Hepatic Portal System Blood Glucose DKA and Insulin Shock
9/19/2014 MDufilho 1 Figure 19.29c Veins of the abdomen.
Hepatic veins
Inferior vena cava Hepatic portal vein Splenic vein
Right gastroepiploic vein Inferior mesenteric vein
Superior mesenteric vein
Small intestine Large intestine
Rectum
The hepatic portal circulation. MDufilho 9/19/2014 2 Figure 19.29a Veins of the abdomen. Inferior vena cava
Inferior phrenic veins Cystic vein Hepatic veins
Hepatic Hepatic portal vein portal system Superior mesenteric vein Splenic vein
Suprarenal veins Inferior mesenteric Renal veins vein Gonadal veins
Lumbar veins
R. ascending L. ascending lumbar vein lumbar vein
Common iliac veins External iliac vein
Internal iliac veins
MDufilho Schematic flowchart. 3 9/19/2014 Blood Glucose • Primary Use? • Storage? • Hormonal Control?
9/19/2014 MDufilho 4 Figure 16.19 Insulin and glucagon from the pancreas regulate blood glucose levels. Stimulates glucose uptake by cells
Insulin Tissue cells
Stimulates glycogen formationw Pancreas Glucose Glycogen Blood Liver glucose falls to normal range.
Stimulus Blood glucose level
Stimulus Blood glucose level Blood glucose rises to normal range.
Pancreas
Glucose Glycogen
Liver Stimulates glycogen Glucagon MDufilho breakdown 5 9/19/2014 Blood Glucose Values • Normal (fasting) = 70-120 mg/dl (mg/100ml)
• Hypoglycemia = <60 mg/dl S&S? weak, light-headed, syncope, nausea, “shaky,” LOC, combative “Rebound Hypoglycemia”
• Hyperglycemia = >140 mg/dl S&S? – Usually none until damage of microcirculation is done – Common in DM … possibly producing DKA • “Juicy Fruit” breath common in DKA • pH causes LOC and Diabetic Coma
9/19/2014 MDufilho 6 Diabetic Ketoacidosis (DKA) • Cells are burning FAs instead of glucose • Ketones are produced faster than liver can process them • pH of blood (acidosis) due to excess ketones • S&S (g r a d u a l onset): – Hyperglycemia – “fruity” acetone breath – abdominal pain (generalized) w N&V – Glucosuria & dehydration & polydipsia due to G > 300 mg/dl – pH causes compensatory rapid & deep ventilations – pH causes LOC (also due to vasoconstriction
resulting from low CO2 – pH causes possible diabetic coma
9/19/2014• Trtmt : hospitalization (severalMDufilho days)… no quick fix 7 Insulin Shock • Severe hypoglycemia due to misuse of insulin • Common in Type 1 DM • Scenario… • S&S (rapid onset): – Light headed w possible fainting – Weak & “shaky” – LOC – Irritable & combative • Trtmt: If conscious – sugar by mouth If unconscious – dextrose by injection • and possibly glucagon by injection
9/19/2014 MDufilho 8