Posted in Psychology & Medicine

Viscera: Kidneys

(Learn more about the organs of the human bodies in other posts in the Viscera series here: https://jineralknowledge.com/tag/viscera/?order=asc)

Despite being a vital organ that one cannot survive without, the kidneys are not very famous to the general populace. Not many people know what the kidneys do, let alone where exactly they lie in the body. The kidneys (of which there are two) are the major excretory organs of the human body. They are found in the back of the abdomen (in an area called the retroperitoneal space), tucked under the lower three ribs below the diaphragm. This is higher than where most people think the kidneys lie, because the abdomen extends quite high into the ribcage, as seen from the location of the liver.

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The kidneys undertake many functions, but they can broadly be grouped into three groups: making urine, filtering blood and maintaining homeostasis.

Although the organ associated with urine is the bladder, it only stores urine, which is made by the kidneys and sent to the bladder via the ureters. Urine is the body’s main way of disposing excess water, salt and other byproducts such as urea. The kidneys fine-tune how much water we lose to urine depending on how much water is in the body. For example, if you drink a lot of water, the kidney senses the blood vessels being dilated and the blood being diluted, then allows more water to leave the body. Conversely, if you are dehydrated, the kidney does everything in its power to hold on to as much water as possible, resulting in concentrated urine.

The kidneys literally act as filters for the blood using a fine, intricate network of sieve-like blood vessels. These vessels have walls that have various sized holes that causes water and small molecules to pass into the kidney, while leaving large proteins in the blood. The filtered blood (containing water, various electrolytes and other metabolites) travel through a pipe network called nephrons, which reabsorb things the body needs (like water when you are dehydrated or salts like sodium), while leaving toxic products like urea and various medications.

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Lastly, the kidneys maintain homeostasis (the status quo of the body) in various ways, such as fine-tuning the water and salt levels of the body. If you have renal failure where your kidneys do not function properly, you will retain too much water and may suffer a build-up of potassium, which can cause fatal changes in your heart rhythm. It is also involved in controlling the acidity of your blood and your blood pressure, through very complex mechanisms.

One way kidneys are famous is that they are popularly mentioned in the context of organ transplants. If you have renal failure, you may be able to get a kidney from a healthy, live donor as you can live with one kidney. When you take out a kidney from a healthy person, the remaining kidney will grow in size to compensate for the other kidney, while the transplanted kidney will go on to save the patient’s life by doing the many jobs mentioned above.

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Posted in Psychology & Medicine

Viscera: Pancreas

(Learn more about the organs of the human bodies in other posts in the Viscera series here: https://jineralknowledge.com/tag/viscera/?order=asc)

The pancreas is probably the most central organ in the human body. It is situated just under the liver and stomach, surrounded by the duodenum (first part of small intestine) and lies in front of the aorta. It is shaped like a fish and thus is divided into parts named the head, neck, body and tail. The head of the pancreas tucks into the loop of duodenum and drains its contents via the pancreatic duct, which joins with the common bile duct (from the liver and gallbladder).

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The function of the pancreas is divided into two functions: exocrine and endocrine.

An exocrine gland is an organ that excretes its products out of the body (including the intestines), such as the salivary or tear glands. The exocrine function of the pancreas is the production and secretion of digestive enzymes that break down proteins, fats and carbohydrates in the small intestine. Because of this, injury to the pancreas often causes a leak of this digestive juice, causing the body to self-digest the pancreas (leading to pancreatitis) and surrounding organs.

An endocrine gland is the opposite in that it secretes its contents into the bloodstream. These glands typically produce hormones, such as the thyroid, ovaries and adrenal glands. The pancreas’ endocrine function is related to an extremely common yet deadly disease: diabetes. Within the pancreas, there are millions of cells that cluster into groups called islets of Langerhans. There are various types of cells, but the most common are the alpha-islet cells that secrete glucagon and beta-islet cells that secrete insulin. Insulin acts to lower blood sugar (glucose) levels by promoting storage and use of glucose after a meal. Glucagon acts to increase blood glucose by promoting the breakdown of glucose storage units (glycogen) and the production of more glucose by the liver. Diabetes occurs when beta-islet cells fail to produce insulin because they are destroyed by the immune system (type 1 diabetes mellitus) or become desensitised by chronically elevated blood glucose levels (type 2 diabetes mellitus).

Another important disease concerning the pancreas is pancreatic cancer. Pancreatic cancer is notorious for its deadliness as it carries a 5-year mortality rate of over 95%. This is because it usually remains hidden – without any symptoms – until it as grown substantially and spread to other organs. However, this prognosis only applies to the most common type of pancreatic cancer involving exocrine cells (adenocarcinoma). There are far rarer cancers of the pancreas that involve the endocrine cells (e.g. insulinoma), which tend to have extremely good prognoses and are usually curable.

Steve Jobs (founder of Apple Inc.) had this kind of pancreatic cancer – an islet cell neuroendocrine tumour. Despite his excellent chance of cure with chemotherapy and surgery, he refused treatment for nine months and instead relied on alternative medicine for cure. However, his disease worsened and he finally resorted to having surgery. By this stage, his disease had spread to the liver due to the nine-month delay in treatment. Spreading of cancer is called metastasis and is often an indication that the cancer is no longer curable. Jobs went against his doctors’ advice and opted for a liver transplant in the hopes of curing his cancer. Organ transplant involves suppressing the patient’s immune system (which also keeps cancers in check) to prevent rejection of the donor organ, which is why oncologists advise against transplants in cancer patients. Jobs’ condition deteriorated quickly after his liver transplant and his decisions ultimately led to his demise.

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Posted in Psychology & Medicine

Hypothermia

A person’s body temperature is always maintained between 36.5~37.5°C. This is because enzymes, which are crucial in all physiological reactions in the body, work most efficiently at this temperature. As physiology is essentially a series of chemical reactions, it is heavily dependent on temperature. If the temperature falls, chemical reactions occur slower and vice versa. When body temperature falls below 35°C, metabolism becomes too slow and it poses a risk to the person’s health. This is known as hypothermia.

How does hypothermia affect the body? Hypothermia is categorised into three classes depending on the severity.

  • Mild hypothermia (32~35°C) leads to the slowing of bodily functions, tremors and difficulty in walking. The patient’s speech is impeded and other neurological symptoms such as decreased judgement skills and confusion start to appear. Also, blood pressure, pulse and breathing rate rise.
  • Moderate hypothermia (28~32°C) causes paralysis of muscles and extreme fatigue (they may complain of being sleepy). As blood (carrying heat) is rerouted to major organs, the skin (especially lips and extremities) become white or purple and very cold. Neurological symptoms worsen with amnesia, memory loss, severe confusion and delusion beginning to show. As sustained hypothermia leads to the tremors stopping, one should not take the lack of tremors as a good sign. Heart rate becomes irregular and arrhythmia may occur.
  • Severe hypothermia (20~28°C) leads to chemical reactions becoming so slowed that physiological functions that support life decline dramatically. Heart rate, blood pressure and breathing all lower to dangerous levels and the heart and lungs may stop functioning. As the patient’s major organs begin to shut down, they enter a state of unconsciousness and eventually, clinical death.

As you can see, hypothermia is a highly dangerous situation that can kill. There are some other fascinating facts about hypothermia.

20~50% of hypothermia death cases are associated with paradoxical undressing. This is a strange phenomenon where the person begins to take off their clothes due to confusion and a lack of judgement from the hypothermia. One theory suggests it is related to the cold damaging the hypothalamus (which controls body temperature), causing the brain to think that the body temperature is rising. Whatever the reason, it is extremely dangerous as it worsens the hypothermia.

As explained above, severe hypothermia leads to death. But interestingly, hypothermia also protects organs. This is why organs for transplanting are transported in ice. Similarly, there are examples of people who “died” from hypothermia recovering with no brain damage. Because of this, medical professionals traditionally say: “they’re not dead until they’re warm and dead”. In fact, if there is something wrong with the patient’s circulation and there is risk of damage to their organs (such as in surgery), sometimes the patient’s body temperature is forced down with ice water injections and cooling blankets, known as protective hypothermia.

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