Week 8

Scientist and Scholar Theme

Metabolic flow: This includes the different metabolic pathways that macromolecules are able to take. The products of one reaction are able to be the substrates of one reaction. These reactions only move in one direction

Intermediate metabolism: This is the process of converting nutritive material to cellular components. In the fasted state this includes the breakdown of glycogen, triglycerides, and proteins into glucose, fatty acids and glycogen, and amino acids for the body

Metabolic processes:

Glycolysis: The main process of converting glucose into usable energy. This process yields a net gain of 2 ATPs

Gluconeogenesis: This is the formation of glucose from non-carbohydrate molecules. The precursors to gluconeogenesis can be amino acids, glycerol, and lactate

Glycogenolysis: This is the breakdown of glycogen into glucose. There is decreased inhibition of this process in the fasted state as there has to be a release of glucose into the bloodstream in order to increase blood glucose levels

Glycogenesis: The process of the formation of glycogen. This process is stimulated by insulin, therefore the relative absence of glucose in the fasted state means that there is decreased stimulation. This means that there is less glucose uptake in cells

In the gluconeogenesis of amino acids, amino acids (most commonly alanine and glutamine) are converted to pyruvate, which is the starting molecule for gluconeogenesis. However, in this process, ammonia (a highly acidic and toxic) molecule is released. To limit its destruction, the ammonia is converted to urea and then sent through the bloodstream to the kidneys to then be excreted out with urine. In terms of glycerol, it is first converted to glycerol-6-phosphate and then to dihydroxyacetone phosphate which is a molecule that is part of the gluconeogenesis process. This means that it can be converted to glucose. Finally, lactate is formed in skeletal muscle due to the process of anaerobic respiration. Lactate can be converted to pyruvate, which then means it can go through gluconeogenesis to form glucose

The process of glycogenolysis occurs when the enzyme glycogen phosphorylase is dephosphorylated. This allow for a glucose-1-phosphate molecule to be cleaved off. Using the mutase enzyme this molecule is isomerised to glucose-6-phosphate which then be dephosphorylated with glucose-6-phosphatase in order to form glucose

Glycogenesis involves the starting molecule which is glucose. Then, the enzyme glucokinase (in the liver) and hexokinase (elsewhere) is able to phosphorylate it to glucose-6-phosphate. The mutase enzyme is then able to isomerise glucose-6-phosphate to glucose-1-phosphate. Next, UTP is able to add another phosphate group to the molecule to make it uridine diphosphate glucose. These 2 phosphate groups are then lost in the process of joining the groups together to form glycogen

This process contains the investment phase where 2 ATPs are added to the process to get it started. Then the cleavage phase begins where the glucose-6-phosphate is cleaved into two glyceraldehyde-3-phosphate molecules. These molecules then go through identical processes through the energy release phase in order to form two pyruvate molecules and 4 ATP molecules (with a net gain of 2 ATPs)

Lipolysis: This is the process of hydrolysing triglycerides (fats) into their constituent molecules; fatty acids, and glycerol. This process occurs with the enzyme lipase and occurs in the fasting state to provide fatty acids as a direct source of energy, a substrate in the process of ketogenesis, and provides glycerol as a substrate in the process of gluconeogenesis

Proteolysis: This is the process of lysing proteins into amino acids. This process occurs in the skeletal muscle during the fasting state to encourage the release of amino acids into the bloodstream so that they can travel to the liver to participate in the process of gluconeogenesis to raise blood glucose levels

Preferred substrate

The preferred substrate for energy biogenesis in the liver, skeletal muscle, brain, and adipose tissue, is glucose. Alternate fuels that may be used include fatty acids which can be used by the skeletal muscle. On the other hand, if these fatty acids go through the process of ketogenesis, they are able to form ketone bodies which are able to be used by the brain in conjunction with glucose as sources of energy. these are not however permanent sources of energy as the build up of ketone bodies can cause for pH of the central nervous of the system to drop, which may denature proteins and cause great damage to the brain

Insulin vs. Glucagon

It is the absence of insulin which allows for all metabolic processes of the fasted state to occur. Glucagon is simply one of the hyperglycaemic hormones which allows for the increase in blood glucose levels

The absence of insulin allows for the decreased inhibition of gluconeogenesis and glycogenolysis. Glucagon on the other hand is able to stimulate the process of ketogenesis which is able to convert fatty acids into ketone bodies

Starved state

In the starved state, the reserves of glucose are low. Therefore the processes of ketogenesis and gluconeogenesis are able to take over. as Glycogen stores are running out, glycogenolysis will also be slowing down. However, as this is the case, the brain will be using more ketone bodies as its source of energy as glucose is not available in the same amounts. Furthermore, to conserve the amino acids of muscles for use in the muscles, to allow for movement and also the repair of injured muscles and parts of the body. In extreme starvation, the amino acids of the muscles will also be used for gluconeogenesis in a last-ditch effort to save the brain and nervous system and therefore the muscles will themselves start to break down, limiting movement.

Eating Disorders

Dietary history is very important for the diagnosis of eating disorders. This is because using the DSM-V, many eating disorders can be diagnosed based on the eating habits of the person. For example, anorexia nervosa can be diagnosed based on if the person is not eating well (has a fear of gaining weight), or is taking extreme measures to lose weight (such as purging themselves). Bulimia nervosa on the other hand is involved with a person eating large amounts of food and then purging themselves afterwards. This act of purging can be through self0induced vomiting and also the misuse of substances such as laxatives and enemas so that they can get rid of the food that they just ate. Finally, binge eating disorder can be identified if the person in question is eating large amounts of food or hoarding food for themselves

Practitioner Theme

Airway - Check if their airway is clear. As they already must be in the recovery position, checking their mouth is essential as well and a finger sweep may have to be performed

Breathing - The patient should be checked to see if they are breathing. Observing their chest rise and fall as well as placing your ear against the opening of their mouth can allow you to see if they are breathing

Send for help - The emergency services should be called for with 000 so that paramedics (professional help can arrive)

Cardio pulmonary resuscitation - This is when CPR must be started. The correct interval is 30 compressions for every 2 breaths to the beat of 'Staying Alive'

Response - Check for any response from the patient. This is usually by asking them a simple question such as "Can you open your eyes?"

Defibrillate - As CPR has been commenced, the defibrillator (AED - Automatic External Defibrillator) must be brought and listening to its instructions, both CPR and shocks must be delivered, making sure that when the shocks are delivered, the people doing the CPR are well clear

Danger - Check for any dangers to the patient and yourself (the person giving assistance)

Health Advocate and Professional Theme

First responders - In all states except Western Australia and the Northern Territory, a medical student or doctor does not have to stop or 'rescue' someone in a motor accident.

However, if the medical student or doctor does render help, then it is expected that they work in the best interests of the person affected, to the best of their ability, with experience, and without any expectation of a fee. As long as these aspects are fulfilled, the medical practitioner or medical student is protected under legislation

Duty of care - The duty of care is an element of negligence. In order for the principle of negligence to be fulfilled, there must be a duty of care owed to the patient, this duty of care must be broken, and if damage is sustained by the patient, then there must have been a causal link between the damage sustained and the actions of the doctor

Interpreters - A governmentally-recognised interpreter must be used to allow for communication if the patient does not speak the same language as the doctor. If the patient however does speak the same language as the doctor (and this language is not English), then the doctor is still able to communicate with the patient. If an interpreter however is not available for a particular language, then the doctor may have to communicate with the patient through pictures. If this is too cumbersome, then family members may have to be resorted to. A child cannot be used, and the member who is to relay the information must be educated that the information supplied must be truthful and that no information should be hidden or changed for the good of the patient

Every medical professional works on the same level, and therefore a professional standard is expected. The onus is on the professionals and a duty of care is owed to a person who is likely to be injured by what we do and do not do. The person affected therefore will initiate the legal action

Legally-valid consent - The consent must be done voluntarily, the patient must be informed, it must cover the procedure, and the consent must be agreed to by an adult who is competent. The patient must not be coerced, put under duress, or misrepresented. This consent can also last as long as the patient's condition has not changed and the patient has not changed their mind. If the patient has a reasonable understanding of the procedure, then the consent is valid

Types of consent - Implied, verbal, and written consent. Implied consent is consent that has already supposedly existed and the medical practitioner is simply only acting on its pre-existing nature. Verbal consent on the other hand is consent that is given through speech. This may be when the doctor explains the risks and the benefits of getting an x-ray. If the patient agrees by saying 'Yes', then consent is given. Verbal consent is one of the most common manners of getting consent. Finally, written consent is most commonly used for high-level and invasive procedures. Each procedure usually has a consent form of its own. This method of consent is the most concrete

Trespass, assault, and battery - Criminal assault involves threatening a person. Battery on the other hand is the physical act of hurting the person. Civil assault is the patient receiving damage based on the procedure they are receiving. A patient can claim assault regardless of the procedure was helpful or not, as either way it was done without the patient's consent. Trespass finally is a civil action that can be brought about by any adult. There does not have to be harm for a patient to be trespassed. It stems from the fact that the patient has been affected in some manner by the treatment they refused

Decision-making capacity and competency - Decision-making capacity is different to competency as every adult as seen by the law has decision-making capacity to decide on the medical procedures they are to have. The differentiation with competency is that they may not be competent in that their mental condition may not allow them to fully understand the procedure. This may be through a mental health condition the patient may have or their circumstances (e.g. they are comatose). In this case, a legal representative or person who can work on the patient's behalf may have to be employed

Stigmatisation

Diagnosis

Communication

Stigmatisation is one of the largest issues regarding eating disorders. This is mainly due to the perception that people have of the community and thinking that they are not accepted in it. People do not like talking about these disorders as it means many are not reported

If the patient admits that they do have an eating disorder, the guidelines of the DSM-V can be applied. Thus, they can be categorised as having anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified eating or feeding disorders. If these eating disorders are recognised, then up to 15% can be successfully treated. The average time for full recovery is five to nine years, with an average of seven

Communication issues may be present as a result of the stigma in the community. Communication with people who have eating disorders is difficult as many hide the food they eat or hide their activities such as purging themselves. This lack of communication can therefore boil down to fear, including for example the fear of gaining weight. This issue can be particularly heavy for parents as some may see that eating disorders are a result of 'bad parenting'

Reasons why patients may not adhere to medical treatment or advice - Reasons include being forced to take treatment and therefore being reluctant, not understanding the treatment plan, not trusting the treatment and its effects, waiting on a second opinion, or having a busy life which interferes with the treatment. All of these issues combined can make the patient's condition worse.