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Go to evolve.elsevier.com/shop to search and browse for products. 2019v1.0 EDITION 7 The Human Body in Health and Illness Barbara Herlihy, BSN, MA, PhD (Physiology), RN Professor Emerita of Biology University of the Incarnate Word School of Mathematics, Science, and Engineering San Antonio, Texas Elsevier 3251 Riverport Lane St. Louis, Missouri 63043 THE HUMAN BODY IN HEALTH AND ILLNESS, SEVENTH EDITION ISBN: 978-0-323-71126-5 Copyright © 2022 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2018, 2014, 2011, 2007, 2003, and 2000. Library of Congress Control Number: 2020943614 Executive Content Strategist: Lee Henderson Senior Content Development Manager: Laurie Gower Senior Content Development Specialist: Laura Selkirk Publishing Services Manager: Julie Eddy Senior Project Manager: Rachel E. McMullen Design Direction: Renee Duenow Printed in India Last digit is the print number: 9 8 7 6 5 4 3 2 1 To all who live wisely and compassionately. Wisely in seeing the divine in each other, our fur friends, and Mother Earth, and Compassionately in drawing the excluded into this sacred circle of life. Everything belongs! Love, Barbara Acknowledgments The publishing and republishing of an anatomy and rewrote, and photocopied in the midst of being a mom physiology text require the combined efforts of many to my three adorable, very mobile, and vocal grand- persons with diverse talents. I have been blessed to children. Whew! Thanks to my children, grandchildren work with many generous and talented individuals (grand total . . . five, from toddler to teen, all great in at Elsevier and offer my grateful thanks, especially to their own way), and friends for their insistence on lei- Melissa Rawe—always available, helpful, and ever- sure and play; they are in charge of my mental health. encouraging. Special thanks also to Lee Henderson I highly recommend “grannyhood”—it is beyond joy who gently, efficiently, and wisely kept it all moving and gets better! forward. Thanks to my fur baby, Annie (woof), for the hours Many thanks also to my students, friends, and ad- she hovered around me and my laptop. As usual, a ministration at the University of the Incarnate Word. special acknowledgment to my beloved dachshund, They have graciously supported me through all seven Pretzyl, who labored so hard on the first two editions. editions. A word of gratitude to the Sisters of Charity Six other furry helpers—Julia, Kenner, Cajun, Zeke, of the Incarnate Word for their vision and commitment Lucy, and Minky—are missed but certainly not for- that enlivens the university and the community it gotten. These fur babies gave me so much pleasure serves. Love them! A special thanks to Dr. Bonnie Mc- and are now hopping around together on Rain- Cormick, a colleague and friend for many years who bow Bridge. A well-fed and sassy feral cat popula- thankfully kept me out of meetings and in the class- tion (five beauties) has been added; other “rescues” room. And that, my friends, was an enormous act of have followed and are “indoor dwellers”—Micky kindness . . . and profoundly appreciated. and Frankie. To all of you who humor me about my Thanks to my husband, Jerry, kind, most often pet collection and devotion, many, many thanks for patient, and always carefully critical (emphasis on understanding. carefully). He has contributed much to this text by Last but certainly not least, many thanks to those constructing tables, proofreading, and offering many who used previous editions and were kind enough to helpful hints; he, too, is a physiologist. Thanks to my forward comments and suggestions. Your assistance is daughter Kellie, a nurse practitioner, who proofread, so appreciated. Keep the comments coming! iv To the Instructor Again, with enthusiasm and wonder, here is the sev- even two) allows. This text focuses on the physiology enth edition of The Human Body in Health and Illness— that is basic and most clinically relevant. Pathophysi- older, wiser, still smiling, and eager to walk with you ology is introduced primarily to clarify physiological on your journey into the health professions. It’s an ex- function. For instance, the different types of anemias citing journey for all, instructors and students, as we illustrate the various steps in the making and sustain- study and ponder the wisdom of the human body. ing of healthy red blood cells. A second concern has The Human Body in Health and Illness tells the story to do with the recognition that we are not preparing of the human body with all its parts and the way these physiologists; instead, we want the student to be able parts work together. It is a story that we have told to use the physiology to understand clinically relevant many times in our classes. It is also a story that gets content such as pathophysiology, physical assessment, better with each telling as the body continues to reveal diagnostics, and pharmacology. An understanding of its mysteries and how marvelously it has been created. physiology is crucial for advancement in the medically I hope that you enjoy telling the story as much as I do. related sciences. The Human Body in Health and Illness is a basic anat- omy and physiology text addressed to the student TEXTBOOK STRENGTHS preparing for a career in the health professions. It is written for students with minimal preparation in the • Anatomy and physiology are clearly and simply sciences; no prior knowledge of biology, chemistry, explained. A meticulously prepared set of illustra- or physics is required. The text provides all the back- tions—complete with amusing cartoons—supports ground science information needed for an understand- the text. In fact, the story of the body is told as much ing of anatomy and physiology. through the art as through the written word. The basic principles of chemistry and biochemistry • The text truly integrates pathophysiology; it is not are presented in Chapters 2–4, and they set the stage merely boxed in or tacked on at the end. The inte- for an understanding of cellular function, fluid and grated pathophysiology is used primarily to amplify electrolyte balance, endocrine function, and digestion. the normal anatomy and physiology. The expanded Chapter 5, Microbiology Basics, presents clinically Medical Terminology and Disorders tables and fre- relevant microbiological topics. Check out the stories quent references to common medical terminology “Rick, Nick, and the Sick Tick” and “Dr. Semmelweis allow the text to be used for an introductory course Screams: ‘Wash Those Mitts!’” The latter is an amus- in pathophysiology and medical terminology. ing presentation of a sad tale in the history of medicine • In addition to the pathophysiology, other topics are and corresponds to the current emphasis on hand hy- liberally integrated throughout the text. These in- giene and health care–associated infection. clude common diagnostic procedures such as blood The anatomy and physiology content is presented count, lumbar puncture, urinalysis, and electrocardi- in a traditional order, from simple to complex. The ography. Pharmacological topics are also introduced text begins with a description of a single cell and pro- and, like the pathophysiology, are used to amplify gresses through the various organ systems. There are the normal anatomy and physiology. For instance, two key themes that run throughout the text: (1) the the discussion of the neuromuscular junction is en- relationship between structure and function—the stu- hanced by a description of the effects of the neuro- dent must understand that an organ is anatomically muscular blocking agents. Because of the effort of the designed to perform a specific physiological function; text to make clinical correlations, it sets the stage for and (2) homeostasis—the role that each organ system the more advanced health science courses, including plays in sustaining life and what happens when that pharmacology and medical-s urgical nursing. delicate balance is disturbed. • As You Age boxes list major physiologic changes The text addresses two concerns about the selec- the occur with aging. tion of content. The first has to do with the amount of • Move It boxes describe the physiologic changes as- content. The field of anatomy and physiology is huge; sociated with exercise. therefore there must be a selection of content that can be • Re-Think and Go Figure boxes are liberally dis- mastered in the short period of time that a semester (or tributed throughout each chapter and encourage v vi TO THE INSTRUCTOR students to master that content before progressing 3. Provide review for students engaged in pathophysi- through the chapter. Ramp It Up! boxes develop se- ology and pharmacology whose memories need to lected clinically relevant topics that are simply too be refreshed in the physiology. advanced to be included in the text as basic informa- STUDY GUIDE tion. These boxed features contain new or advanced content commonly used in the clinical setting and The Study Guide for The Human Body in Health and Ill- allow instructors to scale their coverage in a man- ness offers something for students at all levels of learn- ner appropriate to the course. They offer students ing and is a ready-made resource for instructors look- the chance to make further connections between the ing for homework assignments. Each chapter includes text and their future careers. (See the To the Student two parts: Part I, Mastering the Basics, with matching, preface on page ix for descriptions and examples of labeling, and coloring exercises; and Part II, Putting It each of the chapter features.) All Together, containing multiple-choice questions, case • Medical terminology is introduced, defined, and studies, and word puzzles. Textbook page references used throughout the text. Common clinical terms are included with the questions, and the answer key is such as hyperkalemia, vasodilation, hypertension, and available on the Evolve website, only to instructors.  diagnosis are defined and reused so that the stu- EVOLVE INSTRUCTOR LEARNING RESOURCES dent gradually builds up a substantial medical vo- cabulary. The expanded Medical Terminology and The Evolve website for The Human Body in Health and Disorders tables were deliberately constructed to Illness (http://evolve.elsevier.com/Herlihy) includes maximize the use of common medical terms and all of the Student Resources, as well as the following disorders. To help foster a broader understanding Instructor Resources: of medical terminology, word parts and their mean- • Answer Key for the Study Guide, Audience Re- ings are included for nearly every term presented. sponse System questions, Image Collection, and Ex- Repetition of these helps students gain greater amView Test Banks that include over 2300 questions! ground in understanding the very specific medical • Instructor’s Chapter Exams, Classroom Activities— language they will be learning to use for a future including Bingo, Line ‘Em Up, Sorting, and Word in the health professions. A description is also pro- Puzzles—and the TEACH Instructor Resource. vided, which gives the definition or other pertinent information on the topic. TEACH Instructor Resource on Evolve • The Review Your Knowledge section has been ex- Instructors who adopt the textbook will also receive ac- panded to include questions that require an ana- cess to the TEACH Instructor Resource, which links all lytical response. The Go Figure questions are based parts of the Herlihy educational package with custom- on the story told by the artwork. The questions can izable Lesson Plans based on objectives drawn from only be answered by analyzing the art and/or the the text. The TEACH Lesson Plans are based on the information presented in the tables. This exercise chapter-by-chapter organization of The Human Body encourages the student to see beyond the “pretty in Health and Illness and can be modified or combined pictures” and realize that a picture is truly worth a to meet your curriculum’s scheduling and teaching thousand words. I would encourage you to assist needs. your students to see that the art and the text are con- TEACH has been completely updated and revised veying the same message. for this edition. The TEACH Lesson Plans help instruc- • The text is supported by many activities, exercises, tors prepare for class and make full use of the rich ar- puzzles, and games (e.g., Body Bingo) on Evolve ray of ancillaries and resources that come with the text- (http://evolve.elsevier.com/Herlihy). These activi- book. The content covered in each textbook chapter is ties emphasize the focus of this text—clinically rel- divided across one or more lesson plans, each designed evant anatomy and physiology. to occupy 50 minutes of class time. Lesson plans are • Last, the text incorporates many amusing anecdotes organized into easily understandable sections that are from the history of medicine. Although the human each tied to the chapter learning objectives: body is perfectly logical and predictable, we hu- • Instructor Preparation: This section provides a mans think, do, and say some strange things. Tales checklist of all the things you need to do to prepare from the medical crypt provide some good laughs for class, including a list of all the items you need to and much humility.  bring to class to perform any activity or demonstra- tion included in the lesson plan. • Student Preparation: Textbook readings, study guide CLASSROOM RESOURCES exercises, online activities, and other applicable home- Materials from the Study Guide and Evolve Instructor work assignments for each lesson are provided here, Learning Resources can be used to: along with an overall estimated completion time. 1. Remediate students who are having difficulty in • The 50-Minute Lesson Plan: A lecture outline that grasping the content. reflects the chapter lecture slides that come as part of 2. Remediate students who have missed class(es). TEACH is included, as well as classroom activities TO THE INSTRUCTOR vii and online activities, one or more critical thinking Plan section. An easy-to-use table maps each assess- questions, and time estimates for the classroom lec- ment tool to the lesson plans and chapter objectives ture and activities. so that you can see all your assessment options—by • Assessment Plan: To ensure that your students chapter, by lesson, and by objective—and choose have mastered all the objectives, the TEACH In- accordingly. structor Resource includes a separate Assessment To the Student This book will take you on an amazing journey through MOVE IT the human body. You will learn many body parts and, more importantly, how they work in an integrated This feature describes the physiologic effects of exercise. manner to keep you going. You will use this informa- It supports the view that “sitting is the new smoking.” tion in your clinical practice when patients become ill Hence, the title Move It.  with disorders of those structures. The following spe- GO FIGURE cial features were created to help make learning enjoy- able and fun. The Go Figure boxes contain questions that relate to the figures and art work. The questions prompt the TEXTBOOK FEATURES reader to integrate the figures with the story related in the text.  KEY TERMS MEDICAL TERMINOLOGY AND DISORDERS TABLES Key terms are listed at the beginning of each chapter, These tables describe medical terms and specific dis- along with a page reference. Each is (1) presented in orders related to individual body systems, with a the text in blue print, (2) accompanied by a pronuncia- focus on developing a strong working medical vo- tion guide, (3) thoroughly explained within the chap- cabulary, which is necessary for a career in the health ter, and (4) defined in the glossary.  professions.  OBJECTIVES END-OF-CHAPTER FEATURES Numbered objectives identify the goals for each Summary Outline chapter.  A detailed outline at the end of each chapter summa- rizes key concepts and serves as an excellent review ILLUSTRATIONS of the chapter content. Use it as a study tool to review Original illustrations and full-color cartoons help you your reading and prepare for exams.  make sense of anatomy and physiology using humor, Review Your Knowledge clarity, and insight.  The matching and multiple-choice questions in this DO YOU KNOW section cover the major points of the chapter and allow Most of these boxed vignettes refer to clinical situations; you to test your comprehension.  others relate to interesting and amusing historical ANSWERS TO REVIEW YOUR KNOWLEDGE AND events related to anatomy and physiology.  GO FIGURE QUESTIONS RAMP IT UP! The Appendix contains answers to all Review Your Knowledge and Go Figure questions found in the These features challenge you with more advanced anatomy and physiology topics.  textbook.  GLOSSARY RE-THINK The glossary includes a pronunciation guide and a These questions are liberally placed throughout the brief definition of all key terms and many other words chapter to help reinforce important concepts.  in the text.  AS YOU AGE STUDY GUIDE These boxed features contain numbered lists describing Enhance your learning of the textbook content with the how the aging process affects human anatomy and accompanying Study Guide for The Human Body in physiology.  Health and Illness. The Study Guide has something SUM IT UP! to offer students at all levels of learning, from labeling and coloring exercises to multiple-choice practice tests These features appear regularly throughout the chap- and case studies. ters and help you synthesize key concepts.  viii