Medical sciences Naish

Medical sciences Naish

 

eBook Overview
An integrated approach to teaching basic sciences and clinical medicine has meant that medical students have been driven to a range of basic science textbooks to find relevant information. Medical Sciences is designed to do the integration for you. In just one book, the diverse branches of medical science are synthesised into the appropriate systems of the human body, making this an invaluable aid to approaching the basics of medicine within in a clinical context.

 

 

Medical sciences Naish

.
An integrated approach to teaching basic sciences and clinical medicine has meant that medical students have been driven to a range of basic science textbooks to find relevant information. Medical Sciences does the integration for you. In just one book, the diverse branches of medical science are synthesised into the appropriate systems of the human body, making this an invaluable aid to approaching the basics of medicine within in a clinical context.




Eleven new contributors.
Completely new chapters on Biochemistry and cell biology, Genetics, The nervous system, Bones, muscle and skin, Endocrine and reproductive systems, The cardiovascular system, The renal system and Diet and nutrition.
Completely revised and updated throughout with over 35 new illustrations .
Expanded embryology sections with several new illustrations.
Updated edition
This ebook replaces a previous edition:
Medical Sciences

Table of Contents
Front Cover 1
Medical Sciences 4
Dedication 3
Copyright 5
Contents 6
Contributors 8
Preface 10
Acknowledgements 12
Chapter 1: Introduction and homeostasis 14
CHAPTER 5 HUMAN GENETICS 15
CHAPTER 16 DIET AND NUTRITION 16
Negative feedback 17
Human body temperature ( Clinical box 1.1) 18
Thermoneutral zones 19
WATER AND ELECTROLYTES: HOMEOSTATIC CONTROL OF BODY FLUIDS 20
Movement of fluids between compartments 21
Homeostatic control of fluid balance 22
ACIDBASE BALANCE: HOMEOSTATIC CONTROL OF HYDROGEN IONS ( Clinical box 1.8) 23
Physiological range of pH 24
Protein buffers 25




Renal control of pH ( Clinical box 1.10) 26
Chapter 2: Biochemistry and cell biology 28
PRINCIPLES OF MOLECULAR INTERACTIONS 29
Covalent bonds 30
Spatial arrangement of organic molecules 31
Energy flow in chemical reactions 32
CHEMICAL ELEMENTS THAT FORM THE HUMAN BODY 33
CARBOHYDRATES 34
COMPLEX CARBOHYDRATES 36
Dietary fats 37
Bile acids 38
COMPLEX LIPIDS 39
Synthesis and degradation of nucleotides 40
Nucleotide recycling: the salvage pathways 41
The primary structure of the nucleic acids 42
Complementarity of the DNA strands 43
DNA replication 44
AMINO ACIDS 45
PROTEINS 46
The peptide bond 47
PROTEIN SYNTHESIS AND PROCESSING 49
Translation 50
Post-translational modification of proteins 51
Protein processing in the Golgi apparatus 52
Muscle 53
Enzyme inhibition 55
Cell membranes 56
Proteins in cell membranes 57
NUCLEUS 58
PROTEASOMES 59




Hormones 60
Intracellular receptors 61
Ion channels 62
COORDINATED ACTION OF TRANSPORTERS 63
EXOCYTOSIS 64
CONNECTIVE TISSUE 66
Fat (adipose) tissue 67
NERVOUS TISSUE 68
INTEGRATED LEARNING: THE SYSTEMIC APPROACH 69
Chapter 3: Energy metabolism 70
TRICARBOXYLIC ACID CYCLE 72
Oxidative phosphorylation 73
Electron transport chain inhibition 74
Reversible activation and deactivation by covalent modification 75
Different tissues metabolise different energy substrates 76
FOUR KEY PATHWAYS MAINTAIN AND UTILISE BLOOD GLUCOSE 77
GLYCOLYSIS THE ANAEROBIC CATABOLISM OF GLUCOSE 78
Energy-using reactions in glycolysis glucose phosphorylation 79
Glucokinase 80




Regulation of PFK-1 81
Energy-producing stage of glycolysis production of pyruvate and lactate 82
Pyruvate kinase 83
OXIDATIVE GLUCOSE METABOLISM AEROBIC GLYCOLYSIS 84
GLYCOGEN THE STORAGE FORM OF GLUCOSE 85
Glycogenin, the glycogen primer 86
Allosteric activation of glycogen synthesis 87
GLYCOGENOLYSIS THE BREAKDOWN OF GLYCOGEN 88
Regulation of hepatic glycogenolysis 89
REGULATION OF HEPATIC GLYCOGEN PHOSPHORYLASE 90
Genetic defects in glycogenolysis 91
Gluconeogenesis from protein 92
Gluconeogenesis from glycerol 93
Cori and glucosealanine cycles 94
AMINO ACID METABOLISM 96
NITROGEN IN AMINO ACID METABOLISM 97
Deamination 98
Ammonia 99
Nitrogen balance 100
AMINO ACIDS AND SIGNALLING MOLECULES 101
Dietary fatty acids 102
STORAGE OF LIPIDS 103
TRIACYLGLYCEROLS (TRIGLYCERIDES) 104
Apolipoproteins 105




Lipoprotein receptors 106
Carnitine shuttle 107
Inhibition of the -oxidation spiral by excessCoA 108
Role of ketone bodies in fuel homeostasis 109
Regulation of ACC activity 111
FINE-TUNING OF FATTY ACID SYNTHESIS, OXIDATION AND KETOGENESIS 112
REGULATION OF FAT METABOLISM 113
Chapter 4: Pharmacology 114
DIGOXIN AN EXAMPLE IN CLINICAL PHARMACOLOGY 115
ABSORPTION TRANSFER OF DRUGS ACROSS CELL MEMBRANES 116
Ionised and non-ionised forms of a drug 117
Transporters (carrier proteins) 118
Ion channel proteins 119
Drug distribution to special organs 120
Competitive protein binding 121
Extent of drug distribution into aqueous compartments 122
PHASE I METABOLIC REACTIONS (PRE-CONJUGATION REACTIONS) 123
Reduction 124
PHASE II METABOLIC REACTIONS (CONJUGATION REACTIONS) 125
Enzyme induction 126
Glomerular filtration 127
Diuretic drugs 128
Osmotic diuretics 129
Fate of drugs in the stomach 130
PARENTERAL ADMINISTRATION 131
Intranasal administration 132
Drug clearance 133
Steady state concentration of drugs 134
Therapeutic window 135
STEADY STATE AND MULTIPLE DOSING 134
Multiple dosing 135
DRUG TARGETS 136




False substrates 137
Pharmacokinetics 138
Binding of a ligand to the receptor 139
Ionotropic receptors (ligand-gated ion channels) 140
GPCR (metabotropic receptors) and signal transduction mechanism 141
Phosphodiesterase inhibition 142
Phospholipase C 143
Speed of GPCR transmembrane signalling 144
Anti-cancer drugs 145
CLASSIFICATION OF DRUGS ACCORDING TO PERFORMANCE 146
Comparing potency between drugs 147
QUANTAL DOSERESPONSE CURVES 148
Spare receptors 149
Chemical antagonism/drug sequestration 150
NEUROTRANSMITTERS 151
OVERVIEW OF THE AUTONOMIC NERVOUS SYSTEM 152
Somatic motor reflex 153
PARASYMPATHETIC (CHOLINERGIC) SYSTEM 154
Storage of acetylcholine 155
Irreversible anticholinesterases (organophosphates) 156
Pharmacological effects of nicotinic receptor antagonists 157
Norepinephrine (adrenaline) synthesis 158
Adrenal conversion of norepinephrine to epinephrine 159
Adrenergic neuron blocking drugs (ANBs) 160
Cytoplasmic COMT 161
Respiratory system 162
-Adrenoceptor antagonists 163
Other clinical uses 164
Lipid theory 165
Unwanted effects 166
Chapter 5: Human genetics 168
BASIS OF MODERN GENETICS 169
THE HUMAN GENOME 170
Cell division 171
The cell cycle 172
Mitosis ( Fig. 5.4) 173
Meiosis 174
Chromosome abnormalities 176
DNA AND GENES 179
Regulation of transcription 180
DNA DAMAGE 181
Double-strand breaks (DSBs) 182
Sonic hedgehog 183
ORGANOGENESIS 184
HUMAN GENETIC VARIATION 185
Gene duplications 186
Bottlenecks 187
Genotypes, phenotypes and genetic penetrance 189
MODES OF INHERITANCE 190
Autosomal recessive inheritance ( Figs 5.24 and 5.25) 191
Rare disorders and consanguinity 192
Recessive X-linked inheritance ( Figs 5.28 and 5.29) 193
Haemophilia the royal disease 194
Mitochondrial disorders 195
POLYGENIC OR COMPLEX DISEASE 196
CONTINUOUS EFFECTS MODELS 197
Heritability 198
Biases in twin studies 199
Expression profiles 200
CANCER GENES 201
Oncogenes 202
DNA repair genes 203
Physical maps 204
Cloning 205
Chromosomal comparative genomic hybridization (CGH) arrays 207
Genetic linkage a clinical example 208
Incomplete penetrance 209
Genome microarrays 210
Personal genomics 211
THE HUMAN GENOME PROJECT 212
What the HGP has already told us 213
Molecular phylogenetics 214
Protein modelling 215
Non-mammals as model organisms 216
Bacteria and other microbes 217
CONGENITAL DISEASE 218
Antibiotics and pharmacogenomics ( Clinical boxes 5.15 and 5.16) 220
Protein augmentation 221
In vivo approach 222
Chapter 6: Pathology and immunology 224
INTRODUCTION 225
INFECTION 226
STRUCTURE 227
BACTERIAL CLASSIFICATION 228
VIRUSES (see Information box 6.2) 229
VIRUS CLASSIFICATION 230
VIRUSES AND CANCER 231
CLASSIFICATION 232
STRUCTURE 233
HELMINTHS (see Information box 6.5) 235
REPLICATION 236
THE SYMBIOTIC RELATIONSHIP BETWEEN INFECTIOUS AGENTS AND HUMANS 237
PATHOGENS: SUCCESSFUL BIOLOGICAL INFECTIOUS AGENTS 238
Respiratory tract 239
Placenta 240
Survival within the host 241
Attacking the host 242
Transmission 243
THE PATTERN OF DISEASE 244
Aim of vaccination 245
THE NON-IMMUNOLOGICAL DEFENCE SYSTEM 246
Antigens 247
THE ADAPTIVE IMMUNE SYSTEM 248
Major histocompatibility complex (MHC) 249
Antigen recognition 251
B cell activation 252
B cell response 253
Antibody complexes 254
The classical and lectin pathways ( Fig. 6.16) 255
The alternative pathway ( Fig. 6.16) 256
Factors that encourage positive feedback of the alternative pathway 257
Neutrophils 258
A functioning macrophage 259
Type 1 hypersensitivity 260
Type 4 hypersensitivity 261
TOLERANCE 262
T cell self-tolerance breakdown 263
Cellular events 264
Systemic effects of acute inflammation 265
Manifestation of chronic infection 266
Granulomas and granulation tissue 267
Outcomes of chronic inflammation 268
Proliferation 269
LYMPHOID ORGANS 270
Reticular network and sinuses 271
NEOPLASIA 272
Decreased growth 273
Defects of development 275




PATHOLOGY OF NEOPLASIA 276
Nervous system neoplasms 278
Macroscopic features and growth pattern 279
Differentiation and grade of malignant neoplasms 280
BEHAVIOUR OF MALIGNANT NEOPLASMS 281
EFFECTS OF A NEOPLASM ON THE HOST 282
PARANEOPLASTIC ENDOCRINOPATHIES 283
STAGING OF NEOPLASMS 284
PROGNOSIS OF NEOPLASMS 285
Why do patients die from neoplasia? 286
EFFECTS OF RADIATION 287
MULTISTEP THEORY OF CARCINOGENESIS (see also Ch. 5, Cancer genetics) 288
Chapter 7: Epidemiology: science for the art of medicine 290
PATTERNS OF LIFE AND DEATH 293
Disease prevalence 294
Births and deaths 295
Cancer registration 296
Global infectious disease surveillance 297
Morbidity 298
Health inequalities in the UK 299
Clustering 301
Migration 302
Direct method of standardisation 303
Choice of method for standardisation 304
The normal or Gaussian distribution curve 305
How accurate is the distribution summary? 306
Hypothesis tests 307
AN OVERVIEW OF EPIDEMIOLOGICAL ENQUIRY 309
Cross-sectional studies 310
Selecting the sample for casecontrol studies 311
Analysing and interpreting data from casecontrol studies 312
Consistency of findings 313
Relationship in time 314
Biological plausibility 315
Assembling the cohort 316
The role of genetics in observational studies 317
Interaction with environmental factors 318
Ethical considerations during the planning stage of clinical trials 319
Calculating sample size 320
Outcomes of interest: end-point definition 321
Interim analyses 323
Sensitivity analysis 324
Interpreting the results 325
Presenting the results 326
Looking for differences in categorical data ( Fig. 7.19) 327
The t-test 328
Criteria for applying the t-test 329
Criteria for applying the 2 test 330
Multivariate analysis 331
INVESTIGATION BY REVIEW 332
Experiment or review? 333
Definition of best evidence 334




High-risk strategy 335
Elicit the person’s health beliefs 336
Primary prevention 337
Primary prevention of coronary heart disease 338
Clinical versus laboratory diagnosis or screening 339
Ethical considerations about screening 340
Diagnostic tests and non-dichotomous values 341
Calculations for evaluating screening and diagnostic tests 342
The effect of prevalence on sensitivity and predictive values 343
Evaluating a diagnostic test 344
Consider the prevalence of disease 345
Harming the patient 346
Tertiary prevention 347
Chapter 8: The nervous system 350
Neurulation 351
Developmental disorders of the nervous system 352
Cerebral cortex 353
Basal ganglia 354
Midbrain 356
Pons and medulla 357
Grey matter 358
Somatic nervous system 359
Facial (VII) nerve 360
Accessory (XI) nerve 361
Nerve fibre classification 362
Arachnoid mater 363
Pia mater 364
Absorption of CSF 365
Connectivity 366
Posterior cerebral circulation 367
Venous drainage 368
METABOLIC REQUIREMENTS OF THE BRAIN 369
Depolarisation and hyperpolarisation 370
Refractory period 371
NEUROTRANSMISSION 372
Summation 373
Inhibitory amino acids 375
Purines 376
Peptides 377
MOTOR CORTEX 378
Upper and lower motor neurons 379
SPINAL CORD 380
Golgi tendon organ reflex 381
CRANIAL NERVE REFLEXES 382
Functional subdivisions 383
Cerebellar cortex and circuitry 384
BASAL GANGLIA 385
EYE MOVEMENTS 386
Control of eye movements 387
SENSORY SYSTEMS 388
Receptive field structure 389
Somatosensory cortex 390
Other proprioception pathways 391
Summary of the ascending sensory pathways 392
Analgesic agents 393
Visceral sensation 394
Pupillary reflexes 395
Retina 396
Retinal processing 398
Central visual pathways 399
Central vestibular pathways 401
External and middle ear 402
Central auditory pathways 403
Sound frequency coding 405
Examples of central autonomic control 407
Regulation of thirst and drinking 408
Arousal system 409
The pathways of fear 410
Prefrontal cortex and emotion 411
HIGHER CORTICAL FUNCTIONS 412
Anatomical structures and declarative (explicit) memory 413
ATTENTION 414
BRAIN DEATH 415
Chapter 9: Bone, muscle, skin and connective tissue 416
THE SKELETAL SYSTEM 417
BONE MICROANATOMY 418
BONE FORMATION 419
Compact bone 423
Spongy bone 424
Intramembranous ossification 425
Growth in bone thickness 427
BONE’S ROLE IN CALCIUM HOMEOSTASIS 428
Vitamin D 429
Diet and bone mass 430
JOINTS 431
Gomphosis 432
Articular cartilage 433
The synovial fluid 434
Accessory ligaments 435
Hinge joint 436
Pivot joints 437
Saddle joint 438
A complex joint 441
Bursae and tendon sheaths 444
ANATOMICAL RELATIONSHIPS 445
Neurotransmitter release 446
Neuromuscular blockade 447
Development of sustained tension 448
The contractile proteins 449
Thin filaments 450
The sliding filament model of muscle contraction 451
Cross-bridge formation and muscle contraction ( Fig. 9.17B) 453
Creatine phosphate 454
MUSCLE GROWTH AND REPAIR 455
Muscle names 456
STANDING 457
Epidermis 458
Dermis 459
Sweat glands 460
Types of hair 461
Chapter 10: Endocrinology 464
Peptide hormones: secretion and mechanisms of action 465
Steroid hormones: synthesis, actions and metabolism 466
Modified amino acids: thyroid hormones and catecholamines 467
NEUROENDOCRINOLOGY 468
Endocrine testing 469
Measuring hormones in blood 471
Prolactin secretion is under inhibitory regulation ( Fig. 10.12) 474
Actions of growth hormone 475
THYROID GLAND AND THE REGULATION OF METABOLISM 477
HORMONE SYNTHESIS IN THE THYROID GLAND 478
CONTROL OF THYROID FUNCTION 479
HORMONES AND ‘STRESS’ 480
Adrenal cortex and medulla 481
Stress: the adrenal cortex 482
ENDOCRINE CONTROL OF GLUCOSE METABOLISM (details of biochemistry in Chs 2 and 3) 484
Glucagon 485
Type 1 diabetes 486
Complications of poorly controlled blood glucose 1: diabetic ketoacidosis 487
ENDOCRINE CONTROL OF BLOOD CALCIUM (details of bone in Ch. 9) 488
MALE REPRODUCTIVE ENDOCRINOLOGY 491
Hypothalamicpituitarytesticular axis 492
Spermatogenesis 493
FEMALE REPRODUCTIVE ENDOCRINOLOGY 494
The menstrual and ovarian cycles 495
PUBERTY 497
PREGNANCY 499
Hormone production by the placenta 500
Pregnancy tests 501
Lactation 502
INFERTILITY (SUBFERTILITY) 504
Chapter 11: The cardiovascular system 506
The heart chambers 507
Heart sounds and murmurs 508
THE HUMAN CIRCULATION 510
The pulmonary circulation 512
The systemic circulation 513
Aortic arch 514
Common iliac arteries 515
The venous system 516
Coronary blood flow 517
The skeletal muscle circulation 518
DEVELOPMENT OF THE HEART 519
The atria 520
The great arteries 521
The neonatal circulation 523
Cardiac muscle relaxation 524
Cardiac muscle metabolism 525
The cardiac conduction system 526
Sympathetic supply 527
Adrenal medulla 528
The normal ECG 529
The electrical axis of the heart 530
Cardiac arrhythmias 531
Anti-arrhythmic drugs 533
THE CARDIAC CYCLE 535
Atrial systole 537
CARDIAC OUTPUT AND HEART FAILURE 538
Afterload 539
Treatment of heart failure 540
BLOOD VESSELS 541
Arteries 542
ATHEROSCLEROSIS 543
Smooth muscle proliferation and formation of fibrous cap 544
Risk factors for atherosclerosis 545
Prevention and treatment of atherosclerosis 546
ISCHAEMIC HEART DISEASE 547
Non-ST elevation myocardial infarction 548
ST elevation myocardial infarction 550
THROMBOEMBOLISM 552
Deep vein thrombosis 553
Non-thrombotic emboli 554
The capillary bed 555
Diffusion 556
Filtration and resorption 557
Oedema 558
MECHANICS OF BLOOD FLOW 559
Types of blood flow 560
Vascular smooth muscle contraction 561
Regulation of flow in small arteries and arterioles 562
Sympathetic nervous system mediated vasoconstriction 563
Non-adrenergic autonomic nervous system mediated vasodilatation 564
Vasodilatation by catecholamines 565
Metabolic byproduct vasodilatation 566
SYSTEMIC ARTERIAL BLOOD PRESSURE 567
Chemoreceptor reflexes 568
Long-term control of blood pressure 569
Hypovolaemic shock 570
Cardiogenic shock 571
Vasodilatory (septic) shock 572
Clinical signs of shock 573
Supportive therapy 574
Prognosis in shock 575
Secondary hypertension 576
Drug-induced hypertension 577
Treatment of hypertension 578
Chapter 12: Haematology 580
White blood cells (leucocytes) 581
Monocytes and macrophages 582
STEM CELLS AND THEIR ROLE IN HAEMOPOIESIS 583
Haemopoietic receptors 584
Epo production involves a negative feedback loop 585
TRANSPORT OF OXYGEN BY HAEMOGLOBIN 586
Role of acid in oxygen release 587
THE RED CELL MEMBRANE 588
RED CELL ENZYMES ARE REQUIRED TO MAINTAIN RED CELL COMPONENTS 589
Physiological adaptations to anaemia 590
Classification of anaemia 591
Iron loss 592
Causes of iron deficiency 593
Vitamin B 12 (cobalamin, Cbl) 594
Acquired anaemias due to blood loss 595
Diagnosis of ACD 596
Laboratory findings in AIHA 598
Inherited anaemias 599
Haemoglobin disorders 600
Thalassaemia 601
Laboratory findings in the thalassaemias 602
NORMAL BLOOD PRODUCTION RELIES ON COORDINATED GENE EXPRESSION 603
Primary lymphoid tissues 604
Polycythaemia rubra vera 605
Incidence and causes 606
Laboratory findings 608
PLASMA CELL DISORDERS 609
The role of the endothelium and platelets in the maintenance of haemostasis 610
Coagulation cascade 611
Natural anticoagulants are required to maintain the balance 612
Fibrinolysis inhibitors 613
COAGULATION FACTOR DISORDERS 614
Inherited platelet disorders 615
Immune thrombocytopenic purpura 616
Anti-phospholipid syndrome 617
Changes in blood groups 619
Rh blood group antibodies 620
Duffy 621
Transfusion reactions 622
The antiglobulin test 623
White cell transfusion 624
Chapter 13: The respiratory system 626
EPIDEMIOLOGY OF RESPIRATORY DISEASE AND ITS SOCIAL IMPACT 627
OBSTRUCTIVE PULMONARY DISEASE 628
ANATOMY OF THE UPPER AIRWAYS ( Clinical box 13.4 and Information box 13.2) 629
Pharynx 630
Breath sounds 631
Vocal resonance 632
The gasblood barrier 633
Cell types at the alveolar level 634
Pulmonary lymphatics 635
ANATOMY OF THE PULMONARY CIRCULATION 636
Right-to-left (arteriovenous) shunts 637
Variations in pulmonary blood flow 638
SURFACE ANATOMY OF THE RESPIRATORY SYSTEM 639
The lungs and pleural cavity 640
Expiration 641
PULMONARY VENTILATION 642
Functional residual capacity 643
Peak expiratory flow rate 644
Asthma 646
Inflammation and secretion 647
Surface tension 648
Closing capacity and posture 649
PARTIAL PRESSURES OF GASES IN AIR 650
RESPIRATORY PIGMENTS 651
CARRIAGE OF CARBON DIOXIDE BY THE BLOOD 652
The four classes of acidbase disorder 653
VENTILATIONPERFUSION RATIO 654
CONTROL OF BREATHING 655
Central chemoreceptors 656
Lung receptors 657
Baroreceptors 658
CHALLENGES TO NORMAL RESPIRATION 659
Mountain sickness 660
DIVER’S REFLEX 661
Type I respiratory failure 662
LUNG DEFENCES AGAINST INFECTION 663
Defensins 664
Alveolar phase (32 weeks8 years) 665
RESPIRATORY SYSTEM CHANGES AT NORMAL DELIVERY 666
Chapter 14: The renal system 668
BALANCE OF FLUID INTAKE AND LOSS 669
ANATOMY OF THE KIDNEY 670
Renal pyramids 671
THE NEPHRON 672
Peritubular capillaries 674
NERVE SUPPLY TO THE RENAL TRACT 675
Polycystic kidney disease 676
GLOMERULAR FILTRATION AND THE PRODUCTION OF PRIMARY URINE 677
Pore size and macromolecules 678
The sodium pump 680
Aquaporins 681
Para-aminohippuric acid 682
Nephrotoxicity 683
Renal handling of molecules 684
Renal clearance 685
Urea clearance 686
Clearance of molecules that are filtered and secreted 687
Calculation of renal water excretion 690
Mechanism of urine concentration and dilution 691
Transport properties of the loop of Henle 692
Sodium and chloride 693
Renal sodium handling 694
Autoregulation 695
Reninangiotensionaldosterone system 696
Potassium 697
The thiazide diuretics 698
Diuretics acting on the late distal tubule and the collecting ducts (K + sparing) 699
Disease states 700
The distal nephron 701
Abnormalities of acidbase balance (also see Clinical box 14.14) 702
THE URINARY TRACT 703
Congenital problems 704
Bladder filling and tone 705
GENERAL CLASSIFICATION OF RENAL DISEASE 706
Acute tubular necrosis 707
Causes of chronic kidney disease 708
RENAL REPLACEMENT THERAPY 709
Chapter 15: The alimentary system 712
BLOOD SUPPLY TO THE GASTROINTESTINAL TRACT 713
OVERVIEW OF DIGESTION AND ABSORPTION 714
Carbohydrate digestion 715
General principles of absorption 716
Carbohydrate absorption 717
Fructose absorption 718
Di- and tripeptide absorption 719
Bile salt absorption 720
Calcium absorption 721
Regulation of iron absorption 722
ABDOMINAL REGIONS 723
Left and right lumbar region 724
INNERVATION OF THE ALIMENTARY CANAL 726
MOUTH 727
FUNCTIONS OF SALIVA 728
Organic constituents 729
Secretion of organic constituents 730
Parasympathetic nervous system 731
Oesophageal phase 732
Gastric and duodenal musculature 733
The gastric mucosa 734
CONTROL OF GASTRIC SECRETIONS 735
Gastric phase 736
Cephalic phase 737
Intracellular messenger for the action of acetylcholine, gastrin and histamine 738
Ion movements during acid secretion 739
Peptic ulceration 740
GASTRIC MOTILITY DURING THE INTERDIGESTIVE PERIOD 741
Duodenal contents 742
Other factors 743
Mechanisms of enzyme secretion 744
CONTROL OF PANCREATIC JUICE SECRETION 747
ANATOMY OF THE LIVER 748
FUNCTIONS OF THE LIVER 750
The liver and red blood cells 751
Cellular mechanisms of bile secretion 752
Immunological functions of the liver 753
Some causes of hepatitis 754
Ascites 755
Bile is concentrated in the gall bladder 756
STRUCTURE OF THE SMALL INTESTINE 757
SMALL INTESTINAL MOTILITY 758
LARGE INTESTINE 759
MOTILITY OF THE RECTUM AND ANAL CANAL 760
Chapter 16: Diet and nutrition 762
WORLDWIDE DIETARY PATTERNS AND FOOD GUIDES 763
DIETARY REFERENCE VALUES 764
VARIATIONS IN NUTRITIONAL REQUIREMENTS 765
Lactation 766
NUTRITIONAL STATUS 767
BODY MASS INDEX 768
Waist circumference and waist/hip ratio 769
ENERGY BALANCE 770
Estimates of energy consumption for different types of activity 771
NITROGEN BALANCE AND PROTEIN REQUIREMENTS 772
Energy and protein metabolism during fasting and feeding 773
Absorbed fat in the fed state 774
Decreased insulin fasting state 775
Metabolic response to stress: sepsis and trauma 776
Protein metabolism and acute phase response in illness 777
VITAMINS 778
Vitamin B 2 (riboflavin) 779
Vitamin D (calciferol) 780
ZINC 781
FLUORIDE 782
WATER OVERLOAD 783
THE CONTROL OF FOOD INTAKE 784
Peptides and hormones 785
Insulin 786
Body defence against cancer or invading bacteria 787
Obesity 788
Atherogenesis 789
Cardioprotective diets 790
Exercise in diabetes 791
MALNUTRITION 792
Avoidance of refeeding syndrome 793
Aetiology of obesity 794







Treatment of obesity 795
Pharmacological management 796
Increasing physical activity 797
Index

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