. “One thing cent conferral of Emeritus status in the University of Wisconsin
I’ve learned,” says Kevin, “is that most of us learn scientific con- System has provided him with additional time to interact with stu-
cepts more easily when we can see what’s going on.” His talent for dents and teachers across the country and around the world. His
using imagery to teach is evident throughout this edition with its focus continues to be successful student-centered learning—lever-
extensive array of visual resources. Kevin’s interest in promoting aged by text, Web-based, and ancillary teaching materials. Over the
excellence in teaching anatomy and physiology has led him to years, his success as a teacher has resulted in numerous awards
take an active role in the Human Anatomy and Physiology Society from both students and professional colleagues. Gary is active in
(HAPS), where he is a President Emeritus and was the founding numerous professional organizations including the Human Anato-
director of the HAPS Institute. In 2008, he was awarded the HAPS my and Physiology Society (HAPS), The American Association of
President’s Medal for outstanding contributions in promoting the Anatomists, and the American Association of Clinical Anatomists.
mission of excellence in A&P teaching and learning. Kevin also His biography is included in numerous publications, including
teaches graduate courses to prospective and current A&P profes- Who’s Who in America; Who’s Who in American Education; Out-
sors and produces online resources for A&P students and teach- standing Educators in America; American Men and Women of Sci-
ers, including theAPstudent.org and theAPprofessor.org. ence; and Who’s Who in Medicine and Healthcare. While earning
master’s degrees in both zoology and pharmacology, as well as a
To my family and friends, who never let me forget the joys
PhD in physiology, Gary says that he became “fascinated by the
of discovery, adventure, and good humor.
connectedness of the life sciences.” That fascination has led to this
To the many teachers who taught me more by who they were than edition’s unifying themes that focus on how each concept fits into
by what they said. the “Big Picture” of the human body.
To my students who help me keep the thrill of learning fresh To my parents, M.A. Thibodeau and Florence Thibodeau,
and exciting. who had a deep respect for education at all levels
and who truly believed that you never give up being a student.
Kevin T. Patton
To my wife, Emogene, an ever-generous and uncommonly discern-
ing critic, for her love, support, and encouragement over the years.
To my children, Douglas and Beth, for making it all worthwhile.

Gary A. Thibodeau
This page intentionally left blank
 Contributors

We gratefully acknowledge the following individuals for their contributions to this text:

ED CALCATERRA, BS, MEd DANIEL J. MATUSIAK, BS, MA, EdD

Instructor Adjunct Professor
DeSmet Jesuit High School St. Charles Community College
Creve Coeur, Missouri Cottleville, Missouri

Lead Consultant
KEVIN PETTI, PhD
Professor, Departments of Science and Health
San Diego Miramar College
San Diego, California

Reviewers
The Department of Physiology Rachel Venn Beecham Roger Carroll
The Department of Anatomy Mississippi Valley State University University of Tennessee School
& Structural Biology Brenda Blackwelder of Medicine
Otago School of Medical Sciences Central Piedmont Community College Pattie Clark
University of Otago Abraham Baldwin College
Richard Blonna
Dunedin, New Zealand
William Paterson College Richard Cohen
Mohammed Abbas Union County College
Claude Boucheix
Wayne County Community College
INSERM Harry W. Colvin, Jr.
Laura Anderson University of California–Davis
Charles T. Brown
Elk County Catholic High School
Barton County Community College Dorwin Coy
Bert Atsma University of North Florida
Laurence Campbell
Union County College
Florida Southern College Douglas M. Dearden
John Bagdade General College of University of Minnesota
Patricia W. Campbell
Northwestern University
Carolinas College of Health Sciences Cheryl Donlon
Mary K. Beals Northeast Iowa Community College
Geralyn M. Caplan
Southern University and A&M
Owensboro Community and Technical J. Paul Ellis
College
College St. Louis Community College
vi CONTRIBUTORS

Cammie Emory Brian H. Kipp Mary F. Ruh

Bossier Parish Community College Grand Valley State University St. Louis University School of Medicine
Julie Fiez Johanna Krontiris-Litowitz Jenny Sarver
Washington University School of Medicine Youngstown State University Sarver Chiropractic
Beth A. Forshee William Langley Henry M. Seidel
Lake Erie College of Osteopathic Medicine Butler County Community College The Johns Hopkins University School
Laura Frost Clifton Lewis of Medicine
Georgia Southern University Wayne County Community College Gerry Silverstein
Debbie Gantz Jerri Lindsey University of Vermont–Burlington
Mississippi Delta Community College Tarrant County Junior College
Charles Singhas
Christy Gee Eddie Lunsford East Carolina University
South College–Asheville Southwestern Community College
Becky Gesler Marci Slusser
Bruce Luxon Reading Area Community College
Spalding University
University of Texas Medical Branch
Norman Goldstein Paul Keith Small
Melanie S. MacNeil Eureka College
California State University–Hayward
Brock University
John Goudie William G. Sproat, Jr.
Susan Marshall Walters State Community College
Kalamazoo Area Mathematics
St. Louis University School of Medicine
& Science Center
Snez Stolic
Charles J. Grossman Gary Massaglia
Griffith University
Xavier University Elk County Christian High School
Jeff Mellenthin Aleta Sullivan
Monica L. Hall-Woods Pearl River Community College
St. Charles Community College The Methodist Debakey Heart Center
Lanette Meyer Kathleen Tatum
Rebecca Halyard
Regis University/Denver Children’s Iowa State University
Clayton State College
Hospital Reid Tatum
Ann T. Harmer
Orange Coast College Donald Misumi St. Martin’s Episcopal School
Linden C. Haynes Los Angeles Trade–Technical Center Kent R. Thomas
Hinds Community College Susan Moore Wichita State University
Lois Jane Heller New Hampshire Community Technical Todd Thuma
University of Minnesota School College Macon College
of Medicine Rose Morgan
Stuart Tsubota
Lee E. Henderson Minot State University
St. Louis University
Prairie View A&M University Jeremiah Morrissey
Judith B. Van Liew
Paula Holloway Washington University School of Medicine
State University of New York College
Ohio University Greg Mullen at Buffalo
Julie Hotz-Siville South Louisiana Community College/
Mt. San Jacinto College National EMS Academy Karin VanMeter
Iowa State University/Des Moines Area
Gayle Dranch Insler Robert Earl Olsen Community College
Adelphi University Briar Cliff College
Patrick Jackson Gordon Wardlaw
Susan M. Caley Opsal
Canadian Memorial Chiropractic College Ohio State University
Illinois Valley Community College
Carolyn Jaslow Amy L. Way
Juanelle Pearson
Rhodes College Lock Haven University of Pennsylvania
Spalding University
Gloria El Kammash Wanda Ragland Cheryl Wiley
Wake Technical Community College Macomb Community College Andrews University
Murray Kaplan Clarence C. Wolfe
Saeed Rahmanian
Iowa State University Northern Virginia Community College
Roane State Community College
Kathy Kath
Carolyn Jean Rivard
Henry Ford Hospital School of Radiologic
Fanshawe College of Applied Arts
Technology
and Technology
 Preface

S
uccess in both teaching and learning is, in many help unify information, stimulate critical thinking, and motivate
ways, determined by how effective we are in trans- students to master a new vocabulary.
forming information into knowledge. This is espe- To accomplish this synthesis of information, unifying themes
cially true in scientific disciplines, such as anatomy are required. In addition, a mechanism to position and imple-
and physiology, where both student and teacher ment these themes must be an integral part of each chapter. Unit
continue to be confronted with an enormous accumulation of fac- One begins with “Seeing the Big Picture,” an overview that en-
tual information. Anatomy & Physiology is intended to help trans- courages students to place individual structures or functions into
form that information into a manageable knowledge base by an integrated framework. Then, throughout the book, the specific
effective use of unifying themes and by focusing on the significant information presented is highlighted in a special “The Big Pic-
and on what is truly relevant in both disciplines. ture” section so that it can be viewed as an integral component of
This textbook is intended for use as both a teaching tool and a a single multifaceted organism.
learning tool. It was written to help students unify information, Anatomy & Physiology is dominated by two major unifying
stimulate critical thinking, and acquire a taste for knowledge themes: (1) the complementarity of normal structure and func-
about the wonders of the human body. This textbook will help tion and (2) homeostasis. The student is shown, in every chapter
students avoid becoming lost in a maze of facts in a complex of the book, how organized anatomical structures of a particular
learning environment. It will encourage them to explore, to ques- size, shape, form, or placement serve unique and specialized
tion, and to look for relationships, not only between related facts functions. The integrating principle of homeostasis is used to
in a single discipline, but also between fields of academic inquiry show how the “normal” interaction of structure and function is
and personal experience. It is our hope that Anatomy & Physiolo- achieved and maintained by counterbalancing forces within the
gy will help both students and teachers transform information into body. Repeated emphasis of these principles encourages students
knowledge. to integrate otherwise isolated factual information into a cohesive
This new edition of the text has been extensively revised. We and understandable whole. “The Big Picture” summarizes the
built upon the successful art revision program begun in the previ- larger interaction between structures and functions of the differ-
ous edition by adding several new illustrations and photographs. ent body systems. As a result, anatomy and physiology emerge as
Several of the longer chapters were split into smaller chapters to living and dynamic topics of personal interest and importance to
improve comprehension and better organize study. We also im- students.
proved our execution of a page design and layout that maximizes
learning effectiveness. As with each new edition, we added care-
fully selected new information on both anatomy and physiology to AIMS OF THE REVISION
provide an accurate and up-to-date presentation. We have re- As in past editions, our revision efforts focused on identifying the
tained the basic philosophy of personal and interactive teaching need for new or revised information and for additional visual pre-
that characterized previous editions. In addition, essential, accu- sentations that clarify important, yet sometimes difficult, content
rate, and current information continues to be presented in a com- areas.
fortable writing style. Emphasis is placed on concepts rather than In this eighth edition, we have included information on new
descriptions, and the “connectedness” of human structure and concepts in many areas of anatomy and physiology. For example,
function is repeatedly reinforced by unifying themes. new data on the description of cranial nerves, protein structure, and
updates in terminology have been included. Most of these changes
are subtle adjustments to our current understanding of human sci-
UNIFYING THEMES ence. However, the accumulation of all of these subtle changes
Anatomy and physiology encompasses a body of knowledge that is makes this edition the most up-to-date textbook available.
large and complex. Students are faced with the need to know and One of the most apparent changes that you will notice in this
understand a multitude of individual structures and functions that new edition is a reorganization of chapters. Three of the longer
constitute a bewildering array of seemingly disjointed informa- chapters have been split into small chapters. In cell biology, we
tion. Ultimately, the student of anatomy and physiology must be moved cell growth and reproduction to its own chapter (Chapter
able to “pull together” this information to view the body as a 5). In the nervous system, we moved the autonomic nervous system
whole—to see the “Big Picture.” If a textbook is to be successful as into its own chapter (Chapter 16). And the endocrine system was
a teaching tool in such a complex learning environment, it must split into an introductory chapter on endocrine regulation
viii PREFACE

(Chapter 18) followed by a survey of major endocrine glands In this edition, great effort has been made to make this text ac-
(Chapter 19). A hallmark of our textbook has been its effective cessible to students whose first language is not English. After con-
“chunking” of material into manageable chapters and these sulting with ESL specialists and ESL learners, we have continued
changes reflect our continuing commitment to that approach. to enhance our word lists and improve our readability to make the
The previous edition featured a complete redesign of the page concepts of human structure and function more understandable
layouts and the art program. This enabled us to make the textbook for all students.
easier to use by putting the illustrations, graphs, and tables closer As teachers of anatomy and physiology, we know that to be ef-
to the related text. In this edition, we have improved the creative fective a text must be readable, and it must challenge and excite
layout even more. Additional tables help students visually orga- the student. This text remains one that students will read—one
nize important concepts and complement the improved design to designed to help the teacher teach and the student learn. To ac-
provide a multisensory learning tool. We have expanded the art complish this end, we facilitated the comprehension of difficult
program, while preserving a style as consistent as possible through- material for students with thorough, consistent, and nonintimidat-
out the book. In this edition, we have expanded and improved the ing explanations that are free of unnecessary terminology and ex-
use of a consistent Color Key (pp. xxiv-xxv) for certain cell parts, traneous information. This easy access to complex ideas remains
tissue types, and biomolecules to help make learning easier for the single most striking hallmark of our textbook.
beginning students.

Frontalis
Orbicularis oculi
Temporalis
Zygomaticus major
Occipitalis
Orbicularis Sternocleidomastoid
oris
ILLUSTRATIONS AND DESIGN Levator scapulae
Scalenus anterior
A major strength of this text has always been the exceptional quality, accuracy, Flexors of Depressor and medius
anguli
and beauty of the illustration program. It is the original “visual” anatomy and wrist and
oris
Trapezius
fingers
physiology textbook. We have worked very closely with scientific illustrators to Biceps
Deltoid

provide attractive and colorful images that clearly and accurately portray the brachii Lateral head
of triceps
major concepts of anatomy and physiology. Medial
Brachialis
head of
The truest test of any illustration is how effectively it can complement and triceps Biceps brachii
strengthen the written information in the text and how successfully it can be brachii
Brachioradialis
used by the student as a learning tool. Each illustration is explicitly referred to in Long head Extensor carpi
of triceps brachii radialis longus
the text and is designed to support the text discussion. Careful attention has been Pectoralis major Extensor digitorum
Flexor carpi ulnaris
Serratus anterior
Extensor carpi
External oblique ulnaris
Cytoskeleton
Nucleus Nuclear Nucleolus Gluteus medius
envelope
Latissimus dorsi
Chromatin Gluteus maximus
Tensor fasciae
Rectus femoris latae
Rough endoplasmic
reticulum Sartorius
Mitochondrion Vastus lateralis

Gracilis Iliotibial tract

Vastus
medialis Biceps femoris
Semitendinosus Sartorius
Microfilament
Microtubule
Gastrocnemius
Intermediate
filament
Soleus Tibialis anterior
Cilia
Peroneus (fibularis) longus
Smooth endoplasmic Flexor
reticulum digitorum Peroneus (fibularis) brevis
Microvilli longus Calcaneal
(Achilles) tendon
Lysosome S
Peroxisome
A P
Vesicle
Centrioles Free ribosomes C I
Centrosome

Mitochondrion Golgi
A apparatus
 PREFACE ix

LEARNING AIDS chapters and their top-

Anatomy & Physiology is a student-oriented text. Written in a ics are listed. Before be-
ginning the study of
Unit Four
readable style, the text is designed with many different pedagogi- Transportation
cal aids to motivate and maintain interest. The special features material in a new unit,
and Defense
and learning aids listed below are intended to facilitate learning students are encouraged
and retention of information in the most effective and efficient to scan the introduction
and each of the chapter SE E I N G TH E BI G P I CTU RE

T
he chapters in Unit Four are concerned with

manner. transportation, how the body defends itself, and

stress. Blood (Chapter 20), a complex fluid tis-

20
outlines in the unit to
sue, is discussed and the text explains how Blood, 598

No textbook can replace the direction and stimulation provid-

blood serves to transport respiratory gases and
key nutrients to cells and carry away wastes. The body’s blood
fills the cardiovascular system (Chapters 21 and 22) and is
21 Anatomy of the

ed by an enthusiastic teacher to a curious and involved student. understand the relation- moved through a closed pathway, or circuit, of vessels by the
pumping action of the heart.
The elements of the lymphatic system (Chapter 23) provide
Cardiovascular System, 629

ship and “connected-

an open pathway for return of fluid and proteins from the inter-
22 Physiology of the
Cardiovascular System, 681

However, a full complement of innovative pedagogical aids that

stitial spaces and for fats, which are absorbed from the intes-
tine into the general circulation. The lymphatic system is also
involved in immunity or resistance to disease and in the remov-

ness” of the material to al and destruction of dead red blood cells. The immune system 23 Lymphatic System, 722

are carefully planned and implemented can contribute a great is more fully discussed in Chapter 24. Elements of the immune
system provide a multilayered defense mechanism, involving

be studied. Each unit

both phagocytic cells and defensive proteins called antibodies.
Stress—and the body’s frequently maladaptive response to it— 24 Immune System, 745

deal to the success of a text as a learning tool. An excellent text- is discussed in Chapter 25.

book can and should be enjoyable to read and should be helpful has a color-coded tab at 25 Stress, 782

to both student and teacher. We hope you agree that the learning the outside edge of ev-
aids in Anatomy & Physiology meet the high expectations we have ery page to help you
set. quickly find the infor-
mation you need.
Unit Introductions
Chapter Learning Aids
Each of the six major units of the text begins with a brief overview
statement. The general content of the unit is discussed, and the ■ Study Hints—give specific suggestions for using many of the
learning aids found in each chapter. Because many readers
have never learned the special skills needed to make ef-
fective use of pedagogical resources found in science
textbooks, helpful tips are embedded within each
paid to placement and sizing of the il- Chapter Outline, Language of Science & Medicine
lustrations to maximize usefulness and list, Case Study, Chapter Summary, Review Question
clarity. Each figure and all labels are rel- set, and Critical Thinking section. Answers for all of the case
evant to—and consistent with—the text study questions and also the review and critical thinking ques-
discussion. Each illustration has a bold- tions are in the Instructor’s Resource Manual, the Instructor’s
face title for easy identification. Most il- Electronic Resource DVD, and the instructor’s EVOLVE site
lustrations also include a concise for Anatomy & Physiology. Teachers can then choose to use the
explanation that guides the student questions as homework assignments or include them on tests.
through the image as a complement to
■ Chapter Outline—sum- CHAPTER OUTLINE
the nearby text narrative.
marizes the contents of a Scan this outline before you begin to read the chapter, as
The artistically drawn, full-color art-
chapter at a glance. An
work is both aesthetically pleasing and
overview outline introduc-
functional. Color is used to highlight Composition of Blood, 599 Bloo
es each chapter and en- Blood Volume, 599 Bloo
specific structures in drawings to help organize or highlight Formed Elements of Blood, 600 M
ables the student to Red Blood Cells (Erythrocytes), 601
complex material in illustrated tables or conceptual flow
preview the content and Function of Red Blood Cells 601
charts. The text is also filled with dissection photographs, ex-
direction of the chapter at
ceptional light micrographs, and scanning (SEM) and trans-
the major concept level before beginning a detailed reading.
mission (TEM) electron micro-graphs, some of which are new
Page references enable students to quickly locate topics in the
to this edition. In addition, examples of
chapter.
medical imagery, including CT scans,
PET scans, MRIs, and x-ray photographs, ■ Language of Science—introduces LANGUAGE OF SCIENCE

are used throughout the text to show struc- you to new scientific terms in the embryonic stem cell formed elem

tural detail, explain medical procedures, chapter. A comprehensive list of (em-bree-ON-ik) globin
[em- in, -bryo- fill to bursting, -ic (GLOH-bi
and enhance the understanding of differ- new terms is presented at the be- relating to] [glob- ball

ences that distinguish pathological condi- ginning of the chapter. Each term eosinophil
(ee-oh-SIN-oh-fil)
granulocyte
(GRAN-yo

tions from normal structure and function. in the list has an easy-to-use pro- [eosin- reddish color, -phil love] [gran- gra
erythrocyte hematopoiet
All illustrations used in the text are an in- nunciation guide to help the (eh-RITH-roh-syte) (hee-mah
[erythro- red, -cyte cell] [hem- bloo
tegral part of the learning process and learner easily “own” the word by erythropoiesis heme

should be carefully studied by the being able to say it. Literal transla-
student. tions of the term or its word parts are included to help students
learn how to deduce the meaning of new terms themselves.
The listed terms are defined in the text body, where they ap-
pear in boldface type, and may also be found in the glossary at
x PREFACE

the back of the book. The bold-

Color Key
face type feature enables stu- BIOCHEMISTRY CELLULAR STRUCTURES OTHER STRUCTURES
dents to scan the text for new
words before beginning their first C Carbon D Aspartic Acid Y Tyrosine Cytosol Artery

detailed reading of the material, Cl Chloride C Cysteine V Valine

Extracellular
Fluid
Vein

so they may read without having Energy Energy G Glycine H2O Water
Plasma
Membrane Capillary

to disrupt the flow to grapple ATP ATP E Glutamic Acid Hormone Nucleus Bone

with new words or phrases. The H Hydrogen Q Glutamine Enzyme

Golgi
Apparatus
Muscle

Language of Science word list N Nitrogen H Histidine Protein

Mitochondrion Nerve

includes terms related to the es- Endoplasmic

Schwann Cell
O Oxygen I Isoleucine Carbohydrate Reticulum
sential anatomy and physiology
Potassium Leucine Fatty acid Ribosome Fat
presented in the chapter. Anoth-
K L

DNA, Centrioles Gland

er word list near the end of the Na Sodium K Lysine
Nucleic Acid

Afferent (Sensory)
chapter, a feature described be-

A
G
Microtubule

C
S Sulfur M Methionine RNA Pathway

low as the Language of Medi-

Intermediate Efferent (Motor)
Ca Calcium F Phenylalanine C Cytosine Filament Pathway

cine, is an inventory of all the P Organic

Phosphate
P Proline A Adenine Microfilament Sympathetic

new clinical terms introduced in Pi

Inorganic
Phosphate
U Selenocysteine G Guanine
Actin / Thin
Filament Parasympathetic

the chapter. A Alanine S Serine T

Thymine /
Myosin / Thick
Filament
Process Arrow
Uracil

■ Color-Coded Illustrations— R Arginine T Threonine Chromosome Na+ Channel

help beginning students appreci- N Asparagine W Tryptophan

ate the “Big Picture” of human

structure and function. A special
feature of the illustrations in this text is the careful and consis- |A&P CONNECT |

tent use of color to identify important structures and substanc- concepts. They are Blood transfusions are an important therapeutic tool. Learn
es that recur throughout the book. Consistent use of a color key often illustrated with more about blood transfusions, blood banking, and even ar-
micrographs, medical tificial blood in Blood Transfusions online at A&P Connect.
helps beginning students appreciate the “Big Picture” of hu-
man structure and function each time they see a familiar struc- images, and medical
ture in a new illustration. For an explanation of the color illustrations.
scheme, see the Color Key on pp. xxiv-xxv. ■ Cycle of Life—describes major changes that occur over a per-
■ Directional Rosettes—help students learn the orientation of son’s lifetime. In many body systems, changes in struc-
anatomical structures. Where appropriate, small orien- ture and function are frequently related to a person’s
S
tation diagrams and directional rosettes are included age or state of development. In appropriate chapters of
R L as part of an illustration to help students locate a the text, these changes are highlighted in this special
structure with reference to the body as a whole or section.
I
orient a small structure in a larger view. ■ The Big Picture—explains the interactions of the
■ Quick Check questions—test your knowledge of material just system discussed in a particular chapter with the
read. Short objective-type questions are located immediately body as a whole. This helps students relate informa-
following major p p p tion about body structures or functions that are
topic discus- | QUICK CHECK |
discussed in the chapter to the body as a whole. The
sions through- Big Picture feature helps you improve critical thinking by fo-
1. Name the fluid portion of whole blood.
out the body of 2. What constitutes the formed elements of blood?
cusing on how structures and functions relate to one another
the text. These 3. What factors influence blood volume? on a global basis.
4. Identify the component percentages of the normal
questions cover hematocrit. ■ Mechanisms of Disease—helps you understand the basic
important in- principles of human structure and function by showing what
formation pre- happens when things go wrong. Examples of pathology, or
sented in the preceding section. Students unable to answer the disease, are included in many chapters of the book to stimu-
questions should reread that section before proceeding. This late student interest and to help students understand that
feature therefore enhances reading comprehension. Quick the disease process is a disruption in homeostasis, a break-
Check items are numbered by chapter, and a numerical listing down of normal integration of form and function. The in-
of their answers can be found on the EVOLVE site (http:// tent of the Mechanisms of Disease section is to reinforce
evolve.elsevier.com/Patton/AP/). the normal structures and mechanisms of the body while
■ A&P Connect features—call the reader’s attention to online ar- highlighting the general causes of disorders for a particular
ticles that illustrate, clarify, and apply concepts encountered in body system.
the text. Embedded within the text narrative, these boxes con- ■ Language of Medicine—introduces you to new clinical
nect you with interesting, brief online articles that stimulate terms in the chapter. A brief list of clinical terms is presented
thinking, satisfy your curiosity, and help you apply important near the end of each chapter. As in the Language of Science
 PREFACE xi

list at the be- material covered in the text. Examples of subjects include the
L A N G U A G E O F M E D I C I N E (continued from p. 6
ginning of the RNA revolution and the enteric nervous system.
acute anemia blood loss anemia chapter, each
(ah-KYOOT ah-NEE-mee-ah) (ah-NEE-mee-ah) ■ Health Matters—present current information on diseases, disor-
[acu- sharp, an- without, -emia [an- without, -emia blood condition term has a ders, treatments, and other health issues related to normal struc-
blood condition] bone marrow transplant phonetic pro- ture and function. These boxes contain information
acute lymphocytic leukemia (ALL) chronic lymphocytic leukemia
(ah-KYOOT LIM-foh-sit-ik loo- (CLL)
nu n ci a t i o n related to health issues or clinical applications. In
KEE h) (KRON ik LIM f h it ik l guide and some instances, examples of structural anomalies or
translations of word parts. The listed terms are defined in the pathophysiology are presented. Information of this
text body, where they appear in boldface type. type is often useful in helping students understand the mecha-
■ Case Study—challenges you with “real-life” clinical or other nisms involved in maintaining the “normal” interaction of
practical situations so you can creatively apply what you have structure and function.
learned. Every chapter has a case study preceding the ■ Diagnostic Study—keep you abreast of developments in diag-
chapter summary. The case study consists of a descrip- nosing diseases and disorders. These boxes deal with
tion of a real-life situation and a series of questions that specific diagnostic tests used in clinical medicine or
require the student to use critical thinking skills to deter- research. Lumbar puncture, angiography, and ante-
mine the answers. natal diagnosis and treatment are examples.
■ Chapter Summary—outlines essential information in a way ■ FYI—give you more in-depth information on interesting topics
that helps you organize your study. Detailed end-of-chapter mentioned in the text. Topics of current interest,
summaries provide excellent guides for students as they review such as new advances in anatomy and physiology
the text materials before examinations. Many students also find i research, are covered in these “for your informa-
the summaries to be useful as a chapter preview in conjunc- tion” boxes.
tion with the chapter outline.
■ Sports and Fitness—highlight sports-related topics. Exer-
■ Audio Chapter Summaries—allow you to listen and learn cise physiology, sports injury, and physical educa-
wherever you may be. For the first time, the chapter tion applications are highlighted in these boxes.
summaries are now available in MP3 format for
download at the EVOLVE site. You can play them
■ Career Choices—highlight individuals in health-related careers.
on your computer, import them into your portable
A Career Choices box appears at the end of each unit.
media device, or burn them onto a CD for playback
These boxes describe some of the diverse opportuni-
in your stereo or car.
ties currently available in health-related occupations
■ Review Questions—help you determine whether you have mas- and also demonstrate the importance of how an un-
tered the important concepts of each chapter. Review questions at derstanding of anatomy and physiology will be useful to students
the end of each chapter give students practice in using a narra- in their futures.
tive format to discuss the concepts presented in the chapter.
■ Critical Thinking Questions—actively engage and challenge
you to evaluate and synthesize the chapter content. Critical Glossary
thinking questions require students to use their higher level A comprehensive glossary of terms is located at the end of the text.
reasoning skills and demonstrate their understanding of, not Accurate, concise definitions and phonetic pronunciation guides
just their repetition of, complex concepts. are provided. In this edition, word parts have also been added to
each glossary entry. An audio glossary is also available on the ex-
Boxed Information panded EVOLVE site (http://evolve.elsevier.com/Patton/AP/)
As always, we made every effort to update factual information and with definitions and audio pronunciations for most of the key
incorporate the most current anatomy and physiology research terms in the text.
findings in this edition. Although there continues to be an incred-
ible explosion of knowledge in the life sciences, not all new infor-
mation is appropriate for inclusion in a fundamental-level LEARNING SUPPLEMENTS
textbook. Therefore we were selective in choosing new clinical,
pathological, or special-interest material to include in this edition.
FOR STUDENTS
This text remains focused on normal anatomy and physiology. Brief Atlas of Human Anatomy
The addition of new boxed content is intended to stimulate stu- A full-color Brief Atlas of Human Anatomy containing cadaver dis-
dent interest and provide examples that reinforce the immediate sections, osteology, organ casts, histology specimens, and surface
personal relevance of anatomy and physiology as important disci- anatomy photographs is packaged with every new copy of this edi-
plines for study. tion of Anatomy & Physiology. This helpful supplement serves as
■ General Interest Boxes—provide an expanded explanation of a handy reference for students as they study the human body in
specific chapter content. Many chapters contain boxed essays, class and in the laboratory—and even later on in clinical and ca-
occasionally clinical in nature, that expand on or relate to reer contexts.
 PREFACE xiii

summaries of landmark features used to distinguish microscopic that allow you to hit the ground running. The Evolve website for
specimens. Each exercise concludes with a lab report that may instructors also includes a Computerized Test Bank with more
also serve as a homework assignment or self-test. than 7000 multiple choice, true/false, short answer, and challenge
The new edition of the lab manual includes eLabs for Anatomy questions (which you can also import into your Classroom Per-
& Physiology, an online lab program designed to complement tra- formance System to quickly assess student comprehension and
ditional lab exercises. The lab exercises, both anatomy and physi- monitor your classroom’s response), an Electronic Image Collec-
ology based, are separated into modules. Each lab is composed of tion to accompany Anatomy & Physiology, featuring hundreds of
a variety of learning activities, animations, simulations, and quiz- full-color illustrations and photographs, with labels and lead lines
zes. The labs are designed so that students can easily navigate be- that you can turn off and on, Powerpoint Presentations, and
tween activities, allowing them the freedom to focus on the areas much more!
where they need the most help.
Instructor’s Guide for the Laboratory Manual
TEACHING SUPPLEMENTS The Instructor’s Guide for the Laboratory Manual on Evolve of-
FOR INSTRUCTORS fers detailed information to help the instructor prepare for the
laboratory exercises. Alternate activities, substitutions, student
Instructor Resources on Evolve handouts, and other resources help instructors tailor the use of the
The Instructor’s Resource was written and developed specifically A&P Laboratory Manual to their own course. Answers for all
for this new edition of Anatomy & Physiology. Available on Evolve, questions on the lab reports in the A&P Laboratory Manual are
it provides critical thinking questions, learning objectives and ac- also provided either to check student work or to provide for stu-
tivities, teaching tips for the text, synopses of difficult concepts, dents who use lab reports as self tests. Also included is a cadaver
and clinical applications exercises. To make lecture preparations a dissection video—shot in high definition— that you can use in
little easier, the Instructor’s Resource also includes lesson plans lecture or lab.
Acknowledgments

Over the years, many people have contributed to the development To those at Elsevier who put their best efforts into producing
and success of Anatomy & Physiology. We extend our thanks and this edition, we are indebted. This new edition, and its ever-
deep appreciation to all the students and classroom instructors expanding library of ancillary resources, would not have been pos-
who have provided us with helpful suggestions. We also thank the sible without the efforts of Becky Swisher, our Content Manager,
many contributors who have, over the last several editions, pro- and Kellie White, Executive Content Strategist. In addition, we
vided us with extraordinary insights and useful features that we are grateful to Tom Wilhelm, Executive Publisher, and Sally
have added to our textbook. Schrefer, Executive Vice President, for their continuing guidance
Dan Matusiak and Izak Paul helped us produce our word lists. and support. And where the rubber meets the road, we were fortu-
This was a huge task, and we appreciate their help. Paul Krieger nate to have a wonderful team of professionals working with us to
helped us design the Clear View of the Human Body, for which we keep it all on track and moving along: Emily Thomson, Content
are grateful. Thanks to Betsy Brantley, who contributed many of the Coordinator; Deborah Vogel, Publishing Services Manager; and
case studies found in this edition. Thanks also to Jean Proehl, Mon- John Gabbert, Project Manager. We are also grateful to our friends
teo Myers, Mark Alderman, Dominic Steward, Craig Huard, and at Electronic Publishing Services Inc., who helped us develop
Christina Zaleski for their insights in the Career Choices boxes. and implement our integrated design, layout, and art program.
Kevin Petti served as Lead Consultant, helping to improve our
art program and providing valuable insights and analysis of content
and approach during several stages of revision. Kevin T. Patton
Gary A. Thibodeau
 Contents

UNIT ONE The Body CHAPTER 2 The Chemical Basis

as a Whole, 1 of Life, 33
Basic Chemistry, 34
Elements and Compounds, 34
INTRODUCTION Atoms, 36
Seeing the Big Picture, 2 Attractions Between Atoms—Chemical Bonds, 38
Attractions Between Molecules, 39
CHAPTER 1 Organization Chemical Reactions, 40
Metabolism, 41
of the Body, 3 Catabolism, 41
Science and Society, 4 Anabolism, 42
Anatomy and Physiology, 5 Organic and Inorganic Compounds, 42
Anatomy, 5 Inorganic Molecules, 42
Physiology, 5 Water, 42
Language of Science and Medicine, 5 Oxygen and Carbon Dioxide, 43
Characteristics of Life, 6 Electrolytes, 44
Levels of Organization, 7 Organic Molecules, 45
Chemical Level—Basis for Life, 7 Carbohydrates, 46
Organelle Level, 8 Lipids, 48
Cellular Level, 8 Proteins, 51
Tissue Level, 8 Nucleic Acids and Related Molecules, 55
Organ Level, 8 Combined Forms, 59
System Level, 8 The Big Picture: The Chemical Basis of Life, 59
Organism Level, 9 Mechanisms of Disease, 60
Anatomical Position, 10 Case Study, 61
Body Cavities, 10
Body Regions, 12 CHAPTER 3 Anatomy of Cells, 66
Abdominal Regions, 14 Functional Anatomy of Cells, 67
Abdominopelvic Quadrants, 14 The Typical Cell, 67
Terms Used in Describing Body Structure, 15 Cell Structures, 68
Directional Terms, 15 Cell Membranes, 70
Terms Related to Organs, 15 Membrane Structure, 70
Body Planes and Sections, 15 Membrane Function, 72
Interaction of Structure and Function, 17 Cytoplasm and Organelles, 73
Homeostasis, 18 Endoplasmic Reticulum (ER), 73
Homeostatic Control Mechanisms, 20 Ribosomes, 74
Basic Components of Control Mechanisms, 20 Golgi Apparatus, 74
Negative Feedback Control Systems, 21 Lysosomes, 76
Positive Feedback Control Systems, 22 Proteasomes, 76
Feed-Forward in Control Systems, 22 Peroxisomes, 76
Levels of Control, 23 Mitochondria, 77
Summary of Homeostasis, 24 Nucleus, 78
Cycle of Life: Life Span Considerations, 24 Cytoskeleton, 79
The Big Picture: Organization of the Body, 24 Cell Fibers, 79
Centrosome, 81
Mechanisms of Disease, 25
Molecular Motors, 81
Case Study, 29 Cell Extensions, 82
Cell Connections, 83
xvi CONTENTS

The Big Picture: Cell Anatomy and the Whole Body, 84 Body Membranes, 155
Mechanisms of Disease, 85 Epithelial Membranes, 156
Case Study, 85 Connective Tissue Membranes, 157
The Big Picture: Tissues, Membranes,
CHAPTER 4 Physiology of Cells, 90 and the Whole Body, 158
Movement of Substances Through Mechanisms of Disease, 158
Cell Membranes, 91 Case Study, 162
Passive Transport Processes, 91
Active Transport Processes, 97
Cell Metabolism, 102
UNIT TWO Support
Role of Enzymes, 102
Catabolism, 105
and Movement, 169
Anabolism, 108
CHAPTER 7 Skin
The Big Picture: Cell Physiology
and the Whole Body, 108 and Its Appendages, 170
Mechanisms of Disease, 108 Structure of the Skin, 171
Case Study, 110 Thin and Thick Skin, 172
Epidermis, 173
CHAPTER 5 Cell Growth Dermoepidermal Junction, 176
Dermis, 176
and Reproduction, 113 Hypodermis, 178
Protein Synthesis, 114 Skin Color, 178
Deoxyribonucleic Acid (DNA), 114 Melanin, 178
Ribonucleic Acid (RNA), 115 Other Pigments, 180
Transcription, 116 Functions of the Skin, 181
Editing The Transcript, 116 Protection, 181
Translation, 117 Sensation, 182
Cell Growth, 121 Flexibility, 182
Production of Cytoplasm, 121 Excretion, 182
DNA Replication, 122 Hormone (Vitamin D) Production, 182
Cell Reproduction, 123 Immunity, 182
Mitosis, 123 Homeostasis of Body Temperature, 182
Meiosis, 124 Appendages of the Skin, 185
Regulating the Cell Life Cycle, 125 Hair, 185
Cycle of Life: Cells, 127 Nails, 186
The Big Picture: Cell Growth, Reproduction, and the Skin Glands, 187
Whole Body, 127 Cycle of Life: Skin, 188
Mechanisms of Disease, 127 The Big Picture: Skin and the Whole Body, 189
Mechanisms of Disease, 189
CHAPTER 6 Tissues, 131 Case Study, 195
Introduction to Tissues, 132
Principal Types of Tissue, 132 CHAPTER 8 Skeletal Tissues, 199
Extracellular Matrix, 134 Functions of Bone, 200
Epithelial Tissue, 135 Types of Bones, 200
Types and Locations of Epithelial Tissue, 135 Parts of a Long Bone, 202
Functions of Epithelial Tissue, 135 Parts of a Flat Bones and Other Bones, 203
Generalizations About Epithelial Tissue, 135 Bone Tissue, 203
Classification of Epithelial Tissue, 137 Composition of Bone Matrix, 203
Connective Tissue, 143 Microscopic Structure of Bone, 204
Functions of Connective Tissue, 143 Compact Bone, 204
Characteristics of Connective Tissue, 143 Cancellous Bone, 206
Classification of Connective Tissue, 144 Types of Bone Cells, 206
Fibrous Connective Tissue, 145 Bone Marrow, 207
Bone Tissue, 149 Regulation of Blood Calcium Levels, 208
Cartilage Tissue, 151 Mechanisms of Calcium Homeostasis, 208
Blood Tissue, 152 Development of Bone, 209
Muscle Tissue, 152 Intramembranous Ossification, 209
Nervous Tissue, 154 Endochondral Ossification, 210
Tissue Repair, 154 Bone Remodeling, 212
 CONTENTS xvii

Repair of Bone Fractures, 213 How Muscles Are Named, 308

Cartilage, 214 Hints on How to Deduce Muscle Actions, 311
Types of Cartilage, 214 Important Skeletal Muscles, 311
Function of Cartilage, 215 Muscles of Facial Expression, 312
Growth of Cartilage, 215 Muscles of Mastication, 313
Cycle of Life: Skeletal Tissues, 216 Muscles That Move the Head, 314
The Big Picture: Skeletal Tissues, 216 Trunk Muscles, 315
Mechanisms of Disease, 216 Muscles of the Thorax, 315
Muscles of the Abdominal Wall, 316
Case Study, 219
Muscles of the Back, 318
CHAPTER 9 Skeletal System, 223 Muscles of the Pelvic Floor, 320
Upper Limb Muscles, 322
Divisions of the Skeleton, 224 Muscles Acting on the Shoulder Girdle, 322
Axial Skeleton, 226 Muscles That Move the Upper Arm, 325
Skull, 226 Muscles That Move the Forearm, 326
Hyoid Bone, 243 Muscles That Move the Wrist, Hand, and Fingers, 329
Vertebral Column, 245
Lower Limb Muscles, 333
Sternum, 248
Muscles That Move the Thigh and Lower Leg, 333
Ribs, 248
Muscles That Move the Ankle and Foot, 340
Appendicular Skeleton, 250 Posture, 341
Upper Extremity, 250 How Posture Is Maintained, 341
Lower Extremity, 255 Cycle of Life: Muscular System, 342
Skeletal Differences Between Men and Women, 261 The Big Picture: Skeletal Muscles and the Whole Body, 342
Cycle of Life: Skeletal System, 262 Case Study, 344
The Big Picture: Skeletal System, 263
Mechanisms of Disease, 263 CHAPTER 12 Physiology
Case Study, 267
of the Muscular System, 347
CHAPTER 10 Articulations, 271 General Functions, 348
Classification of Joints, 272 Function of Skeletal Muscle Tissue, 348
Fibrous Joints (Synarthroses), 272 Overview of the Muscle Cell, 348
Cartilaginous Joints (Amphiarthroses), 272 Myofilaments, 352
Synovial Joints (Diarthroses), 274 Mechanism of Contraction, 352
Energy Sources for Muscle Contraction, 356
Representative Synovial Joints, 277
Humeroscapular Joint, 277 Function of Skeletal Muscle Organs, 360
Elbow Joint, 278 Motor Unit, 360
Forearm, Wrist, Hand, and Finger Joints, 279 Myography, 361
Hip Joint, 281 The Twitch Contraction, 361
Knee Joint, 281 Treppe: The Staircase Phenomenon, 362
Ankle Joint, 283 Tetanus, 362
Vertebral Joints, 285 Muscle Tone, 363
Types and Range of Movement at Synovial Joints, 286 The Graded Strength Principle, 364
Measuring Range of Motion, 286 Isotonic and Isometric Contractions, 366
Angular Movements, 291 Function of Cardiac and Smooth Muscle Tissue, 368
Circular Movements, 291 Cardiac Muscle, 368
Gliding Movements, 292 Smooth Muscle, 369
Special Movements, 292 The Big Picture: Muscle Tissue and the Whole Body, 371
Cycle of Life: Articulations, 292 Mechanisms of Disease, 372
The Big Picture: Articulations, 292 Case Study, 374
Mechanisms of Disease, 293
Case Study, 297
UNIT THREE Communication,
CHAPTER 11 Anatomy
of the Muscular System, 301 Control, and Integration, 379
Skeletal Muscle Structure, 302 CHAPTER 13 Nervous System Cells, 380
Connective Tissue Components, 302
Organization of the Nervous System, 382
Size, Shape, and Fiber Arrangement, 304
Central and Peripheral Nervous Systems, 382
Attachment of Muscles, 305
Afferent and Efferent Divisions, 383
Muscle Actions, 305
Somatic and Autonomic Nervous Systems, 383
Lever Systems, 306
xviii CONTENTS

Cells of the Nervous System, 383 Extrapyramidal Tracts, 450

Glia, 383 Cycle of Life: Central Nervous System, 451
Neurons, 387 The Big Picture: The Central Nervous System and the
Classification of Neurons, 390 Whole Body, 452
Reflex Arc, 391 Mechanisms of Disease, 452
Nerves and Tracts, 392 Case Study, 456
Repair of Nerve Fibers, 392
Nerve Impulses, 393 CHAPTER 15 Peripheral Nervous
Membrane Potentials, 393
Resting Membrane Potentials, 394 System, 463
Local Potentials, 395 Spinal Nerves, 464
Action Potential, 395 Structure of Spinal Nerves, 466
Refractory Period, 397 Nerve Plexuses, 466
Conduction of the Action Potential, 398 Dermatomes and Myotomes, 472
Synaptic Transmission, 399 Cranial Nerves, 473
Structure of the Synapse, 399 Olfactory Nerve (I), 474
Types of Synapses, 399 Optic Nerve (II), 474
Mechanisms of Synaptic Transmission, 401 Oculomotor Nerve (III), 474
Summation, 403 Trochlear Nerve (IV), 474
Synapses and Memory, 404 Trigeminal Nerve (V), 476
Neurotransmitters, 404 Abducens Nerve (VI), 477
Classification of Neurotransmitters, 404 Facial Nerve (VII), 477
Acetylcholine, 406 Vestibulocochlear Nerve (VIII), 478
Amines, 406 Glossopharyngeal Nerve (IX), 479
Amino Acids, 408 Vagus Nerve (X), 479
Other Small-Molecule Transmitters, 408 Accessory Nerve (XI), 480
Neuropeptides, 408 Hypoglossal Nerve (XII), 480
Role of Nervous System Cells, 410 Somatic Motor Nervous System, 481
Cycle of Life: Nervous System Cells, 411 Divisions of the Peripheral Nervous System, 481
The Big Picture: Nervous System Cells and the Whole The Big Picture: Peripheral Nervous System and the
Body, 411 Whole Body, 483
Mechanisms of Disease, 411 Case Study, 484
Case Study, 414
CHAPTER 16 Autonomic Nervous
CHAPTER 14 Central Nervous System, 488
System, 420 Overview of the Autonomic Nervous System, 489
Role of the Autonomic Nervous System, 489
Coverings of the Brain and Spinal Cord, 421
Divisions of the Autonomic Nervous System, 490
Cerebrospinal Fluid, 424
Structure of the Autonomic Nervous System, 490
Fluid Spaces, 424
Basic Plan of Autonomic Pathways, 490
Formation and Circulation of Cerebrospinal Fluid, 424
Structure of the Sympathetic Pathways, 490
Spinal Cord, 426 Structure of the Parasympathetic Pathways, 492
Structure of the Spinal Cord, 426 Autonomic Neurotransmitters and Receptors, 494
Functions of the Spinal Cord, 427
Functions of the Autonomic Nervous System, 498
Brain, 429 Overview of Autonomic Function, 498
Structure of the Brainstem, 429 Functions of the Sympathetic Division, 499
Functions of the Brainstem, 432 Functions of the Parasympathetic Division, 501
Structure of the Cerebellum, 432
The Big Picture: Autonomic Nervous System
Functions of the Cerebellum, 433
Diencephalon, 434
and the Whole Body, 501
Structure of the Cerebrum, 437 Case Study, 502
Functions of the Cerebral Cortex, 440
Consciousness, 443 CHAPTER 17 Sense Organs, 505
Language, 444 Sensory Receptors, 506
Emotions, 444 Receptor Response, 506
Memory, 445 Distribution of Receptors, 506
Somatic Sensory Pathways in the Central Nervous Classification of Receptors, 507
System, 448 Classification by Location, 507
Somatic Motor Pathways in the Central Nervous Classification by Stimulus Detected, 507
System, 449 Classification by Structure, 507
Pyramidal Tracts, 450 Sense of Smell, 513
 CONTENTS xix

Olfactory Receptors, 513 The Big Picture: The Endocrine System and the Whole
Olfactory Pathway, 515 Body, 587
Sense of Taste, 516 Mechanisms of Disease, 587
Taste Buds, 516 Case Study, 590
Neural Pathway for Taste, 517
Senses of Hearing and Balance: The Ear, 517
External Ear, 518 UNIT FOUR Transportation
Middle Ear, 519
Inner Ear, 519 and Defense, 597
Vision: The Eye, 524
Structure of the Eye, 524 CHAPTER 20 Blood, 598
The Process of Seeing, 529 Composition of Blood, 599
Cycle of Life: Sense Organs, 534 Blood Volume, 599
The Big Picture: Sense Organs, 534 Formed Elements of Blood, 600
Mechanisms of Disease, 534 Red Blood Cells (Erythrocytes), 601
Case Study, 539 White Blood Cells (Leukocytes), 605
Platelets, 608
CHAPTER 18 Endocrine System, 545 Blood Types (Blood Groups), 609
The ABO System, 609
Organization of the Endocrine System, 546 The Rh System, 610
Hormones, 547 Blood Plasma, 613
Classification of Hormones, 547
How Hormones Work, 550
Blood Clotting (Coagulation), 613
Mechanism of Blood Clotting, 614
Regulation of Hormone Secretion, 553
Conditions That Oppose Clotting, 617
Regulation of Target Cell Sensitivity, 555
Conditions That Hasten Clotting, 617
Prostaglandins, 556 Clot Dissolution, 618
The Big Picture: The Endocrine System and the Whole The Big Picture: Blood and the Whole Body, 619
Body, 569
Mechanisms of Disease, 619
Mechanisms of Disease, 569
Case Study, 625
Case Study, 573
CHAPTER 21 Anatomy
CHAPTER 19 Endocrine Glands, 563
Pituitary Gland, 564 of the Cardiovascular System, 629
Structure of the Pituitary Gland, 564 Heart, 630
Adenohypophysis (Anterior Lobe of Pituitary), 564 Location of the Heart, 630
Neurohypophysis (Posterior Lobe of Pituitary), 570 Size and Shape of the Heart, 630
Pineal Gland, 571 Coverings of the Heart, 634
Thyroid Gland, 572 Structure of the Heart, 635
Structure of the Thyroid Gland, 572 Blood Vessel Types, 642
Thyroid Hormone, 572 Arteries, 642
Calcitonin, 574 Capillaries, 644
Parathyroid Glands, 575 Veins, 645
Structure of the Parathyroid Glands, 575 Structure of Blood Vessels, 645
Parathyroid Hormone, 576 Major Blood Vessels, 647
Adrenal Glands, 577 Circulatory Routes, 647
Structure of the Adrenal Glands, 577 Systemic Circulation, 648
Adrenal Cortex, 578 Cycle of Life: Cardiovascular Anatomy, 669
Adrenal Medulla, 580 The Big Picture: Cardiovascular Anatomy
Pancreatic Islet, 580 and the Whole Body, 669
Structure of the Pancreatic Islets, 580 Mechanisms of Disease, 669
Pancreatic Hormones, 582 Case Study, 676
Gonads, 584
Testes, 584 CHAPTER 22 Physiology
Ovaries, 585
Placenta, 585
of the Cardiovascular System, 681
Thymus, 585 Hemodynamics, 682
Gastric and Intestinal Mucosa, 586 The Heart as a Pump, 683
Conduction System of the Heart, 683
Heart, 586
Electrocardiogram (ECG), 684
Other Endocrine Glands and Hormones, 586 Cardiac Cycle, 687
Cycle of Life: Endocrine System, 586 Heart Sounds, 689
xx CONTENTS

Primary Principle of Circulation, 690 Phagocytosis, 752

Arterial Blood Pressure, 691 Natural Killer Cells, 753
Cardiac Output, 691 Interferon, 755
Peripheral Resistance, 695 Complement, 755
Venous Return to the Heart, 701 Toll-like Receptors, 755
Venous Pumps, 701 Overview of Adaptive Immunity, 756
Total Blood Volume, 702 B Cells and Antibody-Mediated Immunity, 758
Measuring Blood Pressure, 705 Development and Activation of B Cells, 758
Arterial Blood Pressure, 705 Antibodies (Immunoglobulins), 758
Blood Pressure and Bleeding, 707 Clonal Selection Theory, 764
Minute Volume of Blood, 707 T Cells and Cell-Mediated Immunity, 764
Velocity of Blood Flow, 708 Development of T Cells, 764
Activation and Functions of T Cells, 764
Pulse, 709
Mechanism, 709 Types of Adaptive Immunity, 768
Pulse Wave, 709 Summary of Adaptive Immunity, 769
Where the Pulse Can Be Felt, 710 The Big Picture: Immune System
Venous Pulse, 711 and the Whole Body, 772
Cycle of Life: Cardiovascular Physiology, 711 Mechanisms of Disease, 772
The Big Picture: Blood Flow and the Whole Body, 712 Case Study, 777
Mechanisms of Disease, 712
Case Study, 716 CHAPTER 25 Stress, 782
Selye’s Concept of Stress, 783
CHAPTER 23 Lymphatic System, 722 Development of the Stress Concept, 783
Overview of the Lymphatic System, 723 Definitions, 784
Lymph and Interstitial Fluid, 724 Stressors, 784
Lymphatic Vessels, 724 General Adaptation Syndrome, 784
Distribution of Lymphatic Vessels, 724 Mechanism of Stress, 786
Structure of Lymphatic Vessels, 725 Some Current Concepts About Stress, 788
Functions of Lymphatic Vessels, 725 Definitions, 788
Circulation of Lymph, 726 Stress Syndrome, 788
The Lymphatic Pump, 727 Stress and Disease, 788
Indicators of Stress, 790
Lymph Nodes, 728
Corticoids and Resistance to Stress, 790
Structure of Lymph Nodes, 728
Psychological Stress, 790
Locations of Lymph Nodes, 729
Effects of Intrauterine Stress, 792
Functions of Lymph Nodes, 730
The Big Picture: Stress and the Whole Body, 793
Lymphatic Drainage of the Breast, 732
Distribution of Lymphatics in the Breast, 732 Case Study, 794
Lymph Nodes Associated with the Breast, 733
Tonsils, 733
Thymus, 734
UNIT FIVE Respiration,
Location and Appearance of the Thymus, 734 Nutrition, and Excretion, 797
Structure of the Thymus, 734
Function of the Thymus, 734 CHAPTER 26 Anatomy of the
Spleen, 735
Location of the Spleen, 735 Respiratory System, 798
Structure of the Spleen, 735 Structural Plan of the Respiratory System, 799
Functions of the Spleen, 735 Upper Respiratory Tract, 800
Cycle of Life: Lymphatic System, 737 Nose, 800
The Big Picture: Lymphatic System and the Whole Pharynx, 802
Body, 737 Larynx, 803
Mechanisms of Disease, 738 Lower Respiratory Tract, 807
Case Study, 741 Trachea, 807
Bronchi and Alveoli, 808
CHAPTER 24 Immune System, 745 Lungs, 812
Thorax, 814
Organization of the Immune System, 746 Cycle of Life: Respiratory System, 816
Innate Immunity, 748 The Big Picture: Anatomy of the Respiratory System, 816
Species Resistance, 748
Mechanisms of Disease, 816
Mechanical and Chemical Barriers, 748
Inflammation and Fever, 749 Case Study, 820
 CONTENTS xxi

CHAPTER 27 Physiology Structure of the Gallbladder, 885

Functions of the Gallbladder, 885
of the Respiratory System, 823 Pancreas, 886
Respiratory Physiology, 824 Size and Location of the Pancreas, 886
Pulmonary Ventilation, 824 Structure of the Pancreas, 886
Mechanism of Pulmonary Ventilation, 824 Functions of the Pancreas, 886
Pulmonary Volumes and Capacities, 831 Cycle of Life: Digestive System, 887
Pulmonary Gas Exchange, 838 The Big Picture: Anatomy
Partial Pressure, 838 of the Digestive System, 888
Exchange of Gases in the Lungs, 839 Mechanisms of Disease, 888
How Blood Transports Gases, 841 Case Study, 897
Hemoglobin, 842
Transport of Oxygen, 842 CHAPTER 29 Physiology
Transport of Carbon Dioxide, 844
Systemic Gas Exchange, 846 of the Digestive System, 901
Regulation of Pulmonary Function, 848 Overview of Digestive Function, 902
Respiratory Control Centers, 848 Digestion, 904
Factors That Influence Breathing, 849 Mechanical Digestion, 904
Ventilation and Perfusion, 852 Chemical Digestion, 908
The Big Picture: Respiratory Physiology Secretion, 914
and the Whole Body, 853 Saliva, 914
Mechanisms of Disease, 854 Gastric Juice, 914
Case Study, 857 Pancreatic Juice, 916
Bile, 916
CHAPTER 28 Anatomy Intestinal Juice, 917
Control of Digestive Gland Secretion, 918
of the Digestive System, 861 Control of Salivary Secretion, 918
Organization of the Digestive System, 862 Control of Gastric Secretion, 918
Organs of Digestion, 862 Control of Pancreatic Secretion, 920
Wall of the GI Tract, 862 Control of Bile Secretion, 920
Mouth, 864 Control of Intestinal Secretion, 920
Structure of the Oral Cavity, 864 Absorption, 921
Salivary Glands, 867 Process of Absorption, 921
Teeth, 868 Mechanisms of Absorption, 921
Pharynx, 870 Elimination, 924
Esophagus, 870 The Big Picture: Digestion and the Whole Body, 925
Stomach, 872 Case Study, 927
Size and Position of the Stomach, 872
Divisions of the Stomach, 872 CHAPTER 30 Nutrition
Curves of the Stomach, 872
Sphincter Muscles, 872
and Metabolism, 931
Stomach Wall, 873 Overview of Nutrition and Metabolism, 932
Functions of the Stomach, 874 Carbohydrates, 934
Small Intestine, 875 Dietary Sources of Carbohydrates, 934
Size and Position of the Small Intestine, 875 Carbohydrate Metabolism, 934
Divisions of the Small Intestine, 878 Lipids, 946
Wall of the Small Intestine, 879 Dietary Sources of Lipids, 946
Large Intestine, 877 Transport of Lipids, 947
Size of the Large Intestine, 877 Lipid Metabolism, 947
Divisions of the Large Intestine, 878 Proteins, 948
Wall of the Large Intestine, 879 Sources of Proteins, 948
Vermiform Appendix, 879 Protein Metabolism, 949
Peritoneum, 880 Vitamins and Minerals, 952
Liver, 882 Vitamins, 952
Location and Size of the Liver, 882 Minerals, 953
Liver Lobes and Lobules, 882 Metabolic Rates, 955
Bile Ducts, 884 Basal Metabolic Rate, 955
Functions of the Liver, 884 Total Metabolic Rate, 958
Gallbladder, 885 Energy Balance and Body Weight, 958
Size and Location of the Gallbladder, 885 Mechanisms for Regulating Food Intake, 958
xxii CONTENTS

Cycle of Life: Nutrition and Metabolism, 960 Types of pH Control Mechanisms, 1027
The Big Picture: Nutrition, Metabolism, Effectiveness of pH Control Mechanisms—Range of pH, 1028
and the Whole Body, 960 Buffer Mechanisms for Controlling pH
Mechanisms of Disease, 961 of Body Fluids, 1028
Case Study, 965 Buffers Defined, 1028
Buffer Pairs Present in Body Fluids, 1028
CHAPTER 31 Urinary System, 970 Buffer Actions That Prevent Marked Changes in pH
of Body Fluids, 1028
Anatomy of the Urinary System, 971 Evaluation of the Role of Buffers in pH Control, 1032
Gross Structure, 971 Respiratory Mechanisms of pH Control, 1032
Microscopic Structure, 976 Explanation of Respiratory Mechanisms, 1032
Physiology of the Urinary System, 982 Respirations’ Adjustment to Counter pH Imbalance
Overview of Kidney Function, 982 of Arterial Blood, 1032
Filtration, 982 Principles That Relate Respirations to pH Value, 1032
Reabsorption, 984 Urinary Mechanisms That Control pH, 1032
Tubular Secretion, 989 General Principles Concerning
Regulation of Urine Volume, 989 Urinary Mechanisms, 1033
Urine Composition, 992 Mechanisms That Control Urine pH, 1034
Cycle of Life: Urinary System, 993 The Big Picture: Acid-Base Balance, 1036
The Big Picture: Urinary System Mechanisms of Disease, 1036
and the Whole Body, 993
Case Study, 1039
Mechanisms of Disease, 994
Case Study, 999
UNIT SIX Reproduction
CHAPTER 32 Fluid
and Electrolyte Balance, 1003
and Development, 1043
Interrelationship of Fluid and Electrolyte Balance, 1004 CHAPTER 34 Male
Total Body Water, 1004
Body Fluid Compartments, 1005
Reproductive System, 1044
Sexual Reproduction, 1045
Chemical Content, Distribution, and Measurement
of Electrolytes in Body Fluids, 1005 Male Reproductive Organs, 1045
Extracellular vs. Intracellular Fluids, 1006 Perineum, 1046
Measuring Electrolyte Reactivity, 1007 Testes, 1046
Avenues by Which Water Enters and Leaves Structure and Location, 1046
Microscopic Anatomy of the Testis, 1047
the Body, 1009
Testes Functions, 1048
Some General Principles About Fluid Balance, 1009 Spermatozoa, 1050
Mechanisms That Maintain Homeostasis of Total Fluid Reproductive Ducts, 1051
Volume, 1010 Epididymis, 1051
Regulation of Fluid Intake, 1010 Vas Deferens, 1051
Regulation of Urine Volume, 1010 Ejaculatory Duct, 1052
Factors That Alter Fluid Loss Urethra, 1052
Under Abnormal Conditions, 1012
Accessory Reproductive Glands, 1053
Regulation of Water and Electrolyte Levels in Plasma Seminal Vesicles, 1053
and Interstitial Fluid, 1012 Prostate Gland, 1053
Edema, 1015 Bulbourethral Glands, 1054
Regulation of Water and Electrolyte Levels Supporting Structures, 1054
in ICF, 1016 Scrotum, 1054
Regulation of Sodium and Potassium Levels Penis, 1054
in Body Fluids, 1017 Spermatic Cords, 1055
Cycle of Life: Fluid and Electrolyte Balance, 1018 Composition and Course of Seminal Fluid, 1055
The Big Picture: Fluid and Electrolyte Balance, 1019 Male Fertility, 1055
Mechanisms of Disease, 1019 Cycle of Life: Male Reproductive System, 1056
Case Study, 1021 The Big Picture: Male Reproductive System, 1057
Mechanisms of Disease, 1057
CHAPTER 33 Acid-Base Balance, 1025 Case Study, 1059
Mechanisms That Control pH of Body Fluids, 1025
Review of the pH Concept, 1025
Sources of pH-Influencing Elements, 1027
 CONTENTS xxiii

CHAPTER 35 Female Formation of the Primary Germ Layers, 1111

Histogenesis and Organogenesis, 1111
Reproductive System, 1063 Birth, or Parturition, 1114
Overview of the Female Reproductive System, 1064 Stages of Labor, 1115
Function of the Female Reproductive System, 1064 Multiple Births, 1115
Structural Plan of the Female Reproductive System, 1064 Postnatal Period, 1116
Perineum, 1065 Infancy, 1116
Ovaries, 1066 Childhood, 1117
Location of the Ovaries, 1066 Adolescence and Adulthood, 1118
Microscopic Structure of the Ovaries, 1066 Older Adulthood and Senescence, 1118
Functions of the Ovaries, 1068 Effects of Aging, 1120
Uterus, 1068 Skeletal System, 1120
Structure of the Uterus, 1068 Muscular System, 1120
Functions of the Uterus, 1070 Integumentary System (Skin), 1120
Uterine Tubes, 1070 Urinary System, 1121
Location of the Uterine Tubes, 1070 Respiratory System, 1121
Structure of the Uterine Tubes, 1070 Cardiovascular System, 1122
Function of the Uterine Tubes, 1071 Special Senses, 1122
Reproductive Systems, 1122
Vagina, 1071
Benefits of Aging, 1122
Location of the Vagina, 1071
Structure of the Vagina, 1072 Causes of Death, 1122
Functions of the Vagina, 1072 The Big Picture: Growth, Development,
Vulva, 1072 and the Whole Body, 1123
Structure of the Vulva, 1072 Mechanisms of Disease, 1124
Functions of the Vulva, 1074 Case Study, 1126
Female Reproductive Cycles, 1074
Recurring Cycles, 1074 CHAPTER 37 Genetics
Control of Female Reproductive Cycles, 1076
Importance of Female Reproductive Cycles, 1079
and Heredity, 1131
Infertility and Use of Fertility Drugs, 1081 The Science of Genetics, 1132
Menarche and Menopause, 1081 Chromosomes and Genes, 1132
Breasts, 1082 Mechanism of Gene Function, 1132
Location and Size of the Breasts, 1082 The Human Genome, 1133
Structure of the Breasts, 1082 Distribution of Chromosomes to Offspring, 1135
Function of the Breasts, 1084 Gene Expression, 1136
Cycle of Life: Female Reproductive System, 1085 Hereditary Traits, 1136
The Big Picture: Female Reproductive System Sex-Linked Traits, 1138
and the Whole Body, 1086 Genetic Mutations, 1140
Mechanisms of Disease, 1086 Medical Genetics, 1141
Mechanisms of Genetic Diseases, 1141
Case Study, 1092
Single-Gene Diseases, 1142
Chromosomal Diseases, 1144
CHAPTER 36 Growth Genetic Basis of Cancer, 1145
and Development, 1096 Prevention and Treatment of Genetic Diseases, 1146
A New Human Life, 1097 Genetic Counseling, 1146
Production of Sex Cells, 1097 Treating Genetic Diseases, 1148
Ovulation and Insemination, 1101 The Big Picture: Genetics, Heredity, and the Whole
Fertilization, 1101 Body, 1149
Prenatal Period, 1103 Case Study, 1151
Cleavage and Implantation, 1103
Placenta, 1105
Periods of Development, 1107 Glossary, G-1
Stem Cells, 1110 Index, I-1
Color Key
BIOCHEMISTRY

C Carbon D Aspartic Acid Y Tyrosine

Cl Chloride C Cysteine V Valine

Energy Energy G Glycine H2O Water

ATP ATP E Glutamic Acid Hormone

H Hydrogen Q Glutamine Enzyme

N Nitrogen H Histidine Protein

O Oxygen I Isoleucine Carbohydrate

K Potassium L Leucine Fatty acid

DNA,
Na Sodium K Lysine
Nucleic Acid

A
G

C
S Sulfur M Methionine RNA

Ca Calcium F Phenylalanine C Cytosine

P Organic P Proline A Adenine

Phosphate

Inorganic
Pi U Selenocysteine G Guanine
Phosphate

A Alanine S Serine T
Thymine /
Uracil

R Arginine T Threonine Chromosome

N Asparagine W Tryptophan