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| The Surgical Technologist | NOVEMBER 2016 498 They all lie below the diaphragm in the right, left and middle upper quadrant of the abdomen. The stomach lies in the middle-left upper quadrant; the small intestine, specifically the duodenum, lies in the right-mid quadrant; the liver lies behind the ribcage in the right mid to right upper quad- rant with the gallbladder attached to its underside; and the pancreas lies behind the stomach in the middle-left quad- rant of the abdomen with the head nestled below the greater curvature of the stomach, under the liver and gallbladder area, and against the duodenum. The liver and the pancre- as connect to the duodenum of the small intestine, via the common bile duct and the pancreatic duct, which forms the duodenal ampulla. 5 As food is chewed and swallowed, it moves from the mouth, through the laryngopharynx, into the esophagus and down into the stomach where it is acidified for easier protein digestion. Microbial destruction and secretion of pepsin, bile and pancreatic enzymes occur, chyme is created. As the chyme enters the small intestine, it undergoes chemical and mechanical digestion and absorption. The metabolism of this food causes many other complex processes to take place and the end result – about an hour after food consumption – has glucose flowing in the bloodstream. According to the National Institutes of Health (NIH), a healthy person’s pan- creas responds to post-meal BG levels by releasing insulin into the blood stream. 7 Insulin, made by beta (β) cells in the pancreas, lowers BG levels in different ways. It helps muscle, fat and liver cells absorb glucose from blood; it stimulates the liver and muscle tissue to store glucose as glycogen; and insulin lowers BG levels by reducing glucose production in the liver 7 . On the flip side, if BG levels drop – say during overnight sleep, a skipped meal or with heavy exercise – glucagon, made by alpha (α) cells in the pancreas, raises BG levels. This can occur in two ways: when glucagon signals the liver and muscle tissue to break down glycogen into glucose, which then enters the bloodstream, and when glucagon stimulates the liver to make glucose from amino acids. 7 The bodies of people with diabetes are unable to function in this man- ner. Some of the reasons that interfere with these functions are autoimmune malfunction induced by genetic mutation, stress on the body physiology created by viruses, illness and being overweight or obese. Type 1 diabetes (T1DM) is an autoimmune disease where the immune system attacks and destroys β-cells, housed inside islet cells, in the pancreas. Specific T-cells, white blood cells (WBC), are primed to attack these spe- cialized insulin producing cells. 7 Research from the NIH shows there have been gene variants identified that carry instructions for making a protein, called human leukocyte antigen (HLA), on those specific WBCs. These gene vari- ants are linked to the risk of developing T1DM. However, some HLA-produced proteins help the immune system see the WBCs as part of the body, thus refraining from cellular destruction, while other proteins do nothing. 7 Scientists are unclear as to why this occurs. Although there currently is genetic testing is being done, there is no available cure for individuals who possess these genetic variants, and noth- ing has been found to improve prevention nor treatment for T1DM. 7 Some scientists theorize environmental reasons that prompt autoimmune damage of beta cells in people with genetic susceptibility. 7 Viruses and or infections also have been considered and theorized as a possible culpet. 7 The onset of T1DM occurs more in winter months, when viral infections are more common and other people are some- times diagnosed during or after a viral infection. Viruses common to T1DM diagnosis include coxsackievirus B, cytomegalovirus, adenovirus, rubella and mumps. Although these conditions don’t cause diabetes, antibodies to islet cells and beta cell damage – which can cause pancreatitis from congenital rubella syndrome – have been found in patients with these viruses. 7 Other chronic non-curable dis- eases or issues with the pancreas can cause T1DM such as pancreatitis, tumors and pancreatectomy (due to cancer). 7 Recent research has considered insulin to be a trigger Uncontrolledbloodglucose(BG) levelsdam- age the bodies of those who are affected by this condition, and as a result, diabet- ic patients undergo surgical procedures at a higher rate than non-diabetic people.4 Due to these complications, “it is imperative that conscientious attention be paid to the met- abolic statue of patients before, during and after surgical procedures.” 4