Liver

Question 1

Liver

Answer 1

• The liver is the largest gland in the body and can weigh up to 2.3kg in the adult, and is described as having two lobes.
• Following absorption in the small intestine the nutrient rich blood passes via the Portal vein to the liver

Question 2

•Blood leaves the liver via the Hepatic veins, which almost immediately enter the inferior vena-cava

Answer 2

The liver has many functions, those which are associated with the digestive process include

Question 3

The liver has many functions, those which are associated with the digestive process include

Answer 3

• Conversion
• Breakdown
• Production
• Secretion
• Storage
• Synthesis
• metabolism

Conversion of excess amino acids to urea

Conversion of excess glucose to glycogen

Breakdown of stored fat, for use by the body tissues to produce energy

Production of heat

Secretion of bile

Storage of vitamins A,D,E,K,B12, iron and copper

Synthesis of plasma proteins, including blood clotting factors

Inactivation of drugs and hormones

Metabolism of alcohol

Question 4

Functions of Liver

Answer 4

S G - Conversion of excess glucose to glycogen

T I - Iron and copper

O V - Storage of vitamins A,D,E,K,B12,

R E - Breakdown of stored fat, for use by the S body tissues to produce energy

•

Produces H - Production of heat

U - Conversion of excess amino acids to urea

B - Secretion of bile

•dures

DESTORYS P – Breaks down poisons

A - Metabolism of alcohol

D - Inactivation of drugs and hormones

•

•Synthesis of plasma proteins, including blood clotting factors

Question 5

Pancreas

Answer 5

•The pancreas is situated posterior to the stomach and anterior to the abdominal aorta and inferior vena cava

•

•It has two main functions………

Question 6

Functions of pancreas

Answer 6

• Production of pancreatic juice which is secreted into the duodenum via the pancreatic duct
• •Realses Glucogon
• Production of insulin :- Insulin is a hormone produced by specialised cells in the pancreas called the “Islets of Langehans”

glucose blood stream

glycogen stores liver

glcogon realsed from pancreases

glcolysis

Question 7

Peritoneum

Answer 7

•A serous membrane which lines the abdomen and covers the abdominal organs

•

•It prevents friction as the organs move against each other and helps to keep them in position

Question 8

Organs covered by the peritoneal lining

Answer 8

• Spleen
• Liver
• Stomach
• Gall bladder

Bowel

Question 9

Other Abdominal and Pelvic Organs

Answer 9

• Spleen – peritoneal
• Kidneys – retroperitoneal
• Bladder and Ureters - retroperitoneal
• Urethra – pelvic abdomen
• Ovaries, Uterine tubes and Uterus [female] - pelvic

Question 10

Spleen

Answer 10

•Lies in the left hypochondrial region of the abdominal cavity, between fundus of the stomach and the diaphragm

•

•Size varies but usually approx. 12cm long, 7cm wide and 2.5cm thick

•

•Weighs approx. 200g

Question 11

Functions of the Spleen

Answer 11

• Produce new leucocytes (white blood cells) and lymphocytes
• Store erythrocytes (red blood cells)
• Destroy old red blood cells

Question 12

regions of adominal

Answer 12

Question 13

Pancrease

Answer 13

12-15cm long

Produces and releases

1. Digestive enzymes into the duodenum via pancreatic duct (exocrine function)
2. Insulin and Glucagon directly into the blood (endocrine function)

Contains specialised endocrine cells called ‘Islets of Langerhans’ which contain 4 types of hormone secreting cells

Question 14

Islets of Langerhans

Answer 14

• Alpha Cells – secrete the hormone Glucagon which raises the blood glucose levels
• Beta Cells - secrete the hormone Insulin which lowers blood glucose level by allowing it to pass into the cells that need it.
• Delta Cells – secrete growth hormone inhibiting cells (GHIH) or somatostatin, inhibiting secretion of Insulin and Glucagon
• F – Cells – secrete pancreatic polypeptide which regulates digestive enzymes

Question 15

INSULIN

Answer 15

A naturally produced hormone

Insulin is released in response to rising blood glucose levels

Insulin is required to ‘unlock’ the cells to allow the glucose to enter and be transformed into energy.

Also converts excess glucose to glycogen for storage in the liver. This is called glycogenesis.

Question 16

Types of Diabetes Mellitus

Answer 16

Types of Diabetes Mellitus

• Type 1
• Insulin Dependant Diabetes Mellitus (IDDM)
• Sudden onset
• More common in children and young adults

•

• Type 2
• Non Insulin Dependant Diabetes Mellitus (NIDDM)
• Gradual onset
• More common in the over 40 age group
• May require Insulin as the disease progresses

Question 17

Type 1 Diabetes

Answer 17

1. Autoimmune disease
2. Beta calls in the pancreas are destroyed
3. No insulin produced
4. Glucose cannot get into the cells to produce energy.
5. This accounts for 10% of all cases in the UK

Question 18

Type II Diabetes

Answer 18

1. This is more complex than Type I as more factors are at work
2. Insulin may be less effective
3. Cells may not respond as well to it
4. This is more common than Type 1 accounting for 90% of all cases in the UK.

Question 19

Hyperglycaemia

Answer 19

1. •The body attempts to reduce the high glucose levels in the blood
2. •One way is via the kidneys causing excessive urine output (Polyuria) and glucosuria
3. •Patients lose a lot of water leading to an excessive thirst (Polydipsia)
4. •The body also tries to remove Ketones, a complication of too much glucose, through the lungs.
5. •Deep sighing respirations and have an acetone / pear drop smell on their breath (1 person in 4 cannot smell this)
6. This is called Kaussmaul’s respirations.
7. •The signs and symptoms of Hyperglycaemia become evident over a number of hours or days.
8. •he cells still require energy which leads to excessive eating (Polyphagia)

Question 20

Management of Hyperglycaemia

Answer 20

ABCD assessment and manage any problems appropriately.

Measure and record the blood glucose level

Assess for dehydration , SpO2 levels and record ECG

These patients should be managed in hospital.

A Paramedic may be required to administer IV fluids if the patient is hypovolemic.

e patients should be managed in hospital.

A Paramedic may be required to administer IV fluids if the patient is hypovolemic.

Question 21

Hypoglycaemia

Answer 21

•This is defined as blood sugar reading of less than 4mmol/l

•

• Symptoms come on very quickly over minutes
• Example causes:

–Overdose of medication

–Excessive exercise

–Not enough food

–Alcohol

–Recent or current illness

Question 22

Hypoglycaemia – signs and symptoms

Answer 22

• Sweating
• Palpitations
• Shaking
• Hunger
• Headache
• Nausea
• Drowsiness
• Odd / aggressive behaviour
• Speech difficulties
• Fitting
• Confusion
• Unconsciousness

Question 23

Management of Hypoglycaemia

Answer 23

• Assess ABCD’s and correct any problems
• BM pre and post-treatment

Conscious and able

Encourage oral carbohydrates

üSugary milk

üDextrose tablets

üToast and Jam

üHypostop gel

ü

TAKE EXTREEME CARE WITH AIRWAY

Lowered GCS

• IM Glucagon
• IV Glucose (Paramedic)

Question 24

Hypoglycaemia clinical performance indicator (CPI)