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UNIT 1
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
UNIT 2
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
UNIT 3
CHAPTER 18
CHAPTER 19
CHAPTER 20
CHAPTER 21
CHAPTER 22
CHAPTER 23
CHAPTER 24
CHAPTER 25
CHAPTER 26
The Body as a Whole, 1
UNIT 4
Organization of the Body, 2
Homeostasis, 23
Chemistry of Life, 38
Biomolecules, 55
Cell Structure, 75
Cell Function, 98
Cell Growth and Development, 120
Introduction to Tissues, 137
Tissue Types, 154
Transportation
and Defense, 604
CHAPTER 27
CHAPTER 28
CHAPTER 29
CHAPTER 30
CHAPTER 31
CHAPTER 32
CHAPTER 33
CHAPTER 34
Blood, 606
Heart,634
Blood Vessels, 663
Circulation of Blood, 697
Lymphatic System, 725
Innate Immunity, 746
Adaptive Immunity, 759
Stress, 782
Support and Movement, 178
Skin, 180
Skeletal Tissues, 209
Axial Skeleton, 233
Appendicular Skeleton, 263
Articulations, 281
Axial Muscles, 31 0
Appendicular Muscles, 333
Muscle Contraction, 356
Communication, Control,
and Integration, 386
Nervous System Cells, 388
Nerve Signaling, 408
Central Nervous System, 432
Peripheral Nervous System, 473
Autonomic Nervous System, 47 4
General Senses,498
Special Senses, 514
Endocrine Regulation, 526
Endocrine Glands, 556
UN IT 5
Respiration, Nutrition,
and Excretion, 798
CHAPTER 35
CHAPTER 36
CHAPTER 37
CHAPTER 38
CHAPTER 39
CHAPTER 40
CHAPTER 41
CHAPTER 42
CHAPTER 43
CHAPTER 44
Respiratory Tract, 800
Ventilation, 823
Gas Exchange and Transport, 847
Upper Digestive Tract, 860
Lower Digestive Tract, 881
Digestion and Absorption, 900
Nutrition and Metabolism, 928
Urinary System, 963
Fluid and Electrolyte Balance, 996
Acid-Base Balance, 1016
UNIT 6
CHAPTER 45
CHAPTER 46
CHAPTER 47
CHAPTER 48
Reproduction and
Development, 1034
Male Reproductive System, 1036
Female Reproductive System, 1054
Growth, Development, and Aging, 1086
Genetics and Heredity, 1121
Glossary of Anatomy & Physiology, 1144
Index, 1198
Anthony's Textbook of
21ST EDITION
KEVIN T. PATTON, PhD
Professor of Anatomy & Physiology Instruction
New York Chiropractic College
Seneca Falls, New York
Founding Professor of Life Sciences,
Emeritus Faculty
St. Charles Community College
Cottleville, Missouri
Assistant Professor Emeritus of Physiology
Course Director Emeritus in Human Physiology
St. Louis University Medical School
St. Louis, Missouri
AUTHOR EMERITUS
GARY A. THIBODEAU, PhD
Chancellor Emeritus
Professor Emeritus of Biology
University of Wisconsin- River Falls
River Falls, Wisconsin
ELSEVIER
ELSEVIER
32 51 Riverport Lane
St. Louis, Missouri 6304 3
ANTHONY'S TEXTBOOK OF ANATOMY & PHYSIOLOGY, 21ST EDIT ION
ISBN: 978-0-323-52880-1
C opyright © 2019 by Elsevier Inc. All rights reserved.
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Winner of the 2016 Textbook Excellence Award from the Textbook & Academic Authors Association.
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About the Author
Kevin T. Patton
has ta ug ht anatomy :md physiolt>g}' (A&·P) to high sd10oal, community college. and
university shtdenb from \':trious backgrounds for more
th:m 3 (lc:c.:ulc:~-. Kevin found th:tt the wo rk tl1at led him
to:. PhD in verteln a te anatomy and ph~~iology instillc:<l
in him an :.ppreciation for t1H: ~ B ig Picture .. of human
struchtre :ut<l function. T'his cxpcricnce has IH:Ipcd him
prudu~ :1 text tl1at \\ill he e:.sier to m1<le rst.and for all studcnls.
He h:.s earned se\-er.~l citations for te:.ching A&: P, including the lvl issomi Cmrernor's Award for Excel len~ in Te:.ching.
"One tl1ing t·vc lcamcd," s.:ays Kc\~n. "'is that most of us learn scientific
concepts more easily \lll1c:n we c:.n see whafs going on.- His talent for using
imagery to teach is C\~dcnl tluougl10ut th is eclitiun, \\ith ib; extensive :m:.y of
visu:.l rc:sourcc:s. Kc:vin ·s stro ng interest in applying the principles of leaming
scic:nc:e to c:ffectivc:ly tc::.ehing A&P is also c:vi<le nt in the instructional clc:sign
o f th is texthuok, whid1 earned tl1e 1016 Tbthook Excdlenec: Award from the
textbook & Aeademic Authors A.;sociation (l i\.A).
Kevin's work in promoting excellence: in teaching A&P h 3s lc:d h im to take
an active role in tl1c: H um:.n Anatomy :.nd Physiology Society (HAPS). wl1c:re
he is 3 Presiclc:nt Emerihts. He w:.s the fmm<ling director o f the:
HAPS lmtitute ( H.Af>$.() and was :rw;mled the HA PS Presi·
<le nt's 2\•lc:d:.l for o utstanding contrilmtions in Jlromoting the
To my family and friends. who
mission of e.xec:llc:nc:e in A&P tead1ing :.nd learning.
nnl!r let me forget the joys ofdisrovery.
Kevin :.lr.o teaches gra<lu:.te courses to prospective and cur·
adventure. and good humor.
rent A&:P professors. He h:.s sc:rvecl :.s 3 mentor to A&P profes.
To the many teachers who taught
son across the continent and produces online resomees for
me more by who they were than by
A&·P shtdc:nts and tead1c:n. including tlreAI'student.org :.nd
what they said.
theAPprofessor.org. His blog PaUorv\P.org provides insigl1ts
To my tdudents who help me keep
and tc::.ching notes fur f:tculty using this textbook.
the thrill of learning fresh and exciting.
Kel<in '1: l'aHou
v
ane
Rhonda Gamble, PhD
Professor of Physiological Sciences
Mineral Area College
Park Hills, Missouri
Michael Greer, MA
Instructor
University of Arkansas at Little Rock
Little Rock, Arkansas
Suzanne Hembrough, MA
Instructor
Lindenwood University
Saint Charles, Missouri
Saint Louis University
Saint Louis, Missouri
Terry Thompson, MS, MS-HAPI
Professor of Biological Sciences and
Phi Theta Kappa Advisor
Wor-\iVic Community College
Salisbury, Maryland
Peggie Williamson, MS, SPT
Professor
Central Texas College
Killeen, Texas
EVOLVE WRITER
Daniel J. Matusiak, BS, MA, EdD
Life Science Instructor
St. Dominic High School
O'Fallon, Missouri
Adjunct Professor
St. Charles Community College
Cottleville, Missouri
ONLINE COURSE WRITER
Linda Swisher, RN, EdD
Retired
Suncoast Technical College
Sarasota, Florida
ers
Amanda May Boye-Ray
Bhupinder Singh
John Bagdade
AnMed Health School of Radiology
Biztech College
Northwestern University
Carolyn Bunde
Kathy Smith-Stillson
Mary K. Beals
Idaho State University
Regis University
Colorado Christian University
Southern University and A&M College
Teresa Cowan
Baker College of Auburn Hills
Debbie Gantz
Mississippi Delta Community College
Robert S. Kellar
Northern Arizona University
Karen Kelly
Milligan College
Nick Pasquale
UltraSound Institute/MUA: Medical
University of America
Luann Wilkinson
Marion Technical College
Peggie Williamson
Central Texas College
Justin L. Wilson
Hampton University
PAST EDITION REVIEWERS
The Department of Physiology and The
Department of Anatomy & Structural
Biology
Rachel Venn Beecham
Mississippi Valley State University
Brenda Blackwelder
Central Piedmont Community College
Richard Blonna
William Paterson College
Claude Bouchei
INSERM
Charles T. Brown
Barton County Community College
Laurence Campbell
Florida Southern College
East West College of Natural Medicine
Otago School of Medical SciencesUniversity of Otago
Scott D. Schaeffer
Mohammed Abbas
Carolinas College of Health Sciences
Harford Community College
Wayne County Community College
Kim Seigman
Laura Anderson
Covenant School of Radiology
Elk County Catholic High School
Owensboro Community and Technical
College
Paula Denise Silver
Bert Atsma
Roger Carroll
ECPI University- Medical Careers Institute
Union County College
University of Tennessee School of Medicine
Kevin Pierce
•
VI
Patricia W. Campbell
Geralyn M. Caplan
Reviewers
Melvin Chambliss
Alfred State College
SUNY College of Technology
Pattie Clark
Abraham Baldwin College
Richard Cohen
Union County College
Barbara A. Coles
Wake Technical Community College
Harry W. Colvin, Jr.
University of California - Davis
Darwin Coy
University of North Florida
Douglas M. Dearden
General College of University of Minnesota
Cheryl Donlon
Northeast Iowa Community College
J. Paul Ellis
St. Louis Community College
Frank G. Emanuele
Mercyhurst University
Cammie Emory
Bossier Parish Community College
Julie Fiez
Washington University School of Medicine
Beth A. Forshee
Lake Erie College of Osteopathic Medicine
Rebecca Halyard
Clayton State College
Melanie S. MacNeil
Brock University
Ann T. Harmer
Orange Coast College
Susan Marshall
St. Louis University School of Medicine
Linden C. Haynes
Hinds Community College
Gary Massaglia
Elk County Christian High School
Lois Jane Heller
University of Minnesota School of Medicine
Bruce S. McEwan
The Rockefeller University
Lee E. Henderson
Prairie View A&M University
Jeff Mellenthin
The Methodist Debakey Heart Center
Angela R. Hess
Bloomsburg University
Lanette Meyer
Regis University/Denver Children's
Hospital
Paula Holloway
Ohio University
Julie Hotz-Siville
Mt. San Jacinto College
Gayle Dranch lnsler
Adelphi University
Patrick Jackson
Canadian Memorial Chiropractic College
Carolyn Jaslow
Rhodes College
Gloria El Kammash
Wake Technical Community College
Murray Kaplan
Iowa State University
Laura Frost
Florida Gulf Coast University
Kathy Kath
Henry Ford Hospital School of Radiologic
Technology
Debbie Gantz
Mississippi Delta Community College
Brian H. Kipp
Grand Valley State University
Christy Gee
South College - Asheville
Johanna Krontiris-Litowitz
Youngstown State University
Becky Gesler
Spalding University
William Langley
Butler County Community College
Norman Goldstein
California State University- Hayward
Zully Villanueva Gonzalez
Dona Ana Branch Community College
John Goudie
Kalamazoo Area Mathematics & Science
Center
Michael Levitzky
Louisiana State University School of
Medicine
Clifton Lewis
Wayne County Community College
Jerri Lindsey
Tarrant County Junior College
Charles J. Grossman
Xavier University
Eddie Lunsford
Southwestern Community College
Monica L. Hall-Woods
St. Charles Community College
Bruce Luon
University ofTexas Medical Branch
Donald Misumi
Los Angeles Trade- Technical Center
Susan Moore
New Hampshire Community Technical
College
Rose Morgan
Minot State University
Jeremiah Morrissey
Washington University School of Medicine
Greg Mullen
South Louisiana Community College/
National EMS Academy
Robert Earl Olsen
Briar Cliff College
Susan M. Caley Opsal
Illinois Valley Community College
Juanelle Pearson
Spalding University
Nicole Pinaire
St. Charles Community College
Wanda Ragland
Macomb Community College
Saeed Rahmanian
Roane State Community College
Robert S. Rawding
Gannon University
Carolyn Jean Rivard
Fanshawe College of Applied Arts and
Technology
Mary F. Ruh
St. Louis University School of Medicine
Jenny Sarver
Sarver Chiropractic
••
VII
viii
Reviewers
Henry M. Seidel*
Aleta Sullivan
Karin VanMeter
T he Johns Hopkins University School of
Medicine
Pearl River Community College
Iowa State University/Des Moines Area
Community College
Gerry Silverstein
Iowa State University
University ofVermont- Burlington
Charles Singhas
East Carolina University
Marci Slusser
Reading Area Community College
Paul Keith Small
Eureka College
William G. Sproat, Jr.
Walters State Community College
Snez Stolic
Griffith University
· Deceased.
Kathleen Tatum
Reid Tatum
St. Martin's Episcopal School
Kent R. Thomas
Wichita State University
Todd Thuma
Macon College
Stuart Tsubota
St. Louis University
Judith B. Van Liew
State University of New York College at
Buffalo
Gordon Wardlaw
Ohio State University
AmyL. Way
Lock Haven University of Pennsylvania
Anthony J. Weinhaus
University of Minnesota
Cheryl Wiley
Andrews University
Clarence C. Wolfe
Northern Virginia Community College
his textbook relates th e story of the human body's structure and function.
More than a simple collection of facts, it is both a teaching tool and a learning tool. It was written to help students unify information, stimulate critical
thinking, and acquire a taste for knowledge about th e wonders of th e human body.
The story related in th is textbook will h elp students avoid becoming lost in a maze 45°
of facts while navigating a complex learning environment. It will encourage th em to
explore, to question, and to look fo r relationships, not only between related facts in
a single disciplin e, but also between fields of academic inquiry and personal experience.
This new edition of the text has been carefully revised to better tell the story of the
human body. Essential, accurate, and current information continues to be presented in a
comfortable storytelling style. Emphasis is placed on concepts rath er than descriptions,
and the "connectedness" of th e human body- in which structure fits functi on - is repeatedly reinforced by unifying th emes.
UNIFYING THEMES
Anatomy and physiology encompasses a body of knowledge that is large and complex.
Students are fac ed with th e n eed to know and understand a multitude of individual structures and functions that constitute a bewildering array of seemingly disjointed information. Ultimately, th e student of anatomy and physiology must be able to "pull togeth er"
this information to view th e body as a whole-to see the "Big Picture." If a textbook is
to be successful as a teaching tool in such a complex learning environment, it
must help unify information, stimulate critical thinking, and motivate students
to master a new vocabulary.
To accomplish th is synthesis of information, unifying themes are required to tell the story
of the human body effectively. In addition, a mechanism to position and implement these
themes must be an integral part of each chapter. Prior to Unit l is "Seeing the Big Picture,"
an overview that encourages students to place individual structures or functions into an integrated framework. T hen , a special "T he Big Picture" section wraps up th e story of each
chapter so that its significance in th e overall function of the body can easily be seen.
Anthony's Textbook of Anatomy 6 Physiology is dominated by two major unifying
themes: ( l ) structure fits function and (2) homeostasis. The student is shown, as the
story unfolds, how organized anatomical structures of a particular size, shape, form, or
placem ent serve unique adaptive functions. The integrating principle of homeostasis is used to show
how th e "normal" interaction of structure and function is achieved and maintained by counterbalancing forces with in the body. Repeated emphasis of
th ese principles encourages students to integrate otherwise isolated factual information
into a cohesive and understandable whole.
"The Big Picture" summarizes th e larger
interaction between structures and functions of the different body systems. As a
result, the story of anatomy and
physiology emerges as a living and
dynamic topic of personal interest
and importance to students.
•
IX
x
Preface
• AIMS OF THE REVISION
In)' re\'ision ellorts focused on identi~·ing tl1e nec:d for new o r revise<l informdlion
and for a<l<lition.al visual presc:ntdtions that clari~· important, yet sometimes d ifficuIt, c:onlc:nt :.reas.
In tl1is tc:ntl1 e<lition,l have include<l information on new concepU :.ml new perspectives in many
areas o f an:.tomy :.ml pl1p iology. Some: of the ferminology has been upd:.ted to reflec:t the most e mrent us:.gc: in the seic:ntihc community. The d iseuSllion of osmosis in Ch:.ptc:r 4 :.nd se\·eral o ther
chapters l1.as bc:en clarihc:d to reReet the latest seientihc understdnding while: still rc:t:~ining an "entry
level- treahnc:nt of this important eoncept The stress ch:.ptc:r (Ch:.pter H) h:.s heen reorganized and
p;trfi.:.Hr rewritten to hetter reflect current theories o f
stress in humans. Most of tl1e content ch:.nges :.re
subtle a<l justmenb> to our current un<lc:rst.anding of
hum:.n science; however, t11c: accumubtion of all o f
these ch.:.nges makes th is e<lition tl1e most up-to-tlate
textbook :t\'aibble.
'11lis e<lition .:.lso intro<lucc:s a uni<pte ne\v ledrning
fc::.turc: th:.t repbcc:s the: fonner "summ.:.ry" opc:nc:rs
to tl1c: six units o f tl1is ch:.ptc:r. Dc\·c:loped in colb l,.,
ration with cognitive texthook design expert lvlichael
Creer and .:.natmnr and physiologr professor 1C:rry
'11mmpson, each unit now opens with an illustr.ttc:d tool
th:.t jump-stdrb> student le.arning hr rc\'iC~.\ing JXlsf learning :.ml prc\'iC~.\ing nc:w lc:.:.rning yet
to come. 'l11is innov:tti\·c: strafe:~· is b:.sed on cunc:nt, evi<lc:nce·hasc:d leaming theories.
In :.n im~ting. illustr.tted layout, these ne\v interaeti\'e unit openers provide spaced
retrieval practice along \\ith pre-testing exercises proven to enhance shtdent
learning. Student:; wl10 usc: this nc:w fe.ah tre will en joy a more c:ffecti\'c:
learning experience :.s they mo\'e tluough tl1c: textbook.
A h:.llmdrk of this lexthook has bc:en its effecti\'e "chunking- of
m:.teri.:.l into man.age;tb)e b ite-size p ieces-.:.notl1er C\'i<lc:nce-basc:d
enh:.ncement of tl1c: ledrning process. This edition reflects
mr continuing commitment to that approach. In the pre\'i-==~~~ om edition, I undertook significant chunking o f long
~
chapters into sm.:.H, c::.sil)' rc::.d chapter.>, In this ne\v e<lition, I continue the: process h)' carefully clari~~ng an<l
adding sullllc::.ding:o; to im pro\'e the telling o f the story of the
human bodr. Besides provi<ling graphic scaffolding to help shtdents construct a dc::.r umler.;tan<ling of concepts :.s the story unfolds, these: subheadings .:.)so help stmlc:nU hnd rc:lc\'anl material as
thcr later "r.ti<l- their texthook for specific help in cbri~·ing d ifficult
concc:pb>-ur concepU thc:y missc:<l or forgot :.ftc:r their hrst red<ling. I h:.ve
also t.aken opportunities to reduce: cognitive load and impro\'C: rc::.ding comprehension b)· spliHing longer paragraphs into sm.:.llc:r p.:.ragrnphs.
Another .:.im of th is rc:\~sion has been the hne-tuning of tl1e usc: of online:
articles. FOnnerly called A 6 1) Connect, this feahtre is now called Con nect It!
Besi<lc:s JllU\'iding interesting :.sides t11.at hd1) sp:trk interest in a topic and
moti\'ate deeper le.:.ming, these articles provide an opportunity to integrate diverse topics scattered throughout the book. For example:, the
rc:\~sed article The Human Microbionle is c:.lled out in m.lH)' different cl1dpters,
helping rc:a<lers sc:e the numerous connections that ch.:.r:tcterizc: human structure
and fun ction. Such "integrati\'e- use of the articles has bec:n c:xp.:.nded and improved in tl1is c:<lition.
PrC~.·ious editions have featured wh.:.t is nuw our sjgnature page design
that makes the textbook easier to use by putting the illustrations,
graphs, and tables doser to the related text In tl1is edition, our prO<luction tc:.:.m l1.as worked h:.rd to make the page layout cvc:n more effective for
As in p:.st editions,
Preface
telling tl1e story or tl1e human hody. The extensi\-e set of summary tables helps s.tuden~ visually org;tnize important concepb> :md complements the impm..-ed <lesign to provide a muhisc:nsory learning
tool. The art program has been enhance<! by moving descriptions of ..steps- from tl1e legend into
the (liagr.~m itselr. tlnu reducing cognitive lo:.d and imprO\-ing comprd1ension.
The effort.; in represen ting d iversity of the ht.man form continue in th is edition by
a(Ming a new set o r musde illustrations feahu ing a remale subject. Our :.rtish llaYe also replaced many illustr:ltions thro ugl1out tl1e book witl1 :.rt representing a more d iverse set of hum:.n traib.
SC'\·eral new illustr:ltions also maintain the use of :. eonsistent Color Key (round on tl1e
Emh-e website at n'Ofl.-e.~lsevi~r. rom/PaHon/AN) for certain cell parb>, tissue types, :.nd hiomoleeules to help ma~e learning easier ror beginning shulc:nts.
In this e(lition, I continue my effort to ma~e tl1is text :.ccessible to shulents whose fir.ot langua.ge
is not English. Arter consulting witl1 ESL speci:.lists :.nd £Sllearners. I have continued t o refine
chapter word lists and improve readability to make the concep ts o f h uman s tructure and
function more understandable for all studen ts.
As a te:.cher of :matomy :md physiology. I know that to he effective a text must be dear :.nd rea<lable, an<l it must c11allenge and excite the student. Th is text remains one that students will
read- o ne designed t o help the teacher t each and the student learn. 10 :.ccomplisl1 tl1is
end, I f:.cil itate(l the comprehension of (liflicult m:.teri:.l for shulc:nts with thorough, consistent, an<l
nonintimid:.ting expbnations that are free or unneeess:.ry terminology :.ml extr.meous infonnation.
'l'his easy access to complex i(lea.s remains tl1e single most striking l1allm:.rk or this texthool
• LEARNING AIDS
Anthony$ 'textbook ofAnatomy 6 Physiology is a student-oriented text. \ ¥ rinen in:. re:.dable style th:.t
tc:lls a col1erc:nt story, the text is <lesigne<l with many d ifferent pe(lagogical aids to moti..-ate :.ml mainlain interest. T11e special re:.tures and leam ing :.ids listed below are intemled to faci litate learning and
retention of infonnation in the most effecti\·e and efficient manner.
No textbook c:.n replace tl1e direction and stimulation provided by an c:nthusi:.stic teacher to a
curious an<l in\'Oh-ed stm lc:nt. Howe\'er, :1 rull complement o r innovative pedagogical ai(ls that :.re
eardull)' planned and implemented can contribute:. great deal to tl1e success o f a text as:. le:.rning
tool. An excellent textboul: c:.n and should be enjoyable to re:.d an<l sl10uld be l1d pfu1 to both shJdent
and teacher. I l10pe you :.gree that the learning aids in Anthony's 'ff>xtbook ofAnatomy 6 l)hysiology
mec:t the h ig h expectations l l1a\'e set.
INTERACTIVE UNIT INTRODUCTIONS
E.aeh of the six m:.jur units of the tc:xt hegins with a bric:f, interactive le:.ming opportunity that reviews
JUSt learning:.nd "'primes the pump- ror nC'\V le:.m ing in the ch apters th:.t by:.hea<l. Based on mudern le:.ming science, using this strategy "~11 c:nh:.nce yuur understanding :.s you re:.d the chapters o r
each unit. '11tis is rollmved ll}' :. dear o\·c:rviC~.v o r tl1e story told in the chapters or tl1e unit. E:.ch unit
h:.s:. color-coded tab at the outside edge of e\'c:ry )Xlge to help )'UU quickl)' find tl1c: infonnation )'UU
need.
CHAPTER LEARNING AIDS
Study Hints gi1--e specific suggestiom (or using many of th~ l~amiug aids found in ead1 chapter.
Because many readers l1a\·e never le:.m ed the speci:.l skills nee(le<l to make effective use of
the pe<l.agogic:.l resources fo und in science textbooks, hc:lpru l tips :.re emlle(Me<l within e:.ch Chapter Outline, L:mgu.age of Science & 2\•lc:dicine
list. Case: Shtd)', C l1apter Summary, RC'\·ic:w Questions sc:t, and C ritic:.l
.__..;;;;..._.-.
'l11in king section. Answers ror the Quicl: Checl: an<l Case Study (ptc:stions :.re
available ror shtdcnb on the E:mh·e website (n:olv~.elsn'ier.rom/PaltoniAPI). :.nd :.nswers for these
plus the ReviC'\\' and C ritic:. I Thin~ing E.xercises are :J\'aibhle for instm ctors in the TEACH Instructor's Resource.
'l'he Chapter Outline: summari;n the ronknU ofa chapin at a glance. An over\'ic:w outline intm·
<luces e:.ch chapter and c:nallles the student to prc:\-iew the content :.nd direction of tl1c: ch apter at the
m:.jur concept le\'c:l berore heginning a detailed rea<ling. P:tge references en:.ble students to quickl)'
locnte topics in tl1e chapter.
H nt
x:i
xii
Preface
Language of Science introduces you to new scientific tf'mu in the chaptf'r. A comprehensive list of new terms is presc:ntecl :.t l11c: beginning of t11c: d1apter. f.:td1 term in the
list h:.s :.n eaS)'4t~I LSe pro nunciation guide: to help the Ieamer easily "'c1wn- the worcl by
LANGUAGE OF SCIENCE
being :.llle to say it. literal tr:msb tiom o f c::.ch lc:nn's word pam are inc:ludecl to l1c:lp
Isometric contraction
s.tuden~ learn how to clc:<luce the mc::.ning of new lc:nns on their mm. l 1le listecl terms
(a)'e-soh·f.£T.fik kon·TRAK·shlll)
are clc:fined in the text lxxl}'. wl1c:re they :.ppe:.r in bolclf:.cc: type. and :.re also in the: C losl.iso· equa~ -metr· meas~.n,
50ry at t11c: back o f the: bool The: boldface type feature: enables shulc:nU to scan tl1e lc:xt
·k relating to, c:oo- together,
for nc:w wor<ls hefore beginning their first clc:t:~ilc:d rea<ling of the: material, so the)' m:.y
·tmct· drag or lkaw. ·tilt~ process)
reacl without h:.ving to clisrupt the Row to gr:.pplc: witl1 new '"-urds o r phrases. T11e lan
Isotonic contraction
guagc: of Scien~ word list includes terms rc:latc:<l to the essential :.natom)' an<l physiology
(aye·Soh·TON·ii< kon· TRAK·sl'ul)
presc:ntc:d in tl1c: chapter. Anotl1er word list nc:ar tl1e end of the chapter, :1 feature clel.iso· equa~ /IJII· stretdl or tension,
scribc:<l as the L:.nguage o f !vleclicine, is an in\'e ntory of all of the new clinic:.) tenns in
·k relating to, c:oo- together,
troc:lucecl in the: ehaplc:r.
·118Ct· drag or lkaw. ·tilt~ process)
Cnlor-cuded illustr.:ttions help Mginning 5tudf'nts appreciatE' thE' '"Big Picture" of hu·
lactate (IAK· tly1)
jAlct· rnJk., ·ate salt of 111 acidJ
man structure and {unction. A special fc::.ture of the illustr:ltions in th is tc:xt is the: eareful
and consistent use o f color to identify important stmchnes and subsbnces th:.t recur
throughout the book. Consistent me of :1 color ~e)' helps beginning shulc:nU apprc:ciafe
the "Big Picture" elf human stmctmc: an<l function c::.ch time the)' sec: a familiar structure
in a new illustr:~lion. For an explanation of the color scheme, see the Color Ker o n the
E\'Ulve wdlsite (c.11'0lve.elsettier.com/Patton!Ai>l).
Direction al rosettes help students lf'am thE' orientation of anatomical
5fructurrs.. Where: appropriate, small orientation c~agr.um and clirc:ctional
msettc:s are includecl as JXlrf o f an illustr.ltion to help stmlc:nb> locale: a stru~
lure with reference: to the boc:k as a whole or orient :1 small struchue in a
larger vic:w.
Qu ick Check tluestions test your knowledgE' of material you'vE' just
Quick C H E C K
read. Short objc:etive-type questions are locatecl immecli:.tc:ly follc)'l,\rlng
1. L.m the majOf subdivisions of the hu'nan nervous system.
m:.jor topic cliscussions thmughoul the: boclr of the text. '11lc:se ques2. What two organs make up the ceNral nervous system?
tions cover important infonnation presented in t11c: preceding section.
3. Contrast the somatic nervous system with the autonomic oef'IIOus
Shulc:nts un:.llle to answer the questions shoulcl rereacl that section
before JlfOcec:ding. This feature: therefore c:nhan~s reading cmnprc:hc:nsion. Quick Check items are numbered b)' chapter, and a numc:ri
cal listing of their answers ean he fo und o n the: £mlve website: (e-vob't".
4
4
.,....,,
4
C ON N E CT I T ! @
elsn'ier.coml f>aUonJAPI).
Cnn nect It! fc-.ah ues call the readtr's atte-ntion to online articles that
Tiny. barref.shaped organelles called vaults may
illudralf', clarify, and apply conupts f'ncoun lf'red in thE' lf'xl. £mheclclc:d
a1so assm with transport ol molecules to and
from the nucleus. To learn more about these little
within the text narrative, these: boxes connect you with intc:rc:s.ting, hrid
transport sh.rt1les.. check out Vsults oni'le at
o nline: articles th at stimulate thinking. satis~· your curiosity, and help
Comect ttt
you appl}' important concepU. Connect It! articles also help you unclc:r
stan d connections among stmcturc:s and functions throughout the:
bcxly. integrating concepts into a .. Big Pichu e- of lmman function.
'11lc:y are olfen illustratc:<l \\rlth m icrographs, meclical im:.ges, and mc:<li·
cal ilhLslrations.
Cycle of Life describn major changes that OC"CUT on!r a person's lifetimE'. fonn and function. The: intent o f the Mechanisms
In many hod}' srstc:ms, changes in struch1re and function are frequently re- of Disease section is to reinforce: understanding of
lated to a person's age o r state: of dC'I.·elopmc:nt. In appropriate: chapters of the tl1c: normal structures an<l mechanisms of the hody
text. these changes are hig hlighted in this special section.
while: h ighligl1ting the gc:nernl causes of disorders
The Big (Jid u rc explains the interactions of the sy~tem discusU!d in a par·
fur a )Xlrticular hod}' system. These: sections arc:
ticular chaptu with the body as a whole. 'l11is hc:lps sh1dc:nb> relate informa
heavily illustratc:<l with <liagrams and medical pho
lion about bod)· structures o r functions that are cliseussecl in the: chapter to
tographs that hring pathology eoncc:pts to life.
Lang u.:Jgc of M edic ine iulmducn )'OU to Uf'W
the bcxly as a whole. '11lc: Big Picture feature: hc:lps you improve critical
thin~ing h}' focusi ng on hm\' stmchnc:s and functions relate to one anotl1er
clinical terms in the chapter. A hrid list o f clinical
terms is presented near the c:nd o f each chapter. A<;
o n :1 bcxh-.,,i de hasis.
Mcch2nisrm of L>i~ca.'\C helps you understand the basic principles of hu· in the Language of Science: list at the lleginning of
man drudure and {unction by showing what hapfWns whf'n things go wrong. tl1c: chapter, each tc:nn has:. phonetic pronuncia
Examples of pat11ology. or <liseasc:, arc: includecl in man)' chapter.; of the hook tion g u ide and transbtions of \mrd JXII'fs. '11lc:
to stimulate student interest and to help shulc:nts umlc:rstand that the clisease listed terms are <ld i nc:d in tl1e text bod)'. where:
process is :1 <lismption in hmnc:ostasis, a llreakdown o f nonnal integration of ti1C:}' appear in holdfa~ type.
4
~'
4
0
4
4
Preface
A Case Study challenges you with "real-life" clinical
or other practical situations so you can creatively apply
what you have learned. Case studies precede the chapter
•••
XIII
Audio Chapter Summaries allow you to listen and
learn wherever you may be. T hese summaries are available in MP3 fo rmat for download at th e Evolve website
summaries. T he case study consists of a description of a
real-life situation and a series of questions that requ ire
the student to use critical thinking skills to determine
the answers.
The Chapter Summary outlines essential information in a way
that helps you organize your study. D etailed end-of-chapter summaries provide excellent guides for students as th ey review the text materials before examinations. Many students also find th e summaries
to be useful as a chapter preview in conjunction with th e chapter
outline.
(evolve.elsevier.com/Patton/API).
Review Questions help you determine whether you have mastered
the important concepts of each chapter. Review questions at the end
BOXED SIDEBARS
As always, I made every effort to update factual information and incorporate the most current anatomy and physiology research findings in this edition. Although there continues to be an incredible
explosion of knowledge in th e life sciences, not all new info rmation
is appropriate for inclusion in a fundamental-level textbook. T h erefore I was selective in ch oosing new clinical, path ological, and
special-interest material to include in this edition . This text remains
foc used on normal anatom y and physiology. T h e addition of new
boxed content is intended to stim ulate stu dent interest and provide
examples that reinforce the immediate personal relevance of anatomy and physiology as important disciplines for stu dy.
General Interest Boxes provide an expanded explanation of specific chapter content. Many chapters contain boxed essays, occasionally clinical in nature, th at
expand on or relate to material covered in the text. Examples of subjects include th e Brainbow visualization
of neural networks and the enteric nervous system .
Health Matters presents current information on dis-
Diagnostic Study keeps you abreast of developments
in diagnosing diseases and disorders. T h ese boxes deal
with specific diagnostic tests used in clinical m edicine
or research . Lumbar puncture, angiography, and antenatal diagnosis and treatment are exam ples.
0
eases, disorders, clinical applications, and other health
issues related to normal structure and function . In some
instances, examples of structural anomalies or path ophysiology are presented. Information of th is type is often useful in helping students un derstand th e mech anisms involved
in maintaining the "normal" interaction of structure and function .
career choices
of each chapter give students practice in using a narrative for mat to
discuss the concepts presented in th e chapter.
Critical Thinking Questions actively engage and challenge you
to evaluate and synthesize the chapter content. C ritical th inking questions require students to use th eir h igh er level reasoning skills and
demonstrate their u nderstanding of, not just their repetition of, complex concepts.
FYI gives you more in-depth information on interesting
topics mentioned in the text. Topics of current interest,
such as new advances in anatomy and physiology research , are covered in these "for your information" boxes.
Sports and Fitness highlights sports-related topics.
Exercise physiology, sports injury, and physical education applications are highlighted in these boxes.
Career Choices highlights individuals in healthrelated careers. A Career C hoices box appears at the end of each unit.
T hese boxes feature health professionals describing a few of the
diverse opportunities currently available in health-related occupations.
T hey also demonstrate th e im portance of how an understanding of
anatomy and physiology will be useful to students in their futures.
Glossary
A compreh ensive glossary of terms is located at the end of the text.
An expanded list of accurate, concise definitions and phonetic pronu nciation guides is provided, along with word parts and th eir literal
translations. An audio glossary is also available on the expanded
Evolve website (evolve.elsevier.com/Patton/AP/) with definitions and
audio pronunciations for most of th e key terms in the text.
Adult Nurse Practitioner
While going through nursing school, I had the opportunity to shadow
during an open-heart surgery. The quadruple-bypass procedure took
11 hours, but I never moved from my spot beside the anesthesiologist. I was in
awe watching the patient's heart pumping blood through its chambers. My fascination with the cardiac system blossomed in that moment when the heart came
back to life and started functioning after a successful bypass.
More than 20 years later, I still recall that amazing sight. I use A&P every day
in my role as an adult nurse practitioner in a cardiology practice. I see patients
with a variety of cardiovascular diseases, and educating patients on their conditions is key to my practice. I strive to explain complex cardiac anatomy and physiology to my patients in simple terms so that they can understand their disease
and treatment plans. I illustrate this complicated system by dividing cardiology
into three categories: electrical, "plumbing," and function. Electrical problems
involve the intrinsic conduction system of the heart,
including dysrhythmias. Plumbing problems relate
to the coronary arteries that supply the blood flow
to the heart muscle, including all the blockage
problems of that system. The entire function of the
heart is to pump blood through the pulmonary and
systemic circulation. Any disease affecting muscle
function can cause problems such as cardiomyopathies, congestive heart failure, and valve disease.
By educating my patients on the anatomy and
physiology of a healthy heart, I can explain cardiovascular disease treatments aimed at improving
their health. •
Dena Kruse,
APRN, MSN, ANP-BC
xiv
Preface
• LEARNING SUPPLEMENTS
FOR STUDENTS
evolve
EVOLVE.ELSEVIER.COM/PATTON/AP/
This new edition of Anthony's Textbook of Anatomy 6 Physiology is
supported by an expanded multimedia Evolve website, featuring:
• Audio Summaries for each chapter available for streaming
or download in convenient MP3 form.
• Answers to all of the Quick C heck and Case Study questions found in the textbook.
• Ouick access to all Connect It! articles cited in the
textbook.
• An interactive audio glossary with definitions and pronunciations for more than 1000 key terms from the textbook.
• The Body Spectrum E lectronic Anatomy Coloring Book,
which offers dozens of anatomy illustrations that can be
colored online or printed out and colored by hand.
-
• More than 500 Student Post-Test questions that allow you
to get instant feedback on what you've learned in each
chapter.
• State-of-the-art 3-D animations, which show and describe
physiological processes by body system.
You can visit the Evolve site by pointing your browser to evolve.
e!sevier. com/PattonlAPI.
ANATOMY AND PHYSIOLOGY ONLINE
This 24-module online course brings anatomy and physiology to life
and helps you understand the most important concepts presented in
the book. Available for purchase, this online course includes instructionally sound learning modules with animations, interactive exercises, and assessments.
SURVIVAL GUIDE FOR ANATOMY
& PHYSIOLOGY
ThE Survival Guide for Anatomy 6 Physiology (2nd edition), written by Kevin Patton, is an easy-to-read and easy-to-understand brief
handbook to help you achieve success in your anatomy and physiology course. Read with greater comprehension using the 12 survival
skills, study more effectively, prepare for tests and quizzes, and tap
into all of the information resources at your disposal. The included
Maps, Charts, 6 Shortcuts section is filled with illustrations, tables,
analogies, and diagrams that convey all of the important facts and
concepts students need to know to succeed in an anatomy and physiology course.
ANATOMY & PHYSIOLOGY
LABORATORY MANUAL
ThE Anatomy 6 Physiology Laboratory Manual, authored by
Kevin Patton with new contributions from Frank Bell, continues to
be an invaluable resource for students. This extensively illustrated,
full-color manual fea tures an extensively revised illustration program
that includes many new dissection photographs. This popular lab
manual contains 55 well-integrated exercises that provide hands-on
learning experience to help students acquire a thorough understanding of the human body.
Exercises in cat and pig anatomy, along with cow and sheep organs, are included to allow the flexi ble use of dissection specimens.
Other features are boxed hints on handling specimens and managing laboratory activities, safety tips, coloring exercises, and summaries of landmark features used to distinguish microscopic specimens.
Each exercise concludes with a lab report that may also serve as a
homework assignment or self-test.
The lab manual includes eLabs for Anatomy 6 Physiology, an
online lab program designed to complement traditional lab exercises. The lab exercises, based on both anatomy and physiology, are
separated into modules. The labs are designed so that students can
easily navigate between activities, allowing them the freedom to focus on the areas in which they need the most help.
• TEACHING SUPPLEMENTS
FOR INSTRUCTORS
INSTRUCTOR RESOURCES ON EVOLVE
ThE T EACH Instructor's Resource was written and developed specifically for this new edition of Anthony's Textbook of Anatomy 6
Physiology. Available on Evolve, it provides critical thinking questions, learning objectives and activities, teaching tips for the text,
synopses of difficult concepts, and clinical applications exercises. To
make lecture preparations a little easier, the TEACH Instructor's
Resource also includes lesson plans that allow you to hit the ground
.
runmng.
Preface
The Evolve website for instructors also includes:
• Exam View Test Bank with more than 7000 multiple
choice, true/false, and challenge questions (which you can
also import into your Classroom Performance System to
quickly assess student comprehension and monitor your
classroom's response)
• A downloadable Image Collection featuring hundreds of
full-color illustrations and photographs, with labels and
lead lines that you can turn off and on
• A detailed Update G uide, listing all significant revisions in
this edition
• PowerPoint Audience Response Q&A and much more!
xv
INSTRUCTOR'S GUIDE FOR THE
LABORATORY MANUAL
THE Instructor's Guide for the A6P Laboratory M anual on Evolve
offers detailed information to help the instructor prepare for the
laboratory exercises. Alternate activities, substitutions, student handouts, and other resources help instructors tailor the use of the A6P
Laboratory M anual to their own course. Answers for all questions
on the lab reports in the A6P Laboratory Manual are also provided,
either to check student work or to provide for students who use lab
reports as self-tests.
ments
Over the years, many people have contributed to the development
and success of Anatomy 6 Physiology. I extend my thanks and deep
appreciation to all of the students and classroom instructors who
have provided me with helpful suggestions. I also thank the many
contributors and reviewers who have, over the last several editions,
provided me with extraordinary insights and useful features that I
have added to this textbook.
Thanks to Betsy Brantley, who contributed many of the case studies found in this edition. T hanks also to those who provided their
insights in the Career Choices boxes. Dan Matusiak and Linda
Swisher have contributed in many ways to the last few editions.
For this edition, I am grateful for the contributions of Suzanne
Hembrough and Rhonda Gamble, who helped me organize and
update some chapter learning tools. Peggie Williamson's help in revising the stress chapter, as well as Bruce McEwan's advice, are
much appreciated. I'm thankful to Phil Tate for his suggestions for
improving the description and application of the concept of osmosis.
I'm also grateful for Terry Thompson's work in creating the new interactive unit openers, as well as for Michael Greer's wise counsel.
To those at Elsevier who put their best efforts into producing this
edition, I am indebted. This new edition, and its comprehensive library of ancillary resources, would not have been possible without
the efforts of Kellie White, Executive Content Strategist; Melissa
Rawe, Content Development Specialist; and Laura Goodrich, Senior Content Development Specialist. T heir expertise, support, and
hard work have been vital to the success of this revision. Further,
where the rubber meets the road, I am fortunate to have a wonderful
team of professionals working together to keep it all on track
and moving along: Julie Eddy, Publishing Services Manager; and
Clay Broeker, Pro ject Manager. I am also grateful to our friends at
Graphic World, who helped us improve and execute the integrated
design, layout, and art program.
Finally, I want to recognize and thank my longtime writing partner Gary A. Thibodeau. For the many years we have worked together, Gary has been an insightful collaborator, a generous mentor,
and a supportive friend. Although he has retired from coauthoring,
I'm grateful for his continuing role as advisor for successive editions
of this book.
Kevin T. Patton
xvi
Contents
UN IT 1
The Body as a Whole, 1
Set Point, 24
J\lfodel.s of Homeostasi,~>, 25
CHAPTER 1
Organization of the Body, 2
Science and Societv, 3
Scientific Meti1od, 3
Cultural Context, 3
Anatomy and Ph~•iology, 4
Arwtomy, 4
Physiology, 4
Language of Science and Medicine, 4
Characteristics of Life, 5
Levels of Organization, 6
Chemic<JI Level, 6
Organelle Le>•el, 7
Cellular Le>•el, 7
Tissue Lew/, 7
Organ Lew?/, 7
SJ•tem Lewd, 7
Organism um/, 8
Anatomical Position, 8
Anatomical Directions, 9
Directional Tenus, 9
Tenn.<Related to Organs, 9
Alwtomical Com(xlSs Rosette, 10
Body Planes and Sections, 10
Sagittal Planes, 10
Coronal Plane,<, 10
Transverse Planes, I I
Other Plane,~; and $el:tion.s, 11
Body Cavities, 12
Dorsal Cavities, 12
Ventral Cavitie.s, 12
Body Regions, 15
In teraction of Structure and Function, 16
Cycle of Life: Life Span Considerations, 17
11>e Big Picture: Organization of the Body, 17
Case Study, 19
CHAPTER 2
Homeostasis, 23
Homeostasis, 24
lntl!mal Environment, 2'1
Relatiw Stal>ility, 24
-n,e
Homeostatic Control Mechanisms, 26
Feedback Loop,<, 26
Basic Components of Control Systems, 26
Negative Feedback in Control S)wtems, 28
Pos;ti)'e Feedl>atk in Control $)'stems, 28
Changing the Set Point, 29
Feed-FoMard in Control System,<, 30
Levels of Homeostatic Control, 31
Summary of Homeostasis, 3 I
Cycle of Life: Life Span Considerations, 31
The Big Picture: Homeostasis, 32
Mechanisms of Disease, 32
Case Studv, 36
'
CHAPTER 3
Chemistry of Ufe, 38
Units of Matter, 39
Elements and Compounds, 39
Atoms, 40
Atomic Structure, 40
Cloud Model, 40
Atomic Number and J\1as,~; Number, .J I
Energy Le>'els, 41
Isotopes, 42
Attractions Between Atoms, 43
Chemical Bonds, 43
Attractions Between Molecules, 44
H)'drogen Bonds, H
Chemical Reactions, 45
Metabolism, 46
Body Chemistry, 46
Catal"'lism, 46
Arwi><Jiism, .f6
Organic and Inorganic Compounds, 47
Inorganic Molecules, 47
\Vater, 47
Oxygen and Carbon Dioxide, 47
Electrol)'tes, 48
The Big Picture: Chemistry of Life, 50
Mechanisms of Disease, 5 I
Case Studv, SZ
'
xvii
xviii
Contents
Biomolecules, 55
Organic Molecules, 56
Carbohydrates, 56
CHAPTER 4
Monosaccharides, 56
Disaccharides and Polysaccharides, 57
Lipids, 58
Triglycerides or Fats, 58
Phospholipids, 59
Steroids, 60
Prostaglandins, 60
Proteins, 61
Amino Acids, 63
Levels of Protein Structure, 64
Importance of Protein Shape, 65
Nucleic Acids and Related Molecules, 66
DNA and RNA, 66
Nucleotides and Related i\!Iolecules, 67
Combined Forms, 69
The Big Picture: Biomolecules, 69
Mechanisms of Disease, 71
Case Study, 72
CHAPTER 5
Cell Structure, 75
Functional Anatomy of Cells, 76
The Typical Cell, 76
Cell Structures, 77
Cell Membranes, 79
Membrane Structure, 79
Membrane Function, 81
Cytoplasm and Organelles, 82
Endoplasmic Reticulum, 82
Ribosomes, 83
Golgi Apparatus, 83
Lysosomes, 85
Proteasomes, 85
Peroxisomes, 86
Mitochondria, 86
Nucleus, 87
Cytoskeleton, 88
Cell Fibers, 88
Centrosome, 88
Molecular Motors, 89
Cell Extensions, 90
Cell Connections, 92
Desmosomes, 92
Gap Junctions, 92
Tight Junctions, 92
The Big Picture: Cell Anatomy and the Whole Body, 93
Mechanisms of Disease, 93
Case Study, 94
CHAPTER 6
Cell Function, 98
Membrane Transport, 99
Overview of Membrane Transport, 99
Passive Transport Processes, 99
Active Transport Processes, 105
Cell Metabolism, 108
Metabolism, 108
Role of Enzymes, 109
Catabolism, 112
Anabolism, 115
The Big Picture: Cell Physiology and the \Vhole
Body, 115
Mechanisms of Disease, 116
Case Study, 117
CHAPTER 7
Cell Growth and Development, 120
Protein Synthesis, 121
Deoxyribonucleic Acid (DNA), 121
Ribonucleic Acid (RNA), 122
Transcription, 122
Editing the Transcript, 123
Translation, 124
Post-Translation Processing, 125
Cell Growth, 126
Production of Cytoplasm, 127
DNA Replication, 127
Cell Reproduction, 128
Mitosis, 128
Meiosis, 130
Regulating the Cell Life Cycle, 131
Cycle of Life: Cells, 13 1
The Big Picture: Cell Growth, Reproduction, and the
Whole Body, 13 3
Mechanisms of Disease, 13 3
Case Study, 134
CHAPTER 8
Introduction to Tissues, 137
Introduction to Tissues, 138
Principal Types ofTissue, 138
Development ofTissues, 138
Extracellular Matrix, 139
Fluid Environment of the Body, 140
Components of the Extracellular Matrix, 140
Holding Tissues Together, 143
T issue Repair, 144
Body Membranes, 144
Epithelial Membranes, 145
Connective Tissue i\!Iembranes, 147
The Big Picture: T issues, Membranes, and the Whole
Body, 148
Mechanisms of Disease, 148
Case Study, 151
Contents
CHAPTER9
Tissue Types, 154
Epithelial Tissue, 15)
TyJ>e,<and Locntion< of Epithelial Ti$$ue, 155
Function< of Epithelial Tis,<ue, 155
Ceneralizaaons About Epithelial Tissue, 155
Classification of Epithelial Tissue, IS>
Connective Tissue, 16 1
Functiow; o(Cormective 'lissue, 161
Characteristics of Connective Tis,~;ue, 161
Classification ofCormecti'!>-e Tis,~;ue, 163
Fibrous Conneclil'e Ti,~>Sue, 163
Bone Tis,~;ue, 167
Cartilage Tissue, 168
Blood Ti$$ue, 169
Muscle Tissue, 169
Nervous Tissue, 171
11>e Big Picture: Tissue Types and the Whole Body, 171
Case Study, 173
Career Choices, 173
UNIT 2
CHAPTER 10
Support and Movement, 178
Skin, 180
Stnocture of the Skin, lSI
O>'el'lliew of Skin Structure, 181
Tl1in andTilick Skin, 181
Epidermi,<, 183
Dermoepidermal }unction, 185
Dermi,<, 186
Hypodennis, ISS
Skin Color, 189
Melanin, 189
Other Pigmen~<, 190
Functions of the Skin, 191
Di~wsityo{$kin Funcaons, 191
Protection, 192
Sensation, 192
Flexibility, 192
Excretion, 192
Hormone (VUamin D) Production, 193
Immunity, 193
Homeo,~;tasis of Body Temperature, 193
Appendages of the Skin, 195
Hair, 195
Nails, 197
Skin Clands, 198
Cycle of Life: Skin, 198
11>e Big Picture: Skin and the Whole Body, 199
Mechanisms of Disease, 200
c ase s.·tu dy, 70
_ >
CHAPTER 11
Skeletal Tissues, 209
Functions of Bone, 21 0
C ross Structure of Bones, 210
T)'pes of Bones, 210
Structure of Long Bone,<, 211
Structure of Flat Bones, 212
Microscopic $b'tJcture of Bones, 213
Bone Tissue, 213
ComJ>act Bone, 215
Cancellou,<Bone, 21)
T)'pes of Bone Cells, 216
Bone J\1arrow, 2 I7
Cartilage, 217
Regulation of Blood Calcium Le,•els, 219
Bone as a Calcium Depot, 219
tvfedwni,mu; of Calcium Homeostasis, 218
Development of Bone, 220
Osteogenesis, 220
Intramembranous Ossification, 220
Endochondral Ossification, 221
Bone Remodeling, 224
Repair of Bone Fractures, 225
C)de of Life: Skeletal Tissue<, 226
The Big Picture: Skeletal Tissues, 227
Mechanisms of Disease, 227
Case Stud)', 229
CHAPTER 12
Axial Skeleton, 233
Divisions of the Skeleton, 234
Skul1,236
Cranial Bones, 248
Facial Bones. 250
Eye Orl>iu, 250
Fetal Skull, 250
Hvoid Bone, 252
v;rtebral Column, 2)2
(h'en~ieu~ of the Spine, 252
Vertebrae, 252
Sacrum and Coccyx, 2 55
Spirwl Cun-•ature,~;, 2 55
Thorax, 2>8
$temum, 258
Rib.<, 2>8
Mechanisms of Disease, 259
Case Study, 261
CHAPTER 13
Appendicular Skeleton, 263
Upper Extremity, 264
Shoulder Girdle, 264
Arm, 2M
Foreann, 264
Hand, 267
xix
xx
Contents
Lower Extremitv, 268
Pelvic Cirdle, 268
Thigh, 272
Leg, 273
Foot, 273
Skeletal Variations, 27)
Male-Female Skeletal Diffem!C~S, 275
Age Differences, 276
Environmental Factors. 276
Cycle of Life: Skeletal System, 277
111< Big Picture: Skeletal System, 277
Mechanisms of Disease, 277
Case Study, 278
CHAPTER 14
Articulations, 281
Classification of joints, 282
Fibrous Joint.< (Synarthroses), 282
Cartilaginous Joints (Amphiarthroses), 282
SrnoviaiJoints (Diarthroses), 284
Representative Synovial Joints, 286
Humero..«:apular Joint, 286
EIIJOw Join~ 287
Forearm, \Vrist, Hand. and Finger Joints. 288
Hip Joint, 290
Knee Join~ 290
Ankle Joint, 293
Vertebra/Joints, 295
Movement at Synovial Joints, 295
Range of Motion, 296
Angular J\.fm•ements. 296
Circular Nfovement.~. 296
Cliding lvltwements, 297
Special Mm.,ments, 297
Examples ofJoint Mm•ements, 297
Cvc1e of Life: Articulations. 302
1i1e Big Picture: Articulations, 302
Mechanisms of Disease, 303
Case Study, 306
CHAPTER 15
Axial Muscles, 310
Skeletal Muscle StmchJre, 31 I
Connecth•e Tissue Components. 311
Size. Slwpe, and Fiber Arrangement. 311
Attaclnnent of M usc/e.<, 313
Mu.«:le Action.~. 314
Lew!r Systems, 31 5
How Muscles Are Named, 3 I6
Hints on How to Deduce Nfusde Actions, 319
A'ial Muscles, 32 I
Muscles of the Head and Neck, 32 I
Muscles of Facial Expres,<ion, 321
Muscles ofMastication, 322
Mu.<eles Tlwt Move the Head, 323
Tmnk Muscles, 323
Muscles of the Tlmax, 323
Muscles of the Abdomina/Wall, 324
Muscles of the Back, 326
Muscles of the Pel>oic Floor, 327
The Big Picture: A'ial Muscles and the Whole
Body, 329
Case Study, BO
CHAPTER 16
Appendicular Muscles, 333
Appendicular Muscles, 334
Upper Extremity Muscles, 334
Mu,<eles Acting on the Shoulder Cirdle, 3H
Mu,<eles Tlwt Mmoe tl>e Ann, 3H
J\.fu,«:les Tlwt lvl(n>e tl1e Forearm. 337
Mu.<eles Tlwt Mmoe tl>e Wrist, Hand, and
Fingers, l3 7
Lower Extremity Muscles. 341
Mu,<eles Tlwt Mm•e tl>e 'n•igl• and Leg, 341
Mu,<eles Tlwt Mm•e tl>e Ankle and Foot, 341
Posture. 3S I
How Po.~ture Is lvlaintained. 352
Cycle of Life: Muscular System, 353
The Big Pich1re: Appendicular Muscles and the \\~1ole
Body, 3)3
Case Study, 3>4
CHAPTER 17
Muscle Contraction, 356
General Functions, 3S7
Function of Skeletal Muscle Tissue. 3S7
Funt:tiorwl Characteristics of Nfusde, 357
O>•erview of the Muscle Cell, 357
M)'o/ilaments, 359
J\.fechanism o{Contra<:tion, 361
Energy Source,<for Muscle Contraction, 365
Function of Skeletal Muscle O rgans, 368
Motor Uni~ 368
M)•ogral>hy, 369
Tl1e Tulitd1 Contraction, 369
Treppe: -n,e StaircCJSe Phenomenon, 370
Tetarw,<, 371
J\.fu,«:le Tone, 372
Craded Strength Principle, 373
Crades of Muscle Strengt/1, 373
Mobilizing and Stabilizing Contractions, 374
Function of Cardiac and Smooth Muscle Tissue, 375
Cardiac Muscle, 375
Smooth Muscle, 377
The Big Pich~re: Muscle Tissue and the Whole
Body, 378
Mechanisms of Disease: Major Muscular Disorders. 379
Career Choices, 381
Case Study, 38 I
Contents
UNIT 3
CHAPTER 18
Communication, Control,
and Integration, 386
Nervous System Cells, 388
Organi>.alton of the Nenou; S)>lcm, 3&9
Ce11tral a11d Penpheral 1\'mous S1Tte11u, 3b9
Affcront and Efferent DnntOIIS. 390
Somaltc and Aulouomtc l\~tn"'tts Sn,lems, 390
Clia, 391
O.'n>·i<>o· ofCita. 39 I
Cnttral Cl.,, 39 I
Pnipheral Clta, 393
N'euron1, 39;
Structurr and FurtcltOtl o(i\'tutOII1. 39)
Clmst{J<allon of•'<turom. 397
Refle.\ .\re, 3%
Nen. es rand Trac:h, 400
Nen-n. -100
Tracts. 400
White a11d Gra1 Jllall<r. 4!10
Repair of Nene Ftben. 40 I
Cycle of Ltfe: Ncnou< S)'lcm Cell;, 402
The Big Picture: Nenous S)'lcm Cell, and the \\'hole
BO<I). 402
Mech:lni. . ros of Disensc. 403
Case Sh1dy. 404
CHAPTER 19
Nerve Signaling, 408
Eleclrical Nature of Nemon .... 409
tvfcmf)rant l'otcutials. 409
Rc<ti11g ll lembrmre Potentials, 409
I.Jxnl Poter~tial<, 4 /()
Actiot'l Potel'ltials, 4 11
,\ leclw11ism of tire Actro11 Potential. 4 I I
Re{ract(ll'\• Period. 41l
Co11duction of the Actro11 PotentiaL 4 I 4
Splaplic Trammts.sion. 41 S
Structure of the S111apst. 4 I5
T1pe.ofSmapses. 415
.\ltdtanums o(S•mapllc ·lran.smw•m•. i 16
Summa/ton. -fib
Smap... a11d ,\lemon·. of 19
~eurotr:msm•Uers. -119
Fun<ltOti<JI ClaMJ{icatron of 1\:rorolratwmtten, ilO
Structural Cla$St{icatron oft>.' rorolrarwrutten, il I
~eural :\'etuorb... 2-1
Titt Nen.wl \lode/. 42i
Dn-elopment of Neural :>;en.mh. i15
CompltXlh: m Neutol i"\'ttl.'Oth. -12;
The Btg Pt<lurc: Nen c S.gnal111g and the Whole
Bod). 426
xxl
Mechanisms of Disease, 426
Case Srudv, 428
'
CHAPTER 20
Central Nervous System, 432
Co\'erings of the Brain and Spinal Cord, H 3
Cerebrospinal fluid, H>
Fluid Spacts, 4 3>
Fonnation arid Cirrulotion ofCerebmspmal
Fluid, 43)
Spinal Cord, 438
Structurrof tlte Spinal Con/, 4l8
Fundionrof tltt Spinal Con/, 4l9
Brain, ++I
Rtgiom of tlte Brain, 44 I
Brain Dn-elopmenl, ++I
Structurr of the Brainstnn, 442
Functions of tlte Brainstem, ++-1
Structure of tltt Cer.b.llum, 4-14
Functions of tlte Cerebellun~ 4-15
Dimctplralotl, 447
Structure of tlte Cerebrum, ++9
FunclioiiS of tlte Cerebral Cortex, 4)2
Somatic Sensory Pathwal'· 4 59
Somatic Motor Pathways, 460
Final Common Path, 460
Pyramidal Tracts. 461
Extrapyramidal Tracts, 462
Fac:ilitatory and lniJil>ilory Tmtt.s, '162
Cycle of Life: Central Nen•ous System. 463
11>e Big Picture: 11>< Cenlrnl Nel\ous S)•tcm nnd the
Whole Body, 463
Mechanisms of Disease, 464
Case Srudy, 467
CHAPTER 21
Peripheral Nervous System, 473
Spinal ~erYes, 47)
Struclureo{Spinol 1\'m·-., 476
Nen·e Pl.ruse<, 477
Dennatomes and A1mtome&, -f 81
Craniall\en·es, 483
Ol{actorv Nm·e (CN 1), 4&>
Op!ic 1\'m~ (CN 11), 4&6
Oculomotor 1\'m~ (CN Ill}, 4&6
Trocltlear XenY (C.\' 1\'), 4&6
Trigeminal Xm~ (CN \'), 486
Abducens l':m.. (CX \1}, 4~7
Faci<1l Nm~ (Ct-.' \11). ib~
\ 'nlibulorochkar Nen-. (CN \'Ill}, iS~
Clossophanng&JI Nen·e (Ct\' IXl, iS!>
\'agus Nm~ (CN XI, 48!>
Accesson• NtnY (Ct\' Xl), 489
Hypoglossal Nen~ (CN XII), i90
xxii
Contents
Somatic Motor Nervous System, 490
Divisions of the Peripheral Nervous Systems, 490
The Big Picture: Peripheral Nervous System and the
Whole Body, 492
Case Study, 494
CHAPTER 22
Autonomic Nervous System , 47 4
Overview of the Autonomic Nervous System, 499
Role of the Autonomic Nervous System, 499
Divisions of the Autonomic Nervous System, 499
Structure of the Autonomic Nervous System, 500
Basic Plan of Autonomic Pathways, 500
Structure of the Sympathetic Pathways, 500
Structure of the Parasympathetic Pathways, 503
Autonomic
eurotransmitters and Receptors, 504
Norepinephrine and Its Receptors, 505
Acetylcholine and Its Receptors, 505
Nonadrenergic-Noncholinergic Transmission, 506
Synaptic Complexity, 506
Pharmacology, 506
Functions of the Autonomic N ervous System , 507
Overview of Autonomic Function, 507
Functions of the Sympathetic Division, 509
Functions of the Parasympathetic Division, 510
The Big Picture: Autonomic Nervous System and the
Whole Body, 510
Case Study, 511
CHAPTER 23
General Senses, 498
Sensory Receptors, 515
Receptor Response, 515
Distribution of Receptors, 515
C lassification of Receptors, 516
Classification by Sensory Pathway, 516
Classification by Location, 516
Classification by Stimulus Detected, 516
Classification by Structure, 517
Sense of Pain, 517
Sense of Temperature, 519
Sense of Touch, 519
Skin Movement, 519
Itch, 520
Tickle, 520
Light Touch, 52 1
Deep Touch, 52 1
Sense of Proprioception, 52 1
The Big Picture: General Senses, 522
Case Study, 52 3
CHAPTER 24
Special Senses, 514
Sense of Smell, 527
Olfactory Receptors, 527
Olfactory Pathway, 528
Sense of Taste, 528
Taste Buds, 528
Neural Pathway for Taste, 530
Senses of Hearing and Balance, 5 30
Structure of the Ear, 530
The Process of Hearing, 532
Balance, 534
Sense ofVision, 536
Structure of the Eye, 536
The Process of Seeing, 542
C ycle of Life: Special Senses, 547
The Big Picture: Special Senses, 547
M echanisms of Disease, 548
Case Study, 5 50
CHAPTER 25
Endocrine Regulation, 526
Organization of the Endocrine System, 5 57
C lassification of Hormones, 5 58
Steroid Hormones, 558
Nonsteroid Hormones, 558
How H ormones Work, 561
General Principles of Hormone Action, 561
Mechanisms of Steroid Hormone Action, 561
Mechanisms of Nonsteroid Hormone Action, 562
Regulation of Hormone Secretion, 564
Regulation of Target Cell Sensitivity, 566
Eicosanoids, 566
Tissue Hormones, 566
Prostaglandins, 567
Thromboxanes and Leukotrienes, 568
The Big Picture: Endocrine Regulation and the Whole
Body, 568
Mechanisms of Disease, 569
CHAPTER 26
Endocrine Glands, 556
Pituitary Gland, 574
Structure of the Pituitary Gland, 574
Adenohypophysis (Anterior Lobe of Pituitary), 574
Neurohypophysis (Posterior Lobe of Pituitary), 580
Pineal Gland, 58 1
Thyroid Gland, 582
Structure of the Thyroid Gland, 582
Thyroid Hormone, 583
Calcitonin, 583
Contents
Parathyroid Glands 584
Structure of the Parathyroid Glands 584
Parathyroid Hormone 585
Adrenal Glands 586
Structure of the Adrenal Glands 586
Adrenal Cortex 587
Adrenal Medulla 590
Pancreatic Islets 590
Structure of the Pancreatic Islets 590
Pancreatic Hormones 591
Gonads 591
Testes 592
Ovaries 592
Placenta 594
Thymus 594
Gastric and Intestinal Mucosa 594
Heart 594
Adipose Tissue 594
Other Endocrine Glands and Hormones 59 5
Cycle of Life: Endocrine System 595
The Big Picture: The Endocrine System and the Whole
Body 595
Mechanisms of Disease 596
Case Study 599
Career Choices 599
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7
Platelets 620
Structure and Function of Platelets 620
Formation and Life Span of Platelets 620
Hemostasis 621
Vasoconstriction 621
Platelet Plug Formation 621
Blood Clotting (Coagulation) 622
Conditions That Oppose Clotting 624
Conditions That Hasten Clotting 625
Clot Dissolution 625
The Big Picture: Blood and the Whole Body 626
Mechanisms of Disease 626
Case Study 630
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CHAPTER 28
Heart, 634
Heart Structure 635
Location of the Heart 63 5
Size and Shape of the Heart 635
Coverings of the Heart 639
Structure of the Heart 640
The Heart as a Pump 647
Conduction System of the Heart 647
Electrocardiogram 648
Cardiac Cycle 650
Heart Sounds 653
Cycle of Life: Heart 6 53
The Big Picture: Heart 65 3
Mechanisms of Disease 6 53
Case Study 659
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UN IT 4
CHAPTER 27
Transportation
and Defense, 604
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CHAPTER 29
Blood , 606
Blood Composition 607
Blood Tissue 607
Blood Plasma 608
Formed Elements 608
Hematopoiesis 608
Blood Volume 609
Hematocrit 610
Red Blood Cells 610
Structure of Red Blood Cells 610
Function of Red Blood Cells 611
Hemoglobin 611
Formation of Red B food Cells 613
Life Cycle of Red Blood Cells 613
Blood Types 614
White Blood Cells 618
Granulocytes 618
Agranulocytes 619
White Blood Cell Numbers 619
Formation of White Blood Cells 620
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Blood Vessels, 663
Blood Vessel Types 664
Arteries 664
Capillaries 664
Veins 667
Structure of Blood Vessels 667
Circulatory Routes 668
Systemic Circulation 668
Pulmonary Circulation 669
Circulatory Bypasses 669
Systemic Circulation 670
Systemic Arteries 670
Systemic Veins 679
Fetal Circulation 686
Organization of Fetal Circulation 686
Changes in Circulation at Birth 689
Cycle of Life: Blood Vessels 689
The Big Picture: Blood Vessels and the Whole
Body 690
Mechanisms of Disease 690
Case Study 694
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•••
XXIII
xxiv
Contents
CHAPTER 30
Circulation of Blood, 697
Hemodynamics, 698
Primary Principle of Circulation, 698
Arterial Blood Pressure, 699
Cardiac Output, 700
Peripheral Resistance, 704
Venous Return to the Heart, 709
Venous Pumps, 709
Total Blood Volume, 711
Measuring Blood Pressure, 713
Arterial Blood Pressure, 713
Blood Pressure and Bleeding, 715
Minute Volume of Blood, 715
Velocity of Blood Flow, 716
Pulse, 716
Mechanism, 716
Pulse Wave, 717
Where the Pulse Can Be Felt, 718
Venous Pulse, 718
Cycle of Life: Cardiovascular Physiology, 719
The Big Picture: Blood Flow and the Whole Body, 719
Mechanisms of Disease, 719
Case Study, 721
CHAPTER 31
Lymphatic System, 725
Overview of the Lymphatic System, 726
Lymph and Interstitial Fluid, 727
Lymphatic Vessels, 728
Distribution of Lymphatic Vessels, 728
Structure of Lymphatic Vessels, 728
Functions of Lymphatic Vessels, 729
Circulation of Lymph, 729
Origin of Lymph, 729
The Lymphatic Pump, 730
Lymph Nodes, 731
Structure of Lymph Nodes, 731
Locations of Lymph Nodes, 732
Functions of Lymph Nodes, 734
Lymphatic Drainage of the Breast, 734
Distribution of Lymphatics in the Breast, 73 5
Lymph Nodes Associated With the Breast, 735
Tonsils, 736
Thymus, 736
Location and Appearance of the Thymus, 736
Structure of the Thymus, 737
Function of the Thymus, 737
Spleen, 737
Location of the Spleen, 737
Structure of the Spleen, 737
Functions of the Spleen, 739
Cycle of Life: Lymphatic System, 740
The Big Picture: Lymphatic System and the Whole
Body, 740
Mechanisms of Disease, 740
Case Study, 742
CHAPTER 32
Innate Immunity, 746
Organization of the Immune System, 747
Defense of the Body, 747
Innate Immunity, 749
Species Resistance, 749
Mechanical and Chemical Barriers, 749
Inflammation and Fever, 750
The Inflammatory Response, 750
Fever, 750
Phagocytosis, 7 52
Natural Killer Cells, 7 53
Interferon, 75 5
Complement, 755
Toll-Like Receptors, 756
The Big Picture: Innate Immunity and the Whole
Body, 756
CHAPTER 33
Adaptive Immunity, 759
Overview of Adaptive Immunity, 760
B Cells and Antibody-Mediated Immunity, 762
Development and Activation of B Cells, 762
Antibodies (Immunoglobulins), 763
Clonal Selection Theory, 766
T Cells and Cell-Mediated Immunity, 768
Development ofT Cells, 768
Activation and Functions ofT Cells, 768
Types of Adaptive Immunity, 771
Summary of Adaptive Immunity, 772
The Big Picture: Immune System and the Whole
Body, 775
Mechanisms of Disease, 775
Case Study, 779
CHAPTER 34
Stress, 782
Selye's Concept of Stress, 783
Development of Selye's Stress Concept, 783
Definitions, 783
Stressors, 783
General Adaptation Syndrome, 785
Mechanism of Stress, 787
Some Current Concepts About Stress, 787
Allostatic Load Model, 787
Stress Syndrome, 788
Role of the Brain in Stress, 789
Stress and Disease, 791
Indicators of Stress, 791
Effects of Intrauterine Stress, 792
Summary of the Allostatic Model, 793
The Big Picture: Stress and the Whole Body, 794
Contents
Case Study, 79 5
Career Choices, 795
UN IT 5
CHAPTER 35
Respiration, Nutrition,
and Excretion, 798
Respiratory Tract, 800
Structural Organization, 80 1
Upper Respiratory Tract, 802
Nose, 802
Pharynx, 804
Larynx, 805
Lower Respiratory Tract, 807
Trachea, 807
Bronchi and Alveoli, 809
Lungs, 813
Thorax, 815
Cycle of Life: Respiratory Tract, 815
The Big Picture: Respiratory Tract, 816
Mechanisms of Disease, 816
Case Study, 820
CHAPTER 36
Ventilation, 823
Respiratory Physiology, 824
Mechanism of Ventilation, 824
Primary Principle ofVentilation, 824
Inspiration, 825
Expiration, 828
Pulmonary Volumes and Capacities, 832
Pulmonary Volumes, 832
Pulmonary Capacities, 83 3
Pulmonary Airflow, 834
Ventilation and Perfusion, 836
Regulation of Ventilation, 836
Homeostasis of Blood Gases and pH, 836
Respiratory Control Centers, 836
Feedback and Responses, 838
Other Infiuences on Ventilation, 840
The Big Picture: Ventilation and the Whole Body, 841
Mechanisms of Disease, 841
Case Study, 844
CHAPTER 37
Gas Exchange and Transport, 847
Pulmonary Gas Exchange, 848
Partial Pressure, 848
Exchange of Gases in the Lungs, 849
How Blood Transports Gases, 85 1
Hemoglobin, 851
Transport of Oxygen, 85 1
Transport of Carbon Dioxide, 852
Systemic Gas Exchange, 855
xxv
The Big Picture: Gas Exchange and Transport and the
Whole Body, 857
Case Study, 857
CHAPTER 38
Upper Digestive Tract, 860
Organization of the Digestive System, 86 1
The Digestive Tract, 861
Wall of the Gastrointestinal Tract, 862
Mouth, 863
Structure of the Oral Cavity, 863
Salivary Glands, 866
Teeth, 867
Pharynx, 869
Esophagus, 869
Overview of Esophagus, 869
Esophageal Sphincters, 870
Gastroesophageal Refiux, 870
Stomach, 871
Size and Position of the Stomach, 871
Divisions of the Stomach, 872
Curves of the Stomach, 872
Sphincter Muscles, 872
Stomach Wall, 872
Functions of the Stomach, 873
Cycle of Life: Upper Digestive Tract, 873
Mechanisms of Disease, 874
Case Study, 878
CHAPTER 39
Lower Digestive Tract, 881
Small Intestine, 882
Size and Position of the Small Intestine, 882
Divisions of the Small Intestine, 882
Wall of the Small Intestine, 882
Large Intestine, 884
Size of the Large Intestine, 884
Divisions of the Large Intestine, 884
Wall of the Large Intestine, 886
Vermiform Appendix, 886
Peritoneum, 887
Liver, 887
Location and Size of the Liver, 887
Liver Lobes and Lobules, 888
Bile Ducts, 890
Functions of the Liver, 890
Gallbladder, 891
Size and Location of the Gallbladder, 891
Structure of the Gallbladder, 891
Functions of the Gallbladder, 891
Pancreas, 892
Size and Location of the Pancreas, 892
Structure of the Pancreas, 892
Functions of the Pancreas, 892
Cycle of Life: Lower Digestive Tract, 893
xxvi
Contents
The Big Picture: Nutrition Metabolism and the Whole
Body 955
Mechanisms of Disease 95 5
Case Study 959
The Big Picture: The Digestive Tract 893
Mechanisms of Disease 894
Case Study 897
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CHAPTER 40
Digestion and Absorption, 900
Overview of Digestive Function 90 1
Digestion 902
Mechanical Digestion 902
Chemical Digestion 906
Secretion 912
Saliva 912
Gastric Juice 912
Pancreatic Juice 914
Bile 914
Intestinal Juice 915
Control of Digestive Gland Secretion 916
Control of Salivary Secretion 916
Control of Gastric Secretion 916
Control of Pancreatic Secretion 918
Control of Bile Secretion 918
Control of Intestinal Secretion 918
Absorption 919
Process of Absorption 919
Mechanisms of Absorption 919
Elimination 92 1
The Big Picture: Digestion and the Whole Body 923
Case Study 924
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CHAPTER 41
Nutrition and Metabolism, 928
Nutrition and Metabolism 929
Overview 929
Nutrients 929
A Balanced Diet 930
Metabolic Pathways 931
Carbohydrates 932
Dietary Sources of Carbohydrates 932
Carbohydrate Metabolism 932
Lipids 942
Dietary Sources of Lipids 942
Transport of Lipids 942
Lipid Metabolism 942
Proteins 944
Sources of Proteins 944
Protein Metabolism 945
Vitamins and Minerals 946
Vitamins 946
Minerals 949
Metabolic Rates 950
Basal Metabolic Rate 950
Total Metabolic Rate 952
Energy Balance and Body Weight 953
Mechanisms for Regulating Food lntake 953
Cycle of Life: Nutrition and Metabolism 95 5
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CHAPTER 42
Urinary System, 963
Anatomy of the Urinary System 964
Gross Structure 964
Microscopic Structure 969
Physiology of the Urinary System 974
Overview of Kidney Function 974
Filtration 975
Reabsorption 977
Tubular Secretion 982
Regulation of Urine Volume 983
Urine Composition 985
Cycle of Life: Urinary System 986
The Big Picture: Urinary System and the Whole
Body 986
Mechanisms of Disease 987
Case Study 992
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CHAPTER 43
Fluid and Electrolyte Balance, 996
Fluid and Electrolyte Balance 997
Total Body Water 997
Body Fluid Compartments 997
Electrolytes in Body Fluids 998
Extracellular vs. Intracellular Fluids 998
Measuring Electrolyte Reactivity 1000
Avenues of Water Entry and Exit 100 1
General Principles of Fluid Balance 1001
Homeostasis ofTotal Fluid Volume 1002
Regulation of Fluid Intake 1002
Regulation of Urine Volume 1002
Factors That Alter Fluid Loss 1002
Regulation of Water and Electrolytes 1004
Starling s Law of the Capillaries 1004
Edema 1006
Regulation of Water and Electrolytes in Intracellular
Fluid 1007
Regulation of Sodium and Potassium 1008
Cycle of Life: Fluid and Electrolyte Balance 1009
The Big Picture: Fluid and Electrolyte Balance 10 10
Mechanisms of Disease 1010
Case Study 1013
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CHAPTER 44
Acid-Base Balance, 1016
pH of Body Fluids 1017
Review of the pH Concept 1017
Factors That Affect pH of Body Fluids 1018
pH Control Mechanisms 1019
Overview of pH Control Mechanisms 1019
Integration of pH Control 1019
7
7
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7
Contents
Chemical Buffers, 1019
Buffers Defined, 1019
Buffer Pairs, 1019
Buffer Activity, 1020
Role of Buffers in pH Control, 1022
Respiratory Mechanisms, 1022
Overview of Respiratory Mechanisms, 1022
Respiratory Adjustment of Blood pH, 1023
Principles Relating Respiration to pH, 1023
Arterial Blood Gas Analysis, 1023
Urinary Mechanisms, 1024
Overview of Urinary Mechanisms, 1024
Regulating pH of Urine and Blood, 1024
The Big Picture: Acid-Base Balance, 1027
Mechanisms of Disease, 1027
Case Study, 1030
Career Choices, 1030
UNIT 6
CHAPTER 45
Reproduction and
Development, 1034
Male Reproductive System, 1036
Sexual Reproduction, 1037
Male Reproductive Organs, 1037
Male Reproductive Tract, 1037
Perineum, 1037
Testes, 1038
Structure and Location, 1038
Microscopic Anatomy of the Testis, 1038
Testes Functions, 1041
Spermatozoa, 1042
Reproductive Ducts, 1043
Epididymis, 104 3
Vas Deferens, 104 3
Ejaculatory Duct, 1044
Urethra, 1044
Accessory Reproductive Glands, 1045
Seminal Vesicles, 104 5
Prostate Gland, 104 5
Bulbourethral Glands, 104 5
Supporting Structures, 1046
Scrotum, 1046
Penis, 1046
Spermatic Cords, 104 7
Composition and Course of Seminal Fluid, 1047
Male Fertility, 1048
Cycle of Life: Male Reproductive System, 1048
The Big Picture: Male Reproductive System, 1048
Mechanisms of Disease, 1049
Case Study, 1051
CHAPTER 46
XXVII
Female Reproductive System, 1054
Overview of the Female Reproductive System, 105 5
Function, 1055
Structure, 1055
Perineum, 1056
Ovaries, 1057
Location of the Ovaries, 1057
Microscopic Structure of the Ovaries, 1058
Functions of the Ovaries, 1059
Uterus, 1059
Structure of the Uterus, 1059
Functions of the Uterus, 1061
Uterine Tubes, 1061
Location of the Uterine Tubes, 1061
Structure of the Uterine Tubes, 1061
Function of the Uterine Tubes, 1062
Vagina, 1062
Location of the Vagina, 1062
Structure of the Vagina, 1063
Functions of the Vagina, 1063
Vulva, 1063
Structure of the Vulva, 1063
Functions of the Vulva, 1065
Female Reproductive Cycles, 1065
Recurring Cycles, 1065
Control of Female Reproductive Cycles, 1067
Importance of Female Reproductive Cycles, 1070
Infertility, 1072
Menarche and Menopause, 1072
Breasts, 1072
Location and Size of the Breasts, 1072
Structure of the Breasts, 1074
Function of the Breasts, 1074
Cycle of Life: Female Reproductive System, 1076
The Big Picture: Female Reproductive System and the
Whole Body, 1076
Mechanisms of Disease, 1076
Case Study, 1082
CHAPTER 47
Growth, Development, and Aging, 1086
Human Reproduction, 1087
Production of Sex Cells, 1087
Ovulation and Insemination, 1092
Fertilization, 1092
Prenatal Period, 1093
Cleavage and Implantation, 1093
Placenta, 1096
Periods of Development, 1097
Stem Cells, 1098
Formation of the Primary Germ Layers, 1099
Histogenesis and Organogenesis, 1102
••
xxviii
Contents
Birth, 1104
Stages of Labor, 1106
Multiple Births, 1106
Postnatal Period, 1107
Growth, Development, and Aging, 1107
Infancy, 1108
Childhood, 1108
Adolescence and Adulthood, 11 09
Older Adulthood, 1109
Aging, 1109
Mechanisms of Aging, 11 09
Effects of Aging, 1111
Causes of Death, 111 3
The Big Picture: Growth, Development, Aging, and the
Whole Body, 1114
Mechanisms of Disease, 11 15
Case Study, 111 7
CHAPTER 48
Gene Expression, 1126
Hereditary Traits, 1126
Sex-Linked Traits, 1128
Genetic Mutations, 1129
Medical Genetics, 1130
Mechanisms of Genetic Diseases, 1130
Single-Gene Diseases, 1132
Multiple-Gene Diseases, 1134
Epigenetic Conditions, 1134
Chromosomal Diseases, 113 5
Genetic Basis of Cancer, 113 6
Prevention and Treatment of Genetic Diseases, 11 36
Genetic Counseling, 1136
Treating Genetic Diseases, 1138
The Big Picture: Genetics, Heredity, and the Whole
Body, 1139
Case Study, 1140
Career Choices, 1141
Genetics and Heredity, 1121
The Science of Genetics, 11 22
Chromosomes and Genes, 1122
Mechanism of Gene Function, 1122
The Human Genome, 1123
Distribution of Chromosomes to Offsp ring, 1125
Glossary of Anatomy & Physiology, 1144
Index, 1198
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Illustration and Photograph Credits
UNIT 1
5 7. B, 5-12, B, -; . JS, B: Courtesy Charles Flickinger, University of
Virginia. 5-8: Prom l">:ttton KT, Thihode.au C : Human body in health
6 disease, e<l7, St Lo uis, 2018, .:\'lusby. -; .11 , B: Courtesy Bremb
Russell. 5 H : Prom P..ttton Kf, Thihode.au CA: Mosby's handbook
of anatomy 6 physiology, ed 2, St. Louis, 20 1-t, Elsevier. 5 15 (Auoresccnee light microgrnphs (right panel)), -; . J5, A: Cottrtc:sy
I. t-lerm.an, ~n ,ru Uni\'ersity. 5-J 5, 8: Courtesy £. Smith and
E. Fuchs, Uni\·c:rsity of Chic.ago. s.J 5, C : Courtesy C. BoriS)·, Uni
versityofWiscomin, 2\'l:tdison, \ VI. 5 16, B: Comtc:syConly Rie<ler,
W:.dsworth Center, Allxmy, NY. 5-18, A: Susumu Ito. Table 5-J
(figures): From Patton Kf, Thihode.au CA: Mosby's handbook of
anatomy 6 phy~iology, ed 2, St. Louis, 2014, Elsc:\-ier. Connect It!
bux (figure): From Kong LB, et al: Stmchtre oF t11c: \-auh, :t uhiqui
tous ccllubr component. Structure, 7:37 1 379, 1999.
4
Seeing the Big Pic h tre hox: Cop~Tight Kevin Patton, Lion Den Inc,
Weldon Spring, 2\•10 .
4
Chapter 1
4
1-2: De Hum:.ni Corporis J<"':.hric:. (On the Structure: o f tiH: Human
Bodr). in I S43. J-3, 1-8, 1-9: Courtcsr B:.rl~:lr.J Cousins. 1-10: Re<lrawn from Mu5colino JE: Know the body: muscle, bone, and palpation eSSf'ntials, St Loui5, ZO J 2, 2\•losby. I- ll , A: Courle$}' V idic B,
Suarez Rf : Photographic atlas of the human body, St. Louis, 198--J,
Moshy. 1-11, 8: Su:.rcz RF': Photographic atlas of the human body,
St Louis, 1984, 2\'losb)·· Connect It! hox: Prom Col<lman L,
Ausid lo D: Ctcil tntbook of medicine, eel 22, Phil:uldphia, 20(}1,
S:.undcrs.
4
4
4
4
Chapter 2
2-6: Data from Schwartz \ VJ: A clinicia n's primer on tl1c circ.:uiUn
dock: ils locali7.alion, fu nction, and rcseHing. Ad'' lnle-m 1'vled,
38:8 1 106, 1993. In (rc:<lr:.wn From) Koeppen B, Stanton B: &me 6
L.n.y phy~iology, ed 6, St. Louis, 2010, lvlo$by. 2-8, 2 9, B: Prom
PaHon KT, '11lilxxle.au C: Human body in health 6 diseast', c:d 6,
St Louis, 2014, Moshy. 2 9, A: F'mm Donne DC, Vile:$ JH, Crotl1 D,
Melhorn 1: Stntchtre of tl1e recomllinant Full 1ength l1.amstc:r prion
protein PRp (29.23 1): the N tc:nninm is highly Aexillle, Proc Nat/
Acad Sci USA, W, I H;2-l H57, 1997. Cuprrigl>t National Academy
oFScic:nccs, USA.
4
4
4
4
Chapter 3
3-J: from Patton Kf, Thihode.au C: Human body in health 6 dis·
ease, c:<l 6, St Loui$, 20 14, ).•lusby. l _,: From Sugimoto Y, Pou P,
Abc: lvl, et al: Chemical identification of imli\'i<lual surface atoms by
atomic Force: microscopy, Nature, 466:64...67, 2007. l~, C: lvlichad
CO<Iomsl:ifl<lm St.ack &: Associates. Case Study hox: Fmm Potter P,
Perry A: Basic nursing: eSSf'ntials (or practice, ed 6, St. Louis, 2006,
Mosln-.
Chapter 4
-t-13: F'mm P:.tton KT, l l tibcxleau CA.: Mosby's handbook of anal·
amy 6 physiology, ed 2, St. Loui$, 20 14, Elsc:\-ier. 4· 14: Prom
PaHon K Thihode.au C, Dougla$ M: Essentials of anatomy and
physiology, St. Louis, 20 12, lvlo$by. 4 15, Box -t-t (photo): Prom
National Institute oF General Me<lic:tl Sciences, 'fhe structures o(life,
July 2007, retriC~.·ed Nu..-ember 2008 from l1ttp://www.nigms.nih.gov/
ne\\"'S/scienee_e<l/stm ct1ifc: /. Sox 4·2 (photo): Copyrigl1t Kevin
PaHon, Lion Den Inc, Weldon Spring, MO.
4
Chapter 5
5·1, 8 : Courtesy A Arlan Hinchec:. 5 2, 5 9, 5· 10, 5·13, S-15 (dec
tron microgmphs), 5· 17: from Poll.ard T', E:amshaw \ V: Cell biology,
revise:<! reprint, intern:ttional eelition, Phila<lelphi:., 20<H, Satmders.
4
4
4
ChapterS
~5 (photos): Prom lvbjmmlc:r, D. c:l :.1: Reel cdl morphology in
lc:ukemi:., hypopl.astic :tnc:mi:. an<l myd<xl~:splastie syndrome, l>atJtophysiology, 13(4):217-225, 2006. 6-9, t\dapted from McCance K,
Huether S: Pathophysiology, e<l -t, St. Louis, 2002, lvlosby. 6· 11
(d cctron micmgrnphs): Courtesy ).•J.:\•1. Perry and A B. Gilbert,
Edinburgh Research Center. 6.22: Fmm P..ttton KT, Thibodeau C :
Human body in health 6 disease, c:<l 7, St. Louis, 20 18, 2\'losby.
Box 6· 1, S: Prom Coldm.an L. Ausie1lo D: Cecil textbook of medi·
cine, ed ZZ, Philadelphia, lOCH, Saunders.
Chapter 7
7-1 (photo)' Cold Spring H•rbor l..oboratory. 7-t, Adapted from
Poll.arcl T', E.:tm$h:tw \ V: Cell biology, revised reprint. intern:.tional
e<lition, Phibddphia, lOCH, S:.undeD. 7-5: Prom P:tHon KT,
'l11ilxxleau C : Human body in health 6 disetJ$C, ed 7, St. Louis, 20 18,
Mosh)'. 7-JO, J\.fo~: Dennis Stretc:. 7 12: Wikimeeli:. Commons.
4
Chapter 8
S.J: From Patton Kl ', l 11ilxldc::.u CA.: Mosby's handbook ofanatomy
6 physiology, ed 2, St. Louis, 20H, Elsevier. 8_, (hottom image):
Modified from Pollard T D, f.:tmsl1.:tW \V: Cell biology, ed 2, Pl1ib
<lclpl1ia, 2007, \VB Sam1<lcrs Company.&.-; , 8· 13: From Cartner LP,
Hiatt JL: Color textbook of histology, ed 3, Ph i1a<lc:lph i:., 2007, Saun
<lers. 8.6: From P:ttton Kl', Thihodeau C: Human body in health 6
disease, eel 7, St. Louis, 2018, Moshy. 8 7: Prom C:tllen J, C reer K,
Hood A, ct :.1: Color atlas ofdennatology, P11ibdclpl1ia, 1993, S:.un
<lers. S. IO, A, B: f rom Samudson DA: Textbook of \'eieriuary histol·
ogy, \VB Saunders ComJXln)', 2007. S.JO, C : Will 2\1urr:ty (\Villscrit),
http://wilmunaymc:di:..com. S. IZ: Reprinted witl1 permission From
Cregor Reid, Pl1D, l.:t\\'SOn Health Rc:se.arch lm lihtte.
4
4
4
4
Chapter9
9-2, 9-t, 9-6, 9-7, 9-8,9-9, 9-H , 9-16,9-17,9-18,9-23,9-25, 9-26,
9-27, 9-29, 9-30, 9-31, 9-32, 9-33' Dennis Stretc. 9-3 (dmwing)'
JO(ix
xxx
Illustration and Photograph Credits
Barbara Cousins. 9-3 (electron micrograph), 9-10, 9-15, B: From
Erlandsen SL, Magney J: Color atlas of histology, St. Louis, 1992,
Mosby. 9-5: Ed Reschke 9-20, 9-28: From Gartner L, Hiatt J: Color
textbook of histology, eel 3, Philadelphia, 2007, Saunders. 9-21 , 9-24:
From Kerr J: Atlas of functional histology, London, 1999, Mosby.
9-22: Courtesy Gary Thibodeau. Box 9-1: From Zitelli B, Davis H:
Atlas of pediatric physical diagnosis, eel 3, Philadelphia, 1997,
Mosby. Career Choices box: Courtesy of Joanna McGaughey.
2007, Saunders. 11-16: From Patton KT, Thibodeau G: Human
body in health 6 disease, eel 7, St. Louis, 201 8, Mosby. 11-17: From
Zitelli B, Davis H: Atlas of pediatric physical diagnosis, eel 4, Philadelphia, 2002, Mosby. 11-18: Ed Reschke. 11-20: From Booher JM,
Thibodeau Ga: Athletic injury assessment, St. Louis, 1985, Mosby.
11-24, A, B: Courtesy of Dennis Strete. 11-24 C, 11-25: From
Kumar V, Abbas A, Fausto N: Robbins and Cotran pathologic basis
of disease, eel 7, Philadelphia, 2005, Saunders.
UNIT 2
Chapter 10
Chapter 12
10-1 (photo): Ed Reschke. 10-1 (drawing), 10-6, 10-29: Barbara
Cousins. 10-3, 10-18, Case Study (figure): Copyright Kevin Patton,
Lion Den Inc, Weldon Spring, MO. 10-10: From Rouzaud F,
Kadekaro A, Abdel-Malek Za, Hearing VJ: MC1R and the response of
melanocytes to ultraviolet radiation, Mutat Res, 571:136,2005. 10-11:
From Regezi J, Sciubba JJ, Jordan RCK: Oral pathology: clinical
pathologic correlations, eel 5, St. Louis, 2008, Saunders. 10-12: From
Epstein 0 , Perkin CD, Cookson J, de Bono 0: Clinical examination,
eel 3, St. Louis, 2003, Mosby. 10-13 (gradient): From McCance K,
Huether S: Pathophysiology, eel 5, St. Louis, 2005, Mosby. 10-15,
Box 10-6 (figure): From Patton KT, Thibodeau G: Human body in
health 6 disease, eel 7, St. Louis, 2018, Mosby 10-17, C: Copyright ©
by David Scharf, 1986, 1993. 10-20: Courtesy Christine Olekyk.
10-21, 10-24, 10-25: From Habif TP: Clinical demwtology, eel 4,
St. Louis, Mosby, 2004. 10-22: From HabifTP: Clinical dermatology,
eel 2, St. Louis, 1990, Mosby. 10-26: From Potter P, Perry A: Basic
nursing: essentials for practice, eel 5, St. Louis, 2003, Mosby. 10-27:
From James WD, Berger TG, Elston OM: Andrew's diseases of the
skin: clinical dermatology, eel 10, London, 2000, Saunders. 10-28, A:
From Goldman L, Ausiello 0: Cecil textbook of medicine, eel 23,
Philadelphia, 2008, Saunders. 10-28, B: From oble J: Textbook of
primary care medicine, eel 3, Philadelphia, 2001, Mosby. 10-28, C:
From Townsend C, Beauchamp RD, Evers BM, Mattox K: Sabiston
textbook of surgery, eel 18, Philadelphia, 2008, Saunders. 10-28, D:
From Rakel R: Textbook of family medicine, eel 7, Philadelphia, 2007,
Saunders. Box 10-1: Courtesy James A. Ischen, MD, Baylor College
of Medicine. Box 10-4: From Emond R: Color atlas of infectious diseases, eel 4, Ph iladelphia, 2003, Mosby. Box 10-5 (figure): Courtesy
Photo Researchers, Inc. http://images.sciencesource.com/search/
SB1498. Box 10-7 (figure): From Callen JP et al: Color atlas of dermatology, eel 2, Philadelphia, 2000, Saunders.
Chapter 11
11-3, B: From White T: Human osteology, eel 2, Philadelphia, 2000,
Academic Press. 11-4, B: From Moses K, Nava P, Banks J, Petersen 0:
Moses atlas of clinical gross anatomy, Philadelphia, 2005, Mosby.
11-6, B, 11-24, A, B: Dennis Strete. 11-8: From Williams P: Gray's
anatomy, eel 38, Philadelphia, 1996, Churchill Livingstone. 11-9, A:
From Muscolino J: Kinesiology, St. Louis, 2006, Mosby. 11-9, B:
From Erlandsen SL, Magney J: Color atlas of histology, St. Louis,
1992, Mosby. 11-10: Wikimedia Common. 11-1 1, A, B, C: From
Gartner, Leslie P: Color textbook of histology, eel 3, Philadelphia,
2006, Saunders. 11-13: From Patton K, Thibodeau G, Doublas M:
Essentials of anatomy and physiology, St. Louis, 2012, Mosby. 11-14:
From Pollard TO, Earnshaw W: Cell biology, eel 2, Philadelphia,
12-2 (photo), 12-3 (photo), 12-4 (photo), 12-5 (photo), Courtesy
Vidic B, Suarez FR: Photographic atlas of the human body, St. Louis,
1984, Mosby. 12-6 (photo), 12-11, 12-16, 12-13 (inset): From
Williams P: Gray's anatomy, eel 38, Philadelphia, 1996, Churchill
Livingstone. 12-14, A-H: From Gosling J, Harris P, Whitmore I,
Willan P: Human anatomy, eel 4, Philadelphia, 2002, Mosby. 12-17:
Courtesy Dr. N. Blevins, ew England Medical Center, Boston.
Chapter 13
13-2, D, 13-3, C, 13-4, C, 13-5, 13-6, 13-7, 13-8, D, E, 13-9, B
(photos): Courtesy Vidic B, Suarez FR: Photographic atlas of the
human body, St. Louis, 1984, Mosby. 13-7, 13-11, B, D: From
Abrahams P, Marks S, Hutchings R: McMinn's color atlas of human
anatomy, eel 5, Philadelphia, 2003 , Mosby. 13-10 (drawings): From
Yvonne Wylie Walston. 13-10 (photo inset): From Seidel HM,
Ball JW, Dains JE, Benedict GW: Mosby's guide to physical examination, eelS , St. Louis, 2003, Mosby.13-11, A, 13-12: From Patton KT,
Thibodeau G: Human body in health 6 disease, eel 7, St. Louis,
20 18, Mosby. Case Study box: From Browner B, Jupiter J, Trafton P:
Skeletal trauma: basic science, management, and reconstruction, eel 3,
Philadelphia, 2003, Saunders.
Chapter 14
14-3, B, 14-6, 14-7, A, B, 14-8, 14-11: From Gosling J, Harris P,
Whitmore I, Willan PI: Human anatomy, eel 4, Philadelphia, 2002,
Mosby. 14-5, B, D, 14-7, C, 14-9, B, D, 14-10, B, D: Courtesy
Vidic B, Suarez FR: Photographic atlas of the human body, St. Louis,
1984, Mosby. 14-26: From Seidel HM, Ball JW, Dains JE,
Benedict GW: Mosby's guide to physical examination, eel 5, St. Louis,
2003 , Mosby. 14-27: From Swartz MH: Textbook of physical diagnosis, eel 4, Philadelphia, 2002, Saunders. 14-28, A, Box 14-1 (drawing): From Patton KT, Thibodeau G: Human body in health 6
disease, eel 7, St. Louis, 2018, Mosby. Box 14-1 (photo): From
Cummings N, Stanley-Green S, Higgs P: Perspectives in athletic
training, St. Louis, 2009, Mosby. Box 14-3: From Canale ST:
Campbell's operative orthopaedics, eel 9, St. Louis, 1998, Mosby.
Case Study box: From Goldman L, Ausiello 0: Cecil textbook of
medicine, eel 23, Philadelphia, 2007, Saunders.
Chapter 15
15-4: Adapted from Muscolino J: Kinesiology, St. Louis, 2006,
Mosby. 15-14: From Gosling J, Harris P, Whitmore I, Willan P: Human anatomy, eel 4, Philadelphia, 2002, Mosby. Box 15-1 (photo):
From Harkreader H: Fundamentals of nursing: caring and clinical
judgment, eel 3, St. Louis, 2007, Saunders.
Illustration and Photograph Credits
Chapter 16
•
XXXI
Box 16-1: Courtesy Aren Cummings, Ben Munson, and St. Charles
Community College, Cottleville, MO. Box 16-3: From Patton KT,
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
2018, Mosby.
University of Pennsylvania. 20-26: Courtesy D.N. Markand. Box 20-1
(photos): From Forbes CD, Jackson WD: Color atlas and text of
clinical medicine, ed 3, London, 2003, Mosby. Box 20-6 (photo):
From Chipps EM, Clanin NJ, Campbell VG: Neurologic disorders,
St. Louis, 1992, Mosby-Year Book.
Chapter 17
Chapter 21
17-4, A: Courtesy Dr. J.H. Venable, Department of Anatomy, Colorado State University, Fort Collins, CO. 17-4, B, Courtesy Dr. H.E.
Huxley. 17-6: From Leeson CR, Leeson T, Paparo A: Text/atlas of
histology, St. Louis, 1988, Saunders. 17-7, A: Courtesy of Don
Fawcett, Harvard Medical School, Boston, MA. In Pollard TO:
Earnshaw W: Cell biology, ed 2, St. Louis, 2007, Saunders. 17-10,
17-11, 17-15: From Lodish H: Molecular cell biology, ed 4, New
York, 2000, WH Freeman. 17-12, B: Courtesy H.E. Huxley, Brandeis
University, Waltham, MA. 17-1 8, B: Courtesy Dr. Paul C.
Letourneau, Department of Anatomy, Medical School, University of
Minnesota, MN. 17-22: Adapted from Pollard T, Earnshaw W: Cell
biology, ed 2, Philadelphia, 2008, Saunders. 17-30 (photos): Courtesy Dr. Frederic S. Fay, Department of Physiology, University of
Massachusetts, Worcester, MA. 17-32 (photo): Courtesy Kellie
White. Box 17-6, A: From Kumar V, Abbas A, Fausto N: Robbins
and Cotran pathologic basis of disease, ed 7, Philadelphia, 2005,
Saunders. Box 17-7 (photo): From Fritz S: Mosby's fundamentals of
therapeutic massage, ed 5, St. Louis, 2013, Mosby. Career Choices
box: Courtesy of Linda Carlson.
21-1: From Drake RL, et al: Gray's atlas of anatomy, Philadelphia,
2008, Churchill Livingstone/Elsevier. Box 21-3 (photo): From
Habif TP: Clinical dermatology, ed 2, St. Louis, 1990, Mosby.
Box 21-4: From Perkin GO: Mosby's color atlas and text of neurology, London, 1998, Times Mirror International Publishers. Box 21-5:
From Beare P, Myers J: Adult health nursing, ed 3, St. Louis, 1998,
Mosby.
UNIT 3
Chapter 18
18-1: From Patton KT, Thibodeau G: Human body in health 6 disease, ed 6, St. Louis, 2014, Mosby. 18-13: Redrawn from FitzGerald
MJT, Gruener G, Mtui E: Clinical neuroanatomy and neuroscience,
ed 6, Edinburgh, 201 1, Saunders. 18-14: From Feldman M,
Friedman L, Brandt L: Sleisenger 6 Fordtran's gastrointestinal and
liver disease, ed 8, Philadelphia, 2006, Saunders. Box 18-1 , A: Courtesy Marie Simar Couldwell, MD, and Maiken Nedergaard.
Chapter 19
Box 19-1 (photo): From Christensen GJ: A consumer's guide to dentistry, ed 2, St. Louis, 2002, Mosby. Box 19-2: Copyright Kevin
Patton, Lion Den Inc., Weldon Spring, MO. Box 19-3 (photo):
Courtesy Tamily Weissman, Jean Livet, and Jeff Lichtman, Harvard
University.
Chapter 20
20-2, B, 20-10, C , Box 20-3: From Abrahams P, Marks S,
Hutchings R: McMinn's color atlas of human anatomy, ed 5,
Philadelphia, 2003, Mosby. 20-5 , C , Table 20-3: Redrawn from
FitzGerald MJT, Gruener G, Mtui E: Clinical neuroanatomy and
neuroscience, ed 6, Philadelphia, 2011, Saunders. 20-7 (photo):
From Gosling J, Harris P, Whitmore I, Willan P: Human anatomy,
ed 4, Philadelphia, 2002, Mosby. 20-9, B: Courtesy Vidic B,
Suarez FR: Photographic atlas of the human body, St. Louis, 1984,
Mosby. 20-16, C: From Gigandet X, et al: Estimating the confidence
level of white matter connections obtained with MRI tractography,
PLoS ONE, 3(l2):e4006, 2008. 20-25: Courtesy Walter Schreider,
Chapter 22
Case Study box (photo): Courtesy Flickr, Photo Sharing.
Chapter 23
23-1: Adapted from Guyton A, Hall J: Textbook of medical physiology, ed 11, Philadelphia, 2006, Saunders. 23-3, A: From Seidel HM,
Ball JW, Dains JE, Benedict GW: Mosby's guide to physical examination, ed 6, St. Louis, 2006, Mosby. 23-3 , B: From Swartz MH: Textbook of physical diagnosis, ed 4, Philadelphia, 2002, Saunders. 23-4:
Adapted from Boron W, Boulpaep E: Medical physiology, updated
version, Philadelphia, 2005, Saunders.
Chapter 24
24-3 , D: Omikron/Photo Researchers. 24-5, B: From Patton KT,
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
2018, Mosby. 24-8, B: Adapted from Guyton A, Hall J: Textbook of
medical physiology, ed 11, Philadelphia, 2006, Saunders. 24-11:
Copyright Kevin Patton, Lion Den Inc, Weldon Spring, MO. 24-13:
From Newell FW: Ophthalmology: principles and concepts, ed 7,
St. Louis, 1992, Mosby. 24-18, C: Courtesy Dr. Scott Mittman,
Johns Hopkins Hospital, Baltimore, MD. 24-23: From Seidel HM,
Ball JW, Dains JE, Benedict GW: Mosby's guide to physical examination, ed 3, St. Louis, 2003, Mosby. 24-25: Adapted from Boron W,
Boulpaep E: Medical physiology, updated version, Philadelphia,
2005, Saunders. 24-27: From Bingham BJG, Hawke M, Kwok P:
Atlas of clinical otolaryngology, St. Louis, 1992, Mosby Year Book.
24-29, 24-30, A: From Swartz MH: Textbook of physical diagnosis,
ed 4, Philadelphia, 2002, Saunders. Box 24-3 (figure): From
Ishihara's tests for colour deficiency, Tokyo, 1973, Kanehara Trading
Co, Copyright lsshinkai Foundation.
Chapter 25
25-13: Adapted from Hinson J, Raven P: The endocrine system, Edinburgh, 2007, Churchill Livingstone.
Chapter 26
26-2: From Erlandsen SL, Magney J: Color atlas of histology,
St. Louis, 1992, Mosby. 26-7: Adapted from Boron W, Boulpaep E:
Medical physiology, updated version, Philadelphia, 2005, Saunders.
26-9, B: From Jacob S: Atlas of human anatomy, Edinburgh, 2002,
Churchill Livingstone. 26-12, B: From Abrahams P, Marks S,
xxxii
Illustration and Photograph Credits
Hutchings R: McMinn's color atlas of human anatomy, ed 3, Philadelphia, 2003, Mosby. 26-13: Dennis Strete. 26-15: From Gosling J,
Harris P, Whitmore I, \i\Tillan P: Human anatomy, ed 4, Philadelphia, 2002, Mosby. 26-1 7: From Kierszenbaum A: Histology and cell
biology, Philadelphia, 2002, Mosby. Box 26-4, A: From Swartz MH:
Textbook of physical diagnosis, ed 4, Philadelphia, 2002, Saunders.
Box 26-4, B: From Goldman L, Schafer AI: Goldman's Cecil medicine, ed 24, vol. 2, Philadelphia, 2012, Saunders. Box 26-6 (figures):
Courtesy Gower Medical Publishers. Box 26-1 (photo A): Courtesy
Robert F. Gagel, MD and Ian McCutcheon, MD, University of
Texas MD Anderson Cancer Center, Houston, TX. In Black JM,
Hawks JH: Medical-surgical nursing: clinical management for positive outcomes, ed 8, St. Louis, 2009, Saunders. Box 26-1 (photo B):
From Forbes C D, Jackson WF: Color atlas and text of clinical medicine, ed 3, London, 2003, Mosby, Elsevier Science Ltd. Box 26-4, C,
Box 26-6, C : From Patton KT, Thibodeau G: Human body in health
6 disease, ed 7, St. Louis, 2018, Mosby. Career Choices box: Courtesy of Kim Musicante.
UNIT 4
Chapter 27
27-3, D: From Zakus SM: Clinical procedures for medical assistants,
ed 3, St. Louis, 1995, Mosby. 27-4: From Shiland BJ: Mastering
healthcare terminology, ed 3, St. Louis, 20 l 0, Mosby. 27-5: From
Patton KT, Thibodeau G: Human body in health 6 disease, ed 6,
St. Louis, 2014, Mosby. 27-8 (inset): From Carr J, Rodak B: Clinical
hematology atlas, St. Louis, 1999, Elsevier. 27-11 (inset): From
Belcher AE: Blood disorders, St. Louis 1993, Mosby. 27-13, 27-14,
27-15 , 27-16, 27-17: Dennis Strete. 27-18: From Turgeon M: Linne
6 Ringsud's clinical laboratory science, ed 5, St. Louis, 2007, Mosby.
27-19: From Carr JH, Rodak BF: Clinical hematology atlas, ed 2,
St. Louis, 2004, Elsevier. 27-20, B: Copyright Dennis Kunkel Microscopy Inc. 27-23: From Cotran R, Kumar V, Collins T: Robbins
pathologic basis of disease, ed 6, Philadelphia, 1999, Saunders.
27-24, 27-25: From Kumar V, Abbas A, Fausto N: Robbins and
Cotran pathologic basis of disease, ed 7, Philadelphia, 2005,
Saunders. Table 27-2: Adapted from Pagana KD, Pagana TJ:
Mosby's manual of diagnostic and laboratory tests, ed 5, St. Louis,
20 13, Mosby. Case Study box: From Stevens ML: Fundamentals of
clinical hematology, Philadelphia, 1997, Saunders.
Chapter 28
28-1 : Courtesy Patricia Kane, Indiana University Medical School.
28-9 (drawing): From Wilson SF, Giddens JF: Health assessment for
nursing practice, ed 2, St. Louis, 200 l, Mosby. 28-9 (inset): From
Seidel HM, Ball JW, Dains JE, Benedict GW: Mosby's guide to
physical examination, ed 6, St. Louis, 2006, Mosby. 28-13 , A, 28-16,
28-21: From Patton KT, Thibodeau G: Human body in health 6
disease, ed 7, St. Louis, 2018, Mosby. 28-1 7: From Noble A,
Johnson R, Thomas A, Bass P: The cardiovascular system, Edinburgh,
2005, Churchill Livingstone. 28-20: From Kumar V, Abbas A,
Fausto N: Robbins and Cotran pathologic basis of disease, ed 7,
Philadelphia, 2005, Saunders. 28-24: Courtesy Guzzetta CE,
Dossey BM, Cardiovascular nursing: bodymind tapestry, St. Louis,
1984, CV Mosby. 28-25: From Aehlert B: ACLS quick review study
cards, ed 2, St. Louis, 2004, Mosby. 28-26: From Cotran R, Kumar V,
Collins T: Robbins pathologic basis of disease, ed 6, Philadelphia,
1999, Saunders. Box 28-1: From Goldman L, Ausiello D: Cecil textbook of medicine, ed 23, Philadelphia, 2008, Saunders. Case Study
box: From Hicks GH: Cardiopulmonary anatomy and physiology,
Philadelphia, 2000, Saunders.
Chapter 29
29-5: Adapted from McCance K, Huether S: Pathophysiology, ed 5,
St. Louis, 2006, Mosby. 29-9, C, 29-11, A, C, 29-13, B, C: From
Abrahams P, Marks S, Hutchings R: McMinn's color atlas of human
anatomy, ed 5, Philadelphia, 2003, Mosby. 29-24: From Patton KT,
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
2018, Mosby. 29-26 (photo): From Swartz MH: Textbook of physical
diagnosis, ed 4, Philadelphia, 2002, Saunders. 29-29: From Cotran R,
Kumar V, Collins T: Robbins pathologic basis of disease, ed 6, Philadelphia, 1999, Saunders. Box 29-1: Courtesy Simon C, Janner M:
Color atlas of pediatric diseases with differential diagnosis, ed 2,
Hamilton, Ontario, 1990, BC Decker. Case Study box: Courtesy
Dr. Daniel Simon and Mr. Paul Zambino
Chapter 30
30-1: From Harvey W: The anatomical exercises, London, 1995,
Dover Publishing. 30-6: From Rhoades R, Pflanzer R: Human physiology, ed 3, Philadelphia, 1995, Perennial. 30-9: Adapted from
Guyton A, Hall J: Textbook of medical physiology, ed l l , Philadelphia, 2006, Saunders. 30-11, 30-19, B: Adapted from Boron W,
Boulpaep E: Medical physiology, updated version, Philadelphia,
2005, Saunders. 30-19, A: From Patton KT, Thibodeau G: Human
body in health 6 disease, ed 7, St. Louis, 20 18, Mosby. 30-25:
Adapted from Canobbio MM: Cardiovascular disorders, St. Louis,
1990, Mosby. 30-28: Adapted from the National High Blood Pressure Education Program.
Chapter 31
31-2, 31-5,A: From Patton KT, Thibodeau G: Human body in health
6 disease, ed 7, St. Louis, 2018, Mosby. 31-5B: Courtesy Ballinger P,
Frank E: Merrill's atlas of radiographic positions and radiologic procedures, ed 10, vol l, St. Louis, 2003, Mosby. 31-6: Adapted from
McCance K, Huether S: Pathophysiology, ed 4, St. Louis, 2002,
Mosby. 31-7: Adapted from Boron W, Boulpaep E: Medical physiology, updated version, Philadelphia, 2005, Saunders. 31-8, A: Adapted
from Mathers L, Chase R, Dolph J, Glasgow E: CLASS clinical
anatomy principles, Philadelphia, 1996, Mosby. 31-8, B: From
Nielsen M: Human anatomy lab manual and workbook, ed 4,
Dubuque, lA, 2002, Kendall/Hunt Publishing Company. 31-9, B,
31-17, B: Dennis Strete. 31-14: From National Institute of Allergy
and Infectious Diseases, National Institutes of Health, Bethesda,
MD. 31-15, 31-24: From Seidel HM, Ball JW, Dains JE,
Benedict GW: Mosby's guide to physical examination, ed 6, St. Louis,
2006, Mosby. 31-16, B: Courtesy Dr. Edward L. Applebaum, Head,
Department of Otolaryngology, University of Illinois Medical Center, Chicago. 31-18: Adapted from Rhoades R, Pflanzer R: Human
physiology, ed 3, Philadelphia, 199 5, Perennial. 31-19: Courtesy
Vidic B, Suarez FR: Photographic atlas of the human body, St. Louis,
1984, Mosby. 31-21: Courtesy Walter Tunnesen, MD, The American Board of Pediatrics, Chapel Hill, NC. 31-22: From Goldstein B,
Illustration and Photograph Credits
editor: Practical dermatology, ed 2, St. Louis, 1997, Mosby. 31-23:
Copyright Kevin Patton, Lion Den Inc, Weldon Spring, MO. Case
Study box: From Cohen J, Powderly WG: Infectious diseases, ed 2,
St. Louis, 2004, Mosby.
•••
XXXIII
Philadelphia, 2002, Mosby. 35-20, 35-21: From Kumar V, Abbas A,
Fausto N: Robbins and Cotran pathologic basis of disease, ed 7,
Philadelphia, 2005, Saunders. Box 35-1: From Patton KT,
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
2018, Mosby.
Chapter 32
32-1, 32-8, Box 32-1, B: From Abbas A, Lichtman A: Cellular and
molecular immunology, ed 5, Philadelphia, 2003, Saunders. 32-4:
From Roitt IM, Brostoff, Male DK: Immunology, ed 3, St. Louis,
1993, Mosby. 32-6: Adapted from McCance K, Huether, S: Pathophysiology, ed 5, St. Louis, 2006, Mosby. 32-10: From McCance K,
Huether S: Pathophysiology: the biologic basis for disease in adults
and children, ed 7, St. Louis, 2014, Mosby. Box 32-1 , A: From
Copstead-Kirkhorn L, Banasik J: Pathophysiology, ed 2, St. Louis,
1999, Saunders.
Chapter 33
33-1: Copyright Dennis Kunkel Microscopy Inc. 33-3, 33-4, 33-5,
33-9, 33-14, 33-15, 33-16, 33-17, 33-18, 33-20, Box 32-1, B,
Box 33-6: From Abbas A, Lichtman A: Cellular and molecular immunology, ed 5, Philadelphia, 2003, Saunders. 33-13, 33-21: From
Copstead-Kirkhorn L, Banasik J: Pathophysiology, ed 2, St. Louis,
1999, Saunders. Box 33-3: From Stinchcombe JC, Griffiths GM:
The role of the secretory immunological synapse in killing by
C D8+ CTL, Semin Immunol, 15(6):30 1-305, 2003. Box 33-5:
Adapted from McCance K, Huether S: Pathophysiology, ed 4,
St. Louis, 2002, Elsevier. Case Study box: From Mason DJ, Leavitt J,
Chaffee M: Policy and politics in nursing and health care, ed 5,
St. Louis, 2007, Saunders.
Chapter 34
34-1, A: Julie Dermansky/Science Source. 34-1, B: Ria Novosti/
Science Source. 34-1, C : Mauro Fermariello/Science Source.
34-1, D: Global Warming Art. 34-1 , E: Stocktrek lmages!fhinkstock. 34-6: Adapted from McEwan BS, Gianaros PJ: Stress- and allostasis-induced brain plasticity, Annu Rev Med 62:5.1-5.15, 2011.
Career Choices box: Courtesy of Dena Kruse.
UNIT 5
Chapter 35
35-4: From Stevens A, Lowe J: Human histology, ed 3, Philadelphia,
2005, Mosby. 35-8, B. C: From Cox JD: Radiation oncology, ed 9,
St. Louis, 2010, Mosby. 35-9: Adapted from Thompson JM,
Wilson SF: Health assessment for nursing practice, St. Louis, 1996,
Mosby. 35-13, B: From Erlandsen SL, Magney J: Color atlas of histology, St. Louis, 1992, Mosby. 35-12: From Hutchings RT,
McMinn RM: McMinn's color atlas of human anatomy, ed 2, Chicago, 1988, Year Book Medical Publishers. 35-13 , A: From Patton KT,
Thibodeau G: Structure 6 function, ed 15, St. Louis, 20 15, Mosby.
35-14: From Epstein 0, Perkin C D, Cookson J, de Bono D: Clinical
examination, ed 3, Philadelphia, 2003, Mosby. 35-15: From
Patton KT, Thibodeau G: Human body in health 6 disease, ed 7,
St. Louis, 2018, Mosby. 35-16: Courtesy Vidic B, Suarez RF: Photographic atlas of the human body, St. Louis, 1984, Mosby. 35-19:
From Zitelli B, Davis H: Atlas of pediatric physical diagnosis, ed 4,
Chapter 36
36-6: From Drake R, Vogl AW, Mitchell A: Gray's anatomy for students, Philadelphia, 2005, Churchill Livingstone. 36-9, A, 36-16:
Adapted from Boron W, Boulpaep E: Medical physiology, updated
version, Philadelphia, 2005, Saunders. 39-9, B: Antonia Reeve/Science Source. 36-12, Box 36-2: Adapted from Davies A, Moores C:
The respiratory system, Edinburgh, 2004, Churchill Livingstone.
36-14: From Patton KT, Thibodeau G: Human body in health 6
disease, ed 6, St. Louis, 2014, Mosby. Box 36-6: Copyright Kevin
Patton, Lion Den Inc, Weldon Spring, MO. Box 36-7: Adapted from
Guyton A, Hall J: Textbook of medical physiology, ed 11, Philadelphia, 2006, Saunders.
Chapter 37
37-4, 37-13: Adapted from Boron W, Boulpaep E: Medical physiology, updated version, Philadelphia, 2005, Saunders. 37-5: From
Rhoades R, Pflanzer R: Human physiology, ed 3, Philadelphia, 1995,
Perennial. 37-6: From Patton KT, Thibodeau G: Human body in
health 6 disease, ed 6, St. Louis, 2014, Mosby.
Chapter 38
38-5, B: Copyright Kevin Patton, Lion Den Inc, Weldon Spring,
MO. 38-5: Dennis Strete. 38-6, B: From Zitelli B, Davis H: Atlas of
pediatric physical diagnosis, ed 3, Philadelphia, 1997, Mosby. 38-10
(inset): From Weir J, Abrahams P: Imaging atlas of the human
anatomy, ed 2, Philadelphia, 1997, Mosby. 38-11 , 38-12, A, 38-16:
From Patton KT, Thibodeau G: Human body in health 6 disease,
ed 7, St. Louis, 2018, Mosby. 38-12, B: From Stevens A, Lowe J:
Human histology, ed 3, Philadelphia, Mosby, 2005. 38-1 8, A: From
Wilson SF, Giddens JF: Health assessment for nursing practice, ed 2,
St. Louis, 2001, Mosby. 38-1 8, B: From Greig JD, Garden OJ: Color
atlas of surgical diagnosis, London, 1996, Times Mirror International Publishers. 38-20, D: Courtesy Kevin Patton, Weldon Spring,
MO. 38-21 , B, 38-22, Box 38-2: From Daffner DH: Clinical radiology: the essentials, ed 3, Baltimore, 1992, Lippincott, Williams &
Wilkins.
Chapter 39
39-2, B: From Abrahams P, Marks S, Hutchings R: McMinn's color
atlas of human anatomy, ed 5, Philadelphia, 2003, Saunders.
39-4, B: From Erlandsen SL, Magney J: Color atlas of histology,
St. Louis, 1992, Mosby. 39-5: SPL/Photo Researchers. 39-10, A:
Courtesy Baylor Regional Transplant Institute, Baylor University
Medical Center, Dallas, TX. 39-14: Courtesy Thompson JM,
Wilson SF: Health assessment for nursing practice, St. Louis, 1996,
Mosby. 39-20: From Cotran R, Kumar V, Collins T: Robbins pathologic basis of disease, ed 6, Philadelphia, 1999, Saunders. 39-17:
From Doughty DB, Jackson D: Gastrointestinal disorders, St. Louis,
1993, Mosby.
xxxiv
Illustration and Photograph Credits
Chapter 40
40-3, 40-5: From Patton KT, Thibodeau G: Human body in health
6 disease, ed 7, St. Louis, 2018, Mosby. 40-4, Box 40-1: Adapted
from Boron W, Boulpaep E: Medical physiology, updated version,
Philadelphia, 2005, Saunders. 40-19, B: Courtesy Dr. Andrew Evan,
Indiana University. Box 40-2, B: Adapted from Smith M, Morton D:
The digestive system, Edinburgh, 2001, Churchill Livingstone.
Box 40-4, B, C: From Stevens A, Lowe J: Human histology, ed 3,
Philadelphia, 2005, Mosby.
Saunders. Table 42-2: From Bonewit-West K: Clinical procedures for
medical assistants, ed 8, St. Louis, Saunders, 201 1.
Chapter 43
43-7: Copyright Kevin Patton, Lion Den Inc, Weldon Spring, MO.
43-18: Modified from Goldman L, Schafer AI: Goldman's Cecil
medicine, ed 24, Philadelphia, 2012, Saunders. 43-11: Courtesy
Kellie White.
Chapter 44
Chapter 41
41-1 : From the United States Food and Drug Administration: Food
labeling guide, College Park, MD, 2013, Office of Nutrition, Labeling, and Dietary Supplements, HFS-800. 41-2, A: From the United
States Department of Agriculture: MyPlate 2013, Retrieved from
http://www.choosemyplate.gov/print-materials-ordering/graphic-resources.html. 41-2, B: From Health Canada, 2016. Eating well with
Canada's food guide. Reproduced with permission from the Minister
of Health, 2017. 41-14, B: Courtesy Brenda Russell, PhD, University
of Illinois at Chicago. 41-18, B: Adapted from Carroll R: Elsevier's
integrated physiology, Philadelphia, 2007, Mosby. 41-20: Adapted
from Report of the Expert Panel for Population Strategies for Blood
Cholesterol Reduction, Bethesda, MD, 1990, The National Cholesterol Education Program, National Heart Lung and Blood Institute,
Public Health Service, US Department of Health and Human Services, NIH Publication No. 90-3046. 41-25, 41-26, 41-29, 41-32,
Box 41-9, B: Adapted from Mahan LK, Escott-Stump S: Krause's
food, nutrition and diet therapy, ed 11, St. Louis, 2004, Saunders.
41-3 1: Adapted from Guyton A, Hall J: Textbook of medical physiology, ed 11, Philadelphia, 2006, Saunders. 41-33: From Zitelli B,
Davis H: Atlas of pediatric physical diagnosis, ed 3, Philadelphia,
1997, Mosby. Box 41-2: Courtesy Bevelander G, Ramalay J: Essentials of histology, ed 8, St. Louis, 1979, Mosby. Box 41-9, B: Adapted
from Mahan LK, Escott-Stump S: Krause's food, nutrition and diet
therapy, ed 11, St. Louis, 2004, Saunders.
Chapter 42
42-1, A: Barbara Cousins. 42-1, B, 42-2, B: From Abrahams P,
Marks S, Hutchings R: McMinn's color atlas of human anatomy,
ed 5, Philadelphia, 2003, Mosby. 42-2, A, 42-10: Adapted from
Brundage DJ: Renal disorders, Mosby's Clinical Nursing Series,
St. Louis, 1992, Mosby. 42-3 , B: From Weir J, Abrahams P: Imaging
atlas of the human anatomy, ed 2, Philadelphia, 1997, Mosby. 42-6:
From Heylings D, Spence R, Kelly B: Integrated anatomy, Edinburgh, 2007, Churchill Livingstone. 42-7: From Telser A, Young J,
Baldwin K: Elsevier's integrated histology, Philadelphia, 2008, Mosby.
42-1 1, 42-16: From Stevens A, Lowe J: Human histology, ed 3, Philadelphia, 2005, Mosby. 42-8: From Gosling J, Harris P, Whitmore I,
Willan P: Human anatomy, ed 4, Philadelphia, 2002, Mosby. 42-9:
Adapted from Guyton A, Hall J: Textbook of medical physiology,
ed 11, Philadelphia, 2006, Saunders. 42-14, 42-15, B: From
Boron W, Boulpaep E: Medical physiology, updated version, Philadelphia, 2005 , Saunders. 42-18, Box 42-6: From Patton KT,
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
2018, Mosby. 42-29: From Kumar V, Abbas A, Fausto N: Robbins
and Cotran pathologic basis of disease, ed 7, Philadelphia, 2005,
Box 44-1: Courtesy Kevin Patton, Lion Den Inc, Weldon Spring,
MO. Career Choices box: Courtesy of Norma Cooper.
UNIT 6
Chapter 45
45-3, A, 45-8, E: Lennart Nilsson. 45-4, 45-8, F: From Stevens A,
Lowe J: Human histology, ed 3, Philadelphia, 2005, Mosby. 45-5:
Courtesy Dr. Mark Ludvigson, US Army Medical Corps, St. Paul,
MN. 45-9, 45-10, 45-13: From Erlandsen SL, Magney J: Color atlas
of histology, St. Louis, 1992, Mosby. 45-11: Barbara Cousins. 45-12:
From Abrahams P, Marks S, Hutchings R: McMinn's color atlas of
human anatomy, ed 5, Philadelphia, 2003, Mosby. 45-14, B: Courtesy Vidic B, Suarez RF: Photographic atlas of the human body,
St. Louis, 1984, Mosby. 45-15: Adapted from Guyton A, Hall J:
Textbook of medical physiology, ed 11, Philadelphia, 2006, Saunders.
45-16: Adapted from Boron W, Boulpaep E: Medical physiology,
updated version, Philadelphia, 2005, Saunders. 45-17, Box 45-1:
From Seidel HM, Ball JW, Dains JE, Benedict GW: Mosby's guide
to physical examination, ed 6, St. Louis, 2006, Mosby.
Chapter 46
46-1, B: From Moses K, Nava P, Banks J, Petersen D: Moses atlas of
clinical gross anatomy, Philadelphia, 2005, Mosby. 46-3, B, 46-6,
46-7: From Gosling J, Harris P, Whitmore I, Willan P: Human
anatomy, ed 4, Philadelphia, 2002, Mosby. 46-5, C: From Familiari G,
et al: Ultrastructural dynamics of human reproduction, from ovulation to fertilization and early embryo development, Int Rev Cytol,
249:53-141 , 2006. 46-10: From Stevens A, Lowe J: Human histology,
ed 3, Philadelphia, Mosby, 2005. 46-11: From McKee GT: Cytopathology, London, 1997, Mosby-Wolfe. 46-12: Courtesy Dr. Richard
Blandau, Department of Biological Structure, University of Washington School of Medicine, Seattle, WA, from his film Ovulation
and egg transport in mammals, 1973. 46-18: Adapted from Boron W,
Boulpaep E: Medical physiology, updated version, Philadelphia,
2005 , Saunders. 46-21, 46-23: From Mettler F: Essentials of radiology, ed 2, Philadelphia, 2005, Saunders. 46-22, A: From Abrahams P,
Marks S, Hutchings R: McMinn's color atlas of human anatomy,
ed 5, Philadelphia, 2003, Saunders. 46-22, B: From Symonds EM,
MacPherson MB: Color atlas of obstetrics and gynecology, London,
1994, Mosby Wolfe. 46-24: From Kumar V, Abbas A, Fausto N:
Robbins and Cotran pathologic basis of disease, ed 7, Philadelphia,
2005 , Saunders. 46-25, B, C, From Cotran R, Kumar V, Collins T:
Robbins pathologic basis of disease, ed 6, Philadelphia, 1999,
Saunders. Box 46-6 (photo): From Ferri FF: Ferri's color atlas and
text of clinical medicine, Philadelphia, 2009, Saunders/Elsevier.
Box 46-7: Michael Donne, Science Photo Library, Science Source.
Illustration and Photograph Credits
Chapter 47
47-5 (photo), 47-13: Lennart Nilsson. 47-7: Courtesy Lucinda L.
Veeck, Jones Institute for Reproductive Medicine, Norfolk, VA.
47-11, B: From Cotran R, Kumar V, Collins T: Robbins pathologic
basis of disease, ed 6, Philadelphia, 1999, Saunders. 47-12, B:
Adapted from Hinson J, Raven P: The endocrine system, Edinburgh,
2007, Churchill Livingstone. 47-14: From Moore KL, Persand TV:
The developing human, ed 6, Philadelphia, 1998, Saunders. 46-17,
46-18, 47-25: Adapted from Boron W, Boulpaep E: Medical physiology, updated version, Philadelphia, 2005, Saunders. 47-20: From
Patton KT, Thibodeau G: Human body in health 6 disease, ed 7,
St. Louis, 2018, Mosby. 47-23: From Hockenberry MJ, Wilson D:
Wong's essentials of pediatrics nursing, ed 8, St. Louis, 2009, Mosby.
47-24, Box 47-2, B: Copyright Kevin Patton, Lion Den Inc, Weldon
Spring, MO. 47-26: Adapted from Mahan LK, Escott-Stump S:
Krause's food, nutrition and diet therapy, ed 12, St. Louis, 2007,
Saunders. 47-27: Adapted from McCance K, Huether S: Pathophysiology, ed 5, St. Louis, 2005, Mosby. 47-29, B: Adapted from
lgnatavicius D, Bayne MY: Medical-surgical nursing: a nursing
process approach, Philadelphia, 1991, Saunders. 47-30: From
Andersen JL, Schjerling P, Saltin B: Muscle, genes, and athletic
xxxv
performance, Sci Am, 283(3):49-55, 2000. 47-3 1: From Goldman L,
Ausiello D, Cecil textbook of medicine, ed 23, Philadelphia, 2003,
Saunders. Box 47-3 (photo): Courtesy of the Progeria Research
Foundation. Peabody, MA, http://www.progeriaresearch.org. Case
Study box: From Hagen-Ansert SL: Textbook of diagnostic ultrasonography, ed 6, vol 2, St. Louis, 2007, Mosby.
Chapter 48
48-1: Adapted from Boron W, Boulpaep E: Medical physiology, updated version, Philadelphia, 2005, Saunders. 48-2: From Patton KT,
Thibodeau G: Human body in health 6 disease, ed 7, St. Louis,
2018, Mosby. 48-5: From Jorde L, Carey J, Bamshad M: Medical
genetics, ed 3, Philadelphia, 2004, Saunders. 48-10: From
McCance K, Huether S: Pathophysiology, ed 4, St. Louis, 2002,
Mosby. 48-13, B: From Kumar V, Abbas A, Fausto N: Robbins and
Cotran pathologic basis of disease, ed 7, Philadelphia, 2005, Saunders. 48-14, A: Courtesy Lois McGavran, Denver Children's Hospital. 48-14, B: From Zitelli: Atlas of pediatric physical diagnosis, ed 6,
St. Louis, 2012, Mosby. 48-15 , 48-16, B, 48-17, B: Courtesy Nancy
S. Wexler, PhD, Columbia University. Career Choices box: Courtesy of Andrea L. Mose.
the big picture I Seeing the BIG picture
Before reading this introduction, you probably spent a few minutes
flipping through this book. Naturally, you are curious about your
course in human anatomy and physiology, and you want to see what lies ahead.
It is more than that. You are curious about the human body-about yourself,
really. We all have that desire to learn more about how our bodies are put
together and how all the parts work. Unlike many other people, though, you now
have the opportunity to gain an understanding of the underlying scientific principles of human structure and function.
To truly understand the nature of the human body requires an ability to appreciate "the parts" and "the whole" at the same time. As you flipped through this
book for the first time, you probably looked at many different body parts. Some
were microscopic-such as muscle cells-and some were very large-such as
arms and legs. In looking at these parts, however, you gained very little insight
about how they worked together to allow you to sit here, alive and breathing, and
read and comprehend these words.
Think about it for a moment. What does it take to be able to read these words
and understand them? You might begin by thinking about the eye. How do all of
its many intricate parts work together to form an image? The eye is not the only
organ you are using right now. What about the bones, joints, and muscles you
are using to hold the book, to turn the pages, and to move your eyes as they
scan this paragraph? Let's not forget the nervous system. The brain, spinal cord,
and nerves are receiving information from the eyes, evaluating it, and using it to
coordinate the muscle movements. The squiggles we call letters are being interpreted near the top of the brain to form complex ideas. In short, you are thinking
about what you are reading .
However, that does not cover everything. How are you
getting the energy to operate your eyes, muscles, brain,
and nerves? Energetic chemical reactions inside
each cell of these organs require oxygen and nutrients captured by the lungs and digestive tract
and delivered by the heart and blood vessels.
These chemical reactions produce wastes that
are handled by the liver, kidneys, and other
organs. All of these functions must be coordinated, a feat accomplished by regulation of body
organs by hormones, nerves, and other mechanisms.
Learning to name the various body parts, to describe
their detailed structure, and to explain the mechanisms that produce their functions is an essential
step that leads to the goal of understanding the
human body. To actually reach that goal,
however, you must be able to draw together
isolated facts and concepts. In other words,
understanding the nature of individual body
parts becomes more meaningful when you
understand how the parts work together in a
living, whole person .
•
XXXVI
Many textbooks are written like reference books-dictionaries, for example.
They provide detailed descriptions of the structure and function of individual body
parts, often in logical groupings, while rarely stopping to step back and look at
the whole person. In this book, however, we have
incorporated the "whole body" aspect into the
discussion of every major topic. In chapter
and unit introductions, in appropriate paragraphs within each section, and in specific
sections near the end of each chapter, we
have stepped back from the topic at hand
and refocused attention to the broader
•
VIeW.
•
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-----
Anthony's Textbook of
AWARD
At the organelle level within the living skin cells, you
probably think of the mitochondrion shown here as the
Sweat glands in our skin are epithelial tissue exocrine glands that
"power plant" of the cell. In this unit you will learn more
secrete substances onto the surface of
about the process of cellular respiration.
the skin. You know they help cool off
1. What is the molecule produced by this cell part that
your body when overheated, but they
transfers energy from nutrients to the chemical or
also secrete wastes in that fluid.
metabolic processes of life?
2. What other organ system would
a) DNA
b) RNA
••
c) ATP
a/so get rid of wastes as fluids?
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At the biochemical level, the
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subcutaneous layer under our
skin has many fat cells. They
provide insulation and energy
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controlled voluntarily or involuntarily?
If you have ever cut yourself or become
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our skin has a good blood supply. The
larger vessels function for transport, but it
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23
6. This would be part of what body system
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responsible for communication, control,
is the small, microscopic vessels called
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.Some specialized cells in the skin
called melanocytes produce the pigment that gives our
skin color. As you learn new terminology, such as the
name of this cell, use clues in the name to help you
•
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remember its structure and function.
5 . What would you predict would be the name of the
pigment chemical this cell produces?
a) keratin
b) elastin
c) melanin
substances exchanged at capillaries
that are closely related to cellular
respiration occurring in the
mitochondrion shown above?
T
he nine chapters in Unit 1 "set the stage" for the study of human anatomy and physiology. They
provide the unifying information required to understand the "connectedness" of human structure
and function . You will explore different levels of organization from chemical to tissue level. The first
organ you will study in the next unit w ill be the skin. Let's take a look ahead at its structure and
function and figure out what you already know from your own experiences as a human or have
learned before this at the foundational level. Watch for any ideas you have that are oversimplified
so you can add to your knowledge or any misconceptions you can correct based on the scientific
principles in this first unit. Try out these framework questions:
Why a set of hard questions before you even begin
reading? The science of learning shows that it will
go easier if you jump-start your brain with a few
questions that get you thinking about concepts to be
explored in this unit, even if you have to guess! Try
answering (or guessing at) each item, moving clockwise around the facing page, then check your answer at the side of the page. It is okay if you do not
answer them correctly; the goal here is simply to get
you thinking before you read. Even though it seems
odd, and maybe a bit discouraging the first time, it
does work!
•
•
1
Organization of the Body, 2
2
3
4
5
6
7
Homeostasis, 23
8
9
Chemistry of Life, 38
Biomolecules, 55
Cell Structure, 75
Cell Function , 98
Cell Growth and Development, 120
Introduction to Tissues, 137
Tissue Types, 154
Organization
of the Body
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ou have just begun the study of one of nature's most wondrous structures-the human
body. Anatomy and physiology are branches of biology that are concerned w ith the
form and functions of the body. Anatomy is the study of body structure, whereas physiology deals with body function. As you learn about the complex interdependence of structure and
function in the human body, you become, in a very real sense, the subject of your own study.
Regardless of your field of study or your future career goals, acquiring and using information
about your body structure and functions will enable you to live a more knowledgeable, involved,
and healthy life in this science-conscious age. Your study of anatomy and physiology provides
a unique and fascinating understanding of self, and this knowledge allows for more active and
informed participation in your own personal health care decisions. If you are pursuing a health-,
science-, or athletic-related career, your study of anatomy and physiology takes on added significance. It provides the necessary concepts you will need to understand your professional
courses and succeed in clinical experiences .
SCIENCE AND SOCIETY
Before we get to the details, we should emphasize that everything
you will read in this book is in the context of a broad field of inquiry
called science. Science is a style of inquiry that attempts to understand nature in a rational, logical manner.
SCIENTIFIC METHOD
Using detailed observations and vigorous tests, or experiments, scientists winnow out each element of an idea or h ypoth esis until a
reasonable conclusion about its validity can be made. Rigorous experiments that eliminate any influences or biases not being directly
tested are called controlled experiments.
If the results of observations and experiments are repeatable, they
may verify a hypothesis and eventually lead to enough confidence in
the concept to call it a th eory. T h eories in which scientists have an
unusually h igh level of confidence are sometimes called laws. Experiments may disprove a hypothesis, a result that often leads to the
formation of new hypotheses to be tested.
Figure 1-1 summarizes some of the basic concepts of how new
scientific principles are developed. As you can see, science is a dynamic process of getting closer and closer to the truth about nature,
including the nature of the human body. Science is definitely not a
set of unchanging facts as many people in our culture often
assume.
CULTURAL CONTEXT
We should point out the social and cultural context of the science
presented in this book. Scientists drive the process of science, but our
culture drives the kinds of questions we ask about nature and how we
attempt to answer them. For example, cutting apart h uman cadavers
(dead bodies) for the purpose of studying th em has not always been
an acceptable activity in all cultures. Today a debate faced by our
culture concerns the acceptability of using live animals in scientific
experiments. Because our culture does not condone most experiments involving living humans, we have until now often conducted
testing on animals that are similar to humans. In fact, most of the
theories presented in this book are based on animal experimenta-
•
tion, but cultural influences now are pulling scientists in other experimental directions they otherwise may not have taken.
Similarly, science affects culture. Recent advances in understanding human genes and technological advances in our ability to use
so-called stem cells and other tissues from h uman embryos, human
cadavers, and living donors to treat devastating diseases have sparked
Observations and previous experiments
'
'
'
'
Propose hypothesis
Design experiment
Collect and analyze data
Yes
Determine if data are biased
' NO
Refine hypothesis
'
Repeat experiments
'
If results are consistent
Accept as theory
'
If unusually high level of confidence
Accept as law
FIGURE 1 -1
Scientific method. This flowchart summarizes the classic ideal
of how new principles of science are developed. Initial observations or results from
other experiments may lead to the formation of a new hypothesis. As more testing is
performed to eliminate outside influences or biases and ensure consistent results,
scientists begin to have more confidence in the principle and call it a theory or law.
3
4
UNIT 1 The Bo dy as a W hole
new debates concerning how our culture defines what it means to be
a human being.
As you study the concepts presented in this book, keep in mind
that they are not set in stone. Science is a rapidly changing set of
ideas and processes that not only is influenced by our cultural biases
but also affects our cultural awareness of who we are.
CONNECT IT ! @
For a quick peek at the major scientific breakthroug hs t hat have changed
our lives - and serve as t he core concepts of this book - check out The
Nobel Legacy online at Connect It!
• ANATOMY AND PHYSIOLOGY
ANATOMY
Anatomy is often defined as study of the structure of an organism and
the relationships of its parts. T he word anatomy is derived from
Greek word parts that mean "to cut apart." Students of anatomy still
learn about the structure of the human body by literally cutting it
apart. T his process, called dissection, remains a principal technique
used to isolate and study the structural components or parts of the
human body.
Biology is defined as the scientific study of life. Both anatomy and
physiology are subdivisions of this very broad area of inquiry. Each of
these subdivisions can be further divided into smaller areas of study.
For example, the term gross anatomy is used to describe the study of
body parts visible to the naked eye. Before invention of the microscope, anatomists had to study human structure by relying only on
the eye during dissection. These early anatomists could make only a
gross, or whole, examination, as you can see in Figure 1-2. With the
use of modern microscopes, many anatomists now specialize in
microscopic anatomy, including the study of cells, called cytology
(sye-TOL-oh-jee), and tissues, called histology (his-T OL-oh-jee) .
Other branches of anatomy include the study of human growth
and development (developmental anatomy) and the study of diseased
body structures (pathological anatomy) . In the chapters that follow,
you will study the body by systems-a process called systemic anatomy. Systems are groups of organs that have a common function,
such as the bones in the skeletal system and the muscles in the muscular system.
1-2 Gross anatomy.
This famous woodcut of a gross dissection
appeared in the world's first modern
anatomy textbook, De Humani Corporis
Fabrica (On the Structure of the Human
Body), in 1543. This woodcut features the
book's author, Andreas Vesalius, who is
considered to be the founder of modern
anatomy. The body being dissected is
called a cadaver.
FIGURE
PHYSIOLOGY
Physiology is the science that deals with the functions of the living
organism and its parts. The term physiology is a combination of two
Greek words (physis, "nature," and logos, "words or study"). Simply
stated, it is the study of physiology that helps us understand how the
body works. Physiologists attempt to discover and understand the
intricate control systems that permit the body to operate and survive
in changing and often hostile environments.
As a scientific discipline, physiology can be subdivided according
to ( l ) the type of organism involved, such as human physiology or
plant physiology; (2) the organizational level studied, such as molecular or cellular physiology; or (3) a specific or systemic function
being studied, such as neurophysiology, respiratory physiology, or
cardiovascular physiology.
In the chapters that follow, you will see again and again that anatomical parts have structures exactly suited to perform specific functions. Each has a particular size, shape, form, or position in the body
related directly to its ability to perform a unique and specialized activity. This principle- that structure fits function - explains why
studying anatomy and physiology together is the key to understanding the human body.
Quick CHECK
1. Describe how science develops new principles.
2. Define anatomy and physiology.
3. List the three ways in which physiology can be subdivided as a scient ific discipline.
4. What name is used to describe the study of the body that focuses on
groups of organs t hat have a common function?
LANGUAGE OF SCIENCE
AND MEDICINE
You may have noticed by now that many scientific terms, such as
anatomy and physiology, are made up of non-English word parts.
Many such terms make up the core of the language used to communicate ideas in science and medicine. Learning in science thus
begins with learning a new vocabulary, just as when you learn a new
language to help you understand and communicate in a region of
the world other than the one you call home.
To help you learn the vocabulary of anatomy and physiology, we
have provided several helpful tools for you. Within each chapter,
lists of new terms titled Language of Science and Language of Medicine give you each new key (boldface) term that you will be learning
in that chapter. Each term in the list has a pronunciation guide and
an explanation (or meaning) of each of the word parts that make up
the term.
We have also included a separate compact reference called
QuiCK GuiDE TO THE LANGUAGE OF SCIENCE AND MEDICINE with
this textbook. Take a moment now to locate it. After you have finished reading this chapter, quickly review the tips for learning scientific language. Then keep it nearby so that you will have a handy list
of commonly used word parts at your fingertips.
You will see that most scientific terms are made up of word parts
from Latin or Greek. Most Western scientists first began corresponding
Chapter 1 Organizat ion of the Body
5
CHARACTERISTICS OF LIFE
with one another in these languages, because they were commonly the
first written languages learned by educated people. Other languages
Anatomy and physiology are important disciplines in biology-the
study of life. But what is life? What is the quality that distinguishes a
such as German, French, and Japanese are also sources of some scienvital and functional being from a dead body? We know that a living
tific word parts.
As with any language, scientific language changes constantly.
organism is endowed with certain characteristics not associated with
T his is useful because we often need to fine-tune our terminology to
inorganic matter. However, it is sometimes hard to find a single criterion to define life.
reflect changes in our understanding of science and to accommodate new discoveries. But it also sometimes leads to confusion.
One could say that living organisms are self-organizing or selfIn an attempt to clear up some of the confusion, the International
maintaining and nonliving structures are not. This concept is called
Federation of Associations of Anatomists (IFM) formed a worldwide
autopoiesis, which literally means "self-making." Another idea, called
committee to publish a list of "universal" or standard anatomical
the cell theory, states that any independent structure made up of one or
terminology. The list for gross anatomy, the structure we can see
more microscopic units called cells is a living organism.
without magnification, was published in 1998 as Terminologia AnaInstead of trying to find a single difference that separates living
and nonliving things, scientists sometimes define life by listing what
tomica (TA). In 2008 Terminologia Histologica (TH) was published
are often called characteristics of life. Lists of characteristics of life
for microscopic anatomy- the study of body structure requiring significant magnification for the purpose of visualization.
may differ from one physiologist to the next, depending on the type
Although there remain some alternate (and newer) terms used in
of organism being studied and the way in which life functions are
anatomy, the lists are useful standard references. The lists show each
grouped and defined. Attributes that characterize life in bacteria,
term in Latin and English (based on the Latin form), along with a
plants, or animals may vary. Characteristics of life that are considreference number. In this textbook we use the English terms from
ered most important in humans are described in Table 1-1 .
the published lists as our standard reference, but we do occasionally
Each characteristic of life is related to the sum total of all the
refer to the pure Latin form or an alternate term when appropriate
physical and chemical reactions occurring in the body. T he term
for beginning students.
metabolism is used to describe these various processes. T hey include the steps involved in the breakdown of nutrient materials to
One of the basic principles of the standardized terminology is the
avoidance of eponyms, or terms that are based on a person's name.
produce energy and the transformation of one material into another.
Instead, a more descriptive Latin-based term is always preferred.
For example, if we eat and absorb more sugar than needed for the
body's immediate energy requirements, it is converted into an alterT hus the term eustachian tube (tube connected to the middle ear,
named after the famed Italian anatomist Eustachius) is now replaced
nate form, such as fat, that can be stored in the body.
with the more descriptive auditory tube. Likewise, the islets of LangMetabolic reactions are also required for making complex comerhans (in the pancreas) are now simply pancreatic islets.
pounds out of simpler ones, as in tissue growth, wound repair, or
manufacture of body secretions.
In the rare cases where eponyms do appear in a standard list, we
Each characteristic of life- its functional manifestation in the
now avoid the possessive form . Thus Bowman's capsule (in kidney
body, its integration with other body functions and structures, and its
tissue) is now either glomerular capsule or Bowman capsule.
There are no such standard lists of physiTABLE 1-1 Characteristics of Human Life
ological terms. However, many principles
used in anatomical terminology are used in
CHARACTERISTIC
DESCRIPTION
physiology. For example, most terms have
Responsiveness
Ability of an organism to sense, monitor, and respond to changes in both its
an English spelling but are based on Latin
external and internal environments
or Greek word parts. And, as in anatomy,
Capacity of living cells to transmit a wave of electrical d isturbance from one
Conductivity
eponyms are less favored than descriptive
point to another within the body
terms.
Organized increase in the size and number of cells and therefore an increase in
Growth
A QuiCK GuiDE TO THE LANGUAGE OF
size of the individual or a particular organ or part
SCIENCE AND MEDICINE accompanies this
Exchange of respiratory gases (oxygen and carbon d ioxide) between an
Respiration
book. It offers a handy summary of the baorganism and its environment
sic principles of using your new "A&P lanDigestion
Process by which complex food products are broken down into simpler
guage." The quick guide also lists common
substances that can be absorbed and used by individual body cells
roots, prefixes, and suffixes- along with
acronyms, abbreviations, Greek letters, RoAbsorption
Movement of molecules, such as respiratory gases or d igested nutrients,
throug h a membrane and into the body fluids for transport to cells for use
man numerals, and much more.
This may all seem like a lot more than
Production and release of important substances, such as digestive juices and
Secretion
hormones, for diverse body functions
you want to know right now. However, if you
focus on learning the new words as you begin
Removal of waste products from the body
Excretion
each new topic, as though you are in a forCirculation
Movement of body flu ids containing many substances from one body area to
eign land and need to pick up a few phrases
another in a continuous, circular route through hollow vessels
to get by, you will find your study of anatomy
Formation of new individual offspring
Reproduction
and physiology easy and enjoyable.
6
UNIT 1 The Body as a Whole
mechanism of control - is th e subject of study in subsequent chapters of the text.
Quick CHECK
5. What is an eponym?
6. What single criterion might be used to define life?
function effectively. Because you already know that structure fits
functi on, it sh ou ld not surprise you that the h ighly complex and
coordinated functions of th e whole body can be understood by discovering th e many basic processes that occu r in th e smaller parts,
such as organs, tissu es, and cells. These differing levels of organization th at help us better understand th e body are illustrated in
Figure 1-3.
7. Define t he term metabolism as it applies to the characterist ics of life.
CHEMICAL LEVEL
Note that organization of th e body begins at th e chemical level (see
• LEVELS OF ORGANIZATION
Figure 1-3). There are more than 100 different chemical building
Before you begin the study of the structure and function of the hublocks of nature called atoms- tiny spheres of matter so small they
are invisible. Every material thing in our universe, including th e
man body and its many parts, it is important to th ink about how the
parts are organized and how th ey might logically fit together and
human body, is composed of atoms.
Combinations of atoms form larger chemical groupings,
called m olecules. Molecules, in turn, often combine with
Atom
Molecule
oth er atoms and molecules to form larger and more
Vesicles
complex chemicals, called m acrom olecules.
Neuron
T he unique and complex relationships that exist
among atoms, molecules, and macromolecules
in living material form a gel-like material made
-tnQ)
of fluids, particles, and m embranes called
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cytoplasm - the essential material of human life.
-(.)
·-c.
Unless proper relationsh ips
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among chemical elem ents are
Group of neurons
Chemical level
tn
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and support cells
(Chapters 3-4)
maintained, death results.
·Maintaining the type of chem:?!
•
Organelle level · .
ical organization in cytoplasm
(Chapters 5-7)
required for life requires th e
expenditure of energy. In
Cellular level
(Chapters 5-7)
C hapters 3 and 4, important
information related to th e
chemistry of life is discussed
Integumentary
Tissue level
in more detail.
(Chapters 8-9)
Skeletal
Organ level
(Chapter 20) ~-...:--
Muscular
Organ system level
(Chapters 10-46)
Cardiovascular
Brain
' rj
Endocrine
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tn
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1 -3 Levels of organization. The
smallest parts of the body are the atoms that make up
the chemicals, or molecules, of the body. Molecules, in
turn, make up microscopic parts called organelles that fit
together to form each cell of the body. Groups of similar
cells are called tissues, which combine with other
tissues to form individual organs. Groups of organs that
work together are called systems. All the systems of the
body together make up an individual organism. Knowledge of the different levels of organization will help you
understand the basic concepts of human anatomy and
physiology.
FIGURE
Reproductive
Uri nary
Digestive
Nervous
Respiratory
Organism level
Lymphatic/ Immune
Chapter 1 Organization of the Body
ORGANELLE LEVEL
C hemical structures may be organized with in larger units called cells
to form various structures called organ elles, th e next level of organization (see Figure 1-3) . An organelle may be defined as a structure
made of molec ules organized in such a way that it can perform a
specific function. O rganelles are th e "tiny organs" that allow each
cell to live. O rganelles cannot survive outside the cell, but without
organelles th e cell itself could not survive eith er.
D ozens of different kinds of organelles have been identified. A
few examples:
• M itoch ondria - th e "powerh ouses" of cells th at provide
energy needed by the cell to carry on day-to-day functioning, growth , and repair
• Golgi apparatus-set of sacs th at provides a "packaging"
service to th e cell by storing material for future internal use
or for export from the cell
• E ndoplasmic reticulum (ER)- network of channels
within the cell that act as "highways" for the movem ent of
chemicals and as sites for ch emical processing
C hapter 5 contains a more complete discussion of important organelles and th eir functions.
CELLULAR LEVEL
T he characteristics of life ultimately result fro m a h ierarchy of structure and fu nction that begins with the organization of atoms, molecules, and macromolecules. F urther organization that results in organelles is the next step. However, in the view of th e anatomist, th e
most important function of th e ch emical and organelle levels of organization is that of furnish ing the basic building blocks required for
the next h igh er level of body structure- the cellular level.
Cells are the smallest and most numerous structural u nits th at
possess and exhibit th e basic characteristics of living matter. How
many cells are th ere in th e body? One estimate places th e number
of cells in a 150-pound adult hu man body at 100,000,000,000,000.
In case you are having trouble translating this number-1 with 14
zeroes after it-it is 100 trillion! or 100,000 billion! or 100 million
million !
Each cell is surroun ded by a membrane and is characterized by a
single nucleus surrounded by cytoplasm that in cludes th e numerous
organelles required for the normal processes of living.
Although all cells h ave certain features in common, they specialize or d ifferentiate to perform unique functions. Fat cells, for example, are structurally modified to permit the storage of fats, wh ereas
other cells, such as cardiac muscle cells, are able to contract with
great force (see Figure 1-3). Muscle, bone, nerve, and blood cells are
other examples of structurally and functionally unique cells.
TISSUE LEVEL
T he next h igher level of organization beyond the cell is the tissue
level (see Figure 1-3). Tissu es represent anoth er step in the progressive organization of living matter. By definition, a tissu e is a group
of a great many similar cells that all developed together from the
same part of the embryo and all perform a certain fu nction. T issue
cells are su rrounded by varying amounts and kinds of nonliving,
intercellular substances, or the m atrix. T issues are th e "fabric" of
th e body.
7
There are fou r major or principal tissu e types: epithelial, connective, muscle, and n ervous. Considering th e complex nature of th e
human body, this is a surprisingly short list of major tissues. Each of
th e fo u r major tissues, h owever, can be subdivided into several distinct subtypes. Togeth er the body tissu es are able to m eet all th e
structural and fu nctional needs of the body.
The tissue used as an example in Figure 1-3 is nervous tissue.
Note how th e cells are branching and interconnected. The details of
tissue structure and fu nction are covered in C hapters 8 and 9.
ORGAN LEVEL
Organ u nits are more complex than tissues. An organ is defined as a
structure made up of several different kinds of tissues arranged so
that, together, they can perform a special function.
If tissues are the "fabric" of th e body, an organ is like an item of
clothing with a specific function made up of different fabrics. T h e
heart is an example of the organ level: muscle and connective tissues
give it shape and pump blood; epithelial tissues line the cavities, or
chambers; and nervous tissues permit control of the pumping contractions of th e h eart.
T issues seldom exist in isolation. Instead, joined togeth er, they
form organs that represent discrete, but fu nctionally complex, operational units. Each organ h as a u niqu e shape, size, appearance, and
placement in th e body, and each can be identified by th e pattern of
tissues that form it. T he lungs, heart, brain, kidneys, liver, and spleen
are all examples of organs.
SYSTEM LEVEL
Systems are th e most complex of th e organizational u nits of the body.
The system level of organization involves varying numbers and kinds
of organs arranged so that, together, they can perform complex fu nctions fo r the body.
Eleven major systems compose the human body: integumentary,
skeletal, musc ular, nervous, endocrine, cardiovascular, lymphatic/
immune, respiratory, digestive, urinary, and reproductive. Systems
that work together to accomplish the general needs of the body are
summarized in Table 1-2.
Take a few minutes to read th rough Table 1-2. The left colu mn
points out that several different systems often work togeth er to accomplish some overall goal. For example, the first three systems
listed (integumentary, skeletal, muscular) make up th e framework of
th e body and therefore provide support and movement. Note also
that this table corresponds to the organization of th is book. O nce we
get to the system level of organization , we will study each system one
by one, chapter by chapter. To h elp you navigate through the book,
we have organized the chapters into units of several systems eachunits that group the systems by common or overlapping fu nctions.
You are probably aware that some systems can be grouped togeth er or split apart. We use th ose grou pings that are most useful to
us. For example, because both th e skeletal and muscular systems
work together to produce athletic movements, an athletic train er
may study th em together as the skeletomuscular system. A physical therapist may also incl ude con cepts of nervous control of movement and study th e n e uroskeletomuscular system . O n th e other
hand, a neurologist may fin d it useful to keep in min d a distinction
between th e sensory nervous system and th e m otor nervous
system.
8
UNIT 1 The Body as a Whole
In any case, the idea of levels
of organization is universal, and
on ce you know how it works, you
can adapt it to suit your own
changing needs. The plan of dividing the body into 11 major
systems is widely used among
biologists, so we will use it as the
basis of our study too.
C O NN E CT IT ! @
The many important roles of the
microbial systems of the body, or
human microbiome, have come to
the forefront of human biology. The
complex interactions of microorganisms (such as bacteria) in our
body with one another, and with our
own cells, tissues, and organs, have
proven to be critical to maintaining
normal structure and function of the
body. Learn more in The Human
Microbiome at Connect It!
TABLE
1-2
Body Systems (With Unit and Chapter References)
Integumentary
(Chapter 10)
Skin
Protection, temperature
regulation , sensation
Skeletal
(Chapters 11 - 14)
Bones, ligaments
Support, protection, movement,
mineral and fat storage, blood
production
Muscular
(Chapters 15- 17)
Skeletal muscles, tendons
Movement, posture, heat
production
Communication,
control , and
integration
(Un it 3)
Nervous
(Chapters 18- 24)
Brain, spinal cord , nerves,
sensory organs
Control, regulation , and
coordination of other systems,
sensation, memory
Endocrine
(Chapters 25
and 26)
Pitu itary gland, adrenals,
pancreas, thyroid , parathyroids,
and other glands
Control and regulation of other
systems
Transportation
and defense
(Unit 4)
Card iovascular
(Chapters 27- 30)
Heart, arteries, veins, capillaries
Exchange and t ransport of
materials
Lymphatic/ immune
(Chapters 31-34)
Lymph nodes, lymphatic vessels,
spleen, thymus, tonsils
Immunity, fluid balance
Respiration,
nutrition, and
excretion
(Un it 5)
Respiratory
(Chapters 35- 37)
Lungs, bronchial tree, trachea,
larynx, nasal cavity
Gas exchange, acid-base
balance
Support and
movement
(Unit 2)
Digestive
Stomach, small and large
Breakdown and absorption of
ORGANISM LEVEL
intestines, esophagus, liver,
nutrients, elimination of waste
(Chapters 38- 41)
T h e living human organism is
mouth, pancreas
certainly m ore than the sum of
Kidneys, ureters, bladder, urethra
Urinary
Excretion of waste, fluid and
its parts. It is a marvelously coor(Chapters 42- 44)
electrolyte balance, acid- base
dinated team of interactive strucbalance
tures that is able to survive and
Reproduction and
Reproductive
Male: Testes, vas deferens,
Reproductio n, continuity of
flourish in an often hostile envi(Chapters 45- 48)
prostate, seminal vesicles,
genetic information, nurturing
development
.
ronment. Not only can the hupen1
s
of offspring
(Unit 6)
man body reproduce itself (and
Female: Ovaries, fallopian tubes,
its genetic information ) and
uterus, vagina, breasts
maintain ongoing repair and replacement of worn or damaged
Quick CHECK
parts, it can also maintain - in a constant and predictable way-an
incredible number of variables required for a human to lead a
8. List the seven levels of organization.
h ealthy, productive life.
9. Identify three organelles.
We are able to maintain a "normal" body temperature and fluid
10. List the four major tissue types.
balance under widely varying environmental extrem es. We m aintain
11 . List the 11 major organ systems.
constant blood levels of many important ch emicals and nutrients.
We experience effective protection against disease, elimination of
ANATOMICAL POSITION
waste products, and coordinated movement. We correctly and
quickly interpret sound, visual images, and other external stimuli
Discussions about the body, how it moves, its posture, or the relationwith great regularity. These are a few examples of how the different
ship of one area to another assume that the body as a whole is in a
specific position called th e an atomical position. In this reference
levels of organization in the human organism permit expression of
position the body is in an erect, or standing, posture with the arms at
the characteristics associated with life.
As you study the structure and function of th e human body, it is
the sides and palms turned forward (Figure 1-4). T h e head and feet
too easy to think of each part or function in isolation from the body
are also pointing forward. The anatomical position is a reference
as a wh ole. Always remember that you are ultimately dealing with
position that gives m eaning to th e directional terms used to describe
the body parts and regions.
information related to the entire human organism - n ot information
limited to an understanding of the structure and function of a single
Bilateral symmetry is on e of the most obvious of the external
organelle, cell, tissue, organ , or organ system . D o not limit your
organizational features in humans. T he person sh own in Figure 1-4
learning to the memorization of isolated facts. Instead, connect and
is divided by a line into bilaterally symmetrical sides. To say that
humans are bilaterally symmetrical sim ply means that the right and
integrate factual information so that your understanding of human
structure and function is related not to a part of the body but to the
left sides of th e body are mirror images of each other and only one
plane can divide th e body into left and right h alves. One of th e most
body as a wh ole.
Chapter 1
1-4 Anatomical position. In the anatomical
position, the body is in an erect, or standing, posture with
the arms at the sides and palms forward. The head and feet
are also pointing forward. The dashed line shows the axis of
the body's external bilateral symmetry. As a result of this
organizational feature, the right and left sides of the
external body are mirror images of each other.
FIGURE
Organization of the Body
9
Anterior and Posterior
Anterior means "front" or "in front of"; posterior means "back" or
"in back of." For example, th e nose is on the anterior su rface of th e
body, and th e shoulder blades are on its posterior surface .
In h umans-who walk in an uprigh t position - ventral (toward
the belly) can be used in place of anterior, and dorsal (toward th e
back) can be used for posterior.
Medial and Lateral
important features of bilateral symmetry
is balanced proportions. T here is a
remarkable correspondence in size
and shape when comparing
similar anatomical parts or external areas on opposite sides
of the body.
T he terms ipsilateral and
contralateral are often used to
identify the placement of one body
part with respect to another on the
same or opposite side of the body.
Ipsilateral simply means "same
side," and contralateral means "opposite side." T h ese terms may be
used in describing injury to an extremity, for example. If the right
knee were injured and swollen, one
could say that "the right knee is
enlarged compared with the contra-
M edial means "toward the midline of the body"; lateral means
"toward the side of the body, or away from its midline." For example, the great toe is at th e medial side of the foot, and the little toe
is at its lateral side. T he heart lies medial to the lungs, and th e
lungs lie lateral to the heart.
Proximal and Distal
Proximal means "toward or nearest the trunk of th e
body, or nearest the point of origin of one of its parts";
distal means "away from or farthest from the trunk or
the point of origin of a body part." For example, th e elbow lies at th e proximal end of the forearm, whereas th e
hand lies at its distal end.
Superficial and Deep
s
I
lateral knee."
Supine and prone are two
terms used to describe the position of th e body whe n it is not in
the anatomical position. In the supine position the body is lying
face u pward, and in th e prone position the body is lying face
downward.
ANATOMICAL DIRECTIONS
DIRECTIONAL TERMS
To minimize confusion when discussing the relationship between
body areas or th e location of a particular anatomical structure, specific terms must be used. When the body is in the anatomical position, the following directional terms can be used to describe th e location of one body part with respect to another (Figure 1-5).
Superior and Inferior
Superior means "toward the head," and inferior means "toward the
feet." Superior also means "upper" or "above," and inferior means
"lower" or "below." For example, the lungs are located superior to
the diaph ragm, whereas the stomach is located inferior to it.
The simple terms upper and lower are sometimes used in professional language as well. For example, the terms upper respiratory
tract and lower gastrointestinal tract are used commonly by anatomists and health professionals.
Superficial means "nearer the su rface"; deep means "farther away
from the body surface ." For example, the skin of the arm is superficial to the muscles below it, and the bone of the upper part of the
arm is deep to the muscles that surrou nd and cover it. Refer often to
th e table of anatomical directions on th e inside fro nt cover. It is intended to serve as a useful and ready reference for review.
TERMS RELATED TO ORGANS
When discussing anatomical relationships among organs in a system
or region, or anatomical relationships within an organ, additional
terms are often useful.
Lumen
Many organs of th e body are hollow, such as the stomach, small intestine, airways of the lungs, blood vessels, urinary organs, and so on.
T he hollow area of any of these organs is called the lumen. T he term
luminal means "of or near the lumen." For example, blockage of th e
respiratory airway may be called a luminal obstruction.
Central and Peripheral
C entral is plain English and means "near the center." Peripheral
means "around th e bou ndary." For example, the central nervous
system includes the brain and spinal cord, wh ich are near the center
of the body. The periph eral nervous system, on the other hand, includes the nerves of the muscles, skin, and other organs that are
nearer the periphery, or outer boundaries, of the body.
Medullary and Cortical
M edullary refers to an inner region or core of an organ. Cortical
refers to an outer region or layer of an organ. For example, the inner
region of the kidney is the medulla, and any structures there are described as medullary. Similarly, the term cortical describes structures
found in the outer layer of kidney tissue (the cortex of the kidney).
10
UNIT 1 The Body as a Whole
FIGURE 1 -5 Directions and planes
Superior t
of the body. The arrows show anatomical directions and the blue plates show
examples of body planes along which cuts
or sections are made in visualizing the
structure of the body.
..
Posterior
Anterior
=+
Basal and Apical
Some organs, such as the heart and
each lung, are somewhat cone-shaped.
T hus we borrow terms that describe the
point or apex of a cone and the flat part
or base of a cone. Basal refers to the
base or widest part of an organ. Apical
refers to the narrow tip of an organ. For
example, in the heart the term apical
refers to the "point" of the heart that
rests on the diaphragm. Basal and apical may also refer to individual cells: the
apical surface faces the lumen of a hollow organ, and the basal surface of the
cell faces away from the lumen. Many
of the more common directional terms
that you will use in this course are listed
in a handy table inside the front cover
of the book.
ANATOMICAL COMPASS ROSETTE
To make the reading of anatomical figures a little easier, an anatomical compass rosette is used throughout this book. On many figures,
such as those on the opposite page, you will notice a small compass
rosette similar to those on geographical maps. Rather than being labeled N, S, E, and W, the anatomical compass rosette is labeled with
abbreviated anatomical directions:
A = Anterior
D = D istal
I = Inferior
L (opposite M) = Lateral
L (opposite R) = Left
P (opposite A) = Posterior
P (opposite D) = Proximal
S = Superior
M =Medial
R = Right
The anatomical compass rosette sometimes instead uses terms
such as basal and apical if that makes the illustration clearer. For
your convenience, the compass rosette and its possible directions, a
helpful diagram of the planes and directions of the body, and a summary table are found on the inside front cover of this book. Refer to
it frequently until you are familiar enough with anatomy to do without it.
• BODY PLANES AND SECTIONS
The transparent glasslike plates in Figure 1-5 that divide the body
into parts represent different planes of the body. In geometry, a
plane is an imagined flat surface or plate with no th ickness. In
Sagittal planes
Coronal planes
Transverse planes
Oblique planes
anatomy, we often section (cut) the body or an organ along such
an imagined flat surface-a body plane. The resulti ng cut is
called a section of the body or organ. An infinite number of sections can be made along an infinite number of planes, and each
section made is named after the particular plane along which it
occurs.
There are three major body planes that lie at right angles to one
another. They are called the sagittal, coronal, and transverse planes.
SAGITTAL PLANES
Any lengthwise plane running from front to back and top to bottom,
dividing the body or any of its parts into right and left sides, is called
a sagittal plane. A flat cut made along a sagittal plane is called a
sagittal section.
If a sagittal section is made in the exact midline of the body, resulting in equal and symmetrical right and left halves, the section is called
a median sagittal section or midsagittal section (see Figure 1-5).
CORONAL PLANES
Any lengthwise plane running from side to side and top to bottom,
dividing the body or any of its parts into anterior and posterior portions, is called a coronal plane. A coronal plane may also be called
a frontal plane. A cut made along a coronal plane is called a coronal
section or a frontal section.
12
UNIT 1
The Body as a Whole
CONNECT IT ! @
Why bother to learn about planes and sections of the body? In the short term , you'll
need to understand how to interpret the many illustrations like Figure 1-6. In
the long term, you will use the concept of planes and sections in clinical
settings-as in medical imaging.
Cadavers (preserved human bodies used for scientific study)
can be cut into sagittal, frontal, or transverse sections for easy
viewing of internal structures, but living bodies, of course, cannot. This fact has been troublesome for medical professionals
Liver-who must determine whether internal organs are injured or
diseased. In some cases the only sure way to detect a lesion
or variation from normal is extensive exploratory surgery.
Fortunately, advances in medical imaging allow physicians
to visualize internal structures of the body without risking
Right
the trauma or other complications associated with extenkidney-sive surgery. This figure shows a CT (computed tomography) scan similar to the perspective of Figure 1-6. CT
A
scanning and some of the other widely used techniques are
R
L
illustrated and described in Medical Imaging of the Body
online at Connect It!
p
,...---Colon
-Left
kidney
• BODY CAVITIES
The body contains many hollows or cavities that each house compact arrangements of internal organs. T h e location and outlines of
major body cavities are illustrated in Figure 1-7.
s
- - - - - C r anial - cavity
I
DORSAL CAVITIES
The dorsal cavities form along the dorsum or back of the body early
in development as bones grow around the tube that eventually forms
our central nervous system. The dorsal cavities include the cranial
cavity and spinal cavity.
The cranial cavity is the space within the skull that houses the
brain. The spinal cavity, the location of the spinal cord, lies within
th e hollow spinal canal formed by a stacked column of donutlike
vertebrae.
- - - - - - Spinal - cavity
,---Thoracic - - cavity
==-- Pleural
cavities
';"-- Mediastinum
Diaphragm
VENTRAL CAVITIES
During early development, a huge internal body cavity subdivides
into two major ventral cavities-the thoracic cavity (chest cavity)
and th e abdominopelvic cavity.
cavity
--=-Abdominopelvic --"'--'
cavity
Thoracic Cavity
The thoracic cavity has a midportion called the mediastinum,
which contains the heart and other structures surrounded by fibrous
tissue. On the left and right sides of the mediastinum are spaces
called p leural cavities in which the lungs reside.
The m ediastinum houses the heart, the trachea, right and left
bronchi, the esophagus, the thymus, various blood vessels (e.g., thoracic aorta, superior vena cava), the thoracic duct and other lymphatic vessels, various lymph nodes, and nerves (such as th e phrenic
an d vagus nerves) .
T h e h eart is surrou nded by a fibrous sac lined with a thin, slippery
membrane that doubles back on itself to form a lubricating, flu idfilled pocket around the h eart. Figure 1-8 demonstrates how this
structure resembles a water-filled balloon with a fist thrust into it.
D Dorsal body cavities
D Ventral body cavities
s
p
1-7
Major body cavities.
I
The dorsal body cavities are in the dorsal (back) part of the body and include a cranial
cavity above and a spinal cavity below. The ventral body cavities are on the ventral
(front) side of the trunk and include the thoracic cavity above the diaphragm and the
abdominopelvic cavity below the diaphragm. The thoracic cavity is subdivided into the
mediastinum in the center and pleural cavities to the sides. The abdominopelvic cavity
is subdivided into the abdominal cavity above the pelvis and the pelvic cavity within
the pelvis.
FIGURE
Chapter 1
s
TA B L E
1-3
AREAS
Outer
(parietal)
wall
l-------.!~
I
~-- Outer
Inner
(visceral)
wall
(parietal)
wall
-
~ Wate r
----'?.-
Fist
Inner
(visceral)
wall
Fl uid-filled
cavity
Spinal cavity
Spinal cord
Ventral Body Cavities
Thoracic Cavity
Right pleural cavity
Right lung
Med iasti num
Heart
Trachea
Right and left bronchi
Esophagus
Thymus gland
Aortic arch and thoracic aorta
Venae cavae
Various lymph nodes and nerves
Thoracic duct
Left pleural cavity
Left lung
I
......-->;~
Visceral
pe ricardium
Abdominopelv ic Cavity
Abdomi nal cavity
Liver
Gallbladder
Stomach
Pancreas
Intestines
Spleen
Kid neys
Ureters
Pelvic cavity
Urinary bladder
Female reproductive organs
Uterus
Uterine tubes
Ovaries
Male reproductive organs
Prostate gland
Seminal vesicles
Part of vas deferens
Part of large intesti ne, namely, sigmoid colo n
and rectum
......_....._..._...:::..~--ii-- Pericardia!
B
cavity with
pe ricardia!
fl uid
Like th e fist su rrounded by a double wall of balloon, the heart is su rrou nded by a double-walled pericardia} membrane filled with a
small amou nt of watery pericardia} fl uid.
This structural pattern, seen commonly within body cavities, will
be revisited often throughout your study of human anatomy. Often ,
one layer of th e mem brane called the p arietal layer lines the cavity
and doubles back on itself to form a visceral layer covering th e organs. T h e "space" of th e cavity is th us reduced to the flattened
pocket of fl uid between the parietal and visceral layers.
This pattern also occurs in each pleu ral cavity, where a parietal
pleura hugs the inside of the th oracic wall and doubles back to cover
the lung - th us forming a visceral pleura. The term pleural cavity
can refer to th e entire space to the side of th e mediastinum or to just
the potential space left surrounding the lung between the parietal
and visceral pleura. Peek ahead to Figure 8-8 on p. 145 to see th e
double-layer structure of th e pleurae.
Abdominopelvic Cavity
The abdominop elvic cavity has an upper portion, the abdominal
cavity, and a lower portion, th e pelvic cavity. The abdominal cavity
contains th e liver, gallbladder, stomach, pancreas, intestines, spleen ,
kidneys, and u reters. T he bladder, certain reproductive organs
(uterus, uterine tubes, and ovaries in females; prostate gland, seminal vesicles, and part of th e vas deferens in males), and part of th e
large intestine (namely, th e sigmoid colon and rectum) lie in th e
pelvic cavity (Table 1-3).
The m embrane lining the inside of th e abdominal cavity is called
the parietal peritoneum. The membrane that covers the organs
ORGAN(S}
Brain
FIGURE
Parietal
pe ricardium
Body Cavities
Cranial cavity
s
~--
13
Dorsal Body Cavities
A
1-8 Membranes that
line cavities. A, The analogy of a
fist thrust into a water-filled balloon
demonstrates how a membrane
can form a double-walled structure made up of an outer parietal
layer and an inner visceral layer
separated by a thin pocket of
fluid. B, The heart is surrounded
by a thin, fl uid-producing pericardia! membrane that likewise forms a
parietal and visceral layer, creating a
flattened pericardia! cavity fi lled with
pericardia! fluid.
Organizat ion of the Body
within th e abdominal cavity is called th e visceral peritoneum. Looking back to Figure 1-6, you will see that th ere is a space or opening
between the two membranes in th e abdomen . T h is is called th e
peritoneal cavity. Body mem branes are discussed in greater detail in
C hapter 8.
Abdominope/vic Quadrants
To make it easier to locate organs in the large abdominopelvic cavity,
anatomists have divided th e abdominopelvic cavity into fou r abdomi-
nopelvic quadrants:
l.
2.
3.
4.
Right upper quadrant or RUQ (right superior quadrant)
Right lower quadrant or RLQ (right inferior quadrant)
Left upper quadrant or LUQ (left superior quadrant)
Left lower quadrant or LLQ (left inferior quadrant)
As you can see in Figure 1-9, the midsagittal and transverse
planes, wh ich were described in the previous section, pass through
th e navel (umbilicus) and divide th e abdominopelvic region into th e
14
UNIT 1 The Body as a Whole
Epigastric
region
upper
quadrant
(RUQ)
Umbilical
region
Right lower
quadrant
(RLQ)
Left lower
quadrant/
(LLQ)
Ri
il
(ing inal)
.
I On
L~
iac
(inguinal)
---
s
s
I
I
1 -9 Abdominopelvic quadrants. Perpendicular dividing lines are
imagined crossing at the umbilicus (navel).
FIGURE
fo ur quadrants. T h is method of subdividing the abdominopelvic cavity is frequently used by h ealth professionals and is useful for locating
the origin of pain or describing the location of a tumor or oth er
abnorm ality.
You may notice that terms such as upper and lower are often used
to name quadrants, which may seem overly informal compared with
the more technical terms superior and inferior. However, th is practice
reflects the usage fo und in many clinical environments, where one
commonly encounters a mix of informal and formal terminology.
Abdominope/vic Regions
Anoth er and perhaps more precise way to locate organs divides the
abdominopelvic cavity like a tic-tac-toe grid into nine im aginary regions (Figure 1-10):
Upper regions
l . Right hypochondriac region
2. Epigastric region
3. Left hypoch ondriac region
Middle regions
4. Right lumbar (flank) region
5. Umbilical region
6. Left lumbar (flank) region
Left umbar
(flank)
1-1 0 Abdominopelvic regions. A reference grid formed along
horizontal lines imagined at the cartilages of the ninth ribs and the tops of the hip
bones and vertical lines aligned with the nipples is used to locate internal organs.
Only the most superficial structures of the internal organs are shown here.
FIGURE
Lower regions
7. Right iliac (inguinal) region
8. Hypogastric (pubic) region
9. Left iliac (inguinal) region
The most superficial organs located in each of the nine abdom inopelvic regions are sh own in Figure 1-10.
The term h ypoch ondriac means "under cartilage," referring to
the rib cartilage. In th e right hypochondriac region, th e right lobe of
the liver and the gallbladder are visible . Viewed superficially, only a
portion of the stomach and a small portion of the large intestine is
visible in the left hypoch ondriac area.
E p igastric literally means "upon (around) the stomach ." In the
epigastric area, parts of the right and left lobes of the liver and a large
portion of th e stom ach can be seen.
Note that th e right lumbar region includes parts of the large and
sm all intestines (see Figure 1-10). The superficial organs seen in the
umbilical region include a portion of th e transverse colon and loops
of th e small intestine. Additional loops of th e sm all intestine and a
part of the colon can be seen in the left lumbar region.
Chapter 1 Organization of t he Body
The term iliac refers to ileum, which is the lowest part of the
small intestine. The right iliac region contains the cecum and parts
of the small intestine. The left iliac region shows portions of the colon and the small intestine.
Hypogastric means "below the stomach." Only loops of the small
intestine, the urinary bladder, part of the large intestine, and the appendix are seen in the hypogastric region.
• BODY REGIONS
Identification of an object begins with overall recognition of its structure and form. Initially, it is in this way that the human form can be
distinguished from other creatures or objects. Recognition occurs as
soon as you can identi~' the overall shape and basic outline. For
more specific identification to occur, details of size, shape, and appearance of individual body areas must be described. Individuals
Cephalic (head)
Cranial
(upper skull) --;
~Frontal
(forehead)
~orbital
(eye socket)
differ in overall appearance because specific body areas, such as the
face or torso, have unique identifying characteristics. Detailed descriptions of the human form require that specific regions be identified and appropriate terms be used to describe them (Figure 1-11
and Table 1-4) .
The body as a whole can be subdivided into two major portions
or components: axial and appendicular. The axial portion of the
body consists of the head, neck, and torso, or trunk. The appendicular portion of the body consists of the upper and lower extremities
and their connections to the axial portion.
Each major axial and appendicular area is subdivided as shown in
Figure 1-11 . Note, for example, that the torso is composed of the
thoracic, abdominal, and pelvic areas. The upper extremity, or upper
limb, is divided into shoulder, arm, forearm, wrist, and hand components. The lower extremity, or lower limb, is divided into hip, thigh,
leg, ankle, and foot.
----Nasal (nose)
~~l---Zygomatic (upper cheek)
~~';[~--Buccal (lower cheek)
Facial (face)
Temporal
(side of skull)
f--- Cephalic (head)
f--- Cervical (neck)
------oral (mouth)
Thoracic
(chest)
Dorsal (back)
Olecranal
(back of elbow)
t
'•
,._. I
\if
J
~
~
Abdominal Trunk
(abdomen)
Flank
(lateral region)
Upper
extremity
Lumbar
(lower back)
Pelvic
(pelvis)
Gluteal
(buttock)
~
Palmar or volar
(anterior surface
of hand)
Femoral (thigh)----+--+
'--Inguinal
(groin)
Crural (leg)
Digital (toe)- - - l
Popliteal
(back of knee)---~~~·
~,
D Axial skeleton
D Appendicular skeleton
t - - - Pedal (foot)
15
\\
Plantar
(sole of foot) _ _ ____,~,
~~
FIGURE 1-11 Specific body regions. Note that the body as a whole can be subdivided into two major portions:
axial (along the middle, or axis, of the body) and appendicular (the arms and legs, or appendageS). Names of specific body
regions follow the Latin form, with the English equivalent in parentheses.
Lower extremity
16
UNIT 1
TAB L E 1 • 4
The Body as a Whole
l atin- Based Desc riptive Terms tor Body Regions•
BOOY REGION
AREA OR EXAMPLE
BODY REGION
AREA OR EXAMPlE
Abdominal
Anterior torso below diaphragm
Mammary
Breast
Acromial
Shoulder
Manual
Hand
Antebrach ial
Forearm
Mental
CIW>
Antecubital
0E¥KSSSed Ina just in front of etlow (cubital fossa)
Nasal
Nose
Axill,a,y
A.rn~h (axilla)
Navel
Area around navel.
Br achial
Arm
Occipital
Back of lower part of s.kJA
Buccal
Cheel< (mide)
Otecr anal
Back of elbow
Calcaneal
Heel of foot
Or al
MOUih
c......
Wrist
Orbital o r ophthalm ic
Eyes
Cephalic
Head
Otic
Ear
Cervtcal
Neck
Palmar
Palm of h and
Coxal
Hip
Patellar
Front of knee
Cranial
Sl<..
Pedal
Foot
Cn.ral
Leg
Pelvic
lower portion of torso
Cubital
Elbow
PetWleal
Area {perineum) between anus and genitats
Cutaneous
Skin (or body surface)
Plantar
Sole of foot
Digital
Fingers or
Pollex
Th....,
Dorsal
Back or top
Poplitea.l
Area behind knee
Facial
Face
Pubic
Pubis
Femoral
Thigh
Supraclavicular
Area above clavicle
Frontal
Forehead
Suml
Calf
Gluteal
Buttock
Tarsal
Ankle
Hallux
Great toe
Temporal
Side of head
ln guklaJ
Groin
Thoracic
Chesl
lumbar
Lower part of back between tiJs and pelvis
Zygomatic
Cheek (outside)
•oes
Altl1ough most tenns usc:d to deserihe gross body regions are f:..
miiUr, m isu se i!l common. l 1le term leg is a good example:. l (> an
anatomist, leg refc:n to the arc::. of tl1c: lowe r extremity between t11e
knee and ankle, not to the entire l<m:er limh.
Also, !lome term!~ can ha\'e more than one meaning. Fur example,
cubital c.an refer to t11e elbow or to tl1e fore.ann. LikC~.\ise, crural c.an
refer to just the leg. o r to just tl1e t11igl1, o r to tl1e tl1igh and leg te>
gc:the r. \Vhen you encounter such tc:nns, it i!l hest to <le tennine
wl1ich meaning is being used. In this book we consiste ntly c:mpiO)'
the commonly usc:d me.anings listc:<l in Table 1 ~.
Q"ick C HE C K
16. Define the term anatomical position and explain its imponanc:e.
17. Name the two major subdivisions of the body as a whole.
18. Identify the two major body cavities and the subdivisions of each.
19. list the ni"'e abdominopeMc regions and fOU' abdominal quad-ants.
rx umbilicus
• INTERACTION OF STRUCTURE
AND FUNCTION
One of tl1e most uni~·ing and impurt.ant concepts of t11e study of
anatomy and pll)'Siology is the principle of complf'mentarity of structure and {unction. In tl1e cl1.apters tl1.at follow, rou will note :.gain and
again that anatomic.al struchtres are adapted tu perform specifi c
fu nctions. Each stmchtre h:.s :1 )Xlrticular size, !~l1.ape, form, or pbcement in t11e hody that make!~ it e!~pecially effi cient at pc:rfonning a
ttnique and impurt.ant acti\'ity.
'11le rc:l.atio nsh ips among tl1c: le\'c:ls of struclul!ll organi7..atiun will
tal:e on added meaning as rou shtd)' the \'arious organ systems in tl1e
chaptc:n that follow. for example, as you studr the respil!ltory sptc:m
in Chapter 36, you ,,;11 leam about a special chemic.al subst.ance
sec:rc:ted 1>}' cells in the lungs that helps to l:ee p tin)' air !lacs in these
org.ans from collapsing <luring respil!ltion. Hc:redit:.ry m.atc:rial called
DNA (:. macromolecule) "<lirec:h" the differentiation of specialized
Chapter 1
r.
Life Span Considerations
An important generalization about
body structure is that every organ, regardless of location or function, undergoes change over the years. In general, the body
performs its functions least well at both ends of life- in infancy and
in old age. Organs develop and grow during the years before
maturity, and body functions gradually become more and more
efficient and effective. In a healthy young adult all body systems
are mature and fully operational.
After maturity, effective repair and replacement of the body's
structural components often decrease. The term atrophy is used
to describe the wasting effects of advancing age. Atrophy can
result from disuse, as we slow down in our advanced years, or
from the processes of aging itself that reduce our ability to repair or
replace worn tissue.
The changes in functions that occur during the early years are
called developmental processes. Those that occur during the late
years are called aging processes. The study of aging processes
and other changes that occur in our lives as we get older is called
gerontology. Many specific age changes are noted in the chapters
that follow. •
cells in the lungs during development so that th ey can effectively
contribute to respiratory function. As a result of D NA activity, special
chemicals are produced, cells are modified, and tissues appear that
are uniquely suited to th is organ system. The cilia (organelles),
which cover th e exposed surface of cells that form the tissues lining
the respiratory passageways, help detect, trap, and eliminate inhaled
contaminants such as dust. T he structures of the respiratory tubes
Organization of t he Body
17
and lungs assist in efficient and rapid movement of air and also make
possible the exchange of critical respiratory gases such as O>-)'gen and
carbon dioxide beh¥een the air in the lungs and th e blood. Working
together as th e respiratory system, specialized chemicals, organelles,
cells, tissues, and organs supply every cell of the human body with
necessary oxygen and constantly remove carbon dioxide.
Structure determines function, and function influences the actual anatomy of an organism over time. Structure and function are
thus complementary- they are like h¥o sides of a coin. Understanding this fact helps students better understand the mechanisms of
disease and the structural abnormalities often associated with pathology. Current research in the study of human biology is now focused
in large part on integration, interaction, development, modification,
and control of functioning body structures.
By applying the principle of complementarity of structure and
function as you study the structural and functional levels of the
body's organization in each organ system, you will be able to integrate otherwise isolated fac tual information into a cohesive and understandable whole. A memorized set of individual and isolated facts
is soon fo rgotten; the parts of an anatomical structure that can be
related to its function are not.
CONNECT IT ! @
One example of the relationship among body structure, function, and disease relates to how a person's body shape or somatotype can be an indicator of either wellness or risk of disease. To see ectomorph, mesomorph,
and endomorph somatotypes and learn how they may correlate with
health, check out Body Types and Disease at Connect It!
Quick CHECK
20. Define what is meant by "complementarity of structure and function ."
21. Give an example of how the chemical macromolecule DNA can have
an influence on b ody structure.
the big picture Organization of the Body
Ultimately, your success in the study of anatomy and physiology, your
ability to see the "big picture," will require understanding, synthesis,
and integration of structural information and functional concepts. After you have
completed your study of the individual organ systems of the body presented in
the chapters that follow, you must be able to reassemble the parts and view the
body in a holistic, integrated way.
The body is truly more than the sum of the parts, and understanding the
connectedness of human structure and function is the real challenge- and the
greatest reward- in the study of anatomy and physiology. Your ability to integrate
otherwise isolated factual information about bones, muscles, nerves, and blood
vessels, for example, will allow you to view anatomical components of the body
and their functions in a more cohesive and understandable way. This chapter
introduces the principle of homeostasis as the glue that integrates and explains
how the normal interaction of structure and function is achieved and maintained
and how a breakdown of this integration results in disease. Furthermore, it
provides the basis for understanding and integrating the body of knowledge, both
factual and conceptual, that anatomy and physiology encompass.
Mastery of any academic discipline or achieving success in any health carerelated work environment requires the ability to communicate effectively. The
ability to understand and appropriately use the vocabulary of anatomy and physiology allows you to accurately describe the body itself, the orientation of the body
in its surrounding environment, and the relationships that exist between its
component parts in both health and disease. This chapter provides you with information necessary to be successful in seeing "the big picture" as you master the
details of each organ system, which, although presented separately in subsequent
chapters of the text, are in reality part of a marvelously integrated whole. •
18
UNIT 1 The Body as a Whole
LANGUAGE OF SCIENCE (continued from p. 2)
calcaneal (kai-KAY-nee-al)
[ca/cane - heel, -a! relating to]
cardiovascular system
(kar-dee-oh-VAS-kyoo-lar SIS-tern)
[cardia- heart, -vas- vessel,
-u/ar relating to, system
organized whole]
carpal (KAR-pul)
[carp - wrist, -a! relating to]
cell (sel)
[cell storeroom]
cell theory (sel THEE-ree)
[cell storeroom, theor- look at, -y act of]
central (SEN-tral)
[centr- center, -a/ relating to]
cephalic (seh-FAL-ik)
[cephal- head, -ic relating to]
cervical (SER-vih-kal)
[cervic- neck, -a/ relating to]
connective tissue
(kon-NEK-tiv TISH-yoo)
[con- together, -nect- bind,
-ive relating to, tissu- fabric]
contralateral (kon-trah-LAT-er-al)
[contra- against, -later- side,
-a! relating to]
coronal plane (koh-ROH-nal plane)
[corona- crown, -a/ relating to,
plan- flat surface]
cortical (KOR-tik-al)
[cortic- cortex (bark}, -a/ relating to]
coxal (KOK-sal)
[coxa- hip, -a! relating to]
cranial (KRAY-nee-al)
[crani- skull, -a! relating to]
cross-section (kraws SEK-shun)
[cross- across, sect- cut, -tion process]
crural (KROO-ral)
[crur- leg, -a/ relating to]
cubital (KYOO-bih-tal)
[cubit- elbow, -a/ relating to]
cutaneous (kyoo-TAYN-ee-us)
[cut- skin, -aneous relating to]
deep
differentiate (dif-er-EN-shee-ayt)
[different- difference, -iate act of]
digestive system (dye-JES-tiv SIS-tern)
[digest- break apart, -ive relating to,
system organized whole]
digital (DIJ-ih-tal)
[digit- finger, -a/ relating to]
distal (DIS-tal)
[dist- distance, -a! relating to]
dorsal (DOR-sal)
[dors- back, -a/ relating to]
dorsal cavities (DOR-sal KAV-ih-teez)
[dors- back, -a/ relating to, cav- hollow,
-ity state]
endocrine system
(EN-doh-krin SIS-tern)
iliac (IL-ee-ak)
[ilia - loin or gut (ileum}, -ac relating to]
immune system (im-YOON SIS-tern)
[immun- free (immunity}, system
organized whole]
[endo- within, -crin- secrete, system
organized whole]
inferior (in-FEER-ee-or)
endoplasmic reticulum (ER) (en-dohPLAZ -mik reh-TIK-yoo-lum)
pl., endoplasmic reticula
(reh-TIK-yoo-lah)
inguinal (ING-gwih-nal)
[endo- inward or within,
-plasm- substance, -ic relating to,
ret- net, -ic- relating to, -u/- little,
-um thing]
epigastric (ep-ih-GAS-trik)
[epi- upon, -gastr- stomach,
-ic relating to]
epithelial tissue
(ep-ih-THEE-Iee-al TISH-yoo)
[epi- on or upon, -the/i- nipple,
-a/ relating to, tissu- fabric]
eponym (EP-oh-nim)
[epa- above, -nym name]
experimentation
(eks-payr-ih-men-TAY-shun)
[ex- out of, -peri- tested, -ment- thing,
-tion]
facial (FAY-shal)
[faci- face, -a! relating to]
femoral (FEM-or-al)
[femor- thigh, -a! relating to]
frontal (FRUN-tal)
[front- forehead, -a/ relating to]
gluteal (GLOO-tee-al)
[glut- buttock, -a/ relating to,
mus- mouse, -c/e little]
Golgi apparatus
(GOL-jee ap-ah-RA-tus)
[Camillo Go/gi Italian histologist]
gross anatomy (grohs ah-NAT-oh-mee)
[gross large, ana- apart, -tom- cut,
-y action]
hallux (HAL-luks)
pl., halluces (HAL-lus-eez)
[hallux great toe]
hypochondriac (hye-poh-KON-dree-ak)
[hypo- under or below,
-chondr- cartilage, -ac relating to]
hypogastric (hye-poh-GAST-rik)
[hypo- under or below, -gastr- stomach,
-ic relating to]
hypothesis (hye-POTH-eh-sis)
pl., hypotheses (hye-POTH-eh-seez)
[hypo- under or below,
-thesis placing or proposition]
[infer- lower, -or quality]
[inguin- groin, -a! relating to]
integumentary system
(in-teg-yoo-MEN-tah-ree SIS-tern)
[in- on, -teg- cover,
-ment result of action, -ary relating,
system organized whole]
ipsilateral (ip-sih-LAT-er-al)
[ipsi- same, -later side, -a! relating to]
lateral (LAT-er-al)
[later- side, -a! relating to]
law
longitudinal section
(lon-jih-TOO-dih-nal SEK-shun)
[longitud(in)- length, -a/ relating to,
sect- cut, -tion process]
lumbar (LUM-bar)
[/umb- loin, -ar relating to]
lumen (LOO-men) pl., lumina
[lumen light]
lymphatic system (lim-FAT-ik SIS-tern)
[lymph- water, -atic relating to, system
organized whole]
macromolecule
(mak-roh-MOL-eh-kyool)
[macro- large, -mo/ec- mass,
-ule small]
mammary (MAM-mah-ree)
[mamma- breast, -ry relating to]
manual (MAN-yoo-al)
[manu- hand, -a! relating to]
matrix (MAY-triks) pl., matrices
(MAY-tris-eez)
[matrix womb]
medial (MEE-dee-al)
[media- middle, -a/ relating to]
mediastinum (MEE-dee-as-TYE-num)
[mediastin- midway, -um thing]
medullary (MED-oo-lar-ee)
[medu/a- marrow or pith (middle},
-ary relating to]
mental (MEN-tal)
[ment- chin, -a! relating to]
metabolism (me-TAB-oh-liz-im)
[meta- over, -bo/- throw, -ism action]
microbiome (my-kroh-BYE-ohm)
[micro- small, -bio- life,
-orne entire collection]
microscopic anatomy
(my-kroh-SKOP-ik ah-NAT-oh-mee)
[micro- small, -scop- see,
-ic relating to, ana- apart, -tom- cut,
-y action]
mitochondrion (my-toh-KON-dree-on)
pl., mitochondria
(my-toh-KON-dree-ah)
[mito- thread, -chondrion granule]
molecule (MOL-eh-kyool)
[mole- mass, -cui- small]
muscle tissue (MUS-el TISH-yoo)
[mus- mouse, -c/e small, tissu- fabric]
nasal (NAY-zal)
[nas- nose, -a/ relating to]
muscular system
(MUS-kyoo-lar SIS-tern)
[mus- mouse, -cui- little, -ar relating to,
system organized whole]
navel (NAY-vel)
[nave- wheel hub or umbilicus, -(a)!
relating to]
nervous system (NERV-us SIS-tern)
[nerv- nerve, -ous relating to, system
organized whole]
nervous tissue (NERV-us TISH-yoo)
[nerv- nerve, -ous relating to,
tissu- fabric]
neuroskeletomuscular system
(noo-roh-skel-et-aI-MUS-kyoo-lar
SIS-tern)
[neuro- nerve, -skeleto- dried body,
-mus- mouse, -cui- little, -ar relating to
system organized whole]
oblique section (oh-BLEEK SEK-shun)
[ob/iq- slanted, sect- cut, -tion process]
occipital (ok-SIP-it-al)
[occipit- back of head, -a! relating to]
olecranal (oh-LEK-rahn-al)
[o/ecran- elbow, -a/ relating to]
ophthalmic
(opf-THAL-mik or of-THAL-mik)
[oph- eye or vision,
-tha/m- inner chamber, -ic relating to]
oral (OR-al)
[or- mouth, -a/ relating to]
orbital (OR-bih-tal)
[orbit- circle, -a/ relating to]
organ (OR-gan)
[organ instrument]
organelle (or-gah-NEL)
[organ- tool or instrument,
-elle small]
organism (OR-gah-niz-im)
[organ- instrument, -ism condition]
Chapter 1
otic (OH-tik)
[ot- ear, -ic relating to]
palmar (PAHL-mar)
[palm- palm of hand, -ar relating to]
parietal (pah-RYE-ih-tal)
[parie - wall, -a/ relating to]
patellar (pah-TEL-ar)
[pat- dish, -ella- small, -ar relating to]
pedal (PEED-a!)
[ped- foot, -a/ relating to]
pelvic (PEL-vik)
[pe/vi- basin, -ic relating to]
perineal (payr-ih-NEE-al)
[peri- around, -ine- excrete,
-a/ relating to]
peripheral (pe-RIF-er-al)
[peri- around, -phera- boundary,
-a/ relating to]
physiology (fiz-ee-OL-oh-jee)
[physio- nature (function},
-o- combining vowel,
-log- words (study of}, -y activity]
plantar (PLAN-tar)
[p/anta- sole, -ar relating to]
pollex (POL-lex)
pl. , pollices (POL-lis-eez)
[pollex thumb]
popliteal (pop-LIT-ee-al)
[pop/it- back of knee, -a/ relating to]
posterior (pas-TEER-ee-or)
[poster- behind, -or quality]
prone (prohn)
[pron leaning forward]
proximal (PROK-sih-mal)
[proxima- near, -a! relating to]
pubic (PYOO-bik)
[pubis groin]
reproductive system
(ree-proh-DUK-tiv SIS-tern)
[re- again, -produc- bring forth,
-tive relating to system
organized whole]
respiratory system
(RES-pih-rah-tor-ee SIS-tern)
[re- again, -spir- breathe, -tory relating to
system organized whole]
sagittal plane (SAJ-ih-tal plane)
[sagitta- arrow, -a! relating to,
plan- flat surface]
section (SEK-shun)
[sect- cut, -tion process]
skeletal system (SKEL-et-a I SIS-tern)
[skeleto- dried body, -a/ relating to,
system organized whole]
skeletomuscular system (skel-et-ohMUS-kyoo-lar SIS-tern)
[skeleto- dried body, -mus- mouse,
-cui- little, -ar relating to system
organized whole]
superficial (sao-per-FISH-a!)
[super- over or above, -fici- face,
-a! relating to]
Organization of the Body
thoracic (thoh-RAS-ik)
[thorac- chest, -ic relating to]
thoracic cavity {thoh-RAS-ik KAV-ih-tee)
[thorac- chest (thorax},
-ic relating to], cav- hollow, -ity state
tissue {TISH-yoo)
[tissue fabric]
transverse plane {TRANZ -vers plane)
superior (soo-PEER-ee-or)
[trans- across or through, -vers tum,
plan- flat surface]
[super- over or above, -or quality]
supine (SOO-pyne)
[supin lying face up]
urinary system
(YOOR-ih-nayr-ee SIS-tern)
supraclavicular
(soo-pra-cla-VIK-yoo-lar)
[supra- above or over, -clavi- key,
-u/a- little, -ar relating to]
sural (SUR-al)
[urin- urine, -ary relating to,
system organized whole]
ventral (VEN-tral KAV-ih-teez)
[ventr- belly, -a/ relating to]
ventral cavities (VEN-tral KAV-ih-teez)
[sura- calf of leg, -a/ relating to]
[ventr- belly, -a/ relating to, cav- hollow,
-ity state]
system (SIS-tern)
[system organized whole]
tarsal {TAR-sal)
viscera, visceral (VIS-er-ah) (VIS-er-al)
sing., viscus (VIS-kus)
[tars- ankle, -a/ relating to]
temporal (TEM-poh-ral)
19
[vise- internal organ, -a/ relating to]
zygomatic (zye-goh-MAT-ik)
[tempora- temple (of head},
-a! relating to]
[zygo- union or yoke,
-ic relating to]
theory {THEE-ree)
[theor- look at, -y act of]
LANGUAGE OF MEDICINE
atrophy {AT-roh-fee)
[a- without, -troph nourishment,
-y state]
ectomorph (EK-toh-morf)
[ecto- outside, -morph form]
endomorph (EN-doh-morf)
[endo- within, -morph shape]
mesomorph (MEZ-oh-morf)
[meso- middle, -morph form]
somatotype (soh-MAT-a-type)
H nt
Use the Audio Glossary at evolve.
elsevier com to reinforce your
pronunciations.
[soma- body, -type kind]
case study
Seamus is just starting his first year in college, and he's been thinking about going into the medical field-maybe nursing. To find out
what nursing is really like, Seamus signs up for a "shadow a nurse" day at the
local hospital. He's scheduled to follow a
nurse in the emergency department to see
what the job involves.
Everything is rather boring and quiet
for the first hour; then suddenly an ambulance pulls into the bay and a paramedic
rushes a patient in on a stretcher. The
paramedic gives a quick patient report,
and Seamus hears, "Stab wound to the
right upper quadrant. He has additional
cuts to his brachial region and a large
contusion on his right lower extremity just
proximal to the knee."
Seamus feels like he's listening to a
foreign language! Can you help him interpret the paramedic's report?
1. Where was the patient stabbed?
a. In his thoracic cavity
b. In his abdominopelvic cavity
c. In his pericardia! cavity
d. In his pleural cavity
2. What organ is most likely to have been damaged by the attack?
a. His heart
c. His liver
b. His lungs
d. His spleen
3. Where is the bruise (contusion) on the patient's body?
a. Near his groin
c. His lower thigh
b. Just above his ankle
d. Behind his knee
4. Where is the patient's brachial region?
a. His femoral region
b. His crural region
nt
c. His humoral region
d. His popliteal region
To solve a case study, you may have to refer to the glossary or index,
other chapters in this textbook, Connect It!, and other resources.
20
UNIT 1 The Body as a Whole
CHAPTER SUMMARY
To download an MP3 version of the chapter summary for use with your
mobile device, access the Audio Chapter Summaries online at
evolve. elsevier. com.
Scan this summary after reading the chapter to help you reinforce the
key concepts. Later, use the summary as a quick review before your
class or before a test.
Science and Society
A. Science involves logical inquiry based on experimentation (Figure 1-1)
1. Hypothesis-idea or principle to be tested in experiments
2. Experiment-series of tests of a hypothesis; a controlled experiment
eliminates biases or outside influences
3. Theory-a hypothesis that has been supported by experiments and thus
shown to have a high degree of confidence
4. Law-a theory that has an unusually high level of confidence
B. The process of science is active and changing as new experiments add new
knowledge
C. Science is affected by culture and culture is affected by society
Anatomy and Physiology
A. Anatomy and physiology are branches of biology concerned with the form
and functions of the body
B. Anatomy-science of the structure of an organism and the relationship of
its parts
1. Gross anatomy-study of the body and its parts relying only on the
naked eye as a tool for observation (Figure 1-2)
2. Microscopic anatomy-study of body parts with a microscope
a. Cytology-study of cells
b. Histology-study of tissues
3. Developmental anatomy-study of human growth and development
4. Pathological anatomy-study of diseased body structures
5. Systemic anatomy-study of the body by systems
C. Physiology-science of the functions of organisms; subdivisions named
according to:
1. Organism involved-human or plant physiology
2. Organizational level-molecular or cellular physiology
3. Systemic function-respiratory physiology, neurophysiology, or cardiovascular physiology
Language of Science and Medicine
A. Scientific terms are often based on Latin or Greek word parts
B. Terminologia Anatomica (TA) and Terminologia Histologica (TH)
1. Official lists of anatomical terms (TA gross anatomy; TH, microscopic
anatomy)
2. Terms listed in Latin, English, and by number
3. Avoids use of eponyms (terms based on a person's name)
C. Physiology terms do not have an official list but follow the same principles
as TA and TH
Characteristics of Life
A. A single criterion may be adequate to describe life, for example:
1. Autopoiesis-living organisms are self-organized and self-maintaining
2. Cell theory-if it is made of one or more cells, it is alive
B. Characteristics of life considered most important in humans are summarized
in Table 1-1
C. Metabolism-sum total of all physical and chemical reactions occurring in
the living body
Levels of Organization
(Figure 1-3)
A. Chemical level
1. Organization of chemical structures separates living material from
nonliving material
2. Organization of atoms, molecules, and macromolecules results in living
matter-agel called cytoplasm
B. Organelle level
1. Chemical structures organized to form organelles that perform individual
functions
2. It is the functions of the organelles that allow the cell to live
3. Dozens of organelles have been identified, including :
a. Mitochondria
b. Golgi apparatus
c. Endoplasmic reticulum
C. Cellular level
1. Cells-smallest and most numerous units that possess and exhibit characteristics of life
2. Each cell has a nucleus surrounded by cytoplasm within a limiting
membrane
3. Cells differentiate to perform unique functions
D. Tissue level
1. Tissue-an organization of similar cells specialized to perform a certain
function
2. Tissue cells are surrounded by nonliving matrix
3. Four major tissue types
a. Epithelial tissue
b. Connective tissue
c. Muscle tissue
d. Nervous tissue
E. Organ level
1. Organ-organization of several different kinds of tissues to perform a
special function
2. Organs represent discrete and functionally complex operational units
3. Each organ has a unique size, shape, appearance, and placement in the
body
F. System level
1. Systems-most complex organizational units of the body
2. System level involves varying numbers and kinds of organs arranged to
perform complex functions (Table 1-2):
a. Support and movement
b. Communication, control, and integration
c. Transportation and defense
d. Respiration, nutrition, and excretion
e. Reproduction and development
3. Microbiome-set of interacting communities of bacteria and other
microorganisms that inhabit the human body; microbial systems influence normal body function
G. Organism level
1. The living human organism is greater than the sum of its parts
2. All of the components interact to allow the human to survive and flourish
Chapter 1 Organization of the Body
Anatomical Position (Figure 1-4)
A. Primary anatomical reference position
1. Body erect with arms at sides and palms forward
2. Head and feet pointing forward
B. Bilateral symmetry-a term meaning that right and left sides of the external
body are roughly mirror images
1. Bilateral symmetry confers balanced proportions
2. Remarkable correspondence of size and shape between body parts on
opposite sides of the body
3. Ipsilateral structures are on the same side of the body in anatomical
position
4. Contralateral structures are on opposite sides of the body in anatomical
position
C. Other major body positions
1. Supine body lying face upward
2. Prone-body lying face downward
Anatomical Directions
A. Directional terms (Figure 1-5)
1. Superior-toward the head, upper, above
2. Inferior-toward the feet, lower, below
3. Anterior-front, in front of (same as ventral in humans)
4. Posterior-back, in back of (same as dorsal in humans)
5. Medial-toward the midline of a structure
6. Lateral-away from the midline or toward the side of a structure
7. Proximal-toward or nearest the trunk, or nearest the point of origin of a
structure
8. Distal-away from or farthest from the trunk, or farthest from a structure's point of origin
9. Superficial-nearer the body surface
10. Deep-farther away from the body surface
B. Terms related to organs
1. Lumen (luminal)
2. Central and peripheral
3. Medullary (medulla) and cortical (cortex)
4. Apical (apex) and basal (base)
C. Anatomical compass rosette-a compass rosette that signifies anatomical
directions rather than geographic directions, as on a map
D. A list of directional terms and a guide to using the anatomical compass
rosette are found inside the front cover of the book
Body Planes and Sections (Figures 1-5 and 1-6)
A. Planes are lines of orientation along which cuts or sections can be made to
divide the body, or a body part, into smaller pieces
B. There are three major body planes, which lie at right angles to each other:
1. Sagittal plane runs front to back so that sections through this plane
divide the body (or body part) into right and left sides
a. If section divides the body (or part) into symmetrical right and left
halves, the plane is called midsagittal or median sagittal
2. Frontal (coronal) plane runs lengthwise (side to side) and divides the
body (or part) into anterior and posterior portions
3. Transverse (horizontal) plane is a "crosswise" plane and divides the body
(or part) into upper and lower parts
C. Other planes and sections
1. Cross-section runs along a plane parallel with the short axis of an organ
2. Longitudinal section follows a plane parallel with the long axis of an organ
3. Oblique sections run along diagonal (slanted) planes
21
Body Cavities (Figure 1-7; Table 1-3)
A. Dorsal cavities
1. Cranial cavity
2. Spinal cavity
B. Ventral cavities
1. Thoracic cavity
a. Mediastinum-contains heart and surrounding structures
b. Right and left pleural cavities-contain lungs
c. Ventral cavities are lined with slippery double-layered membranes
(Figure 1-8)
(1) Parietal layer-covers inside wall of cavity
(2) Visceral layer-covers internal organ(s)
(3) Cavity can refer either to the potential space between these two
layers or to the entire space in which the organs reside
2. Abdominopelvic cavity
a. Abdominal cavity
b. Pelvic cavity
c. Abdominal quadrants (Figure 1-9)
(1) Right upper quadrant
(2) Left upper quadrant
(3) Right lower quadrant
(4) Left lower quadrant
d. Abdominopelvic regions (Figure 1-10)
(1) Upper
(a) Right hypochondriac region
(b) Epigastric region
(c) Left hypochondriac region
(2) Middle
(a) Right lumbar region
(b) Umbilical region
(c) Left lumbar region
(3) Lower
(a) Right iliac (inguinal) region
(b) Hypogastric region
(c) Left iliac (inguinal) region
C. Other cavities are hollows found in many organs throughout the body
Body Regions (Figure 1-11; Table 1-4)
A. Axial subdivision
1. Head
2. Neck
3. Torso, or trunk, and its subdivisions
B. Appendicular subdivision
1. Upper extremity and subdivisions
2. Lower extremity and subdivisions
Interaction of Structure and Function
A. Complementarity of structure and function is an important and unifying
concept in the study of anatomy and physiology
B. Anatomical structures are adapted to perform specific functions because of
their unique size, shape, form, or body location
C. Understanding the interaction of structure and function assists in the integration of otherwise isolated factual information
22
UNIT 1 The Body as a Whole
Cycle of Life: Life Span Considerations
A. Structure and function of body undergo changes over the early years (developmental processes) and later years (aging processes)
B. Infancy and old age are periods when the body functions least well
C. Young adulthood is period of greatest homeostatic efficiency
D. Atrophy-term to describe the wasting effects of advancing age
7. Define briefly each of the following terms: anterior, distal, sagittal plane,
medial, dorsal, coronal plane, organ, parietal peritoneum, superior, tissue.
8. Locate the mediastinum.
9. Discuss in general terms the principle of complementarity of structure and
function.
CRITICAL THINKING QUESTIONS
REVIEW QUESTIONS
Write out the answers to these questions after reading the chapter and
reviewing the Chapter Summary. If you simply think through the answer
without writing it down, you won't retain much of your new learning.
1. Define the terms anatomy and physiology.
2. List and briefly describe the levels of organization that relate the structure of
an organism to its function. Give examples characteristic of each level.
3. Give examples of each system level of organization in the body and briefly
discuss the function of each.
4. What is meant by the term anatomical positiorf? How do the specific anatomical terms of position or direction relate to this body orientation?
5. What is bilateral symmetry? What terms are used to identify placement of
one body part with respect to another on the same or opposite sides of the
body?
6. What does the term somatotype mean? Name the three major somatotypes
and briefly describe the general characteristics of each. (Hint: Review Body
Types and Disease online at Connect It~
After finishing the Review Questions, write out the answers to these
more in-depth questions to help you apply your new knowledge. Go
back to sections of the chapter that relate to concepts that you find
difficult.
1. Each characteristic of life is related to body metabolism. Explain how digestion, circulation, and growth are metabolically related.
2. What diseases may result in a patient with an endomorph somatotype and a
waist-to-hip ratio of 1:2? (Hint: Review Body Types and Disease online at
Connect It~
3. An x-ray technician has been asked to take radiographs of the entire large
intestine (colon), including the appendix. Which of the nine abdominopelvic
regions must be included in the radiograph?
4. Body cavities can be subdivided into smaller and smaller sections. Identify,
from largest to smallest, the cavities in which the urinary bladder can be
placed.
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