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Fundamentals of Anatomy & Physiology

Seventh Edition

Frederic H. Martini, Ph.D.

with

William C. Ober, M.D.

Art Coordinator and Illustrator

Claire W. Garrison, R.N.

Illustrator

Kathleen Welch, M.D.

Clinical Consultant

Ralph T. Hutchings

Biomedical Photographer

San Francisco Boston New York

Cape Town Hong Kong London Madrid Mexico City

Montreal Munich Paris Singapore Sydney Tokyo Toronto

Publisher: Daryl Fox

Executive Editor: Leslie Berriman

Project Editor: Nicole George

Development Manager: Claire Alexander

Development Editor: Alan Titche

Assistant Editor: Michael Roney

Editorial Assistant: Blythe Robbins

Director of Media Development: Lauren Fogel

Media Producer: Heather Steil

Media Editor: Kim Neumann

Managing Editor: Deborah Cogan

Production Management: Elm Street Publishing Services, Inc.

Design Manager: Mark Ong

Compositor: Preparé, Inc.

Interior Designer: Kathleen Cunningham Design

Cover Designer: Yvo Riezebos

Photo Researcher: Maureen Spuhler

Senior Manufacturing Buyer: Stacey Weinberger

Executive Marketing Manager: Lauren Harp

Cover Photo Credit: Lois Greenfield Photography

Notice: Our knowledge in clinical sciences is constantly changing. The author and the publisher of this volume have taken care that the information contained herein is accurate and compatible with the standards generally accepted at the time of the publication. Nevertheless, it is difficult to ensure that all information given is entirely accurate for all circumstances. The author and the publisher disclaim any liability, loss, or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this volume.

Library of Congress Cataloging-in-Publication Data Martini, Frederic.

Fundamentals of anatomy & physiology / Frederic H. Martini, with William C. Ober…[et al.].—7th ed.

p. cm.

Includes index.

ISBN 0-8053-7298-9

1. Human physiology. 2. Human anatomy. I. Title: Fundamentals of anatomy and physiology. II. Ober, William C.

III. Title.

QP34.5.M27 2006

612—dc22 2004022401

Copyright © 2006 by Frederic H. Martini, Inc. Published by Pearson Education, Inc., publishing as Benjamin Cummings, 1301 Sansome St., San Francisco, CA 94111. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. To obtain permission(s) to use material from this work, please submit a written request to Pearson Education, Inc., Permissions Department, 1900 E. Lake Ave., Glenview, IL 60025. For information regarding permissions, call (847) 486-2635.

Many of the designations used by manufacturers and sellers to distinguish their products are claimed as trademarks. Where those designations appear in this book, and the publisher was aware of a trademark claim, the designations have been printed in initial caps or all caps.

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1—DOW—08 07 06 05 04

ISBN 0-8053-7298-9

www.aw-bc.com

Text and Illustration Team

Frederic (Ric) H. Martini, Ph.D.

Author

Dr. Frederic H. Martini received his Ph.D. from Cornell University in comparative and functional anatomy for work on the comparative pathophysiology of stress. His publications include journal articles, technical reports, magazine articles, and a book for naturalists about the biology and geology of tropical islands. He is the coauthor of seven other undergraduate texts on anatomy and physiology or anatomy. He is on the faculty of the University of Hawaii— Hilo and remains affiliated with the Shoals Marine Laboratory, a joint venture between Cornell University and the University of New Hampshire. Dr. Martini is President-Elect of the Human Anatomy and Physiology Society, and he is a member of the American Physiological Society, the American Association of Anatomists, the Society for Integrative and Comparative Biology, the Western Society of Naturalists, and the International Society of Vertebrate Morphologists.

William C. Ober, M.D.

Art Coordinator and Illustrator

Dr. William C. Ober received his undergraduate degree from Washington and Lee University and his

M.D. from the University of Virginia. While in medical school, he also studied in the Department of Art as Applied to Medicine at Johns Hopkins University. After graduation, Dr. Ober completed a residency in Family Practice and later was on the faculty at the University of Virginia in the Department of Family Medicine. He is an Instructor in the Division of Sports Medicine at the University of Virginia and is part of the Core Faculty at Shoals Marine Laboratory, where he teaches Biological Illustration every summer. The textbooks illustrated by his company, Medical & Scientific Illustration, have won numerous design and illustration awards.

Claire W. Garrison, R.N.

Illustrator

Claire W. Garrison, R.N., B.A., practiced pediatric and obstetric nursing before turning to medical illustration as a full-time career. She returned to school at Mary Baldwin College, where she received her degree with distinction in studio art. Following a five-year apprenticeship, she has worked as Dr. Ober's partner in Medical & Scientific Illustration since 1986. She is on the Core Faculty at Shoals Marine Laboratory and co-teaches the Biological Illustration course with Dr. Ober.

Kathleen Welch, M.D.

Clinical Consultant

Dr. Kathleen Welch received her M.D. from the University of Washington in Seattle and did her residency at the University of North Carolina in Chapel Hill. For two years, she served as Director of Maternal and Child Health at the LBJ Tropical Medical Center in American Samoa and subsequently was a member of the Department of Family Practice at the Kaiser Permanente Clinic in Lahaina, Hawaii. She has been in private practice since 1987. Dr. Welch is a Fellow of the American Academy of Family Practice and a member of the Hawaii Medical Association, the Maui County Medical Society, and the Human Anatomy and Physiology Society. She is coauthor of the A&P Applications Manual and an undergraduate textbook on health and disease.

Ralph T. Hutchings

Biomedical Photographer

Ralph T. Hutchings was associated with the Royal College of Surgeons for 20 years. An engineer by training, he has focused for years on photographing the structure of the human body. The result has been a series of color atlases, including the Color Atlas of Human Anatomy, the Color Atlas of Surface Anatomy, and The Human Skeleton (all published by Mosby-Yearbook Publishing). For his anatomical portrayal of the human body, the International Photographers Association has chosen Mr. Hutchings as the best photographer of humans in the twentieth century. He lives in North London, where he tries to balance the demands of his photographic assignments with his hobbies of early motor cars and airplanes.

Brief Contents

UNIT 1:LEVELS OF ORGANIZATION

Chapter 1 An Introduction to Anatomy and Physiology 3

Chapter 2 The Chemical Level of Organization 26

Chapter 3 The Cellular Level of Organization 62

Chapter 4 The Tissue Level of Organization 106

UNIT 2:SUPPORT AND MOVEMENT

Chapter 5 The Integumentary System 153

Chapter 6 Osseous Tissue and Bone Structure 179

Chapter 7 The Axial Skeleton 205

Chapter 8 The Appendicular Skeleton 238

Chapter 9 Articulations 258

Chapter 10 Muscle Tissue 283

Chapter 11 The Muscular System 326

UNIT 3:CONTROL AND REGULATION

Chapter 12 Neural Tissue 379

Chapter 13 The Spinal Cord, Spinal Nerves, and Spinal Reflexes 421

Chapter 14 The Brain and Cranial Nerves 451

Chapter 15 Neural Integration I: Sensory Pathways and the Somatic Nervous System 495

Chapter 16 Neural Integration II: The Autonomic Nervous System and Higher-Order Functions 517

Chapter 17 The Special Senses 549

Chapter 18 The Endocrine System 590

UNIT 4:FLUIDS AND TRANSPORT

Chapter 19 Blood 639

Chapter 20 The Heart 669

Chapter 21 Blood Vessels and Circulation 708

Chapter 22 The Lymphatic System and Immunity 763

UNIT 5:ENVIRONMENTAL EXCHANGE

Chapter 23 The Respiratory System 813

Chapter 24 The Digestive System 862

Chapter 25 Metabolism and Energetics 915

Chapter 26 The Urinary System 951

Chapter 27 Fluid, Electrolyte, and Acid-Base Balance 994

UNIT 6:CONTINUITY OF LIFE

Chapter 28 The Reproductive System 1029

Chapter 29 Development and Inheritance 1074 Contents

Preface xxx

UNIT 1:LEVELS OF ORGANIZATION

Chapter 1

An Introduction to Anatomy and Physiology 3

An Introduction to Studying the Human Body 4

The Relationship between Anatomy and Physiology 4

Anatomy 5

Physiology 5

Levels of Organization 6

Homeostasis 11

The Role of Negative Feedback in Homeostasis 12

Systems Integration, Equilibrium,

and Homeostasis 14

Frames of Reference for Anatomical Studies 15

Superficial Anatomy 15

Sectional Anatomy 18

Body Cavities 19

Chapter Review 23

Chapter 2

The Chemical Level of Organization 26

Atoms, Molecules, and Bonds 27

Atomic Structure 27

Chemical Bonds 30

Chemical Notation 34

Chemical Reactions 35

Basic Energy Concepts 35

Types of Chemical Reactions 35

Reversible Reactions 36

Enzymes, Energy, and Chemical Reactions 36

Inorganic Compounds 37

Water and its Properties 37

Inorganic Acids and Bases 41

Salts 41

Buffers and pH Control 41

Organic Compounds 42

Carbohydrates 42

Lipids 44

Proteins 49

Nucleic Acids 54

High-Energy Compounds 56

Chemicals and Cells 57

Chapter Review 58

Chapter 3

The Cellular Level of Organization 62

An Introduction to Cells 63

The Cell Membrane 63

Membrane Lipids 66

Membrane Proteins 66

Membrane Carbohydrates 67

The Cytoplasm 68

The Cytosol 68

The Organelles 68

The Nucleus 77

Contents of the Nucleus 78

Information Storage in the Nucleus 79

Gene Activation and Protein Synthesis 80

How the Nucleus Controls Cell Structure and Function 84

How Things Get Into and Out of Cells 84

Diffusion 85

Carrier-Mediated Transport 89

Vesicular Transport 92

The Transmembrane Potential 94

The Cell Life Cycle 95

Interphase 95

Mitosis 96

Cytokinesis 98

The Mitotic Rate and Energy Use 98

Regulation of the Cell Life Cycle 99

Cell Division and Cancer 99

Cell Diversity and Differentiation 100

Chapter Review 101

Chapter 4

The Tissue Level of Organization 106

Tissues of the Body: An Introduction 107

Epithelial Tissue 107

Functions of Epithelial Tissue 107

Specializations of Epithelial Cells 108

Maintaining the Integrity of Epithelia 108

Classification of Epithelia 111

Glandular Epithelia 114

Connective Tissues 118

Classification of Connective Tissues 118

Connective Tissue Proper 119

Fluid Connective Tissues 123

Supporting Connective Tissues 125

Membranes 129

Mucous Membranes 129

Serous Membranes 129

The Cutaneous Membrane 130

Synovial Membranes 131

The Connective Tissue Framework of the Body 131

Muscle Tissue 132

Skeletal Muscle Tissue 132

Cardiac Muscle Tissue 134

Smooth Muscle Tissue 134

Neural Tissue 134

Tissue Injuries and Repair 135

Inflammation and Regeneration 135

Aging and Tissue Structure 137

Aging and Cancer Incidence 137

Chapter Review 138

SYSTEMS OVERVIEW 142

UNIT 2:SUPPORT AND MOVEMENT

Chapter 5

The Integumentary System 153

The Integumentary System:

An Overview 154

The Epidermis 155

Layers of the Epidermis 155

The Basis of Skin Color 158

The Epidermis and Steroid Production 159

The Roles of Epidermal Growth Factor 161

The Dermis 161

Dermal Organization 161

The Subcutaneous Layer 163

Accessory Structures 164

Hair and Hair Follicles 164

Glands in the Skin 167

Nails 169

The Response of the Integument to Injury 170

Repair of Localized Injuries to the Skin 170

Aging and the Integumentary System 173

Integration with Other Systems 174

Clinical Patterns 174

Chapter Review 174

Chapter 6

Osseous Tissue and Bone Structure 179

An Introduction to the Skeletal System 180

The Gross Anatomy of Bones 180

Bone Shapes 180

Bone Markings (Surface Features) 181

Bone Structure 183

Bone Histology 183

The Matrix of Bone 184

The Cells of Bone 184

The Structure of Compact Bone 185

The Structure of Spongy Bone 185

The Periosteum and Endosteum 188

Bone Formation and Growth 189

Endochondral Ossification 189

Intramembranous Ossification 192

The Blood and Nerve Supplies 193

The Dynamic Nature of Bone 194

Effects of Exercise on Bone 194

Hormonal and Nutritional Effects on Bone 194

The Skeleton as a Calcium Reserve 196

Fracture Repair 198

Aging and the Skeletal System 199

Types of Fractures 200

Chapter Review 201

Chapter 7

The Axial Skeleton 205

The Axial Division of the Skeletal System 206

The Skull 206

The Individual Bones of the Skull 212

Summary: Foramina and Fissures of the Skull 220

The Orbital and Nasal Complexes 220

The Skulls of Infants and Children 222

The Vertebral Column 224

Spinal Curvature 224

Vertebral Anatomy 225

Vertebral Regions 226

The Thoracic Cage 231

The Ribs 233

The Sternum 234

Chapter Review 235

Chapter 8

The Appendicular Skeleton 238

The Pectoral Girdle and Upper Limbs 240

The Pectoral Girdle 240

The Upper Limbs 242

The Pelvic Girdle and Lower Limbs 245

The Pelvic Girdle 245

The Lower Limbs 249

Individual Variation in the Skeletal System 253

Chapter Review 255

Chapter 9

Articulations 258

The Classification of Joints 259

Synarthroses (Immovable Joints) 260

Amphiarthroses (Slightly Movable Joints) 260

Diarthroses (Freely Movable Joints) 260

Form and Function of Synovial Joints 263

Describing Dynamic Motion 263

Types of Movements at Synovial Joints 264

A Structural Classification of Synovial Joints 267

Representative Articulations 269

Intervertebral Articulations 269

The Shoulder Joint 272

The Elbow Joint 273

The Hip Joint 274

The Knee Joint 276

Aging and Articulations 278

Integration with Other Systems 278

Clinical Patterns 278

Chapter Review 280

Chapter 10

Muscle Tissue 283

Skeletal Muscle Tissue and the Muscular System 284

Functional Anatomy of Skeletal Muscle 284

Organization of Connective Tissues 284

Blood Vessels and Nerves 285

Skeletal Muscle Fibers 286

Sliding Filaments and Muscle Contraction 291

The Contraction of Skeletal Muscle 292

The Control of Skeletal Muscle Activity 293

Excitation-Contraction Coupling 295

Relaxation 298

Tension Production 300

Tension Production by Muscle Fibers 300

Tension Production by Skeletal Muscles 304

Energy Use and Muscular Activity 308

ATP and CP Reserves 309

ATP Generation 309

Energy Use and the Level of Muscular Activity 310

Muscle Fatigue 310

The Recovery Period 312

Hormones and Muscle Metabolism 312

Muscle Performance 313

Types of Skeletal Muscle Fibers 313

Muscle Performance and the Distribution of Muscle Fibers 314

Muscle Hypertrophy and Atrophy 314

Physical Conditioning 315

Cardiac Muscle Tissue 316

Structural Characteristics of Cardiac Muscle Tissue 316

Functional Characteristics of Cardiac Muscle Tissue 317

Smooth Muscle Tissue 318

Structural Characteristics of Smooth Muscle Tissue 319

Functional Characteristics of Smooth Muscle Tissue 319

Chapter Review 321

Chapter 11

The Muscular System 326

Muscle Organization and Function 327

Organization of Skeletal Muscle Fibers 327

Levers 328

Muscle Terminology 330

Origins and Insertions 330

Actions 330

Names of Skeletal Muscles 331

Axial and Appendicular Muscles 333

The Axial Muscles 336

Muscles of the Head and Neck 336

Muscles of the Vertebral Column 344

Oblique and Rectus Muscles 346

Muscles of the Pelvic Floor 348

The Appendicular Muscles 350

Muscles of the Shoulders and Upper Limbs 351

Muscles of the Pelvis and Lower Limbs 363

Aging and the Muscular System 371

Integration with Other Systems 372

Chapter Review 374

UNIT 3:CONTROL AND REGULATION

Chapter 12

Neural Tissue 379

An Overview of the Nervous System 380

The Anatomical Divisions of the Nervous System 380

The Functional Divisions of the Nervous System 380

Neurons 380

The Structure of Neurons 381

The Classification of Neurons 383

Neuroglia 384

Neuroglia of the Central Nervous System 384

Neuroglia of the Peripheral Nervous System 387

Neural Responses to Injuries 387

Ion Movements and Electrical Signals 390

The Transmembrane Potential 390

Changes in the Transmembrane Potential 394

Graded Potentials 396

Action Potentials 398

Synaptic Activity 404

General Properties of Synapses 404

Cholinergic Synapses 405

The Activities of Other Neurotransmitters 408

Neuromodulators 408

How Neurotransmitters and Neuromodulators Work 409

Information Processing by Individual Neurons 412

Postsynaptic Potentials 412

Presynaptic Inhibition and Presynaptic Facilitation 414

The Rate of Generation of Action Potentials 415

Chapter Review 416

Chapter 13

The Spinal Cord, Spinal Nerves, and Spinal Reflexes 421

General Organization of the Nervous System 422

Gross Anatomy of the Spinal Cord 423

Spinal Meninges 425

Sectional Anatomy of the Spinal Cord 427

Spinal Nerves 429

Peripheral Distribution of Spinal Nerves 430

Nerve Plexuses 431

Principles of Functional Organization 437

Neuronal Pools 438

An Introduction to Reflexes 439

Spinal Reflexes 441

Monosynaptic Reflexes 441

Polysynaptic Reflexes 443

Integration and Control of Spinal Reflexes 445

Voluntary Movements and Reflex Motor Patterns 445

Reinforcement and Inhibition 445

Chapter Review 447

Chapter 14

The Brain and Cranial Nerves 451

An Introduction to the Organization of the Brain 452

A Preview of Major Regions and Landmarks 452

Embryology of the Brain 452

Ventricles of the Brain 453

Protection and Support of the Brain 455

The Cranial Meninges 455

Cerebrospinal Fluid 456

The Blood Supply to the Brain 458

The Medulla Oblongata 459

The Pons 462

The Cerebellum 462

The Mesencephalon 464

The Diencephalon 465

The Thalamus 466

The Hypothalamus 467

The Limbic System 469

The Cerebrum 470

The Cerebral Cortex 470

The White Matter of the Cerebrum 472

The Basal Nuclei 472

Motor and Sensory Areas of the Cortex 474

Cranial Nerves 480

Cranial Reflexes 490

Chapter Review 491

Chapter 15

Neural Integration I: Sensory Pathways and the Somatic Nervous System 495

An Overview of Sensory Pathways and the Somatic Nervous System 496

Sensory Receptors and Their Classification 496

Sensory Receptors 497

The General Senses 498

The Organization of Sensory Pathways 503

Somatic Sensory Pathways 503

Visceral Sensory Pathways 507

The Somatic Nervous System 508

The Corticospinal Pathway 509

The Medial and Lateral Pathways 511

The Basal Nuclei and Cerebellum 511

Levels of Processing and Motor Control 513

Chapter Review 514

Chapter 16

Neural Integration II: The Autonomic Nervous System and Higher-Order Functions 517

An Overview of the ANS 518

Divisions of the ANS 519

The Sympathetic Division 521

Organization and Anatomy of the Sympathetic Division 522

Sympathetic Activation Neurotransmitters and Sympathetic 524

Function 525

Summary: The Sympathetic Division 526

The Parasympathetic Division 527

Organization and Anatomy of the Parasympathetic Division 528

Parasympathetic Activation Neurotransmitters and Parasympathetic 529

Function 529

Summary: The Parasympathetic Division 530

Interactions between the Sympathetic and Parasympathetic Divisions 531

Anatomy of Dual Innervation 531

Autonomic Tone 533

Integration and Control of Autonomic Functions 534

Visceral Reflexes 535

Higher Levels of Autonomic Control 535

The Integration of SNS and ANS Activities 536

Higher-Order Functions 537

Memory 537

States of Consciousness 540

Brain Chemistry and Behavior 541

Aging and the Nervous System 542

Integration with Other Systems 543

Clinical Patterns 543

Chapter Review 545

Chapter 17

The Special Senses 549

An Introduction to the Special Senses 550

Olfaction 550

Olfactory Receptors 551

Olfactory Pathways 551

Olfactory Discrimination 551

Gustation 552

Taste Receptors 553

Gustatory Pathways 553

Gustatory Discrimination 553

Vision 554

Accessory Structures of the Eye 554

The Eye 557

Visual Physiology 566

The Visual Pathway 571

Equilibrium and Hearing 573

Anatomy of the Ear 573

Equilibrium 576

Hearing 579

Chapter Review 586

Chapter 18

The Endocrine System 590

Intercellular Communication 591

An Overview of the Endocrine System 593

Classes of Hormones 593

Secretion and Distribution of Hormones 595

Mechanisms of Hormone Action 595

Control of Endocrine Activity 599

The Pituitary Gland 600

The Anterior Lobe 601

The Posterior Lobe 604

Summary: The Hormones of the Pituitary Gland 605

The Thyroid Gland 606

Thyroid Follicles and Thyroid Hormones 606

Functions of Thyroid Hormones 610

The C Cells of the Thyroid Gland and Calcitonin 610

The Parathyroid Glands 611

The Adrenal Glands 613

The Adrenal Cortex 613

The Adrenal Medulla 615

The Pineal Gland 616

The Pancreas 616

The Pancreatic Islets 617

Insulin 617

Glucagon 619

The Endocrine Tissues of Other Systems 620

The Intestines 621

The Kidneys 621

The Heart 622

The Thymus 622

The Gonads 623

Adipose Tissue 624

Patterns of Hormonal Interaction 624

Role of Hormones in Growth 624

The Hormonal Responses to Stress 626

The Effects of Hormones on Behavior 628

Aging and Hormone Production 628

Integration with Other Systems 628

Clinical Patterns 628

Chapter Review 631

UNIT 4:FLUIDS AND TRANSPORT

Chapter 19

Blood 639

The Cardiovascular System: An Introduction 640

The Nature of Blood 640

Plasma 642

Plasma Proteins 642

Red Blood Cells 643

Abundance of RBCs 644

Structure of RBCs 644

Hemoglobin 644

RBC Formation and Turnover 646

RBC Production 648

Blood Types 650

White Blood Cells 654

WBC Circulation and Movement 654

Types of WBCs 655

The Differential Count and Changes

in WBC Profiles 657

WBC Production 657

Platelets 660

Platelet Functions 660

Platelet Production 660

Hemostasis 661

The Vascular Phase 661

The Platelet Phase 661

The Coagulation Phase 662

Fibrinolysis 664

Chapter Review 665

Chapter 20

The Heart 669

The Organization of the Cardiovascular System 670

Anatomy of the Heart 670

The Pericardium 671

Superficial Anatomy of the Heart 672

The Heart Wall 673

Internal Anatomy and Organization 674

Connective Tissues and the Fibrous Skeleton 680

The Blood Supply to the Heart 680

The Heartbeat 684

Cardiac Physiology 684

The Conducting System 684

The Electrocardiogram 687

Contractile Cells 688

The Cardiac Cycle 690

Cardiodynamics 695

Overview: The Control of Cardiac Output 697

Factors Affecting the Heart Rate 697

Factors Affecting the Stroke Volume 699

Summary: The Control of Cardiac Output 702

The Heart and the Cardiovascular System 703

Chapter Review 703

Chapter 21

Blood Vessels and Circulation 708

The Anatomy of Blood Vessels 709

The Structure of Vessel Walls 709

Differences between Arteries and Veins 709

Arteries 710

Capillaries 712

Veins 716

The Distribution of Blood 717

Cardiovascular Physiology 718

Pressure 719

Resistance 719

An Overview of Cardiovascular Pressures 720

Capillary Pressures and Capillary Exchange 723

Cardiovascular Regulation 725

Autoregulation of Blood Flow within Tissues 726

Neural Mechanisms 727

Hormones and Cardiovascular Regulation 730

Patterns of Cardiovascular Response 732

Exercise and the Cardiovascular System 732

Cardiovascular Response to Hemorrhaging 733

Special Circulation 735

The Distribution of Blood Vessels: An Overview 736

The Pulmonary Circuit 737

The Systemic Circuit 738

Systemic Arteries 738

Systemic Veins 745

Fetal Circulation 753

Placental Blood Supply 753

Circulation in the Heart and Great Vessels 753

Cardiovascular Changes at Birth 754

Aging and the Cardiovascular System 756

Integration with Other Systems 756

Clinical Patterns 756

Chapter Review 758

Chapter 22

The Lymphatic System and Immunity 763

An Overview of the Lymphatic System and Immunity 764

Organization of the Lymphatic System 764

Functions of the Lymphatic System 764

Lymphatic Vessels 765

Lymphocytes 768

Lymphoid Tissues 769

Lymphoid Organs 770

The Lymphatic System and Body Defenses 775

Nonspecific Defenses 775

Physical Barriers 775

Phagocytes 777

Immunological Surveillance 778

Interferons 779

Complement 779

Inflammation 781

Fever 782

Specific Defenses: An Overview of the Immune Response 782

Forms of Immunity 782

Properties of Immunity 783

An Introduction to the Immune Response 784

T Cells and Cell-Mediated Immunity 784

Antigen Presentation 784

Antigen Recognition 786

Activation of CD8 T Cells 787

Activation of CD4 T Cells 788

B Cells and Antibody-Mediated Immunity 789

B Cell Sensitization and Activation 789

Antibody Structure 790

Primary and Secondary Responses to Antigen Exposure 793

Summary of the Immune Response 795

Normal and Abnormal Resistance 796

The Development of Immunological Competence 796

Hormones of the Immune System 798

Immune Disorders 800

Stress and the Immune Response 801

Aging and the Immune Response 802

Integration with Other Systems 802

Clinical Patterns 802

Chapter Review 805

UNIT 5:ENVIRONMENTAL EXCHANGE

Chapter 23

The Respiratory System 813

The Respiratory System: An Introduction 814

Functions of the Respiratory System 814

Organization of the Respiratory System 814

The Upper Respiratory System 817

The Nose and Nasal Cavity 817

The Pharynx 819

The Larynx 819

Cartilages and Ligaments of the Larynx 819

Sound Production 821

The Laryngeal Musculature 821

The Trachea and Primary Bronchi 821

The Trachea 821

The Primary Bronchi 822

The Lungs 824

Lobes and Surfaces of the Lungs 824

The Bronchi 824

The Bronchioles 826

Alveolar Ducts and Alveoli 826

The Blood Supply to the Lungs 829

The Pleural Cavities and Pleural Membranes 829

An Overview of Respiratory Physiology 830

Pulmonary Ventilation 830

The Movement of Air 831

Pressure Changes during Inhalation and Exhalation 833

The Mechanics of Breathing 835

Respiratory Rates and Volumes 837

Gas Exchange 839

The Gas Laws 839

Diffusion and Respiratory Function 840

Gas Pickup and Delivery 842

Oxygen Transport 842

Carbon Dioxide Transport 845

Summary: Gas Transport 846

Control of Respiration 847

Local Regulation of Gas Transport and Alveolar Function 848

The Respiratory Centers of the Brain 848

Respiratory Reflexes 850

Voluntary Control of Respiration 852

Changes in the Respiratory System at Birth 853

Aging and the Respiratory System 853

Integration with Other Systems 854

Clinical Patterns 856

Chapter Review 856

Chapter 24

The Digestive System 862

The Digestive System: An Overview 863

Functions of the Digestive System 863

The Digestive Organs and the Peritoneum 864

Histological Organization of the Digestive Tract 866

The Movement of Digestive Materials 868

Control of Digestive Function 868

The Oral Cavity 870

The Tongue 871

Salivary Glands 871

The Teeth 873

The Pharynx 875

The Esophagus 875

Histology of the Esophagus 876

Swallowing 876

The Stomach 877

Anatomy of the Stomach 877

Regulation of Gastric Activity 881

Digestion and Absorption in the Stomach 883

The Small Intestine and Associated Glandular Organs 884

The Small Intestine 884

Histology of the Small Intestine 885

Intestinal Movements 887

The Pancreas 888

The Liver 890

The Gallbladder 894

The Coordination of Secretion and Absorption 895

The Large Intestine 896

The Cecum 897

The Colon 897

The Rectum 899

Histology of the Large Intestine 899

Physiology of the Large Intestine 899

Digestion and Absorption 902

The Processing and Absorption of Nutrients 902

Carbohydrate Digestion and Absorption 902

Lipid Digestion and Absorption 905

Protein Digestion and Absorption 905

Water Absorption 906

Ion Absorption 906

Vitamin Absorption 907

Aging and the Digestive System 907

Integration with Other Systems 908

Clinical Patterns 908

Chapter Review 910

Chapter 25

Metabolism and Energetics 915

An Overview of Metabolism 916

Carbohydrate Metabolism 918

Glycolysis 918

Mitochondrial ATP Production 920

Energy Yield of Glycolysis and Cellular Respiration 924

Gluconeogenesis 926

Lipid Metabolism 927

Lipid Catabolism 927

Lipid Synthesis 927

Lipid Transport and Distribution 927

Protein Metabolism 930

Amino Acid Catabolism 930

Protein Synthesis 933

Metabolic Interactions 933

Diet and Nutrition 936

Food Groups and Food Pyramid 936

Nitrogen Balance 937

Minerals 937

Vitamins 938

Diet and Disease 940

Energy Gains and Losses 941

The Energy Content of Food 941

Metabolic Rate 942

Thermoregulation 942

Chapter Review 946

Chapter 26

The Urinary System 951

An Overview of the Urinary System 952

The Kidneys 952

Sectional Anatomy of the Kidneys 953

Blood Supply and Innervation of the

Kidneys 953

The Nephron 956

Principles of Renal Physiology 961

Basic Processes of Urine Formation 961

An Overview of Renal Function 963

Renal Physiology: Filtration at the Glomerulus 965

Filtration Pressures 966

The Glomerular Filtration Rate 967

Control of the GFR 967

Renal Physiology: Reabsorption and Secretion 969

Reabsorption and Secretion at the PCT 970

The Loop of Henle and Countercurrent Multiplication 970

Reabsorption and Secretion at the DCT 973

Reabsorption and Secretion along the Collecting System 975

The Control of Urine Volume and Osmotic Concentration 976

The Function of the Vasa Recta 978

The Composition of Normal Urine 978

Summary: Renal Function 980

Urine Transport, Storage, and Elimination 982

The Ureters 983

The Urinary Bladder 984

The Urethra 985

The Micturition Reflex and Urination 986

Aging and the Urinary System 987

Integration with Other Systems 988

Clinical Patterns 988

Chapter Review 988

Chapter 27

Fluid, Electrolyte, and Acid-Base Balance 994

Fluid, Electrolyte, and Acid-Base Balance: An Overview 995

An Introduction to Fluid and Electrolyte Balance 996

The ECF and the ICF 996

Basic Concepts in the Regulation of Fluids and

An Overview of the Primary Regulatory

The Interplay between Fluid Balance and Electrolyte

Electrolytes 998

Hormones 998

Balance 999

Fluid Balance 999

Fluid Movement within the ECF 1000

Fluid Gains and Losses 1000

Fluid Shifts 1001

Electrolyte Balance 1002

Sodium Balance 1002

Potassium Balance 1004

Balance of Other Electrolytes 1005

Acid-Base Balance 1007

The Importance of pH Control 1008

Mechanisms of pH Control 1009

Maintenance of Acid-Base Balance 1012

Types of Acids in the Body 1008

Disturbances of Acid-Base Balance 1014

Respiratory Acidosis 1015

Respiratory Alkalosis 1017

Metabolic Acidosis 1017

Metabolic Alkalosis 1018

The Detection of Acidosis and Alkalosis 1019

Aging and Fluid, Electrolyte, and Acid-Base Balance 1019

Chapter Review 1021

UNIT 6:CONTINUITY OF LIFE

Chapter 28

The Reproductive System 1029

Introduction to the Reproductive System 1030

The Reproductive System of the Male 1030

The Testes 1030

Spermatogenesis 1036

The Anatomy of a Spermatozoon 1038

The Male Reproductive Tract 1040

The Accessory Glands 1041

Semen 1043

The External Genitalia 1044

Hormones and Male Reproductive Function 1045

The Reproductive System of the Female 1048

The Ovaries 1049

The Uterine Tubes 1052

The Uterus 1053

The Vagina 1057

The External Genitalia 1058

The Mammary Glands 1059

Hormones and the Female Reproductive Cycle 1061

Summary: Hormonal Regulation of the Female Reproductive Cycle 1062

The Physiology of Sexual Intercourse 1065

Male Sexual Function 1065

Female Sexual Function 1066

Aging and the Reproductive System 1066

Menopause 1066

The Male Climacteric 1067

Integration with Other Systems 1067

Clinical Patterns 1067

Chapter Review 1068

Chapter 29

Development and

Inheritance 1074

An Overview of Topics in Development 1075

Fertilization 1075

The Oocyte at Ovulation 1076

Oocyte Activation 1077

The Stages of Prenatal Development 1077

The First Trimester 1078

Cleavage and Blastocyst Formation 1078

Implantation 1079

Placentation 1082

Embryogenesis 1085

The Second and Third Trimesters 1089

Pregnancy and Maternal Systems 1089

Structural and Functional Changes in the Uterus 1091

Labor and Delivery 1092

Stages of Labor 1092

Premature Labor 1093

Difficult Deliveries 1094

Multiple Births 1094

Postnatal Development 1094

The Neonatal Period, Infancy, and Childhood 1094

Adolescence and Maturity 1097

Senescence 1098

Genetics, Development, and Inheritance 1098

Genes and Chromosomes 1098

Patterns of Inheritance 1099

Sources of Individual Variation 1102

Sex-Linked Inheritance 1103

The Human Genome Project 1104

Chapter Review 1105

Appendices A-1

I Answers to Concept Check and End-of-Chapter Questions A-1

II Weight and Measures A-36

III Periodic Table A-39

IV Normal Physiological Values A-40

V 100 Keys A-42

Glossary G-1

Credits C-1

Index I-1

Preface

TO THE INSTRUCTOR

You may or may not be familiar with earlier editions of this book, so I will focus on things that I'd want to know if I were considering a text for use in one of my classes.

What Sets This Text Apart from the Others?

I have often heard people say, “All A&P books are the same.” Well, certainly the available texts are about the same size and length, and they all have a similar organization, feature colorful illustrations, and include an assortment of supplements. But they differ widely in the way they organize information and present complex concepts. I will cite four specifics that set this text apart from all that are available:

#1: The Consistent and Highly-Effective Art Program

Most texts are illustrated by a dozen or more different artists and studios, all working in relative isolation. There are no common conventions, no consistent presentation or theme. This is the only text that has all of the art done by a pair of medical illustrators—William C. Ober, M.D., and Claire W. Garrison, R.N. (see the biographical notes on p. vii). Bill and Claire have worked with me since the start of the First-Edition illustration program in 1986. They know the material, they know the text, and, as they work, they know how they will illustrate related topics in later chapters. As a result, the art flows as smoothly as the text. Please turn to the Visual Introduction (pp. xxiv-xxxiv) for an illustrated tour of the art program, including details on how figures have been enhanced for the Seventh Edition.

#2: The Clear and Direct Narrative Style

I believe that it is important to organize material so that it can easily be studied, understood, and reviewed for exams. This is not a novel that will be read for fun. This textbook is a resource that helps students accomplish a specific task—mastering the material—as efficiently as possible. The narrative in this new edition has been revised with special attention paid to those features that have proven to aid in the actual learning process:

  1. Overviews that help students see the big picture

  2. Navigator Figures that provide a road map through complex discussions

  3. Lists that make it easier to organize information and focus on key facts and concepts

  4. Tables that summarize information concisely, in a format that makes it easy to memorize when memorization is required

#3: The Thorough and Time-Saving Pedagogical Framework

This focus on the needs of students is reflected in many pedagogical devices used throughout the text:

  1. Students can check their progress periodically by answering short Concept Check questions at the ends of major sections.

  2. When material relates to topics presented earlier, Concept Links signaled with icons l provide specific page numbers that facilitate review.

  3. The end-of-chapter Study Outlines are unusually comprehensive.

  4. The end-of-chapter Review Questions are organized in increasing levels of difficulty and sophistication, so that students can test their mastery first of facts and terminology, then of concepts, and finally of critical thinking and clinical applications.

  5. A new feature called 100 Keys has been added. These are basic concepts and principles that I would like students to remember five years after the course is over, regardless of their ultimate career paths. Signaled with icons, the keys are factual statements that function as organizers of central information in A&P.

#4: The Helpful and Practical Ancillaries Provided with the Text

Today, no single text, no matter how good or how comprehensive, can provide all the resources that students should be able to draw on for help in mastering this demanding subject. Accordingly, this book has been designed as the central component of a fully integrated learning system that includes both media and print components. The complete package includes five additional components, all of which are automatically packaged with new copies of the text:

  1. InterActive Physiology® CD-ROM, a media program that has helped thousands of students improve their grades in A&P with animations, tutorials, and quizzes to teach the most difficult physiological concepts.

  2. The A&P Applications Manual, organized to parallel the text, and including discussions of clinically important disorders for each of the body's organ systems, together with information about the relevant diagnostic techniques, laboratory tests, and treatment options.

  3. Martini's Atlas of the Human Body, expanded and enhanced, now with 252 photographs, clinical images, and scans, including anatomical photographs by Ralph T. Hutchings, a renowned biomedical photographer.

New Anatomy 360 ™ CD-ROM, featuring three-dimensional rotatable and layered visualizations derived from the Visible Human Project, along with labeling activities, interactive exercises, and self-review questions.

A Student Access Kit for MyA&P™, an online resource site where students will find a variety of interactive exercises and self-quizzes for each chapter.

All of these components are completely integrated with the text through icons and specific references that appear both within the chapters and in the Chapter Reviews. More complete descriptions appear in the Visual Introduction section (pp. xxiv-xxxiv).

What's Different about the Seventh Edition?

The basic chapter sequence and organization of the text remain largely unchanged. However, you will find several new organizational features within the narrative, as well as refinements to (and more generous use of) features that have been highly praised by students and instructors, including Navigator Figures, the Systems Overview section, and integrative sections that discuss the interactions among the various organ systems.

#1: Improvements to Text Readability

A thorough and complete line-by-line edit was applied to the entire book to tighten the writing and improve the consistency and coordination between the text prose and the art figures. The combination of more succinct writing, a noticeably larger text font size, and a fresh clear, and open design provides students with a more inviting, “readable” textbook.

#2: Enhancements to the Art Program

Bill Ober and Claire Garrison have made substantial improvements to the already superb art program of previous editions. Virtually every figure has been altered to some degree to make the use of colors, arrow conventions, and design features consistent at all levels. Please turn to the Visual Introduction (pp. xxiv-xxxiv) for an illustrated overview of the upgraded “Stepped” Art Figures, Macro-to-Micro Views, Compound Art, and Navigator figures.

#3: Re-Organization of the Clinical Material

The clinical material has been further integrated within the text to increase its pedagogical value. Short Clinical Notes deal with pathologies that shed light on the principles of normal physiological function. Longer, boxed versions of the Clinical Notes deal with topics of particular medical or social importance (such as cancer and AIDS) that require more extended exploration.

The revised A&P Application Manual contains an abundance of supplementary clinical material, including a number of topics that were previously included in the text. It includes authoritative discussions of a broad range of diseases with extensive information about relevant laboratory tests, diagnostic procedures, and treatments. With an organization that parallels the text, system by system and chapter by chapter, the A&P Application Manual can be used as a supplement to the text, as a reference, or as a resource for those students who want to learn more about clinical topics. See the Visual Introduction (pp. xxiv-xxxiv) for an illustrated presentation of the clinical material in the program.

#4: Improved Pedagogy and Media References

Along with the new 100 Keys feature (see page xxvi in the Visual Introduction), new labels and design improvements have been added to the Concept Check, Clinical Notes, Systems Overview, and System in Perspective features. The Seventh Edition makes it easier than ever to connect the two accompanying CD-ROMs and the website with the core material in the text. The InterActive Physiology® CD-ROM, Anatomy 360 ™. CDROM, the MyA&P™ online course management system and website are referenced with distinctive icons at appropriate points throughout the book.

To let me know what you think of the Seventh Edition or give suggestions to be considered for the Eighth Edition, please e-mail me at the following address.

Frederic H. Martini

martini@maui.net

TO THE STUDENT

How to Get the Most Out of This Program

You probably have several reasons for taking this course. You might have questions about your own body and its functions. You may be curious about the origins of health problems or diseases. Perhaps you need a course in anatomy and physiology to further your career plans.

If you are like most college students, you have two short-term goals in mind: (1) to learn and understand the material, and (2) to be able to demonstrate your mastery to the satisfaction of the instructor. I've tried to build features into the text that will help you reach both of these goals. In many respects, I've assembled this text like an owner's manual for the human body—it not only has the important information, but it is also designed to help you find that information quickly. As a result, you may find that it is different from the texts you've used for other classes. In this section, I've tried to give you some advice on how to use the features and unique organization of this text to your advantage. If you charge off into the text without reading further, you may miss some suggestions that could help you succeed.

Learn the Terminology

You will find that there are a lot of new words to learn. The faster you can learn the terminology, the easier it will be for you to master the concepts. Throughout the text, the most important terms appear in boldface print so they are easy to spot. Any time there's a chance of confusion regarding how a new term is pronounced, I've included a pronunciation guide. Accented syllables are in capital letters, and for the vowels:

as in tray a as in track

as in tree e as in help

as in spine i as in ink

as in bone o as in Tom

as in use u as in run

Witch the Big Picture

Although there is a lot of detailed information in anatomy and physiology, don't lose sight of the big picture.

  1. Each chapter begins with an outline. Use it to get a sense of the scope and organization of the chapter as a whole.

  2. Each of the major sections in the chapter starts with a list of Objectives. The list will give you a preview of the main points that you can expect to learn as you work through the material in the section.

  3. Many of the chapters include Navigator Figures, clearly labeled as such, which function as a kind of road map. Use them to help keep track of where you are in a complex discussion without getting lost in the details.

  4. Many of the chapters include Summary Tables that integrate large blocks of information in a format that makes the material easier to review. Make sure you understand the information before moving ahead in the chapter.

Organize Important Information

You've got to have a study plan and a method of organizing your notes. Don't try to memorize everything. Organize the material, focus on the key points, and look for common themes and patterns.

  1. Take advantage of the many lists in the text as well as the abundance of tables. Both of these formats summarize important information in a way that will make it easier for you to grasp and memorize.

  2. The material in each chapter builds on the material presented in earlier chapters. Often you will want to review the relevant discussions. To make this easier, I've inserted a symbol with a page reference: l p. 000. To help you proceed directly to the proper page, you will find that the page numbers appear in bold in the upper margin of each page of narrative, or at the bottom margin of each page of artwork.

Keep an Eye on the Art

I've provided a lot of visual support in this package because, whether you are considering processes or structures, you need to be able to visualize what's being described in the narrative.

  1. There are a LOT of illustrations in the text, and I work closely with the artists, an M.D. and an R.N., who review the text before creating the images. Because the text and art are developed together, you will find yourself moving back and forth between the text and the art as you read the chapter. At each spot in the narrative where you are sent to the art, a red dot serves as a place holder—use it to help you find your way back to the point in the text that you left.

  2. Many of the figures show dynamic processes underway in a series of steps; these same steps are also clearly identified and explained in the narrative. Breaking a complex process into stages is one way to make it easier to follow and understand.

  3. Some figures are accompanied by an ATLAS citation, which directs you to another view of the same structure in Martini's Atlas of the Human Body, packaged with your text. You'll find that looking at a single anatomical feature from different perspectives or visualized using different techniques is a powerful way of enhancing your understanding of what you are seeing.

Consider What the Information Means

You probably would not be taking this course if you did not have at least some interest in health and medicine. The text and its ancillaries contain a wealth of clinical material, organized so that you can easily focus on precisely what is relevant to your own or your instructor's concerns:

  1. Short Clinical Notes embedded in the text deal with many kinds of pathologies. These topics have been selected to help you understand the principles of normal function by showing what happens when something goes wrong.

  2. Topics of great general importance or that require more extended treatment are considered in longer boxed Clinical Notes.

  3. Information about a variety of diseases not discussed in the text, as well as additional details about many that are, can be found in the A&P Applications Manual that came with your new text, together with information about the diagnosis and treatment of these conditions. The A&P Applications Manual is organized in exactly the same way as the text to make it as easy as possible for you to consult. Use it as a supplement to the text, as a reference, or just to satisfy your individual curiosity. Look for the red icon, AM, that will direct you to relevant topics in the A&P Applications Manual.

Put It All Together

The human body is an integrated whole, not a collection of isolated systems, so it's important that you be able to see information pertaining to specific systems in a larger context.

  1. For each body system, you'll find a System in Perspective art figure that focuses on its interactions with every other body system and outlines relevant clinical aspects of the system. These figures can be an important part of your study, because they integrate the contents of the entire book.

  2. You will find 100 important concepts and principles flagged in the text. These concepts are identified by the icon . Commit the 100 Keys to long-term memory, as many of them will prove useful in your studies as well as in your daily life.

Pace Yourself

It is usually a bad idea to read a chapter in this textbook as if it were a chapter in a novel—from beginning to end, with no breaks. It's much more efficient to pace yourself and take a few pauses along the way to test your understanding of the material presented thus far. You are building your knowledge base, and there's no use reading the next section until you understand what was covered in this section.

  1. At the end of each major section, you will find a few short review questions in the Concept Check section. Take a moment to answer them. If you find them easy to answer, you can go on to the next section. If you find them difficult to answer, go back and reread the material. It's like building a house—it's not wise to start working on the second floor if the first floor is shaky.

Throughout the chapter are references to tutorials or three-dimensional anatomical views on the InterActive Physiology® CD-ROM or the Anatomy 360 ™ CD-ROM, which are packaged with your text. Don't hesitate to take advantage of these resources if you feel that you need to reinforce or deepen your understanding of the material you have just covered.

Review the Chapter after You Complete It

It might take you a week to work through a chapter, and by the time you reach the end, you may not have a clear perspective on the presentation as a whole. That's the time to review the end-of-chapter material.

The Study Outline at the end of each chapter gives you an opportunity to review all the chapter's key information and concepts. You can also use it as a jumping-off point for the CD-based tutorials and visualizations referenced within the chapter (InterActive Physiology® and Anatomy 360 ™), because those references are repeated here.

The Review Questions are organized so that you can assess your mastery of the chapter on three levels. You can test your grasp of facts and terminology (Level 1), your understanding of concepts (Level 2), and your ability to apply the material to realistic clinical situations (Level 3). If you need additional practice, there are more self-assessment quizzes in various formats at MyA&P (http://www.myaandp.com) or on the Anatomy and Physiology Place Website (www.anatomyandphysiology.com).

I wrote this book to give you the information you need as clearly as possible. If you find certain sections especially difficult, if you don't find information that you or your instructor would really like to cover, or if you have other comments or suggestions for future editions, please let me know using the e-mail address below.

Good luck and best wishes, Ric

martini@maui.net

Visual Introduction

THE ART PROGRAM

An Award-Winning Presentation of Anatomy & Physiology

Compound Art

pairs an artist's drawing with a photograph to encourage students to compare a detailed rendering with the “real thing” as they would see it in a laboratory.

Martini's Atlas of the Human Body is packaged with every new book, and references to it are marked with an "ATLAS."

Navigator Figures

present a “big picture” overview at the beginning of complex discussions and are repeated at appropriate intervals with specific details highlighted to break the material into smaller, clearer units.

NEW! Navigator Figures are now called out with a Navigator heading and a compass icon so students can clearly see that the figure relates to later figures.

“Stepped”Art Figures

break down multifaceted processes into step-by-step illustrations that coordinate with the author's narrative descriptions.These easy-to-follow sequences in the book are also featured in the new Media Manager CD-ROMs for instructors to use in classroom presentations.

NEW! Re-designed “Stepped”Art Figures provide clearer step headings to help students follow the sequence of events.

Macro-to-Micro Views

bridge the gap between familiar and unfamiliar structures of the body by illustrating smaller anatomical structures within larger ones.A large-scale orienting image is followed by corresponding smaller-scale sectional views.

NEW! Macro-to-Micro Views have been substantially re-designed and re-arranged to present a more intuitive “flow,” and arrows are more strongly used to show progressions.

TEXT FEATURES

Save Time and Raise Test Scores!

NEW! 100 Keys

offer 100 important concepts and principles over the course of the chapters. Signaled with an icon, the Keys are factual statements that function as organizers of central information in anatomy & physiology.

Concept Check Questions

appear at the end of chapter sections and help students test their comprehension before moving on to the next topic.

Concept Links

are used when material relates to topics presented earlier and offer specific page numbers to facilitate review.

Figure Locator Dots

appear with every figure reference in the narrative and function as placeholders to help students return to reading after viewing a figure.

Learn Applications to the Real World!

An A&P Applications Manual that extends the clinical information in the chapters is packaged with every new book, and references to it are marked with an "AM."

Clinical Notes

present relevant clinical information throughout the text.Those embedded in the narrative deal with pathologies and their relation to normal physiological function, while the larger boxed versions address important medical or social topics.

NEW! Core clinical topics are now more prominent in the chapters.

Focus Boxes

include concentrated coverage of a particular topic with clear text explanations and many illustrations or photographs.

TEXT FEATURES

See the Big Picture!

Systems Overview Section

appears between Chapters 4 and 5—after the introductory material on chemical, cellular, and tissue levels of organization—to prepare students for the body systems chapters and to serve as a convenient “big picture” summary for easy reference.

System in Perspective Summaries

provide an excellent, illustrated review of the basic functions of each body system and help students understand that the body functions as an integrated unit rather than as a set of isolated, independent systems.

INSTRUCTOR SUPPLEMENTS

Dynamic Lectures in Half the Time!

NEW! Media Manager

combines all instructor and student media for Fundamentals of Anatomy & Physiology, Seventh Edition into the ultimate chapter-by-chapter resource.The package includes seven CDs plus a foldout Quick Reference Guide.The CDs contain all of the art from the book. A special collection of Precision Art has Figure Edit and Text Edit capabilities that allow instructors to customize the art and labels to the needs of their students. Other resources include powerful animations, three-dimensional images and movies, links to the InterActive Physiology® and Anatomy 360º media programs, PowerPoint® lecture presentations, the Test Bank, and much more!

MEDIA MANAGER INCLUDES CUSTOMIZABLE ART!

Precision Art

lets you tailor the art from the book to your classroom needs in two ways:

Figure Edit art facilitates step-by-step presentation of complex topics.

Text Edit art allows you to edit terms and labels in the figure.

In addition to the features displayed on this screen, the Media Manager offers:

  1. • All images from the text, in labeled, unlabeled, and leadered-only versions

  2. • Over 120 animations

  3. • More than 50 three-dimensional anatomical presentations with peel-away, flythrough, and panoramic views

  4. • Chapter-specific links to the InterActive Physiology and Anatomy 360º media programs

  5. • Active Lecture Questions, for in-class projection, that students can respond to using personal response systems (in H-ITT or PRS formats), for easy checking of comprehension

  6. • An Additional Resources section, including MRI and CT Scans, Histology images, the Instructor's Manual, the A&P Applications Manual, and more.

INSTRUCTOR SUPPLEMENTS

Everything You Need to Teach Your Course Your Way

Transparency Acetates

package includes more than 800 high-quality acetates with all of the art from the text in enhanced colors with enlarged figure labels for use in lecture halls.

Instructor's Manual

includes lecture sugges tions, vocabulary aids, applications, and classroom demonstrations to help you prepare for the classroom.A chapter-by-chapter Quick Reference Guide of all available media helps you organize your presentations.

Test Bank and Computerized Test Bank

include more than 3,000 questions organized into the text's three-level learning system for designing a variety of tests and quizzes. Available in both a print version and TestGen software.

MyA&P,WebCT,and Blackboard

provide ready-to-as-sign materials in the most widely used course management systems. See the very beginning pages of this text for an overview of MyA&P.

Instructor's Visual Guide

lets you see all of the art and PowerPoint® slides that are available on the Media Manager CD-ROMs in a convenient printed reference guide that you can use when selecting visuals for classroom presentation.

STUDENT SUPPLEMENTS

A Superb Student Learning Package

Included with every new copy of the text:

  1. InterActive Physiology® CD-ROM

  2. • Anatomy 360º CD-ROM

  3. • MyA&P

  4. • Martini's Atlas of the Human Body

  5. • A&P Applications Manual

See descriptions of these components on the inside front cover of this text.

Study Guide

by Charles Seiger provides additional review of basic facts and concepts and practice for developing problem-solving skills.A wide variety of questions, including labeling and concept mapping, are keyed to every learning objective in the textbook and are organized around the text's three-level learning system.

ISBN: 0-8053-7294-6

The Anatomy Coloring Book

by Wynn Kapit and Lawrence M. Elson helps students memorize structures of the body by coloring in line drawings. Use of the coloring book sharpens concentration and increases attention to detail, thereby aiding students in retention of material.

ISBN: 0-8053-7282-2

FOR THE LAB

Manuals That Meet Your Needs

Benjamin Cummings publishes a variety of best-selling laboratory manuals to meet the diverse needs of lab courses.

Laboratory Manual for Anatomy & Physiology

by Michael G.Wood This full-color lab manual has been designed to complement Fundamentals of Anatomy & Physiology, Seventh Edition and includes much of the same high-quality art by illustrators Bill Ober and Claire Garrison.

  1. • Main Version,Third Edition ISBN: 0-8053-7368-3

  2. • Cat Version,Third Edition ISBN: 0-8053-7369-1

  3. • Pig Version,Third Edition ISBN: 0-8053-7370-5

Human Anatomy & Physiology Laboratory Manual

by Elaine N. Marieb

This full-color lab manual guides students through well-planned

lab activities to aid in mastery of the subject.

  1. • Main Version, Seventh Edition Update ISBN: 0-8053-5514-6

  2. • Cat Version, Eighth Edition Update ISBN: 0-8053-5516-2

  3. • Pig Version, Eighth Edition Update ISBN: 0-8053-5518-9

Integrate

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Acknowledgments

This textbook is not the product of any single individual. It represents a group effort, and the members of the group deserve to be acknowledged.

Foremost on my thank you list are the instructors who reviewed the published text of the Sixth Edition and the manuscript for the Seventh Edition to offer the suggestions that helped guide me through the revision process. To them, I express my sincere thanks and best wishes:

Mary E. Allen-Martin, San Antonio College

Nishi Bryska, University of North Carolina—Charlotte

Sarah Caruthers Jackson, Florida Community College—Jacksonville

Clifford L. Fontenot, Southeastern Louisiana University

Karen Hart, Peninsula College

Martin F. Hicks, Community College of Southern Nevada

Bonnie Kalison, Mesa Community College

Marie L. Kotter, Weber State University Circle

Charles Matsuda, Kapi'olani Community College

Karen McCourt, El Paso Community College

Robert McMullen, Pikes Peak Community College

Colin A. Morris, Pensacola Junior College

Christopher Nicolay, University of North Carolina—Asheville

Amy Griffin Ouchley, University of Louisiana—Monroe

Chuck Robinson, Mississippi Gulf Coast Community College

Dee Sato, Goldenwest College

Tamara McNutt Scott, Clemson University

Robert R. Speed, Wallace Community College

Ralph W. Stevens III, Old Dominion University

Janis G. Thompson, D.V.M., Lorain County Community College

Don Wager, Broome Community College

Jyoti R. Wagle, Houston Community College—Central

David Ward, Modesto Junior College

After the initial drafts were completed, five dedicated instructors functioned as technical editors, assisting with the review and correction of page proofs. They have been immensely helpful to me during the revision of this edition:

Gillian Bice, Michigan State University

Kelly J. Johnson, University of Kansas

Alan Magid, Durham Technical Community College

Judi Nath, Lourdes College

Marilyn Shannon, Indiana University—Purdue University Indianapolis

Focus groups and meetings with students helped me concentrate on students' needs. Every day I receive e-mails from faculty members and students who have comments, questions, and suggestions. Their interest in the subject, concern for the accuracy and method of presentation, and wide range of abilities and backgrounds made the revision process an engaging and educational experience for me.

Over time, a textbook evolves. As with organisms, each evolutionary step builds on a preexisting framework. Thus, I also thank the individuals who helped with the development of previous editions:

Maxine A'Hearn, Prince George's Community College

Shylaja Akkaraju, College of DuPage

Ahmed Naguy Ali, Alexandria, Egypt

John Aliff, Georgia Perimeter College

Steven Amdur, Nassau Community College

Paul Anderson, Massachusetts Bay Community College

Karen Apel, University of Wisconsin—Milwaukee

Timothy Alan Ballard, University of North Carolina—Wilmington

Debra Joan Barnes, Contra Costa College

Edwin Bartholomew, Lahainaluna High School

CeCe Barto, Tomball College

Steven Bassett, Southeast Community College

Robert Bauman, Jr., Amarillo College

Dean Beckwith, Illinois Central College

Doris Benfer, Montgomery Community College

Michèle Bertholf, Metropolitan State College and Front Range Community College

Latsy Best, Palm Beach Community College—North

Alfred Beulig, University of South Florida at New College

Charles Biggers, University of Memphis

Greg Bohm, Hillsborough Community College

Mark Bolke, Clark College

Michael Bonnert, University of Toronto

Cynthia Bottrell, Scott Community College

Spencer R. Bowers, Oakton Community College

Mimi Bres, Prince George's Community College

Alan Bretag, University of South Australia School of Pharmacy

C. David Bridges,Purdue University

Sandra Bruner, Polk Community College

Gene Carella, Niagara County Community College

Robert M. Carey, University of Arizona

Wayne Carley, Lamar University

Leslie Carlson, Iowa State University

Catherine Carter, Georgia Perimeter College

Lucia Cepriano, SUNY Farmingdale

William M. Chamberlain, Indiana State University

William D. Chapple, University of Connecticut

Beng Cheah, University of Newcastle

Anthony Chee, Houston Community College

Suzzette Chopin, Texas A & M University—Corpus Christi

Chin Moi Chow, Cumberland College of Health Sciences, University of Sydney

Ana Christensen, Lamar University

O. D. Cockrum,Texas State Technical College

Kim Cooper, Arizona State University

Richard Coppings, Chattanooga State College

William F. Crowley, Harvard Medical School

Grant Dahmer, University of Arizona

Charles Daniels, Kapiolani Community College

Darrell Davies, Kalamazoo Valley Community College

Mary Dawson, Kingsborough Community College

Brent DeMars, Lakeland Community College

Danielle Desroches, William Paterson University

Eric Dewar, Lansing Community College

Charles Dick, Pasco-Hernando Community College

Gerald R. Dotson, Front Range Community College

Ellen Dupre, Indian River Community College

John Dziak, Community College of Allegheny County

Paul Emerick, Monroe Community College

Lee Famiano, Cuyahoga Community College

Lee Farello, Niagara County Community College

Marion Fintel, Jefferson State Community College

Kathleen A. Flickinger, Maui Community College

Ruby Fogg, New Hampshire Tech

Mildred Fowler, Tidewater Community College

Sharon Fowler, Dutchess Community College

Ralph Fregosi, University of Arizona

Denise Friedman, Hudson Valley Community College

Ann Funkhouser, University of the Pacific

Mildred Galliher, Cochise College

Paul Garcia, Houston Community College

Lori K. Garrett, Danville Area Community College

Anthony J. Gaudin, Ivy Tech State College

Michelle Geremia, Quinnipiac University

Jeff Gerst, North Dakota State University

Louis Giacinti, Milwaukee Area Technical College

Delaine Gilcrease, Mesa Community College

Linda Gingerich, St. Petersburg College

Freda Glaser, University of Maryland—Baltimore County

Kathleen M. Gorczyca, North Shore Community College

Bonnie Gordon, Memphis State University

Susan Grigsby, Houston Community College

Mac E. Hadley, University of Arizona

William Hairston, Harrisburg Area Community College

Cecil Hampton, Jefferson College

Ernest Harber, San Antonio College

Jobn P. Harley, Eastern Kentucky University

Ann Harmer, Orange Coast Community College

Linden Haynes, Hinds Community College

Ruth Lanier Hays, Clemson University

Mary Healey, Springfield College

Jean Helgeson, Collin County Community College

Vickie S. Hennessy, Sinclair Community College

Timothy Henry, University of Texas—Arlington

Cynthia Herbrandson, Kellogg Community College

Donna Hoel, Stark Community College

Elvis J. Holt, Purdue University

Jacqueline A. Homan, South Plains College

James Horowitz, Palm Beach Community College

Beth Howard, Rutgers University

Yvette Huet-Hudson, University of North Carolina—Charlotte

Angie Huxley, Pima Community College

George A. Jacob, Xavier University

Renu Jain, Houston Community College

Aaron James, Gateway Community College

Desiree Jett, Essex County College

Kelly Johnson, University of Kansas

Drusilla Jolly, Forsyth Technical Community College

David Kalichstein, Ocean County College

Eileen Kalmar, St. John Fisher College

George Karleskint, St. Louis Community College

Nancy G. Kincaid, Troy State University Montgomery

C. Ward Kischer, University of Arizona

Frank Kitakis, Wayne County Community College

William Kleinelp, Middlesex County College

Michael Kokkinn, University of South Australia School of Pharmacy

Carissa Krane, University of Dayton

Bob Kucera, University of Newcastle

Jerry K. Lindsey, Tarrant County Junior College

Mary Lockwood, University of New Hampshire

Susan Lustick, San Jacinto College—North

Greg Maravellas, Bristol Community College

Dan Mark, Penn Valley Community College

Jane Marks, Scottsdale Community College

Cris Martin, University of Maryland

William Mautz, University of Hawaii—Hilo

Alice Gerke McAfee, University of Toledo Technical College

Thomas W. McCort, Cuyahoga Community College

Mike McCusker, Eastern College

Robert McDonough, Georgia Perimeter College

Ruth McFarland, Mt. Hood Community College

Paul McGrath, University of Newcastle

Michael P. McKinley, Glendale Community College

Eddie McNack, Houston Community College

Roberta Meehan, University of North Carolina

Judy Megaw, Indian River Community College

Richard F. Meginniss, College of Lake County

Beta Meyer, Mount San Antonio College

Ann Miller, Middlesex Community College

Leslie Miller, Iowa State University

Alice Mills, Middle Tennessee State University

Melvin Mills, Scottsdale Community College

Ron Mobley, Wake Technical Community College

Rose Morgan, Minot State University

Aubrey Morris, Pensacola Junior College

Robert L. Moskowitz, Community College of Philadelphia

Richard Mostardi, Akron University

Mahtas Moussavi, Houston Community College

Ann Murphy, Sydney University

Judi Nath, Lourdes College

Elizabeth Naugle, Lane Community College

Martha Newsome, Tomball College

Bill Nicholson, University of Arizona

Auguste Nioupin, Houston Community College

Richard Northrup, Delta College

Erik Nyholm, Umea University

Claire R. Oakley, Rocky Mountain College

John M. Olson, Villanova University

Joyce Ono, California State University—Fullerton

Betty Orr, Sinclair Community College

Mary Theresa Ortiz, Kinsborough Community College

Betsy Ott, Tyler Junior College

Michael Palladino, Monmouth University

David L. Parker, Northern Virginia Community College

Mark Paulissen, Slippery Rock University

Brian K. Paulsen, California University of Pennsylvania

Lois Peck, Philadelphia College of Pharmacy

Philip Penner, Borough of Manhattan Community College

Beverly Perry, Houston Community College

Ingrid Persson, Umea University

Ed Pivorum, Clemson University

Clifford Pohl, Duquesne University

Robert Pollack, Nassau Community College

Dan Porter, Amarillo College

Linda Powell, Community College of Philadelphia

Robert L. Preston, Illinois State University

Gary Quick, Paradise Valley Community College

Anil Rao, Metropolitan State College

Joel Reicherter, SUNY Farmingdale

Peta Reid, Faculty of Nursing, University of Sydney

Jackie Reynolds, Richland College

Chris Riegle, Irvine Valley College

Jean Rigden, Scottsdale Community College

Todd Rimkus, Marymount University

John M. Ripper, Butler County Community College

Carolyn J. Rivard, Fanshawe College

Carolyn C. Robertson, Tarrant County Junior College

Nidia Romer, Miami Dade Community College

Kevin Ryan, Stark Technical College

Kristi Sather-Smith, Hinds Junior College

Frank Schwartz, Cuyahoga Community College

Charles Seiger, Atlantic Community College

Judith Shardo, University of South Alabama

Mark Shoop, Macon College

Marilyn Shopper, Johnson County Community College

Milton Shult, Houston Community College

Sherrie Shupe, Delaware Technical and Community College

Carl Shuster, Amarillo College

P. George Simone, Eastern Michigan University

Sharon Simpson, Broward Community College

Robert A. Sinclair, San Antonio College

Tom Smeaton, University of South Australia School of Pharmacy

David S. Smith, San Antonio College

Jeffery Smith, Delgado Community College

Philip Sokolove, University of Maryland—Baltimore County

Michael Soules, University of Washington

Thomas S. Spurgeon, Colorado State University

Sandra Stewart, Vincennes University

Ann Stoeckmann, Pennsylvania State University—Worthington Scranton

Dennis Strete, Houston Community College

Kris Stuempfle, Gettysburg College

Jenna Sullivan, University of Arizona

Eric Sun, Macon College

P. Swaroop, Houston Community College

Richard Symmons, California State University—Hayward

Robert Tallitsch, Augustana College

Dennis Taylor, Hiram College

Kathy Taylor, University of Arizona

Mark Taylor, Baylor University

Jay Templin, Widener University

Diane G. Tice, SUNY Morrisville

Caryl Tickner, Stark State Technical College

Marge Torode, Cumberland College of Health Sciences, University of Sydney

Lucia Tranel, St. Louis Community College and St. Louis College

Steve Trautwein, Southeast Missouri State University

Pat Turner, Howard Community College

Kent M. Van De Graaff, Brigham Young University

Sheila Van Holst, Faculty of Nursing, University of Sydney

Michael Vennig, University of South Australia School of Pharmacy

Connie Vinton-Schoepske, Iowa Central Community College

Jyoti Wagle, Houston Community College

Jane Wallace, Chattanooga State Technical Community College

Cheryl Watson, Central Connecticut State University

Eva Weinreb, Community College of Philadelphia

Mary Weis, Collin County Community College

Debra A. Wellner, Wichita State University

Mary Pat Wenderoth, University of Washington

Rosamund Wendt, Community College of Philadelphia

Shirley Whitescarver, Lexington Community College

Vernon Wiersema, Houston Community College

J. Wilkinson, School of Biological Sciences, University of Sydney

Stephen Williams, Glendale Community College

Bruce Wingerd, San Diego State University

Eric Wise, University of California—Santa Barbara

Michael G. Wood, Del Mar College

Jamie Young, Chattanooga State Technical Community College

Nancy L. Young, Seattle Pacific University

The accuracy and currency of the clinical material in this edition of the textbook and in the A&P Applications Manual in large part reflect the work of my wife, Kathleen Welch, M.D. Her professionalism and concern for practicality and common sense make the clinical information especially relevant for today's students.

Virtually without exception, reviewers stressed the importance of accurate, integrated, and visually attractive illustrations in helping students understand the content of anatomy and physiology. The revision of the art program was directed by William C. Ober, M.D., and Claire W. Garrison,

R.N. Their suggestions about topics of clinical importance, presentation sequence, and revisions to the proposed art were of incalculable value to me and the project. The illustration program for this edition was further enhanced by the efforts of two other talented individuals. Jim Gibson designed most of the new features in the art program and consulted on the design and layout of individual figures. His talents have helped produce an illustration program that is attractive, cohesive, and easy to understand. Anita Hylton helped to create the new photo/art combinations which provide a greater sense of realism in important anatomical figures.

Many of the text's illustrations include color photographs or micrographs collected from a variety of sources. The striking anatomical photos in the text, in Martini's Atlas of the Human Body, and in the Laboratory Manual for Anatomy & Physiology by Michael G. Wood are the work of Ralph T. Hutchings, whose efforts on this project are deeply appreciated. Dr. Eugene C. Wasson III and the staff of Maui Radiology Consultants, Inc., provided valuable assistance in the selection and printing of many of the CT and MRI scans included in the revised Atlas.

I also express my appreciation to the editors and support staff at Benjamin Cummings. First on the list is Nicole George, Project Editor for my texts, who somehow managed to handle every crisis and kept things moving in the right direction. Her support, hard work, and patience are deeply appreciated.

I owe special thanks to my editor, Leslie Berriman, for her creativity and dedication. Her vision helped shape this book in countless ways. I also owe thanks to Kim Neumann for her creative efforts on the media supplements and for generating new media components for incorporation into the MyA&P course management program, the Media Manager instructor presentation CDs, and the Anatomy and Physiology Place website for Martini.

Alan Titche, my Development Editor, played a vital role in fashioning the Seventh Edition. I could not have survived this process without him, and his unfailing attention to detail and quality made a tremendous difference in the final package.

Thanks are also due to the rest of the editorial team, including Michael Roney and Blythe Robbins, for their assistance with the integrated supplements package.

This book would not exist without the extraordinary dedication of the production team, including Debbie Cogan, Corinne Benson, and Heather Johnson, who solved many problems under pressure with unfailing good cheer.

Thanks to Mark Ong, Kathleen Cunningham, and Yvo Riezebos for this edition's stunning and effective interior and cover designs. I am grateful to Lillian Carr, Creative Director, for her spectacular designs of the media packages and this book's Visual Introduction. I would also like to express my gratitude to Linda Davis, President of Benjamin Cummings; Daryl Fox, Publisher; Lauren Fogel, Director of Media Development and Publishing Technology; Stacy Treco, Director of Marketing; and Lauren Harp, Executive Marketing Manager, for their continuing support of this project.

No one person could expect to produce a flawless textbook of this scope and complexity. Any errors or oversights are strictly my own rather than those of the reviewers, artists, or editors. To help improve future editions, I encourage you to send any pertinent information, suggestions, or comments about the organization or content of this textbook to me directly, using the following e-mail address. I will deeply appreciate any and all comments and suggestions and will carefully consider them in the preparation of the Eighth Edition.

Frederic H. Martini

martini@maui.net

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