Hepatic Portal System Blood Glucose DKA and Insulin Shock 9/19/2014 MDufilho 1 Figure 19.29c Veins of the abdomen. Hepatic veins Gastric veins Liver Spleen 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 .