Alcohol and the Liver – Revision

liver and organs

The Liver

The liver is situated above the pancreas, stomach and duodenum, and has the gallbladder near to its central area. The liver is made up of lobules, with hexagonal cells called hepatocytes. These hepatic lobules are supplied with oxygenated blood from the heart through the hepatic artery. Deoxygenated blood goes back to the heart through the hepatic portal vein.

liver

Instead of capillaries, the liver’s circulation relies on the sinusoids or blood channels, which have kupffer cells inside. The kupffer cells eliminate worn out red blood cells and other unwanted debris. The liver has bile channels called canaliculi, which meet to form a common hepatic duct that supplies bile to the gallbladder. The alkaline bile is stored there until chyme (broken up food) enters the duodenum, and then it is used to emulsify the fats and neutralise the acid.

hepatocytes

The liver is basically a chemical processing plant…

The liver stores glycogen which can later be turned into glucose through the uptake of insulin. It does this to maintain blood glucose levels. The liver also makes glucose from fructose, galactose and amino acids. It also stores iron and copper, and vitamins A, B12, D, E and K. The liver converts the vitamin D into its active form, so it can assist calcium in being absorbed into the body.

In a high protein diet, the liver will break down the protein into carbohydrates and amino acids. Amino acids are DEAMINATED, or broken down, by the liver. 8 amino acids are acquired through a balanced diet, and the liver makes 12 more using the 8 that are available. Through this process of TRANSAMINATION – the manufacture of amino acids – 20 amino acids are accessed. As the amino acids are deaminated by the liver, nitrogenous waste is made, via ammonia, urea and urine. Ammonia is toxic, and so is changed into urea (less toxic), and then changed into urine and eliminated.

The liver also makes four proteins that circulate in the blood: globulin and albumen are plasma proteins, while prothrombin and fibrinogen are clotting proteins. The clotting factor of a person’s blood is measured using the INR (international Number Ratio).

The liver also makes cholesterol, including HDLs and LDLs. High density lipoproteins contain more protein than fat, and are good cholesterol. Low density lipoproteins contain more fat than protein, and are bad cholesterol.

The liver metabolises, or breaks down, all prescription and recreational drugs, including alcohol. It also changes the bilirubin so it can be excreted in the bile. Bilirubin is the broken down product of the haemoglobin from red blood cells.

Liver Disease

When the liver is damaged, bilirubin will accrue in the body, and the person will develop jaundice, appearing yellow in their skin and the whites of their eyes. The person’s faeces will be pale and clay-like.

jaundice

The blood will no longer clot easily, and there may be problems with excessive bleeding and bruising. The liver will swell up and cause the abdomen to be bloated. The person will lose weight, and experience nausea, vomiting and tiredness.

Blood tests can reliably diagnose problems with the liver, as enzymes will be raised if liver cells are damaged. ALP, ALT and AST will all be elevated, as will Gamma GT. The latter is more specific to alcohol liver disease, while the others may be more specific to liver diseases, such as Hepatitis A, B and C, and cancer.

liver healthy and ill

The Short Term Effects of Alcohol

Alcohol is a diuretic and can cause dehydration. Alcohol produces a false feeling of bodily warmth and may lead to hypothermia. Alcohol is also a depressant and will exacerbate any underlying anxiety and depression, thus reducing the efficacy of anti-depressant drugs. Unfortunately when depressed, many individuals use alcohol as a negative coping strategy. Alcohol increases the release of dopamine, and triggers the reward areas of the brain, thus making us feel happy and relaxed. This feeling does not last however, and if drinking continues, areas of the brain will be physically depressed, including judgement and reasoning, visual and spatial awareness, the management of emotions and memory impairment. Rash impulsive decisions may be made as a result, and some people may become verbally or physically aggressive, thus getting into trouble, such as fights.

jaundice man

Females may become sexually disinhibited, as their testosterone levels go up, and may thus place themselves in danger. Males, in contrast, tend to lose sexual drive through the reduction of testosterone, and can experience problems with erectile dysfunction.

The brain’s cerebellum will be affected and the person’s balance and gait will become unsteady. The body’s reflex reaction times will significantly slow, and so falling over and sustaining an injury becomes more of a risk.

Driving a car is definitely to be avoided, although many people over-estimate their abilities when under the influence of alcohol. The reality of course, is that their reaction times behind the wheel will be much slower, and so last minute braking is virtually impossible. Speeds and distances will be extremely hard to judge. It is always best to avoid drinking altogether when planning to drive, as just one unit of alcohol takes approximately one hour to be metabolised by the body.

drink driving

When drinking lots of alcohol, many people experience an increase in their appetite and often will order late-night takeaways. People drinking at home may be more tempted to cook something independently, and there have been many instances in which individuals have set their homes on fire, through oil in chip pans catching fire, because they had gone to sleep.

Exceeding sensible alcohol limits can be a high risk behaviour. It is best to avoid alcoholic binges, and to drink responsibly and safely, perhaps enjoying alcohol with a meal. Drinking alcohol with food reduces its absorption, as well as being pleasant and adding a sense of occasion.

food and wine

 

Stress Revision

I continue to be extremely busy on placement within the community, working alongside the Home-Based Treatment Team (formerly called the Crisis Team). This week I also spent two days with the Rapid Assessment Team at two separate local hospitals. The teams deal with mentally ill people who present at Accident and Emergency, and also assess patients who are in hospital already (usually with physical problems), but are also presenting with signs of possible mental illness. Many of the A & E attendees are referred to the Home-Based Treatment Team where I am presently working, and the people are then supported in the community through daily home visits.

a & e

Aside from this, I am still busy revising for my forthcoming exam which takes place towards the end of September. At the moment I am revising stress, and in order to help me clarify my learning (like last week with the diabetes topic), I thought that I would try to rewrite some of the main facts that I have learnt.

Long-term Stress and the Effects upon the Body

Short-term positive stress, sometimes known as eustress, can be beneficial, and can help us to achieve things, such as passing an exam! Long term stress, in contrast, is negative and distressing to the individual’s body and their mind.

Short-term stress can produce temporary beneficial changes, such as raised blood pressure and raised blood glucose, and the body’s homeostasis is quickly regained. Long term stress also produces the same increases, as well as a weakened immune system. The body’s homeostatic levels however, are eventually re-set at a much higher level, and the resulting consequences can sometimes be serious illness, such as myocardial infarction and cancers.

When faced with stressful circumstances, the brain’s hypothalamus causes the body to go into fight or flight mode. This stimulates the sympathetic branch of the autonomic nervous system, which then stimulates the adrenal medulla to release adrenaline. The adrenaline causes the heart rate to increase and the blood pressure goes up. If the stress is short-lived, as in healthy individuals, the parasympathetic branch of the autonomic nervous system will eventually take over, and a state of relaxation and calm will once again return. In long-term stress however, the heightened, and potentially damaging, effects of the sympathetic branch are maintained by the release of several hormones.

fight or flight

Stimulated by the hypothalamus, Corticotrophin Releasing Hormone (CRH) stimulates the production of cortisol, which leads to loss of appetite and loss of libido. It also causes a reduction in the immune system, the slow healing of wounds, muscle wastage, loss of bone mass and the breakdown of glycogen to glucose, thus increasing blood glucose levels. The CRH also stimulates the release of AdrenoCorticoTrophic Hormone (ACTH). ACTH stimulates the adrenal medulla to produce aldosterone and cortisol. The aldosterone stimulates the kidneys to retain sodium, which then attracts water, and so the blood volume and blood pressure therefore increase. High blood pressure (hypertension) is associated with problems such as stroke, heart disease and diabetes. Growth Hormone is also released, and this breaks down fat and converts glycogen to glucose. Thyroid Hormone is additionally released, and this stimulates Thyroid Stimulating Hormone (TSH). TSH increases the speed of all bodily reactions, including the metabolic rate, thus increasing the chances of weight loss.

blood pressure

Stressed individuals frequently experience poor sleep, and this inability to rest and recuperate, sadly and ironically, enhances the stresses. Negative coping strategies such as alcohol and drug misuse can make the problem worse, as can poor diet and lack of exercise. Sleep, when achieved, stimulates the parasympathetic branch of the autonomic nervous system, which in turn reduces the adrenaline. Sleep is therefore a great healer in recovering from stress.

Lack of sleep and stress can be antecedents to anxiety and depression. Concentration is diminished or lost, and the small things in life can soon start to feel like huge mountains. Other complications of stress can be migraine, Irritable Bowel Syndrome, ulcers and gastritis.

snoopy sleeping

Needless to say, stress is not good for our working lives either. The Health and Safety Executive (2012) stated that 10.4 million working days were lost through stress, while the Labour Force Survey (2012) found that females generally experienced higher working stress, and that the age group of 35–44 had the highest amounts of individuals affected. This could perhaps be on account of the females’ additional responsibilities such as children, household chores, and possibly caring for elderly parents.

Stress is clearly a potentially negative force, and one that can damage both our bodies and our minds.

Diabetes Revision

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Currently I am extremely busy on placement within the community, and am working alongside a Home-Based Treatment Team (formerly called the Crisis Team). Aside from this, I am also revising for a forthcoming exam which takes place towards the end of September. At the moment I am revising diabetes, and in order to help me clarify my learning, I thought that I would try to rewrite some of the main facts that I have learnt.

The Pancreas and Diabetes

The pancreas is a 90% exocrine and 10% endocrine gland. As an exocrine, it produces secretions which are released into ducts, and also produces digestive enzymes which are passed into the pancreatic duct and then into the duodenum. As an endocrine, the pancreas produces the two hormones glucagon and insulin.

Glucagon is made in the Alpha cells, and promotes the production of glucose through utilising stored glycogen – a process called GLYCOGENOLYSIS. Additionally, glucagon can also make glucose from fats and proteins, and does this through GLUCONEOGENESIS.

Insulin is made in the Beta cells in the Islets of Langerhans, and in conjunction with insulin receptors, it allows cells to uptake glucose in order to obtain essential energy. It does this through making glycogen – GLYCOGENESIS. Insulin also contributes to the maintenance of homeostatic blood glucose levels.

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Other hormones in the body can effect blood glucose levels. The growth hormone (Somatotrophin) can elevate blood glucose levels, as well as Adrenocorticotrophin – producing Cortisol in stressful situations; while the adrenal medulla produces adrenaline and noradrenaline in stressed individuals, once again causing blood glucose levels to rise.

Diabetes occurs in two main types: Type 1 and Type 2. Type 1 is usually an autoimmune disorder which causes the beta cells to stop producing insulin. It typically affects young people, and will need to be treated with insulin injections and dietary monitoring. In Type 2 diabetes the pancreas is still making insulin, but is not working so efficiently. The insulin receptors, which allow the insulin to get into the cells, are much reduced. Type 2 diabetes typically affects middle aged overweight people, and will need to be treated through adopting a healthy diet, some weight loss and exercise.

Symptoms of Type 1 Diabetes –

Hyperglycaemia

These are increased thirst (polydipsia), increased urination (polyuria), glucose in urine (glycosuria), increased appetite (polyphagia) and loss of weight. Within the body, the cells are unable to utilise glucose for energy, and glucose builds up in the bloodstream causing hyperglycaemia. The kidneys filter the blood and try to reabsorb the glucose, but there is just too much for them to cope with. The body’s cells are still trying to obtain glucose, so they break down stored glycogen and turn it into glucose – GLYCOGENESIS, as well as turning fats and proteins into glucose – GLUCONEOGENESIS. As the glucose is unable to be utilised, the blood glucose levels become dangerously high and the person will start to breath rapidly (Kussmaul breathing) in an attempt to get rid of accumulating carbon dioxide. A smell of ketones will be evident in their breath, as these will have been produced by the glucagon making glucose from the fat cells.

 

Hyperglycaemia can be reversed by taking insulin, but where the blood glucose levels are too high, hospitalisation will urgently be needed as Diabetic Keto Acidosis (DKA) will be present. In DKA the blood turns acidic, and if untreated the patient will die by falling into a coma. An individual with DKA will have nausea, vomiting or diarrhoea. In order to counteract the dehydration and acidity, IV fluids will need to be administered, plus a sliding scale of insulin. The body’s electrolytes will also be imbalanced, and potassium will commonly need to be given. In order to regain homeostasis, regular checking of blood glucose levels and electrolytes will be essential.

 

Hypoglycaemia

These symptoms present as sweating, confusion and disorientation, and being pale in appearance. Slurred speech and drowsiness may occur, and the danger is that a hypoglycaemic individual may be perceived as being drunk. Hypoglycaemia will occur as a result of taking too much insulin, or going without food for too long. As long as the individual is conscious, it can easily be rectified by drinking a carton of orange juice, a full sugar cola or consuming some glucose sweets (although liquids are more fast acting). An unconscious patient however, needs to get to hospital urgently, as they can start to get convulsions, go into a coma and brain damage can occur.

Symptoms of Type 2 Diabetes

These can be tiredness, lethargy, blurred vision, repeated fungal infections (thrush), getting up in the night to urinate (nocturia), obesity and hyperglycaemia. People with Type 2 diabetes do not commonly experience hypoglycaemia.

If people with either type of diabetes do not look after themselves, the long term effects can be devastating and include: loss of nerves in the fingers and toes (neuropathy); foot sores and wounds, which may lead to septicaemia and eventual amputation of limbs; damage to the eyes, which may result in diabetic retinopathy, glaucoma, cataracts or eventual blindness; kidney damage; heart disease, and even brain damage.

We only have one body, so clearly we need to look after ourselves, whether we have diabetes or not.  A healthy diet and lifestyle is one of the best ways to do this.

A female perspective of STRESS

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Stress is an extremely common modern day occurrence, and is probably often due to the vast amounts of things that we try to fit into our ever increasing busy lifestyles. Just 40-50 years ago, people generally seemed to lead more relaxed and less hectic everyday lives. The reason for the reduced pressure, I believe, is that most females still stayed at home and raised a family, while their male partners went out to work and provided an income. Women would occupy themselves with childcare and domestic tasks, taking the time to cook meals from scratch, and to bake pies, cakes and even bread for the family. This existence almost sounds like a golden age, and yet it hides a hidden frustration and boredom that was experienced by many females. The women’s dissatisfaction, of course, was the need to obtain equality to their male counterparts; but, ironically, by drastically changing and increasing their opportunities, a female generation emerged who wanted to have it all, and yet found that the price was an increasing amount of stress.

images64OMCKOZThe new generation of women gained academic qualifications and established careers for themselves. They still married and had children, but the task of the main child-care was often assigned to a grandparent, a professional nanny or nursery. This generation of career women had to pick up the child-care at the end of the day, when they were feeling tired and really needed to relax and unwind, and yet there was still a meal to cook, clothes to wash, a house to keep clean and the children to entertain, bathe, feed and eventually put to bed. It would be nice to think that husbands and fathers would have shared in these chores, but for many years, these changes happened far too slowly, and it is only now that the majority of fathers have started to share and help their partners, with the children and the household tasks.

images3MOEPE1NThere will always have been exceptions to these rules, and I know that as I write, there are now many house husbands that have taken over the traditional female role. Whatever the family circumstances, however, contemporary life can be incredibly stressful. As well as males and females having more equal roles, we generally seem to have higher expectations of what we require from our lifestyles. Children often have many clubs after school and it is the parent’s job to transport them to and fro’. Parents will have social lives of their own, both separately and together. They will plan foreign holidays a couple of times each year, and they will regularly change their cars and move to bigger and better homes. The homes will be equipped with an array of the latest technology, which will be used to help the family to ‘relax’. What often happens however, is that the children fight over a Playstation game, while the adults chat over social media or generally surf the web. When bedtime comes, it is hard to switch off and to obtain a relaxed sleep mode. Less people read books to help them to get to sleep, and less people enjoy books as a way of generally relaxing as a hobby. People often expect far too much from their modern existences, and in ensuring that they obtain these ‘necessities’, they self-impose varying degrees of pressure, and they often forget about the simple, and often free, things in life.

imagesWBWX1H7MTo minimise stress, I believe that we should always strive to achieve a healthy work-life balance. While the children are young, it is surely acceptable for one partner to stay at home for a few years, or to work part-time hours. Perhaps even both partners can work part-time to obtain the equivalent income of a full-time wage.

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Perhaps it may not be possible to have expensive holidays, new cars and gadgets, but materialistic belongings are not guaranteed to make us happy. Instead families and couples can enjoy the beautiful surroundings of the UK, and can sample the simplicity of camping and caravanning holidays. Weekends can be spent walking and picnicking in the countryside. It is fun and cheap to take along a rucksack with some sandwiches, fruit and a flask. On wetter and colder days, it is also great fun, and really educational, to visit one of the UK’s historic National Trust properties, gardens and parklands. An annual ticket is extremely reasonable, and it then gets you into the properties completely free of charge.

images6HXJTIXYInstead of focussing upon computer access and borrowing DVDs, we should start to sample books from our local libraries, or could even cheaply purchase reasonable used paperbacks from charity shops and various on-line booksellers. Reading slows down our brains and makes us concentrate and focus, and in so doing, we can acquire a wealth of knowledge, enjoyment, relaxation and stimulation. I also personally find that having dogs can be particularly good for our stress levels. Stroking a dog can be hugely therapeutic, and walking with a dog is excellent for both body and mind, as the event allows us to connect with the outdoor green environment, as well as other dogs and their owners. All forms of exercise are excellent for combating stress, as they make the body release beneficial endorphins, which lift and improve the mood. In times of stress, we often do not feel like exercising, but if we push ourselves and make the effort, the benefits will usually be very much self-evident.

basset on lead

Finally, I am a huge believer in the benefits of a healthy diet. It may not always be possible to cook meals from scratch, but when we can, they are usually cheaper and healthier. Whenever we shop, it is better to choose wholegrain bread, pasta, rice and cereals, and we should always strive to include our daily five portions of fruit and vegetables. A large percentage of people do not, but five portions is really not that difficult to achieve! You could have a glass of orange juice with breakfast, a banana mid-morning, some salad and an apple at lunch time, and then two portions of vegetables with your main meal, not including potatoes (and which actually equates to six portions).

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In addition to food, we need to pay attention to our fluid intake, and about 2 litres of water daily is roughly about right. It is worth remembering that much water can be gained from our diet. Foods high in water include porridge, soup, fruit, vegetables, custard and yoghurt, etc. Drinking water can be taken directly from the tap, in squash, herbal teas, juices, milk, and tea and coffee to some extent. The latter two are diuretics and therefore make us pass more urine, hence not hydrating us as effectively as the other options. It is therefore best to drink tea and coffee in moderation, and of course, they contain caffeine. Too much caffeine can make us feel shaky and we can experience palpitations. In short, caffeine is likely to exacerbate our stress levels.

untitled (3)If we all looked after our bodies and achieved a balanced lifestyle of work, relaxation and leisure time, I believe we could eliminate the modern malaise of experiencing too much bad and damaging stress. Don’t forget, a little stress can be a good thing, and can often help us to achieve our goals. Too much stress however, leads to depression, heart disease, cancers and more.