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Get a sample page by clicking on the available downloads below. John Campbell is a lecturer and writer who has international clinical and teaching experience.
An understanding of normal and abnormal body function is necessary if we are to understand the basis of clinical care. It is only when we understand normal physiology that the abnormal pathological situation makes any sense. Therefore, a study of physiology is a necessary introduction to any student of the health care professions. If we can understand how the body functions in health and goes wrong in disease, we can readily apply this knowledge to the maintenance of health and the management of disease. Subjects are systematically taught in the text complemented by clear, explanatory diagrams. Also, if you are interested in aiding distribution to your fellow students, we're eager to get in touch with you.
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I am convinced that everyone who works in a clinical environment needs a working knowledge of the normal functioning of the human body. It is only when we understand the normal that the abnormal pathological situation makes any sense. If we can understand how the body goes wrong, then it often becomes obvious what needs to be done to treat a disorder. So, physiology and pathophysiology can both be used to inform our clinical interventions and provide us with rationales for care. This provides us with more accountability for clinical practice, optimises interventions and makes us more informed and knowledgeable practitioners.
I originally wrote these notes as a revision guide for my students and because they proved useful, I decided to expand and publish. The aim is to keep the text concise but to explain the physiology and necessary basic science in a way that is easy to understand and can be learned. Diagrams are an important part of this philosophy. When I first discussed the book with my publisher, we thought about getting the diagrams professionally drawn, but rather than producing beautiful pictures we decided that I would draw the diagrams myself, as I draw them for my students. If the diagrams are kept simple in this way, they too may be learned. Learning to draw diagrams takes practice but in the end, it really helps us to understand the physiology. You may also find it helpful to colour some of the diagrams. Physiology is a complicated subject and is not easy to learn, the terminology alone is like learning a foreign language. But, if you stick at it and work through the book, both you and your patients will benefit for the rest of your career.
Campbell's Physiology and Pathophysiology books are the only text books that are supported by multinational research of effectiveness, read the full research report using the link below to Sage Open academic publishing.
Chapter 1 Cells and Tissues –This chapter introduces a series of essential basic concepts in physiology starting with cells, tissues and body organisation. Cells are explained in terms of their organelles including cell membranes, cytosol, cytoskeleton, endoplasmic reticulum, ribosomes, golgi, mitochondria, lysosomes and peroxisomes. The nucleus of the cell is considered by discussing chromosomes the nucleus and nucleolous. Organisational functions of cells are explained by considering specialised differentiated cells, cell reproduction, mitosis and meiosis. Other aspects of cell function include cells and ageing, enzymes and metabolism. Hierarchical organisation is further considered using tissues, (muscle, connective, neurological and epithelial). Body fluid compartments are explained in the context of osmosis and diffusion. Whole body structure and body cavities are introduced.
Chapter 2 Cardiovascular System - Starting off with the basic structure of the heart, this chapter explains anatomy in terms of the three principle layers of the cardiac wall, the endocardium, myocardium and pericardium. One-way flow of blood through the heart is seen to be controlled by the 4 heart valves, the tricuspid, mitral pulmonary and aortic arterial valves. These valves also generate the Lub-Dub of heart sounds. Atrial and ventricular function are logically explained and how they coordinate to generate effective cardiac output. Systole and diastole as phases of the cardiac cycle are seen to determine arterial blood pressure. Blood circulation through the systemic and pulmonary circulation distribute oxygen around the body. Regulation of heart beat is controlled by the internal electrical conducting system, sinoatrial (SA) node or pacemaker, atrioventricular (AV) node, bundle of His (AV bundle) and Purkinje fibres. PQRST waves form the EKG (ECG) of a cardiac cycle as seen using the electrocardiograph. Exercise is seen as beneficial. Blood vessels are arteries, arterioles, capillaries, venules and veins transporting blood around the lungs and body. Tissue fluid is formed as a consequence of capillary physiology. Gaseous exchange is facilitated by a large internal vascular surface area. Blood returns to the heart facilitated by the mechanisms of venous return. Portal veins exist in two places in the body. As always structure is related to function.
Chapter 3 Lymphatic System - Lymphatic capillaries drain tissue fluid and proteins from the tissue spaces, this fluid is now lymphatic fluid and is filtered through lymph nodes. Lymphatic tissue protects the body against infection and is also found in the tonsils and appendix. Lymphatic capillaries are located between the cells and blood capillaries of the tissues. Once tissue fluid enters a lymphatic capillary it is referred to as lymphatic fluid. Arrows indicate direction of lymphatic fluid flow from lymphatic capillaries into progressively larger vessels. Valves ensure one-way flow from the tissues towards lymph nodes. The vessel is afferent because it is transporting lymphatic fluid towards a lymph node.
Chapter 4 Blood - Blood is composed of plasma and cells, red cells are the erythrocytes and white cells are termed leucocytes. Plasma carries plasma proteins, nutrients and waste products. White cells are described with their functions including neutrophils, basophils, eosinophils, lymphocytes, natural killer cells, monocytes and thrombocytes (platelets). Blood groups are explained using the ABO rhesus system.
Chapter 5 Respiratory System - Looks at the mouth, which with the nose is the first part of the respiratory system. You will also know about the air-filled spaces in the bones of the skull called sinuses if you have ever suffered from sinusitis. Air then travels through the pharynx and larynx which housed the vocal cords for the production of the voice. Entrance to the trachea is protected by the epiglottis, this stops food 'going down the wrong way'. The bronchial tree starts with the trachea and expands into the right and left bronchus. Progressively smaller air passages form the 'branches' of the fractal bronchial tree. The large internal surface area of the lungs is generated by the microscopic structure of the bronchioles and the air sacs themselves called the alveoli. The lungs are surrounded by the pleural membranes, you will need to understand these if you ever look after a patient with a 'collapsed lung'. Mechanisms of breathing (inspiration and expiration) and respiratory volumes are explained. Moving air into the lungs by generating negative pressures and breathing out using positive pressure is understood in terms of the functions of the functions of the ribs, intercostal muscles and diaphragm. Gaseous exchange is seen in terms of the pulmonary blood circulation between the alveoli and the pulmonary capillaries.
Chapter 6 Nervous System - The nervous system is an internal communication system allowing for rapid transport of messages within the body. This includes perception, processing of information and control of responses. Anatomically the nervous system may be divided into the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal cord and the PNS consists of all of the other nervous tissue in the body such as the nerves going to and from the spinal cord and the nerves in the limbs.
Chapter 7 Endocrine System - A gland is a structure which produces and secretes a chemical product. There are two forms of gland in the body; these are referred to as exocrine and endocrine. An exocrine gland secretes a product via a duct into a localised area whereas an endocrine gland always secretes the product directly into the blood. Endo means inside. Endocrine glands release their products directly into the blood and so into the internal systemic environment. These glands have no ducts and for this reason, in the past, were called ductless glands. Endocrine products are released directly into the blood circulating through a gland. This means that the endocrine products are rapidly systemically distributed. Endocrine products are referred to as hormones. A hormone is a chemical messenger which circulates in the blood at low concentrations. After being produced in an endocrine gland a hormone circulates in the blood until it reaches a specific target tissue. The hormone will then bind onto a specific receptor on the target tissue. It is the combination of a hormone and the receptor site which then initiates a physiological response in the target cell.
Chapter 8 Digestive System - The functions of the digestive system can be summarised as ingestion, digestion, absorption and elimination. Ingestion refers to taking food and water into the body, the processes of eating and drinking. Ingested food molecules are often large and insoluble; in order for them to be absorbed into the body they must first be broken down into smaller units. The process of converting large, ingested food molecules into a form which may be absorbed is termed digestion. After food has been digested it must then be absorbed into the blood or lymphatic systems of the body before it can be utilised. The process whereby digested food is transferred from the lumen of the gut into the circulatory systems is called absorption. Not all ingested material is absorbed, some continues along the length of the digestive tract and is eliminated as waste. Fibre is not broken down by any digestive processes and is eliminated in the same form it was eaten. Water is absorbed unaltered into the blood.
Chapter 9 Liver - The liver is the largest solid organ in the body with only the skin having a greater total mass. In men it normally weighs 1.4-1.8 kg and 1.2-1.4 kg in women. The liver is involved in many of the biochemical processes which are necessary within the body. This is why the liver is sometimes referred to as the ‘chemical factory’ of the body. It is accurate to classify the liver as an exocrine gland as it produces approximately 500 mls of bile per day. This bile is secreted from the liver via the right and left hepatic ducts which merge to form the common hepatic duct. The cystic duct transports bile from the common hepatic duct into the gallbladder where it is stored and concentrated. The same cystic duct carries bile out of the gallbladder into the common bile duct. The pancreatic duct merges with the common bile duct before it communicates with the duodenum. This arrangement means that bile and pancreatic juices both enter the duodenum together via the hepatopancreatic sphincter (of Oddi) and major duodenal papilla. The major duodenal papilla is an elevation on the internal wall of the duodenum.
Chapter 10 Renal and Urinary Systems - The urinary system consists of the organs and structures which produce, transport and store urine. Urine is produced in the kidneys and transported to the urinary bladder via the right and left ureter. From time to time the bladder is emptied and urine is voided from the body via the urethra. The urinary system describes the whole of the kidney, ureter, bladder and urethra system but the term renal is specific to the kidneys. Normally more water and ions are ingested than are required to meet the requirements of homeostasis. Ions include potassium from fruit and sodium and chloride from salt. In order to prevent the body becoming overloaded with water and ions the excess must be excreted. The way water and ions are eliminated from the body is to incorporate them into urine which is then voided. This means the kidneys are responsible for regulation of the volume as well as the composition of body fluids. In addition, the kidneys excrete waste products from metabolic activity. Metabolic biochemical processes are carried out by all living cells. As a result of this biochemical activity, waste products are produced. If these are allowed to accumulate in body fluids, they will soon reach toxic levels. The kidneys are able to isolate and concentrate waste products in urine, which is then excreted from the body.
Chapter 11 Skin - Skin covers the entire outer surface of the body and is continuous with the membranes which line the various orifices such as the mouth, nostrils, anus and vagina. Skin thickness varies over different parts of the body from about 1.5 to 4 mm and has a total weight of about 4 to 5 kg. In an average adult it accounts for about 8% of body weight. This means, in terms of mass, the skin is the largest organ in the body. The second largest is the liver which is normally less than 3% of body weight. Clearly, skin surface area varies between individuals, but in most adults, it covers about 1.5 to 2m2. Skin is arranged in two distinct layers, the outer epidermis and under this the dermis.
Chapter 12 Thermoregulation - Life can only exist within narrow temperature ranges. Some animals, e.g. fish and reptiles, vary their body temperature depending on environmental conditions. These animals are described as ‘cold blooded’ or poikilothermic. However, in higher animals and humans, body temperature must be finely controlled within a fairly narrow temperature range. As previously discussed, cellular biochemistry is essential for life. All intracellular biochemistry is catalysed by enzymes which only work within narrow ranges of temperature. If the body becomes too hot or too cold enzymic activity will be reduced and physiological functions will no longer work efficiently. Eventually both hyper or hypothermia will lead to death. Humans are biologically classified as homoiotherms because we maintain a constant body temperature. This means that if body temperature starts to rise cooling mechanisms must be employed. Likewise, when body temperature falls there must be mechanisms available
to conserve heat and increase body temperature.
Chapter 13 Musculoskeletal System - The skeleton supports the softer tissues of the body providing rigidity and a structural framework. This framework supports the weight of the body and maintains an upright posture. Bones also provide the attachment points for tendons and skeletal muscles thereby facilitating movement. Many delicate components of the body are protected by overlying bony structures. For example, the cranial bones of the skull protect the brain and the vertebrae protect the spinal cord. The ribs protect the heart, lungs and major blood vessels. Large blood vessels and nerves in the limbs often run deep within or under the soft tissues medially to lateral bones. This means these important structures are protected from blows or falls applying forces from the outside. Red bone marrow is the site of red and white blood cell production. Platelets are formed from a type of white blood cell which develops in red bone marrow. Red bone marrow is found in the ends of the long bones of the arms and legs. It is also found in flat bones including the sternum, ribs, pelvis, skull and vertebrae. If the bone marrow is damaged by radiation or drugs the body will not be able to produce new blood cells or platelets. Yellow bone marrow is found predominantly in the shafts of long bones. As yellow bone marrow consists mostly of adipose cells (adipocytes) its main function is to store fat in the form of triglycerides. Minerals such as calcium and phosphorus are stored in bone and can be mobilised and released into the blood if needed to maintain homeostasis.
Chapter 14 Male Reproductive System - Each testis contains a surrounding capsule of dense white fibrous tissue called the tunica albuginea. This fibrous structure folds inwards to form numerous septa which divide each testis into 200-300 lobules. Within each lobule there are one to three (occasionally more) tightly coiled tubules forming closed loops which open at the top to allow sperm to exit. These are the seminiferous tubules of which there are a total of 400-600 per testis. Each individual seminiferous tubule would be 70-80 cm in length if straightened out. These seminiferous tubules are the site of sperm production, a process correctly termed spermatogenesis. Between the seminiferous tubules, within the lobules, there are groups of interstitial cells called Leydig cells. These are the cells which produce and secrete the male hormones collectively referred to as androgens.
Chapter 15 Female Reproductive System - Externally the female genitals consist of the labia majora, labia minora, clitoris, vestibule, vestibular glands, vaginal orifice and hymen. Collectively this area is described as the vulva. The internal organs of the female reproductive system are located in the pelvis the principle structures involved are the vagina, uterus, two uterine (also called Fallopian) tubes and ovaries. This structure is located at the anterior junction of the labia minora. The clitoris is homologous to the male penis and is a small cylindrical mass of erectile tissue. The external exposed part of the clitoris is the glans. Many sensory nerve endings are located within the clitoris. In appropriate emotional situations the clitoris is the principle sensory structure which stimulates an orgasm. Orgasm describes the climax of the pleasurable sensations associated with sexual activity.
Chapter 16 Eyes - Structures of the eye. The tissues are arranged in 3 layers. An outer fibrous layer consists of the sclera which is continuous with the transparent cornea. The middle vascular layer is composed of 3 continuous structures which are the choroid, ciliary body and iris. An inner light sensitive layer of pigmented and neuronal tissue is called the retina. The eyes are protected within the orbital cavity of the skull. Between the eyeball and the bone of the orbit is a layer of fat which is also protective.
Chapter 17 Ears - The ear is the organ of hearing and balance; it is divided into three main parts, the outer, middle and inner ear. The outer ear extends from the auricle to the tympanic membrane. The middle ear begins with the tympanic membrane and extends to the oval and round windows and arguably includes the pharyngotympanic tube. The inner ear lies on the medial side of these windows and contains the cochlea and semi-circular canals.
Chapter 18 Inflammation and Immunity - Inflammation is not a disease in itself but it is the local reaction of the body to some insult or injury. The inflammatory response is both normal and necessary. As inflammation is the first stage in the healing process, it is a necessary initial reaction which promotes further tissue regeneration after injury. Inflammation literally means ‘to set afire’ and the suffix ‘itis’ is used to describe an inflammatory response. Conditions with an inflammatory component are seen daily in any form of clinical practice. For example, bronchitis describes inflammation of the bronchial passages. Tonsillitis is inflammation of the tonsils. Appendicitis is inflammation of the appendix. Peritonitis, the peritoneal membranes. Conjunctivitis, the conjunctiva lining the front of the eye. Meningitis, the meningeal layers of the dura, arachnoid and pia mater. Gastritis, the stomach. Cholecystitis, the gallbladder. Cystitis, the bladder. Pyelonephritis, the kidneys. Colitis, the colon.
Chapter 19 Genetics - Observation makes it clear that offspring resemble their parents. Firstly, humans have baby humans not giraffes or monkeys. Secondly, children resemble their parents more than they do other members of the same species. The reason for this is that we all inherit our genetic material from our parents, half from mother and half from father. All the information required to construct the human body is carried as a coded sequence of chemical instructions in molecules of deoxyribonucleic acid (DNA). DNA is essentially the recipe to make the proteins of the body. A sequence of a DNA molecule, which carries enough information to produce a specific protein, is referred to as a gene. The DNA which codes for the genes is part of the chromosomes, which are located in the cell nucleus. When it is time for a gene to be expressed the information is transferred from DNA into another molecule called ribonucleic acid or RNA. RNA then travels out of the nucleus to the ribosomes in the cytoplasm; here amino acids are synthesised into the proteins coded for by the DNA information. Unfortunately, as well as carrying useful genetic information genes may also carry disease conditions. Although most purely genetic diseases are rare, over 4000 separate disorders have been identified.
Chapter 20 Nutrition - The essential components of the diet are water, carbohydrates, fats, proteins minerals, vitamins and fibre. These are the seven nutrient groups that are needed for the maintenance of health. A nutrient is a chemical found in food which is needed for body growth, maintenance or repair. A healthy diet must contain a balanced and adequate proportion of these seven dietary nutrient groups. (It can be argued that fibre is not a nutrient as it is not absorbed into the body but remains in the gut). Malnutrition refers to a state of abnormal nutrition. This will develop when there is a deficiency or excess of one or more dietary components. Deficiencies are most likely to occur at times when more nutrients are required such as during pregnancy, lactation, growth or recovery from illness or trauma. Obesity is also a form of malnutrition as too much of some nutrients are consumed. One of the great ironies of our world is that many people suffer from the effects of overeating while others are not able to access enough food to fulfil their physiological requirements.