Republic of the Philippines

ISABELA STATE UNIVERSITY

City of Ilagan Campus, Isabela
COLLEGE OF NURSING

REVIEW OF THE ANATOMY AND PHISIOLOGY OF THE AFFECTED ORGAN

KIDNEYS

Kidneys are located at the dorsal body wall

in a retroperitoneal position in the superior
lumbar region. An adult kidney is about
12cm (5 inches) long, 6 cm (2.5 inches)
wide, and 3 cm (1 inches) thick, about the
size of a large bar of soap.

Parts Function
HILUM Several structures including the ureters, the renal blood vessel
and nerves enters or exits the kidney at the hilum.
FIBROUS CAPSULE Enclose each kidney and gives a fresh glistening appearance
RENAL CORTEX The outer region of the kidney and it is where the nephron
begins.
RENAL MEDULLA It regulates the concentration of the urine
MINOR CALYX Collects urine from the medulla pyramids
MAJOR CALYX Where the urine passes before continuing through the renal
pelvis
RENAL PELVIS Urine collects here and is funnelled into the ureters that’s
connects the kidney to the bladder.
RENAL ARTERY They carry large amount of blood from the aorta to the kidney
approximately ½ cup of blood passes from renal arteries every
minute.
 Republic of the Philippines
ISABELA STATE UNIVERSITY
City of Ilagan Campus, Isabela
COLLEGE OF NURSING

SEGMENTAL ARTERIES
INTERLOBULAR Supplies blood to the glomerular capillaries.
ARTERIES
ARCUATE ARTERIES Deliver blood into the inter lobar veins
CORTICAL RADIATE Drain blood from the renal cortex into the arcuate vein.
VEIN

ARCUATE VEIN Veins of the kidney that accompany the arcuate arteries, drain
from the interlobular veins, and empty into the into the inter
lobar vein.

INTERLOBULAR VEIN Run alongside the interlobular arteries and collects venous
blood from the capillary plexus of the cortex.
RENAL VEIN Carries filtered blood form the kidney and ureters to the inferior
vena cava.

URETER Tube that caries urine from the kidney to the bladder.

This illustration shows the processes involved in the renal system which comprises glomerular
filtration, tubular reabsorption, and tubular secretion.
 Republic of the Philippines
ISABELA STATE UNIVERSITY
City of Ilagan Campus, Isabela
COLLEGE OF NURSING

THE PANCREAS

The function of the pancreas is

to make digestive enzymes which
digest food materials in the small
intestines. In addition, the pancreas
also makes insulin which controls
the blood glucose levels.
As chyme floods into the small
intestine from the stomach, two
things must happen:
 acid must be quickly and
efficiently neutralized to
prevent damage to the
duodenal mucosa
 macromolecular
nutrients - proteins, fats
and starch - must be
broken down much
interestingly fur this before their constituents can be absorbed through the mucosa
into blood
The pancreas plays a vital role in accomplishing both of these objectives, so vital in fact that
insufficient exocrine secretion by the pancreas leads to starvation, even if the animal is
consuming adequate quantities of high-quality food.

In addition to its role as an exocrine organ, the pancreas is also an endocrine organ and the
major hormones it secretes - insulin and glucagon - play a vital role in carbohydrate and lipid
metabolism. They are, for example, necessary for maintaining normal blood concentrations of
glucose.

Every cell in the human body needs energy in

order to function. The body’s primary energy
source is glucose, a simple sugar resulting from
the digestion of foods containing carbohydrates
(sugars and starches). Glucose from the
digested food circulates in the blood as a ready
energy source for any cells that need it. Insulin
is a hormone or chemical produced by cells in
the pancreas, an organ located behind the
stomach. Insulin bonds to a receptor site on the
outside of cell and acts like a key to open a
doorway into the cell through which glucose
can enter. Some of the glucose can be
 Republic of the Philippines
ISABELA STATE UNIVERSITY
City of Ilagan Campus, Isabela
COLLEGE OF NURSING

converted to concentrated energy sources like glycogen or fatty acids and saved for later use.
When there is not enough insulin produced or when the doorway no longer recognizes the insulin
key, glucose stays in the blood this entering the cells.

Exocrine Function of the Pancreas

The bulk of the pancreas is composed of pancreatic exocrine cells and their associated
ducts. Embedded within this exocrine tissue are roughly one million small clusters of cells called
the Islets of Langerhans, which are the endocrine cells of the pancreas and secrete insulin,
glucagon and several other hormones.

Pancreatic exocrine cells are arranged in grape-like clusters called acini. The exocrine cells
are packed with membrane-bound secretory granules which contain digestive enzymes that are
exocytosis into the lumen of the acinus. From there, these secretions flow into larger intralobular
ducts, which eventually combine into the main pancreatic duct which drains directly into the
duodenum.

Endocrine Function of the Pancreas

The endocrine pancreas refers to those cells within the pancreas that synthesize and
secrete hormones. The endocrine part of the pancreas takes the form of many small clusters of
cells called Islets of Langerhans.

Pancreatic islets house three major cell types, each of which produces a different endocrine
product:
 Alpha Cells (A cells) secrete the hormone glucagon
 Beta Cells (B cells) produce insulin which are the most abundant of the islet cells
 Delta Cells (D cells) secrete the hormone somatostatin, which is also produced by a
number of other endocrine cells in the body

The different cell types within an islet are not randomly distributed – beta cells occupy the
central portion of the islet and are surrounded by a rind of alpha and delta cells.

Islets are highly vascularized, allowing their secreted hormones’ ready access to the
circulation. Although islets comprise only 1 to 2% of the mass of the pancreas, they receive
about 10 to 15% of the pancreatic blood flow. Additionally, they are innervated by
parasympathetic and sympathetic neurons, and nervous signals clearly modulate secretion of
insulin and glucagon.

Control of Insulin Secretion

Insulin is secreted in primarily in response to elevated blood concentrations of glucose. This
makes sense because insulin is "in charge" of facilitating glucose entry into cells. Some neural
stimuli (e.g. sight and taste of food) and increased blood concentrations of other fuel molecules,
including amino acids and fatty acids, also promote insulin secretion.
 Republic of the Philippines
ISABELA STATE UNIVERSITY
City of Ilagan Campus, Isabela
COLLEGE OF NURSING

Our understanding of the mechanisms behind insulin secretion remain somewhat

fragmentary. Nonetheless, certain features of this process have been clearly and repeatedly
demonstrated, yielding the following model:
 Glucose is transported into the beta cell by facilitated diffusion through a glucose
transporter, elevated concentrations of glucose in extracellular fluid lead to elevated
concentrations of glucose within the beta cell.
 Elevated concentrations of glucose within the beta cell ultimately leads to membrane
depolarization and an influx of extracellular calcium. The resulting increase in
intracellular calcium is thought to be one of the primary triggers for exocytosis of insulin-
containing secretory granules. The mechanisms by which elevated glucose levels within
the beta cell cause depolarization is not clearly established but seems to result from
metabolism of glucose and other fuel molecules within the cell, perhaps sensed as an
alteration of ATP:ADP ratio and transduced into alterations in membrane conductance.
 Increased levels of glucose within beta cells also appears to activate calcium-independent
pathways that participate in insulin secretion.

Insulin and Carbohydrate Metabolism

Glucose enters the blood stream after the small intestine hydrolyzes carbohydrates such as
starch and sucrose to form glucose. High concentrations of glucose in the blood stimulate insulin
secretion. This insulin then acts on various cells throughout the body to stimulate uptake,
utilization and storage of glucose. Two important effects are:

1. Insulin facilitates entry of glucose into muscle, adipose and several other tissues. The
only mechanism by which cells can take up glucose is by facilitated diffusion through a
family of hexose transporters. In many tissues, such as muscle, the major transporter used
for uptake of glucose (called GLUT4) is made available in the plasma membrane through
the action of insulin.

In the absence of insulin, GLUT4 glucose transporters are present in cytoplasmic vesicles,
where they are useless for transporting glucose. Binding of insulin to receptors on such cells
leads rapidly to fusion of those vesicles with the plasma membrane and insertion of the glucose
transporters, thereby giving the cell an ability to efficiently take up glucose. When blood levels
of insulin decrease and insulin receptors are no longer occupied, the glucose transporters are
recycled back into the cytoplasm.

Please note that some tissues, such as the brain and liver, do not need insulin for efficient
uptake of glucose. This is because they use a glucose transporter that is not insulin dependent.

2. Insulin stimulates the liver to store glucose in the form of glycogen. A large fraction of
glucose absorbed from the small intestine is immediately taken up by hepatocytes, which convert
it into the storage polymer glycogen.
 Republic of the Philippines
ISABELA STATE UNIVERSITY
City of Ilagan Campus, Isabela
COLLEGE OF NURSING

Insulin has several effects in liver which stimulate glycogen synthesis. First, it activates the
enzyme hexokinase, which phosphorylates glucose, trapping it within the cell. Coincidently,
insulin acts to inhibit the activity of glucose-6-phosphatase. Insulin also activates several of the
enzymes that are directly involved in glycogen synthesis, including phosphofructokinase and
glycogen synthase. The net effect is clear: when the supply of glucose is abundant, insulin "tells"
the liver to store as much of it as possible for use later.

A well-known effect of insulin is to decrease the concentration of glucose in blood, which

should make sense considering the mechanisms described above. Another important
consideration is that, as blood glucose concentrations fall, insulin secretion ceases. In the absence
of insulin, a majority of the cells in the body become unable to take up glucose, and begin a
switch to using alternative fuels like fatty acids for energy. Neurons, however, require a constant
supply of glucose, which in the short term, is provided from glycogen reserves.

In the absence of insulin, glycogen synthesis in the liver ceases and enzymes responsible for
breakdown of glycogen become active. Glycogen breakdown is stimulated not only by the
absence of insulin but by the presence of glucagon, which is secreted when blood glucose levels
fall below the normal range.

Insulin and Lipid Metabolism

The metabolic pathways for utilization of fats and carbohydrates are deeply and intricately
intertwined. Considering insulin's profound effects on carbohydrate metabolism, it stands to
reason that insulin also has important effects on lipid metabolism. Important effects of insulin on
lipid metabolism include the following:

Insulin promotes synthesis of fatty acids in the liver. As discussed above, insulin is
stimulatory to synthesis of glycogen in the liver. However, as glycogen accumulates to high
levels (roughly 5% of liver mass), further synthesis is strongly suppressed.

When the liver is saturated with glycogen, any additional glucose taken up by hepatocytes is
shunted into pathways leading to synthesis of fatty acids, which are exported from the liver as
lipoproteins. The lipoproteins are ripped apart in the circulation, providing free fatty acids for use
in other tissues, including adipocytes, which use them to synthesize triglyceride.

Insulin inhibits breakdown of fat in adipose tissue by inhibiting the intracellular lipase that
hydrolyzes triglycerides to release fatty acids. Insulin also facilitates entry of glucose into
adipocytes, and within those cells, glucose can be used to synthesize glycerol. This glycerol,
along with the fatty acids delivered from the liver, is used to synthesize triglyceride within the
adipocyte. By these mechanisms, insulin is involved in further accumulation of triglyceride in fat
cells.
 Republic of the Philippines
ISABELA STATE UNIVERSITY
City of Ilagan Campus, Isabela
COLLEGE OF NURSING

From a whole-body perspective, insulin has a fat-sparing effect. Not only does it drive most
cells to preferentially oxidize carbohydrates instead of fatty acids for energy, but insulin also
indirectly stimulates accumulation of fat in adipose tissue.