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Hepatorenal Syndrome Pathophysiology Jun 13, 2023

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"Hepatorenal syndrome is a life-threatening condition characterized by rapidly Progressive kidney failure that is seen in people with Advanced liver disease the prognosis is very Bleak and is usually fatal without the transplant there are two types type 1 has a median survival of two weeks and features a rapidly increasing creatinine level type 1 happens commonly in taneous bacterial peritonitis type 2 is a slightly more moderate form with a median survival of 10 weeks and a steadier creatinine here patients typically have a site that is resistant to DirectX approximately 18% of cirrhotic patients who have ascites will develop hepatorenal syndrome within one year so what exactly that makes this condition so bad the Hallmark is a renal basic constriction in the setting of vasodilation in splanchnic breasts those are the intestines spleen liver and pancreas the main branches of the aorta that make it up at the Celiac artery as well as the superior and inferior mesenteric arteries the underfill theory is that as liver disease progresses and portal hypertension follows possibly also generating ascites there is a splash so dilation because of release of vasodilatory mediators like nitric oxide and prostaglandins this vasodilation leads to more blood being directed into the splanchnic vessels which ends up draining into the portal circulation which causes the juxtaglomerular apparatus of the kidney to activate the renin-angiotensin-aldosterone system leading to vasoconstriction and in particular in the kidneys but the splanchnic vasculature is resistant to vasoconstriction due to the production of local vasodilators like nitric oxide and so remains vasodilate it the cycle leading to this vicious cycle of the renal vasoconstriction and splanchnic vasodilation ultimately leading to renal failure the activation of the renin-angiotensin-aldosterone is thought to be an important step in the formation of ascites in patients with cirrhosis to the extent that ascites and hepatorenal syndrome may be considered a splanchnic vasodilation determined the resistance of ascites to diuretics as is seen in type 2 hepatorenal syndrome as well as the onset of kidney vasoconstriction that leads to the initial onset of hepatorenal syndrome it is important to remember that having a cirrhotic patient with an AK I does not mean that the patient has HRS they may have the Aki for other reasons and so hepatorenal..."

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Diarrhea Causes, Organic vs Functional Diarrhea, Acute vs Chronic Diarrhea Jun 12, 2023

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"diarrhea is defined as having stools that occur more than three times a day and a looser than usual specifically 200 grams 24 hours is considered diagnostic but as you can imagine trying to measure the weight of stools in everyone referring to diarrhea would be a mess literally so first off the call divide them into acute and chronic causes for start acute diarrhea is defined as lasting less than four weeks and is often caused by infections that they usually eat a viral or toxin-mediated typically they will resolve spontaneously I see cases lasting more than four weeks need to be divided into either organic or functional causes and the difference between them is that organic causes can be detected or Quantified through testing while functional causes cannot samples of organic causes include celiacs disease inflammatory bowel disease like ulcerative colitis or Crohn's disease we can also have bacterial and parasitic infections pain and of course intestinal neoplasms on the other hand functional causes of chronic diarrhea include irritable bowel syndrome lactose intolerance food alcohol how then can we begin to narrow down the causes when we encounter a patient with diarrhea let's first tackle how to distinguish functional from organic diarrhea firstly the duration of secondly the volume of organic diarrhea is usually larger than in functional next we look for the presence or absence of blood functional will never have blood while organic often does we can also ask about the naming organic doesn't have any specific pattern but may wake the patient up at night well functional is usually in the morning and will not wake the patient up this is also closely tied to stress where organic diarrhea doesn't have much Association to stress but functional diarrhea often coincides with we take this few seconds our valued loyal listener about the best health and fitness podcast shows from the Nez pod Studios join us as we give you the best of the best health and wellness updates you can rely on for the treatment of chronic classic functional medicine Back to Basics health tips and special updates from the best doctors in the United States of America check out this health and wellness podcast shows explore Health talk weekly healthy lifestyle matters excellent Health digest healthy and free daily and last but not least weekly Health and Fitness also check out nasty boy CC the truest story never told Fiction podcast for that real-life on-the-go experience with the 27 year old Golden Boy Who made our guest he tells us about his story as it happens in real time and in real life it's nasty boy CC the truest story never told go get a load of that happiness because happiness is healthy as we know it join us every week as we continue to provide you the best of health and fitness Wellness updates from around the globe enjoy the show"

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Nephritic Syndrome Jun 07, 2023

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Nephrotic syndrome is a collection of signs and symptoms that result from damage to the kidneys and is often confused with nephritic syndrome in fatigue syndrome there is a substantial amount of protein being lost through the kidneys in the urine defined as more than 3.5 grams per day this leads to hypoalbuminemia a low level of albumin in the blood as albumin is the most abundant protein normally in the blood these two are defining features in nephrotic syndrome nephritic syndrome is different in that there is less proteinuria but also the presence of hematuria and red blood cell or white blood cell casts in the urine hypertension and oliguria which is a reduced urine output typically between 80 and 400 ml per day the unit of the kidney is the nephron and normally in the glomerulus of the Nephron there is a specialized membrane that forms the filter made up of a fenestrated endothelium the Maryland basement membrane and the foot processes of podocytes which are cells that wrap around the capillary giving this additional filtration layer all together these structures normally act as a filter and prevent large molecules from passing through into the Bowman's capsule and renal tubules they have a net negative charge which may mean that they can repel other negatively charged molecules albumin is negatively charged in the fatigue syndrome there is sufficient injury to these structures to change the permeability and allow albumin and other molecules to pass into the urine leading to hypoalbuminemia the signs and symptoms linked to hypoalbuminemia which includes peripheral edema and fluid overload particularly in children this can be evident as facial swelling but can also occur in adults particularly around the eyes fluid overload can mean weight gain peripheral edema and even the development of ascites or pleural effusion which can manifest as shortness of breath known as this near the reduction in the blood levels of albumin causes the oncotic pressure of the blood 24 meaning fluid will more readily leak into the surrounding tissues causing edema this is sensed as hypovolemia because less fluid is in the vessels which then triggers the renin-angiotensin-aldosterone system causing retention of salt and water this is known as the underfill hypothesis while another is the

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Acute kidney injury Jun 02, 2023

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a sudden deterioration in the function of the kidneys is known as an acute kidney injury sometimes also called acute renal failure to measure this reduction in kidney function glomerular filtration rate or GFR is normally used which is a measurement of how well the kidneys are filtering the blood the functional unit of the kidney that actually does this is the Nephron made up of the glomerulus which is a modified capillary and as blood passes through it the waste is filtered into the Bowman's capsule GFR is the volume filtered through the glomerulus into the Bowman's capsule and through the Nephron in a given unit of time the filtrate passes along through the proximal convoluted tubule Loop of henle distal convoluted tubule and the distal collecting duct undergoing secretion and reabsorptionas it travels ultimately it forms urine and collects into the renal pelvis and passes into the bladder through the ureter to directly measure this process is difficult we instead use creatinine clearance to estimate the GFR creatinine is a normal breakdown product of creatine released from muscle tissue and this is freely filtered by the glomerulus and is not reabsorbed so fits the kind of substance we need however creatinine is secreted into the filtrate by the peritubular capillaries so it does tend to overestimate the GFR slightly the cockcroft and Gault formula is a famous formula used to estimate the creatinine clearance and therefore GF are taking into account age Mass gender and the serum creatinine as it travels ultimately it forms urine and collects into the renal pelvis and passes into the bladder through the ureter to directly measure this process is difficult we instead use creatinine clearance to estimate the GFR creatinine is a normal breakdown product of creatine released from muscle tissue and this is freely filtered by the glomerulus and is not reabsorbed so fits the kind of substance we need however creatinine is secreted into the filtrate by the peritubular capillaries so it does tend to overestimate the GFR slightly the cockcroft and Gault formula is a famous formula used to estimate the creatinine clearance and therefore GF are taking into account age Mass gender and the serum creatinine

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Polycystic kidney disease May 30, 2023

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polycystic kidney disease is a condition characterized by the development of multiple cysts within the renal tubules of the kidney and is the most common hereditary renal disease the normal functional unit of the kidney is the nephron made up of a glomerulus and Bowman's capsule proximal convoluted tubule Loop of henle distal convoluted tubule and the collecting duct blood filters through the glomerulus forming filtrate which then passes through the tubules undergoing see and reabsorption eventually forming urine and passing into the ureter and bladder overall there are around 1 million of these nephrons in each kid in polycystic kidney disease these tubules develop into cysts which become filled with fluid and can range in size from being microscopic to several centimeters in size the process can start even in utero meaning in the womb as the tubules become cysts they cannot carry the normal filtering function therefore the number of functioning nephrons begins to decrease this is worsened by the fact that as the cysts grow they compress nearby nephrons also making them dysfunctional initially this may not be seen to have any clinical impact as the remaining number of nephrons may increase there to maintain the glomerular filtration rate but as the disease progresses and more nephrons are affected the remaining ones cannot make up the difference overall renal function then deteriorates eventually reaching end-stage renal disease by definition the presence of structural injury makes polycystic kidney disease a form of chronic kidney disease with end-stage renal disease being defined as needing renal replacement therapy like dialysis or transplant or a GF far below 15 ml per minute there are two main types of polycystic kidney disease both caused by genetics the first is autosomal dominant with two main types one coming from mutations in P KD 1 on a chromosome 16 which codes for the protein polycystic in this is affected in around 85% of cases and is involved in cell to cell or cell Matrix interaction cell cycle regulation and calcium transport the second coming from mutations in PKD to on chromosome for coding for Polly system to which codes for

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Chronic kidney disease May 29, 2023

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"...chronic kidney disease or chronic renal failure is a progressive irreversible condition characterized by either a reduction in kidney function or kidney damage as a result of any cause that a present for more than 3 months it is divided into stages based on the glomerular filtration rate which is a measure of how well the kidneys are functioning it shows the flow rate of filtrate through the glomerulus of the Nephron into the Bowman's capsule and ultimately through the renal tubules the stages are labeled 1 to 5 with 2 groups in stage 3 the definition of a reduced GFR is below 60 milliliters per minute but in groups 1 and 2 the GFR may actually be above 60 but there is evidence of kidney damage end-stage renal disease is classed as a GF are below 15 or the need for renal replacement therapy like dialysis or renal transplant kidney damage can be defined as signs of damage seen on Imaging or on testing such as a high albumin to creatinine ratio which is a measurement of the amount of protein lost in the urine in fact in combination with GFR these patients are divided into three food groups based on the albumin creatinine ratio with higher values indicating more damage and an increased likelihood of progression initially chronic kidney disease may not cause many problems and it is often asymptomatic however as it progresses it brings with it several significant complications these can include an elevated cardiovascular risk with patients are 5 to 10 times more likely to die from cardiovascular disease than end-stage renal disease the risk of stroke has been found to increase as the GFR lowers around seven percent for every 10 ml per minute lost this may also be the result of CKD contributing to hypertension as well as being caused by it this can be due to activation of the renin-angiotensin-aldosterone system and can also be because as the disease progresses the kidney is less able to excrete leading to retention and subsequent fluid overload signs of fluid overload could be dismissed near due to pulmonary edema or a fusion and peripheral edema or ascites anemia is also common which contributes to disappear and can come from a reduction in erythropoietin from the..."

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Nephritic Syndrome With Nephritic Syndrome With Pathology May 26, 2023

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"...nephritic syndrome is a collection of signs and symptoms that result from glomerulonephritis which is inflammation of the kidney specifically the glomerulus this could be remembered because it means inflammation rather than being a disease itself nephritic syndrome is the manifestation of an underlying disease that causes the inflammation and there are many of these causes it is easily confused with nephrotic syndrome which instead is a collection of signs and symptoms resulting from a high amount of protein being lost through the kidneys in the urine this leads to hypoalbuminemia meaning low levels of albumin in the blood these are the two defining features in nephrotic syndrome there is some overlap but nephritic syndrome is different in that the degree of proteinuria is lower and there is the dozens of hematuria meaning blood in the urine which could be microscopic or macroscopic red blood cell casts in the urine sterile / urea which is the presence of white blood cells without evidence of bacteria hypertension and oliguria which is a reduced urine output typically between 80 and 400 ml per day the functional unit of the kidney is the Nephron which includes the glomerulus and modified capillary surrounding this there are multiple layers which together form a filter these include a fenestrated endothelium the glomerular basement membrane and the foot processes of podocytes which are cells that wrap around the capillary in most cases of nephritic syndrome there is a trigger causing inflammation in this area overall featuring cellular proliferation complement activation recruitment of leukocytes and production of proteases and free radicals that ultimately lead to injury of the kidney this then leads to the characteristic features for example injury to the glomerular filtration membrane allows protein to leak into the urine though not as much as is seen in nephrotic syndrome red blood cells can also pass through causing hematuria and they can be dysmorphic with a camping sites in particular suggesting glomerular injury red blood cells can also Clump together within the tubules forming cylindrical structures called castes in fact this is considered suggestive of glomerulonephritis the injury and inflammation means white blood cells are recruited and can pass into the urine and as we said it's termed sterile pyuria because there..."

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Tennis Elbow and Golfer's Elbow (Lateral & Medial Epicondylitis) May 24, 2023

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"...tennis elbow and golfer's elbow a to similar conditions causing pain in the elbow and a medically know is lateral and medial epicondylitis respectively this means inflammation of the epicondyles which are bony protuberance has on the distal of the humerus the elbow is made up of the humerus articulated with the radius and ulna and allows for flexion and extension of the forearm however there are muscles that attach to the epicondyles that allow for wrist hand and finger movements like grasping and twisting and repetitive use of these muscles is thought to lead to micro attendance generating pain for this reason the conditions are known as enter Sapa these-- which means attachment point disease in act more recently it has been recommended that the conditions be referred to as tendinosis or epicondyle Alger rather than epicondylitis as histologically there is usually granulation tissue and a lack of traditional inflammatory cells suggesting that degeneration of the tendon maybe more an inflammation in the pathogenesis Motions like using handheld tools or even drawing are associated with the conditions and the names are slight misnomers is playing tennis can give you golfer's elbow and vice versa over all the movements causing the conditions do not necessarily need to be sports-related in some cases they can be triggered by a sudden contraction possibly from trauma elbow pain is the primary symptom in each lateral like this is 7 to 10 times more common and the pain is on the lateral or outer part of the elbow usually on the dominant hand it is generally worsened by extension of the wrist or fingers as the muscles responsible for these movements attached to the lateral epicondyle collectively known as the extensor tendons in particular the extensor carpi radialis brevis is commonly affected in lateral epicondylitis there is typically worsening of the pain with wrist extension against resistance when the is extended known as cozens test medial epicondylitis is less common but features pain on the medial or inner of the elbow it comes from tendinosis of the flexor and pronate attendance which originate from the medial epicondyle in particular the carpi radialis and the pronator teres and most commonly affected the pain is usually reproduced when the wrist is flexed and pronated against resistance well the is flexed called the reverse cozens test overall it is usually a gradual onset of pain that progressively get worse and can persist at night it also tends to be worsened by use of the forearm such as grasping and the pain may also be elicited by palpating several millimeters distal to the air condyles which corresponds with the location of the tendons people may also experience weaker grip strength the diagnosis is largely meaning no specific test or Imaging is required to make a diagnosis however Imaging like x-ray may be done to rule out arthritis of the elbow..."

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The Bones of the Hand & Wrist In 2 Minutes (With Fractures) May 22, 2023

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"...tricky to remember but this pneumonic will help you remember not only the names but also their positions the rest is made up of eight bones roughly in two rows of four the pneumonic starts as some lovers try positions s is for the scaphoid L flew name T4 triquetrum and P Pi is a form to remember the position you can use the letter P because the Paisa form is on the same side as the pinky the scaphoid and the lunate articulate with the and the radius is always on the same side as the thumb the second half of the pneumonic is that they can't handle which is for the trapezium trapezoid capitate and hamate the scaphoid is the most commonly injured bone of the wrist usually from a fall onto an outstretched hand and it is associated with pain in the anatomical snuffbox and with axial pressure applied on the thumb it is also famous for having a risk of a vast necrosis because it has a retrograde blood supply meaning blood flow from its distal end towards its proximal end this is mostly from the dorsal branch of the radial artery if the scaphoid is fractured blood might not be able to reach the proximal end giving avascular necrosis of the proximal part of the scaphoid at the metacarpals numbered 1 to 5 from the thumb which is easy to remember because each hand only has one thumb a famous fracture of the metacarpal is the boxer's fracture which is on the fifth metacarpal after striking with a closed fist this can lead to misalignment of the knuckle as the metacarpal makes up the now you then have the phalanges there are three in each finger called the proximal middle and distal phalange but only two in the thumb the proximal and distal phalanges we take this few seconds off to inform you are valued loyal listener about the best health and fitness podcast shows from the nest Studios join us as we give you the best of the best health and wellness updates you can rely on for the treatment of chronic health problems classic functional medicine Back to Basics health tips and special best doctors in the United States of America check out this health and wellness podcast shows explore Health talk weekly healthy lifestyle matters excellent Health digest healthy and free and last but not least weekly health and fitness Corner also check out nasty Boise see the truest story never told Fiction podcast for that real-life on the..."

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Osgood Schlatter Disease (Tibial Tubercle Apophysitis) May 19, 2023

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"...Osgood-Schlatters disease also known as tibial tubercle apophysitis is a condition characterized by the anterior knee due to inflammation of the apophysis and apophysis is a normal developmental protuberance from a bone that provides an insertion site for tendons in this case the patellar tendon on to the tibial tubercle it primarily affects children and adolescents because by adulthood the apophysis will fuse with the rest of the tibia it is weaker than 10 and so is prone to injury Osgood-Schlatters disease is a stress or traction injury that occurs due to repetitive Force being applied through the strong patellar tendon on to the tibial tubercle typically from movements involving leg extension such as running or jumping but also during growth spurts the force can lead to small avulsion fractures of the tibial tubercle apophysis generating and pain and in rare cases a complete avulsion of the tibial tubercle knee pain is the most common symptom which is on the anterior portion of the knee just below the patella in most cases it is unilateral but both sides are affected in around 30 percent of cases in general it has an Insidious gradual onset with no trauma and may initially be episodic but go on to become continuous the tibial tubercle itself can be tender to touch and may have some Associated enlargement which can be felt as a prominent lump males in particular are up to seven times more likely to be affected..."

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