DISCHARGE PLAN:

Medications

Instruct patient to take all medications that were prescribed and discuss the dosage, action, side

effects, and contraindications of those drug. Exact dosage is important as well as proper timing

for the drug to be effective.

Warn the patient of the side effects because it may be uncomfortable to the patient.

Also, to tell the patient to avoid taking medicines that is not prescribed by the doctor.

Remind the patient to report to the physician if adverse effects occur.

Advise client to supplement with multivitamins to provide added nutrition.

Exercise/Environment

Tell patient to avoid exerting too much effort on muscles such as doing strenuous exercises to

avoid injury.

Avoid places that are stress provoking to facilitate fast recovery of the patient.

Treatment

Discussing the purpose of treatments to be done and continued at home and continue

monitoring blood pressure.

Tell patient to continue submitting self to diagnostic examination to make sure that she is not

having any complications.

Tell patient to follow advice of physician or any other health care provider.

Health Teaching

Encouraged client to provide adequate rest periods to avoid stress.

Instructed patient to clean wound daily and dress it properly to avoid infection.

Encouraged patient to be more hygienic.

Impart to patient to have follow-up check-ups.

Outpatient Referral

Remind patient and family that frequent check-ups are important to improve her condition and

maintain optimum balance of wellness.

Inform family to report for any abnormalities as soon as possible to prevent further

complications.

Diet

Advised patient to eat healthy food such as fruits and vegetables and less intake of fatty food.

Salt is okay for patient to add in her food as long as it is not that salty or less than 1.76 g. per

day.

Advised patient to drink milk 3 times a day to provide calcium to her body and have stronger

bones.

Advised client to eat food rich in protein to aid in tissue repair since she had her post operation

for fast recovery.

OBJECTIVES:

General

This case study aims that the students and the readers will gain knowledge and further

understanding about Severe Preeclampsia and Gestational Diabetes.

Specific

To be able to:

1. Choose a patient who has an illness that is in favor of our choice;

2. Interview the patient comprehensively;

3. Construct an overview related to the diseases of the patient studied in this case;

4. Gather necessary information about our patient’s personal data including family

background, socio-economic and educational status, and lifestyle;

5. To outline the health history of the patient;

6. To create a graphic representation of a family tree that displays data on relationships

among individuals and history of diseases by means of a Genogram;

7. Gather information about the patient’s physical developmental data;

8. Define terminologies mentioned in the diagnosis;

9. Discuss human anatomy and physiology related to our case;

10. To identify the factors that may lead to the onset of disease and enumerate their different

signs and symptoms exhibited by our patient;

11. Trace the pathophysiology of Severe Preeclampsia and Gestational Diabetes and

associate it with other diseases experienced by our patient;

12. Interpret lab results accurately and relate its significance to the condition of the patient;

13. Discuss the medications given to the client which include the action, indication,

contraindication, side effects, drug interactions, and its nursing responsibilities.

14. Find and relate the different nursing theories that is appropriate to our patient;

15. Discuss the planned nursing management of the patient;

16. Educate the patient and his family by giving information and additional knowledge about

our patient’s diseases in order to promote awareness of the diseases to prevent further

complications;

17. Create a discharge plan by using the M.E.T.H.O.D system which is applicable to the

patient;

18. Identify and discuss the prognosis of the patient;

19. Acknowledge the reference of the study;

PROGNOSIS:

CRITERIA POOR FAIR GOOD RATIONALE

ONSET OF ILLNESS

Our patient found out about

her condition and her being

pregnant on her 2nd month. It

was during her 1st pre-natal

check-up when she learned

she had pre-eclampsia and

she started being conscious

with her diet by sometimes

minimizing foods rich in salt

and sugar during her 1st

trimester. However, there

were still times that she

wasn’t able to resist eating

such foods since those were

her favorites, and instead,

consumed them in large

amounts.

DURATION OF

ILLNESS

Her illness started during her

1st -2nd trimester and is still

monitored up to the present

since she was advised by her

physician to continuously

check her blood sugar levels.

ENVIRONMENTAL

FACTOR

Mrs. Ecly is having a hard

time budgeting their money

since she has no job and only

her husband works for their

living but she is able to

budget their money and relax

to overcome the stress she

underwent during her

pregnancy. Her place

however is small but clean

just enough for both her and

husband to live properly.

WILLINGNESS TO

TAKE THE

MEDICATIONS

The patient is willing to take

and comply with her

treatment regimen because

she knows it is for her own

benefit.

AGE

The patient’s age is 35.

Preeclampsia is common

with ages 35 and above as

well as 20 and below.(

http://www.healthsystem.vir

ginia.edu)

FAMILY SUPPORT

Her family supports her

especially his husband who

was with her most of the

time during her pregnancy

and hospitalization.

PRECIPITATING

FACTORS

The patient has family

members with diabetes, two

aunts from her mother’s side

and hypertension from her

grandmother and uncle both

from her father’s side.

Poor………0x1=0

Fair……….4x2= 8

Good……...3x3=9

Total: 17/7=2.4

Legend Range

Poor=1 1.0-1.6

Fair=2 1.7-2.3

Good=3 2.4-3.0

General Prognosis

The patient has a good prognosis. If she is able to comply with the treatment regimen and

change her lifestyle then there for sure she will recover fast from her illness and thus prolonging

her life.

ANATOMY AND PHYSIOLOGY

Changes during Pregnancy

The physiologic, biochemical, and anatomic changes that occur during pregnancy are

extensive and may be systemic or local. Teleologic alterations during pregnancy maintain a

healthy environment for the fetus without compromising the mother’s health. Although,

sometimes determine small discomfort to the mother.

Gastrointestinal Tract

During pregnancy, nutritional requirements, including those for vitamins and minerals, are

increased, and several maternal alterations occur to meet this demand. The mother’s appetite

usually increases, so that food intake is greater, some women have a decreased appetite or

experience nausea and vomiting. These symptoms may be related to relative levels of human

chorionic gonadotrophin (hCG).

Oral Cavity

Salivation may seem to increase due to swallowing difficulty associated with nausea and if the

pH of the oral cavity decreases, tooth decay may occur. Tooth decay during pregnancy, however,

is not due to lack of calcium in the teeth. Indeed, dental calcium is stable and not mobilized

during pregnancy as is bone calcium.

The gums may become hipertrofic, hiperemic and friable; this maybe due to increased systemic

estrogen. Vitamin C deficiency also can cause tenderness and bleeding of the gums. The gums

should return to normal in the early puerperium.

Gastrointestinal Motility

Gastrointestinal motility may be reduced during pregnancy due to increased levels of

progesterone, which in turn decrease the production of motilin, a hormonal peptide that is known

to stimulate smooth muscle in the gut. Transit time of food throughout the gastrointestinal tract

may be so much slower that more water than normal is reabsorbed, leading to constipation.

Small and Large Bowel and Appendix

The large and small bowel moves upward and laterally, the appendix is displaced superiorly in

the right flank area. These organs return to the normal positions in the early puerperium.

As noted previously, motility is generally decreased and gastrointestinal tone is decreased.

Gallbladder

Gallbladder function is also altered during pregnancy because of the hypotonia of the smooth

muscle wall. Emptying time is slowed and often incomplete. Bile can become thick, and bile

stasis may lead to gallstone formation.

Cardiovascular

Cardiac output (CO) increases 30 to 50%, beginning by 6 wk gestation and peaking between 16

and 28 wk (usually at about 24 wk). It remains near peak levels until after 30 wk. Then, CO

becomes sensitive to body position. Positions that cause the enlarging uterus to obstruct the vena

cava the most (eg, the recumbent position) cause CO to decrease the most. On average, CO

usually decreases slightly from 30 wk until labor begins. During labor, CO increases another

30%. After delivery, the uterus contracts, and CO drops rapidly to about 15 to 25% above

normal, then gradually decreases (mostly over the next 3 to 4 wk) until it reaches the

prepregnancy level at about 6 wk postpartum.

Hematologic

Iron requirements increase by a total of about 1 g during the entire pregnancy and are higher

during the 2nd half of pregnancy—6 to 7 mg/day. The fetus and placenta use about 300 mg of

iron, and the increased maternal RBC mass requires an additional 500 mg. Excretion accounts

for 200 mg. Iron supplements are needed to prevent a further decrease in Hgb levels because the

amount absorbed from the diet and recruited from iron stores (average total of 300 to 500 mg) is

usually insufficient to meet the demands of pregnancy.

Urinary

Postural changes affect renal function more during pregnancy than at other times; ie, the supine

position increases renal function more, and upright positions decrease renal function more. Renal

function also markedly increases in the lateral position; this position relieves the pressure that the

enlarged uterus puts on the great vessels when pregnant women are supine. This positional

increase in renal function is one reason pregnant women need to urinate frequently when trying

to sleep.

Respiratory

Lung function changes partly because progesterone increases and partly because the enlarging

uterus interferes with lung expansion. Progesterone signals the brain to lower CO2 levels. To

lower CO2 levels, tidal and minute volume and respiratory rate increase, thus increasing plasma

pH. O2 consumption increases by about 20% to meet the increased metabolic needs of the fetus,

placenta, and several maternal organs. Inspiratory and expiratory reserve, residual volume and

capacity, and plasma PCO 2 decrease. Vital capacity and plasma PO 2 do not change. Thoracic

circumference increases by about 10 cm. Considerable hyperemia and edema of the respiratory

tract occur. Occasionally, symptomatic nasopharyngeal obstruction and nasal stuffiness occur,

eustachian tubes are transiently blocked, and tone and quality of voice change. Mild dyspnea

during exertion is common, and deep respirations are more frequent.

Dermatologic

Increased levels of estrogens, progesterone, and MSH contribute to pigmentary changes,

although exact pathogenesis is unknown. These changes include melasma (mask of pregnancy),

which is a blotchy, brownish pigment over the forehead and malar eminences; darkening of the

mammary areolae, axilla, and genitals; and linea nigra, a dark line that appears down the

midabdomen. Melasma due to pregnancy usually regresses within a year.

Incidence of spider angiomas, usually only above the waist, and thin-walled, dilated capillaries,

especially in the lower legs, increases.

Metabolism

As the fetus and placenta grow and place increasing demands on the mother, phenomenal

alterations in metabolism occur. The most obvious physical changes are weight gain and altered

body shape. Weight gain is due not only to the uterus and its contents but also to increase breast

tissue, blood and water volume in the form of extravascular and extracellular fluid. Deposition of

fat and protein and increased cellular water are added to the maternal stores. The average weight

gain during pregnancy is 12.5Kg.

Source:

Last full review/revision June 2007 by Haywood L. Brown, MD

Content last modified June 2007

DeCherney,Pernoll-Obstetric & Gynecologic Diagnosis & Treatment

http://www.medstudents.com.br/ginob/ginob5.htm

FEMALE MENSTRUAL CYCLE

Females of reproductive age (anywhere from 11-16 years) experience cycles of hormonal

activity that repeat at about one-month intervals. (Menstru means "monthly"; hence the term

menstrual cycle.) With every cycle, a woman’s body prepares for a potential pregnancy, whether

or not that is the woman’s intention. The term menstruation refers to the periodic shedding of the

uterine lining.

The average menstrual cycle takes about 28 days and occurs in phases: the follicular phase, the

ovulatory phase (ovulation), and the luteal phase.

There are four major hormones (chemicals that stimulate or regulate the activity of cells or

organs) involved in the menstrual cycle: follicle-stimulating hormone, luteinizing hormone,

estrogen, and progesterone.

Follicular phase

This phase starts on the first day of your period. During the follicular phase of the menstrual

cycle, the following events occur:

Two hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH) are

released from the brain and travel in the blood to the ovaries.

The hormones stimulate the growth of about 15-20 eggs in the ovaries each in its own

"shell," called a follicle.

These hormones (FSH and LH) also trigger an increase in the production of the female

hormone estrogen.

As estrogen levels rise, like a switch, it turns off the production of follicle-stimulating

hormone. This careful balance of hormones allows the body to limit the number of

follicles that complete maturation, or growth.

As the follicular phase progresses, one follicle in one ovary becomes dominant and

continues to mature. This dominant follicle suppresses all of the other follicles in the

group. As a result, they stop growing and die. The dominant follicle continues to produce

estrogen.

Ovulatory phase

The ovulatory phase, or ovulation, starts about 14 days after the follicular phase started. The

ovulatory phase is the midpoint of the menstrual cycle, with the next menstrual period starting

about 2 weeks later. During this phase, the following events occur:

The rise in estrogen from the dominant follicle triggers a surge in the amount of

luteinizing hormone that is produced by the brain.

This causes the dominant follicle to release its egg from the ovary.

As the egg is released (a process called ovulation) it is captured by finger-like projections

on the end of the fallopian tubes (fimbriae). The fimbriae sweep the egg into the tube.

Also during this phase, there is an increase in the amount and thickness of mucus

produced by the cervix (lower part of the uterus.) If a woman were to have intercourse

during this time, the thick mucus captures the man's sperm, nourishes it, and helps it to

move towards the egg for fertilization.

Luteal phase

The luteal phase begins right after ovulation and involves the following processes:

Once it releases its egg, the empty follicle develops into a new structure called the corpus

luteum.

The corpus luteum secretes the hormones estrogen and progesterone. Progesterone

prepares the uterus for a fertilized egg to implant.

If intercourse has taken place and a man's sperm has fertilized the egg (a process called

conception), the fertilized egg (embryo) will travel through the fallopian tube to implant

in the uterus. The woman is now considered pregnant.

If the egg is not fertilized, it passes through the uterus. Not needed to support a

pregnancy, the lining of the uterus breaks down and sheds, and the next menstrual period

begins.

Circulatory System

The circulatory system is an organ system that moves nutrients, gases, and wastes to and from

cells, helps fight diseases and helps stabilize body temperature and pH to maintain homeostasis.

This system may be seen strictly as a blood distribution network, but some consider the

circulatory system as composed of the cardiovascular system, which distributes blood, and the

lymphatic system, which distributes lymph.

The main components of the human circulatory system are the heart, the blood, and the blood

vessels. The circulatory system includes: the pulmonary circulation, a "loop" through the lungs

where blood is oxygenated; and the systemic circulation, a "loop" through the rest of the body to

provide oxygenated blood. An average adult contains five to six quarts (roughly 4.7 to 5.7 litres)

of blood, which consists of plasma that contains red blood cells, white blood cells, and platelets.

Two types of fluids move through the circulatory system: blood and lymph. The blood, heart,

and blood vessels form the cardiovascular system. The lymph, lymph nodes, and lymph vessels

form the lymphatic system. The cardiovascular system and the lymphatic system collectively

make up the circulatory system.

Systemic Circulation

Systemic circulation is the portion of the cardiovascular system which carries oxygenated

blood away from the heart, to the body, and returns deoxygenated blood back to the heart.

Arteries always take blood away from the heart, regardless of their oxygenation, and

veins always bring blood back. In general, arteries bring oxygenated blood to the tissues;

veins bring deoxygenated blood back to the heart. In the case of the pulmonary vessels,

however, the oxygenation is reversed: the pulmonary artery takes deoxygenated blood

from the heart to the lungs, and oxygenated blood is pumped back through the pulmonary

vein to the heart. As blood circulates through the body, oxygen and nutrients diffuse from

the blood into cells surrounding the capillaries, and carbon dioxide diffuses into the blood

from the capillary cells.

The release of oxygen from red blood cells or erythrocytes is regulated in mammals. It

increases with an increase of carbon dioxide in tissues, an increase in temperature, or a

decrease in pH. Such characteristics are exhibited by tissues undergoing high

metabolism, as they require increased levels of oxygen.

Pulmonary Circulation

Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-

depleted blood away from the heart, to the lungs, and returns oxygenated blood back to

the heart.

De-oxygenated blood enters the right atrium of the heart and flows into the right ventricle

where it is pumped through the pulmonary arteries to the lungs. Pulmonary veins return

the now oxygen-rich blood to the heart, where it enters the left atrium before flowing into

the left ventricle. From the left ventricle the oxygen-rich blood is pumped out via the

aorta, and on to the rest of the body.

Coronary Circulation

The coronary circulatory system provides a blood supply to the heart.

Heart

The heart pumps oxygenated blood to the body and deoxygenated blood to the lungs

-In the heart there is one atrium and one ventricle for each circulation, and with both a systemic

and a pulmonary circulation there are four chambers in total: left atrium, left ventricle, right

atrium and right ventricle.

Female Reproductive Sytem

Vagina

The vagina is a hollow musculomembranous canal located posterior to the bladder and

anterior to the rectum. It extends from the cervix of the uterus to the external vulva. Its function

is to act as an organ of intercourse and to convey sperm to the cervix so that sperm can meet to

the ovum in the fallopian tube. With childbirth it expands to serve the birth canal. When a

woman is lying on her back the course of the vagina is inward and downward. Because of this

downward slant and the angle of the uterine cervix, the length of the anterior wall of the vagina

is approximately 6-7 cm; the posterior wall is 8-9 cm. At the cervical end of the structure, there

are recesses on all the sides of the cervix, termed fornices. Behind the cervix is the posterior

fornix; at the front, the anterior fornix; and at the sides, the lateral fornices. The posterior fornix

serves as a place for the pulling of semen after coitus; this allows a large number of sperm to

remain close to the cervix and encourages sperm migration into the cervix.

Uterus

The uterus is a hollow, muscular, pear-shaped organ located in the lower pelvis, posterior

to the bladder and anterior to the rectum. The function of the uterus is to receive the ovum from

the fallopian tube; provide a place for implantation and nourishment during fetal growth; furnish

protection to a growing fetus; and, at mmaturity of the fetus, expel it from the woman’s body.

Anatomically, the uterus consists of three divisions; the body or corpus, the isthmus and

the cervix. The body of the uterus is the uppermost part and forms the bulk of the organ. The

lining of the cavity is continuous with that of the fallopian tubes, which enter at its upper aspects.

The portion of the uterus between the points of attachment of the fallopian tubes is termed the

fundus. During pregnancy, the body of the uterus is the portion of the structure that expands to

contain the growing fetus. The fundus is the portion that can be palpated abdominally to

determine the amount of uterine growth occurring during pregnancy, to measure the force of

uterine contractions during labor, and to assess that the uterus is returning to its non-pregnant

state after childbirth. The isthmus is a short segment between the body and cervix. During

pregnancy this portion also enlarges greatly to aid in accomodating the growing fetus. The

cervix, is the lowest portion of the uterus. It represents approximately one-third of the total

uterus size and is approximately 2-5 cm long. Approximately, half of it lies above the vagina and

half extends to the vagina. A central cavity is turned the cervical canal. The opening of the canal

at the junction of the cervix and the isthmus is the internal cervical os; the distal opening to the

vagina is the external os. The level of ther external os is at the level of the ischial spines.

Pelvis

The pelvis serves both to support and protect the reproductive and other pelvic organs. It

is a bony ring formed by four united bones; the two innominate bones which formed the anterior

and lateral portion of the ring, and the coccix and sacrum, which form the posterior aspects. Each

innominate bone is divided into three parts: ilium, ischium and the pubis. The ilium forms the

upper and lateral portion. The flaring superior border of these bones is what forms the

prominence of the hip. The ischium is the inferior portion. At the lowest portion of the ischium

are two projections; the ischial tuberosites. This is the portion of bone on which a person sits.

These projections are important markers used to determine lower pelvic grid. Other important

terms in relation the pelvis are the inlet, the pelvic cavity and the outlet. The inlet is the entrance

to the true pelvis or the upper ring of bone through which the fetus must pass to be born

vaginally. It is at the level of the linea terminalis or is marked by the sacral prominence in the

back. The ilium of the sides and the superior aspects of the symphisis pubis is in the front. If one

looks down at the pelvic inlet, the passageway at this point appears heart-shaped because of the

jutting sacral prominence. It is wider transversely than in the anteroposterior dimension. The

outlet is the inferior portion of the pelvis, or the portion bounded in the back of the coccyx, at the

sided by the ischial tuberositis and in front by the inferior aspect of the symphysis pubis. In

contrast to the inlet of the pelvis, the greatest diameter of the outlet is its anteroposterior

diameter. For the baby to be delivered vaginally, he or she must be able to pass through the inlet,

the cavity and the outlet of the pelvic bone. This is not a problem for an average fetus; it may be

a problem if a mother is a young adolescent who has not yet achieved full pelvic growth or a

woman who has not had an injury.

Ovaries

The ovaries are grayish-white and appear pitted or with minute indentations on the

surface. An unruptured, glistening, clear, fluid-filled graafian follicle (an ovum about to be

discharged) or miniatured yellow corpus luteum often can be observed on the surface of the

ovary. Ovaries are located close to and on both sides of the uterus and the lower abdomen. The

function of the two ovaries is to produce, mature and discharged ova. Ovarian function is

necessary for maturation and maintenance of secondary sex characteristics in females. The

ovaries are held suspended and in close contact with the ends of the fallopian tubes by three

strong supporting ligaments attached to the uterus or the pelvic wall.

Fallopian tubes

The fallopian tubes arise from each upper corner of the uterine body and extend outward

and backward until each opens at its distal end, next to an ovary. Their function is to convey the

ovum from the uterus and to provide a place for fertilization of the ovum by sperm.

Female External Structures

Mons Veneris

The mons veneris is a pad of adipose tissue located over the symphisis pubis, the pubic

bone joint. It is covered by a triangle of coarse, curly hairs. Its purpose is to protect the pubic

bone from trauma.

Labia Majora

The labia majora are two fold of adipose tissue covered by loose connective tissue and

epithelium; they are positioned later to the labia minora. Covered by pubic hair, the labia majora

serves as a protection for the external genitalia and the distal urethra and vagina.

Labia Minora

It is located posterior to the mons veneris spread two hairless fold of connective tissue.

Before the menarch, these folds are fairly small; by childbearing age, they are firm and full; after

menopause they atrophy and again they become smaller.

Vestibule

The vestibule is the flattened, smooth surface inside the labia. The openings to the

bladder (urethra) and the uterus both arise from the vestibule.

Clitoris

The clitoris is a small rounded organ of erectile tissue at the forward junction of the labia

minora. It is covered by fold of skin known as the prepuce. It is sensitive to touch and

temperature and is the center of sexual arousal and orgasm in the female. When the

ischiocavernosus muscle surrounding it contracts with sexual arousal, the venous outflow for the

clitoris is blocked leading to clitoral erection.

Pancreas

The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both

exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing

several important hormones, including insulin, glucagon, and somatostatin). It also produces

digestive enzymes that pass into the small intestine. These enzymes help in the further

breakdown of the carbohydrates, protein, and fat in the chyme.

The pancreas in humans is a solid, elongated, flattened gland about 10 in. (25cm) long, lying

behind the stomach and attached to the back of the abdominal cavity. Its “head” is just to the

right of the mid-line and its “body” and “tail” point slightly upwards and lie just beneath the

extreme edge of the left side of the ribs. The head is closely attached to the first part of the small

intestine, into which the stomach empties partially digested solid and liquid food. It is to this the

pancreas adds its digestive juices, containing enzymes. The tube draining the liver of its bile (the

bile duct) lies just behind the head of the pancreas and usually joins the bowel at the same place

where the fluids from the pancreas enter the bowel.

The exocrine products of the pancreas enter the duodenum (the first part of the small intestine)

through the pancreatic duct. The pancreatic juices are a combination of various enzymes which

help digest foods which have arrived at the duodenum from the stomach. Pancreatic enzymes

break down carbohydrates, proteins, and fats. The pancreas also produces bicarbonate, an

alkaline substance that helps to neutralize the food which has become quite acidic in the

environment created by the stomach.

As an endocrine gland, the pancreas plays a vital role in the processing of sugars (glucose). The

pancreas contains specialized cells, called the islets of Langerhans, which produce two important

hormones: insulin and glucagon. Both of these hormones serve to maintain the appropriate levels

of glucose circulating within the bloodstream.

Insulin

Insulin is secreted by the beta cells of the pancreas in response to high blood sugar, although the

pancreas always secretes a low level of insulin. After a meal, the amount of insulin secreted into

the blood increases as the blood glucose rises. Likewise, as blood glucose falls, insulin secretion

by the pancreatic islet beta cells decreases.

In response to insulin, cells (muscles, red blood cells, and fat cells) take glucose in from the

blood, which ultimately lowers the high blood glucose levels back to the normal range.

Glucagon

Glucagon is secreted by the alpha cells of the pancreas when blood glucose is low. Blood

glucose is low between meals and during exercise. When blood glucose is high no glucagon is

secreted from the alpha cells. Glucagon has the greatest effect on the liver although it affects

many different cells in the body. Glucagon’s function is to cause the liver to release stored

glucose from its cells into the blood. Glucagon also the production of glucose by the liver out of

buildings blocks obtained from other nutrients found in the body, for example, protein.

Liver

The liver is the largest internal organ in the human body and is present in vertebrates and some

other animals. The liver is necessary for survival; a human can only last up to 24 hours without

liver function. It plays a major role in metabolism and has a number of functions in the body,

including glycogen storage, decomposition of red blood cells, plasma protein synthesis, and

detoxification. The liver is also the largest gland in the human body. It lies below the diaphragm

in the thoracic region of the abdomen. It produces bile, an alkaline compound which aids in

digestion, via the emulsification of lipids. It also performs and regulates a wide variety of high-

volume biochemical reactions requiring very specialized tissues.

Anatomy

The adult human liver normally weighs between 1.4 - 1.6 kilograms (3.1 - 3.5 pounds), and it is a

soft, pinkish-brown, triangular organ. Averaging about the size of an American football in adults,

it is both the largest internal organ and the largest gland in the human body.

It is located on the right side of the upper abdomen below the diaphragm anatomy. The liver lies

to the right of the stomach and overlies the gallbladder.

Flow of blood

The splenic vein joins the inferior mesenteric vein, which then together join the superior

mesenteric vein to form the hepatic portal vein, bringing venous blood from the spleen, pancreas,

stomach, small intestine, and large intestine, so that the liver can process the nutrients and by-

products of food digestion.

The hepatic veins of the blood can be from other branches such as the superior mesenteric artery.

Both the portal venules & the hepatic arterioles enter approximately one million identical lobules

acini, likened to and changes in the size of chylomicrons lipoproteins of dietary origin brought

about by the quantity & types of food fats.

Approximately 60% to 80% of the blood flow to the liver is from the portal venous system, and

1/4 is from the hepatic artery.

Fetal blood supply

In the growing fetus, a major source of blood to the liver is the umbilical vein which supplies

nutrients to the growing fetus. The umbilical vein enters the abdomen at the umbilicus, and

passes upward along the free margin of the falciform ligament of the liver to the inferior surface

of the liver. There it joins with the left branch of the portal vein. The ductus venosus carries

blood from the left portal vein to the left hepatic vein and then to the inferior vena cava, allowing

placental blood to bypass the liver.

In the fetus, the liver develops throughout normal gestation, and does not perform the normal

filtration of the infant liver. The liver does not perform digestive processes because the fetus

does not consume meals directly, but receives nourishment from the mother via the placenta. The

fetal liver releases some blood stem cells that migrate to the fetal thymus, so initially the

lymphocytes, called T-cells, are created from fetal liver stem cells. Once the fetus is delivered,

the formation of blood stem cells in infants shifts to the red bone marrow.

After birth, the umbilical vein and ductus venosus are completely obliterated two to five days

postpartum; the former becomes the ligamentum teres and the latter becomes the ligamentum

venosum. In the disease state of cirrhosis and portal hypertension, the umbilical vein can open up

again.

Kidney

The kidneys are complicated organs that have numerous biological roles. Their primary role is to

maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as

urea) and minerals from the blood and excreting them, along with water, as urine. Because the

kidneys are poised to sense plasma concentrations of ions such as sodium, potassium, hydrogen,

oxygen, and compounds such as amino acids, creatine, bicarbonate, and glucose, they are

important regulators of blood pressure, glucose metabolism, and erythropoiesis (the process by

which red blood cells (erythrocytes) are produced). The medical field that studies the kidneys

and diseases of the kidney is called nephrology. In humans, the kidneys are located in the

posterior part of the abdomen. There is one on each side of the spine; the right kidney sits just

below the liver, the left below the diaphragm and adjacent to the spleen. Above each kidney is an

adrenal gland (also called the suprarenal gland). The asymmetry within the abdominal cavity

caused by the liver results in the right kidney being slightly lower than the left one while the left

kidney is located slightly more medial.

The kidneys are retroperitoneal and range from 9 to 13 cm in diameter; the left slightly larger

than the right. They are approximately at the vertebral level T12 to L3. The upper parts of the

kidneys are partially protected by the eleventh and twelfth ribs, and each whole kidney and

adrenal gland are surrounded by two layers of fat (the perirenal and pararenal fat) and the renal

fascia which help to cushion it. Congenital absence of one or both kidneys, known as unilateral

(on one side) or bilateral (on both the sides) renal agenesis, can occur.

Excretion of waste products

The kidneys excrete a variety of waste products produced by metabolism, including the

nitrogenous wastes: urea (from protein catabolism) and uric acid (from nucleic acid metabolism)

and water.

Homeostasis

The kidney is one of the major organs involved in whole-body homeostasis. Among its

homeostatic functions are acid-base balance, regulation of electrolyte concentrations, control of

blood volume, and regulation of blood pressure. The kidneys accomplish these homeostatic

functions independently and through coordination with other organs, particularly those of the

endocrine system. The kidney communicates with these organs through hormones secreted into

the bloodstream.