Comprehensive Textbook of Medical Physiology (Volume 2) Gopal Krushna Pal, Pravati Pal, Nivedita Nanda
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fm1Comprehensive Textbook of Medical Physiologyfm2
fm3Comprehensive Textbook of Medical Physiology
Vol 2
Author Gopal Krushna Pal MBBS BNYT MD PhD MD (AM) MABMS FABMS FABAP FSAB Professor of Physiology Faculty In-Charge, Advance Center for Yoga and Registrar (Academic) Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry, India Co-Authors Pravati Pal MBBS MD MABMS Professor Department of Physiology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry, India Nivedita Nanda MSc PhD (Medical Biochemistry) Assistant Professor Department of Biochemistry Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry, India
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Comprehensive Textbook of Medical Physiology (Vol 2)
First Edition: 2017
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fm5Dedicated at the feet of
Sreema, the Divine Mother
Sri Aurobindo, the Divine Master
All Nature dumbly calls to her alone
To heal with her feet the aching throb of life
And break the seals on the dim soul of man
And kindle her fire in the closed heart of things.
All here shall be one day her sweetness' home,
All contraries prepare her harmony;
Towards her our knowledge climbs, our passion gropes;
In her miraculous rapture we shall dwell,
Her clasp shall turn to ecstasy our pain.
Our self shall be one self with all through her.
In her confirmed because transformed in her,
Our life shall find in its fulfilled response
Above, the boundless hushed beatitudes,
Below, the wonder of the embrace divine.
Sri Aurobindo (in ‘SAVITRI')fm6
Oh India, land of light and spiritual knowledge!
Wake up to your true mission in the world,
Show the way to union and harmony.
The Mother (of Sri Aurobindo Ashram, Puducherry, India)
Physiology is the key subject in medicine. Starting from the knowledge of body functions, physiology provides the concept of dysfunctions, the basis of understanding the disease processes and the insight into disease management and prevention. Physiology is the core of medical wisdom. Due to its enormous contribution to the growth of medical knowledge, the Nobel Prize in health sector has been designated as Nobel Prize in Physiology and Medicine. Physiology as a subject in medical science has changed over the years from its nonclinical to preclinical and then to the current proclinical format with the incorporation of Applied and Clinical Physiology as the essential components in its core curriculum. Physiology is the foundation of medical practice. Many clinical investigations related to neurological disorders, autonomic dysfunctions, cardiovascular and respiratory diseases, endocrinal, renal, reproductive and metabolic problems are carried out in the well-equipped laboratories of physiology departments. Further, many research investigations are conducted in physiology laboratories. Sooner, the superspecialty course in Clinical Physiology will be a reality.
In India, Physiology as a subject in medical curriculum has changed immensely over decades. With the introduction of the new Medical Council of India (MCI) guidelines in 1997, the duration of first MBBS course was reduced from its original one-and-half years to one year. With subsequent modifications by MCI, directing physiology to become a more clinically oriented subject, a need aroused in reshaping the subject, integrating it with subjects of paraclinical and clinical medicine and orienting physiology knowledge for application-based learning. Therefore, in the present textbook, we have made all our sincere efforts without diluting the core concepts of physiology that includes regulation and integration of body functions, to amalgamate the knowledge in physiology with other subjects for its application in medicine.
After the publication of our Textbook and Practical Book of Physiology, the students and teachers in Physiology across the globe have been requesting to write a comprehensive book in Physiology that can offer a holistic concept of functions, integration, dysfunctions of body systems, and physiological basis of management and prevention of diseases. With all their wishes and blessings, finally this book has been made available to them. We hope this book will fulfill the aspiration of the readers in acquiring and applying the knowledge of physiology in clinics. Nevertheless, this is a project in evolution, and needs inputs, support and encouragement from our readers for its endless progression.
Gopal Krushna Pal
Pravati Pal
Nivedita Nandafm8
Let us work as we pray. For indeed work is the body's best prayer to the Divine.
The Mother (of Sri Aurobindo Ashram, Puducherry, India)
With pride and privilege, we acknowledge the contribution of all our past teachers, especially the professors of VSS Medical College, Burla, Odisha for educating us acquire the principle and practice of clinical medicine. We also gratefully acknowledge our past physiology teachers at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India for having guided us learn the essentials of physiology, and notable among them are Dr DP Thombre, Dr V Srinivasan, and Dr (Late) DB Koner.
We sincerely acknowledge the contribution of Shri Jitendar P Vij, Group Chairman, Jaypee Brothers Medical Publishers Pvt Ltd, New Delhi for personally coming to Puducherry, and motivating and inspiring us to take up this special responsibility of writing such a wonderful book. For preparing the manuscript of the present book, we are especially thankful to Ms Chetna Malhotra Vohra (Associate Director - Content Strategy) and Ms Angima Shree (Senior Development Editor) for their constant support and timely help. The contribution of Ms Angima Shree is immense and praiseworthy. We also thank the other editors and designers of the Jaypee group who helped in the preparation of this book. We acknowledge Mr Narendra Singh Shekhawat (Delhi, India), Mr Venugopal (Bengaluru, Karnataka, India), and Mr Muralidharan (Puducherry, India) of the Jaypee group for their support. We are also thankful to Jaypee Brothers Medical Publishers for providing us many of the pictures and materials of their medical publications.
We are thankful to all our colleagues and students across the globe for reading our book and providing us their inputs for its further improvement. We thank all our colleagues and residents of JIPMER for their constant inspiration and support.
Auroprajna and Auroprakash, the divine children gifted to us, have been the constant support to us in all our endeavors. We shall fail in our duty if we do not appreciate the contribution of our sister Sabita Nanda, who has been constantly taking care of all our family requirements. We always keep in high esteem our parents Dr (Late) Artatran Nanda, Smt Anupama Nanda, Sri Mrutyunjay Pal and Srimati Malatimani Pal for showering on us their love and blessings and providing us everything to come to the greater heights in our life. We take this opportunity to express our heartfelt obeisance to Ms Kumud Ben of Sri Aurobindo Ashram, who is no more physically on this earth but lives in our hearts forever.fm10
fm11Special Features of the Book/How to use it Best
All sincere prayers are granted, every call is answered. With my Blessings.
The Mother (of Sri Aurobindo Ashram, Puducherry, India)
This Comprehensive Textbook of Medical Physiology has the following special features. These tips are meant for the readers to best use the book.
Learning Objectives: The topics start with ‘Learning Objectives'. By reading the learning objectives, a student will know the gross content of the topic, and how much he should acquire from it after reading the topic. The objectives have been divided into ‘Must Know' criteria that a student should minimum acquire, and ‘May Know' criteria that a student is desirable to acquire. These ‘Must Know' and ‘May Know' criteria will help a teacher prepare the content of his lecture class and to focus more on the major criteria.
Scientists Contributed: Invariably, important topics start with the contributions of great scientists in the concerned field, especially those who have received the Nobel Prize and/or are popular for their contributions in that field. Often, examiners ask to name the scientists who have invented/discovered the concepts or profoundly contributed to the development of the subject. This will not only give the information of the history of medicine, but will also inspire students and teachers to take up research in physiology and medicine. This part the readers should not miss!
Application Box: The concepts of Physiology have lot of applications in daily life and medical practice. Therefore, a major component of physiology is ‘Applied Physiology'. These important concepts and applied aspects of the topic are depicted in the ‘Application Box' and highlighted by green-colored boxes. If a student will miss to read these boxes, he/ she will miss the core concepts in physiology.
Clinical Physiology: Presently, the learning in physiology is oriented to understand the etiology of the disease, and the physiological basis of management. Therefore, the major part of physiology is devoted for ‘Clinical Physiology'. The Clinical Physiology has been depicted in this book in the following formats:
  • At the end of each topic, a description has been given for the common dysfunctions and disorders or diseases. A note has been given to explain the pathophysiology of the disease process and the physiological basis of the management. This is primarily to sensitize the 1st MBBS student for learning medicine, and to highlight the importance of physiology in learning medicine.
  • Constructed pictures or original photos of the common diseases have been shown at the end of the topics. This is to create interest in the mind of the 1st MBBS student for clinical medicine. It also helps to understand and memorize Clinical Physiology.
  • The core concepts related to diseases and patient management have been highlighted in ‘Clinical Box'. This provides the core concepts of understanding clinical medicine. The clinical boxes are highlighted with pink-colored bars.
The Clinical Physiology part is the uniqueness of this book, which is not given in any other textbook in this structured format. A student should never miss to read these clinical components in physiology.
Important Note: Some important and useful facts that are not covered in application or clinical boxes, are depicted as ‘Important Note'. These are useful information that may be asked in examinations, especially in viva voce.
Structured Presentation: Every chapter is divided into various parts by different headings and subheadings with different fonts and colors. Further, all important and complex mechanisms are structured and presented in a point-wise description. This structured presentation will help the student easily grasp the topic and memorize it. Further, this will ensure that a student does not miss any of the relevant points.
fm12Flowcharts: All major concepts are simplified and summarized in ‘Flowcharts'. Not only it helps to memorize and recap the topic, but also, presenting the text along with flowcharts in examination helps the examiner easily assess the knowledge of the student. Usually, presentation with flowcharts in examination is more marks-fetching. The presentation of many flowcharts is a special feature of this book. A student must read and remember these flowcharts.
Schematic Diagrams and Graphs: All the relevant and significant mechanisms, theories and concepts are described in this book with the help of schematic diagrams and graphs. If a student is able to draw a labeled schematic diagram, it is always considered that a student has understood the topic. Especially in an examination, due to shortage of time, if a student draws a good schematic diagram and gives a brief answer with the help of flowcharts, even if he fails to give a descriptive answer, he gets good marks invariably. Therefore, the student should never miss to understand the diagrams and figures.
Tables: All important data, special concepts and lengthy information that a student needs to remember have been presented in structured tabular format. Reading the tables helps to revise and remember these facts quickly.
Histological Pictures: All mechanisms and manifestations of a disorder that require structural knowledge of a tissue or organ to comprehend the concept of the disease have been identified with appropriate histological pictures. For example, when a student sees the blood cells of an anemia in a blood smear, he understands and remembers better. A student must see these histological pictures.
Chapter Summary: All topics end with a ‘Chapter Summary' that has been divided into two parts:
  1. The first part is the ‘Key Concepts', that depicts the central theme or the major take-home message of the topic. This is not the chapter summary, rather the summary of the main concepts.
  2. The second part is the ‘Important to Know (Must Read)' that provides all the probable long questions and short questions that usually come in theory examinations. Also, the questions that are usually asked in oral (viva) examination, are listed in this section. Students will definitely find it very useful. This will also help teachers to frame questions for the examination. A student should never miss this part.
Thus, this book is a comprehensive textbook that has incorporated all the requirements of a medical student for imparting the knowledge and skill of the subject, for acquiring all the ingredients needed to appear in the examination, and to complete the course with the best results.fm13fm14fm15fm16fm17