Essentials of Medical Physiology K Sembulingam, Prema Sembulingam
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1Essentials of MEDICAL PHYSIOLOGY2
3Essentials of MEDICAL PHYSIOLOGY
Fourth Edition
K Sembulingam PhD
and
Prema Sembulingam PhD Sri Lakshmi Narayana Institute of Medical Sciences Osudu, Villianur Commune Pondicherry, India 605 502 Formerly at M.R. Medical College, Gulbarga Karnataka, India and Sri Ramachandra Medical College and Research Institute Chennai, India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Rel: 32558559, Fax: +91-11-23276490, +91-11-23245683
Branches
Essentials of Medical Physiology
© 2007, K Sembulingam, Prema Sembulingam
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 1999
Second Edition: 2000
Third Edition: 2004
Fourth Edition: 2006
Reprint: 2007
9788180618260
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd, Sector 60, Noida
5Dedicated
to
our beloved students6
7Foreword
It is indeed with a great sense of pleasure and privilege that I give this Foreword to the book Essentials of Medical Physiology written by two of our dedicated teachers Dr K Sembulingam and Dr Prema Sembulingam. The students have always appreciated the efforts of these two teachers and their ability to make Physiology easily comprehended and interesting. Why one more book in physiology, is what I asked myself first before I reviewed the book. The book has been largely directed to the broad and specific needs of the undergraduate students, and simplicity and clarity have been emphasized. The students can easily assimilate the logical sequence in which the subjects have been presented not only for them to understand the same but also perform well in the various types of objective and routine examinations.
Several readily understandable diagrams and tables have been included to make subject comprehension and revision easy. Applied physiology, clinical importance and altered situations in pediatrics, geriatrics and pregnancy have been well brought out. The approach utilized in dealing with the subject of physiology would be appreciated by other teachers as well. I have no doubts that this will be a valuable addition to the armamentarium of a student of physiology who is preparing for examination and is seeking a strong foundation to build further on.
Here at Sri Ramachandra Medical College and Research Institute (Deemed University) the faculty involved in writing and editing books of this nature are greatly appreciated and I as its Vice-Chancellor wish to congratulate the Sembulingams on their great effort.
Dr. T.K. Partha Sarathy8
9Preface to the Fourth Edition
We are crossing another milestone in the journey of publishing the textbook titled Essentials of Medical Physiology. We are happy to bring out the Fourth Edition of this book. The journey was safe and satisfactory so far because of the acceptance of this book by the students and the appreciation and overwhelming support from our fellow teachers.
The inspiration for improving this book comes from the student population who are in need of a Textbook in Physiology which is packed with basics and the complete with latest developments in this field.
In this edition, many of the chapters are upgraded as per the suggestions from our colleagues and fellow teachers from various institutes and universities in and out of India. Many new tables and new figures including flow charts are added so that the students can understand the subjects easily. A sincere attempt was made to include most of the new findings in physiology which are essential for students.
Our thirst for improving this book is still alive. The improvement is possible only by the comments and suggestions expressed by the readers. So, we welcome the opinions, comments and valuable suggestions from one and all who happen to come across this book.
K Sembulingam
Prema Sembulingam
11Preface to the First Edition
The need for having a simple book with basic principles of Medical Physiology has been felt since long. A sincere and maiden attempt has been made with the idea of fulfilling the requirements of present day curriculum. The script of the book is formatted in such a way that it will be suitable not only for Medical students, but also for Dental students and the students of allied health subjects like Physiotherapy, Occupational therapy, Pharmacy, Nursing, Speech, Hearing and Language, etc.
Written in a textbook form, this book encompasses the knowledge of basic principles of physiology in each system. An attempt is also made to describe the applied physiology in each system.
To give an idea of the matters to be studied, the topics are listed at the beginning of each chapter. Most of the figures are given in schematic form to enable students to understand and reproduce the facts. The probable questions given for each section will help the students preparing for examinations. However, it will be ideal for the students to read each section thoroughly before referring to the questions.
We will be very happy to receive opinions, comments and valuable suggestions from all our senior colleagues, fellow teachers and students so that, every aspect of the book can be reviewed in succeeding editions.
K Sembulingam
Prema Sembulingam12
13Acknowledgements
We express our profound gratitude to Late Mr NPV Ramasamy Udayar, Founder Chancellor, Sri Ramachandra Medical College and Research Institute (Deemed University), Chennai, India for his keen interest in all the academic activities of the faculty members.
We would like to express our sincere gratitude to Sri VR Venkatachalam, The Chancellor of Sri Ramachandra Medical College and Research Institute (Deemed University) for accepting to grace the occasion of “Book Releasing Ceremony” of Essentials of Medical Physiology – First Edition and for releasing the book. We are very much thankful to the former Vice-Chancellor of this University Dr TK Partha Sarathy who honored us by attending the function and received the First Copy of the Book. We are also overwhelmed by his magnanimity for his encouragement and for going through the entire script before giving the Foreword.
We sincerely thank Mrs Radha Venkatachalam, Registrar and Administrative Director, Sri Ramachandra Medical College and Research Institute (Deemed University) who always encouraged the faculty of the University for publications.
We thank Dr Sylvia Walter, Professor Emeritus, Department of Physiology, Sri Ramachandra Medical College and Research Institute, who is the inspiration for us to bring out this book. We are also indebted to her for giving many valuable clues to modify the script in many chapters. Our special thanks to Dr V Srinivasan, former Professor and Head of Physiology Department, Sri Ramachandra Medical College and Research Institute for his strong belief in this project, constant encouragement and valuable suggestions. We are very much grateful to Dr V Srinivasan for his keen interest and valuable suggestions for upgrading the script in each edition.
We thank all our fellow teachers and senior professors from various institutes and universities in and out of India for their comments and suggestions which enabled us to bring out each edition of the book successfully.
We are deeply indebted to our students of Sri Ramachandra Medical College and Research Institute, Chennai, and MR Medical College, Gulbarga, Karnataka who were the spirit behind the idea of bringing out this book.
Our special thanks to Dr M Chandrasekar MD PhD, Professor and Head of Physiology Department, Meenakshi Medical College, Kanchipuram, Tamil Nadu for writing a review article on this book in the Journal “Biomedicine” (Vol 20, No. 1). Many valuable suggestions from him enabled us to upgrade the book in each edition.
We are grateful to Professor Mafauzy Mohamad, Director, Health Campus, Universiti Sains Malaysia for providing the photos of endocrine disorder patients. We are thankful to Dr Nivaldo Medeiros, Former Director of Hematology and Cytology Services, Central Laboratory, University of Säo Paulo School of Medicine, USA for giving us the hematology pictures. We thank Ms Norma Abdul Ghani and Mr Ahmad Fansuri bin Salleh, the Graphic artists, School of Health Sciences, Universiti Sains Malaysia for making the figures attractive.
We are thankful to Shri JP Vij (Chairman and Managing Director), Mr Tarun Duneja (General Manager - Publishing) and Mr PS Ghuman (Senior Production Manager) of M/s Jaypee Brothers Medical Publishers Pvt Ltd, for publishing the book in the same format as we wanted. We thank Mrs Yashu Kapoor, Mrs Geeta Srivastava, Mr Shakiluzzman, Mr Neelambar Pant and Mr Deepak Goel for their wholehearted contribution while formatting the book.
14Special Acknowledgements
We sincerely acknowledge the following fellow-teachers for their valuable suggestions. All the points suggested by them were acknowledged and incorporated in this edition.
  1. Dr M Chandrasekar
    Professor and Head
    Department of Physiology
    Meenakshi Medical College
    Kanchipuram, Tamil Nadu
  2. Dr P Sai Kumar
    Vice Principal
    Sree Balaji Medical College and Hospital
    Chennai, Tamil Nadu
  3. Dr Rose Davy C
    Assistant Professor
    Department of Physiology
    Govt Medical College, Thrissur
    Thrissur, Kerala
  4. Dr Mrs VJ Watne
    Associate Professor
    Department of Physiology
    DY Patil Medical College
    Kolhapur, Maharashtra
  5. Dr KJ Vedavathi
    Assistant Professor
    Rajarajeshwari Medical College and Hospital
    Kambipura, Bangalore
  6. Dr Mrs NV Mishra
    Associate Professor
    Department of Physiology
    Medical College
    Nagpur (MS), UP
  7. Dr KS Udayashankar
    Professor and Head
    Department of Physiology
    Sri Rajarajeshwari Medical College and Hospital
    Bangalore, Karnataka
  8. Dr Komale
    Lecturer
    Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka
  9. Dr MG Hymavthi
    Professor or Physiology
    Rajarajeshwari Medical College and Hospital
    Bangalore, Karnataka
  10. Dr D Venkatesh
    Professor of Physiology
    M.S. Ramaiah Medical College
    Bangalore, Karnataka
  11. Dr Laroline V
    Lecturer
    Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka
15Introduction
Physiology is the most fascinating and ancient branch of science. It is fascinating because, it unfolds the mystery of complicated functional aspects of individual organs in the body. It is ancient because, it exists ever since the origin of life. Even before knowing the language, culture and society, man knew about the hunger, thirst, pain and fear which are the basics of physiology.
Physiology is defined as the study of functions of various systems and different organs of the body. Physiology is of different types namely, Human Physiology, Animal Physiology and Plant Physiology. Human Physiology and Animal Physiology are very much interrelated. Knowledge of Human Physiology is essential to understand the other allied subjects like Biochemistry, Pharmacology, Pathology, Medicine, etc. however, it is worthwhile to have a brief knowledge of anatomy of different systems and various organs to understand the principles of Human Physiology.
The basic physiological functions include, provision of oxygen and nutrients, removal of metabolites and other waste products, maintenance of blood pressure and body temperature, hunger and thirst, locomotor functions, special sensory functions, reproduction and the higher intellectual functions like learning and memory.
In the unicellular organisms, all the physiological functions are carried out by simple diffusion through the cell membrane. Because of the evolutionary and ecological changes over the years, individual system is developed for each function such as digestive system, cardiovascular system, respiratory system, excretory system, etc. Every system in the body is independent structurally and functionally yet, all the systems are interdependent.
Human Physiology is usually studied under the following headings: