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HOLE’S
HUMAN
ANATOMY&
PHYSIOLOGY
F I F T E E N T H E D I T I O N

DAVID SHIER
E M E R I T U S FAC U LT Y,
WA S H T E N AW CO M M U N I T Y CO L L E G E

JACKIE BUTLER
G R AYS O N CO L L E G E

RICKI LEWIS
A L D E N M A RC H B I O E T H I C S I N S T I T U T E

D I G ITA L AUTH O R S

LESLIE DAY
NORTHEASTERN UNIVERSIT Y

JULIE PILCHER
UNIVERSIT Y OF SOUTHERN INDIANA
HOLE’S HUMAN ANATOMY & PHYSIOLOGY, FIFTEENTH EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2019 by ­
McGraw-Hill Education. All rights reserved. Printed in the United States of America. Previous editions
© 2016, 2013, and 2010. No part of this publication may be reproduced or distributed in any form or by
any means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill
Education, including, but not limited to, in any network or other electronic storage or transmission, or
broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the
United States.

This book is printed on acid-free paper.

1 2 3 4 5 6 7 8 9 LWI 21 20 19 18

ISBN 978-1-259-86456-8
MHID 1-259-86456-1

Executive Brand Manager: Amy Reed

Product Developer: Michelle Gaseor
Marketing Manager: James Connely
Content Project Managers: Jane Mohr, Christina Nelson, and Sandra Schnee
Buyer: Sandy Ludovissy
Design: Tara McDermott
Content Licensing Specialist: Lori Hancock
Cover Image: ©Tim Tadder/Getty Images
Compositor: SPi Global

All credits appearing on page are considered to be an extension of the copyright page.

Library of Congress Cataloging-in-Publication Data

Names: Shier, David, author. | Butler, Jackie, author. | Lewis, Ricki, author.
Title: Hole’s human anatomy & physiology / DAVID SHIER, Emeritus Faculty,
Washtenaw Community College, Jackie Butler, Grayson College, Ricki Lewis,
Alden March Bioethics Institute ; digital authors Leslie Day, Northeastern
University, Julie Pilcher, University of Southern Indiana.
Other titles: Hole’s human anatomy and physiology | Human anatomy & physiology
Description: Fifteenth edition. | New York, NY : McGraw-Hill Education,
[2019] | Includes index.
Identifiers: LCCN 2017025439 | ISBN 9781259864568 (alk. paper)
Subjects: LCSH: Human physiology. | Human anatomy.
Classification: LCC QP34.5 .S49 2019 | DDC 612--dc23 LC record available at https://lccn.loc.
gov/2017025439

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website
does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education
does not guarantee the accuracy of the information presented at these sites.

mheducation.com/highered
BRIEF CONTENTS
About the Authors   vi | Acknowledgments   viii | Updates and Additions   ix | Dynamic Art Program   xvi |
Learn, Practice, Assess   xviii | McGraw-Hill Connect   xx | LearnSmart Prep   xxii | Contents   xxiii | Connections   xxviii

PREVIEW UNIT 4
TRANSPORT 529

Foundations for Success 1 14 Blood 529

15 Cardiovascular System 558
16 Lymphatic System and Immunity 618
UNIT 1
LEVELS OF ORGANIZATION 9
UNIT 5
1 Introduction to Human Anatomy and ABSORPTION AND EXCRETION 651
Physiology 9
2 Chemical Basis of Life 59 17 Digestive System 651
3 Cells 84 18 Nutrition and Metabolism 696
4 Cellular Metabolism 122 19 Respiratory System 731
5 Tissues 149 20 Urinary System 769
21 Water, Electrolyte, and Acid-Base
Balance 804

UNIT 2
SUPPORT AND MOVEMENT 178 UNIT 6
THE HUMAN LIFE CYCLE 824
6 Integumentary System 178
7 Skeletal System 200 22 Reproductive Systems 824
8 Joints of the Skeletal System 268 23 Pregnancy, Growth, and Development 868
9 Muscular System 292 24 Genetics and Genomics 907

Appendices 927
UNIT 3
Glossary 940
INTEGRATION AND COORDINATION 359
Index 963
10 Nervous System I: Basic Structure and
Function 359
11 Nervous System II: Divisions of the
Nervous System 389
12 Nervous System III: Senses 444
13 Endocrine System 489

v
ABOUT the AUTHORS

Courtesy of Fran Simon Courtesy of Michael’s Photography Courtesy of Dr. Wendy Josephs

DAVID SHIER JACKIE BUTLER RICKI LEWIS

Emeritus Faculty Grayson College Alden March Bioethics Institute
Washtenaw Community College Jackie Butler’s professional background Ricki Lewis’s career communicating science
David Shier has more than thirty years of expe- includes work at the University of Texas Health began with earning a Ph.D. in Genetics from
rience teaching anatomy and physiology, pri- Science Center conducting research about the Indiana University in 1980. It quickly blos-
marily to premedical, nursing, dental, and allied genetics of bilateral retinoblastoma. She later somed into writing for newspapers and maga-
health students. He has effectively incorporated worked at MD Anderson Hospital investigat- zines, and writing the introductory textbook
his extensive teaching experience into another ing remission in leukemia patients. A popular Life. Since then she has taught a variety of life
student-friendly revision of Hole’s Essentials educator for more than thirty years at Grayson science courses and has authored the textbook
of Human Anatomy and Physiology and Hole’s College, Jackie has taught microbiology and Human Genetics: Concepts and Applications
Human Anatomy and Physiology. His interest human anatomy and physiology for health sci- and books about gene therapy, stem cells, and
in physiology and teaching began with a job as ence majors. Her experience and work with stu- scientific discovery. She is a genetic counselor
a research assistant at Harvard Medical School dents of various educational backgrounds have for a large medical practice, teaches a graduate
from 1976–1979. He completed his Ph.D. at the contributed significantly to another revision of online course in “Genethics” at Albany Medi-
University of Michigan in 1984, and served on Hole’s Essentials of Human Anatomy and Phys- cal College, and writes for Medscape Medical
the faculty of the Medical College of Ohio from iology and Hole’s Human Anatomy and Physi- News, Genetic Literacy Project, Rare Disease
1985–1989. He began teaching at Washtenaw ology. Jackie Butler received her B.S. and M.S. Report, and medical journals. Ricki also writes
Community College in 1990. David has experi- degrees from Texas A&M University, focusing the popular DNA ­Science blog at Public Library
ence in online course delivery, including record- on microbiology, including courses in immunol- of Science and is a frequent public speaker.
ing lectures for so-called “flipped” classrooms. ogy and epidemiology.
He has also been interested in the relationship
between pedagogy and assessment, and the use
of tools traditionally associated with assessment
(e.g., lab quizzes) as pedagogical tools, often
associated with group activities.

vi
DIGITAL AUTHORS

Courtesy of Leslie Day Courtesy of Gary Pilcher

LESLIE DAY JULIE C. PILCHER

Northeastern University University of Southern Indiana
Leslie Day earned her B.S. in Exercise Physi- Julie Pilcher began teaching during her gradu-
ology from UMass Lowell, a M.S. in Applied ate training in Biomedical Sciences at Wright
­Anatomy & Physiology from Boston Univer- State University, Dayton, Ohio, while working
sity, and a Ph.D. in Biology from Northeastern on her doctorate in cardiovascular physiology.
University with her research on the kinematics She found that working as a teaching assistant
of locomotion. She currently works as an Asso- held her interest more than her research. Upon
ciate Clinical Professor in the Department of completion of her Ph.D. in 1986, she embarked
Physical Therapy, Movement and Rehabilitation on her teaching career, working for many years
Sciences at Northeastern University. Her main as an adjunct in a variety of schools in St. Louis
teaching role is in Gross Anatomy and Neuro- and Detroit. The courses she taught included
anatomy courses. Students enjoy her clinical Microbiology, General Biology, and Anatomy
teaching style, use of technology, and innovative and Physiology. In 1998 she began teaching
teaching methods. She has received the Uni- Anatomy and Physiology full-time at the Uni-
versity Teaching with Technology award three versity of Southern Indiana, Evansville, even-
times and in 2009 was awarded the Excellence tually serving as coordinator for the course.
in Teaching award. In 2017 she received national Her work with McGraw-Hill began with doing
recognition for her teaching by being the recipi- reviews of textbook chapters and lab manuals.
ent of the ADInstruments Sam Drogo Technol- Later she was involved in writing content during
ogy in the Classroom award from the Human the early stages of LearnSmart development for
Anatomy & Physiology Society (HAPS). Her several anatomy and physiology texts. Her peda-
current research focuses on the effectiveness gogical interests include use of online assess-
of different teaching pedagogies on students’ ment materials and development of a flipped
motivation and learning, including the flipped- classroom.
classroom and various technologies.

vii
ACKNOWLEDGMENTS
Any textbook is the result of hard work by a large team. Although Christina Nelson, Sandy Ludovissy, Tara McDermott, Sandy
we directed the revision, many “behind-the scenes” people Schnee, and Lori Hancock: and most of all, John Hole, for giving
at McGraw-Hill were indispensable to the project. We would us the opportunity and freedom to continue his classic work. We
like to thank Thomas Timp, Amy Reed, Fran Simon, Michelle especially thank our wonderfully patient families for their support.
­Gaseor, Joan Weber, Katie Ward, Michael Koot, Tammy Ben,
David Shier, Jackie Butler, Ricki Lewis
Jim Connely, Kristine Rellihan, Angie Fitzpatrick, Jayne Klein,

REVIEWERS
We would like to acknowledge the valuable contributions of all professors and their students who have provided detailed recommendations
for improving chapter content and illustrations throughout the revision process for each edition. They have played a vital role in building a
solid foundation for Hole’s Human Anatomy & Physiology.

Jaysen C. Arno, Pitt Community College Jennifer Holloway, Faulkner State Community College
Sharon R. Barnewall, Columbus State Community College Carol Johnson, Lone Star College North Harris
Cathy Bill, MS, DVM, Columbus State Community College Mary Kananen, Penn State University Altoona
Jennifer M. Boalick, Guilford Technical Community College Dr. Craig Lafferty, Arkansas State University Mid-South
Janet Brodsky, Ivy Tech Community College, Lafayette Rosario Murdie, Ivy Tech Community College
Dr. Jack Brown, EdD, Paris Junior College Ivan Paul, John Wood Community College
James Cain, Aurora University Mary Leigh Poole, Holmes Community College Goodman
Susan Caley Opsal, Illinois Valley Community College Letha Richards, Coahoma Community College
Natalia V. Chugunov, MD, Ivy Tech Community College, Michelle Scanavino, Moberly Area Community College
South Bend Marilyn Shopper, Johnson County Community College
Paula Edgar, John Wood Community College Dr. Melanie Shorter Cooper, Fayetteville State University
Georgia Everett, Ivy Tech Community College, Kokomo Ester Siegfried, Penn State University Altoona
Sharon Feaster, Hinds Community College Sanjay Tiwary, Hinds Community College Jackson
Dr. Alana Gabler, Southwest Mississippi Community College Dr. Nancy Tress, University of Pittsburgh at Titusville
Emily K. Getty, M.Sci.Ed, Ivy Tech Community College Janice Webster, Ivy Tech Community College
Andrew Goliszek, Ph.D., North Carolina A&T State University Scott Rahschulte, Ivy Tech Community College
Janelle Green, KCTCS Hazard Community and Technical College Koushik Roy, Southwest TN Community College
Ray Hawkins, ASU Mid-South Community College Albert Urazaev, Ivy Tech Community College

DEDICATION
This book is dedicated with much affection and appreciation to our families, our students, and in particular to Fran Simon and Jayne Klein,
whose leadership and support continue to bring out the best from the authors with whom they work.

viii
UPDATES AND ADDITIONS
Global Changes ∙ Existing Reconnect and A Glimpse Cell Membrane Mechanisms, Cell-to-
Ahead features now relate back Cell Communication, Feedback Loops,
∙ LEARN, PRACTICE, and ASSESS
to a new section, Core Themes in Balance, Energy Processes).
components have been clearly
identified throughout the text.
Anatomy and Physiology, in chapter 1. ∙ Reconnect and A Glimpse Ahead refer
A short paragraph highlights the to specific subsections rather than to
∙ Small boxes have been integrated into connection to Key Concepts (The Cell, pages, providing a broader context for
the text flow or into big boxes (Clinical Internal Environment, Homeostasis students.
Application, From Science to Technology). Interdependency of Cells, Structure and ∙ Longer paragraphs have been broken
∙ Learning Outcomes have been moved Function) and Underlying Mechanisms up to better suit today’s learner.
to their respective sections throughout and Processes (Gradients and
each chapter. Permeability, Cellular Differentiation,
SELECTED SPECIFIC CHANGES

SELECTED SPECIFIC CHANGES AT-A-GLANCE

Chapter Topic Change Rationale
1 Common themes in anatomy and New section 1.4 Clarity, reinforcement of basic
physiology principles

1 Life and the maintenance of life Old sections 1.4 and 1.5 combined as 1.5 Minimize change in chapter flow with
addition of section 1.4

1 Homeostasis Rewritten section on control mechanisms and Clarity, detail

feedback loops

1 Homeostasis Rewritten discussion of positive feedback. New Clarity, detail, visual support
fig. 1.8a and b on positive feedback (previous 1.8
combined with 1.7 as 1.7b)

1 Organization of the human body Rewritten description of the mediastinum Clarity, accuracy

1 Organ systems Introduction of the term innervated early on Clarity

1 Relative position Introduction of combined terms, such as Clarity, detail

anterolateral

2 Atoms and elements Text rewritten and an explanation of criteria for Clarity, accuracy
natural occurring elements added to Appendix D

2 Ionic bonds Text rewritten Accuracy

2 Acidosis and alkalosis Rewritten description of examples Clarity

2 Water Discussion of solvent, solute, and solution added Clarity

2 Lipids The term triglycerides used preferentially to fats Clarity, accuracy

2 Protein structure Amino acid sequence defined in context Clarity

2 Protein Structure Fig. 2.19, placement of enlargement arrow changed Clarity

3 Microscopy Comparison of LM, TEM, SEM moved from small box Style change
to fig. 3.4 legend

3 Microscopy Fig. 3.3 (white man in white coat at TEM) dropped Delete stereotype

3 Other cellular structures Reordered text and figures so that components Logic, clarity
(microtubules, microfilaments, intermediate filaments)
precede structures (centrosomes, cilia, flagella)

3 Movements into and out of cell First paragraph distinguishes mechanisms by energy Clarity
use or not rather than physical or physiological

—Continued

ix
UPDATES and ADDITIONS

SELECTED SPECIFIC CHANGES AT-A-GLANCE —Continued

Chapter Topic Change Rationale
3 Fig. 3.24b Replaced shrunken RBC Detail

3 Mitosis New Glimpse Ahead and text stress 23 Clarity

chromosome pairs adding up to 46 and replicated
vs. unreplicated chromosomes

4 Intro New first two sentences place anabolism and Clarity

catabolism into context

4 Triglyceride/fat terminology Triglyceride primary term Accuracy

4 Protein synthesis Series of figures redone Clarity

4 Cofactors + coenzymes Added coverage of coenzyme Q10 Familiarity

4 Cellular respiration Theoretical maximum ATP = 30–32 Accuracy

4 Mutations Fewer disease examples to better focus concepts Clarity

5 Connective Tissue Added new line art, micrograph, and locator icon for Clarity
dense irregular connective tissue

5 Connective tissue Revised discussion of bone tissue Clarity

6 Clinical Application, Tanning and Changed the “e” in the ABCDE rule to evolution Accuracy
Skin Cancer (change)

6 Skin color Added the terms eumelanin and pheomelanin to Clarity, detail
the discussion

6 Fig. 6.12 Body temperature Changed muscle activity generates heat to skeletal Clarity
regulation muscle activity generates heat

7 Bone Growth and Development Put the definition of ossification in the first Clarity
paragraph of the section

7 Radiograph of epiphyseal plates Moved to the first mention of epiphyseal plates Clarity

7 Clinical Application, Preventing Revised Update

Fragility Fractures

8 Joint movements Added photos demonstrating extension/flexion of Clarity

the shoulder and extension/flexion of the hip

8 Figure 8.14 Shoulder joint Redrawn Accuracy

8 Clinical Application, Joint Revised Update

Disorders

9 Thick and thin muscle filaments Fig. 9.6 revised to more accurately show orientation Accuracy, clarity
of thin filaments

9 Stimulus for contraction Revised to more clearly describe relative roles of Clarity, accuracy
sodium and potassium ions

9 Muscle relaxation Revised to clarify the role of the synaptic cleft Clarity, accuracy

9 Creatine phosphate Fig. 9.11 redrawn Accuracy, clarity

9 Cellular respiration Fig. 9.12 modified to reflect current estimates of Update, accuracy
ATP yield

9 Interaction of skeletal muscles Rewritten section on agonist, antagonist, prime Clarity, clinical relevance
mover, and synergist

x
SELECTED SPECIFIC CHANGES AT-A-GLANCE —Continued
Chapter Topic Change Rationale
9 Recording of a muscle Optimal length defined in context Clarity
contraction

9 Origin and insertion Rewritten to include alternate terminology— Clarity, update

proximal attachment and distal attachment

9 Major skeletal muscles Fig. 9.25 redrawn to depict more accurate location Clarity, accuracy
and relative size of muscles

9 Muscle actions Revised actions for neck muscles in table 9.6 Accuracy, clarity

9 Muscles that move the head and Fig. 9.26 revised Accuracy, clarity
vertebral column

9 Movements at shoulder Fig. 9.27 revised Accuracy, clarity

9 Muscles of the arm and forearm Supinator added to fig. 9.32 Clarity

9 Muscles of the arm and forearm Figure 9.33 revised Accuracy, clarity

9 Pelvic floor Table 9.12 reorganized for clarity: External anal Clarity. accuracy
sphincter added

9 Muscles that move the leg Text revised to include components of quadriceps Detail, clarity
femoris group

10 General characteristics of the Revised discussion of CNS, PNS, and synapses Clarity, accuracy
nervous system

10 Clinical Application 10.1, Partly rewritten Update

Migraine

10 Neuroglia Added functions for Schwann cells and Update

satellite cells

10 Axonal regeneration Fig. 10.10 revised Accuracy, clarity

10 The synapse Fig. 10.11 revised Clarity

10 Resting potential Section revised Accuracy, clarity

10 Cell membrane potential Action potential used in preference to impulse Clarity, consistency

10 Ion movements during action Fig. 10.6 revised with units added to graphs Clarity
potentials

10 Ion movements during action Section revised Detail, Clarity

potentials

10 Neurotransmitters Action linked to the type of receptor present Clarity, Detail

10 Facilitation Mechanism revised Update

10 Sections on convergence and Revised Clarity

divergence

—Continued

xi
UPDATES and ADDITIONS

SELECTED SPECIFIC CHANGES AT-A-GLANCE —Continued

Chapter Topic Change Rationale
11 CSF Fig. 11.4 revised Clarity

11 Brain Fig. 11.6 revised Clarity

11 Brain Fig. 11.7 revised Clarity

11 Brain Fig. 11.8 revised Accuracy, clarity

11 Brain Names of specific areas of cortex (e.g., Clarity

somatosensory cortex) added to discussion

11 Memory Added discussion of working memory Update

11 Basal nuclei Fig. 11.10 revised Clarity, accuracy

11. Brainstem Several text revisions Clarity

11 Sleep Added definition of sleep to text discussion Clarity

11 Cerebellar peduncles Fig. 11.13 redrawn Clarity

11 Spinal cord Explanations of numbering of spinal nerves moved Clarity

to this section and revised

11 Spinal cord Distinction between posterior and anterior roots revised Clarity

11 Spinal cord Terms posterior root and anterior root used Update
preferentially to dorsal root and ventral root

11 Segmental innervation Revised figs 11.18 and 11.19 to label spinal segments Clarity

11 Tracts Figs 11.21 and 11.22 revised Clarity, accuracy

11 Peripheral nervous system Expanded subdivisions of the nervous system in Clarity, accuracy
table 11.8.

11 Cranial nerves Fig. 11.25 revised to better show left and right Accuracy
cerebral hemispheres

11 Autonomic nervous system Revised introduction and general organization Clarity

12 Sensation and Perception Revised text Clarity, accuracy

12 Touch and pressure senses Revised text Clarity

12 Cannabinoids Section rewritten Update

12 Taste Section reorganized and revised Clarity, accuarcy

12 Cochlear duct Fig. 12.12 revised Clarity

12 Cochlea, spiral organ Fig. 12.13 revised Clarity, accuracy

12 Motion sickness Section revised Clarity

12 Iris Section revised Clarity, accuracy

12 Disorders of the eye New table 12.8 Clinical relevance

13 Prolactin secretion Description of control revised Update

13 Actions of oxytocin Text discussion expanded Update

13 Thyroid hormone disorders New text discussion Clinical relevance

xii
SELECTED SPECIFIC CHANGES AT-A-GLANCE —Continued
Chapter Topic Change Rationale
13 Catecholamine synthesis New fig. 13.31 Clarity, detail

13 Hormones of the adrenal cortex Revised table 13.11 Clarity

13 Clincal Application 13.1, Revised Clarity, update

Diabetes mellitus

13 Stress response Section partially rewritten to add exhaustion phase Clarity, detail

14 Clinical Application, Universal Revised Update

Precautions

14 Plasma proteins Revised the albumin discussion Clarity

15 Heart Revised the discussion of the regulation of the Clarity

cardiac cycle

15 Fig 15.22b Autonomic impulses Nervous structures recolored Consistency of color with chapter 11
alter the activities of the SA and
AV nodes

15 Fig 15.49 Major branches of the Moved leader for femoral artery on posterior view Accuracy
external iliac artery

16 Body Defenses Against Infection Immunity definition moved to the beginning of the Accuracy, clarity
(Immunity) section because both innate defenses and adaptive
defenses provide immunity

16 Clinical Application, Immunity In table 16A on how AIDS is not transmitted, Accuracy, clarity
Breakdown: HIV/AIDS changed donating blood to receiving donated blood

17 Structure of the wall of the Expanded serosa discussion to differentiate Accuracy

alimentary canal between the serosa of digestive organs within the
abdominal cavity and the serosa of digestive organs
not contained within the abdominal cavity

17 Fig 17.4b Segmentation mixes Added leaders and labels for alternating rings of Clarity
the contents of the small intestine contraction and the mixing that occurs as a result

17 Clinical Application, Disorders of Revised to distinguish between inflammatory bowel Clarity

the Large Intestine disease and irritable bowel disease

18 Protein sources Revised the discussion of complete proteins and Accuracy

incomplete proteins

18 Clinical Application, Dietary New photo Update

Supplements

19 Upper respiratory tract Larynx included in upper respiratory tract Clinical relevance

19 Larynx Reworded description of location relative to the Clarity, accuracy

laryngopharynx

19 Clinical Application 19.1, The Added new section on electronic cigarettes Clinical relevance, update
Effects of Cigarette Smoking on
the Respiratory System

19 Glottis Fig. 19.7 revised Detail, accuracy

19 Structure of respiratory tubes Added paragraph on bronchodilation and Clarity

bronchoconstriction

19 Breathing mechanism Wording added describing movement of gas down Clarity

a pressure gradient
—Continued

xiii
UPDATES and ADDITIONS
SELECTED SPECIFIC CHANGES AT-A-GLANCE —Continued
Chapter Topic Change Rationale
19 Inspiration and expiration Sections revised Clarity

19 Clinical Application 19.2, Lung New photo depicts air pollution in Beijing Update
Irritants

19 Respiratory volumes and Added text on tidal volume Clarity

capacities

19 Respiratory volumes and Fig. 19.27 revised Clarity

capacities

19 Nonrespiratory air movements Speaking added to section Detail

19 Factors affecting breathing Section revised Clarity, update

19 Factors affecting breathing Fig. 19.28 revised Clarity, accuracy

19 Respiratory membrane Revised discussion, revised fig. 19.33 Accuracy

19 Diffusion through the respiratory Revised discussion Accuracy, clarity

membrane

19 Gas transport Additions to text on oxygen transport, including Clarity, clinical relevance
conditions of low oxygen

19 Gas transport Additions to text on carbon dioxide transport Clarity

20 Cortical versus juxtamedullary Introduced earlier in text and in further revised fig. 20.6 Clarity, accuracy
nephrons

20 Renal blood vessels Portal system reinforced in text Clarity

20 Nephrons Added discussion of nephron subdivisions. Figures Clarity, update

and text revised accordingly

20 Basic renal processes Revised introduction to urine formation. Fig. 20.15 Clarity
revised for a more schematic presentation.

20 Glomerular filtration Section reorganized Clarity

20 Control of glomerular filtration New fig. 20.18, revised text Clarity

20 Tubular reabsorption Some text moved to earlier, under basic renal processes Clarity

20 Sodium and water reabsorption Section rewritten, fig. 20.21 (formerly 20.20) revised Clarity, update

20 Tubular secretion Fig. 20.22 (formerly 20.21) revised Clarity

20 Urine concentration Text and fig. 20.23 (formerly 20.22), and table 20.3 Clarity
revised

20 Urinary bladder and relationship Redrawn figure 20.31 (formerly 20.30) Accuracy, clarity
to sphincters

20 Micturition Text rewritten Accuracy, clarity,

21 Aldosterone and antidiuretic Clarification of sites of action Clarity

hormone

21 Regulation of electrolyte output Calcitonin included Clarity

21 Absorption of anions Mechanism rewritten Accuracy

21 Chemical buffer systems Table 21.3 revised Clarity

xiv
SELECTED SPECIFIC CHANGES AT-A-GLANCE —Continued
Chapter Topic Change Rationale
21 Acid-base imbalances Acidemia, alkalemia distinguished from acidosis, Accuracy
alkalosis

21 Alkalosis Text reorganized into numbered list to parallel Clarity

presentation of acidosis

22 Career Corner, Midwife Job description and certification rewritten Accuracy, clarity

22 Prostate gland Revised secretion description Accuracy

22 Clinical Application, Prostate Revised Update

Cancer

22 Terminology—oocyte, ovum Terms were changed as per correct usage: Accuracy, clarity
(egg), zygote oocyte = cell that can and does undergo meiosis I;
ovum (egg) = cell that results when the fertilized
oocyte completes meiosis II; zygote = cell that
results when the nuclei of the sperm and ovum join

22 Menstrual cycle Changed from using reproductive cycle to Accuracy

This will affect other chapters. menstrual cycle

22 Birth control Deleted diaphragm and cervical cap Update

22 Clinical Application, Breast Revised Update

Cancer

22 Table 22.6 Diseases Associated Changed the numbers of infected cases and added Update
with Sexually Transmitted Trichomonas vaginalis
Infections

23 From Science to Technology, Revised Update

Assisted Reproductive
Technologies

23 Fig. 23.9 Primary germ layers Redrawn Accuracy, clarity

23 Clinical Application, Some Revised and added Zika virus Update

Causes of Birth Defects

23 Fetal blood and oxygen transport Rewritten Clarity

23 Clinical Application, Human Milk Revised Accuracy

23 Table 23.11 Ten leading causes Reordered and percentages changed as necessary Accuracy
of death

24 Sister chromatids Insert added to fig. 24.1 Clarity

24 Meiosis Reconnect explanation reinforces role of meiosis in Detail, clarity

inheritance

24 Career Corner, Genetic Counseling other than face-to-face Update

Counselor

24 Eye color inheritance New Reconnect to iris Clarity

24 Fig. 24.13 Re-ordered so sequence is as in pregnancy: fetal Clarity, update, familiarity

DNA, CVS, amniocentesis

24 Section 24.7, Genomics and Complete rewrite, covers genetic testing and Update
Health Care treatments

xv
 Final PDF to printer

N •
AR

P
SS • LE

RA
DYNAMIC ART PROGRAM

CTI
C
E
E
• ASS

The authors have examined every figure to ensure it is engaging and accurate. The fifteenth edition’s
art program will help students understand the key concepts of anatomy and physiology.

New Art – in some cases line art

Microphone sends Reflex sends has been added to help clarify
stronger electrical stronger signal to
signal to amplifier uterus key principles. In other cases
micrographs have been replaced for
Stretch receptors
clarity and visual impact.
Microphone picks Uterus increases
Amplifier increases sense increased
up louder sound force of
electrical signal stretch contractions

Contractions push
Speakers produce Amplifier sends Cervix is fetal head more
louder sound increased electrical stretched further forcefully toward
signal to speakers cervix

(a) (b)

New figure illustrating familiar and physiological

examples of positive feedback.

New figure illustrating vascular effects on glomerular

filtration rate (GFR)

Decreased GFR Increased GFR

(a) Vasoconstriction of the afferent arteriole (b) Vasoconstriction of the efferent arteriole
decreases net filtration pressure and GFR. increases net filtration pressure and GFR.

Collagen fiber bundles:

Longitudinal section

Cross section

Fibroblast nuclei

Ground substance

Slight decrease in GFR Increased GFR

(c) Vasoconstriction of both afferent and efferent (d) Vasodilation of the afferent
arterioles combines the effects of (a) and (b).
Net filtration pressure decreases, but not as
arteriole increases net
filtration pressure. New micrograph showing the structure of dense,
much as it would in response to afferent
arteriolar constriction alone. irregular connective tissue.

xvi

shi64561_fm_i-xxviii.indd xvi 10/17/17 03:37 PM

 Glucose
Revised art – Many existing art pieces have been impoved for
High-energy
electrons (e–) and clarity or updated for accuracy.
hydrogen ions (H+)

Glycolysis 2 ATP Aerobic respiration updated to reflect accepted yields of ATP

Cytosol
2 Pyruvic acids
(Each enters separately)

Mitochondrion

High-energy
electrons (e–) and
hydrogen ions (H+)
CO2

Acetyl CoA

Muscle figures redrawn for accuracy

Oxaloacetic
acid Citric acid
Epicranial aponeurosis
Frontalis
High-energy Citric acid
electrons (e–) cycle Epicranius
and hydrogen
ions (H+) Occipitalis
Temporalis
2 CO2
Orbicularis oculi
2 ATP
Zygomaticus major
Electron
transport Zygomaticus minor
chain

Masseter
Buccinator
26-28 ATP Cell of Surfactant- Fluid with
Sternocleidomastoid alveolar wall secreting cell surfactant Orbicularis orisMacrophage
1/2 O
2 2e– + 2H+
H2O
Trapezius
Platysma

(a)

Temporalis
Alveolus

Sound transduction in the inner ear redrawn for clarity

Lateral pterygoid Respiratory
membrane

Medial pterygoid

Buccinator

Red blood cell Cell of capillary wall

Respiratory membrane redrawn for accuracy
Capillary lumen

Stapes vibrating in Helicotrema

(b) (c) fluid
Alveolar
oval window Alveolus (with surfactant)
Scala vestibuli
filled with perilymph Alveolar
epithelium

Diffusion
Vestibular of O2 Fused basement
membrane membranes of Respiratory
Diffusion alveolar membrane
Basilar of CO2 epithelium
membrane
and capillary
endothelium
Scala tympani
Membranous
filled with
labyrinth
perilymph Capillary
Cochlear duct endothelium
Round window filled with endolymph
Capillary

xvii
 11
Nervous System II AR
N •
Final PDF to printer

P
SS • LE
Divisions of the
LEARN, PRACTICE, ASSESS

RA
CTI
Nervous
tens System
of thousands of synaptic connections to other neurons, form-
the diencephalon that in

C
E
E
ing 60 trillion links. Second, a certain pattern of synapses can (hi″po-thal′ah-mus). It • ASS

Learn persist for years.

LEARN
Eventually memories are stored in various parts of the cere-
forms the lower walls an
plates 9 and 13).
bral cortex in a process called memory consolidation. The Other parts of the
Learning tools to help the student succeed. . . hippocampus After studyingplays this
an important
chapter, youroleshould
in directing
be ablememory
to infor- which originate from th
mation to the appropriate
complete the “Learning location in the cortex,
Outcomes” although
that follow it does
the major optic nerve fibers cross
Check out the Preview, Foundations for Success, on page 1. The
not actually
headings store memories.
throughout theAnother
chapter.area of the temporal lobe, stalk), which is a coni
Chapter Preview was specifically designed to help the student
the amygdala, assigns value to a memory, such as whether it was which the pituitary glan
LEARN how to study. It provides helpful study tips. 11.1 General Characteristics of Divisions of the
pleasant. Nervous System gland, which hangs fro
Unusual behaviors and skills of people who have dam- to the infundibulum; (4
aged 11.2 Meninges have taught researchers much about this
the hippocampus which are two rounded
intriguing
11.3 part of the and
Ventricles brain. In 1953, a surgeon
Cerebrospinal Fluid removed parts Rev.(5)Confirmingthe pineal gland, w
LearningFalsely
Outcomes have been
colored scanning electronmoved!
micrographThey
(SEM)now
of thefollow the
cell body of aappropriate heading within the chapter. They Pages
single neuron of the human cerebral cortex—the outer gray matter of the of the
11.4 hippocampus
Brain and the amygdala of a young man to relieve roof of the diencephalon
continue to be closely linked to Chapter Assessments and Integrative Assessments/Critical Thinking questions
brain (7,200×). © CNRI/SPL/Science Source his severe epilepsy. His seizures became less frequent, but he The thalamus is a
found at the end of the chapter. Learning Outcomes are also tied to Connect 11.5 acontent.
Spinal Cord
suffered profound loss in the ability to consolidate short-term ascending from other p
Rev. Confirming Pages

memories
11.6 into long-term
Peripheral ones. AsSystem
Nervous a result, events in his life faded cortex. It receives all s
The WHOLE Picture quickly answers
from his the question:
memory. He was “What
unable istothe bigany events that
recall with the sense of smell)
picture of how this 11.7 Autonomic toNervous System
took chapter relates Human Anatomy if itand
THE WHOLE PICTURE placePosterior
since surgery,
median living always asGray was the 1950s. He
commissure of the cortex for interpr

11
Physiology”? would 11.8readsulcus
Life-Span
the same Changes
magazine article repeatedly withPosterior renewed The thalamus relay
Rev. Confirming Pages

Neurons conduct action potentials, and all of these action poten- interest
Posterior each time.
funiculus horn action potentials. Consi
tials are the same. Yet, the nervous system can process Anatomy and Physiology
a wide Lateral
Gray lates the lateral genicul
Common carotid a.

White Lateral funiculus

Larynx
horn Thyroid cartilage

variety of information from theSystem

Nervous Revealed
externalII environment, matter (APR)
including Basal
icon atNucleithe Anterior
matter
which then sends action
Right subclavian a.

Brachiocephalic a.
Trachea

Left subclavian a.

sight, sounds, and touch on of

Divisions thethesurface of the skin. The nervous
beginning of each chapter
Anterior funiculus horn Those action potentials Arch of aorta

Nervous System The basal nuclei, also called the basal ganglia, are masses of gray Superior vena cava
Pulmonary a.

system can also interpret information from receptors tellsthat

which sensesystem in APR by the LGN’s neurons Pulmonary trunk

matter deep within the cerebral hemispheres. They include the

Right atrium Pulmonary v.

changes in the internalLEARN environment and can activate effectors object, such as a bar. If t
Left atrium

applies to this chapter. nucleus, the putamen, and the globus pallidus, and they
Right ventricle Lung

to correct those changes. Among the most fascinating aspects Posteriorcaudate

root
After studying this chapter, you should be able to

thalamic action potentia

Left ventricle
complete the “Learning Outcomes” that follow the major
of spinal develop from the anterior portion of the forebrain (fig. 11.10).
Lobes of liver Diaphragm (cut)
headings throughout the chapter. (lifted upward)

of nervous system function are the abilities of the brain to store 11.1 General Characteristics of Divisions of the
nerve ity of action potentials,
Gallbladder
Spleen

The basal nuclei produce the neurotransmitter dopamine. The neu-

Nervous System Cystic duct Stomach

memories and to process conscious thought.

11.2 Meninges

Falsely colored scanning electron micrograph (SEM) of the cell body of a

single neuron of the human cerebral cortex—the outer gray matter of the
11.3
11.4
Posterior root
Brain rons of the basal nuclei interact with other brain areas, including
Ventricles and Cerebrospinal Fluid selects which stimuli to
Duodenum

All of these things are accomplished by neurons working ganglion

in
brain (7,200×). © CNRI/SPL/Science Source
11.5
11.6 the motor cortex, thalamus, and cerebellum. These interactions,
Spinal Cord
Peripheral Nervous System
the thalamus is not only
Ascending colon
Transverse colon

Jejunum (cut)

much the same way, but serving different functions within the Pathways connect
Mesentery (cut)

through a combination of stimulation and inhibition, facilitate vol-

11.7 Autonomic Nervous System Descending colon

THE WHOLE PICTURE 11.8 Life-Span Changes

Common iliac a.

brain, the spinal cord, or the peripheral nerves. This is the chapter
Neurons conduct action potentials, and all of these action poten- Anterior
thalamus, and parts of th
lleum (cut) Ureter

untary
Portionmovement.
AnteriorClinical Application 11.3 discusses Parkinson
Cecum
tials are the same. Yet, the nervous system can process a wide
of root median Central canal Sigmoid colon

in which your brain gets to learn about itself and the other parts of
Appendix

from them and send im

variety of information from the external environment, including
spinal nerve of spinal nerve fissure
disease, in which neurons in the basal nuclei degenerate.
sight, sounds, and touch on the surface of the skin. The nervous Rectum

system can also interpret information from receptors that sense Uterus

the nervous system! tains homeostasis by reg

Ovary
changes in the internal environment and can activate effectors
(a) Tensor fasciae latae m.

The basal nuclei are often called the basal ganglia, but techni-
Uterine tube
to correct those changes. Among the most fascinating aspects Round ligament of uterus
of nervous system function are the abilities of the brain to store Femoral a.

memories and to process conscious thought.

All of these things are accomplished by neurons working in
cally a ganglion is a cluster of neuron cell bodies in the periph- by linking the nervous
Femoral v.
a
Adductor longus m.
Urinary bladder

The hypothalamus
much the same way, but serving different functions within the Great saphenous v.

eral nervous system. Notice that the term nucleus (plural, nuclei)
brain, the spinal cord, or the peripheral nerves. This is the chapter Rectus femoris m.
Gracilis m.
in which your brain gets to learn about itself and the other parts of
the nervous system!
Reference Plates Vastus lateralis m.

has three meanings. It can refer to (1) the central part of an atom,
Vastus medialis m. Sartorius m.

offer detail of 1. heart rate and arter

(2) the part of a cell containing the DNA, or (3) an isolated region
PLATE FIVE Human female torso with the lungs, heart, and small intestine sectioned and the liver reflected (lifted back). (a. stands for artery, m.

2. body temperature
N •
AR P stands for muscle, and v. stands for vein)

body structures.
SS • LE

Module 7: Nervous System

RA

of gray matter formed by a cluster of neuron cell bodies in the

CTIC

3. water and electroly

E

E
• ASS

Ncentral
• nervous system. 44 |
4. control of hunger a
AR
REFERENCE PLATES THE HUMAN ORGANISM

P
5. control of moveme
SS • LE

Module 7: Nervous System

RA

shi64561_ch11_389-443.indd 389 08/23/17 08:03 PM

shi64561_ch01_009-058.indd 44 08/05/17 05:11 PM

PRACTICE stomach and intesti

CTIC

Practice 6. production of neuro

E

13. What is hemisphere dominance?

E
• ASS
the pituitary gland
14. What are the functions of the nondominant hemisphere?
Practice questions after major sections test understanding of growth, control var
15. Distinguish between short-term and long-term memory. physiology
the material.
16. What is the function of the basal nuclei? 7. sleep and wakefuln

shi64561_ch11_389-443.indd 389
(b)
08/05/17 05:23 PM
Structures in the re
tant in controlling emot
FIGURE 11.15 Diencephalon
Spinal cord. (a) A cross section of the spinal cord. (b) A micrograph of the spinal cord (10×).
(b) © Carolina Biological Company/Medical Images tex in the medial parts
Figure Questions, part of key figures The diencephalon (di″en-sef′ah-lon) develops from the posterior with the hypothalamus
in each chapter, provide an additional forebrain and is located between the cerebral hemispheres and
PRACTICE nuclei. These structures
assessment. superior to the brainstem (see figs. 11.6 and 11.10). It surrounds It controls emotional ex
Where would you expect to find the thecell
third ventricle
bodies andinisthelargely
of neurons composed of gray matter. In the
above figure?
the way a person acts
Answer can be found in Appendix G.
diencephalon, a dense mass called the thalamus (thal′ah-mus) pleasure, and sorrow.
bulges into the third ventricle from each side. Another region of life-threatening upsets
Reflex Arcs neuron. Impulses on these sensory neurons enter the CNS and con-
xviii Communication in the nervous system combines a series of action stitute a sensory or afferent limb of the reflex. The CNS is a pro-
potentials along the axon of a neuron and synaptic transmission cessing center. Afferent neurons may synapse with interneurons,
between that neuron and a postsynaptic cell. Two or more neurons which may in turn connect with other parts of the CNS. Afferent
involved in such communication constitute a nerve pathway. The neurons or interneurons ultimately connect with motor neurons,
simplest of the nerve pathways begins with a sensory receptor and whose fibers pass outward from the CNS to effectors. (It may help
ends with an effector, and includes as few as two neurons. Such a to remember that efferent neurons control effector organs.)
shi64561_fm_i-xxviii.indd xviii 10/17/17 03:37 PM
nerve pathway is called a reflex (re′fleks). Reflexes occur throughout the CNS. Those that involve the
shi64561_ch11_389-443.indd 403
All reflexes share the same basic components, which together spinal cord are called spinal reflexes and reflect the simplest level
 tissue and contains many blood vessels and nerves. The dura mater Meningitis, an inflammation of the meninges usually caused
attaches to the inside of the cranial cavity and forms the internal peri- by bacterial or viral infection of the CSF, affects the arachnoid
osteum of the surrounding skull bones (see reference plate 13). and pia maters and sometimes the dura mater, mostly in children.
In some regions, the dura mater extends inward between Complications include visual loss, hearing loss, paralysis, and
lobes of the brain and forms supportive and protective partitions intellectual disability. Meningitis may be fatal. Children are vac-
(table 11.1). In other areas, the dura mater splits into two layers, cinated against Haemophilus influenza type b, which was once the
Understanding Words helps most common bacterial cause of meningitis.
forming channels called
U N D dural T A N D Ishown
E R S sinuses, NG W in Ofigure
R D S11.1b.
the student remember scientific Venous blood flows through these channels as it returns from the
cephal-, head: encephalitis—inflammation of funi-, small cord or fiber: PRACTICE
funiculus—major mening-, membrane: meninges—
word meanings. Examine root brain to vessels leading thetobrain.
the heart. nerve tract or bundle of myelinated axons membranous coverings of the brain
The dura materchiasm-,
continues cross:into
opticthe vertebral canal as a strong,
chiasma—X-shaped within the spinal cord. and spinal cord.
words, stems, prefixes, suffices, structure produced by the crossing over
tubular sheath that surrounds the spinal cord. It is attached to the
1. Describe the meninges.
gangli-, swelling: ganglion—mass of neuron plex-, interweaving: choroid plexus—mass
of optic nerve fibers. cell bodies. 2. Name the layers of the meninges. of specialized capillaries associated with
pronunciations, and build a solid cord at regular intervals flacc-, by a band
flabby: flaccidof pia mater of
paralysis—loss (denticulate
tone liga- 3. Explain the location of cerebrospinal spaces in the brain.
fluid.
anatomy and physiology vocabulary.ments) that extends the length of the spinal cord on either side. The
in muscles innervated by damaged axons.

dural sheath ends as a closed sac at the level of the second sacral
vertebra, below the tip of the spinal cord. The sheath around the
spinal cord is not attached directly to the vertebrae but is separated CAREER CORNER
|
cell bodies (and unmyelinated axons) appear gray and are called
11.1which
by an epidural space, Generallies between Characteristics
the dural sheath andof the
gray matter, whereas areas containing myelinated axons appear
bony walls (fig. 11.2). Career
This space Corners
Divisions of the Nervous System white andOccupational
contains blood vessels, loose Therapist
are called white matter. Both the brain and the spinal
connective tissue, and adipose tissue that pad the spinal cord.
introduce
A blow to the head may
interesting
rupture some blood vessels associated The
cord have gray matter and white matter. In the brain, the outer lay-
LEARN ersman
of the with amyotrophic
cerebral hemispheres lateral
and sclerosis
cerebellum(ALS, or Lougray
are largely
career opportunities.
with the brain, and the escaping blood may collect beneath the dura Gehrig’s disease)
matter. White hadrepresenting
matter, been growing frustratedaxons,
interconnecting with is hisfound
mater. This condition, called subdural
1. Describe the relationship amongcan
hematoma, increase
the brain, pres-
brainstem, increasing
deeper, with inability
islands to of carry out the
gray matter activities
located of daily
throughout. living.
In the spi-
and spinal cord. Henalcouldn’t
cord, inuse contrast, gray matter
his hands, and his (thewrists
cell bodies
wereof neurons) is
growing
sure between the rigid bones of the skull and the soft tissues of the
found more
weaker. A visit centrally,
from an with white matter therapist
occupational more peripheralgreatly and con-
brain. Unless theTheaccumulating blood is promptly removed, com-
central nervous system (CNS) consists of the brain and improved sisting of both
axonshis extending up to the brain
independence and or hisdown from the brain.
spirit.
pression of the brain may cord.
the spinal lead to Thefunctional losses
brain is the or and
largest evenmost death.
complex part Theoccupational
brain connects therapist
to the spinal cord through the how
brainstem.
The arachnoid The showed the man to
nervous is
of the mater a thin,
system. weblike
It oversees manymembrane
aspects of that physiology, Axons conducting impulses up to the brain are bundled in ascend-
does not have suchbloodas vessels
sensation and is locatedmovement,
and perception, between and dura The continue
the thinking. to use a bathroom sink by supporting his weight on
ing tracts. Those conducting impulses down through the spinal cord
Clinical Applications present and pia maters.brain includes over
It spreads the twothe cerebral
brain andhemispheres,
spinal cord diencepha- hisarearms,
the but and howtracts.
in descending to use Both mirrors
the brainto and
compensate
the spinal cordfor his neck
connect
disorders, physiological responses generally does lon,to
not thedipbrainstem,
into the andgrooves
the cerebellum, all described in
and depressions on detail in stiffness. The therapist
to the peripheral nervous was system comforting and practical
(PNS) via peripheral nerves. as he
section 11.4. brain contains about oneFrom
The Pages Science
hundred billion (1011) showed to Technologythe membranes,
Bones, man how toand boxes
repurpose
fluid surroundrelate
metal the
thesalad
organs ofevolution
tongsthe toCNS. hold
environmental factors, and theirother
surfaces. Many
topics Rev.thin strands extend from its undersurface
Confirming
multipolar neurons as well as countless branches of the axons by toilet
and attach to the pia these
which mater. A subarachnoid
neurons communicate with space of
each
modern
between
other andthe with neu-
medical The paper
occupies
tools,
brain lies
to in such
the
care for hisas
cranial
the vertebral canal
cavity tissue
bathroomof the needs.
in the helps
vertebral
engineering
skull, and the spinal cord
column. maintain
Beneath these
of general interest. arachnoid and pia maters
rons elsewhere contains
in the the clear,
nervous and immunotherapy,
watery cerebrospinal
system. bony
An occupational
from
coverings, the
therapist
membranes discoveries
called meninges,
a person
ofinjury,
located basic
between
nor-
the Pages
Rev. Confirming
mal activities while struggling with a disease, disability,
fluid (ser″ĕ-bro-spi′nal
Recall floo′id),
from sectionor CSF.
10.3, Description of Cells of the Nervous orbone and the soft tissues of the nervous system,the protect the brain
System, that areas of the nervous system
The subarachnoid space of the meninges completely surrounds science.
containing mostly neuron
other limitation.
and spinal cord (fig. 11.1a).
The therapist evaluates patient’s situ-
11.1 C L I N I C A L A P P L I C AT I O N ation and how it is likely to change, sets goals, researches
the brain and spinal cord, so these organs in effect float in the CSF. and presents interventions and adaptive equipment that may
Traumatic Brain Injury
The fluid protects the brain and spinal cord by absorbing forces help, and assesses results. The therapist may also instruct
A traumatic brain injury (TBI) results from mechanical force such that might otherwise jar and damage their delicate tissues. Clinical 5.2 F R O M S C I Efamily N C E TO T E C H N and
members O LOcaregivers
GY on how to assist the patient.
Skin
Scalp
as from a fall, accident, attack, or sports-related injury. According Application 11.1 discusses traumatic brain injury, which vividly Tissue Engineering: Building a Replacement
Occupational Bladder
therapists work in health-care
Subcutaneous tissue facilities,
to the Brain Trauma Foundation, TBI in the United States is the
leading cause of death and disability from ages one to forty-four illustrates the importance of the cushioning function of CSF.
Cranium schools, home health services, Bone and of nursing
skull homes. They
If an appliance part is damaged or fails, replacing it is simple. Not balloonlike, with layers of smooth muscle, connective tissue, and
years, and is responsible for 52,000 deaths per year. More than
5 million people have such injuries, which are classified as mild,
The pia mater isCerebrumthin and contains many nerves, so forasthe well as Donor organs
human body. must haveforatransplant
and tissues master’s adegree inDural
occupational
lining of urothelium. sinus (superiortherapy and
mild repetitive, or severe. blood vessels that nourish the underlying cells of the brain and are in short supply, so in the futurestate licensure.
spare parts may come from Researchers sagittal
pioneeredsinus)
replacement bladders in children who
Mild TBI, also known as a concussion, produces loss of con- tissue engineering. In this technology, a patient’s cells, extracel- have birth defects in which the malfunctioning bladder can harm
Tentorium Arachnoid granulation
sciousness or altered mental status. Its effects are more psycho- lular matrix, and other biochemicals are grown with a synthetic the kidneys. Each patient donated a postage-stamp-size sample
cerebelli
logical than neurological, and it does not appear to cause lasting scaffold to form an implant. The cells come from the patient, so of bladder tissue that consisted of about a million cells, from which
damage. Symptoms include disturbed sleep, ringing in the ears, the immune system does not reject them. Tissue engineering the researchersDura separated
matertwo types of progenitor cells—for
memory lapse, balance problems, irritability, and sensitivity to Cerebellum has provided skin, cartilage, bone, and blood vessels. Combin- smooth muscle and urothelium—and let them divide in culture in a
light and sound. These physical symptoms are heightened if Rev. Confirming Pages ing engineered tissues into structures that can replace organs is specific mixture Arachnoid
of growth factors. Within seven weeks the million
Meninges
the person also suffers from depression or post-traumatic stress where the creativity comes in. Consider the replacement bladder. cells had dividedmater
to yield 1.5 billion cells, which were seeded onto
disorder (PTSD). Mild TBI may cause PTSD if, as the brain hits Vertebra Each year in the United States, about 10,000 people need domes made of Pia a synthetic
mater material. The confluent layers of cells
the skull, the injury generates a shearing force that impairs the their urinary bladders repaired or replaced. Typically a urologic that formed were attached to the lower portions of the patients’
prefrontal cortex’s control of a region called the amygdala so surgeon replaces part of the bladder with part of the large intes- Falx cerebri
bladders, after removing the upper portions. The scaffolds degen-
Spinal cord
that it becomes overactive. As a result, the person cannot let go tine. However, the function of the intestine is to absorb, and the erated over time, leaving new bladders
Subarachnoid space built08/05/17
from the patients’
shi64561_ch11_389-443.indd 391 function of the bladder is to hold waste. Tissue engineering is own cells. Today tissue-engineered Rev. Confirming
bladders 05:23
usedPM
are alsoPages in
of psychological trauma, which is the definition of PTSD. Meninges
32. ADraw
sports-related formof
the underside ofamild
brainrepetitive
and labelTBI theiscranial
chronic trau-
nerves. 36. Describe the parts of a spinal nerve and their functions. providing a better replacement bladder. The natural organ is adults whose bladders have been removed to treat cancer.
Gray matter
33. Match
matic the cranial (CTE).
encephalopathy nerve with its function(s).
It results from many Functions may
small injuries 37. Define plexus, and locate the major plexuses of the Cerebrum
White matter
be used
over time, more
rather than
than a once.
single violent blow. The first report of spinal nerves.
the condition in a medical journal appeared in 2005, regarding 11.7 Autonomic Nervous System (a) (b)
a player(1)for
olfactory nerve Football
the National A. League,
conductsbut impulses to
in the 1980s CTE 38. The autonomic portion of the PNS functions _________.
(2) optic nerve
was recognized musclesinused
in boxers and wrestlers, whom in swallowing
it was called a. consciously
(3) oculomotor nerve B. conducts impulses to muscles
“punch-drunk syndrome” and “dementia pugilistica.” Symptoms b. voluntarily FIGURE 11.1 Meninges. (a) Membranes
disorders that maycalled begin to meninges
cause symptoms enclose the brain
in older and spinal
adulthood cord.sleep
generally (b) Thefewermeninges
hours per night include than three
they oncelayers:
did, experi-
(4) trochlear nerve that move the tongue
typically begin years after the first of the repetitive head injuries c. without conscious effort dura mater, arachnoid mater, and pia mater. include stroke, depression, Alzheimer disease, Parkinson disease, Neuron encing transient difficulty in getting to sleep and staying asleep,
(5) trigeminal nerve C. conducts impulses to
associated with the nerve
(6) abducens sport. They include
musclesdepression,
that move the impulsive
eyes
d. dependently and multi-infarct dementia. with more frequent movements when they are sleeping. Many
and erratic behavior, 39. Contrast the sympathetic and parasympathetic divisions Noticeable signs of a normally aging nervous system include Nucleus have bouts with insomnia, sometimes not sleeping more than an
(7) facial nerveheadaches,D.dizziness,
conductsmemory
impulses loss, demen-
to viscera
of the autonomic nervous system.
tia, and(8)
loss of executive function
vestibulocochlear E. (ability
conducts to process
impulsesinformation
to 390 fiberisUNIT | fading memory and slowed responses and reflexes. Decline in
3 INTEGRATION AND COORDINATION hour or two a night. Changing electroencephalogram patterns indi-

Assess
FIGURE 11A Chronic
40. Distinguish traumatic
between encephalopathy
a preganglionic aand
form
a of mild
and makenerve decisions). These difficulties stem from mechanical
muscles of facial expression repetitivepostganglionic
traumatic brain fiber.
injury seen in football players. function of the sympathetic nervous system may cause transient cate that stage IV slow-wave sleep as well asRev. REM sleep diminish.
Confirming Pages
trauma (9)to glossopharyngeal
the cortex, hematomas F. conducts
(bleeding) impulses to
in the subcortex, drops in blood pressure, which, in turn, may cause fainting. By the All of these changes may result in daytime sleepiness.
41.Jasienski/Getty
© Paul Define paravertebral
Images ganglion.
vasospasm, nerve
ischemia, and sudden muscles movement of neck
of the skull, which seventh decade, waning ability of nerves in the ankles to respond Nuclei of
42. Trace a sympathetic nerve pathway through a ganglion neuroglia
(10) vagus
tears axons. The nerve
brains of peopleG. whoconducts impulses
have died with CTE show dangerous type of TBI. The brain is initially jolted forward at a
to an effector. to vibrations from walking may affect balance, raising the risk of
(11) accessory nerve associated with hearing force PRACTICE
changes characteristic of Alzheimer disease. Studies of CTE in 43.exceeding 1,600 feet per second,
Trace a parasympathetic and then is hit again as
nerve pathway. falling. Poor eyesight, anemia, inner ear malfunction, and effects Neuroglial cell
(12)
football hypoglossal
players nervehelmets
who wear H. conducts impulses
with sensors to
to record the air in theDistinguish
cranium rushes forward.
44. between cholinergic and adrenergic nerve fibers. of drugs also contribute to poor balance in the later years. Because Cellular
muscles that raise eyelids shi64561_ch11_389-443.indd 390 48. How does aging of the nervous system begin even before 05:23
08/05/17 birth?PM
forces applied to their brains show that a college football player A problem
45. Define in treating blast-related
sympathetic tone. brain injury is recogniz- of these factors, nearly a third of individuals over age sixty-five processes
I. conducts impulses associated 49. What are some diseases that affect the aging nervous system?
receives on average 950 hits to thewith head ing 46. Explain
it swiftly, how autonomic
because symptoms neurotransmitters
may not appear influence
until hoursthe
sense of smell (fig. 11A).
in a season
have32.
at least
Draw onetheserious
underside fall aofyear.
a brain and label the cranial nerves. 36. Describe the parts of a spinal nerve and their functions.
after theactions
violentofevent.
effector cells. one soldier immediately after 50. What are some of the physical and functional signs of an aging

Tools to help make the connection and master anatomy & physiology!
Severe TBI is seen in combat situations,
J. conducts where from
impulses the cause Whereas
Changes
33. Match
(a) inthesleep
cranialpatterns
nerve accompany aging,
with its function(s). reflecting
Functions the
may 37. Define
(b) plexus, and locate the major plexuses of the
and pattern of damage is called “blast-related
upper and lower brainteeth
injury.” The the 47.
blastDistinguish between
might be blind alphaoradrenergic
or deaf unable toand move beta
or speak, be used
nervous system?
functioning of themore than once.
reticular activating system. Older individuals spinal nerves.
damage results from a change K. in conducts
atmospheric pressure, a vio-
impulses another adrenergic
soldier whoreceptors.
has suffered similar injuries to the soft tis-
11.8 Life-Span Changes 11.7 Autonomic Nervous System
lent release of energy (sound, heat, pressure,
associated with orvision
electromag- sue of the brain might not show such effects until later. The FIGURE 5.33 nerve A neuron
(1) olfactory has cellular
A. conducts processes
impulses to that extend into its surroundings. (a) Idealized
Chapter Assessments check understanding
netic waves), and sometimes exposure to a neurotoxin released
from the blast. Rocket-propelled grenades, improvised incendi-
effects
48. ofExplain
ans49.of the
blast-related
List three ways
Vietnam
brainofinjury
the effects
Warthat
are lasting.
apoptosis
the nervous
indicate
on theStudies
developing
systemcognitive
injury-related
on veter-
changes as
brain.
we age.
decline
representation
(2) optic nerve
only (3) ASSESS
theoculomotor
of a neuron and neuroglia.
nuclei of thenerveneurogliaB.are
muscles (b) used Micrograph
stained.)impulses
conducts
in swallowing
to muscles
(b): © McGraw-Hill
38.
Education/Al Telser
The autonomic
of a section through nervous
a. consciously
portion
tissue (350×). of the
(Note thatPNS functions _________.

34. Explain how the spinal nerves are grouped and numbered. b. voluntarily
of the chapter’s learning outcomes.
ary devices, and land mines are the primary causes of this most
35. Define cauda equina.
50. Describe
years after the injury. sleep problems that may accompany aging. (4)
CHAPTER
(5)
trochlear
Nervous
(6) abducens
nerve
ASSESSMENTS
trigeminal nerve tissues
(ner′vus)
that
C. conducts
nerve of Divisions
move the
are foundimpulses
musclesofthat
tongue
in the brain,
move
to spinal cord,
the eyes
c. without conscious effort
cells support and bind the components of nervous tissue, carry
d. dependently
11.1and peripheral
General nerves.
Characteristics The basic cells arethe called
Nervous
neurons, or nerve 18. 39.onNamephagocytosis,
Contrast thethefunctions andofhelp
sympathetic the and supply
midbrain, growth
pons, and
parasympathetic factors and nutrients
medulla
divisions
(7) facial nerve
System D. conducts impulses to viscera oblongata.
cells,(8)and they are highly specialized. Neurons to certain types 19.toDescribe
sense neurons
of by connecting
the autonomic nervousthem system. to blood vessels. They also play

| Cerebrospinal
CSF is formed in four interconnected cavities called ventricles vestibulocochlear E. conducts impulses
11.3 Ventricles and
ASSESS 1.ofExplain
changes theingeneral
their surroundings.
functions of Incoming
the brain andsignals
spinal stimulate
cord, cel- 40.a role Distinguish thebetween
locationcommunications.
in cell-to-cell and function of the
a preganglionic reticular
fiber and a10
Chapter formation.
discusses ner-
Integrative
INTEGRATIVE Assessments/Critical
Fluid THINKING
ASSESSMENTS/CRITICAL Thinking (ven′trĭ-klz) that lie in the cerebral hemispheres and brainstem
(fig. 11.3 and reference plates 13 and 14). These spaces are filled
and
lular
11.2respond
Meninges
nerve
their interrelationship.
(9)processes
glossopharyngealcalled dendrites,
by conducting electrical
nerve
muscles
F. conducts
impulses
muscles
of facial
whichimpulses
expression
may cause to neurons to 21.vous
20. Distinguish
along cellular processes 42. a.Trace
of neck
41. The
tissue. between
postganglionic
Definecerebellum
Table
fiber.normal and paradoxical sleep.
paravertebral________.
5.8 summarizes
ganglion.
the general characteristics of muscle
communicates withnerve
the rest of thethrough
CNS
questions connect and apply information from with CSF and are continuous with the central canal of the spinal a sympathetic pathway a ganglion
(10) axons
2.called vagus nerve
to other neurons G. or toand
conducts musclesimpulsesor glands (fig. 5.33). and nervous tissues. From Science
body’s to Technology 5.2 discusses
Outcomes LEARN
4.4, 11.4 4. Brown-Seguard syndrome is due to an injury on one side of
cord,thewhich extends the full length of the cord (although in most As
Name
(11)
a
the layers
accessory
result of the
of the
nerve
meninges,
patterns by associated
which
explain
neurons
their
with hearing
functions.
communicate with
b.
to
tissue
creates
an awareness
effector.
engineering,
of the location in space
1. In planning treatment for a patient who has had a cerebro-
spinal cord. It is characterized by paralysis below the injury 11.3 Ventricles and Cerebrospinal Fluid 43. c. coordinates
Trace skeletalofmuscle
part
a parasympathetic anerve
fieldactivity
called regenerative medicine.
pathway.
adults it is at least partially closed).
previous chapters
(CVA), why would itas well as information within
(12) hypoglossal nerve H. conducts impulses to
3.each other theand relationship
with muscleamong and gland cells, they can coordinate, 44. d.Distinguish
and on the same side as the injury, and by loss of sensations all of the between
above cholinergic and adrenergic nerve fibers.
vascular accident be important to know
3. Discuss the formation and function of cerebrospinal fluid. Describe the cerebrospinal
muscles that raise eyelids fluid,
whether the CVA was caused by a ruptured or obstructed
of temperature and pain on the opposite side. How would you regulate, and integrate
the ventricles, manyplexuses,
the choroid I.body functions.
conducts and arachnoid
impulses associated
45. Spinal
11.5 Define PRACTICE
sympathetic tone.
Cord
explain these symptoms? 46. Explain how autonomic neurotransmitters influence the
the current chapter.
392
blood vessel?
|
UNIT 3 INTEGRATION AND COORDINATION
Outcomes 11.5, 11.6
In addition to neurons, nervous
granulations.
4.neuroglia, shown ofincerebrospinal
List the functions
with sense
figureJ. conducts
5.33.fluid.
tissue
Unlike
of smell
impulses
includes abundant 22.
neurons,
from neuroglia 23. 25.
Describe
24. Describe
actions
thethe
of
List Distinguish
the two main
47. Distinguish
structure of the spinal cord.
general characteristics
effector cells.
functions
between
between neurons
alpha
of the
of nervous tissue.
and spinal cord.
neuroglia.
adrenergic and beta
Outcomes 7.6, 7.7, 11.2, 11.3 5. The biceps-jerk reflex employs motor neurons that exit from 11.4divide
Brainand are crucial to the functioning upper and lower of neurons.
teeth Neuroglial 24. Distinguish between a reflex arc and a reflex.
adrenergic receptors.
2. If a physician plans to obtain a sample of spinal fluid from K. conducts impulses 25. Which of the choices is the correct sequence of events in
the spinal cord primarily in the fifth spinal nerve (C5), that is, 5. Describe the events of brain development. 11.8 aLife-Span
reflex arc? Changes
a patient, what anatomical site can be safely used, and associated with vision
fifth from the top of the cord. The triceps-jerk reflex involves CHAPTER 5 | Tissues 173
Chapter Summary
patient be positioned toOutlines
6. Which choice lists the parts of the brainstem?
how should the
shi64561_ch11_389-443.indd
procedure?
392
facilitate this help review the motor neurons primarily in the seventh spinal nerve
might these reflexes be used to help locate the site of damage
(C7).05:23
08/05/17 How PM
34. b.
a. midbrain, pons, and medulla oblongata
forebrain,
Explain how midbrain,
the spinal and hindbrain
nerves are grouped and numbered.
48. a. effectors
Explain
49. Listsensory
three ways
to motor
the effects
receptor
ofneurons
apoptosis to on
interneurons
the developing
that the nervous system changes as we age.
to CNS to
brain.

50. b. sensorysleep
Describe receptor to CNS
problems thatto may
interneurons
accompany to motor
aging.neu-
chapter’s
Outcomes 11.4,main11.5 ideas. in a patient with a neck injury? 35. c. sulci cauda
Define and fissures
equina.
d. frontal, parietal, and temporal lobes
rons to effectors
c. effectors to CNS to interneurons to motor neurons to
3. What functional losses would you expect to observe in a Outcome 11.7 7. Describe the structure of the cerebrum.
shi64561_ch05_149-177.indd 173 sensory receptor 08/05/17 05:17 PM
patient who has suffered injury to the right occipital lobe of 6. What symptoms might the sympathetic division of the auto- 8. Define cerebral cortex. d. sensory receptor to motor neurons to CNS to interneu-
9. Describe the location and function of the sensory areas of
the cerebral cortex? To the right temporal lobe? nomic nervous system produce in a patient experiencing stress?
the cortex.
ASSESS rons to effectors
26. Describe a withdrawal reflex.
10. INTEGRATIVE
Explain the function ASSESSMENTS/CRITICAL
of the association areas THINKING
of the lobes 27. Indicate whether each nerve tract is ascending or
of the cerebrum. descending:
Outcomes
11. Describe 4.4,
the 11.4
location and function of the motor areas of 4. Brown-Seguard syndrome is due to an injury on one side of
a. rubrospinal b. corticospinal
Chapter Summary 12.
the
Broca’s
cortex.
1. In planning treatment for a patient who has had a cerebro-
area controls _______.
the spinal cord. It is characterized by paralysis below the injury
and
c. spinothalamic d. fasciculus gracilis
on the same side as the injury, and by loss of sensations
vascular accident (CVA), why would it be important to know e. reticulospinal f. spinocerebellar
1. The brain oversees sensation and perception, movement, a. memory of temperature and pain on the opposite side. How would you
11.1 General Characteristics of Divisions of the whether the CVA was caused by a ruptured or obstructed
b. defecation
28. Explain the consequences of nerve fibers crossing over.
explain these symptoms?
and thinking. blood vessel?
Nervous System c. understanding grammar 11.6 Peripheral Nervous System
2. The brainstem connects the brain and spinal cord,
The central nervous system (CNS) consists of the brain and d. movements used in speaking Outcomes
29. Distinguish 11.5,between
11.6 the somatic and autonomic nervous
allowing communication between the two. Outcomes
spinal cord. 13. Explain7.6, 7.7, 11.2,
hemisphere 11.3
dominance. 5. Thesystems.
biceps-jerk reflex employs motor neurons that exit from
3. The spinal cord provides communication between the 2.14.
If a Distinguish
physician plans to obtain a sample
between short-term andoflong-term
spinal fluid from
memory. 30.
theDescribe
spinal cord theprimarily
connective tissue
in the fifth and nervous
spinal nerve tissue making
(C5), that is,
CNS and the PNS. a patient,
15. Explainwhat anatomical of
the conversion site can be safely
short-term used, and
to long-term fifthup a peripheral
from the top ofnerve.
the cord. The triceps-jerk reflex involves
howmemory.
should the patient be positioned to facilitate this 31.
motorWhich of theprimarily
neurons followinginconduct
the seventh sensory impulses
spinal to the
nerve (C7). How
440 UNIT 3 | INTEGRATION AND COORDINATION procedure?
16. The ________ conducts sensory information from other mightCNS fromreflexes
these receptors be in muscle
used to helpor skin?
locate the site of damage
parts of the nervous system to the cerebral cortex. in aa.patient
general withsomatic
a neckefferent
injury? fibers
Outcomes a. pineal 11.4,
gland 11.5 b. hypothalamus b. general somatic afferent fibers
c. thalamus d. basal nuclei
3. What functional losses would you expect to observe in a Outcome 11.7 visceral afferent fibers
c. general
17. List the parts of the limbic system, and explain its functions. d. general visceral efferent fibers
patient who has suffered injury to the right occipital lobe of 6. What symptoms might the sympathetic division of the auto-

439 xix
the cerebral cortex? To the right temporal lobe? nomic nervous system produce in a patient experiencing stress?
shi64561_ch11_389-443.indd
CHAPTER 11 | Nervous System II
440 08/05/17 05:23 PM

Chapter Summary
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CONTENTS
About the Authors   vi | Acknowledgments   viii | Updates and Additions   ix | Dynamic Art Program   xvi | Learn, Practice, Assess   xviii |
McGraw-Hill Connect   xx | LearnSmart Prep   xxii | Contents   xxii | Clinical Applications   xxviii

PREVIEW

Foundations for Success 1

P.1 Approaches to Learning 2
P.2 Strategies for Success 2
CHAPTER ASSESSMENTS 7
I N T E G R AT I V E A S S E S S M E N T S / C R I T I C A L T H I N K I N G 8
CHAPTER SUMMARY 8

© Comstock Images/Jupiterimages RF

UNIT 1
LEVELS OF ORGANIZATION 9

CHAPTER 1 2.3 Chemical Constituents of Cells

CHAPTER ASSESSMENTS 81
70

Introduction to Human Anatomy

I N T E G R AT I V E A S S E S S M E N T S / C R I T I C A L T H I N K I N G 81
and Physiology 9
CHAPTER SUMMARY 82
1.1 Origins of Medical Science 10
1.2
1.3
Anatomy and Physiology 11
Levels of Organization 12
CHAPTER 3
1.4 Core Themes in Anatomy and © Brand X Pictures/PunchStock RF Cells 84
Physiology 14
3.1 Cells Are the Basic Units of
1.5 Life and the Maintenance of Life 15 the Body 85
1.6 Organization of the Human Body 20 3.2 A Composite Cell 85
1.7 Life-Span Changes 29 3.3 Movements Into and Out of
1.8 Anatomical Terminology 29 the Cell 100
Some Medical and Applied Sciences 33 3.4 The Cell Cycle 108 © Keith R. Porter/Science Source

CHAPTER ASSESSMENTS 35 3.5 Control of Cell Division 112

I N T E G R AT I V E A S S E S S M E N T S / C R I T I C A L T H I N K I N G 36 3.6 Stem and Progenitor Cells 114
CHAPTER SUMMARY 36 3.7 Cell Death 115
CHAPTER ASSESSMENTS 118
R E F E R E N C E P L AT E S 1 – 2 5
I N T E G R AT I V E A S S E S S M E N T S / C R I T I C A L T H I N K I N G 119
The Human Organism 39 CHAPTER SUMMARY 119

CHAPTER 2 CHAPTER 4
Chemical Basis of Life 59
Cellular Metabolism 122
2.1 The Importance of
4.1 Metabolic Processes 123
Chemistry in Anatomy
and Physiology 60 4.2 Control of Metabolic
Reactions 125
2.2 Structure of Matter 60 © Biophoto Associates/
© Science Photo Library/Alamy RF Science Source

xxiii